The article discusses the main causes of development and clinical features of the instability of the cervical spine in children of different ages. A clinical and instrumental study of 146 children was carried out to determine the relationship between dysplastic instability of the cervical spine and clinical manifestations of neuroorthopedic pathology. Risk factors for the formation of undifferentiated connective tissue dysplasia (UCTD) were identified, signs of osteoligamentous dysplasia on radiographs of the cervical spine and external phenotypic osteoarticular and muscle signs of UCTD in children with instability of the cervical spine were identified. Predicting the development of connective tissue dysplasia before the birth of a child with preventive measures, as well as early diagnosis of pathological conditions and timely treatment will prevent the formation of chronic somatic, neurological and orthopedic diseases.
Mobile flat feet is a significant orthopedic pathology in children of primary school age. The implementation of accessible and objective rapid diagnostic methods of mobile flat feet into routine clinical practice is highly relevant. Objective. To develop a combination of diagnostic, preventive, and rehabilitation measures to reduce the incidence of flat feet in primary school children. Patients and methods. We performed a comprehensive assessment of foot condition in 126 children aged 8 to 10 years (67 boys (53.2%) and 59 girls (46.8%)). We have developed a portable diagnostic device for rapid diagnostics of flat feet during preventive examinations in kindergartens and schools (patent of the Russian Federation No 175246 dated 11.28.2017). Results. The incidence of flat feet in children of primary school age was 19.0%. Forty-four children (35.0%) were diagnosed with grade I longitudinal flat feet; 29 children (23.0%) were diagnosed with grade II longitudinal flat feet; 11 children (9.0%) were diagnosed with grade III longitudinal flat feet; 42 children (33%) were healthy. The incidence was 2.4% higher in boys. We analyzed the risk factors for flat feet and developed cost-effective correctors for heel position. Conclusion. The implementation of portable device for rapid diagnostics of flat feet during preventive examination in educational institutions enables early detection of foot pathology and identification of risk groups. The inclusion of heel position correctors in the comprehensive rehabilitation for mobile flat feet restored normal foot function. Timely diagnosis and correction of mobile flat feet can prevent the development of this pathology at an early stage and improve the quality of life of the child. Key words: mobile flat feet, children, portable rapid diagnostic device, heel position corrector
Objective. To describe in details the prevention of scoliotic spinal deformity in children with mild neuro-orthopedic pathology. Materials and methods. The health status of 125 children aged 3 to 15 years was studied. To investigate in details the neuro-orthopedic pathology and estimate the efficiency of treatment, the method of computed optic topography and electroneuromyography was used. Results. Clinical and functional features in children with mild neuro-orthopedic disorders were characterized by the combination of vegetative, topographic and electromyographic changes. Scoliosis and spinal deformity progressed in children, who were not treated. Computer-topographic method of diagnosis determines the degree of severity of spinal state. Electroneuromyographic study is the method that permits to assess and predict the muscular dysfunction degree. All the children had conservative complex treatment at ambulatory-polyclinic rehabilitation institutions. The total efficiency of treatment was 95 %. Conclusions. 1. Mild neuro-orthopedic pathology is formed and progresses against the background of neuro-muscular and vegetative disorders while a child is growing and developing. 2. Computed optic topography is a reliable early diagnostic and prognostic criterion for estimation of scoliosis in the therapeutic program. 3. Purposeful conservative treatment and follow-up of children and adolescents prevent the progression of neuro-orthopedic pathology.
1 ГБОУ ВПО «Пермский государственный медицинский университет им. акад. Е.А. Вагнера» Минздрава России, Пермь, Российская Федерация, 614900; 2 ГБУЗ Пермского края «Городская детская клиническая больница №15», Пермь, Российская Федерация, 614066Цель -совершенствование комплексной нейроортопедической реабилитации детей с церебральным параличом в раз-личные возрастные периоды. Пациенты и методы. Изучены 267 больных церебральным параличом в возрасте от 1 года до 16 лет. Мальчиков было 158 (59,2%), девочек -109 (40,8%). Результаты и обсуждение. Ортопедическое лечение двига-тельных нарушений проводили с учетом возраста, психоневрологического статуса, вегетативной дисфункции. Консерва-тивное лечение проведено у 104 (39%) детей, оперативное -у 163 (61%). У детей до 3 лет вегетативное рассогласование было наиболее выражено. В процессе лечения преобладала ортопедическая коррекция мышечного тонуса. Использовали иммобилизацию этапными гипсовыми повязками с последующим ношением ортезов и ортопедической обуви, массаж и ЛФК. В возрастной группе от 4 до 7 лет доминировало хирургическое лечение, направленное на нормализацию работы мышечно-связочного аппарата. Консервативное лечение было связано с коррекцией вегетативной дистонии. Дифферен-цированно применяли методы аппаратной физиотерапии. В группах детей от 8 до 12 лет и от 13 до 15 лет хирургическая коррекция была направлена на ликвидацию грубых деформаций. Дифференцированное лечение, различные модели обо-рудования оказались эффективными в ликвидации мышечной спастичности и гипотрофии, коррекции деформаций, спо-собствовали восстановлению или улучшению движений, стимулировали физическое и умственное развитие ребенка. Objectives. The present study was aimed at the improvement of comprehensive neuro-orthopedic rehabilitation of the children of different age presenting with cerebral palsy. Material and methods. A total of 267 patients with infantile cerebral paralysis at the age from 1 year to 16 years were available for the observation including 158 (59.2%) boys and 109 (40.8%) girls. Results. The orthopedic treatment of locomotor disorders was adjusted for the patients' age, the neuropsychiatric status, and the type of autonomous dysfunction. The conservative treatment was given 104 (39%) patients and the surgical intervention performed on 163 (61%) ones. Vegetative disbalance was the predominant condition in the children aged up to 3 years. Orthopedic alignment of the muscle tone was one of the most common methods of the treatment. We used milestone plaster bandages for immobilization followed by wearing the orthoses and orthopedic shoes in combination with massage and therapeutic physical exercises. The surgical treatment aimed at the normalization of the musculo-ligamentous apparatus was the predominant strategy for the age group of 4-7 years. The conservative treatment was most frequently prescribed for the correction of vegetative dystonia. The physiotherapeutic methods were applied differentially. In the groups of children aged from 8 to 12 years and from 13 to 15 years, th...
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