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BACKGROUND: Enthesitis-related arthritis is one of the subtypes of juvenile idiopathic arthritis and is characterized by the involvement of the joints, enthesitis, and axial skeleton (sacroiliitis and spondylitis). The clinical variability of enthesitis-related arthritis and similar manifestations with orthopedic diseases present difficulties in diagnosis. AIM: To present the clinical features of enthesitis-related arthritis and issues of differential diagnosis based on literature analysis. MATERIALS AND METHODS: A literature search was conducted in the open electronic databases of eLibrary, PubMed, and Cochrane Library. In total, 46 foreign and 4 Russian publications were analyzed, which were limited to 19812021. The keywords used in the literature search were as follows: enthesitis, enthesitis-related arthritis, juvenile spondyloarthritis, and SAPHO syndrome. Own archive data for instrumental investigations were used in the article. RESULTS: The clinical manifestations can be variable, and laboratory tests do not always allow us to prove the inflammatory nature of the pain syndrome. The most priority diagnostic tests were imaging methods, namely, magnetic resonance imaging and ultrasonography. The greatest diagnostic difficulty was found in patients in whom enthesitis prevailed over arthritis, and in some cases, it was the only disease manifestation. The classification criteria used for the diagnosis of EAA were considered. The differential diagnosis of enthesitis included various orthopedic diseases. Ultrasound diagnostics of joints and enthesis should be performed in every patient with local pain musculoskeletal symptoms, which allows patients to be correctly routed. CONCLUSIONS: The alertness of both orthopedists in relation to enthesitis-related arthritis and the awareness of rheumatologists of the most common orthopedic diseases that affect the entheses are necessary.

BACKGROUND: The choice of pelvic osteotomy in young children with late diagnosis of hip dysplasia most often depends on the experience and preferences of the surgeon, and the diagnosis of the degree of violation of the ratios is based on the generally accepted classification of hip dysplasia without considering possible variants of the deformation of the acetabulum. We hypothesized that the choice of the pelvic osteotomy technique in the surgical treatment of children with hip dysplasia of varying severity should be based on the variant of acetabulum deformation and the corrective capabilities of pelvic osteotomy. AIM: This study aimed to compare and analyze the results of the surgical treatment of children with hip dysplasia of varying severity and to evaluate the effectiveness of the proposed differentiated approach to the choice of the pelvic osteotomy technique. MATERIALS AND METHODS: The study included 150 patients (150 hip joints) aged 24 years (3.1 0.45) with grade IIIV hip dysplasia, according to the supplemented classification of Tnnis. Depending on the verified variant of acetabulum deformity and taking into account the corrective capabilities of various osteotomies, we divided the patients into three groups. All patients underwent conventional clinical and X-ray examinations. During radiometry, the following indicators were evaluated: acetabular index (AI), Wiberg angle, neckshaft angle (NSA), anteversion angle of the proximal femur, degree of bone coverage, acetabulum depth (AD) and pelvic height, length of the acetabular arch (LAA), and presence or absence of a bone oriel (BO). RESULTS: In the comparative analysis of the radiographic anatomical condition of the hip joint in children with hip dysplasia of varying severity, the differentiated use of the modified Salter pelvic osteotomy without autograft and pericapsular acetabuloplasty according to Pemberton and Pembersal surgery led to adequate correction of various variants of congenital acetabular deformity with approximately normal anatomy of the acetabulum and not lead to significant deformation of the hemipelvis, such as elongation. CONCLUSIONS: The results of the surgical treatment of young children with hip dysplasia of varying severity according to the proposed differentiated approach to the choice of the pelvic osteotomy technique, which is based on the variant of acetabulum deformation, indicate the achievement of adequate correction of congenital deformity of the acetabular component of the joint with the restoration of its anatomical structure and avoidance of secondary deformation of the hemipelvis. The effectiveness of the proposed approach to the choice of pelvic osteotomy technique in the treatment of young children with hip dysplasia of varying severity is confirmed by the changes in AI, Wiberg angle, AD, and PH, whose values became close to the individual norm (p 0.05), and reduction of possible secondary deformities.

Purpose: In this study, we investigated the relationship between the results of thoracic curve correction using minimally invasive surgeries in 35 patients and open surgical correction in 47 patients with adolescent idiopathic scoliosis. Methods: The correlations between the Cobb’s angle of the primary and postoperative curves, angle of thoracic kyphosis and lumbar lordosis, correction percentage, derotation values, estimated blood loss, duration of surgery, and period of hospitalization after surgery were assessed by calculating the mean and standard deviation. Calculation and comparison were performed using Pearson correlation. Results: The Cobb’s angle correction ranged from 53.4° ± 11.8° to 6.7° ± 5.2° ( p Conclusion: The open surgical correction procedures were more effective than minimally invasive surgery in correcting the spinal curve. The increase in the duration of open surgical correction increases the estimated blood loss, but it also more significantly improves the correction of Cobb’s angle. Level of evidence: III.

