scholarly journals Analysis of causes of metal structure destabilization in correction of congenital spinal deformation in children of a younger age group

2020 ◽  
Vol 8 (1) ◽  
pp. 15-24
Author(s):  
Dmitry N. Kokushin ◽  
Sergei V. Vissarionov ◽  
Michael A. Khardikov ◽  
Nikita O. Khusainov ◽  
Aleksandra N. Filippova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Trauma Surgery ◽  
Congenital Scoliosis ◽  
Metal Structure ◽  
Average Diameter ◽  
Control Group ◽  
Anthropometric Parameters ◽  
National Medical ◽  
Repeated Surgery

Background. One of the most common vertebral malformations that lead to the occurrence and progression of congenital scoliosis is disorders of vertebral formation. Most specialists adhere to the active tactics of surgical correction of spinal deformity in early childhood. The aim. To evaluate the variants and causes of the transpedicular spinal system destabilization, which is not related to the violation of its integrity, in the surgical treatment of children with congenital spinal deformities. Materials and methods. The case histories of 286 children under the age of 6 years undergoing surgical treatment in H. Turner National Medical Research Center for Сhildrens Orthopedics and Trauma Surgery between 2014 and 2019 were analyzed. Depending on the outcome of the surgical treatment, the patients were divided into groups: the main group (n = 7) included those with spinal system destabilization and the control group (n = 12) consisted of those without spinal system destabilization. During the study, the sizes of the bases of the arcs adjacent to the abnormal vertebra, the magnitude of the scoliotic and kyphotic components of the deformation, and the correct position of the supporting elements of the spinal system on the Gertzbein scale were determined. Results. Patients of the studied groups were identified according to their age and the magnitude of scoliotic and kyphotic components of spinal deformity. The average diameter of the arc base in the studied groups varied (p 0.05). In all patients, the complete correction of the congenital curvature of the spine was achieved after surgery. In the long-term postoperative period in patients of the study group after radiation analysis, the malposition of supporting elements relative to the base of the vertebral arch and a loss of correction of spinal deformity by an average of 25 were revealed, which required the repeated surgery in order to restore the stability of the spinal system and to correct deformation. Conclusions. The reasons for the spinal system destabilization during the correction of the spinal congenital deformations are the peculiarities of vertebral anatomical-anthropometric parameters in the curvature zone, as well as tactical aspects during surgery. The main reason for the spinal system destabilization without violating its integrity is the small size of bases of adjacent vertebral arches relative to the abnormal one. The small size of the bases of the vertebral arches and the significant amount of necessary correction of congenital spinal deformity necessitate the installation of a longer spinal system in order to restore physiological profiles in the curvature zone.

scholarly journals Use of torso orthoses in the treatment of congenital spinal deformities: A literature review

2021 ◽  
Vol 9 (2) ◽  
pp. 235-244
Author(s):  
Ignatij А. Redchenko ◽  
Sergei V. Vissarionov ◽  
Maxim G. Gusev ◽  
Grigoriy A. Lein ◽  
Ivan V. Pavlov
Keyword(s):  
Surgical Treatment ◽  
Congenital Malformations ◽  
Congenital Scoliosis ◽  
Metal Structure ◽  
Congenital Deformity ◽  
Spinal Deformities ◽  
Complex Treatment ◽  
Clear Trend ◽  
Keywords And Phrases ◽  
Significant Correction

