Pediatric Traumatology, Orthopaedics and Reconstructive Surgery
ISSN (print): 2309-3994, ISSN (online): 2410-8731 Founders: H.Turner Scientific Research Institute for Children's Orthopedics , Eco-Vector Editor-in-Chief: Baindurashvili A.G., academican of RAS, Doctor of Sc., Full Professor Frequency / Assess: 4 issues per year / Subscription Included in: White List (3rd level), Higher Attestation Commission List, RISC, Scopus, Embase
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A Photometric Method for Measuring Ankle Dorsiflexion Reproducibility in Young Athletes
论证。足背屈是反映足部潜在功能能力的重要生物力学指标之一。对其进行定量评估在临床检查、判断儿童参与体育活动的适宜性及评估运动损伤风险方面具有重要意义。 目的：评估光度测量法在测量运动儿童足背屈角度方面的重现性，并与传统的量角器法进行比较。 材料与方法。纳入30名运动儿童（年龄为6–12岁），均无已知骨科疾病。由两名独立专家基于解剖定位点，分别采用量角器法与光度测量法测量足背屈角度。通过组内相关系数（intraclass correlation coefficient, ICC）评估两位专家测量结果的一致性。采用Bland–Altman图分析两种方法之间的一致性。 结果。量角器法测得的平均角度为17.15°，光度测量法为18.1°（统计学差异，t检验，p = 0.04）。光度测量法显示出更高的专家间一致性（ICC = 0.91），而量角器法为（ICC = 0.78）。 结论。光度测量法是一种可靠且重现性良好的足背屈角度测量工具，适用于运动儿童的临床评估与动态监测。
脑瘫患儿膝关节屈曲挛缩的外科治疗。文献综述
膝关节屈曲挛缩在脑瘫患儿所有下肢畸形中占据主要地位，发生率为47%–53%。该病长期存在会导致显著的功能障碍：步行能量消耗增加、儿童运动能力下降及继发性骨科并发症，严重影响患者生活质量。本文分析了已发表的文献资料，内容涉及脑瘫患儿膝关节屈曲挛缩的现代外科矫治方法，评估了这些方法的临床疗效，指出了并发症的发生频率，并明确了影响最佳治疗策略选择的相关因素。检索PubMed、Google Scholar、Cochrane Library、Crossref和eLibrary数据库。检索时间范围为1952年至2024年，不设语言限制。最终纳入74篇文献，包括原始研究和系统综述，均涉及脑瘫患儿膝关节屈曲挛缩的外科治疗。胫骨屈肌延长术和股骨矫形性伸直型髁上截骨术被认为是脑瘫患儿膝关节屈曲挛缩的主要矫治方法。屈肌延长术被认为是主要的手术方式，最适用于各年龄段的患者。同时应强调，股骨截骨术在年长的患者中，尤其是股骨远端严重畸形者中具有较高的临床疗效。两种方法均显示出良好结果，但可能伴随一定并发症风险。文献中还分析了替代方法，包括肌腱转位、临时性半骺阻滞术及联合治疗策略。文献综述表明，脑瘫患儿膝关节屈曲挛缩的外科治疗是一种有效的方法，但具体手术方式的选择应基于患者的个体解剖和临床特点、挛缩程度及年龄特征。
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圣彼得堡儿童肌肉骨骼系统疾病的患病率
论证。多数肌肉骨骼系统疾病在儿童期即被发现，这对于防止疾病迁延发展并避免成年期劳动力丧失具有重要意义。近年来，儿童疾病监测具有重要的科研和实践意义，包括对未来组织管理任务的重新评估。 目的：比较分析2017—2023年间圣彼得堡儿童肌肉骨骼系统与结缔组织疾病的总患病率动态。 材料与方法。基于2017—2023年间的官方统计报告，对圣彼得堡及全俄罗斯0–14岁和15–17岁儿童肌肉骨骼系统与结缔组织疾病的患病率进行比较评估。患病率按每千名相应年龄段儿童计算。通过对统计汇编中所列疾病的总体及具体病种计算优势比，对其特征进行了定量分析。优势比的统计学显著性以95%置信区间不包含1为准（p < 0.05）。数据分析使用 Microsoft Office 2010（Word, Excel） 进行。 结果。圣彼得堡儿童肌肉骨骼系统与结缔组织疾病患病率维持在极高水平，呈上升趋势，并与俄罗斯其他地区的差距逐年扩大。在COVID-19大流行期间，多数具体疾病分类的患病率增长幅度超过了此前时段的增长水平。在疫情期间，圣彼得堡0–14岁儿童的优势比在反应性关节病（上升23.6%）、 变形性脊柱病（27.4%）和其他类疾病（23.0%）中呈上升趋势；而在青少年中，则在幼年型关节炎（7.9%）、各类关节病（13.3%）、变形性脊柱病（15.5%）和其他类疾病（22.7%）中也观察到优势比上升。相比之下，脊柱病变在两个年龄组中均表现出检出率下降的趋势。在评价优势比的显著性与研究结论可靠性时，应优先采用最小计量单位作为分析尺度。 结论。圣彼得堡儿童肌肉骨骼系统与结缔组织疾病的患病风险持续上升，且其优势比高于俄罗斯其他地区。这表明有必要进一步完善本地区的分级诊疗体系和现代化的预防与治疗策略，同时在俄罗斯各地区提升医疗资源的数量与质量。
颈髓缺血性脑卒中：文献综述与临床病例报告
论证。脊髓缺血性脑卒中是一种罕见病，仅占所有脑卒中病例的约1%。由于该病在儿童中罕见，且与其他急性脊髓病综合征的鉴别诊断较为困难，预后常较差，同时临床医生对该病在儿科中的认知有限，因此本研究具有较高的现实意义。 临床观察。本文报告一例8岁儿童急性脊髓病综合征的临床病例。颈段脊髓磁共振成像结果与临床表现相符，提示在颈部脊髓前脊髓动脉供血区存在循环障碍。 讨论。脊髓急性循环障碍的可能原因包括系统性低血压、供血脊髓的血管闭塞（创伤性、医源性、血栓性或栓塞性）、动脉夹层、动静脉畸形与瘘管，以及高凝状态等。 结论。在儿童出现急性脊髓病综合征时，除了炎症性和感染性病因外，应将“脊髓缺血性脑卒中” 作为重要的鉴别诊断，特别是在具有高危因素的患儿中。早期识别脊髓急性血流障碍对于及时开展神经影像学检查、相关学科会诊至关重要；一旦明确急性缺血的病因，应尽早进行病因治疗或对症治疗，并启动早期康复。
儿童手部软骨内瘤：病因机制、诊断与治疗的现代认识。文献综述
儿童良性骨肿瘤的较高发病率决定了其对骨科医生的研究价值。本文聚焦于儿童手部软骨内瘤。尽管该病相对常见，但目前缺乏专门针对该疾病的临床指南，凸显了该议题的现实意义。作者基于CyberLeninka、eLibrary、PubMed和Scopus等数据库中1990年至2023年的全文资料，在387篇文献中筛选出70篇纳入分析。综述内容涵盖儿童手部软骨内瘤的最新病因机制观点、诊断和治疗难点及疾病预后。在诊断方面，首选方法为X线检查和计算机断层扫描。确诊必须依赖组织病理学验证。 特别强调了外科治疗策略，包括最佳手术时机与手术范围的选择、骨缺损替代材料的使用、复发风险因素及其发生率。文献分析有助于系统梳理儿童手部软骨内瘤的病因机制，明确诊断措施的优先顺序，整理诊断与鉴别诊断标准，并理清治疗策略与方法选择的原则。治疗策略、方法和时机的选择应个体化，考虑肿瘤过程的解剖部位和组织发生特征，并在必要时结合辅助检查结果及并发症发生的风险。近年来，专家更倾向于尽早开展外科治疗，而非采取观望策略；在自体骨与异体骨的选择上，则取决于具体的临床情境。自体骨被视为“金标准”，但在骨损伤后的结构和功能重建中， 异体骨的应用也是一种合理且有据的替代方案，尽管存在较高的供区并发症风险。此类决策应由多学科专家共同商议决定，涉及肿瘤骨科医生、影像科医生、病理科医生及康复科医生等专业人员的意见。
2025年6月2日，杰出的儿童外科专家、俄罗斯脊柱外科学的奠基人之一、圣彼得堡儿童脊柱外科流派的创始人，医学博士、教授Eduard Vladimirovich Ulrikh，享年87岁。虽言87岁，但其思维依然清晰敏捷，握手依旧坚定有力，学识渊博，意志坚毅，工作能力惊人，对所钟爱的事业无比忠诚，且在脊柱外科前沿趋势判断方面展现出卓越的洞察力，实属年龄所不能限。
儿童髌骨不稳定的临床与MRI影像学表现
论证。髌骨不稳定是指髌骨相对于股骨滑车沟发生反复性脱位或半脱位的状态。该病是儿童膝关节最常见的疾病之一。骨性结构与软组织结构共同作为髌骨的稳定器，任一结构的改变均可能成为导致不稳定的原因。对于髌骨不稳定患儿，磁共振成像所提供的髌股关节区域骨软骨及软组织结构状态的信息具有重要的实用价值，且可与临床表现进行对照分析。 目的：评估儿童髌骨不稳定患者髌股关节区磁共振成像的主要表现及其临床特征。 材料与方法。分析髌骨不稳定患者与前交叉韧带损伤患者的流行病学资料、临床数据及磁共振成像结果。共有52例主组患儿和44例前交叉韧带损伤的对照组患儿符合纳入标准。年龄分布无统计学显著差异。 结果。在Wiberg髌骨类型、脱位预感和髌骨过度活动度方面，各组之间存在显著差异。在患者的股骨滑车外侧倾斜角度、滑车窝深度以及脱位预感和髌骨过度活动度等临床表现方面也观察到统计学显著差异（p < 0.001）。 结论。股骨滑车发育不良是促使儿童患者出现髌骨不稳定的重要因素。本研究证实，表征股骨滑车发育不良的指标在儿童髌骨不稳定中具有统计学显著差异，且该因素与临床表现之间存在相关性。
重度胸段青少年特发性脊柱侧凸患者的矢状位平衡参数评估
论证。近年来，矢状位平衡的概念在不同病因所致脊柱畸形患者的治疗中愈发重要。关于特发性脊柱侧凸患者矢状位平衡参数的研究多为零散个例，且很少纳入重度患者。 目的：评估重度胸段特发性脊柱侧凸青少年患者的整体及区域性矢状位平衡参数。 材料与方法。纳入45例12–17岁的青少年胸段特发性脊柱侧凸患者（Lenke分型为第1、2、3型），主弯 Cobb角范围为80°至150°。所有患者均接受X线检查，评估其区域性和整体矢状位平衡参数及冠状面脊柱畸形特征。根据整体矢状位平衡参数的数值将患者分为两组。所得数据接受了描述性、 相关性、回归和比较性统计分析。 结果。冠状面脊柱畸形程度与胸椎后凸角之间存在正相关。回归分析显示，当主弯角度超过约100°时， 胸椎后凸角往往超过60°。胸椎后凸角（thoracic kyphosis）的增大是该类患者矢状面畸形的主要表现，但无论是胸椎后凸角还是冠状面主弯角度，与任何整体矢状位平衡指标均无统计学显著相关。 矢状位平衡参数更多地与脊柱-骨盆参数（PI、PT、SS、LL、PI–LL）相关。 结论。在手术治疗重度特发性脊柱侧凸时，必须考虑采用对后凸成分具有矫正效果的矫形方法。 即便在主弯角度极大的情况下，胸段特发性脊柱侧凸患者也不典型地表现出明显的前方矢状位失衡。其主要风险因素包括较低的PI和LL值。该类患者所呈现出的相关性机制目前尚未被完全阐明。
儿童骨盆骨折患者中腰骶移行椎的 检出率及其类型和亚型结构分析
论证。儿童腰骶移行椎的多个方面因诸多关键问题尚未明确而仍具有研究价值。例如，该疾病在儿童中的检出率及其各类型和亚型的构成尚属未知。尚未研究其临床症状的特点，尤其是其主要症状——疼痛。尚未建立针对不同儿童群体中与移行椎相关腰痛的有效且具有病理机制依据的治疗和预防策略。 目的：确定骨盆骨折儿童中腰骶移行椎的检出率及其类型和亚型的结构特征。 材料与方法。在2022—2024年间的41例骨盆骨折患儿组成的研究组中，10例被诊断为腰骶移行椎。所有患者均接受了腰椎与骨盆的计算机断层扫描，检查方案为创伤科常规评估流程。为明确患儿骨盆骨折的类型，采用Tile/AO分型标准。在评估髋臼骨折时，采用R. Judet等人提出的分类方法。 腰骶移行椎则按照A.E. Castellvi等人的分类方法将其分为不同的类型和亚型。 结果。本研究中腰骶移行椎的检出率为24.4±6.7%。在该病变类型构成中，以IIa亚型最为常见，占比50.0±15.8%。排名第二的是IIIb亚型，占30.0±14.5%的患者。Ia型与IIb型各占10.0±9.4%的临床病例。研究发现，相较于成人患者，儿童患者的一个显著特征是在病程中缺乏典型的局限性腰骶部疼痛。 结论。此类病变在儿童中虽可长期隐匿存在，然而其检出率较高，提示在影像学评估中应有针对性地检查腰骶交界区。一旦发现腰骶移行椎，应及时向患者告知其存在，并共同制定个体化的腰骶疼痛预防措施。
