Проведен анализ результатов применения различных методов лучевой диагностики острого гематогенного остеомиелита у 108 пациентов от 3 до 17 лет и у 97 пациентов с острым метаэпифизарным остеомиелитом, возраст которых составлял от 0 до 3 лет, проходивших лечение в период с 2003 по 2018 гг. в детской областной клинической больнице г. Твери. Представлены недостатки и преимущества, оценены ранние диагностические возможности с учетом возраста и фазы воспалительного процесса таких методов, как рентгенография, ультразвуковое исследование, магнитно-резонансная томография, компьютерная томография. Наиболее эффективными и надежными у детей раннего возраста в интрамедуллярную фазу являются ультразвуковое исследование и магнитно-резонансная томография. В данной возрастной группе МРТ требует проведения анестезиологического пособия. В экстрамедуллярную фазу показаны рентгенография и компьютерная томография. Компьютерная томография оказывает высокую лучевую нагрузку на детский организм. У пациентов в возрасте от 3 до 17 лет в интрамедуллярную фазу предпочтение отдается магнитно-резонансной томографии и эхографическому исследованию. В экстрамедуллярную фазу наиболее результативны компьютерная томография (при сроке заболевания более 7 суток) и рентгенологическое исследование. Ключевые слова: острый гематогенный остеомиелит, метаэпифизарный остеомиелит, дети, рентгенография, ультразвуковое исследование, магнитно-резонансная томография, компьютерная томография.
Until recently, only findings of local status and laboratory diagnostics were used as objective tests which defined terms and volume of therapeutic and preventive measures for clinical examination of patients who survived acute hematogenous osteomyelitis. The prescribed complex treatment does not take into account the following indexes: patient’s co-morbidity which is characterized by the autonomic reactivity; presence of stigmas of the connective tissue dysplasia, trophic status as well as psychological characteristics of patients. During the present study, connective tissue dysplasia was revealed in 70% of patients who had acute hematogenous osteomyelitis what was confirmed by the revealed phenotypic signs and biochemical blood markers. While assessing trophic status, a disharmonious body type and insufficient physical development were seen in patients who survived septic-pyemic form of the disease. Patients who had acute hematogenous osteomyelitis, even in the absence of markers of active inflammatory process, demonstrated signs of impaired adaptation-compensatory mechanisms involving the humoral regulation and a wide range of psychological problems which reflect tension of systems and play an important role in self-development and self-maintenance of the pathological process - the so-called principle of pathoautokinesis. Patients who survived hematogenous osteomyelitis, especially in the septic form, should continue their rehabilitation, have follow-up examinations and anti-relapse treatment. In this group of patients, multidisciplinary approach is needed for developing their rehabilitation program. Terms of this program should be individualized and defined by the normalizing of objective indicators (local status and comorbid conditions).
Clinical and histological changes were studied in 96 adolescents with knee pathology of non-traumatic genesis, with signs of connective tissue disease (CTD). The detection of connective tissue dysplasia was carried out according to the data of a clinical examination, functional and radiation diagnostic methods in accordance with the Russian recommendations for algorithms for the diagnosis and treatment of children with connective tissue disease (2015). Serial sections stained with hematoxylin and eosin were examined on an Olympus CX-41 microscope at a magnification of ×100, ×200, ×400. Some of the preparations were additionally stained with picrofuchsin according to van Gieson. Signs of a pronounced diffuse pathological process of a degenerative-dystrophic nature were revealed, caused by hypoxic and metabolic disorders, which led to the development of pain syndrome and became a reason for subsequent surgical intervention.
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