<p>What is AVN?<br /><br />AVN – avascular necrosis – is a condition in which the ball – or femoral head – in a child’s hip joint loses its circulation. This can occur at any age, but it has different effects on infants, children, and adults.<br /><br />What causes AVN?<br /><br />AVN from developmental hip dysplasia (DDH) is a result of treatment but it doesn’t mean that your doctor did anything wrong. The circulation to an infant’s hip is naturally weak because the blood comes in from blood vessels below the hip because the blood supply can’t come in through the joint surface at the top of the ball . If the hip is dislocated, the blood vessels are kinked from the dislocation. Sometimes the blood vessels stop working when the hip is pulled down from the dislocated position and put back into the hip joint. AVN is more common when a lot of force is required to put the hip back into the joint or when an extreme position of the hip is used to hold the hip in the joint. Rarely, the blood supply can be damaged during surgery, but the usual cause is simply putting the hip back into the joint. The International Hip Dysplasia Institute (IHDI) is studying the frequency of AVN to see if there are ways to find more risk factors so we can find better ways to avoid AVN.<br /><br />What happens after AVN occurs?<br /><br />When an adult hip loses its blood supply, the hip usually deteriorates rapidly and causes severe arthritis. In children between the ages of 5 and 12 years, the condition is called Legg-Calv?-Perthes disease and the results are variable depending on severity and treatment. Loss of circulation in this 5-12 year age group can cause collapse of the ball so that it’s flat instead of round. Flattening of the ball in this age group limits activities and leads to early arthritis.<br /><br />AVN in infants and very young children doesn’t act anything like AVN after the age of six years, so there may be some confusion when you look up AVN online and see what happens to adults or slightly older children. When AVN occurs in babies or young children, the hip stays round and eventually recovers its blood supply, but the temporary loss of circulation can damage the growth plate of the upper end of the thigh bone. As the child grows, the leg on the affected side may be shorter, or the neck of the femur may be short and cause a limp.<br /><br />사진 1<br />This is an 8 year and 3 month old girl who developed AVN after closed reduction and spica cast for a dislocated right hip at age 16 months. You can see the difference between the normal left hip and the shortened right hip from growth disturbance. The good news is that the ball is round and she is not likely to develop arthritis at a young age. Surgery around the age of 12 years can restore her leg lengths to equal and the hip to a more normal shape, but it’s usually best to wait until about that age to do anything for AVN that develops from DDH treatment.<br /><br />A bigger problem that often goes along with AVN is incomplete reduction of the hip. There’s no need to treat the AVN at a young age, but incomplete reductions need to be corrected whether there’s AVN or not.<br /><br />사진2<br />This is a 19 month old girl who was treated with a Pavlik harness at age 3 months. She is 16 months after treatment and the bone that should be in the ball of both hips has not appeared, although there is a faint appearance of some bone on the right side. Both hips are in the sockets and there is no need for more treatment at this age. Eventually, she may need surgery if the shape of the upper thigh becomes abnormal with growth. Compare this to the hips of the child below.