电邮这篇文章 Fractures of lower limbs in children with spina bifida
- 作者: Ivanov S.V.1, Kenis V.M.1, Prokopenko T.N.1, Fedoseyeva A.S.2, Ugurchieva M.A.3
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隶属关系:
- The Turner Scientific Research Institute for Children’s Orthopedics
- Children’s City Hospital of St. Olga
- Pavlov First Saint Petersburg State Medical University
- 期: 卷 6, 编号 3 (2018)
- 页面: 25-31
- 栏目: Original papers
- URL: https://journals.rcsi.science/turner/article/view/10224
- DOI: https://doi.org/10.17816/PTORS6325-31
- ID: 10224
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详细
Background. Spina bifida is a serious defect in the development of the spine and spinal cord. It is accompanied by several orthopedic disorders of the spine and lower limbs, including fractures of long tubular bones. In spina bifida, osteoporosis plays an important role in the pathogenesis of motor disorders.
Aim. The objective was to determine the patterns of occurrence and the clinical and radiological features of fractures of the long tubular bones of the lower limbs in children with sequelae of spina bifida.
Materials and methods. From 2006 to 2017, 544 patients with spina bifida were examined and treated at the Turner Research Institute for Children’s Orthopedics. Clinical-neurological and radiographic methods were used. The neurosegmental level of spinal cord involvement was determined using the Sharrard classification, and the motor level was assessed according to the method proposed by Melbourne Medical University.
Results. The clinical picture of a fracture of a long tubular bone in a child with spina bifida has many characteristics. There was no abnormal mobility in the fracture site in 56% of cases, edema was absent in 88% of children, and pain in the fracture region was observed in only 19% of cases. The radiographic features of the atypical fracture of long tubular bones in children with sequelae of spina bifida included lack of a fracture line, presence of a hypertrophic periosteal reaction, and sclerosis areas at the fracture site.
Conclusion. The frequency and localization of fractures of the lower limbs in children with sequelae of spina bifida are determined according to the neurosegmental level. The clinical picture of fracture often differs from usual fractures by the absence of pain syndrome, edema in the fracture region, and displacement of bone fragments, which must be considered for diagnosis. The peculiarities of the clinical and radiological picture are associated with the presence of osteoporosis in this pathology due to a decrease in the motor activity level of the patients.
作者简介
Stanislav Ivanov
The Turner Scientific Research Institute for Children’s Orthopedics
编辑信件的主要联系方式.
Email: ortostas@mail.ru
ORCID iD: 0000-0002-2187-3973
MD, PhD, Head of the Spina Bifida Center of the Department No 4
俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Vladimir Kenis
The Turner Scientific Research Institute for Children’s Orthopedics
Email: kenis@mail.ru
ORCID iD: 0000-0002-7651-8485
MD, PhD, Associate Professor, Deputy Director for Development and International Relations, Head of the Department N 4
俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Tatyana Prokopenko
The Turner Scientific Research Institute for Children’s Orthopedics
Email: prokopenkotn@mail.ru
MD, Pediatrician of the Consultative and Diagnostic Center
俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Aleksandra Fedoseyeva
Children’s City Hospital of St. Olga
Email: dok72101@mail.ru
ORCID iD: 0000-0001-5196-4748
MD, Orthopedic and Trauma Surgeon
俄罗斯联邦, Saint PetersburgMilana Ugurchieva
Pavlov First Saint Petersburg State Medical University
Email: m110393@mail.ru
ORCID iD: 0000-0002-1888-4866
MD, Resident of the Department of Traumatology and Orthopedics
俄罗斯联邦, 6/8, Lva Tolstogo street, St. Petersburg, 197089参考
- Баиндурашвили А.Г., Иванов С.В., Кенис В.М. Подвывих и вывих бедра у детей с последствиями спинномозговых грыж (Обзор литературы) // Травматология и ортопедия России. – 2013. – № 4. – С. 97–102. [Baindurashvili AG, Ivanov SV, Kenis VM. Subluxation and dislocation of the hip in children with spina bifida (Review). Travmatologiia i ortopediia Rossii. 2013;(4):97-102. (In Russ.)]
