УДК 617.3 КЛИНИКО-РЕНТГЕНОЛОГИЧЕСКИЕ ПОКАЗАТЕЛИ ПОЗВОНОЧНО-ТАЗОВЫХ СООТНОШЕНИЙ У ДЕТЕЙ С ДЦП Новиков В.А., Умнов В.В., Умнов Д

КЛИНИЧЕСКИЙ ПРИМЕР ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПРИВОДЯЩЕЙ КОНТРАКТУРЫ ПЕРВОГО ПАЛЬЦА КИСТИ, СОЧЕТАЮЩЕГОСЯ С НЕСТАБИЛЬНОСТЬЮ ПЯСТНО-ФАЛАНГОВОГО СУСТАВА, У ПАЦИЕНТА С ДЕТСКИМ ЦЕРЕБРАЛЬНЫМ ПАРАЛИЧОМНовиков В

УДК 617.3 РОЛЬ ГОЛОВОК ТРЕХГЛАВОЙ МЫШЦЫ ГОЛЕНИ В РЕАЛИЗАЦИИ КЛОНУСА У ПАЦИЕНТОВ ДЦП С ЭКВИНУСНОЙ УСТАНОВКОЙ СТОП Звозиль А.В., Новиков В.А., Умнов В.В., Винокурова Т.С

КЛИНИЧЕСКИЙ ПРИМЕР ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ СГИБАТЕЛЬНОЙ КОНТРАКТУРЫ ЛОКТЕВОГО СУСТАВА У ПАЦИЕНТА С ДЕТСКИМ ЦЕРЕБРАЛЬНЫМ ПАРАЛИЧОМНовиков В.А

АНАЛИЗ РЕНТГЕНОЛОГИЧЕСКИХ ОСОБЕННОСТЕЙ ТАЗОБЕДРЕННЫХ СУСТАВОВ У ДЕТЕЙ СО SPINA BIFIDAИванов С.В., Новиков В

СЕЛЕКТИВНАЯ НЕВРОТОМИЯ МЫШЕЧНО-КОЖНОГО НЕРВА КАК СПОСОБ КОРРЕКЦИИ ТОНИЧЕСКОЙ СГИБАТЕЛЬНОЙ КОНТРАКТУРЫ ЛОКТЕВОГО СУСТАВАНовиков В.А., Умнов В.В., Звозиль А.В

The cardiofaciocutaneous syndrome is a condition of sporadic occurrence, with patients showing multiple congenital anomalies and mental retardation. The syndrome is caused by molecular disturbances in the RAS/MAPK pathway. We report on the girl, 9 year-old, with the cardiofaciocutaneous syndrome presenting with typical craniofacial appearance, heart defects, ectodermal abnormalities, neglected orthopedic pathology, developmental delay and spasticity, which rare in this syndrome.

The cardiofaciocutaneous syndrome is a condition of sporadic occurrence, with patients showing multiple congenital anomalies and mental retardation. The syndrome is caused by molecular disturbances in the RAS/MAPK pathway. We report on the girl, 9 year-old, with the cardiofaciocutaneous syndrome presenting with typical craniofacial appearance, heart defects, ectodermal abnormalities, neglected orthopedic pathology, developmental delay and spasticity, which rare in this syndrome.

Cerebral palsy (CP) considerably impairs the ability to maintain upright stance. The effects of locomotor training and functional electrical stimulation (FES) on postural control were determined in 27 children aged 6–12 years with severe CP. The severity level of the clinical manifestations of CP was classified as 3 according to the Gross Motor Function Classification System (GMFCS). All patients participated in 15 30-min mechanical therapy sessions using robot-assisted passive stepping. In 12 out of 27 children, the locomotion therapy was accompanied by FES. Stabilometry and plantography tests were performed in 23 healthy age-matched children. Postural control in children with CP differed from the stabilograms of healthy children in a forward shift of the center of pressure (COP) projection; higher values of the COP trajectory area and length, the mean amplitude of the COP oscillations, and the absence of COP response to the eyes closed condition. After treatment, the posturographic characteristics tended to normalize in relation to the values obtained in neurologically intact children. The improvement was observed in 43% of children without FES and in 75% of children in the group with FES. Analysis of plantograms revealed normalization of footprints in children who received FES. Thus, it was demonstrated that FES combined with locomotor training resulted in the improvement in vertical posture control in children with severe CP.

Детский церебральный паралич относится к числу распространенных заболеваний, приводящих к существенному ограничению двигательных возможностей. В обзоре рассмотрены новые методы двигательной реабилитации детей с детским церебральным параличом с точки зрения современной физиологии, обобщены и проанализированы результаты экспериментальных исследований эффективности этих методов.

Cerebral palsy (CP) is one of the most common diseases that cause substantial motor disability. The review considers new methods of motor rehabilitation in children with CP in the context of modern physiology and summarizes the experimental data on their efficacy.

