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Чем образована вертлужная впадина

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17 августа 2019

Вертлужная впадина — одна из составных частей тазобедренного сустава. Он по праву считается самым крупным и сильным в организме человека, так как на него приходится наибольшая нагрузка. Более чем сорок процентов всех движений, совершаемых человеком, выполняется с использованием этого сустава.

Костные и хрящевые структуры

Вертлужная впадина и головка бедренной кости являются опорными костями сустава. Эта впадина представляет собой углубление в месте соединения костей таза. По форме оно похоже на полумесяц. Размеры этого углубления рассчитаны точно по величине головки бедренной кости так, чтобы можно было свободно совершать активные и пассивные движения, но в то же время ограничивать их амплитуду и не допускать вывихов.

Место соприкосновения тазовой и бедренной кости покрыто хрящом. Это необходимо для защиты от трения и лучшего скольжения поверхностей относительно друг друга.

Связочный аппарат

Вертлужная впадина, благодаря своей специфической форме, обеспечивает возможность движения сразу в нескольких плоскостях. Но для того, чтобы удерживать головку бедренной кости в суставе, костных образований недостаточно. Поэтому для стабилизации сустава существуют связки. Анатомы выделяют пять парных соединительнотканных тяжей:

  • связка головки бедренной кости;
  • седалищно-бедренная связка;
  • подвздошно-бедренная;
  • лобково-бедренная;
  • круговая.

Как видно, связки тянутся от сустава к каждой тазовой кости отдельно, кроме того, толстый пласт ткани удерживает кости циркулярно. Такое строение позволяет свести к минимуму угрозу повреждения при ходьбе или беге. Помимо связок, для движений в суставе необходимы мышцы. Основную работу выполняют передняя и задняя группа мышц бедра.

Другие элементы сустава

Рассматриваемая впадина и головка бедренной кости образуют тазобедренный сустав, в котором, помимо ключевых структур, есть еще не такие сильные и крепкие, но не менее важные элементы:

  1. Синовиальная оболочка. Она обеспечивает необходимое количество жидкости для смазки поверхностей сустава, питает его и предоставляет иннервацию.
  2. Синовиальные сумки – это удвоения синовиальной оболочки, формирующие углубления, в которых скапливается жидкость. Их задача – уменьшить трение между костными элементами.
  3. Сосуды. Питание головки бедренной кости обеспечивает соответствующая артерия. Она берет на себя все заботы о питании сустава и в случае перелома шанс, что кровоснабжение вернется к норме, крайне мал. Кроме того, в районе сустава пролегают крупные артериальные стволы, что делает травмы в этой области особенно опасными.
  4. Нервные окончания. В данном случае это веточки седалищного, запирательного и бедренного нерва. Именно поэтому при поражении сустава боли не будет непосредственно в месте патологического процесса, а она будет иррадиировать в крестец, пах или ногу.

Физиология

Тазобедренный сустав благодаря сферической конструкции своих суставных поверхностей может без особых затруднений выполнять сложные движения. К ним относятся:

  • отведение ноги в бок и обратно;
  • сгибание и разгибание;
  • вращение в суставе.

Связки и суставная капсула несколько ограничивают амплитуду движений, чтобы не допустить переразгибания ноги и вывихов.

Особенностью анатомии вертлужной впадины является наличие анатомических опор (или колонн) для головки бедренной кости. Выделяют:

  • Переднюю колонну – она располагается от подвздошной кости к лобковому сочленению.
  • Заднюю колонну – между седалищной вырезкой и бугристостью седалищной кости.
  • Наружную — образует крыша вертлужной впадины.
  • Внутренняя колонна – это дно суставной впадины.

Патология

Тазобедренный сустав при всех свои достоинствах имеет и наибольшую склонность к травматизму, так как на него постоянно давит весь вес тела человека. Одним из распространенных является синдром бедренно-вертлужного соударения, иначе называемый импинджемент-синдромом. Механизм образования этого заболевания довольно прост: при выполнении движений происходит соприкосновение шейки бедренной кости с краем вертлужной впадины. Это возможно только в том случае, если хрящи сустава сильно утолщены или имеют неровную поверхность.

