Introduction. The treatment of polytrauma in children requires identifying the signs that characterize the severity of the acute period and quantifying the priorities of the parameters. Collectively, these reflect the direction of drift of the leading pathophysiological manifestations at each stage of the patient withdrawal program from a state of severe shock. Purpose. This study uses discriminant analysis to clarify the tactics of children with polytrauma in the first days of overcoming its consequences. It is based on the pathogenetically sound idea that each of the observed parameters role, together in the form of a vector, reflects injury severity and the childs prognosis. Materials and methods. This analysis included 45 children (34 boys and 11 girls) with polytrauma aged from 2.5 to 17 years and hospitalized in Kemerovos intensive care unit. Two groups were analyzed: the survivors and those who were deceased. Both were dominated by severe traumatic brain injury (PMT). The injury severity score (ISS) scale was used for clinical assessment of injury severity. Results. Combined with objectively obtained data on the structure of polytrauma in the direction of drift, a successful outcome is defined as a whole. It borders on the day to day priorities, potassium, PH, white blood count, and hematocrit. Also, the vector orientation pattern was observed to increase organ failure. This progressive decline occurred despite timely surgical intervention to stop internal bleeding, very active efforts to compensate for hypovolemia, acidosis, and the use of adequate means of detoxification. The deterioration in the child's condition manifests itself by increased potassium losses against the background of almost no reaction from leukocytes. Conclusions. The application of discriminant analysis enables the better revelation of the peculiarities of a polytraumas multidimensional dynamics in children in the first few days of resuscitation. It also permits the numerical expression of the priorities of individual parameters that describe their state, and by the severity and individual patient response in real-time to optimize treatment.
BACKGROUND: The etiology and pathogenesis of the development of LeggCalvePerthes disease, despite intensive research, remains not fully understood. Most studies have concluded about the multifactorial genesis of the development of hip osteochondropathy. Moreover, a complete understanding of all elements of pathogenesis leading to the manifestation and the progressive development of aseptic necrosis make it possible to develop targeted antiresorptive therapy. At present, several studies have investigated impaired functioning of signaling pathways that influence bone homeostasis during the development of LeggCalvePerthes disease. In addition, impaired metabolism in avascular necrosis is characterized by significant complexity and heterogeneity, which is based on aseptic inflammation associated with ischemic stress. Concepts of antiresorptive therapy were developed based on the results of studies on the pathogenesis of LeggCalvePerthes disease. Nevertheless, these treatment algorithms have not achieved wide practical application and require further investigation. AIM: This study aimed to conduct a literary analysis of the molecular basis of the etiology and pathogenesis of LeggCalvePerthes disease and assess the prospects of therapy aimed at correcting bone homeostasis disorders. MATERIALS AND METHODS: Data sources were PubMed, Medline, Scopus, Web of Science, and RSCI databases, without language restrictions. RESULTS: The relationship between ischemic stress and the induction of a cytokine cascade with a predominance of the biological actions of proinflammatory cytokines, with parallel activation of intracellular regulatory networks that determine osteoresorptive processes, including due to pyroptosis, is shown. Data on the possibility of various variants of targeted antiresorptive therapy with the use of genetically engineered drugs are presented. CONCLUSIONS: The pathogenesis of LeggCalvePerthes disease is characterized by significant genetic heterogeneity with the induction of various mediators of inflammation, angiogenesis, and osteogenesis, depending on the disease stage. Investigating features of impaired bone homeostasis regulation in the case of LeggCalvePerthes disease at the molecular and cellular level opens up opportunities for the development and clinical application of personalized therapy.
Aim. To develop an animal model of femoral head aseptic necrosis for studying Legg–Calvé–Perthes disease.Materials and Methods. To induce the development of aseptic necrosis, we used Wistar rats (n = 8) which suffered from combined hypoperfusion of the femoral head and increased intra-articular pressure in the hip joint. Having employed isoflurane anesthesia, we performed an incision (≈ 3 cm length) on the outer surface of the thigh in the projection of the hip joint and then excised periosteum in the proximal third of the femur. A dense vicryl ligature was applied around the femoral neck to reduce blood perfusion of the femoral head. Further, 1.5 mL 2% rheopolyglucinum solution (10% isotonic dextran, 30-40 kDa molecular weight) was injected into the hip joint cavity to increase intra-articular pressure. Rats were sacrificed upon 8-week follow-up with subsequent X-ray and histological examination.Results. Our animal model of femoral head aseptic necrosis includes two main components of Legg–Calvé–Perthes disease: an increase in the intra-articular pressure and insufficient blood perfusion of the femoral head. In all (8/8) cases, aseptic necrosis of the femoral head was achieved. Eight weeks post intervention, the condition of the proximal femur 8 was similar to impression fracture.Conclusion. Our model of femoral head aseptic necrosis fully reflects the pathogenesis of LeggCalve-Perthes disease and can be therefore used in experimental studies.
INTRODUCTION: The introduction of minimally invasive methods in clinical practice has significantly expanded the indications for surgical treatment of bone fractures in children. The method of osteosynthesis with titanium elastic nails is widely used at the age of 7 to 14 years and has many advantages. At the same time, the elastic-stable osteosynthesis has a number of probable complications and limitations. AIM: To analyze probable complications of the method of intramedullary osteosynthesis with titanium elastic nails in children of different age categories. MATERIALS AND METHODS: The results of treatment of 98 children with fractures of the long bones of the lower extremities were analyzed. All the patients underwent osteosynthesis with titanium elastic nails. The patients were divided to three age groups: 2 to 6 years, 7 to 13 and 14 to 16 years. Clinical and X-ray examinations of the patients were conducted. RESULTS: In young children, excellent results of treatment were obtained in 82.6% and satisfactory results in 17.4% of cases, no poor results were noted. In patients of the group 7 to 13 years, the results of treatment were considered excellent in 82.3%, and satisfactory in 17.7% of cases. In older children, outcomes of treatment were excellent in 62.5%, satisfactory in 29.2%, and poor outcomes that required repeated surgical interventions, were observed in 8.3% of cases. CONCLUSION: The most preferable age for osteosynthesis with titanium elastic nails was found to be from 6 to 14 years. There exist technical difficulties in use of this method in children of 2 to 4 years of age with "unstable in length" femoral bone fractures, nevertheless, the displacement of bone fragments was leveled out in all the observed cases. The greatest number of complications are associated with the use of TEN in the treatment of adolescents of 15 to 16 years due to insufficient rigidity of fracture fixation.
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