上肢应力性（过度使用性）骨折是运动员中较为少见的一类病变。由于其发病缓慢、临床症状通常不明显，且影像学检查有时无异常发现，该病常被漏诊。本文旨在汇总该病的发病机制、临床特征、诊断方法与治疗策略的最新研究数据。通过PubMed（MEDLINE）数据库和Google搜索系统，对1975年至2024年间的文献进行了检索，采用“стрессовые переломы”（应力性骨折）、“нагрузочные переломы”（过度使用性骨折）、“верхние конечности”（上肢）、“спортсмены”（运动员）等关键词（stress fractures, overuse fractures, upper extremities, athletes），并组合使用OR和AND运算符。共计纳入70篇文献，其中 22篇发表于近10年内。应力性（过度使用性）骨折在约40%的运动员中发生，其中80–95%累及下肢， 仅有5–20%为上肢骨折。其发生原因是骨骼在反复机械负荷作用下，伴随骨周肌肉疲劳，使得破骨细胞介导的骨组织吸收速度超过成骨细胞介导的新骨生成速度。磁共振成像是首选的诊断手段。多数患者通过限制负荷和调整运动方式（如避免反复性致伤动作）即可实现骨折愈合。在某些情况下，如“体操运动员腕”III期、移位达到或超过10 mm的内上髁撕脱性骨折、尺侧副韧带部分或完全断裂、鹰嘴骨折及腕骨骨折等，常需进行外科干预。尽管上肢应力性骨折的发生率不高，但对运动员的竞技能力和职业发展可能造成显著影响。详尽的病史采集、体格检查与损伤机制分析有助于临床医生识别该病。通过合理限制训练负荷、避免诱因、逐步恢复训练强度并优化运动技术，多数患者可避免手术治疗并成功重返运动赛场。
对青少年运动员对侧下肢足底压力中心波动的幅频特性评估
论证。当前，开发用于功能性评估参与体育锻炼儿童机体适应性变化的仪器诊断方法具有现实意义。 目的：分析青少年运动员在直立姿势下，不同频率范围内对侧下肢足底压力中心波动的幅值特性。 材料与方法。对18名年龄为7—10岁、规律参加田径训练的男女儿童在直立姿势下的足底压力中心波动的幅频特性进行了分析。采用两块稳定测量平台，分别记录左右下肢足底压力中心在低频范围（≤1.0 Hz，记录20秒）和高频范围（1.0–6.0 Hz，记录1秒）内的波动参数。测定下肢波动轴与身体中轴线之间的偏移角α（°）。在低频范围内测量足底压力中心波动的首个最大幅度和频率： а1、а2、а3（mm）和f1、f2、f3（Hz）；在高频范围内测量А1、А2、А3（mm）和F1、F2、F3（Hz）。对照组为18名身体活动水平处于一般日常水平的同龄儿童。 结果。与未参加体育锻炼、生活方式相对静态的同龄儿童相比，儿童运动员在低频和高频频段的足底压力中心波动幅频特性表现更为理想。具体表现为波动频率的偏移、低频和高频范围内所有峰值幅度的减小、波动幅度不对称性的降低，以及整个频谱范围内足底压力中心波动同步性的稳定性更高。 结论。在小学年龄段儿童的体育训练中，应考虑对侧下肢足底压力中心波动的幅频特性，以防止因疲劳引发的神经肌肉失衡，从而降低损伤风险。
儿童髁间隆突撕脱骨折关节镜下复位固定术式的比较评估
论证。胫骨髁间隆突撕脱骨折是一种罕见的损伤，主要发生于8至14岁的青少年，若骨折愈合不良， 可能导致致残。针对该类骨折，现已开发多种手术治疗方法，采用多种胫骨髁间隆突骨块固定方式。 目的。确定作者开发的在保留生长板条件下治疗Meyers–McKeever–Zaritsky III型胫骨髁间隆突撕脱骨折患者的手术方法的疗效，并将其与采用关节镜辅助下Herbert螺钉固定胫骨髁间隆突骨块的治疗结果进行比较。 材料与方法。分析45例年龄14–17岁的儿童胫骨髁间隆突骨折患者的术后功能结果，随访时间为术后3、6、12个月。A组包括22名儿童，采用关节镜辅助下使用Herbert螺钉固定髁间隆突骨块；B组包括23名儿童，采用作者开发的关节镜辅助下自锁环固定技术。 结果。B组患者的膝关节前后稳定性及旋转稳定性均优于A组。B组患者术后根据IKDC 2000评分、 Lysholm Knee Scoring Scale及Tegner评分进行的膝关节功能评估结果与A组相比，在统计学上具有显著差异，且表现更好，p=0.00006。A组患者在术后期间并发症发生率为18.1%（p≤0.05），包括螺钉断裂4.5%和异物反应性无菌性滑膜炎13.6%。B组患者未记录到术后并发症（p<0.05）。 结论。作者开发的在儿童保留生长板条件下的胫骨髁间隆突骨折固定方法，比Herbert螺钉固定更可靠和安全，可推荐用于临床应用。
专业从事竞技体操的儿童股骨头特发性无菌性坏死： 临床与X线影像学数据分析
论证。在专业从事艺术体操训练的儿童中，股骨头骨坏死是一种严重且进展迅速的退行性-营养不良性疾病。该疾病表现为股骨头出现显著破坏性改变，导致髋关节功能明显受限，进而导致疾病结局不佳。髋关节的X线解剖结构特征、在高强度和专业性体育负荷下的疾病发生与发展过程，以及可能导致该疾病晚期诊断和治疗延误的原因尚未得到充分研究。 目的。呈现从事艺术体操的儿童股骨头特发性无菌性坏死患者的临床与X线影像学特征。确定导致晚期诊断和治疗延误的原因。 材料与方法。分析了45例年龄在12至17岁、从事艺术体操训练的股骨头特发性无菌性坏死儿童患者的病史资料和影像学检查结果。 结果。该研究患者多表现出严重的临床病程，这主要由股骨头的全头或亚全头型损害所致。从事专业艺术体操的儿童髋关节解剖结构的显著特征包括：关节呈发育性髋关节发育不良形态，并伴有稳定性指标降低；股骨头呈Kalamchi II型“外翻性形成”变形；同时髋臼存在后倾趋势。这些结构特征促使股骨头更易发生外移和变形，从而加速了病理性改变的发展。导致该疾病晚期诊断和治疗延误的主要原因包括：家长、教练和医生对该疾病的认知不足；临床症状发展逐渐且无明显外伤史；以及在疾病早期阶段患者检查过程中存在漏诊问题。 结论。发现的髋关节先天性解剖结构异常整体加重了该疾病在青少年中的临床过程。对于体操运动员，早期进行髋关节疼痛的差异性诊断极为重要，包括应用磁共振成像检查，以有针对性地排除股骨头骨坏死的可能性。
儿童幼年特发性关节炎与色素绒毛结节性滑膜炎的鉴别诊断中滑液钙卫蛋白（S100A8/A9）含量检测的诊断价值 （单中心研究初步结果）
论证。幼年特发性关节炎是儿童最常见的慢性骨关节系统炎症性疾病，其中以寡关节型最常见。 色素绒毛结节性滑膜炎是一种少见的良性滑膜疾病，属于腱鞘巨细胞瘤类，可能表现为类似寡关节型幼年特发性关节炎的临床过程。幼年特发性关节炎与色素绒毛结节性滑膜炎的鉴别诊断常常存在困难。应用于幼年特发性关节炎的关节腔内激素可能对色素绒毛结节性滑膜炎产生不良影响。 为排除色素绒毛结节性滑膜炎而进行的骨科手术常对儿童带来较大负担。在疾病早期阶段，两种疾病在磁共振成像中的表现往往相似。部分研究显示，血清钙卫蛋白是幼年特发性关节炎的一个有前景的特异性生物标志物。 目的：研究寡关节型幼年特发性关节炎与色素绒毛结节性滑膜炎患者滑液中钙卫蛋白浓度。 材料与方法。采用酶联免疫吸附法检测42例寡关节型幼年特发性关节炎儿童和12例膝关节弥漫型色素绒毛结节性滑膜炎儿童滑液中的钙卫蛋白、白介素-6和肿瘤坏死因子α浓度。所有幼年特发性关节炎儿童在疾病首次发作时采集滑液，色素绒毛结节性滑膜炎儿童在治疗性诊断关节镜检查前采集滑液。 结果。研究发现，寡关节型幼年特发性关节炎儿童滑液中钙卫蛋白浓度显著多倍升高， 为108 [28.2；237] μg/mL，明显高于色素绒毛结节性滑膜炎儿童的1.53 [1.26；1.69] μg/mL （p<0.001）。在患有幼年特发性关节炎和色素绒毛结节性滑膜炎的患者滑液中，肿瘤坏死因子α和白介素-6 的浓度无统计学显著差异。ROC分析结果显示，滑液钙卫蛋白浓度高于2.9 μg/mL时提示幼年特发性关节炎（AUC 0.996±0.00479；95%可信区间0.926–1.000）。 结论。儿童寡关节型幼年特发性关节炎的诊断常因存在临床表现相似的非风湿性关节疾病而面临一定困难。滑液常规检测的主要炎症标志物在幼年特发性关节炎与色素绒毛结节性滑膜炎的鉴别诊断中无明显价值。滑液钙卫蛋白的定量指标可能成为指示幼年特发性关节炎的生物标志物之一。
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儿童踝关节及足部翻转损伤：与体育活动及合并疾病的关系（基于医疗信息系统数据的分析结果）
论证。踝关节及足部损伤是儿童肌肉骨骼系统中最常见的损伤类型之一。损伤机制在很大程度上决定损伤的特征。 目的。确定优化儿童踝关节及足部翻转损伤诊断和治疗的途径，分析其与体育活动及合并疾病的关系。 材料与方法。分析了2014–2023年期间就诊于本院咨询诊断科的患者门诊病历。从中筛选出1518例涉及踝关节及足部损伤的病例，其中111例为初步诊断为“韧带拉伤”且明确提示翻转型损伤机制的患者。 结果。患者包括10至16岁的男孩和女孩，其中三分之一从事体育活动（主要为球类和体操项目）。参与体育活动的儿童中翻转型损伤的复发率明显更高，这一情况在制定训练计划和安排运动员伤后复出时应予以考虑。分析翻转型损伤相关疾病和损伤的频率发现，不参与体育活动的儿童中以韧带拉伤最常见（39%），而参与体育活动的儿童中则以骨折最常见（38%）。 结论。本研究揭示了儿童踝关节及足部翻转型损伤中骨损伤和韧带损伤的高发生率，同时进一步明确了体育活动在该类损伤中的作用。更广泛地应用磁共振成像和超声检查，以及改进并标准化其检查方法，将有助于拓展对足部翻转型损伤的认识，并制定更完善的诊断与治疗算法。
Alla Vladimirovna Ovechkina——医学副博士、大学副教授、俄罗斯G.I. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery的首席专家、俄罗斯联邦荣誉医生， 正在庆祝80华诞。Alla Ovechkina 的医疗与科研工作始终与H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery密切相关，她将五十余年的职业生涯全部奉献于该中心的发展。自1988年至2025年，Alla Ovechkina担任学术秘书。她以充沛的精力、勤奋敬业的精神和精益求精的态度，成为H. Turner中心历任八位主任不可或缺的得力助手。Alla Ovechkina的科研工作主要聚焦于脊柱疾病患儿的保守治疗。
非运动员儿童群体的差异化稳态测量姿势控制分析及与少年运动员的比较评估