В травматологии выделяют два типа этого синдрома:

  1. Эксцентрический, когда причиной соприкосновения является неправильная конфигурация головки бедренной кости. На ней могут быть бугорки, выступы или другие дефекты.
  2. Пинсер-тип связан с патологическим увеличением хрящевого покрытия впадины.

Диагностика

Вертлужная впадина тазовой кости — сложная для диагностики область, так как из-за мощных мышц и обилия тканей доступ к ней органичен. Поэтому, в первую очередь, врачи прибегают к оспросу пациента. Они выясняют характер болевых ощущений, их продолжительность, связь с физической нагрузкой и распространение.

При первом типе боль будет остро ощущаться при вращении и сгибании ноги в суставе. Во втором случае для появления неприятных ощущений необходимо выполнить большие по амплитуде движения.

Из инструментальных методов используют компьютерную или магнитно-резонансную терапию, рентгеноскопию в нескольких проекциях.

Травма вертлужной впадины

Наиболее часто переломы элементов тазобедренного сустава встречаются у пострадавших в дорожно-транспортных происшествиях или при падении человека со значительной высоты. Все травмы этого участка можно условно разделить на простые, когда повреждены передние колонны, задняя и/или передняя стенка, и на сложные. Во втором случае повреждено дно вертлужной впадины, излом проходит сразу через несколько тазовых костей и захватывает соседние области.

Основными симптомами перелома вертлужной впадины являются:

  • боль в паховой области и в проекции сустава;
  • укорочение ноги;
  • невозможность выполнять произвольные (активные) движения ногой;
  • патологический поворот ноги.
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При определении типа перелома выбирается соответствующее лечение. Если травма простая, без смещения отломков, то накладывается стандартная шина и нога помещается на вытяжение сроком в тридцать дней. Если же перелом сложный, оскольчатый, со смещением костей, то производится скелетное вытяжение на металлических спицах. Длительность этого метода может колебаться от полутора месяцев и более.

Артроз тазобедренного сустава

Угол наклона вертлужной впадины зависит от правильного анатомического строения и взаиморасположения элементов сустава. Если в суставе наблюдаются хронические воспалительные явления, то конфигурация его поверхностей может изменяться и, как следствие, угол наклона – тоже.

Из-за вялотекущего воспалительного процесса на суставных поверхностях образуется грубая соединительная ткань, которая мешает свободному движению и истончает хрящевую и скелетную часть сустава. Причинами такого состояния могут быть:

  • атрофия хряща;
  • нарушения кровоснабжения и иннервации сустава;
  • генетическая склонность и врожденные аномалии тазобедренных суставов;
  • привычные вывихи;
  • длительная гиподинамия, повышенная масса тела;
  • переломы в анамнезе.

Для лечения используется лечебная физкультура, массажи, физиотерапия. Болевой синдром снимается приемом нестероидных противовоспалительных препаратов.

Болезнь Отто

Наравне с другими органами и частями тела, которые имеют свои именные симптомы и синдромы, успела отличиться и вертлужная впадина. Анатомия и физиология тазобедренного сустава несколько отличается у людей с болезнью Отто. Эта патология была описана еще в начале девятнадцатого века, причем исключительно у женщин. Проявляется заболевание укорочением ног и ограничением подвижности в суставах. Болевых проявлений у пациенток не наблюдалось.

Причины заболевания пока остаются в тайне. Известно только, что оно передается по наследству. Для того чтобы подтвердить диагноз, врач-травматолог или ортопед назначает прицельный рентген тазобедренных суставов, УЗИ и МРТ.

Существует лечение этой болезни. Это операция, которая включает в себя вправление вывиха, коррекцию суставных поверхностей, длительное вытяжение, а в тяжелых случаях замена сустава на протез. Для детей применяются такие способы, как массаж, тугие пеленания, гимнастика и физкультура.

Коксартроз

Это один из видов дистрофического изменения, которому подвергается вертлужная впадина тазовой кости и головка бедренной кости. Болезнь поражает людей среднего и пожилого возраста. Развитие патологии происходит медленно, поэтому симптомы могут быть не заметны для человека.