Objective - to determinate the influence of kyphosis correction in thoracic spine on the ability to have vertical balance of the body in patients with cerebral palsy.Material and methods. The authors have performed a comprehensive survey of 17 patients with cerebral palsy aged from 6 to 17 years with the generated non-fixed "habitual" thoracolumbar kyphosis associated with joint contractures of the lower extremities. The analysis of the radiological data was carried out to determine the dependence of severity of kyphosis on the position of the body. The state of the vertical stability of children before and after thoracolumbar orthosis with body corset were evaluated by means of computed stabilometrics.Results. Radiological findings in all children have shown a normal correlation of changes in the degree of kyphosis - its reduction if there was an exclusion of the vertical load on the spine, as well as the trunk orthosis. In this case correction of sagittal profile of the spine occurred mainly due to the lumbar area. This feature of spinal biomechanics in patients with infantile cerebral palsy unpredictably reflected on the motor activity of patients. After correction of kyphosis with corset only 29.4% of the children surveyed with stabilometrics demonstrated the improvement in the function of maintaining the vertical position of the body. In 70.6% of patients the correction of sagittal profile of the spine has led to a deterioration of the vertical balance of the body. Negative dynamics of test research in this group presupposes the exhaustion of children's adaptive capacity, which indicates the risk of developing abnormal compensatory reactions because of corset bracing.Conclusion. The advanced integrated observation of the patients with cerebral palsy can improve the prediction of outcomes in planning of the correction of kyphosis in thoracolumbar spine.

The purpose - to devise the algorithm of patient examination with spastic hand to determine what the variant of surgical treatment is indicated. The variant of surgical treatment and it's results are depend on the cause of upper extremity deformation. Materials and methods. This study is based on a survey of children with cerebral palsy with lesions of the upper extremity. The main criterion for the selection of patients was the presence of the combined lesion of the upper extremity, where the cause of dysfunction hands are not only fixed contractures, but primary tonic. Was to survey 47 patients with spastic forms of cerebral palsy with the defeat of the upper limb, but the study group included only 26 of them in the ages of 7 to 18 years (average 12,1), as having the clinical picture both types of contractures. We have developed and applied a system of examinations, modeling expected outcome of selective neurotomy motor nerves of the upper limb, which allows to estimate the possible result of such treatment, and clearly differentiate tonic and fixed contracture. Results and conclusions. Based on the results of study we supposed that, using diagnostic blockade motor nerve at the period of planning surgical treatment help us to create temporary reversible model of selective neurotomy motor nerve branches and identify the type of contracture, degree of manifestation and functional perspective.

Objective: to improve the results of surgical correction of flexion contracture of knee joint in patients with cerebral palsy. Material and methods. 196 patients with cerebral palsy aged from 2.5 to 18 years old were examined. In 131 patients aged from 8 to 18 years old we performed lengthening of tibia flexors with posterior capsulotomy and without it, in 4 patients aged from 11 to 16 years old the contracture was corrected after preliminary reduction of muscle tone using lumbar dorsal selective rhizotomy (LDSR). Among 246 operated segments a slight contracture in 23 cases was eliminated only with lengthening of tibia flexors, in the remaining 223 cases in addition after lengthening of tibia flexors the residual contracture was corrected by the method of pre-dosed correction in plaster cast. In 16 segments if there was a severe contracture we performed a posterior capsulotomy of knee joint. Besides, we investigated the dependence of contraction degree from phase-tonic activity of tibia flexors, as well as the influence of LDSR on the possibility to correct flexion contracture in 65 knee joints of patients aged from 2.5 to 16 years old. Results. The high degree of dependence of knee flexion contracture (KFC) from tone increase of tibia muscle flexors (correlation coefficient r p

By data of the literature and own supervision, authors describe features pathogenesis of equinoplanovalgus foot deformations (EPVFD) in cerebral palsy patients and also the clinical displays of disease revealed by them at inspection of 52 patients (79 foot). In article you can find the earlier not described clinical supervision - presence by a considerable part of patients of the expressed feeling of tiredness feet at walking. This complaint was at 87,0 % patients. Main principles and methods of diagnostics of disease are described, and also a new way is computed tomography scan, allowing to visualize all characteristic for deformation of infringement of anatomy of joints and bones of foot in the conditions of influence modeling on it orthostatic load. Authors come to the conclusion that EPVFD by cerebral palsy children’s possesses a number of prominent features which probably to reveal special receptions and diagnostics methods, and also it is necessary to consider for increase of efficiency of the complex surgical approach to treatment EPVFD at patients with cerebral palsy.

In article authors describe the isolated data of the foreign and domestic literature concerning a problem of conservative and surgical treatment of the upper limb extremity at patients with cerebral palsy. In the publication the features of various techniques gained the greatest distribution and actively applied now are considered. Besides, the analysis of results of treatment is carried out and problems up to the end not solved are sounded till now.

World literature disembodied data about methods of observation of upper extremity in children with infantile cerebral paralysis are elucidated and systematized in this article. The most essential research and clinical technique are described and analyzed, namely: clinical examination, the assessment of spasticity, functionality and sensibility of spastic hand, electromyography, radiography and intelligence assessment. The most often used classifications are presented.

The authors describe specific effects of prolonged epidural blockade in treatment of contractures of the lower extremity joints in children with cerebral palsy. The method was used in 5 patients aged from 11 to 16 years. The prolonged epidural blockade during 4-5 weeks allowed adequate motor rehabilitation and conditions for learning to walk.