论证。对儿童运动系统功能参数的监测有助于评估其对体力活动的适应性反应。对从事体育运动的儿童而言，健康状况的定期监测应当具有系统性。稳态测量法在青少年运动员运动系统功能诊断中具有较高的应用潜力。 目的。基于对双侧对侧下肢足底压力中心稳态测量参数不对称性的分析，制定儿童不同年龄阶段姿势控制系统的差异化评估标准，并与少年运动员的相应参数进行比较。 材料与方法。本研究分两个阶段，在两块稳态测量平台上评估健康儿童的身体垂直平衡。第一阶段对照组评估旨在确定正常稳态测量参数范围，纳入59名5至16岁的儿童，这些儿童未从事任何体育运动，其运动活动水平不超过日常身体活动负荷。该组儿童被分为4个年龄亚组：5–6岁16人、7–10岁13人、11–13岁15人、14–16岁15人。第二阶段评估主组，包括15名7–10岁的男女运动员，均在圣彼得堡体育学校接受训练。 结果。对照组儿童自5–6岁起，身体垂直平衡随年龄增长逐步改善，在14–16岁时达到最高测量值。主组7–10岁儿童在接受规律性的高强度体育训练下，其身体垂直平衡及对侧下肢功能均未受到不良影响。这可能与采用符合儿童生理年龄特点的、兼顾负荷平衡和规范化的温和训练方法有关。 儿童运动员的平衡功能质量高于不参与体育运动的同龄儿童，其各项参数的中位数分别为80%和72%（p<0.05）。同时，运动员组的压力中心线速度及静态动稳图面积参数表明其垂直平衡更加高效。 这可能与主组儿童在姿势系统发育过程中，对其运动系统所承受的系统性、定量增加的体力负荷所产生的适应性过程有关。 结论。必须考虑少年运动员对侧下肢功能的不对称性，这是儿童成长过程中正常的生理特征。该现象是由大脑半球功能侧化所引起的左、右下肢压力中心运动的生理性年龄不对称。在训练过程中，宜将对侧下肢运动功能不对称性作为重要因素加以考虑，以预防运动性损伤。
儿童个体化带X线显影标记的3D模板在经椎弓根固定中的应用与“徒手法”的比较
论证。在合并胸廓发育异常的儿童先天性脊柱畸形患者中，经椎弓根螺钉植入需要特别高的精准性和规范性。应用带有X线显影标记的个体化导航模板可以显著提高螺钉定位的准确性，降低并发症风险。 目的。分析带X线显影标记的创新型个体化手术模板的应用效果，以及在合并胸廓发育异常的儿童先天性脊柱畸形患者中经椎弓根螺钉植入金属内固定装置的准确性，并与“徒手法”进行比较。 材料与方法。纳入26例（4–9岁）在专业中心接受手术治疗的患者。所有患者分为两组：第一组 （n=13）在螺钉植入过程中使用带X线显影标记的新型模板；第二组（n=13）采用“徒手法”。通过术后X线和CT评估螺钉位置，依据Gertzbein分级进行准确性评分。统计分析采用t检验，显著性水平p<0.05。 结果。使用导航模板的组别中，100%的螺钉均（Grade 0）被正确置入。在“徒手法”组，正确置入率为80.5%，其中16.9%的螺钉轨迹偏差在2 mm以内（Grade 1），2.6%偏差超过2 mm（Grade 2）。此外， 使用导航模板建立骨道的时间明显少于“徒手法”，差异具有统计学意义。 结论。带X线显影标记的导航模板在合并胸廓发育异常的儿童先天性脊柱畸形患者经椎弓根螺钉植入中展现出高度的准确性和正确性，可降低螺钉植入位置不良的风险，并缩短手术时间。其广泛应用可显著提高该类患者外科治疗的安全性和有效性。
儿童双侧病理性髋关节脱位的髋关节成形术
论证。低龄儿童的病理性髋关节脱位是股骨近端干骺端血源性骨髓炎及败血性关节炎最严重的并发症。若双侧髋关节同时受累，将导致解剖与功能障碍变得更加严重，因此需要付出额外努力进行矫正。这类患者的康复过程往往需多年，不仅包括手术矫正，还需持续的保守治疗。严格遵循康复方案极为重要，否则治疗不足或不当，将导致关节挛缩、髋关节活动受限，甚至加重继发畸形。 目的。分析采用脱矿骨软骨同种异体移植进行髋关节成形术治疗儿童双侧病理性髋关节脱位的手术效果，并关注康复阶段的特点，以获得良好的近期及远期术后结果。 材料与方法。分析了11例（共22个关节）1.5–10岁双侧破坏性病理性髋关节脱位儿童的手术治疗结果，手术采用脱矿骨软骨同种异体移植行髋关节成形术。 结果。在远期随访（1–12年）期间，在大多数（86.4%）经X线证实稳定的手术侧髋关节中，观察到屈曲活动度保持不少于80°。 结论。采用脱矿骨软骨同种异体移植进行髋关节成形术，可能是治疗儿童破坏性病理性髋关节脱位的一种有效方法，能够在较长时间内维持髋关节的稳定性及活动度。在儿童双侧髋关节病变的情况下，采取连续性、系统性和综合性的治疗措施，是实现康复成功、以及恢复和维持患侧关节功能的关键因素。
一名重度漏斗胸青少年患者的外科治疗(临床观察)
论证。漏斗胸是一种胸部畸形，它是以肋骨和胸骨软骨区不同程度变形为表现的畸形，据文献报道，占胸部畸形总数的75%～91%。尽管有大量的手术矫正方法，但漏斗胸儿童的手术治疗目前仍是一个迫切需要解决的问题。现有的方法并不通用，尤其是对于不对称、僵硬的畸形，因此，这些方法正在不断的改进和完善。 临床观察。一名17岁的患者，因心脏缺陷曾接受过心脏手术治疗，导致极度严重的漏斗胸畸形，因此，接受了纵向胸骨切开术和二尖瓣成形术。手术治疗包括松解主要、重要解剖结构，术中使用高矫正力矩外固定器，在心功能监测下逐步进行术中矫正。 讨论。在之前进行过纵向胸骨切开术的基础上，对严重的漏斗状胸部畸形进行矫正，是一项并发症风险较高的手术，包括致命的并发症（心搏停止、大出血）。本观察的作者认为以下手术技术适用于这些临床病例：微创胸廓成形术，附加亚剑突下入路，并使用外固定器抬高胸骨。作者认为，在这种情况下，不适合使用标准的胸骨抬高方法（开瓶器、缝合材料、夹钳），因为在硬性畸形明显的情况下，这种方法可能会导致胸骨体受损，不建议使用标准 MIRPE的孤立胸腔镜，因为这种方法不能保证胸腔器官的完整性，也不适合使用传统的胸板翻转方法，以实现对漏斗状胸部畸形的一次性 （强制）矫正。 结论。漏斗胸患者明显超过严重程度，且曾接受过心脏手术，需要采用不同于漏斗胸畸形标准胸廓成形术的治疗方法。在复杂的临床情况下，可能会推荐所考虑的治疗方案，包括释放主要的生命解剖结构，在心功能监测下使用外固定装置进行渐进的术中矫正。
股骨髁骨软骨破坏性病变联合修复术在青少年中的应用：临床观察与文献综述
论证。儿童和青少年股骨髁病变的主要原因之一是营养不良过程，该过程伴有骨下骨破坏，并进一步累及覆盖软骨。主要病理状态包括离断性骨软骨炎和因糖皮质激素治疗导致的药物性骨坏死。 目前文献中缺乏关于股骨髁骨软骨缺损患者最佳手术治疗方法的数据。 临床观察。报道2例青少年广泛性股骨髁骨软骨缺损患者的临床病例。 讨论。进行了文献综述，介绍了相关分类，并探讨了股骨髁深层骨软骨缺损患者的手术治疗方法。 现有方法可获得良好至优异的临床结果，但由于缺乏涵盖所有治疗方法的随机或比较性研究，尚无法明确确定最佳手术方法。在大多数现代研究中，治疗效果主要通过间接影像学评估，而该评估方式与临床结局呈负相关，这可能会扭曲对治疗效果的正确解读。 结论。股骨髁骨软骨缺损问题在创伤与矫形外科领域具有重要意义，包括青少年和儿童患者。在众多现有治疗方法（从再血管化骨钻孔术到关节置换术）中，联合应用自体骨与胶原膜的修复术可能提供稳定的临床和功能改善效果。 TRANSLATE with x English Arabic Hebrew Polish Bulgarian Hindi Portuguese Catalan Hmong Daw Romanian Chinese Simplified Hungarian Russian Chinese Traditional Indonesian Slovak Czech Italian Slovenian Danish Japanese Spanish Dutch Klingon Swedish English Korean Thai Estonian Latvian Turkish Finnish Lithuanian Ukrainian French Malay Urdu German Maltese Vietnamese Greek Norwegian Welsh Haitian Creole Persian TRANSLATE with COPY THE URL BELOW <!--a id="TwitterLink" title="Share on Twitter"> <a-- id="FacebookLink" title="Share on Facebook"> </a--> Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster Portal Back
先天性脊柱侧凸发生中的遗传决定因素作用。文献综述
论证。先天性脊柱侧凸是一种复杂的多因素疾病，由于胚胎发育期间脊柱形成过程的异常所致。胚胎发育任何阶段出现障碍均可能导致先天性脊柱侧凸，进而引发脊柱进行性畸形。最近研究越来越多指出，遗传因素是该病发展的重要决定因素。 目的。分析文献数据，探讨先天性脊柱侧凸的遗传基础、分子调控机制、其发生频率、突变改变及特定基因的作用。 材料与方法。通过在PubMed、Google Scholar、Cochrane Library、Web of Science、 Lens.org、eLibrary数据库，以关键词进行文献检索，检索范围覆盖近25年。纳入标准包括：全文来源、荟萃分析、系统综述、先天性脊柱侧凸患者的队列研究、动物实验模型、病例-对照研究。排除标准包括：无全文、专利、实用新型、无临床数据支持的研究。根据上述标准，共筛选出54篇文献进行详细分析。 结果。根据文献分析，相关基因分为4类：易感基因（LMX1A、PTK7、SOX9、TBX6、TBXT）；突变可直接导致伴发脊柱侧凸的综合征或单基因疾病的基因（FBN1）；拷贝数变异基因（DHX40、DSCAM、MYSM1、 NOTCH2）；在脊柱侧凸患者中出现异常甲基化的基因（COL5A1、GRID1、GSE1、RGS3、SORCS2、IGH1、 IGH3、IGHM、KAT6B、TNS3）。 结论。科学文献分析显示，存在与先天性脊柱侧凸发生及其不同表型表现相关的遗传易感因素。 大规模研究数据有助于进一步厘清病因，拓展对先天性脊柱侧凸病程的预测能力。同时，小样本研究可能为进一步寻找该疾病的遗传决定因素提供研究前景。
脑瘫儿童马蹄-平足外翻型足畸形中的Hallux valgus。病因与发病机制。文献综述。第一部分
论证。目前，hallux valgus在脑瘫儿童中仍属于研究不足的问题。治疗通常按残留原则进行，即在较大年龄、完成足部挛缩和畸形矫正后，仅在患儿出现主诉时才进行干预。此外，在畸形形成早期、患者尚未出现主诉前，缺乏预防和治疗方法。理解该人群的基本病因与发病机制，以及步态生物力学异常，对于制定预防和治疗方法尤为重要。 目的。分析国际文献中关于脑瘫儿童足部畸形形成理论的数据，并将其与患有无神经系统疾病的特发性hallux valgus患者的步态生物力学研究结果进行比较。 材料与方法。本研究使用了64篇科学文章和出版物，来源于多个数据库，检索时间不设限制。 结果。将马蹄-平足外翻型足畸形视为脑瘫儿童hallux valgus形成的主要病因因素。Hallux valgus的生物力学变化表现为：第一趾背屈受限、第一足跖骨过度背屈、后足及中足旋后受限，以及在支撑期末踝关节跖屈增加。在马蹄-平足外翻型足畸形中，后足和中足的过度内旋由于中跗关节运动范围狭小而无法被代偿，这导致中足旋后受限，并且在支撑期末无法激活中足和前足的锁定机制。 结论。下肢复杂多关节系统中，任何导致后足和中足旋后减少、第一足柱外翻，并进一步限制第一趾背屈的生物力学障碍，均可能促使畸形形成。脑瘫患者存在多样化的运动障碍、挛缩及畸形组合，这一现象需要进一步研究，以明确导致hallux valgus形成的关键因素。研究结果有助于制定在畸形发展早期阶段的预防和治疗策略。
自体脂肪来源间充质干细胞在实验动物透明软骨缺损治疗中的应用（文献综述）
背景。软骨组织的退行性疾病是现代创伤学和骨科领域中具有重要流行病学意义的问题。软骨缺损修复的困难在于软骨组织的低再生能力，而使用自体间充质干细胞修复软骨缺损被认为是当前研究中最具前景的方向之一。 研究目的。综述文献中关于脂肪来源间充质干细胞在实验动物软骨缺损修复中的应用研究。 材料与方法。本文基于过去20年的俄文和英文文献，使用关键词在 Google Scholar、Ciberleninka、 PubMed、eLibrary、Mendeley 和 Science Direct 等数据库中进行检索。共筛选出113篇文献，并从中挑选出25篇符合纳入标准的全文和摘要研究进行分析。 结果。文献数据显示，自体脂肪来源间充质干细胞在透明软骨缺损修复中能够促进再生。在绝大多数研究中，无论基质载体或凝胶的组成如何，添加分化或未分化细胞均可显著加速软骨组织修复过程。此外，脂肪来源间充质干细胞还可作为一种独立技术，无需载体直接应用于治疗。 结论。尽管已有多种技术、手术方法和材料用于修复软骨缺损，目前尚未找到能够完全再生软骨组织的理想移植物。然而，脂肪来源间充质干细胞在实验研究中表现出显著的再生潜力，能够加速软骨缺损修复，并可能成为治疗软骨退行性疾病的新策略。进一步研究应集中于临床转化应用， 以验证其在人体软骨修复中的安全性和有效性。