BACKGROUND: Congenital malformations of the spine require urgent treatment, despite the popularity of this problem. The choice of the term and method of surgical treatment of congenital spinal deformities with vertebral malformations does not have diametrically opposed views in the domestic and foreign literature, but the scientific discussion continues regarding the use of orthotics. Currently, several designs of orthoses on the trunk are known worldwide, which can be used not only for idiopathic but also for congenital scoliosis. А unified view of the use of this type of complex treatment is necessary, but there are opposite opinions in the scientific literature. AIM: This study aimed to analyze publications that present the use of torso orthoses in the treatment of congenital malformations of the spine. MATERIALS AND METHODS: We searched for data in the open electronic databases of PubMed and e-LIBRARY using the following keywords and phrases: congenital deformity of the spine, congenital scoliosis, orthosis, and effectiveness of orthosis. The search covered 30 years of literature. RESULTS: Several authors have reported a significant correction of the congenital curves using orthotics, but this issue has not been sufficiently studied and is still at the research stage. Some specialists consider the formation or progression after the operation of compensatory counter-curve above or below the established metal structure, which can be corrected not only by repeated surgery, but also by using orthoses. CONCLUSIONS: There is a clear trend toward complex treatment of children with isolated congenital malformations of the spine, including a reasonable combination of surgical treatment and orthotics. In Europe and Russia, preference is given to the Rigo system Cheneau brace.

scholarly journals The use of guide templates in the surgical treatment of preschool children with congenital scoliosis of thoracic and lumbar localization

2020 ◽  
Vol 8 (3) ◽  
pp. 305-316
Author(s):  
Dmitry N. Kokushin ◽  
Sergei V. Vissarionov ◽  
Alexey G. Baindurashvili ◽  
Alla V. Ovechkina ◽  
Nikita O. Khusainov ◽  
...  
Keyword(s):  
Preschool Children ◽  
Surgical Treatment ◽  
Structural Changes ◽  
Young Patients ◽  
Congenital Scoliosis ◽  
Metal Structure ◽  
Optimal Size ◽  
Correct Position ◽  
Grade Ii ◽  
Vertebral Bodies

Background. The use of transpedicular screws as support elements from the standpoint of biomechanics is preferable as compared to that of laminar fixation, albeit the former carries the risk of various complications (such as malposition screws, damage to the Dura mater, spinal cord, and major blood vessels) caused by structural changes in the vertebrae under the background of their defects, with small size of roots arcs vertebrae in young children. Thus, the issue of ensuring safe and correct installation of transpedicular screws in the surgical treatment of children with congenital scoliosis remains relevant. Aim. We aimed to evaluate the correctness of the position of the transpedicular screws installed in the vertebral bodies in preschool children with congenital scoliosis of thoracic and lumbar localization using guide templates (SHN). Materials and methods. We conducted a prospective analysis of the outcomes of surgical treatment of 30 patients with congenital scoliosis against the background of impaired formation of the vertebrae of the thoracic and lumbar spine. The patients included 12 boys and 18 girls of age: 1 year 8 months to 6 years 5 months (average: 3 years 4 months). Based on the computed tomography of the spine, performed postoperatively, the correctness of the position of the installed elements of the corrective multi-support metal structure was evaluated. The correctness of the position of the installed transpedicular support elements was evaluated based on the scale described by S.D. Gertzbein and co-authors (1990). Results. The total number of implanted transpedicular screws sets was 96 (100% of the planned transpedicular screws set), and 48 SHN were used for transpedicular screws installation. The correct position of installed screws by degree of displacement revealed Grade 0 93.7% (90 screws), Grade I 4.2% (4 screws), Grade II 2.1% (2 screws), Grade III 0%. The number of screws with a Grade 0 + Grade I offset was 94 (97.9%). Conclusion. The results obtained with the use of SHN among preschool children with congenital scoliosis of thoracic and lumbar localization revealed high accuracy and correctness of transpedicular screws installation (93.7%) with the use of this type of navigation in clinical practice. The use of SHN for installing transpedicular screws in the surgical treatment of congenital spinal deformities in young patients allows for the selection of the optimal size and correct position of the transpedicular support elements in the vertebrae to be instrumented.

scholarly journals Differentiated approach to radical surgical treatment of elderly patients with tumor diseases of the pancreatoduodenal zone

2021 ◽  
Vol 13 (2) ◽  
pp. 49-56
Author(s):  
Badri V. Sigua ◽  
Vyacheslav P. Zemlyanoy ◽  
Alexey V. Gulyaev ◽  
Malkhaz Yu. Tsikoridze ◽  
Evgeny A. Zakharov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Comparison Group ◽  
Main Group ◽  
Control Group ◽  
Study Group ◽  
Tumor Diseases ◽  
Results Of Treatment ◽  
Repeated Surgery ◽  
Pancreatic Fistulas