Причинами появления болезни могут быть частые вывихи бедра, некроз головки бедренной кости, хроническое воспаление этой области, сколиоз, кифоз и плоскостопие. Кроме того, способствовать формированию патологии могут перманентные стрессы, гормональные сдвиги (менопауза у женщин) или нарушения обмена веществ.

Выделяют следующие симптомы заболевания:

  • боль в паховой области и бедре;
  • боль при ходьбе, при вставании со стула или кровати;
  • отчетливый хруст в суставе;
  • хромота, ограничение движений;
  • видимая «на глаз» атрофия мышц.

Заболевание не имеет обратного развития, поэтому лечение лучше начинать как можно раньше, чтобы сохранить функцию сустава. В запущенных случаях возможно радикальное хирургическое вмешательство. Терапия начинается с приема противовоспалительных лекарств и ходропротекторов, миорелаксантов, согревающих компрессов и мазей, а также физиопроцедур. Это позволяет затормозить процесс разрушения сустава, но полностью остановить его все равно не получится.

На поздних стадиях болезни помочь может только замена своего сустава искусственным. Это плановая операция, которая дает гарантию полного восстановления функции конечности. При соблюдении всех рекомендаций человек может прожить с протезом больше двадцати лет.

Вертлужная впадина — одна из составных частей тазобедренного сустава. Он по праву считается самым крупным и сильным в организме человека, так как на него приходится наибольшая нагрузка. Более чем сорок процентов всех движений, совершаемых человеком, выполняется с использованием этого сустава.

Костные и хрящевые структуры

Вертлужная впадина и головка бедренной кости являются опорными костями сустава. Эта впадина представляет собой углубление в месте соединения костей таза. По форме оно похоже на полумесяц. Размеры этого углубления рассчитаны точно по величине головки бедренной кости так, чтобы можно было свободно совершать активные и пассивные движения, но в то же время ограничивать их амплитуду и не допускать вывихов.

Место соприкосновения тазовой и покрыто хрящом. Это необходимо для защиты от трения и лучшего скольжения поверхностей относительно друг друга.

Связочный аппарат

Вертлужная впадина, благодаря своей специфической форме, обеспечивает возможность движения сразу в нескольких плоскостях. Но для того, чтобы удерживать головку бедренной кости в суставе, костных образований недостаточно. Поэтому для стабилизации сустава существуют связки. Анатомы выделяют пять парных соединительнотканных тяжей:

  • связка головки бедренной кости;
  • седалищно-бедренная связка;
  • подвздошно-бедренная;
  • лобково-бедренная;
  • круговая.

Как видно, связки тянутся от сустава к каждой тазовой кости отдельно, кроме того, толстый пласт ткани удерживает кости циркулярно. Такое строение позволяет свести к минимуму угрозу повреждения при ходьбе или беге. Помимо связок, для движений в суставе необходимы мышцы. Основную работу выполняют передняя и задняя группа

Другие элементы сустава

Рассматриваемая впадина и головка бедренной кости образуют тазобедренный сустав, в котором, помимо ключевых структур, есть еще не такие сильные и крепкие, но не менее важные элементы:

  1. Синовиальная оболочка. Она обеспечивает необходимое количество жидкости для смазки поверхностей сустава, питает его и предоставляет иннервацию.
  2. Синовиальные сумки – это удвоения синовиальной оболочки, формирующие углубления, в которых скапливается жидкость. Их задача – уменьшить трение между костными элементами.
  3. Сосуды. Питание головки бедренной кости обеспечивает соответствующая артерия. Она берет на себя все заботы о питании сустава и в случае перелома шанс, что кровоснабжение вернется к норме, крайне мал. Кроме того, в районе сустава пролегают крупные артериальные стволы, что делает травмы в этой области особенно опасными.
  4. Нервные окончания. В данном случае это веточки седалищного, запирательного и бедренного нерва. Именно поэтому при поражении сустава боли не будет непосредственно в месте патологического процесса, а она будет иррадиировать в крестец, пах или ногу.
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Физиология

Тазобедренный сустав благодаря сферической конструкции своих суставных поверхностей может без особых затруднений выполнять сложные движения. К ним относятся:

  • отведение ноги в бок и обратно;
  • сгибание и разгибание;
  • вращение в суставе.

