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Реферат Склеротические остеодисплазии-группа относительно редко встречающихся заболеваний, общим признаком которых является диффузное или очаговое уплотнение костной ткани. Причиной их развития являются врожденные нарушения энхондрального и интрамембранозного остеогенеза как наследственного характера, так и возникающие вследствие спонтанных мутаций. Основные диагностические проблемы возникают при дифференцировании склеротических дисплазий от различных симптоматических остеопатий, сопровождающихся уплотнением костной ткани. Целью настоящей работы является информация о группе редких врожденных заболеваний, характеризующихся распространенным и локальным остеосклерозом, и анализ литературы по их диагностике и дифференциальной диагностике от другой патологии, сопровождающейся уплотнением костной ткани. Выполнен поиск публикаций на русском и английском языках в электронных базах данных PubMed, PubMed Central, Google Sholar и eLIBRARY по ключевым словам: sclerosing bone displasias, hyperostosis, osteopetrosis, osteopoikilosis, pyknodisostosis, melorheostosis, osteopathia striata, progressive diaphiseal dysplasia, diaphiseal sclerosis, enostosis и их русским аналогам за период с 1953 по 2015 г. В настоящем обзоре представлены клинические и рентгенологические признаки остеопетроза, полосчатой остеопатии, остеопойкилии, эностоза, пикнодизостоза, прогрессивной диафизарной дисплазии, генерализованных кортикальных гиперостозов, мелореостоза и ряда других форм склеротических остеодисплазий. Основное внимание уделено клинической и рентгенологической диагностике и дифференциальной диагностике с остеобластическими метастазами, первичными доброкачественными и злокачественными костными опухолями, хроническим остеомиелитом и другой патологией, сопровождающейся локальным или диффузным остеосклерозом.
Purpose of the study— to generalize and arrange the data published in scientific literature and to present currentviews on epidemiology, diagnostics and treatment options for pubic symphysis diastasis during pregnancy and delivery. Semeiotic separation wider than 10 mm is considered pubic symphysis diastasis during pregnancy and delivery. Diastasis above 14-25 mm might be associated with ruptures of sacroiliac joints. Frequency of such pathology is reported in the range from 0,03 to 2,8%. Key risk factors of this pathology include multiparity and repeated labor. Symptoms of pubic separation include pain and signs of pelvic instability manifesting immediately after delivery or within a short period of time after the delivery. AP roentgenography is the principal diagnostics method however lately ultrasound exam is done more frequently. Conservative option prevails in treatment of pubic symphysis diastasis. Surgical procedures are recommended in case of separation above 30-50 mm, ruptures of sacroiliac joints, open lesions, failed conservative treatment and urological dysfunction. In such cases preferred option is the internal fixation by plate and screws. Some authors use external fixation. Late-term outcomes of both methods do not demonstrate significant differences. Pain regress after the surgery is observed within 3 weeks to 6 months postoperatively, walking with partial load is restored in 5-14 days, full load on the lower limbs is possible 6 months postoperatively. Indications for removal of implants after internal fixation are not clearly defined. Following surgical treatment of pubic symphysis diastasis the majority of authors incline to subsequent operative delivery.
Traumatic hip dislocations occupy the fourth place among dislocations of various localizations and, as a rule, are the result of exposure to a high-energy traumatic agent. Such injuries are more often observed in young and middle-aged males. The main cause of hip dislocations is road accidents. The femoral head is more often dislocated posteriorly, but anterior dislocations are not casuistic and account for approximately 10%. Hip dislocations are often combined with acetabular fractures, while their fairly clear clinical picture in the presence of fractures can be leveled. Traumatic hip dislocations require urgent diagnosis and treatment. After the clinical examination of the patient, an x-ray of the pelvis and hip joints are performed. Radiographic diagnosis of hip dislocation remains relevant, but modern imaging methods allows to study the hip joint in more detail and identify concomitant injuries. The main treatment for hip dislocation is closed reduction. Early dislocation reduction and the absence of damage to the structures forming the hip joint are important for the treatment results prognosis. The further patient management tactics after the dislocation reduction is determined by the results of stress tests and the CT data. When confirming the instability and associated injuries of the hip joint anatomical structures, surgical treatment is indicated. Among the complications of hip dislocation: sciatic nerve damage, post-traumatic coxarthrosis, the femoral head avascular necrosis, heterotopic ossification. Current literature data indicates the importance of early diagnosis of dislocation-associated injuries of the hip joint and periarticular tissues. Early and comprehensive repair of all existing injuries is crucial for favorable outcomes. A number of therapeutic and diagnostic methods, primarily arthroscopy, show optimistic results, but need further study.
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