Relevance. Significant incidence of hip pathology in different groups of patients with cerebral palsy and factors that may affect its formation are relevant objects of the study. The goal of the study. To establish the features of the hip joint’s formation, examining the clinical and radiographic dependences of the functional status and indices of the hip joint in patients with cerebral palsy. Materials and methods. The total number of patients was 47 persons (86 joints). We conducted a clinical and radiographic examination of the hip joints using our own methods and standard anterior-posterior radiography, as well as a statistical analysis of hip parameters and factors that may have influenced their formation. Results. Correlation relationships have been established between hip parameters and factors that may affect them: Gross Motor Function Classification System (GMFCS), gait function, level of lesion, developmental dysplasia of the hip, and adductor myotomy in medical history. Conclusions. The Reimers’ index showed greater reliability compared to the Wiberg angle. Positioning of the patient’s body using our own method way can be used to screen the hip joints in cerebral palsy based upon the Reimers index while obtaining the true parameters of the femoral neck–shaft angle and torsion of the femur.
Relevance. Specific hip joint pathologies in children are characterized by insufficiency of the femoral head (FH) coverage by the acetabulum. This is reflected in the contact area reduction between the FH and acetabulum. In order to correct these acetabular deformities properly, the pediatric orthopedist must know in which direction develops a deficit of contact area between the FH and acetabulum and be able to assess the level of this deficit. Objective: to create an algorithm for the contact area assessment between the FH and acetabulum in children taking into account triradiate cartilage. Materials and Methods. Pelvic CT scans of a 6-year-old male child without hip joint pathologies were selected. A digital model of the pelvis was created using these CT scans. The pelvic model was transferred to a custom-made software, where the contact area between the FH and acetabulum was assessed in an indirect way. Results. The algorithm of the contact area assessment between the FH and acetabulum in children that takes into account triradiate cartilage was developed. Using the abovementioned algorithm, the contact area between the FH and acetabulum from both sides was assessed in a 6-year-old male child. Conclusions. Assessment of the normal contact area between the FH and acetabulum and in various pathological conditions in children will help pediatric orthopedists to understand better different hip joint pathologies and improve preoperative planning.
Summary. Slipped capital femoral epiphysis (SCFE) is a multifactorial disease caused by a number of factors, and each of them can be triggered in its occurrence. Modern research is increasingly pointing to the leading role of epigenetic structures in the origin and course of this group of diseases. In recent years, the most promising area is the study of the role of microRNAs as an epigenetic factor that plays a leading role in the pathogenesis of multifactorial diseases. Objective: to develop a methodology for genetic genealogical examination of patients with juvenile epiphysiolysis of the femoral head. Materials and Methods. The study material was 26 patients with SCFE (15 girls and 11 boys) in different periods of sexual development: prepuberty – 7 patients, induction of puberty – 12 patients, and puberty and postpuberty – 7 patients. A questionnaire developed by us was used for clinical and genealogical research of the patients. The material for the epigenetic study, namely the study of microRNA-21 expression in patients with SCFE, was venous blood. Results. The expression of microRNA-21 in the blood of patients with SCFE is different (average expression is 0.86 conventional units) from those of healthy donors (average 0.393 conventional units) of the same age (p<0.05). Analysis of dependence on the period of sexual development revealed statistical differences in indicators depending on the group (p<0.05). No dependence of the level of microRNA-21 expression in patients with SCFE on sex and the period before or after surgery (p>0.05) was revealed. The obtained data on the probability of the influence of hereditary factors on the occurrence of SCFE are statistically significant (p<0.05). Conclusions. Our results of epigenetic and clinical genealogical research of patients with SCFE showed a high probability of influence of hereditary and epigenetic factors on the occurrence and course of this disease.
Relevance: Significant incidence of hip pathology in different groups of children with cerebral palsy and factors that may affect its formation are relevant objects of the study. The Goal of the Study: To establish the features of the hip joint’s formation, examining the clinical and radiographic dependences of the functional status and indices of the hip joint in patients with cerebral palsy. Materials and Methods: We conducted a clinical and radiographic examination of the hip joints using our own methods and standard anterior-posterior radiography, and statistical analysis of hip parameters and factors that may have influenced their formation. The total number of patients was 47 persons (86 joints). Results: Correlation relationships have been established between hip parameters and factors that may affect them: Gross Motor Function Classification System (GMFCS), gait function, level of lesion, developmental dysplasia of the hip, and adductor myotomy in medical history. Conclusions: The Reimers’ index showed greater reliability compared to the Wiberg angle. Positioning the patient's body using our own method can be used to screen the hip joints in cerebral palsy based upon the Reimers index while obtaining the true parameters of the femoral neck-shaft angle and torsion of the femur.
Summary. Relevance. Developmental dysplasia of the hip (DDH) is a common hip joint pathology in pediatric orthopedist’s practice. Untreated DDH or residual acetabular dysplasia in walking patients usually requires surgery (pelvic osteotomy is one of the surgical options). During pelvic osteotomies, plastic changes take place in so-called 'hinge points'. These hinge points are described in the literature; however, there are some contradictions regarding the classical locations of these hinge points. Objective: to develop a digital pelvic model that can be used for various pelvic osteotomies modeling. Materials and Methods. Pelvic CT scans of a 6-year-old child were obtained, and a virtual model of pelvic bones was created. Pemberton pelvic osteotomy was simulated, material properties were assigned, and pelvic ligaments were added. Simulation of the Pemberton osteotomy was performed, and biomechanical changes during this intervention were assessed. Results. The digital pelvic model of a 6-year-old child was created, Pemberton pelvic osteotomy was simulated, and biomechanical changes during this surgery were evaluated. It was found that there is no single hinge point during this surgery (as believed previously); the main stress generation took place in triradiate cartilage anterior and posterior arms. Pelvic ligaments’ role during Pemberton pelvic osteotomy was assessed (sacrospinous and sacrotuberous ligaments were the main constraints during the lower iliac fragment movement). Also, the possibility of simultaneous bilateral application of Pemberton pelvic osteotomy or its combination with other pelvic osteotomies in 6 years old patients was biomechanically justified. Conclusions. The development of a digital pelvic model with subsequent pelvic osteotomies modeling according to the method described in this article allows to evaluate biomechanical changes during these osteotomies.
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