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骨骼的神经支配：感觉神经支配（第一部分，文献综述）
背景。骨组织的重建调控是一个复杂的多因素过程，受到内分泌、旁分泌和机械因素的共同控制。 近二十年前的研究首次表明，除了传统机制外，骨代谢还受到神经系统的调控。然而，国内文献中关于骨组织神经支配特点的研究几乎为空白。 研究目的。分析文献中关于感觉神经支配在骨代谢调控中的作用，以及其在骨痛病理生理机制中的角色。 材料与方法。通过 PubMed、Google Scholar、Cochrane Library、Crossref 和 eLibrary 等数据库检索俄文和英文文献，使用关键词“骨骼神经支配”、“感觉神经支配”、“骨代谢”、“骨痛”进行分析和综合研究。本文综述的大部分研究成果发表于过去20年。 结果。感觉神经纤维的分布：伤害性感知的感觉神经纤维广泛分布于骨的所有结构区域；骨痛类型取决于病变位置和病理过程性质。痛觉信号的传递：A-δ纤维和C型纤维是将骨痛信号传递至中枢神经系统的主要通路；这些纤维具有不同的传导速度、神经递质、受体特性和功能。神经递质在骨稳态中的作用：感觉神经通过释放降钙素基因相关肽（CGRP）和P物质等神经递质来调节骨的稳态；这些递质在调控骨吸收和骨形成过程中起到重要作用。在骨化中心的作用：感觉神经在内软骨成骨和膜内成骨过程中，特别是初级和次级骨化中心的形成中发挥关键作用。软骨中的神经纤维：某些研究证实，在特定发育阶段，关节软骨中存在神经纤维。 结论。感觉神经纤维是骨骼和软骨组织代谢神经调节的重要环节。紊乱的感觉神经支配：感觉神经支配的紊乱会导致骨重建的恶化以及内软骨成骨过程的延缓，从而影响骨的生长和发育，尤其在幼年期患者中表现更为明显。骨痛的病理生理机制：理解感觉神经在骨痛中的作用对制定针对性的治疗策略至关重要。
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超声评估外固定装置固定期间患有软骨发育不良的患者胫骨再生体的结构状态
背景。在固定期间评估骨再生体的必要性在于，在此治疗期间，进行的临床活动旨在预防可能的并发症：评估肢体轴的正确性，明确延长肢体和对侧肢体的长度（在再次延长时），保持固定的刚度；功能性地控制术后肢体的负荷以及患者的运动活动。所有这些直接影响拉伸再生体的结构状态、 其成熟的时间以及是否准备好拆除外固定装置。由于比远端再生体（5.5 [5.0；6.0] cm）更大的延长量，近端再生体的研究尤为重要，且其成熟决定了外固定装置拆卸的时间。 研究目的。评估患有软骨发育不良的患者在固定期间不同年龄段的胫骨拉伸再生体的结构状态。 材料与方法。本研究使用日本AVISUS Hitachi超声设备，配备7.5 MHz频率的线性探头进行。使用标准程序评估再生体。对6-9岁（I组，n = 15）和10~15岁（II组，n = 15）的软骨发育不良患者进行了研究。研究在固定开始后的第5天、30天、60天和90天进行（对于再次延长肢体的患者）。在I组的单侧小腿骨延长时，延长量为6.5 [6；7] cm；而在I组和II组的双侧小腿延长时，近端再生体的延长量为5.5 [5.0；6.0] cm，远端为2.5 [2.0；3.0] cm。 结果。I组和II组的骨生成过程均表现出良好的进展，并且再生体区域的形成呈现典型周期性。 特征性差异在于II组再生体结构形成较慢，导致固定时间延长。因此，I组儿童的固定时间为55 ± 5天（p ≤ 0.05），而II组则为63 ± 3天（p ≤ 0.05）。唯一例外为1名患者（10名再次延长小腿的患者之一），该患者在拉伸过程中再生体中间区域出现了低回声囊性样病变。皮质板形成期延长至85 ± 5天（p ≤ 0.05）。 结论。在固定期间，超声评估显示，胫骨拉伸再生体的修复骨生成活动与拉伸期的修复骨生成活动相当。尽管由于母骨端的回声密集碎片，固定期间无法完全显示所获得的延长量，但超声检查可以评估再生体填充的动态、血管化特征以及再生体拆除外固定装置的准备情况。
一过性臂丛神经病在成人和儿童中的表现（文献综述）
背景。一过性臂丛神经病，又称刺痛综合征或灼烧综合征，是一种轻度的臂丛神经损伤，通常由手臂或颈椎的剧烈运动引起，较少由直接撞击锁骨上区造成。这种病症主要发生在从事接触性运动的运动员中，例如美式足球和橄榄球运动员。典型临床表现包括突发的锐利刺痛，从颈部延伸到手指尖，通常持续数秒至几分钟。由于国内文献中缺乏关于该病的信息，本综述对创伤骨科医生、 神经科医生、运动医学医生、教练及康复师具有参考价值。 研究目的。提供关于一过性臂丛神经病的发病机制、诊断、治疗策略以及患者运动能力恢复的最新研究数据。 材料与方法。数据来源：通过 PubMed（MEDLINE）数据库和 Google 搜索系统检索了 1965年至2024年 的相关文献；检索关键词及逻辑运算符：“一过性臂丛神经病”、“刺痛综合征”、 “灼烧综合征”、“运动医学”、“儿童”（transient brachial plexopathy，stinger syndrome， burner syndrome，sports medicine，children）；共筛选出49篇文献，其中13篇为最近10年发表。 结果。发病率：在美式足球和橄榄球运动员中，一过性臂丛神经病的诊断率为18.8%至65%。儿童病例：文献描述了多种儿童病例，包括摔倒撞到肩部、跑步时头部快速向对侧倾斜碰撞墙壁，以及肩关节高可动性导致的刺痛综合征。发病机制：一过性臂丛神经病的发生机制主要涉及C5-C6脊神经根或臂丛神经上干的损伤。症状表现：疼痛通常持续数秒至数分钟；可伴随感觉异常、麻木和上肢无力；约55.5%的症状发生在比赛期间，其中63.8%的患者症状会在比赛结束后24小时内消失。 诊断和处理：若症状迅速缓解，通常无需进一步检查或治疗；若症状持续超过1小时，伴随颈部疼痛、 特定神经根损伤症状或复发性发作，需进行影像学检查（如MRI或CT）。 结论。一过性臂丛神经病是一种常见于运动员的轻度神经损伤，但也可能发生在儿童和日常生活中。及时诊断、科学管理及对运动员技术动作的改进可以有效预防或减少复发。本病虽然多为自限性，但持续或复发性症状需引起重视，并进行进一步检查和治疗。
增材制造技术在儿童先天性脊柱畸形外科治疗中的应用（文献综述）
背景。尽管目前已有多种方法可用于矫正脊柱畸形，但针对学龄前儿童先天性脊柱畸形的外科治疗仍是一个重要而紧迫的问题。现有的椎弓根螺钉安装技术在精确性和安全性方面仍存在一些不足之处。 研究目的。基于文献数据，分析用于矫正胸椎和腰椎先天性畸形的外科治疗方法的效果，这些畸形通常伴随椎体形成障碍。 材料与方法。本文系统回顾了关于增材制造技术在矫正先天性脊柱畸形中的应用的文献研究 结果。通过 PubMed 和 eLibrary 等科学文献数据库，使用相关关键词（如“先天性脊柱侧弯”、 “半椎体”、“增材制造技术”）进行检索。时间范围：2000年至2023年；文献数量：共找到396篇相关文献，其中51篇符合研究主题。 结果。尽管增材制造技术在脊柱外科中的应用显示出一定潜力，但由于相关文献中患者组样本较小，目前尚难以对其在手术矫正中的积极效果得出明确结论。尤其是在学龄前儿童中，针对半椎体畸形的手术矫正效果仍缺乏足够的证据支持。 结论。通过分析学龄前儿童胸椎和腰椎先天性畸形（伴随椎体形成障碍）的病例，我们发现使用模板导向器安装椎弓根螺钉是一种前景广阔的方法。这种技术利用增材制造技术的个性化优势， 显著提高螺钉植入的精确性，减少并发症的发生。然而，尚需进一步开展大规模研究，以验证其长期效果和安全性。
肘关节骨折的后果在儿童中的研究
背景。肘关节骨折是儿童中最常见的骨折类型之一。尽管在处理这些损伤的专业帮助方面已进行过方法学的研究，临床实践中仍然常见负面的解剖学和功能性结果。 研究目的。分析儿童肘关节骨折的后果，评估原发性损伤的结构和初始治疗策略。 材料与方法。基于纳入标准，形成了回顾性队列（n = 115）。分析了2022-2023年间住院于俄罗斯卫生部下属的“G.I. Turner儿童创伤学与骨科研究中心”并接受外科治疗的肘关节骨折后果的临床、 病史和影像学数据。对定量指标采用Shapiro-Wilk检验（样本量少于50）或Kolmogorov-Smirnov检验（样本量超过50）进行正态分布检验。对于多变量列联表中的百分比，通过皮尔逊卡方检验进行比较。 结果。分析样本中的患者平均年龄为11岁（4至17岁）。受伤时间为15.6 ± 1个月（最小值 = 3， 最大值 = 65）。后果分组中确定了三组：挛缩42例（36.5%）、变形31例（27%）、挛缩和变形42例（36.5%）。原发性损伤的结构中，以肱骨髁上骨折（40%）和内侧髁突的骨骺分离（31%）为主。 82名患者（71%）接受了初步保守治疗，33名患者（29%）接受了初步手术治疗；其中17例病例从保守治疗转为外科治疗。31名患者（27%）接受了重复手术治疗。 结论。在儿童肘关节骨折的负面后果中，挛缩占主导地位。分析组的初步治疗策略（如保守治疗） 和重复手术治疗表明，改善儿童创伤治疗专家的培养仍然是当务之急。尽管已有现代化的治疗算法，诊断错误、治疗策略问题以及手术操作技术错误仍然是目前造成负面结果的主要原因。
健康学龄前儿童足部评估结果：视觉评估、FPI-6量表、背屈角度（群体研究）
背景。在俄罗斯文献中缺乏关于学龄前儿童足部的视觉评估与FPI-6量表参数和背屈角度之间关系的资料，这一空白成为本研究的启动因素。 研究目的。评估健康学龄前儿童的足部视觉评估、FPI-6量表参数和背屈角度之间的相互关系。 材料与方法。研究了81名5至7岁儿童（162只足部）的结果。所有儿童均进行了足部的视觉评估、 FPI-6量表评估、被动背屈角度评估，并分析了贝顿量表评估的高可动性数据及人体测量指标 （身高/体重）。背屈角度的评估是在膝关节弯曲和伸展时稳定后部位置进行的。为确定数据分布的正态性，使用了Kolmogorov–Smirnov检验，然后采用了参数和非参数统计检验。使用ANOVA分析比较三组的平均值。为了评估相关性，采用了皮尔逊相关系数。 结果。在所有儿童中，平足的发生率为41.0%。平足组中男孩的数量是女孩的两倍，而无平足组中女孩的数量比男孩多1.5倍。根据FPI-6量表对同一足部的评估，平足儿童的得分为8分及以上，无平足儿童的得分为0到4分。发现临床诊断“平足”与FPI-6量表参数之间有中等强度的相关性。对于 95%的5至7岁儿童，膝关节伸展时的背屈角度为11.4°至34.2°。背屈角度在膝关节弯曲和伸展时的平均差值为24.1 ± 9.5°。方差分析显示，平足儿童与非平足儿童在背屈角度上没有显著差异。 结论。学龄前儿童的背屈角度的平均值为22.8 ± 5.7°。未发现平足儿童与非平足儿童在背屈角度上的显著差异。定量分析了小腿肌肉的收缩程度。
膝关节后外侧角结构的解剖特点与生物力学特性
背景。膝关节后外侧角结构的损伤较为罕见，但通常由高能量机制引起，并导致膝关节快速进展的退行性病变。目前，对于在手术治疗中修复膝关节后外侧角受损结构是否能够实现有效稳定性， 尚无一致意见。探讨后外侧角解剖结构对膝关节后外侧旋转不稳定性的影响，具有重要的理论和实践意义。 研究目的。研究腘肌腱和腓骨侧副韧带的解剖特点和形态计量参数，特别是其附着点在股骨上的分布，以及这些结构在膝关节后外侧旋转与内翻不稳定性中的作用。 材料与方法。本研究为单中心综合性局部解剖学研究，基于50具未固定下肢解剖学标本 （30名女性，20名男性），年龄范围为30至60岁，均因非骨骼系统病理原因死亡。通过精确解剖对膝关节后外侧角的腘肌腱和腓骨侧副韧带的结构进行详细研究，并记录其在股骨上的附着区域的形态计量特点。随后，通过逐步切割后外侧角结构，评估其对膝关节后外侧旋转不稳定性、胫骨内翻偏移（内翻应力测试）及胫骨后移（后抽屉试验）的影响。 结果。当切断腓骨侧副韧带时，膝关节的最大内翻角偏移为5°± 3.0°。切断腘肌腱后，胫骨外旋最大增加为11°± 1.5°。切断后交叉韧带导致胫骨相对于股骨的最大后移量为9（7.9~10.2）毫米。 结论。本研究详细分析了膝关节后外侧角结构的解剖和功能特点。研究结果表明，腘肌腱在膝关节后外侧旋转不稳定性中具有主导作用，而腓骨侧副韧带在内翻不稳定性中起主要作用。这对于膝关节不稳定性患者的诊断和手术治疗具有重要意义。