Связки и суставная капсула несколько ограничивают амплитуду движений, чтобы не допустить переразгибания ноги и вывихов.

Особенностью анатомии вертлужной впадины является наличие анатомических опор (или колонн) для головки бедренной кости. Выделяют:

  • Переднюю колонну – она располагается от подвздошной кости к
  • Заднюю колонну – между седалищной вырезкой и бугристостью седалищной кости.
  • Наружную — образует крыша вертлужной впадины.
  • Внутренняя колонна – это дно суставной впадины.

Патология

Тазобедренный сустав при всех свои достоинствах имеет и наибольшую склонность к травматизму, так как на него постоянно давит весь вес тела человека. Одним из распространенных является синдром бедренно-вертлужного соударения, иначе называемый импинджемент-синдромом. Механизм образования этого заболевания довольно прост: при выполнении движений происходит соприкосновение шейки бедренной кости с краем вертлужной впадины. Это возможно только в том случае, если хрящи сустава сильно утолщены или имеют неровную поверхность.

В травматологии выделяют два типа этого синдрома:

  1. Эксцентрический, когда причиной соприкосновения является неправильная конфигурация головки бедренной кости. На ней могут быть бугорки, выступы или другие дефекты.
  2. Пинсер-тип связан с патологическим увеличением хрящевого покрытия впадины.

Диагностика

Вертлужная впадина — сложная для диагностики область, так как из-за мощных мышц и обилия тканей доступ к ней органичен. Поэтому, в первую очередь, врачи прибегают к оспросу пациента. Они выясняют характер болевых ощущений, их продолжительность, связь с физической нагрузкой и распространение.

При первом типе боль будет остро ощущаться при вращении и сгибании ноги в суставе. Во втором случае для появления неприятных ощущений необходимо выполнить большие по амплитуде движения.

Из инструментальных методов используют компьютерную или магнитно-резонансную терапию, рентгеноскопию в нескольких проекциях.

Травма вертлужной впадины

Наиболее часто переломы элементов тазобедренного сустава встречаются у пострадавших в дорожно-транспортных происшествиях или при падении человека со значительной высоты. Все травмы этого участка можно условно разделить на простые, когда повреждены передние колонны, задняя и/или передняя стенка, и на сложные. Во втором случае повреждено дно вертлужной впадины, излом проходит сразу через несколько тазовых костей и захватывает соседние области.

Основными симптомами перелома вертлужной впадины являются:

  • боль в паховой области и в проекции сустава;
  • укорочение ноги;
  • невозможность выполнять произвольные (активные) движения ногой;
  • патологический поворот ноги.

При определении типа перелома выбирается соответствующее лечение. Если травма простая, без смещения отломков, то накладывается стандартная шина и нога помещается на вытяжение сроком в тридцать дней. Если же перелом сложный, оскольчатый, со смещением костей, то производится скелетное вытяжение на металлических спицах. Длительность этого метода может колебаться от полутора месяцев и более.

Артроз тазобедренного сустава

Угол наклона вертлужной впадины зависит от правильного анатомического строения и взаиморасположения элементов сустава. Если в суставе наблюдаются хронические воспалительные явления, то конфигурация его поверхностей может изменяться и, как следствие, угол наклона – тоже.

Из-за вялотекущего воспалительного процесса на суставных поверхностях образуется грубая соединительная ткань, которая мешает свободному движению и истончает хрящевую и скелетную часть сустава. Причинами такого состояния могут быть:

  • атрофия хряща;
  • нарушения кровоснабжения и иннервации сустава;
  • генетическая склонность и врожденные аномалии тазобедренных суставов;
  • привычные вывихи;
  • длительная гиподинамия, повышенная масса тела;
  • переломы в анамнезе.

