Developmental pathophysiology of the hip
Fisiopatología del desarrollo de la cadera
Resumen:
Normal hip development follows a pre-established schedule imprinted into its genes. During fetal development the muscles which participatein skeleton remodellation, appear. If muscle structure is altered due to any genetic or acquired factor, its function becomes etiogenic and produces skeleton alterations which affect the joints in particular. Myodysplasia alters its normal development by means of severa! mechanisms: 1 . Increase in pressure between joint components.2. Morp).ological alterations of collum ( neck). 3. Malfunction of joints which tend to dislocate. Etiogenic activity of dysplasic muscles acts on movable segment of hip, i. e. upper end of femur. Alterations of cotyloid cavity ( acetabulum) are secondary to femoral alterations. ''here is delay in appearence and growth of epiphysis due to excessive compression which affects its circulation. In extreme cases this results in total ischemia with necrosis of epiphysis. Normal evolution of femur collum stops, re&ulting in valgus and anteversion in variable degree, due to disharmonic acttvi,y- of muscles. By reason of same mechanism, normal relationship of cotyloid cavity (acetabulum) with epiphysis is lost.Morphology of cotyloid cavity (acetabulum) is altered due to abnormal position of head. This abnormal position is due to morphological alterations ofcollum and to dislocating action of dysplasic muscles. Consequently it can be classified as a secondary dysplasia. Sequel!a in mild forms i¡ represented by an apparentlynormal cotyloid cavity ( acetabulum), which however is lacking in depth; this can be detected by increased thickness of cotyloid cavity (acetabulum). lt is called pre-dislocation. In more serious forms the cotyloid roof ceiling ( acetabulum) is altered so that it is vertically broad with slanting roof ( ceiling. insufficiently deep and very thick. This is termed subdislocation.Finally, in congenital dislocation there is dillocated head and altered epiphysis. Cotyloid cavity ( acetabulum) is small in all its diameters and bottom is thin, thus differing from abovementioned cases.
El desarrollo normal de la cadera se cumple siguiendo un plan preconcebido que está impreso en los genes que le dan origen. Durante el desarrollo fetal aparecen los músculosque participan en el remodelado del esqueleto. Si por alguna razón genética o adquirida se altera la estructura del músculo su función se hace patógenay produce alteraciones esqueléticas, y fundamentalmente articulares. La miodisplasia de la cadera altera su normal desarrollo por varios mecanismos:1° Aumento de la presión entre los componentes articulares. 2) Alteraciones morfológicas del cuello. 3) Disfunción articular con tendencia a la luxación.La acción patógena de los músculos displásicos se ejerce sobre el segmento móvil de la cadera: la extremidad superior del fémur. Las alteraciones que sufre el cotilo son secundariasa las alteraciones femorales. La epífisis ;ufre un retardo en su aparición y en su crecimiento por exceso de compres10n. La compresión actúa comprometiendo su circulación. En casosgraves produce una isquemia total con necrosis epifisaria. El cuello del fémur detiene ¡u evolución normal quedando en valgo y en anteversión de grados variablespor acción desarmónica de los músculos. Por el mismo mecanismo la epífisis pierde sus relaciones normales con el cotilo. El cotilo altera su morfología por el apoyo anormalde la cabeza. Este apoyo enormal se debe a las alteraciones morfológicas del cuello y a la acción luxante de los músculos displásicos. Es, pues, una displasia secundaria.En los grados mínimos dejan como secuela un cotilo de apariencia normal pero poco profundo, lo que se aprecia por el aumento de espesor del fondo del cotilo.Es la llamada preluxación. En grados mayores se altera el techo del coí:ilo quedando un cotilo ancho verticalmente con tec:ho oblicuo, poco profundo y de gran espesor; es la subluxación. Finalmente, en la luxación congénita aparece la cabeza luxada, la epífisis alterada. El cotilo chico en todos sus diámetros y el fondo del cotilo de escasoespesor, a diferencia de los casos anteriores.
1973 | |
cadera traumatología cirugía hip traumatology surgery |
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Español | |
Sociedad de Cirugía del Uruguay | |
Revista Cirugía del Uruguay | |
https://revista.scu.org.uy/index.php/cir_urug/article/view/2491 | |
Acceso abierto |
Sumario: | Normal hip development follows a pre-established schedule imprinted into its genes. During fetal development the muscles which participatein skeleton remodellation, appear. If muscle structure is altered due to any genetic or acquired factor, its function becomes etiogenic and produces skeleton alterations which affect the joints in particular. Myodysplasia alters its normal development by means of severa! mechanisms: 1 . Increase in pressure between joint components.2. Morp).ological alterations of collum ( neck). 3. Malfunction of joints which tend to dislocate. Etiogenic activity of dysplasic muscles acts on movable segment of hip, i. e. upper end of femur. Alterations of cotyloid cavity ( acetabulum) are secondary to femoral alterations. ''here is delay in appearence and growth of epiphysis due to excessive compression which affects its circulation. In extreme cases this results in total ischemia with necrosis of epiphysis. Normal evolution of femur collum stops, re&ulting in valgus and anteversion in variable degree, due to disharmonic acttvi,y- of muscles. By reason of same mechanism, normal relationship of cotyloid cavity (acetabulum) with epiphysis is lost.Morphology of cotyloid cavity (acetabulum) is altered due to abnormal position of head. This abnormal position is due to morphological alterations ofcollum and to dislocating action of dysplasic muscles. Consequently it can be classified as a secondary dysplasia. Sequel!a in mild forms i¡ represented by an apparentlynormal cotyloid cavity ( acetabulum), which however is lacking in depth; this can be detected by increased thickness of cotyloid cavity (acetabulum). lt is called pre-dislocation. In more serious forms the cotyloid roof ceiling ( acetabulum) is altered so that it is vertically broad with slanting roof ( ceiling. insufficiently deep and very thick. This is termed subdislocation.Finally, in congenital dislocation there is dillocated head and altered epiphysis. Cotyloid cavity ( acetabulum) is small in all its diameters and bottom is thin, thus differing from abovementioned cases. |
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