长期牵伸腓肠三头肌计划对儿童高可动性平足及跟腱缩短患者腓肠三头肌纤维羽状角的影响
背景。腓肠三头肌的收缩在儿童平足的发病机制中具有重要意义。作为一组羽状肌，其肌纤维相对于腱膜的倾斜角度可以被测量，此角度称为羽状角或纤维羽状角。 研究目的。评估长期腓肠三头肌牵伸计划对高可动性平足伴跟腱缩短儿童腓肠三头肌纤维羽状角的影响。 材料与方法。研究包括82名患有高可动性平足及跟腱缩短的儿童。通过超声诊断测量腓肠三头肌纤维的羽状角。主要干预措施为持续6个月的腓肠三头肌牵伸训练。统计分析使用 SPSS v. 26.0 完成。 结果。实验组包括63名参与牵伸计划的儿童，对照组包括19名未按规定强度参与牵伸训练的儿童。 足部形态与位置评估量表（FPI-6）：实验组显示显著改善，对照组无变化。足背屈角的变化： 初始值：实验组为4.84 ± 0.10°，对照组为4.81 ± 0.17°；6个月后：实验组为11.34 ± 0.24°， 对照组为4.85 ± 0.19°（p < 0.01）。纤维羽状角的变化：腓肠肌内侧头和比目鱼肌的纤维羽状角均显著增加。 结论。在平足儿童中实施长期牵伸计划可显著提高足背屈角。这些变化伴随着肌肉的形态和功能重塑，表现为腓肠肌内侧头和比目鱼肌纤维羽状角的显著增加。进一步研究将有助于揭示肌肉解剖和功能重塑的机制及其对平足解剖参数的影响。
使用双膦酸盐治疗伴有骨关节炎表现的莱格-卡尔维-佩尔特斯病儿童的前景：单中心研究的初步结果
背景。莱格-卡尔维-佩尔特斯病是一种多因素疾病，其坏死病灶形成机制被认为是无炎性缺血性病变。在某些情况下，病程更加严重，儿童可能出现伴有骨关节炎的表现。这种病程特征包括活跃的骨组织炎症和滑膜炎，常导致股骨头显著变形及早发性髋关节骨关节炎。目前，由于非甾体抗炎药（NSAIDs）的疗效有限，治疗伴骨关节炎的莱格-卡尔维-佩尔特斯病儿童仍是一个未解决的问题。在成人中，通过双膦酸盐抑制破骨细胞活性的治疗方法被证明对特发性股骨头无菌性坏死具有病理生理学意义。然而，双膦酸盐在伴骨关节炎的莱格-卡尔维-佩尔特斯病儿童中的应用尚未被研究。 研究目的。评估双膦酸盐治疗伴骨关节炎的莱格-卡尔维-佩尔特斯病儿童的疗效和安全性。 材料与方法。本研究包括14名儿童（平均年龄7.5 ± 2.4岁，71.4%为女孩），均处于印压性骨折阶段，并伴有髋关节活跃性骨关节炎。这些儿童对非甾体抗炎药治疗的关节炎反应迟钝， 病程不少于3个月。治疗方案：7岁以下儿童：每次剂量为 1.0 mg 的伊班膦酸；7岁以上儿童：每次剂量为 1.5 mg；静脉输注频率：每3个月一次，共进行5次输注。评估指标：临床、影像学和实验室数据的综合动态评估；在治疗的 6、12、18个月 后记录结果；骨关节炎活动程度使用 改良SCORING OF HIP MRI FOR JIA量表 进行评估。 结果。疼痛改善：所有儿童在第一次输注伊班膦酸后髋关节疼痛症状均有所减轻。骨关节炎非活动性阶段：78.5%（11名）儿童在三次连续输注后达到非活动性阶段；其余 21.5%（3名）儿童在四次输注后达到相同阶段。输注后反应：85.7%（12名）儿童在治疗初期阶段出现短暂的输注后反应。 实验室指标：血清中的红细胞沉降率（ESR）、C反应蛋白（CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子α（TNF-α）水平均未超出参考范围。维生素D状态：在确诊骨关节炎时，仅 28.5%（4名）患者表现出25-OH维生素D不足。 结论。双膦酸盐治疗伴骨关节炎的莱格-卡尔维-佩尔特斯病儿童可被视为一种创新且病理生理学上有依据的治疗方法。本研究初步结果显示，双膦酸盐在缓解症状和控制骨关节炎活动性方面具有前景。然而，需对研究组儿童进行长期随访，以进一步评估其疗效和安全性。
使用具备可视化控制功能的新型个性化导向模板评估在儿童先天性脊柱畸形中的应用效果
背景。在治疗儿童先天性脊柱畸形时，使用个性化的外科导向模板安装椎弓根螺钉能够显著提高手术的精准性和安全性。 研究目的。开发并对比分析一种新型外科导向模板的应用效果，该模板在安装椎弓根螺钉时具备可视化控制功能，适用于伴有胸廓畸形的儿童先天性脊柱畸形患者。 材料与方法。本研究纳入了2022年6月至2023年6月接受外科治疗的30名伴有先天性脊柱和胸廓畸形的患者。分组方法：实验组（15名）- 使用新型导航模板；对照组（15名）- 采用传统“自由手” 技术。评估方法：术后通过计算机断层扫描（CT）数据，使用S.D. Gertzbein评分量表评估螺钉植入的准确性；数据分布正态性通过Shapiro–Wilk检验验证；两组结果通过独立样本t检验进行比较，统计显著性设为p < 0.05。 结果。实验组（新型导航模板）：97.7%的螺钉无偏差（Grade 0）；2.3%的螺钉偏差不超过2毫米（Grade I）；无出现超过2毫米偏差的螺钉（Grade II及以上）；无并发症报告。对照组（“自由手” 技术）：89.7%的螺钉无偏差（Grade 0）；7.5%的螺钉偏差在2毫米以内（Grade I）；2.8%的螺钉偏差超过2毫米（Grade II及以上）。 结论。新型个性化导航模板具备可视化控制功能，可显著提高椎弓根螺钉植入的精准性，减少偏差，且未导致并发症。这一工具在治疗先天性脊柱畸形的临床实践中表现出良好的可靠性和便捷性， 具有广阔的应用前景。
Analysis of vertebrotomy treatment in children with congenital scoliosis with unsegmented rod and rib synostosis
BACKGROUND: Congenital anomalies of vertebral development account for 2%–11% of cases in the general structure of nosologies that cause spinal deformity. An unsegmented rod (unilateral violation of vertebral segmentation) is attributed to a prognostically unfavorable malformation. Rib synostosis causes the development of thoracic insufficiency syndrome. AIM: To analyze the results of treatment of children with congenital scoliosis caused by an unsegmented rod and rib synostosis by vertebrotomy. MATERIALS AND METHODS: This cohort, retrospective, monocenter study evaluated the treatment results of 55 patients. The patients were divided into two groups: group 1, children aged 2–8 years, the scope of intervention was wedge-shaped osteotomy of a non-segmented rod at the apex of the deformity, and group 2, children aged 8–18 years, the scope of intervention was wedge-shaped osteotomy at the apex of the deformity and two linear osteotomies of a non-segmented rod in the cranial and caudal directions. Clinical, radiological, and statistical research methods were used. RESULTS: Significant correction of scoliosis was achieved in 65.5% of patients aged 2–7 years (group 1) and 56.3% in children aged 8–18 years (group 2). Hypokyphosis of the thoracic spine was observed in the patients. The percentage of correction of kyphosis was 21.1% in group 1 and 19.1% in group 2. Lung volume increased by 27.9% (p = 0.01776) in group 1, and lung volume on the concave side increased by 23.5% (p = 0.04975) and on the convex side by 29.6% (p = 0.01073). Improvement in the overall respiratory impedance reached 47.3% (p < 0.05). In group 2, a insignificant increase was found in VVC by 12.6% (p = 0.3509) and FEV1 by 8.7% of the initial (p = 0.1534), as well as an increase in total lung volume of 13.3% (p = 0.1527) and the contribution of the lung along the concave side of 18.8% (p = 0.1535), and the lung along the convex side was 8.4% (p = 0.169), indicating no significant impact on lung development and function. CONCLUSIONS: In children with spinal deformity caused by a non-segmented rod with normal respiratory function, vertebrotomy at the apex of the deformity with subsequent correction and stabilization of the spinal deformity is recommended. Performing simultaneous multilevel osteotomies of a non-segmented rod allows for significant correction of rigid spinal deformity.
Efficiency of the decision support system for determining the severity of scoliotic spinal deformity by the analysis of radiographs
