1 ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России, Смоленск; 2 ОГБУЗ «Смоленская областная клиническая больница», Смоленск; 3 ФГБУ «НИДОИ им. Г.И. Турнера» Минздрава России, Санкт-Петербург В статье представлен анализ различных методов диагностики эпифизарного остеомиелита -рентгенография, ультразвуковая диагностика, компьютерная томография, магнитно-резонансная томография, радиоизотопная остеосцинтиграфия. Приводятся недостатки и преимущества, а также оцениваются возможности каждого из методов с позиций ранней диагностики остеомиелита у детей. По данным литературы, наиболее эффективными и надежными методами ранней диагностики эпифизарно-го остеомиелита в педиатрической практике являются магнитно-резонансный и ультразвуковой, у представ-ленных методов отсутствует лучевая нагрузка, в то же время при использовании ультразвукового метода не требуется полная неподвижность пациента, его можно применять с момента новорожденности и в любом количественном режиме, а общедоступность и относительная низкая стоимость ультразвуковой аппаратуры позволяет иметь ее в любых медицинских учреждениях.Ключевые слова: острый эпифизарный остеомиелит, ребенок, рентгенография, ультразвуковая диагностика, компьютерная томография, магнитно-резонансная томография, радиоизотопная остеосцинтиграфия. Summary. The article presents the analysis of different method for diagnosis of epiphyseal osteomyelitis, including radiography, ultrasonography, computed tomography, magnetic resonance tomography, and radioisotope bone scans. We address the advantages, disadvantages, and possibilities of each method from the standpoint of early diagnosis of osteomyelitis in children. Based upon the literature, the most effective and reliable methods for early diagnosis of epiphyseal osteomyelitis in pediatric patients are magnetic resonance and ultrasound. The present diagnostic methods involve no radiation exposure. Using an ultrasonic diagnostic method does not require complete immobility of the patient, can be used from the moment of birth, has widespread availability, and has a relative low cost to allow its use in any medical institution. METHODS OF DIAGNOSIS OF ACUTE EPIPHYSEAL OSTEOMYELITIS IN CHILDREN
При выполнении реконструктивных оперативных вмешательств у детей, страдающих от обширных послеожо-говых гипертрофических рубцов, главной проблемой является дефицит донорских резервов -неизмененной кожи. Цель: определить возможности использования метода экспандерной дермотензии при получении свободных толсто-расщепленных кожных аутотрансплантатов большой площади. Материалы и методы. Проведен сравнительный анализ лечения 39 детей с обширными послеожоговыми гипертрофическими рубцами. У 16 детей (основная группа) первым этапом выполнена дермотензия донор-ской области для получения толсто-расщепленного кожного трансплантата большой площади (более 100 см²). У 23 детей (контрольная группа) трансплантаты большой площади срезались без предварительной дермотен-зии донорской области. Результаты исследования показали, что при необходимости закрытия раневого изъяна площадью более 100 см² целесообразно выполнять предварительную экспандерную дермотензию донорского места. Эта методи-ка позволяет не только получить резистентный к травме свободной имплантации полноценный пластический материал, но и обеспечивает многократную эксплуатацию донорской области, не нарушая эстетику последней.Ключевые слова: термическая травма, гипертрофические рубцы, рубцовые деформации, экспандерная дермо-тензия. FREE SKIN GRAFTING IN RECONSTRUCTIVE SURGERY OF BURNS IN CHILDREN © K.A. Afonichev, M.S. Nikitin, Ya.N. ProshchenkoThe Turner Scientific and Research Institute for Children's Orthopedics, Saint Petersburg, Russia When performing reconstructive surgery in children suffering from extensive post-burn hypertrophic scars, the main problem is deficiency of donor intact skin. Aim. This study aimed to determine the possibility of using the expander skin balloon expansion method for obtaining free, large area split-thickness skin autografts. Materials and methods. A comparative analysis of treatment for 39 children with extensive post-burn hypertrophic scars was performed. In 16 children (experimental group), balloon skin expansion of a donor site for obtaining large area split-thickness skin grafts (more than 100 cm²) was performed. In 23 children (control group), the large area grafts were cut off without prior balloon skin expansion of the donor site. Results. In cases where it is necessary to close a wound defect over 100 cm², it is advisable to perform prior balloon skin expansion of the donor site. This technique enables attainment of an injury-resistant free implant full grafting material and also provides multiple uses of a donor site without disturbing the esthetics.
ФГБУ «ФЦТОЭ» Минздрава России, Смоленск Представлен анализ лечения 15 пациентов 11-17 лет с травматической формой нестабильности плечево-го сустава, которая у детей наблюдается в форме первичного травматического вывиха плеча и привычного вывиха. Выявлены причины развития привычного вывиха плеча: повреждение губы гленоида по типу Банкарта, SLAP-повреждение, дефект Хила -Сакса, перелом суставного отростка лопатки, 3-й тип соот-ношения и ретровесия головки плечевой кости, а также дефекты лечения при первичном вывихе плеча. Хирургическое лечение выполнено 7 пациентам с привычным вывихом плеча (7 суставов). Неудовлет-ворительный результат, обусловленный 3-м типом соотношения головки плечевой кости и суставного от-ростка лопатки, наблюдался у 1 пациента (1 сустав). Ключевые слова: вывих, плечо, ребенок.
