Hip pain in children

Hip joint pain is a common disease in children due to damaged spots at the development stage. The disease is not dangerous, but if not detected and treated promptly, it often leads to destruction in patients.

There are 13-year-old male patients with symptoms of mechanical hip pain, increasing gradually. For one year, the patient found that his left leg was more painful, limping. Taking an x-ray of the hip joint, she was diagnosed with a left hip tuberculosis and transferred to a central TB hospital for treatment. After that, the family brought me to the Department of joints, Bach Mai hospital for treatment. At this time, the child was restricted in joint movement in posture and rotation positions, the movement of normal hip joints and without any other local symptoms. Tests also show no inflammatory syndrome. On X-ray film shows, the wide hip joint, flattened femoral head, speckled spots make the bone head uneven, the portion of the mortar is completely normal. The doctor concluded that this is a form of coxa plana, one of the group of spot defect (ostéodystrophies) in the developmental stage of children.

Group of ostéodystrophies

(Photo: People)

This group of diseases includes bone or osteoarthritis lesions, which occur in children or adolescents, often localized in short bones or a bone (bone, spine head or edge of the bone marrow area). This group of diseases is generally benign, however, they can leave severe mechanical consequences in adolescence, easily degenerating joints later.

This group of diseases carries many different names such as unexplained aseptic necrosis, inflammation of the end-point in the development stage of children . In addition, each different lesion location has its name. is the name of the authors who discovered them. A hip joint injury, called Legg-Perthes-Calvé.

The disease is characterized by patients with prolonged hip pain (often manifested by knee pain despite damage to the hip joint). Legs are limp (sometimes this is the first symptom). Limited joint movement, especially in posture and spin positions.

It is important that the patient does not have any other symptoms in place: the joint is not hot, not swollen, not touching the inguinal lymph nodes. The patient also had no other symptoms: no fever, no cough, no palpation of the neck (or anywhere else). Patients will find it difficult to squat, difficult to rotate the hip joint, difficulty walking. Examination of the left hip joint is restricted to joint movement in the posture and turns the normal left hip joint movement. Tests show that there is no inflammatory syndrome (sedimentation rate, number of pinks, leukocytes and other normal parameters).

The disease is usually 4-10 years old, most (85%) are boys. In Vietnam, the disease usually comes later, between 7-14 years old. There are even cases of patients over 20 years of age who come to the stage where there has been sequelae with the femoral head completely removed. Most cases are misdiagnosed as hip joint tuberculosis at the primary level. Injury can be one or two sides, most of the changes are gradual, but there are also cases of sudden changes.

The basic injury of the disease is the nuclear necrosis of the femoral head. The bone head, initially necrosis, is then invaded by the reaction of the blood vessels and the connective organization. In the final stage, the active bone organization replaces the necrotic section. The main point of the disease is the progressive recovery of bone over a long period of time (2-4 years), the femoral head is very soft, tends to collapse, so the disease is called coxa plana. Jointed components - the synovial membrane reacts by vascular hyperplasia - organization of association, hyperinfection, followed by fibrosis. The next stage, bone and joint components - the synovial membrane is easily degraded secondary or joint deformity at a later stage. The progress of the disease is relatively fast if not detected. For example, in a film taken by a 13-year-old patient, after only 3 months, without treatment, without counseling, the left thigh bone was clearly canceled.

During the onset, the disease usually has two types of indirect and direct symptoms. On the X-ray film of the indirect phase often occurs: the joint joints widen (the femoral head appears to be far from the bottom of the mortar, especially in the lower part). The first part of the bone changes (there are speckled spots that make the bone head uneven, sometimes with small defects in the bone cartilage border, loss of minerals. Symptoms of the direct phase are the special image of Thighs, transforming the structure of the crown, the "nail imprint" image (the bright area separated from the joint by a piece of bone.) Entering the necrotic stage, the nucleus mutations become obvious: flattened cap (with the image of "calf hat" or "train seat cushion"; uneven shape of the crown, changing the head of the bone along with the joint between the bone and the broad tip, creating the image " The head of the head " of the femoral neck. The average progression time is about 2-3 years.

The period of degeneration lasts 16 months to 3 years, the recovery period takes place in about 16-20 months.

Treatment

If at an early stage, the child only needs to remain motionless for 18 months to 3-4 years.Children must not operate on diseased legs: do not run, limit movement.Children need calcium supplements, vitamins.Need to follow progressive radiography.When signs of recovery of injury appear (the head and head are closed, loss of blurring at the top of the bone) allows children to move.All medical facilities can carry out this treatment.However, it is best to bundle anti-rotating castings to conserve, avoid capillary.The orthopedic surgery department at Saint Paul's Hospital or Viet Duc Hospital can implement these measures.The disease can be cured with cases detected and treated at an early stage.

When detected early, the child can fully recover the femoral head, the child can develop normally.But if in the late stage, when the femoral head has been removed, at a stable stage, the patient will have no pain, but half of the cases will progress toward osteoarthritis.

In adulthood, patients can still use hip joints, but increasingly pain in the hip and lumbar spine due to secondary degeneration after the body axis is deformed.Finally, the patient will have to replace the artificial hip joint.Therefore, the role of detecting and treating diseases at an early stage is very important.

Doctor - Doctor Nguyen Thi Ngoc Lan