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"code": "Q65",
"name": "Врожденные деформации бедра",
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"etiology": "<p>В силу врожденного порядка происходят задержка развития ядра, окостенение эпифиза головки бедра и после его появления – медленное развитие эпифиза.</p>",
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"diagnostics": "<p>Рентгенологически определяется почти вертикальное расположение зоны роста. Уменьшение шеечно-диафизарного угла прогрессирует с возрастом. К 5–8 годам укорочение конечности может равняться 4–8 см.</p>",
"treatment": "<p>Ортопедическое, по показаниям – хирургическое.</p>",
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"clinical_picture": "<p>Если в норме шеечно-диафизарный угол у новорожденных является 135°, а в дальнейшем равен 127–130°, то при Coxa vara он уменьшен до 90° или бывает острым. Увеличение угла свыше 135° носит название Coxa valga.</p>\r\n<p> </p>\r\n<p>Основные симптомы: ограничение отведения бедра, смещение большого вертела кверху выше линии Розера-Нелатона, в более старшем возрасте – положительный симптом Тренделенбурга из-за сближения точек прикрепления средней и малой ягодичных мышц, функциональное укорочение конечности, при двусторонней Coxa vara наблюдаются «утиная» походка и образование поясничного лордоза.</p>\r\n<p> </p>\r\n<p>Характерными являются наличие костного бугорка на наружной поверхности бедра в его средней части, укорочение и <a href=\"/symptom/anormalnoe_polozhenie_tela/\" title=\"Перейти на страницу симптома Анормальное положение тела\">искривление</a> диафиза бедра и утолщение бедра в нижней части. С возрастом <a href=\"/symptom/anormalnoe_polozhenie_tela/\" title=\"Перейти на страницу симптома Анормальное положение тела\">искривление</a> диафиза бедра и бугорок на наружной поверхности выравниваются.</p>",
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"diagnostics": "<p>Постановка диагноза основывается на клинических и рентгенологических данных.</p>",
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"clinical_picture": "<p>При врожденной косолапости наблюдаются изменения формы и положения стопы. Внутренняя косолапость (pes varus) характеризуется изменением формы пяточной кости, костей плюсны. При pes equinus стопа находится в положении подошвенного сгибания. При приведении аддукции переднего отдела стопы – pes adductus. Если имеется сумма этих отклонений, стопа носит название pes equino-varus-adductus.</p>\r\n<p> </p>\r\n<p>Врожденная косолапость делится на 2 группы: типичные и нетипичные формы. К нетипичным формам относится косолапость при амниотических перетяжках, врожденных дефектах костей, врожденных спастических параличах.</p>\r\n<p> </p>\r\n<p>Типичная группа врожденной косолапости варусная, контрактуры Остен-Сакена (при этом изменение в костях, связках, мышцах незначительные). При костных формах косолапости наряду с изменениями со стороны связок и мышц отмечаются выраженные изменения таранной кости и ее смещение вперед и кнутри. Наружная лодыжка мешает исправлению деформации, тогда как размеры внутренней лодыжки меньше, чем в норме.</p>\r\n<p> </p>\r\n<p>При врожденной косолапости стопа повернута внутрь, особенно в области пятки и среднего отдела стопы. Имеется приведение переднего отдела стопы, в результате чего на внутренней его поверхности в области I клиновидной кости и ладьевидной кости проходит глубокая складка – борозда Адамса. Стопа находится в положении подошвенного сгибания. Степень деформации колеблется в широких пределах. После того как дети начинают ходить, появляется огрубение кожи по наружному краю стопы. Походка становится своеобразной, «ходульной».</p>",
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