Hip synovitis is a modern medical name for a sterile inflammatory disease that occurs in children, also known as pediatric hip synovitis, and is a common clinical disorder of pediatric soft tissue injury.
There are no ideal drugs available, and if left untreated, it can lead to serious consequences. In the treatment of children, only rely on internal Chinese medicine to carry out treatment, its effect is far from enough, also should not take too many drugs orally, and therefore in the clinical exploration without oral, Shen et al. believe that external medicine is a most direct and effective green therapy. Specially, some clinical cases are reported.
1.Data and methods
1.1 General information
All 70 cases, 49 males and 21 females; 40 cases of left hip, 50 cases of right hip, 32 cases of double hip; minimum age 2 years, maximum age 15 years, average 7 years; shortest duration 3 days, longest duration 1 year, average 30 days, 37 cases with obvious history of trauma, 4 cases with history of upper respiratory tract infection, unknown 29 cases. According to the Diagnostic Efficacy Criteria of Chinese Medicine, 33 cases were identified by Chinese medicine as Qi stagnation and blood stasis type, 24 cases were identified as wind-cold and damp paralysis type, and 13 cases were identified as liver and kidney deficiency type. According to the principle of random assignment, the patients were divided into 3 groups, 30 in the comprehensive group, 25 in the Chinese medicine external application group, and 15 in the traction group.
1.2 Symptoms and signs
Acute onset of unilateral hip pain, pain usually confined to the ipsilateral groin and hip joint mostly, common claudication and forward gait. The hip joint is not bony, but the image of the gluteus minimus flattened may become curved, the joint capsule is swollen and swollen, and the medial space of the head socket is wider than the healthy side by lmm-3mm. the pelvis is tilted to the affected side. The pelvis is tilted to the affected side.
1.3 Diagnostic criteria
According to the Diagnostic and Therapeutic Criteria of Chinese Medicine Diseases as follows.
(1) History of overexertion or sprain of the lower limbs.
(2) Age between 3 and 14 years old.
(3) Limp in the affected limb, unwilling to stand and walk, complaining of pain in the hip or knee joint.
(4) The pelvis is tilted toward the affected limb, the pseudo-degeneration of the affected limb is within 2.5cm, there is pressure pain in the groin, mild swelling, resistance to hip flexion, inversion, rotation, etc. The “4” test is positive; in severe cases, the hip flexion contracture test is positive, and the affected limb is placed in the abduction and external rotation position.
(5) X-ray radiography: mild pelvic tilt, unequal bilateral closed holes, widened joint space if there is a lot of joint effusion, but no bone destruction of the femoral head.
(6) Total blood leukocyte count and sedimentation are occasionally increased, and bacterial culture is negative.
1.4 Differential diagnosis and exclude ischemic necrosis of femoral head, rheumatoid arthritis and rheumatic fever in children, septic arthritis and synovial tuberculosis of hip joint.
① Ischemic necrosis of the femoral head. Although this disease has claudication and hip pain, the history of the disease is long and the deformation and compression of the femoral head epiphysis is visible on x-ray.
② Rheumatoid arthritis and rheumatic fever in children. The disease is also common in children, also has hip pain, muscle spasm, limp and other symptoms, but its condition is often progressive progressive development, and the disease involves more than one joint, laboratory tests may have elevated white blood cells and blood sedimentation.
(3) Septic arthritis. This disease also often has hip pain, limp and pelvic tilt, but its body temperature is higher than normal, blood picture is significantly higher than normal, and the disease is more serious, and pus can be extracted from the hip joint by puncture.
④Tuberculosis of the hip joint. It is a chronic disease with a long history, and may also show systemic symptoms of tuberculosis.
⑤ Pediatric congenital hip dislocation. The limp is obvious, the “4” test is positive, if it is unilateral, the lower limbs are unequal, but there is no obvious hip pain, muscle tension, positive pressure pain, and the X-ray film has special performance.
2.Treatment methods
2.1 External application of traditional Chinese medicine
Shuangbai San: 100g of rhubarb, 100g of cypress, 100g of zelen, 100g of peppermint, 20g of panax ginseng, 50g of safflower, 50g of Chuanxiong for the type of qi stagnation and blood stasis, 50g of douhu for the type of wind-cold and dampness paralysis, 70g of Xanthium, 100g of epimedium for the type of spleen and kidney deficiency. mix the above drugs into powder, mix with honey to make a paste and spread on gauze on the affected area. Apply once a day for 6-8 hours each time for 2 courses of treatment. If the local skin is red, remove the medicine and reapply after the skin recovers.
2.2 Skin traction treatment
Bed rest, braking of the affected limb, skin traction treatment in a straight and neutral position on the affected side, with a weight of about 1.0-2.0 kg for 8-10 hours a day, loosening for a moment every 1-2 hours of traction.
2.3 Manipulative treatment
The patient is placed in the supine position. The assistant presses both hands on the anterior superior iliac spine of the child to fix the pelvis. The physician stands on the affected side and first uses the thumb to flick to smooth out the spasm of the internal femoral retractor muscle group to avoid the increase of intra-articular pressure caused by the sudden rotation of the hip joint and the injury of the blood supply to the femoral head. After relaxing the spasm, hold the affected limb on the ankle with one hand and the knee joint with the other hand. First, gently flex the knee and hip until there is pain and no strong flexion, make flexion and extension of the knee and hip activities within the pain-free range, and when the patient’s muscles are relaxed, suddenly flex the knee and hip to the maximum extent, stay for 2 to 4 minutes, and when the pain is slightly relieved, make flexion of the hip, internal retraction and internal rotation of the affected limb for those with long legs; make flexion of the hip, external rotation and abduction of the affected limb for those with short legs. Then straighten the affected limb under traction to end the manipulation. In each group, the treatment was carried out with this method.
3.Treatment results
3.1 Therapeutic efficacy criteria
In accordance with the Diagnostic Efficacy Criteria for Chinese Medical Evidence. Cured: no lameness, no painful walking, normal squatting, negative “4” test and rotational hip flexion test, equal length of both lower limbs, no recurrence; improved: improvement of symptoms and signs, still with mild lameness, or recurrence after healing; not healed: no improvement of symptoms and signs.
3.2 Treatment results
The treatment was 2 courses, and according to the above criteria, 25 cases were cured, 4 cases were improved, and 1 case was invalid in the comprehensive group, with a total efficiency of 99%; 17 cases were cured, 5 cases were improved, and 3 cases were invalid in the traditional Chinese medicine external application group, with a total efficiency of 88%; 5 cases were cured, 5 cases were improved, and 5 cases were invalid in the traction group, with a total efficiency of 66%.