BACKGROUND: In 2020, a decision support system was developed at expense of grant from Innovation Promotion Fund and integrated into medical base of prosthetic and orthopedic center “Sсoliologic.ru.” It is the first computer program for determining severity of scoliotic spinal deformity in analysis of radiographs. AIM: To evaluate performance of a computer program for determining Cobb angle by comparing obtained automated data with manual measurement data by various specialists. MATERIALS AND METHODS: From medical base of prosthetic and orthopedic center “Sсoliologic.ru,” 411 digital radiographs of spine of children and adolescents were selected, which were drawn by a radiologist (BP-etalon), an orthopedic traumatologist with 5 years of experience and experience in vertebrology (OO), and an orthopedic traumatologist with less than 1 year of experience and no experience in vertebrology (OB) and computer program (KP). The number and proportion of exact matches and mean absolute percentage error (MAPE) of results of measuring the Cobb angle of reference data were compared with indicators obtained by OO, OB, and KP in, for various types of scoliosis according to the classification of Rigо, as well as in determining the main arc. Bland–Altman graphs were used. The mean absolute deviation (MAD) and MAPE for the main arc with magnitude ranging from 20° to >50° were calculated. RESULTS: The exact matches of KP with standard were 21%. Hence, every fifth measurement of the Cobb angle on X-ray, calculated automatically, was identical to standard. The highest proportion of matches with standard was noted in OO (33%), and the lowest in OB (16%). The highest accuracy of KP was found at types E1 and E2, and the arc of 3 was 30% and 24%, respectively. The proportion of KP matches with standard increased to 61%, with an error of 3°, and to 75%, with an error of 5°; with an error of 7°, the proportion of matches reached 84%. Moreover, the proportion of coincidences of a non-experienced researcher increased from 34% to 58%. When determining magnitude of the main arc of scoliosis, OO increased his/her accuracy by almost 2,6 times, KP by 2,1 times, and OB by 1,5 times. The MAD of KP for all major arcs was 3.8°. Good reliability of the obtained KP indicators compared to the reference (ICC = 0.9) was noted. CONCLUSIONS: The use of a computer program may be recommended for automated determination of Cobb angle, because current algorithm of computer program has been found to be accurate compared to reference measurement. Its accuracy was significantly higher than that of novice orthopedic traumatologists with no experience in vertebrology.
Slipped capital femoral epiphysis in children engaged in sports
BACKGROUND: Epiphysis displacement factors in slipped capital femoral epiphysis are defined as an external mechanical impact on the affected joint of different orientation and intensity, the nature of which may determine the type, direction, and severity of epiphysis displacement. There may be differences in the immediate causes of dislocation and in the nature of the course and timing of detection of the disease in children who were engaged in sports compared to those who were not engaged in sports. Identifying these differences may be beneficial for preventing the occurrence of epiphyseal displacement in slipped capital femoral epiphysis. AIM: To determine the immediate causes of epiphyseal displacement and the peculiarities of the course of SCFE in children practicing sports. MATERIALS AND METHODS: The study included 256 patients aged 11–14 years with slipped capital femoral epiphysis who were admitted at our center, from whom 68 patients were subsequently selected. The main group included 34 children who were engaged in sports and whose first symptoms of the disease appeared during training. The control group included 34 children who were not engaged in sports activities and whose first symptoms of the disease appeared for no apparent reason. Clinical, radiologic, and statistical methods of research were used. RESULTS: In the main group, no severe forms of slipped capital femoral epiphysis such as bilateral displacement, acute displacement with chronic displacement, and early complications of the disease were noted, whereas in the control group, the number of patients with such conditions was 6 (17.6%), 4 (11.8%), and 1 (2.9%), respectively. Additionally, in 2 (5.9%) children of the main group, an extremely rare “valgus” displacement of the epiphysis was detected. Both cases occurred in gymnast girls owing to the use of a special “split” sitting technique. CONCLUSIONS: Severe forms of slipped capital femoral epiphysis are less frequent in children who practiced sports than in those who were not engaged in sports. This is associated with earlier medical attention. “Valgus” displacement of the epiphysis is more common in children with slipped capital femoral epiphysis who practiced sports than in those who did not do sports. This may be attributed to the use of some of the most traumatic exercises in the training process.
