Early diagnosis and treatment of developmental hip dislocation

  Congenital hip dislocation, also known as developmental hip dislocation, is characterized by the dislocation of the femoral head from the acetabulum after birth or shortly after birth, and the lesion often involves the joint capsule and the ligaments and muscles around the hip joint in addition to the femoral head and acetabulum. It is one of the most common congenital malformations in children. According to a survey of 85,000 newborn babies in six cities in China, including Beijing, Shanghai and Dalian, the incidence of congenital hip dislocation ranges from 0.19% to 8.2%, with an average of 3.9%. Our province is a large population province, and the incidence rate varies slightly in different areas, with higher incidence rates in Puyang, Zhumadian, Xinyang and other areas.  Its incidence rate is characterized by “three highs”: (1) the incidence rate of anterior hip dislocation is absolutely dominated by girls, and the ratio of men to women is 1:5; (2) unilateral incidence is more common than bilateral; (3) the left side is twice as much as the right side. The incidence rate varies greatly by region and race, and is related to genetic factors, environmental influences and lifestyle habits. The prevalence rate of blood relatives of children with anterior hip dislocation is 20-30%, and that of immediate relatives is 3-4%.  The incidence is low in the Yongzhou region where babies are habitually carried on their backs; the incidence is significantly higher in the western Hunan region where binding methods are preferred to fix the hip joint of newborns in the extended and inward position.  The incidence of breech birth is higher, about 23% in foreign countries, 26% in Shanghai, 28.5% in Shenyang, and only 5% in normal births; the incidence of anterior hip dislocation is 10 times higher in breech births than in cephalic births; the incidence of anterior hip dislocation is higher in cesarean births than in vaginal births, accounting for 30% in Shanghai, with significant differences, and the incidence of babies with heavy body weight in cesarean births is found to be high.  The treatment effect of congenital hip dislocation has a great relationship with age. The earlier it is detected and the more timely the treatment, the better the results tend to be. Our pediatric orthopedics department has accumulated rich experience in the treatment of congenital hip dislocation: generally speaking, children within 1.5 years of age are mainly treated conservatively by traction, manipulation, plaster and brace, which have a high cure rate; children over 1.5 years of age, as the bony components of the femoral head and acetabulum increase with age, the contracture of the adductor muscle is obvious, plasticity decreases, and pathological changes aggravate, surgery is the main treatment.  Since the 1980s, our department has been applying combined surgical methods to treat developmental hip dislocation in children, from the initial Salter pelvic osteotomy to the modified Pemberton iliac osteotomy acetabularplasty, with a total of more than 3,000 sides of the hip treated, all of which have achieved satisfactory results. At present, based on the summary of previous surgical experience, the medical staff of our department has developed the pelvic triple osteotomy for the treatment of developmental hip dislocation in children of older age, and has achieved initial success.