Summary
Therapeutic success in dysplasia and congenital dislocation of the hip depends on an early diagnosis. The physiopathology remains very debatable and several concepts are propounded. For a better physiopathologic understanding, the authors have carried out a study of the morphology and development of 22 pre- and neonatal hips. At first, the acetabulum is cartilaginous and distorted by the moving femoral head; this acetabulum is histologicaly affected by the femoral pressure.The pathologic hip is characterized by defective posterior bony coverage of the femoral head by the acetabulum. The acetabulum ossifies during the 3 months following birth, forming a cup-like cavity under the pressure of the femoral head. Therefore, neonatal screening tests such as sonography must take place in the first weeks of life.
Résumé
Le succès du traitement des dysplasies et luxations congénitales de hanche est lié à la précocité du diagnostic. La physiopathologie de ces affections reste discutée et plusieurs conceptions ont pu être proposées. Les auteurs ont réalisé une étude structurale et évolutive de 22 hanches anté et néonatales afin de mieux comprendre cette physiopathologie. Dans les périodes anté- et néonatale, l'acétabulum est cartilagineux, déformable sous l'action d'une tête fémorale en mouvement et il est le siège de remainements histologiques dépendant de la pression exercée par l'épiphyse fémorale. L'ossification de l'acétabulum s'effectue lors du ler trimestre postnatal, construisant la cavité articulaire sous l'effet de la pression de la tête du fémur. Dysplasies et luxations apparaissent comme un défaut de couverture postéro-supérieure de l'épiphyse fémorale par l'acétabulum. Le dépistage d'anomalies, notamment par l'échographie, devra donc être réalisé dans les premières semaines de la vie.
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Avisse, C., Gomes, H., Delvinquiere, V. et al. Anatomic study of the pre- and neonatal hip. physiopathologic considerations on dysplasia and congenital dislocation of the hip. Surg Radiol Anat 19, 155–159 (1997). https://doi.org/10.1007/BF01627966
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DOI: https://doi.org/10.1007/BF01627966