BACKGROUND: In recent years, there has been a widespread increase in the incidence of tumors of the pancreatoduodenal zone, especially noticeable in the older age group. A decrease in the incidence of postoperative complications and mortality after pancreatoduodenal resection made it possible to expand the indications for surgical treatment of elderly and senile patients. AIM: Improvement of the immediate results of pancreatoduodenal resection in the treatment of elderly and senile patients suffering from tumor diseases of the pancreatoduodenal zone. MATERIALS AND METHODS: Pancreatoduodenal resection was performed in 61 elderly and senile patients with tumors of the pancreatoduodenal zone. The main group consisted of 32 patients, whose treatment was carried out in accordance with the developed algorithm for choosing a method for forming a pancreatodigestive anastomosis based on a scale for assessing the risk of developing pancreatic fistulas. The comparison group consisted of 29 patients in whom the method of forming a pancreatodigestive anastomosis was carried out in accordance with the preferences of the operator without taking into account the risk of developing a pancreatic fistula. RESULTS: In the main group, compared with the control group, pylorus-saving interventions were performed significantly more often 27 (84.4%) and 14 (48.3%) (p 0.01). There was also a decrease in the frequency of performing pancreaticojejunostomy 16 (50%) and 22 (75.9%) (p 0.05), due to the use of reservoir terminolateral pancreatojejunostomy 8 (25%) and 0, respectively (p 0.01). Postoperative complications were observed in 14 (43.8%) of the study group and in 21 (72.4%) patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 8 (27.6%) to 2 (6.2%) (p 0.05) in the study group. Repeated surgery was required in 5 (15.6%) patients of the main group and 11 (37.9%) in the comparison group (p 0.05). The lethal outcome was recorded in 3 (9.4%) patients of the main group and in 7 (24.1%) in the comparison group (p 0.05). CONCLUSIONS: The results of performing pancreatoduodenal resection in the treatment of elderly and senile patients can be comparable with the results of treatment of the general population. The use of the developed algorithm made it possible to reliably reduce the incidence of complications from 72.4 to 43.8% (p 0.05), postoperative pancreatic fistulas from 27.6 to 6.2% (p 0.05), as well as the frequency of repeated interventions. from 37.9 to 15.6 % (p 0.05). In addition, a downward trend in mortality was achieved from 24.1% to 9.4%.

scholarly journals Algorithm of medical care for children with polytrauma

2020 ◽  
Vol 7 (4) ◽  
pp. 67-78
Author(s):  
Damir I. Yunusov ◽  
Viktoriya Yu. Aleksandrovich ◽  
Petr I. Mironov ◽  
Konstantin V. Pshenisnov ◽  
Gleb E. Ulrich ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Treatment ◽  
Medical Care ◽  
Trauma Surgery ◽  
Main Group ◽  
Control Group ◽  
Skeletal Traction ◽  
Surgical Department ◽  
Icu Stay ◽  
Specialized Center

Backgrоund. Polytrauma is the main reason for incapacitation and death in children of all ages. The appropriate timing of specialized medical care plays a crucial role for the outcomes of the polytrauma. Aim. The aim of the study is to analyze the results of the treatment of musculoskeletal injuries with the use of a decision-making algorithm in pediatric patients with polytrauma. Materials and methods. This is a prospective, observational, controlled, single-center study. The research included 130 children who were divided into two groups. In the main group, the children were provided with specialized medical care by a multidisciplinary team. After stabilization, the patients were transferred to a specialized center for final surgical treatment by minimally invasive fracture osteosynthesis. After the elimination of existing life-threatening conditions and the fitting of skeletal traction, the patients in the control group received surgical treatment only after transferal to a specialized center. Results. In the main group, pain regressed significantly earlier (1.7 0.6 vs 3.2 0.4, p 0.05), and the duration of the postoperative ICU stay was significantly reduced (1.5 0.9 vs 2.4 1.4 days, p 0.05). The optimization of the surgical treatment of injuries facilitated a reduction in the duration of the ICU stay of patients in the main group (5.6 0.3 vs 6.5 0.4 days), in the surgical department (21.5 0.7 vs 25 0.9 days), and the overall hospital stay (up to 27.5 days). Conclusions. This study developed a decision-making algorithm for administering medical care to children with polytrauma based on the principle of stabilization of the condition and early low-trauma surgery in the hours following injury.