- Баиндурашвили А.Г., Иванов С.В., Кенис В.М. Нейросегментарный уровень и его значение при лечении подвывиха и вывиха бедра у детей с последствиями спинномозговых грыж // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2016. – Т. 4. – № 4. – C. 6–11. [Baindurashvili AG, Ivanov SV, Kenis VM. Clinical implications of the neurosegmental level of injury in the treatment of hip dislocation and subluxation in children with spina bifida. Pediatric traumatology, orthopaedics and reconstructive surgery. 2016;4(4):6-11. (In Russ.)]. doi: 10.17816/PTORS446-11.
- Иванов С.В., Кенис В.М., Икоева Г.А., Коченова Е.А. Использование роботизированной двигательной реабилитации в комплексном лечении подвывиха и вывиха бедра у детей с последствиями спинномозговой грыжи // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2014. – Т. 2. – № 4. – С. 32–35. [Ivanov SV, Kenis VM, Ikoeva GA, Kochenova EA. The use of robotic rehabilitation in complex treatment of subluxation and dislocation of the hip in children with sequelae of spina bifida. Pediatric traumatology, orthopaedics and reconstructive surgery. 2014;2(4):32-35. (In Russ.)]. doi: 10.17816/PTORS2432-35.
- Щеплягина Л.А., Моисеева Т.Ю. Проблемы остеопороза в педиатрии: возможности профилактики // РМЖ. – 2003. – Т. 11. – № 27. – С. 1554–1556. [Scheplyagina LA, Moiseeva TY. Problemy osteoporoza v pediatrii: vozmozhnosti profilaktiki. RMZh. 2003;11(27):1554-1556. (In Russ.)]
- Yasar E, Adiguzel E, Arslan M, Matthews DJ. Basics of bone metabolism and osteoporosis in common pediatric neuromuscular disabilities. Eur J Paediatr Neurol. 2018;22(1):17-26. doi: 10.1016/j.ejpn.2017.08.001.
- Пырьева Е.А., Сорвачева Т.Н., Сафронова А.Н. Нутритивная поддержка в лечении детей с неврологической патологией // Вопросы детской диетологии. – 2016. – Т. 14. – № 1. – С. 47–53. [Pyreva EA, Sorvacheva TN, Safronova AN. Nutritive support in treatment of children with neurological pathology. Problems of Pediatric Nutritiology. 2016;14(1):47-53. (In Russ.)]. doi: 10.20953/1727-5784-2016-1-47-53.
- Kilpinen-Loisa P, Pihko H, Vesander U, et al. Insufficient energy and nutrient intake in children with motor disability. Acta Paediatr. 2009;98(8):1329-1333. doi: 10.1111/j.1651-2227.2009.01340.x.
- Lock TR, Aronson DD. Fractures in patients who have myelomeningocele. J Bone Joint Surg Am. 1989;71(8):1153-1157.
- Marreiros H, Loff C, Calado E. Osteoporosis in paediatric patients with spina bifida. J Spinal Cord Med. 2012;35(1):9-21. doi: 10.1179/2045772311Y.0000000042.
- Hara H, Matsumoto S, Ohishi T, et al. Posterior Iliopsoas Transplantation in the Treatment of Paralytic Hip Dislocation in Spina Bifida. Orthop Traumatol. 1980;29(4):718-721. doi: 10.5035/nishiseisai.29.718.
- Pauly M, Cremer R. Levels of mobility in children and adolescents with spina bifida-clinical parameters predicting mobility and maintenance of these skills. Eur J Pediatr Surg. 2013;23(2):110-114. doi: 10.1055/s-0032-1324689.
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