Radiografías m superior e inferior
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MIEMBRO SUPERIOR
Dr. Mg. Luis Naranjo N
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DISPLASIA DEL DESARROLLO
DE LA CADERA
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• Luxación Congénita de
Cadera
•Displasia congénita
•Enfermedad luxante
•Displasia evolutiva
•Enfermedad del desarrollo
de la cadera
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TERMINOLOGÍA Y CONCEPTO
.
• Displasia del desarrollo de cadera.
Luxación congénita de
cadera
Término congénito por desarrollo
Definición: Formación anormal de la articulación coxofemoral entre la fecha de la organogénesis y la maduración
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DATOS IMPORTANTES
• La LCC es una patología más frecuente en Ortopedia.
• Valoración clínica
• Ayudados del diagnóstico por imagen – revolución.
• En caso de un diagnóstico positivo – el tratamiento adecuado.
• Niño camina – signos clínicos son sutiles – rodilla más baja que la otra (signo Galleazi positivo)
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EMBRIOLOGÍA Y
DESARROLLO • Centros primarios de osificación se ven:
* Iliaco (2 m), isquión (3 m) y pubis (4 m) fetales
• Al 5º mes la articulación de la cadera y su soporte ligamentoso capsular y muscular están desarrollados.
• El centro secundario de osificación aparece en niñas de 3-5 meses neonatales y en niños de 4-7 meses.
• Visibles radiológicamente 100% el 7º mes.
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FACTORES
PREDISPONENTES • Hiperlaxitud ligamentosa
• Fuerzas mecánicas (posición pélvica)
• Oligohidramnios
• Primíperas
• Afectación de cadera izquierda (60%)
• Factores genéticos
• Factores ambientales
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ETIOLOGIA
Factor hormonal
Factor mecánico
Factor uterino
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FACTOR HORMONAL
Relacionados con la laxitud articular.
Las hormonas implicadas:
Estrógenos,
Progesterona y
Relaxina.
Inducen relajación de la pelvis en el periodo
previo al parto.
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FACTOR MECANICO Actúan en el último trimestre de la gestación.
Restricción del espacio disponible intrauterino.
El 60% de los afectados son primogénitos
La musculatura abdominal y uterina inextensible de la
madre dificulta el movimiento del feto.
Sobrepeso, macrosomias, gemelaridad u
oligohidramnios tendrían un efecto similar.
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FACTOR UTERINO
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Niñas más frecuente, 4 a 1 más
que varones.
2/3 de los niños con inestabilidad
son primogénitos.
La posición del feto dentro del
útero y las relaciones entre los dos
miembros inferiores pueden
explicar la relación de 11:1:4 de
afectación izquierda, derecha y
bilateral.
EPIDEMIOLOGIA
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De gran importancia es el
papel que juega la posición
intrauterina normal de
cadera flexionada en el
mantenimiento de una
posición adecuada de la
cabeza femoral.
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Posición fetal
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PERÍODOS EN QUE LA CADERA
PUEDE LUXARSE
• PRIMER PERÍODO – 12 semanas – movimiento de la articulación con rotación y gran presión – pudiendo luxarse.
• SEGUNDO PERÍODO – 18 semanas
• Los músculos y ligamentos completamente desarrollados pero son laxos y pueden desplazarse.
• TERCER PERÍODO – 4 últimas semanas de gestación todo desarrollado pero una posición defectuosa intrauterina.
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DIAGNOSTICO
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1) CLÍNICA – valoración minuciosa – dificultad
apertura.
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Maniobras de Ortolani y
Barlow
Pliegues
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ESTUDIOS DE IMAGEN
•Ecografía
•Radiología
•Tomografía Computarizada
•Resonancia Magnética
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ECOGRAFIA
Utilziada desde 1980 por el Dr.
Graff y 1984 Hark hace el primer
estudio dinámico.
Nos brinda un excelente detalle
antómico.
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RADIOLOGIA
Se recurre a una serie de mediciones
radiologías.
Línea Hilgenreiner
Línea de Perkin
Línea de Shenton
Indice Acetabular
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• Línea de Hilgenreiner:
Es una horizontal a través de los dos
cartílagos trirradiados.
• Línea de Perkins:
Perpendicular a la anterior por el margen
lateral del acetábulo.
• Línea de Shenton-Menard:
Prolongación del borde inferior del cuello
femoral con el borde superior del agujero
obturatríz
Contínuo - Se rompe en las formas
luxadas.
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.
.
Algunas caderas normales pueden quedar por debajo de estos valores así para niños de tres meses el AA es de 25º 3,5º
A los 2 años el AA ha descendido a 18º +/-3,5º.
Entre la línea de Hilgenreiner y una trazada siguiendo el margen del techo acetabular.
El AA es sugestivo de luxación si es mayor de 30º al nacimiento y mayor de 20º al año
Indice acetabular Aunque muy usadas es difícil de trazar y son
frecuentes los errores
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MEDIDAS DEL ANGULO
ACETABULAR
NIÑAS NIÑOS
Recién
Nacidos
28,8+/- 4,8° 26,4 +/- 4,4°
6 meses 23,2 +/- 4 ° 20,3 +/- 3,7 °
12 Meses 21,1 +/- 3,8 ° 19,8 +/- 3 3,6
°
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Displasia cadera derecha
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TOMOGRAFIA
COMPUTARIZADA
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Técnica que irradia y que debe ser complementaria
No aconsejable para el diagnóstico primario.
Cuando previamente ha sido intervenida.
En una cadera rígida, que impide una correcta reducción radiográfica
Es de gran valor para determinar anteversión o
retroversión.
Puede usarse para delinear mejor la anatomía de la luxación de la cadera.
- Para comprobar la reducción tras la colocación de un yeso.
- En una cadera en la que falló la reducción inicial
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RESONANCIA
MAGNETICA
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Cuando la ecografía resulta insuficiente
en el estudio preoperatorio de una
luxación que va a ser sometida a
reducción abierta
Desventaja: Sedación del niño.
Tiene algunas indicaciones en el
postoperatorio.
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COMPLICACIONES
DEL TRATAMIENTO
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La necrosis isquémica de la
cabeza femoral aparece en la
DCC sólo tratamiento -
yatrógena.
La incidencia descrita ha llegado
al 73% y puede ocurrir en la
cadera normal contralateral
cuando ambas caderas entán
inmovilizadas.
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COMPLICACIONES DE LCC Si la cadera permanece luxada creará un falso acetábulo,
apareciendo artrosis secundaria.
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COMPLICACIONES DE LCC La mayor complicación es la necrosis isquémica de la
cabeza femoral.
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MIEMBRO INFERIOR
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H
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LUXACIONES
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