<br /><br /><br /><br />How do you identify AVN?<br /><br />AVN is identified after treatment with a Pavlik harness, a cast, or surgery when the bone in the ball of the hip fails to appear on x-ray or fails to grow for a period of one year. Once it does start to appear, it looks different from the other hip. The x-rays are all that’s needed to diagnose AVN after DDH. Tests like MRI, bone scans, or CT scans are used to diagnose AVN in adults of in older children with Legg-Calv?-Perthes disease, but these tests are rarely helpful before the age of five years. There’s no need to diagnose AVN right away in babies or young children because there is no treatment. The focus of treatment in this age group needs to be on making sure the hip stays in the socket because the growth disturbance from AVN takes time to show up and more time before treatment.<br /><br />사진 3<br />This is a 19 month old boy who was treated with a Pavlik harness at the age of eight months. You can see that both hips have formed normally and the bone in the ball of each hip is large and round. This boy did not develop AVN.<br /><br />Summary<br /><br />AVN is a serious problem because it means that the child is not finished with treatment. Every doctor who treats DDH occasionally has a child with AVN and this is worrisome to the doctors and the parents because we cannot always look back and see why it happened. However, there is no need for early treatment except to make sure the hip is in the socket. There are four grades of AVN and grade 1 rarely causes trouble, but grade 4 always needs more surgery around the age of 8-12 years. The only good way to tell the grades is to follow the child and see what happens. The IHDI is doing all it can to study and teach methods that may decrease the risk of AVN.<br /><br /></p><p><br /></p><p><img src='https://t1.daumcdn.net/cfile/cafe/217830435510EC891D'/></p><p><br /></p><p><img src='https://t1.daumcdn.net/cfile/cafe/2425773F5510EC9112'/></p><p><br /></p><p><img src='https://t1.daumcdn.net/cfile/cafe/275879405510ECB308'/></p><p><br /></p>
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고관절을 맞추는 입장에서는 어린 나이일수록 효과가 더 좋습니다.다만, 어린 나이 일수록 혈관이 더 좁기때문에... 무혈성괴사의 위험률이 조금 더 높아지는 거죠. 그리고 너무 엠자로 바짝조이거나 너무 벌어져도 무혈성괴사가 올 확률이 높아지므로... 보조기를 정확히 차는 게 얼마나 중요한지 생각하게 됩니다. 무혈성괴사가 왔다고 의사가 치료를 잘 못 한 건 아니랍니다. 윗 글에 적힌 내용입니다. www.hipdysplasia.org
맨 아래 요약된 단락 보시면, however, there is no need for early treatment except to make sure the hip is in the socket. 그러나 뼈가 빨리 제자리에 들어가야 하는 우리 아이들 입장에서는 이른 치료는 어쩔 수 없는 선택이죠.. 그러니 보정기를 제대로 차는 것이 얼마나 중요한지 다시 한 번 상기시켜 주네요
그치만..모든 가능성을 열어두고..알고있어야..의논도되고..수술빨리안하면 골반도 이상하게 자라고..여기카페에 오는게 정보를 주고받으려는거니.. 라맘님의 마음을 나쁘게 여기지 않습니다 전..우리애 다리 수술하고 보조기로 이게 다인가했는데.. 정신잡고 기도해야겠다고.. 긍정적으로 자극을 받았습니다~
첫댓글 AVN 상당히 무섭네요..수술후..언제 누구에게 일어날지 모를수도 있는거네요 ㅠㅜ 아.. 기도해야겠어요 우리 아기들 .. 건강히 뼈가 잘자리잡고 피가 제대로 돌수있도록~
아무래도 골두형성에도 영향을 끼치니깐요... ㅠㅠ
네~ ㅠㅜ
무혈성괴사는 너무 이른 치료가 그 결과를 초래한다고 하죠.이른 치료가 뼈를 제자리에 넣는 장점하나 뿐이니 양단성을 가지고 있어서 엄마로썬 그것도 고민입니다.
비밀글 해당 댓글은 작성자와 운영자만 볼 수 있습니다.15.03.24 22:36
고관절을 맞추는 입장에서는 어린 나이일수록 효과가 더 좋습니다.다만, 어린 나이 일수록 혈관이 더 좁기때문에... 무혈성괴사의 위험률이 조금 더 높아지는 거죠. 그리고 너무 엠자로 바짝조이거나 너무 벌어져도 무혈성괴사가 올 확률이 높아지므로... 보조기를 정확히 차는 게 얼마나 중요한지 생각하게 됩니다. 무혈성괴사가 왔다고 의사가 치료를 잘 못 한 건 아니랍니다. 윗 글에 적힌 내용입니다. www.hipdysplasia.org
맨 아래 요약된 단락 보시면, however, there is no need for early treatment except to make sure the hip is in the socket. 그러나 뼈가 빨리 제자리에 들어가야 하는 우리 아이들 입장에서는 이른 치료는 어쩔 수 없는 선택이죠.. 그러니 보정기를 제대로 차는 것이 얼마나 중요한지 다시 한 번 상기시켜 주네요
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그치만..모든 가능성을 열어두고..알고있어야..의논도되고..수술빨리안하면 골반도 이상하게 자라고..여기카페에 오는게 정보를 주고받으려는거니.. 라맘님의 마음을 나쁘게 여기지 않습니다 전..우리애 다리 수술하고 보조기로 이게 다인가했는데.. 정신잡고 기도해야겠다고.. 긍정적으로 자극을 받았습니다~