[The hip joints of preterm neonates in sonographic evaluation]. / Stawy biodrowe wczesniaków w ocenie ultrasonograficznej.

The introduction of sonography to the evalution of the hip joint, allowed for the non-invasive examination in preterm neonates and thus assessment of the development their hip joints. MATERIAL AND METHODS. The examined group consisted of 143 preterm neonates with the body weight by delivery lower then 2000 grams (286 hip joints) and the control group of 31 children from term delveries forming the control group. The sonographic examination was conducted stricktly according to the rules presented by Graf. First examination was performed averagely in the 3rd week of life, second avg. in the 14th, third in avg. the 23rd, fourth avg inthe 33r week of life. Wyniki. In the first examination, done in the 3rd week of life it was noticed that highest rate of the hips Ia appeared in the group I (newborns with the lowest bogy weight), and together with the increase in body weight the incidence of such hips decreased, when the incidence of type IIa hips increased at the same time. At the final examination no statistically significant differences were found between the hip joints and no dysplastic hips were found. Wnioski. According to our results, we found that preterm delivery is not a risk factor for the developmetal hip dysplasia.

Evaluation of the operative treatment of the developmental hip dislocation performed second year of life.

Background. Both conservative and surgical treatment are applied in the treatment of developmental hip dislocation in the second year of life. Our study to evaluated the results of surgical treatment at this age using open reduction combined with transiliac osteotomy and translation of the distal insertion of the iliopsoas muscle. Material and methods. The analyzed group consisted of 21 hip joints. The mean follow-up was 6 years (2-11 years). The age of the patients at surgery was 13 -24 months, average 18 months. Results. According to Severin's classification scheme 71% of the patients had excellent results and 29% good. However, when the analyzed joints were evaluated according to our classification scheme, the results were significantly worse: 29% excellent, 48% good, 23% satisfactory. The difference between the results was caused by parameters not included in Severin's classification: neck-shaft angle and neck centering angl. The true antetorsion angle was decreased in the final examination in comparison to preoperative results. The mean head-metaphyseal index of Kruczynski averaged 120.61% of normal in the whole group, and values higher than 120% were found in 13 cases (62%). Conclusions. The described method of treatment provided stable reduction with good coverage of the femoral head by the acetabular roof in more than 90% of cases. The problem of increased neck-shaft angle and neck centering angle occurring in 25% of cases remains unsolved. The antetorsion angle is still high in some cases at follow-up.

Development and remodeling of the hip joint of preterm neonates in sonographic evaluation.

Background. Recent studies on the developmental dysplasia of the hip emphasize the role of the last trimester of pregnancy in the origin of the pathology. The aim of the study was to evaluate the development of the hip joints of preterm neonates born with different weight and in different periods of pregnancy.
Material and metods. 286 hip joints of preterm neonates born between 24 and 37 week of pregnancy and 62 ones of newborns from term deliveries were analysed. The evaluated newborns were divided into 3 groups of preterm ones: with the weight at birth below 1000 g (23 children), between 1000 and 1500 g (40 children), between 1500 and 2000 g (80 children) and a control group- 31 children from term deliveries with normal weight. In every case 4 single sonographic examinations were performed using the method presented by Graf. First, before the 6 week of age (mean 3 weeks), next after the 3rd month af age (mean 14 weeks), next after 5th month of age (mean 23 weeks) and the last one after the 7th month. The evaluation of the remodeling of the hips was based on the observation of changes in a and ss angles.
Results. It was found that the lower was the newborn's weight at birth the higher was the b angle. The similar tendency was noticed for the ss angle but was observed only in the group of preterm neonates. When the evaluation was based on the postconceptional age at the examination, it was found that the values of both angles worsened together with age, reaching the worst values between 37th and 42th week of postconceptional age. It proves the theory, that in the last trimester of the pregnancy, the acatabulum becomes more shallow and vertical together with the worsening of the cartilaginous femoral head coverage with time.
Conclusion. The presented results show that the worst anatomical parameters of the hip joint can be found at physiological term of delivery.