BACKGROUND: Тhe study of the treatment results of patients with idiopathic scoliosis should include both objective assessment methods, such as radiography and multispiral computed tomography, and subjective methods related to the response of the patient or his/her parents to treatment. A set of indicators will only allow an objective assessment of the long-term treatment outcomes. AIM: To examine long-term treatment results of posterior transpedicular fixation in patients with idiopathic scoliosis of varying severity. MATERIALS AND METHODS: Long-term treatment results by posterior transpedicular fixation were studied in 300 patients with idiopathic scoliosis of varying severity. To assess the effectiveness of treatment, clinical and radiological diagnostic methods and SRS30 and SRS22 questionnaires were used. RESULTS: Treatment results in 1 year were studied in all patients and in 2 years in 225 patients (75%). In 150 patients (50%), the long-term treatment results was studied in 5, and in 15 of them (10%) in 1012 years. The achieved correction value was maintained with a slight loss depending on the magnitude of the initial deformity and correction achieved after the operation. The SRS22 questionnaire 2 years after treatment of grade II deformity (according to Chaklin) showed that the indicators of postoperative function and remained practically unchanged, and the scores on self-esteem, appearance, and attitude were higher (p 0.05). In grade IV deformity, the scores on the appearance and attitude of others were high without significant differences. CONCLUSION: Dorsal correction of the spine using transpedicular implants in patients with idiopathic scoliosis allows obtaining good treatment outcomes, which was confirmed by the preservation of correction during dynamic X-ray examination and assessment using the SRS22 questionnaire.
Introduction Multifactoriality in the etiology of idiopathic scoliosis (IS) requires an integrated approach to diagnosis, while the regular examination of patients is limited to radiography, computed tomography without a detailed analysis of the data obtained on the state of the musculoskeletal system. The problem of complex diagnosis of IS is practically not covered by the literature including the syndromic approach to the rationale for the method of treatment and rehabilitation. Purpose of the study To define the concept of "syndromocomplex" of idiopathic scoliosis based on the study of the state of the spine, muscles, proximal femur, bone mineral density (BMD), mineral metabolism and bone metabolism using current diagnostic methods. Materials and methods The state of the spine (300 patients), proximal femur (57 patients), paravertebral (40 patients) and gluteal muscles (60 patients of the main group and 40 of the control group) were studied using the method of multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), densitometry – BMD (40 patients of the main and 40 of control one), mineral metabolism and bone metabolism were studied by biochemical methods in 55 patients with IS. Results and discussion The study of patients with idiopathic scoliosis at different ages and with different grades of deformities in various parts of the musculoskeletal system revealed pronounced disorders in the shape of the vertebrae, including an increase in the frontal diameter, wedge shape with a significant difference in density along the convex and concave sides, structural changes in the vertebrae, manifested in a decrease in density, the presence of rarefaction zones, areas of maximum density at the top of the deformity, malnutrition and fatty degeneration of the paravertebral and gluteal muscles, a decrease in BMD, a decrease in the density of the femoral head, impaired mineral metabolism and bone metabolism. Conclusion Severe disorders in the shape, X-ray morphological changes in the vertebrae, malnutrition and fatty degeneration of the paravertebral and gluteal muscles, concomitant changes in BMD, hip joint, mineral metabolism and bone metabolism, are included in the concept of "syndromocomplex” of idiopathic scoliosis, underlie the tactical concept for diagnosis, treatment and further rehabilitation measures for patients with severe forms of scoliosis.
Objective: Analysis of the results of the study of mineral metabolism and bone formation markers in patients with idiopathic scoliosis, depending on the magnitude of the deformity.Material and methods: Based on the retrospective single‑center study in 30 patients diagnosed with scoliosis the preoperative parameters of calcium metabolism (total and ionized calcium, parathyroid hormone, 24‑hour urine calcium), phosphorus, bone formation markers (alkaline phosphatase, osteocalcin, P1NP in the blood), deoxypyridinoline in morning urine, blood levels of 25(OH)D have been analyzed. The patients were divided into 3 groups: with a deformity of 25–40 ° (group 1), 40–60 ° (group 2) and 60–80 ° (group 3) (n = 30). The mean age in all groups was 18.5 ± 4.7.Results: In patients with idiopathic scoliosis, alkaline phosphatase and P1NP significantly exceeded normal values in the first group, which indicated a more high‑turnover type of bone remodeling with a deficient level of 25(OH)D. A higher excretion of deoxypyridinoline and a decrease in phosphorus in blood in patients with a deformity of 60–80 ° suggest a violation of the ratio of the processes of synthesis and resorption in bone tissue.Conclusion: The study of mineral metabolism and all the main markers of bone formation made it possible to obtain a more complete picture of the state of metabolic processes in bone tissue, to obtain reliable data on the effect of some of them on the nature of bone remodeling and the magnitude of spinal deformity.
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