Features of vertical body balance in children with asymmetric pectus excavatum before and after surgical correction
BACKGROUND: Currently, minimally invasive repair of pectus excavatum are being developed. However, studies on the physiological aspects of the patient’s body in response to surgery are limited. Recently, researchers have become interested in the functional diagnosis of the state of the musculoskeletal system in patients with this pathology. AIM: To assess the dynamics of vertical body balance in patients with severe right-sided pectus excavatum before and after minimally invasive reconstructive operations aimed at eliminating deformity. MATERIALS AND METHODS: Clinical radiation and stabilometric studies of 22 patients aged 13–16 years with right-sided pectus excavatum were conducted. Group A included patients with a low body mass index of 16.0 (15.3–17.7) kg/m2. Group B consisted of ten patients with normal body mass index values of 18.5 (17.7–20.4) kg/m2. In patients of both groups, an analysis of the stabilometric parameters of the movement of the general body pressure center and individually the pressure centers of the left and right lower extremities was performed before surgery and 1.5–2 years after. The patients underwent the same type of bone reconstructive surgery that is, minimally invasive repair of pectus excavatum. The stabilometric parameters of the patients were compared with similar parameters of 20 healthy children in the control group. RESULTS: In both groups of patients, a deterioration in vertical balance was recorded before surgery compared with healthy children. In group A, a relatively stable balance of the total body pressure center was revealed, with a deterioration in the movement parameters of the pressure centers of the left and right lower extremities. In contrast, in group B, the mechanism for ensuring a vertical stance was the opposite: a less stable balance of the general center of body pressure against the background of greater postural stability of the contralateral lower extremities was observed. This indicates heterogeneous locomotor strategies to ensure vertical balance in patients with different body mass indices. In the long term, to correct chest deformity after surgery, the patients of both groups showed opposite changes in the postural control system. In patients with a low body mass index, further deterioration was noted in vertical balance; the quality of balance function decreased from 78% to 69% (p < 0.05). Moreover, patients with normal body mass index showed an improvement in posture stability; the quality of balance function increased from 74% to 83% (p < 0.05). CONCLUSIONS: In patients with pectus excavatum with reduced body mass index, it is recommended to conduct an individual rehabilitation program after minimally invasive deformation correction to adapt them postoperatively and normalize the vertical balance of the body.
Usefulness and accessibility of information on the treatment of children with congenital clubfoot: results of a survey of parents
BACKGROUND: Treatment of congenital clubfoot remains controversial from both specialists and parents regarding the details of its practical application, individual effectiveness, and follow-up, rehabilitation treatment, prevention, and treatment of relapses. The assessment of parental attitudes using an online survey optimizes doctor–patient interaction. Information available to parents regarding the diagnosis and treatment of children with congenital clubfoot is lacking. AIM: This study aimed to assess the usefulness and accessibility of information for parents about the treatment of children with congenital clubfoot. MATERIALS AND METHODS: To assess the usefulness and accessibility of information about the treatment of congenital clubfoot, a survey of the patients’ parents was conducted using an electronic fillable form proposed for anonymous completion in a thematic group dedicated to the treatment of congenital clubfoot on the social network “VKontakte”; the study included 5500 participants at the time of the survey (2 weeks), with 328 responses received. RESULTS: Most parents noted a lack of information regarding clubfoot treatment before it actually began. The preferred source of information was Internet resources (i.e., websites of medical institutions and social networks). Achilles tenotomy and wearing braces raised the most questions, requiring additional information from both doctors and alternative sources. The possibility of errors and complications in wearing braces caused the greatest concern among parents, as well as possible relapses and the correctness of prescriptions during the rehabilitation treatment. Online parent communities and physician blogs are considered significant information sources. Most parents prefer to expand information about congenital clubfoot on the Internet, including social networks and popular resources. CONCLUSIONS: Analysis of the results of an anonymous survey of parents of children with congenital clubfoot showed a significant demand for high-quality, accessible information regarding the diagnosis, treatment, and rehabilitation of children with congenital clubfoot. Significant interest in the information provided by social media and other Internet resources determines the need for competent representatives of the professional community to participate in this process.
Efficacy of a new customized navigation template for placement of transpedicular screws for unilateral access in children with congenital spinal deformity and thoracic malformation
BACKGROUND: Surgical treatment of congenital spinal deformities combined with thoracic development anomalies in children is an urgent and a complex problem in surgical practice. The surgical method of correcting congenital deformities caused by segmentation disorder of the lateral surfaces of vertebral bodies and unilateral rib synostosis is aimed at correcting the existing deformity using a transpedicular system. This technique is effective for treating this group of patients. However, it requires precise and accurate installation of the supporting elements of the metal structure owing to the high risk of damage to the neurovascular structures in the area of surgical intervention. A solution to this problem is the use of an individualized guide template with rib support for unilateral access in children with congenital deformities of the thorax and spine. AIM: To perform a comparative analysis of the results of using an individual rib-supported guide template for transpedicular screw placement and the “free hand” method in children during surgical correction of congenital spinal deformities accompanied by thoracic development anomalies. MATERIALS AND METHODS: The study included 14 patients who underwent surgical treatment for congenital deformity of the thoracic spine against the background of segmentation disorder of the lateral surfaces of the vertebral bodies in combination with thoracic anomalies. The patients were divided into two groups. Group 1 included six patients operated on using a new navigation template guide, and group 2 consisted of eight patients who underwent installation of support elements using the “free hand” method. The following parameters were compared: time spent at the stage of formation of bone canals for the support elements of the metal structure and accuracy and correctness of support element installation. Clinical data included demographic information and the size of the scoliotic arch, number of support elements, and presence of complications. Statistical analysis using Student’s t-test for unpaired samples or Mann–Whitney test was used to compare results. RESULTS: Data obtained in the course of the study confirmed the high efficiency and accuracy and showed that the use of the template reduces the time of bone canal formation, increases the accuracy, and provides greater correctness of the position of the supporting elements compared to the “free hand” method, which increases the efficiency and safety of surgical treatment. CONCLUSIONS: The developed template guide with support on the rib for the installation of the supporting elements of the metal structure in the surgical treatment of children with congenital deformity of the thoracic spine in combination with thoracic development anomaly showed better results compared to the use of the “free hand” method.
Amplified pain and complex regional pain syndrome in children: clinical cases and literature review
BACKGROUND: Musculoskeletal pain is a common reason for visiting pediatric clinics. Causes of chronic musculoskeletal pain include various inflammatory or noninflammatory conditions. Amplified pain syndrome refers to a wide range of conditions manifested by chronic pain, the common feature of which is central and/or peripheral sensory amplification of pain. Complex regional pain syndrome is characterized by spontaneously occurring or provoked by irritating stimuli pain of high intensity, disproportionate to the actual injury or other stimulus, and the presence of several concomitant vegetative and motor disorders. CLINICAL CASES: This article presents three clinical cases of pediatric patients with chronic musculoskeletal pain and an analysis of the current literature on chronic pain in children. DISCUSSION: Complex regional pain syndrome is more common in adolescent girls, and conflict or psychological trauma is a common trigger. Symptoms of disproportionate burning pain (causalgia) with trophic changes may indicate complex regional pain syndrome. To date, there are no generally accepted pharmacological treatments recommended for children with complex regional pain syndrome. Nonsteroidal anti-inflammatory drugs (ibuprofen) and paracetamol and their combination are commonly administered in cases wherein symptoms of chronic pain first appear. CONCLUSIONS: Currently, a multidisciplinary approach, including physical, psychological, medical, and invasive methods, appears to be the most adequate treatment method for musculoskeletal pain. The use of analgesics should comply with approved protocols of pain management in pediatric practice.
Features of the state of bone tissue in children with cerebral palsy. Part 1. Etiological aspects. A literature review
BACKGROUND: The growth of the human body is the most significant period of development of the bone tissue, because it is during this period that the size, shape, and architectonics of bone are formed against the background of increasing body weight and increasing physical exertion. Considering a number of pathological factors of the underlying disease (alimentary, neurological, hormonal, stress, and physical), bone tissue in children with cerebral palsy grows and develops with deviations from the norm. АIM: To present up-to-date generalized information about the features of bone tissue in children with cerebral palsy to orthopedic traumatologists, neurologists, and physical therapy specialists. MATERIALS AND METHODS: Studies on the problem of bone tissue condition in patients with cerebral palsy were analyzed. Data published over the past 20 years were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language restrictions. RESULTS: In the last 20 years, the number of studies about pediatric osteoporosis has increased. The gold standard for determining the level of bone mineral density is dual-energy X-ray absorptiometry. However, its use in children has presented some difficulties and limitations. In children, the relationship between bone mineral density values and the risk of fractures has not been well studied, which does not allow us to discuss about osteoporosis based on densitometric bone mineral density data alone. In patients with cerebral palsy, a decrease in bone mineral density and bone mass during growth was found. Previous studies showed that the main factors associated with a decrease in bone mineral density in this group of patients include neuroendocrine causes due to growth retardation against the background of CNS damage, alimentary factors, decreased calcium and vitamin D concentrations, systemic use of glucocorticoids, intake of antiepileptic drugs, decreased motor activity, and low muscle mass. Increasing serum vitamin D concentrations does not have a positive effect on bone mass, although increasing serum calcium concentrations is associated with an increase in bone mineral density. CONCLUSIONS: Identifying and correcting factors leading to decreased bone mineral density in children with cerebral palsy can improve bone health in this group of patients. The absence of a relationship between bone mineral density values and the risk of fractures in children with cerebral palsy does not allow us to discuss about osteoporosis based only on bone mineral density densitometric data. There may be more factors leading to an increased risk of bone fractures in children with cerebral palsy that require further study.
Experimental burn models for evaluating wound healing agents and its current situation and existing disadvantages: a literature review
BACKGROUND: Burns remain a crucial part of the structure of injuries in Russia and abroad. Therefore, providing high-quality medical care to burn victims is relevant. Despite the large number of proposed solutions to this condition, developments in the field of tissue engineering and medical materials science still lack standardization and consideration of specific features of animal burn models for their testing. Many studies showed minor and major disadvantages from a technical and descriptive point of view. AIM: To analyze and identify the main disadvantages of existing burn models to assess the effect of wound healing agents. MATERIALS AND METHODS: This article examines the search results in the databases Google Scholar and PubMed using the keywords “burns,” “rats,” “animal model,” and “wound healing.” Sixty publications were analyzed. RESULTS: Seven quality criteria for the animal burn model have been determined, which allow obtaining reliable results and reproducing the described experiment: indication of the terms of quarantine and conditions of keeping laboratory animals, detailed description of the technique of applying burn injury, presence of one burn on a laboratory animal, presence of a control biopsy, indication of the absolute value of the initial burn area, presence of surgical treatment of burn wounds, and correct use of formulas for the planimetric assessment of wound healing. CONCLUSIONS: A solution to the problem of creating a standardized model may be a more detailed description of techniques and following the proposed quality criteria.