scholarly journals Venous resections and reconstructions in surgery of pancreatic cancer

2020 ◽  
Vol 28 (3) ◽  
pp. 340-349
Author(s):  
Oleg I. Kit ◽  
Oksana V. Katelnitskaya ◽  
Andrey A. Maslov ◽  
Yuriy A. Gevorkyan ◽  
Evgeniy N. Kolesnikov
Keyword(s):  
Pancreatic Cancer ◽  
Surgical Treatment ◽  
Palliative Chemotherapy ◽  
Average Diameter ◽  
Early Postoperative Period ◽  
The Body ◽  
Portal System ◽  
Control Group ◽  
Tumor Infiltration ◽  
Venous Resection

Aim. To evaluate results of venous resections in tumor infiltration of venous wall in pancreatic cancer (PC). Materials and Methods. The study included 74 patients with PC and tumor invasion of the wall of the mesenteric-portal system (T3 N0-1 M0). The control group included patients (n=53), receiving palliative chemotherapy. The average age of patients in the group of surgical treatment was 61.89.8 years, in the control group 63.210.1 years (р0.05), the average diameter of the tumor was 39 mm and 43 mm, respectively (р0.05). In 62 cases of the group of surgical treatment the tumor was located in the head of pancreas (P), the patients were conducted pancreaticoduodenal resection with venous resection. In the rest of cases (n=12) the tumor was located in the body of P, corporocaudal resection of P was conducted with venous resection. Results. In the early postoperative period 2.7% of patients developed thrombosis of the reconstruction zone, 1.4% developed bleeding. 30-Day postoperative lethality was 4.1%. Median survival in surgical treatment of PC with venous resection was higher in comparison with palliative chemotherapy: 19 months vs 13 months, р0.05. In the group of venous resection the lowest annual survival (46.2%) was noted in patients with marginal resection of the vein. No significant differences were found in the parameters of survival with use of direct venous anastomose and venous prosthetics (66.7% vs 63.2%, p0.05). Conclusions. Angioplastic interventions permitting to achieve microscopically complete resection of the tumor in PC with tumor infiltration of mesenteric-portal system, permit to improve survival of patients in comparison with palliative chemotherapy.

scholarly journals Treatment strategies for early-onset scoliosis

2018 ◽  
Vol 3 (5) ◽  
pp. 287-293 ◽  
Author(s):  
Ilkka J. Helenius
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Spinal Deformity ◽  
Early Onset ◽  
Treatment Strategies ◽  
Congenital Scoliosis ◽  
Early Onset Scoliosis ◽  
Growing Rods ◽  
Paediatric Orthopaedic ◽  
Short Spine

Early-onset scoliosis (EOS) is defined as a spinal deformity occurring before the age of ten years. Untreated EOS or early spinal fusion resulting in a short spine is associated with increased mortality and cardiopulmonary compromise. EOS may progress rapidly, and therefore prompt clinical diagnosis and referral to a paediatric orthopaedic or spine unit is necessary. Casting under general anaesthesia can be effective and may prevent or delay the need for surgery in curves of less than 60°. ‘Growing’ rods (traditional or magnetically-controlled) represent the standard surgical treatment in progressive curves of 45° or greater. Children with congenital scoliosis associated with fused ribs benefit from surgery with a vertical titanium prosthetic rib. Surgery with growth-friendly instrumentation is associated with a high risk of complications.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170051

scholarly journals SURGICAL TREATMENT OF THE COMBINED NON-NEOPLASTIC PATHOLOGY OF THE ANAL CHANNEL AND RECTUM

2016 ◽  
pp. 22-25
Author(s):  
A. V. Borota ◽  
F. I. Gulmamedov ◽  
V. A. Gulmamedov ◽  
G. E. Polunin ◽  
I. A. Plahotnikov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Anal Canal ◽  
Average Duration ◽  
Surgical Pathology ◽  
Control Group ◽  
Duration Of Surgery ◽  
Duration Of Hospitalization ◽  
Repeated Surgery