Для лечения используется лечебная физкультура, массажи, физиотерапия. Болевой синдром снимается приемом нестероидных противовоспалительных препаратов.

Болезнь Отто

Наравне с другими органами и частями тела, которые имеют свои именные симптомы и синдромы, успела отличиться и вертлужная впадина. Анатомия и физиология тазобедренного сустава несколько отличается у людей с болезнью Отто. Эта патология была описана еще в начале девятнадцатого века, причем исключительно у женщин. Проявляется заболевание укорочением ног и ограничением подвижности в суставах. Болевых проявлений у пациенток не наблюдалось.

Причины заболевания пока остаются в тайне. Известно только, что оно передается по наследству. Для того чтобы подтвердить диагноз, врач-травматолог или ортопед назначает прицельный рентген и МРТ.

Существует лечение этой болезни. Это операция, которая включает в себя вправление вывиха, коррекцию суставных поверхностей, длительное вытяжение, а в тяжелых случаях замена сустава на протез. Для детей применяются такие способы, как массаж, тугие пеленания, гимнастика и физкультура.

Коксартроз

Это один из видов дистрофического изменения, которому подвергается вертлужная впадина тазовой кости и головка бедренной кости. Болезнь поражает людей среднего и пожилого возраста. Развитие патологии происходит медленно, поэтому симптомы могут быть не заметны для человека.

Причинами появления болезни могут быть частые вывихи бедра, некроз головки бедренной кости, хроническое воспаление этой области, сколиоз, кифоз и плоскостопие. Кроме того, способствовать формированию патологии могут перманентные стрессы, гормональные сдвиги (менопауза у женщин) или нарушения обмена веществ.

Выделяют следующие симптомы заболевания:

  • боль в паховой области и бедре;
  • боль при ходьбе, при вставании со стула или кровати;
  • отчетливый хруст в суставе;
  • хромота, ограничение движений;
  • видимая «на глаз» атрофия мышц.
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Заболевание не имеет обратного развития, поэтому лечение лучше начинать как можно раньше, чтобы сохранить функцию сустава. В запущенных случаях возможно радикальное хирургическое вмешательство. Терапия начинается с приема противовоспалительных лекарств и ходропротекторов, миорелаксантов, согревающих компрессов и мазей, а также физиопроцедур. Это позволяет затормозить процесс разрушения сустава, но полностью остановить его все равно не получится.

На поздних стадиях болезни помочь может только замена своего сустава искусственным. Это плановая операция, которая дает гарантию полного восстановления функции конечности. При соблюдении всех рекомендаций человек может прожить с протезом больше двадцати лет.

Здравствуйте, уважаемые посетители! В нашем обзоре мы рассмотрим такую часть тела, как вертлужная впадина. На данный элемент приходится до 20 % всех тазовых недугов. Именно травмирование вертлужной впадины является особенно серьезным. Осложнения могут сформироваться при сочетании перелома с травмой шейки бедра и с вывихом тазобедренного сустава. Возникает нарушение работы конечности, и проявляются ощущения комфортности.
Итак, выясним, какие бывают симптомы и лечение вертлужной впадины.

Анатомия

Вертлужная впадина тазовой кости выглядит, как небольшая дуга с выемкой внутри. Область содержит хрящевые ткани. Данный элемент формирует тазобедренный сустав. Создается часть при помощи подвздошной, седалищной и лобковой кости. Вертлужная впадина включает стенки спереди и сзади и колонны вертлужной области.
Тазобедренный сустав прикрыт фиброзной сумкой из соединительных тканей. Сумка фиксируется к элементам кости в виде ободка. Вертлужная впадина отклонена вниз на 45 градусов и развернута на 15 градусов.

Перелом вертлужной впадины

Представляет собой сильное повреждение. Травмирование в дальнейшем может спровоцировать возникновение коксартроза. Для благополучного исхода необходимо зафиксировать отломки и восстановить анатомическую форму. Травмы часто происходят при автомобильных авариях и при падениях с высоты.

Причины повреждения

Факторы, провоцирующие перелом вертлужной впадины могут быть различными. На кость падает значительное давление, в результате которого случается поломка. Головка бедренной кости ударяется по суставу, что вызывает повреждение.