Impact of pectus excavatum deformity on the cardiopulmonary function: a literature review
BACKGROUND: Pectus excavatum deformity is the most common chest wall malformation. Currently, surgeons and researchers of this problem have no consensus on whether pectus excavatum is a purely aesthetic problem or whether pectus excavatum disturbs the function of the cardiopulmonary system. AIM: To analyze publications on the effect of pectus excavatum on the cardiorespiratory system and the functional features of the heart and lung after thoracoplasty in patients with pectus excavatum. MATERIALS AND METHODS: Data were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language limitation. In this article, the method of analysis and synthesis of information was used. Most of the studies included in the analysis were published in the last 20 years. RESULTS: In patients with pectus excavatum, severity of cardiorespiratory dysfunction depends on the degree of chest deformity. According to obtained data, the pulmonary function test in patients with pectus excavatum in the majority of cases revealed restrictive pattern (formed vital capacity <80% of the norm, with normal ratio of forced expiratory volume in 1 minute to forced lung capacity). In most cases, echocardiography showed compression of the right heart chambers. Comparative analysis of the pre- and postoperative study of cardiorespiratory system in most cases indicated improvement and adaptation of the cardiopulmonary system to stress after surgical intervention. CONCLUSIONS: Funnel chest is an aesthetic problem wherein a severe degree of deformity leads to impaired respiratory mechanics and dysfunction of the cardiovascular system. Surgical restoration of the volume of the retrosternal space allows improvement of the functional capabilities of the heart and lungs.
Valentin A. Neverov, Honored Physician of the Russian Federation, Doctor of Medical Sciences, Professor, celebrates his 80th birthday. V.A. Neverov is the president of the Russian Association of Traumatologists-Orthopedists of St. Petersburg and Leningrad Region, a member of the editorial board of the journals Grekov’s Bulletin of Surgery and Traumatology and Orthopedics of Russia, and a member of the dissertation council on traumatology and orthopedics. His main scientific research focuses on reconstructive and restorative surgery of the musculoskeletal system and hip arthroplasty.
Prognostic efficiency of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy
BACKGROUND: A feature of the disease course in patients with spastic cerebral palsy is a combination of motor neurological disorders with contractures in extremity joints. Neurosurgical methods are currently the main treatment for correcting the pathological tone of the “spastic hand.” However, the decreased tone does not affect secondary (fixed) contractures; therefore, the effectiveness of this type of treatment is extremely dependent on the accurate selection of a certain category of patients. Presumably, diagnostic blockade of the median nerve can create a reversible model for planned neurosurgical treatment. The inclusion of this technique as a standard for examining a patient with spastic cerebral palsy before invasive tone-lowering treatment can radically promote treatment effectiveness. AIM: This study aimed to assess the prognostic effectiveness of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy. MATERIALS AND METHODS: A longitudinal prospective study enrolled 39 children (aged 5–18 years) with spastic cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic n. medianus under electrical stimulation and ultrasound control. After a diagnostic blockade, only patients who had a good functional and goniometric response were selected for the study, which served as an indication for selective neurotomy of the median nerve, and orthopedic treatment was performed in children with a negative event. Patients referred for neurotomy underwent a standardized examination before treatment during the diagnostic blockade and after neurosurgical treatment. The examination included the assessment of the amplitude of passive and active movements in the joints of the upper extremities, muscle tone, and functional capabilities of the upper extremities and dynamometry. RESULTS: In comparison with the initial data, a significant increase in the amplitude of passive and active hand extension, passive and active abduction of the first finger, and upper limb functional capabilities according to the MACS classification and the Miller scale was determined both after the diagnostic blockade and after selective neurotomy of the motor branches of the median nerve. CONCLUSIONS: Based on the results of the study, the effect of the diagnostic blockade and neurosurgical treatment outcomes are unidirectional, which allows the use of blockade as a method for modeling the possible result in clinically complex cases of spastic hand. The use of diagnostic blockade in clinical practice makes it possible to adequately assess the severity of fixed contractures and reduce the pathological hypertonicity of the target muscles. Diagnostic blockade allows for the collection of sufficient information to make an objective decision about which type of treatment is most preferable for each patient – neurosurgical, orthopedic, or sequential use of both methods.
Musculoskeletal injuries and pain in children involved in sports: A literature review
BACKGROUND: In children, sports aims to obtain positive emotions and improve health and personal development. Sports injuries are associated with various risk factors, such as sex, age, previous injuries, and early specialization. AIM: This study aimed to analyze published data on the epidemiology, etiology, pathogenesis, and diagnosis and treatment of musculoskeletal injuries and associated pain in children engaged in sports. MATERIALS AND METHODS: The literature regarding the epidemiology, diagnosis, and treatment of pain in children involved in sports was explored. The literature search garnered 64 publications, including original articles, reviews, and normative documents. RESULTS: For most athletes, pain commonly occurs during training and competition. Injuries are an inherent risk when playing sports. However, coaches and parents can minimize the risk of injury by ensuring that they choose the right sports activities, use appropriate equipment, follow the rules, use safe practice, and provide adequate supervision. The negative consequences of sports injuries must be balanced with the social, psychological, and health benefits of sports participation. CONCLUSIONS: Treatment of injuries and analgesia must be implemented effectively to prevent pain from becoming chronic and reduce psychological burden on the young athletes.
Advantages of using template guides in children for the correction of congenital spinal deformities and thoracic anomalies
BACKGROUND: In children, progressive congenital deformities of the thoracic spine combined with thoracic anomalies require surgical intervention to correct the curvature and prevent further progression during the child’s growth. Surgical correction of congenital deformity caused by segmentation disorders of the lateral surfaces of the vertebral bodies with unilateral rib synostosis aims at full correction of the existing curvature using the transpedicular spinal system and is an effective and reliable treatment option for these patients. However, this technology requires precise and correct installation of the supporting elements of the metal structure to exclude possible irreversible complications. A solution is the use of template guides in the installation of the support elements of the spinal metal structure. AIM: This study aimed to conduct a comparative analysis of the results of using template guides for the placement of transpedicular screws with the free-hand method in children during surgical correction of congenital spinal deformities combined with thoracic anomalies. MATERIALS AND METHODS: The results of surgical treatment of 20 patients, aged 3–9 years, were analyzed retrospectively to compare the time and accuracy of spinal metal support element placement with and without the use of template guides. The data collected included demographic information, time of bone canal formation, accuracy of spinal transpedicular screw placement, and various complications. RESULTS: Compared with the free-hand method, the use of template guides in the surgical correction of congenital spinal deformities combined with thoracic anomalies in children reduces the time of bone canal formation and increases the accuracy of metal screw placement. These results confirm the efficacy and safety of using template guides during spinal surgery in children with these congenital malformations. CONCLUSIONS: The use of template guides is an effective and reliable method of inserting transpedicular metal screws in the correction of congenital spinal deformities combined with thoracic anomalies in children, which increases the accuracy of implantation of support elements and reduces the surgical time. These results confirm the necessity of using template guides in the correction of congenital spinal deformities in children.
Clinical and radiological variants of the nail–patella syndrome: Why is it important to make a correct diagnosis?
BACKGROUND: Nail–patella syndrome is an autosomal dominant disease caused by LMX1B mutations, characterized by a combination of dermatological and musculoskeletal abnormalities. The classic tetrad of the nail–patella syndrome includes hypoplasia of the nail plates, absence or hypoplasia of the patella, elbow joint contractures, often accompanied by posterior subluxation of the radial head, presence of “iliac horns” on radiographs of the pelvic bones, and renal changes. However, its diagnosis and treatment are not described in sufficient detail in domestic and foreign literature. AIM: This study aimed to analyze the variability of clinical and radiological manifestations in children with nail–patella syndrome. MATERIALS AND METHODS: Nine patients with nail–patella syndrome were examined and treated (aged 4 months to 14 years). All children presented to the H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery with a diagnosis of congenital multiple arthrogryposis. The examination results excluded this diagnosis. The diagnosis of nail–patella syndrome has been verified. RESULTS: Various variants of the nail–patella syndrome have been identified, with lesions to only the elbow joints (n = 3), damage to the upper and lower extremities (n = 5), and damage to only the lower extremities (n = 1). All patients had hypoplasia of fingernail plates. However, the pathognomonic sign – “iliac horns” on radiographs of the pelvic bones – was noted only in 33% of cases. Regarding functional disorders of the kidneys, proteinuria was observed in one patient, which appeared at the age of 15 years. In two cases, the parents suffered from this disease. A genetic examination was performed in three patients: a pathogenic variant in LMX1B was detected in a heterozygous state. All patients underwent conservative treatment for knee and elbow joint contractures and foot deformities. When casting, the presence of dislocation of the radial head or patella was considered. Surgical treatment was performed on five patients. The results of surgery on the lower extremities (knee contractures, foot deformities, and hip dislocation) were good in 87% of the cases. Recurrence of flexion contractures in the elbow joints was observed both after conservative and after surgical treatment in all cases; however, their severity varied. CONCLUSIONS: Clinical observations were considered to attract the attention of doctors of different specialties to a rare pathology. Moreover, a molecular genetic study is recommended for the timely diagnosis of the nail–patella syndrome, determining the treatment techniques and disease prognosis.
BACKGROUND: Achilloplasty is one of the most common procedures in the reconstruction of various foot deformities. Achilles tendon lengthening is often used in most reconstructive interventions in patients with flatfeet. Literature data reflecting the dynamics of foot dorsiflexion after percutaneous achilloplasty are limited. AIM: This study aimed to determine the foot dorsiflexion dynamics in children with flatfeet at different time points after foot reconstruction in combination with percutaneous Achilles tendon lengthening. MATERIALS AND METHODS: The study included the observation results of 159 children (260 feet) aged 12 (9–17) years having flatfeet with Achilles tendon shortening after flatfoot reconstruction and percutaneous Achilles tendon lengthening. Dynamic follow-up was performed for 3 years after foot reconstruction. The obtained data were analyzed statistically by nonparametric one-factor analysis of variance, Kruskal–Wallis and post hoc test, pairwise comparisons, and Dwass–Steel–Critchlow–Fligner test. RESULTS: At follow-up after Achilles tendon lengthening, significant differences were obtained in the magnitude of the initial foot dorsiflexion up to 2 years after surgery, and other indicators were not significantly different. Foot dorsiflexion with tarsal joint stabilization was significantly different at all stages of follow-up compared with baseline. Foot dorsiflexion tended to decrease throughout the follow-up period. CONCLUSIONS: After reconstructive interventions on the feet in combination with percutaneous Achilles tendon lengthening, the dorsiflexion of the feet decreased over time. At 2 and 3 years after Achilles surgery, dorsiflexion was not significantly different from baseline. The angle of dorsiflexion of the feet with the tarsal joint stabilization 3 years after Achilles tendon lengthening was significantly different from the initial level, but throughout the follow-up there was also a tendency to its gradual decrease.