Background. The recurrence rate of adolescent chronic shoulder instability is approximately 56%–68%. However, this pathology is often missed in childhood and adolescence.Aim. To identify the clinical forms of shoulder joint instability in pediatric patients.Materials and methods. The authors present the data from 57 pediatric patients aged 3−17 years with a total of 61 unstable shoulder joints. All patients were divided into groups according to the form of instability. Traumatic chronic shoulder instability was identified in 40 patients (Bankart and Hill–Sachs injuries). Of these, non-traumatic shoulder instability was diagnose in 17, including five with recurrent dislocation, and spontaneous shoulder dislocation due to dysplasia of glenoid and labrum was diagnosed in 12. Of the 57 patients in the study cohort, 53 underwent surgery. Postoperatively, two patients developed recurrent shoulder dislocation (Andreev–Boichev technique) due type III shoulder dysplasia in the first patient and multidirectional injury in the second.Conclusions. Shoulder joint instability should be considered as the traumatic or non-traumatic form. Treatment decisions should be based on anatomical characteristics that predispose to recurrent dislocation.
Background. The frequency of occurrence of dislocation of the shoulder joint is the highest among that for all other limb joints. Simultaneously, recurrent instability of the shoulder joint develops majorly in children and adolescents, which, in the future, lead to the development of persistent pain syndrome. Past evidence indicate that the features of the spatial positioning of the articular process of the scapula can be considered as a risk factor toward the development of instability in the shoulder joint among adult patients. However, there is no reliable data in the literature regarding the influence of tilt and rotation of the shoulder blade glenoid on the occurrence of instability in the shoulder joint among children and adolescents. Encouraged, we undertook this subject for our study. Aim. To clarify the impact of changes in the version and inclination of the glenoid on the instability of the shoulder joint among children. Materials and methods. We analyzed the survey data of 42 children with a habitual dislocation of the shoulder of traumatic and atraumatic origins. The average ages of the examined children were 15.57 1.75 and 15.07 1.64 years, respectively, for those with shoulder instability of traumatic and atraumatic origins, respectively. Results. Statistical data processing revealed no significant differences in the versioning and inclination of the glenoid process between the groups with traumatic and atraumatic instabilities of the shoulder joint. Notably, the average values of versioning and inclination indicators were in the normal range. Conclusion. Based on our results, we suggest that, in the childhood, the dynamic and static soft tissue stabilizers of the shoulder joint play the leading role in the formation of instability of the shoulder joint.
BACKGROUND: Restoration of significant anatomical and functional bone defects is one of the most urgent problems of reconstructive surgery in children. Various options for plastic surgery of bone defects are considered. However, some publications present both positive and negative aspects of using vascularized bone autotransplants. AIM: This study aimed to conduct a systematic analysis of foreign literature data on the use of blood-supplied fibular grafts with a functioning growth zone. MATERIAL AND METHODS: A systematic literature search was performed in the PubMed information data base and Google Scholar from 1988 to February 7, 2021. Based on the criteria for the selection of literature sources, 21 literary sources were identified. In the analysis, special attention was paid to the age of patients at the time of reconstructive surgery, type of vascularized bone graft used with vessels that are part of the feeding leg, follow-up period, complications in the area of the surgical intervention, as well as the functional result and functioning of the graft growth zone. RESULTS: In this study, 21 articles comprised the sample, of which 14 were descriptions of clinical observation and seven were descriptions of clinical series. These publications include information on the follow-up of 54 patients with an average age of 6.86 years (minmax, 115 years). The average duration of postoperative follow-up was 56 months (minmax, 622 years). Indications for surgical interventions were extensive bone defects formed as a result of the tumor process (n = 44), trauma (n = 4), infectious process (n = 1), and birth defects (n = 5). CONCLUSIONS: In pediatric orthopedics, bone-vascularized fibular grafts with a functioning growth zone are used for the reconstruction of extensive bone defects in complex clinical situations if standard bone auto-/alloplasties are impossible. According to the literature, this technique allows us to achieve satisfactory functional results in most cases. Despite the positive functional results, postoperative complications are quite common in patients.
Остеохондропатия проксимального отдела локтевой кости -редкое заболевание, которое поражает не толь-ко локтевой, но и венечный отросток. В отечественной и зарубежной медицинской литературе мы не нашли описания остеохондропатии венечного отростка у ребенка, вызывающей большой интерес с точки зрения диа-гностики и лечения. В статье представлен клинический случай остеохондропатии венечного отростка, описана клиническая картина поражения локтевого сустава у пациента, которая проиллюстрирована рентгенограмма-ми, сделанными до и после хирургического лечения. В описанном клиническом случае после хирургического лечения у ребенка прошли боли и восстановилась в полном объеме функция локтевого сустава, что позволяет нам расценить результат лечения как хороший и предположить, что выбранная активная хирургическая тактика лечения данного заболевания адекватна и своевременна.Ключевые слова: локтевая кость; ребенок; остеохондропатия. OSTEOCHONDROPATHY OF THE CORONOID PROCESS OF THE ULNA IN A CHILD: CASE REPORT © M.S. Nikitin, Ya.N. ProshchenkoThe Turner Scientific Research Institute for Children's Orthopedics, Saint Petersburg, Russia Osteochondropathy of the proximal ulnar bone is a rare disease that affects not only the ulnar, but also the venous process. To our knowledge, the existing domestic and foreign medical literature does not provide a description of osteochondropathy of the coronal process, a topic of considerable interest from the point of view of diagnosis and treatment. Here, we describe a clinical case of osteochondropathy of the coronal process and present a clinical picture of the defect of the elbow joint in the patient, with radiographs taken before and after the surgery. In the present clinical case, postoperatively, the patient reported pain; however, the elbow joint function was fully restored, indicating the success of the treatment and that active surgical treatment of this disease is adequate and timely.
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