PURPOSE. To evaluate the results of surgical treatment of hemorrhoids in combination with other pathologies of the rectum and anal canal. MATERIALS AND METHODS. 331 patients are operated in clinic concerning non-neoplastic surgical pathology of the anal channel (AC) and the rectum (R) from 2012 to 2015. The probed group (PG) was 159 (48,0±2,7%) patients who underwent combined surgical treatment of hemorrhoids and other pathology AC and R. Control group (CG) was 172 (52,0±2,7%) patients who underwent hemorrhoidectomy. RESULTS. The average duration of surgery in PG was 28±5 min, in CG - 19±3 minutes (p>0.05). The amounts of long-term postoperative complications in the PG was 4,4±1,6/, in the CG - 2,3±1,1% (p> 0,05).The average duration of hospitalization in the PG was 5,1±1,0 days, in СG - 3,2±1,0 days (p> 0,05), the duration of rehabilitation in the PG was 20,3±3,2 days, in CG -15,1±2,0 days (p>0,05). CONCLUSION. Existence of the pathology of AC and R in combination with hemorrhoids is the indication to the combined surgical treatment. The increation in the duration ofsurgery, postoperative complications, duration of hospitalization and rehabilitation in the PG compared with the CG are not statistically significant. Simultaneous surgical treatment of hemorrhoids and other pathologies AC and R relieves the patient from having to perform repeated surgery and its possible complications.

scholarly journals The use of orthotics in a patient with congenital backbone deformation after surgical treatment

2018 ◽  
Vol 6 (4) ◽  
pp. 103-109
Author(s):  
Vladislav V. Murashko ◽  
Dmitry N. Kokushin ◽  
Sergei V. Vissarionov ◽  
Grigoriy A. Lein ◽  
Ivan V. Pavlov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Postoperative Period ◽  
Clinical Observation ◽  
Surgical Intervention ◽  
Congenital Scoliosis ◽  
Congenital Deformity ◽  
Congenital Deformities ◽  
Thoracic And Lumbar Spine ◽  
Congenital Spinal Deformity

Introduction. New questions of indications and methods of surgical treatment of children with congenital spinal deformity are covered in detail. However, straightening deformed segment of the spine and fixing with metal construction is not sufficient, and conditions for its retention and prevention of migration must be created. The expediency of the study is relevant because of lack of systematic review of the results of orthotic support as complex treatment of this group of patients, both in Russia and abroad. The problems faced by vertebral surgeons are the following: the tendency of deformation relapse as the child grows, tendency of deformation of unfixed (lower and upper) segments of the vertebral column. Clinical case. For observation, we selected an 11-year-old patient. The diagnosis was congenital scoliosis on posterolateral hemivertebra Th4, dysplastic course of congenital spinal deformity. The surgical treatment performed was extirpation of hemivertebra Th4(S) and the correction of local congenital deformity with multicore corrective system in combination with bone grafting. We achieved complete correction of congenital local curve at the level of the posterior lateral hemivertebra and reduction of compensatory curves in the thoracic and lumbar spine. In the postoperative period, the patient was provided with corrective brace, with the aim of influencing on the compensatory curve. Discussion. This clinical observation aimed to determine the different approaches to treatment of children with congenital deformities of the thoracic spine, which consists of surgical correction of local congenital curvature curve with subsequent correction of compensatory curves by using a correcting brace. Conclusion. As a result of the surgical intervention, correction of congenital spinal deformity was achieved, and the use of a corrective brace in the postoperative period allowed the correction of compensatory curves and maintained the achieved result until the end of the patient’s growth.

