The hip joint is a multi-part joint, formed by the acetabulum of the pelvic bone and the femur head. The acetabulum is located at the junction of three bones: from above - iliac, from below - ischial, from inside - pubic. The joint bag of the hip joint goes along the edge of the joint cavity, passes to the hip and is attached to the front of the intervertebral line, therefore most of the neck of the hip is located in the cavity of the hip joint.
Fig. 1. Right hip joint (in front): 1-ilio-femoral ligament (external section); 2 - anterolateral iliac bone; 3 - the location of the iliac-scallop sac; 4-thinned area of the anterior part of the joint capsule; 5 - lanno-femoral ligament; 6-zipper; 7-small spit; 8 - interturn line; 9-ilio-femoral ligament (internal department).
Fig. 2. Frontal dissection of the right hip joint: 1 joint joint; 2- ligament of the femoral head; 3 - articular bag.
In the bag of the joint weave the ligaments : in front - iliac-femoral from below and inside - pubic-femoral, behind - ischial-femoral, deep inside the bag is strengthened by a circular ligament. Inside the joint cavity, there is a bundle of the femoral head (Figures 1 and 2). In form, the hip joint refers to spherical joints with a limited range of movements. The basic movements in the hip joint are flexion and extension around the frontal axis; In addition, withdrawal, rotation and rotation inside and out are possible. Flexion produces muscles: ilio-lumbar, straight, muscle, straining the broad fascia of the thigh, tailor, tender. Extension is carried out: semimembranous, semitendinous, long head biceps and partly large gluteal, large adductor muscle. The withdrawal takes place due to the middle gluteus and the small gluteus muscle. Reduction is possible with the reduction of large, long, short leading, tender and crest muscles. Inward turn is performed by the medial gluteus muscle (anterior section) and a small gluteus. Blood supply of the hip joint is carried out by the branches of the lower gluteal and blocking arteries. Venous outflow from the hip joint goes to the deep vein of the thigh and the internal iliac vein. Lymphatic vessels penetrate the pelvis through the occlusion channel and flow into the internal iliac lymph nodes. Innervation of the hip joint occurs by the branches of the femoral, blocking and sciatic nerves. The most frequent congenital diseases of the hip joint are dislocations (see), subluxations and dysplasia (see).
Deformation . If the axis of the femoral neck with the axis of the femoral diaphysis forms an angle less than 127 °, the deformation is called coxa vara. This pathology can be congenital, rickety, juvenile (endocrine etiology), traumatic.The
Coxa vara is characterized by: lameness , limb shortening, restriction of hip abduction and external rotation of the thigh, positive Trendelenburg symptom - when standing on a sore leg, the femoral and gluteal fold of the opposite side drops below the similar fold of the diseased side, the large spit is located above the Roser-Nelaton line (see Fig. Roser-Nelaton line ); with bilateral coxa vara lumbar lordosis is expressed (see). Radiographically, a decrease in the neck-diaphysial angle is determined. Treatment in early stages in young children is conservative: general restorative therapy, joint relief, easy traction at the hip abduction position at an angle of 50-60 °, massage, therapeutic gymnastics . Children older than 6-7 years are indicated surgical treatment - osteotomy, reconstruction of the neck of the hip.
Coxa valga - deformation of the hip joint, characterized by an increase in the size of the neck and diaphyseal angle above 130 °, is observed with insufficient load on the limb ( poliomyelitis , dislocation, amputation stump). The diagnosis is usually roentgenologically. Deformation does not cause functional disorders and does not require special treatment.
Hip joint injuries can occur as bruises, dislocations and fractures. Contusions (see) are subject to conservative treatment according to general rules. Traumatic dislocations arise as a result of direct trauma, they are quite rare. Victims should be immediately referred to a surgeon to correct the dislocation. Fractures of the femoral neck often occur in the elderly and are divided into medial, lateral and isolated fractures of skewers. Treatment conservative - stretching, special position of the patient, a coaxial plaster bandage (see Gypsum technique). In the case of unsuccessful conservative treatment, surgery - osteosynthesis (see) is indicated.
Gunshot wounds of the hip joint can be: tangential, blind and through. First aid: application of aseptic dressing and immobilization, at the medical division - surgical treatment of the wound . Gunshot wounds of the hip joint are often complicated by inflammation requiring special treatment (see Coxit). Among benign tumors of the hip joint are more often: chondromas, chondroblastomas, and from malignant tumors - chondrosarcoma. Treatment - operative.