Прямое влияние проявляется в результате:

  1. Падения.
  2. Несчастных случаев.
  3. Аварий.
  4. Падения тяжелых предметов в область таза.

Получить повреждение можно и непрямым способом. Нарушения возникают при несоблюдении техники безопасности при тренировках тяжелыми видами спорта. При этом наблюдаются нагрузки на конечность. В результате вывихов и подвывихов происходит смещение и перелом.


Также к причинам повреждения стоит отнести хронические болезни суставов, запущенные формы остеохондроза и физические нарушения.
Протрузия вертлужной впадины и другие проблемы часто бывают у пожилых людей. Кости становятся хрупкими и ломаются даже при небольших нагрузках.

Травмы случаются при падении на бок. Иногда проблемы возникают и при неправильном приземлении.
При таких травмах кости долго заживают, а при повторном травмировании редко срастаются без смещения.

Симптомы

Перелом задних отделов впадины сопровождается значительными болями. При этом движения резко ограничены. Трещины в костных тканях сопровождаются ноющими болями.

Многие принимают такие признаки за проявление артрита. При любых трудностях с передвижением нужно обратиться к квалифицированным специалистам. Это позволит исключить проявление травмы.

Стоит отметить следующие признаки болезни:

  1. Болевые ощущения в области тазобедренного сустава и паха.
  2. Вынужденное расположение конечностей.
  3. Ограничение подвижности.
  4. Сложности с опиранием на поврежденную конечность.
  5. Возникновение хруста и щелчков.
  6. Отечность и покраснение больной области.

При сочетании нарушений целостности передней и задней поверхностей наблюдается появление шокового состояния. Точная диагностика позволит выполнить своевременное лечение и снижает риск возникновения последствий.

Врач может назначить рентгенологическую оценку степени оссифицированности. Для постановки диагноза дополнительно выполняется и КТ тазовой области. Методика помогает определить степень перелома. В некоторых случаях перелом дополняется нарушением седалищного нерва. Кроме областей травматологии и ортопедии проблемой занимается и неврология.

Лечение переломов

Для лечения применяется хирургический и консервативный способы. Выбор методики определяется состоянием здоровья пациента, степенью смещения и наличием осколков.
Консервативные методы используются, если при травме не возникло смещений и осколков.

В других случаях применяется оперативное вмешательство. Во время операции фрагменты кости соединяются с помощью металлических деталей. Для закрепления лечебного эффекта применяется лечебная физкультура.


К консервативным методам относится крепление гипса. Он фиксируется при помощи стержней. Подобное приспособление способствует быстрому восстановлению.
Чтобы ускорить сращивание используются различные лекарственные препараты на основе кальция.

Для всасывания данного компонента применяется витамин Д. Врачи назначают такие препараты, как Кальцемин, Структум и Кальций Д3 никомед. На повышение выработки витамина Д влияет принятие солнечных ванн.
Дополнительно назначаются и нестероидные лекарства с противовоспалительным эффектом. Пользуется популярностью Алмирал, Мовалис, Ксефокам и Аэртал.

Реабилитация

Сроки восстановления после перелома определяются качеством проведенной реабилитации. Специальная гимнастика проводится после получения травмы. Занятия проводит реабилитолог. Движения помогают повысить тонус организма. Упражнения отличаются простотой. Это сгибания и разгибания пальцев, круговые движения стопами и подъемы таза.


Второй этап восстановления начинается после операции и до тех пор, пока пациент не сможет передвигаться своими силами. Специалист обучает передвигаться на костылях, а затем с тростью. Гимнастика помогает стимулировать ток лимфы и крови.
На третьем этапе движения выполняются в полной степени. Нужно ходить без опоры, менять темп и преодолевать препятствия.
Лечебные процедуры и регулярные упражнения способствуют восстановлению поверхностей тазобедренного сустава и суставной ямки тазобедренной области.

Важным моментом является своевременная диагностика, поэтому при появлении первых симптомов следует обратиться к врачу. До свидания, уважаемые гости!

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