Severity of Penetrating Eye Trauma in Children in Tajikistan

2020 ◽  
pp. 39-42
Author(s):  
K.M. Saidzhamolov ◽  
◽  
E.V. Gromakina ◽  
S.K. Makhmadzoda ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Eye Injury ◽  
Case Histories ◽  
Second Child ◽  
National Medical ◽  
Eye Trauma ◽  
Penetrating Eye Injury ◽  
Eye Damage ◽  
The Republic ◽  
Large Wound

Purpose. To assess the severity of penetrating eye trauma in children in Tajikistan. Material and methods. Retrospectively there was analyzed 277 case histories of children with a diagnosis of penetrating eye injury, admitted to the children’s department of the National Medical Centre of the Republic of Tajikistan for the provision of specialized ophthalmological care. Results. The average age of children at the time of injury to the organ of sight was 7.06 ± 3.01 years, mainly these were villagers (70%). Children under 7 years old accounted for 57.8% of those admitted to the hospital. The terms of admission to the hospital ranged from 1 to 14 days, an average of 43.02 ± 33.35 hours. The severity is caused by damage to 2 or more structures of the eyeball in 81,3%. Wounds larger than 6 mm prevailed and amounted to 63,5%. Endophthalmitis at admission was noted in 8,3% of cases. Enucleation was performed in 2 children; 244 children underwent primary surgical treatment. Visual acuity at discharge was higher than 0.1 in 72 of 275 children (26.2%), lower than 0,1 in 194 (70.7%). Conclusion. Almost every second child (43.0%) is admitted to the hospital for primary surgical treatment of an eyeball wound after 24 hours. About 2/3 of cases of eye damage are characterized by large wound sizes. Stab wounds were noted in 90.2% of cases. In 58.8% of cases, damage to the cornea was observed and in 68.6% – damage to the lens area.

scholarly journals The Association of Obesity and Liver Enzyme Activities in a Student Population at Increased Risk for Cardiovascular Disease / Veza Između Gojaznosti I Aktivnosti Jetrenih Enzima U Studentskoj Populaciji Sa Povećanim Rizikom Za Nastanak Kardiovaskularnih Bolesti

2013 ◽  
Vol 32 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Emina Čolak ◽  
Dragana Pap ◽  
Nada Majkić-Singh ◽  
Ivana Obradović
Keyword(s):  
Body Mass Index ◽  
Waist Circumference ◽  
Liver Enzyme ◽  
Body Mass ◽  
Statistical Processing ◽  
The Body ◽  
Control Group ◽  
Anthropometric Parameters ◽  
Nonalcoholic Fatty Liver ◽  
Increased Risk

Summary Background: It has been reported that obesity is associated with metabolic syndrome, insulin resistance, cardiovascular risk but also with nonalcoholic fatty liver disease (NAFLD). The prevalence of obesity in children and adolescents is increasing rapidly all over the world. The aim of this study was to analyze the value of liver enzymes: AST, ALT and γGT in a group of obese students in order to establish their correlation to anthropometric parameters such as: BMI (body mass index), WC (waist circumference), HC (hip circumference), and WHR (waist-to-hip ratio) compared to non-obese students who comprised the control group (CG). Methods: In this study, 238 students from the University of Novi Sad of both sexes (126 men and 112 women) with a mean age of 22.32 ± 1.85 years were included. According to the body mass index (BMI) lower and higher than 25 kg/m2 and waist circumference (WC) lower and higher than 94 cm (80 cm for females) the whole group of 238 students was divided into 2 subgroups: the obese group at increased risk for CVD (Group 1) and the group at lower risk for CVD (Group 2). AST, ALT and γGT activities were determined in fasting blood samples. Results: Statistical processing data revealed significantly higher values of AST, ALT and γGT in the group of students with BMI>25 kg/m2, WC>94 cm for males and WC>80 cm for females, HC>108 cm for males and HC>111 cm for females, and WHR>0.90 for males and WHR>0.80 for females (P<0.001). Significant association was established between anthropometric parameters and liver enzyme levels (P<0.0001). Conclusions: Obese students with higher BMI, WC, HC and WHR values have higher liver enzyme activites and a higher chance to develop NAFLD in the future.

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