BACKGROUND: The situational approach is a promising direction in the study of the determinants of mental development and behaviors in modern psychological research. This study considered the possibility of using a situational approach in the study of psychological problems of children and adolescents with orthopedic diseases and discussed the objective and subjective characteristics of the life situation associated with orthopedic diseases and surgical treatment. AIM: The study aimed to examine the peculiarities of life situations in adolescents with various orthopedic diseases. MATERIALS AND METHODS: The study involved adolescents aged 1217 years diagnosed with idiopathic scoliosis (n = 54) and juvenile chronic arthritis (n = 44) and healthy adolescents (n = 43). Clinicalpsychological and psychodiagnostic methods were used. Mathematical and statistical data processing was carried out. RESULTS: The life situation of adolescents with idiopathic scoliosis and juvenile chronic arthritis was characterized by events that cause traumatic experiences. Objective factors of the life situation and traumatic life events presented in the mental picture of the disease of adolescents agree with the pronounced emotional problems of patients with orthopedic diseases. Compared with healthy adolescents, adolescents with orthopedic diseases had higher general index of PTS, which indicates a pronounced subjective difficulty of the life situation of adolescents with orthopedic diseases. The results are confirmed by the severity of the subjective negative emotional reactions to certain characteristics of the disease. The objective and subjective characteristics of the life situation of adolescents with idiopathic scoliosis and juvenile chronic arthritis may determine the degree of difficulty and the degree of risk in the occurrence of emotional trauma for illness, hospitalization, and treatment. CONCLUSIONS: Understanding the life difficulties of adolescents with orthopedic diseases can improve the prediction of behavioral problems and adaptation opportunities in hospital settings and provide timely psychological assistance to adolescents with severe orthopedic diseases, taking into account situational variables.

BACKGROUND: Slipped capital femoral epiphysis is one of the most severe diseases of the hip joint in children and is characterized by the displacement of the proximal femoral epiphysis, occurring as a result of a decrease in the mechanical strength of its growth plate. Some pathological processes in the hip joints and lumbosacral spine cause changes in the position (vergence) of the pelvis in the sagittal plane and the development of degenerative dystrophic diseases. The analysis of the spinepelvis relationships in children with slipped capital femoral epiphysis may provide the basis for the development of new approaches to the surgical correction of the deformity of the hip component of the affected joint. AIM: To assess the radiological parameters of the frontal and sagittal spinepelvis relations in children with proximal femur deformity in slipped capital femoral epiphysis. MATERIALS AND METHODS: The study included 30 patients (30 hips) aged 1114 years with a severe form of slipped capital femoral epiphysis characterized by the presence of a posterior displacement of the epiphysis of 60 combined with the downward displacement of no more than 10 in one of the joints and absence of displacement (pre-slip stage) in the other. Patients underwent clinical and radiological examinations. The radiographs taken in the standing position were used to assess the values of thoracic kyphosis and lumbar lordosis, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), and spinesacral angle (SSA). The obtained data were subjected to statistical processing. RESULTS: The patients had pelvic retroversion (decreased values of the PI and SS indices and increased PT index) and formed hypolordotic type of vertical posture according to P. Roussouly classification. In addition, thoracic hyperkyphosis occurred, and the SVA shifted to the front, which can be considered a mechanism of trunk balance compensation for the existing pelvic retroversion and reduction of lumbar lordosis to maintain the ability to move in an upright position. CONCLUSIONS: Children with this severe form of slipped capital femoral epiphysis are characterized by pelvic retroversion, decreased lumbar lordosis and increased thoracic kyphosis, positive trunk imbalance, and PT toward the affected limb. Planning and reconstructive restorative interventions on the affected hip joint should consider existing pathological changes to restore the correct spinepelvis relationships and prevent degenerative dystrophic processes in the lumbosacral spine.

BACKGROUND: Sacral neuromodulation is a neurosurgical method for the correction of bladder and bowel dysfunctions of various origins that are refractory to conservative treatment. AIM: To analyze chronic sacral neurostimulation results as a correction method for pediatric bladder and bowel dysfunction of various origins. MATERIALS AND METHODS: The results of chronic sacral neurostimulation for treating urination and defecation disorders of various origins in children reported in the world literature were analyzed. The literature search was performed in the open electronic scientific databases eLIBRARY, PubMed, and Cochrane Library. The source selection was limited by 20022022. RESULTS: Most authors report good and satisfactory results in the treatment of bladder and bowel dysfunction by sacral neurostimulation. However, the level of evidence on the effectiveness of sacral neurostimulation remains low because data were obtained from small and heterogeneous groups of patients and studies employed different criteria for inclusion and methods for analyzing the results. CONCLUSIONS: Conducting randomized trials will allow for the assessment of the efficacy and safety of sacral neuromodulation in children with bladder and bowel dysfunctions of various origins that are refractory to standard conservative treatment.

BACKGROUND: The surgical treatment of children with pectus excavatum is regarded as an urgent problem still demanding solution despite the multitudes of surgical correction methods available nowadays. The currently available well-known techniques cannot be considered perfect because they are not proper enough for solving all the tasks, not to mention the problem of asymmetric forms of pectus excavatum treatment. AIM: To analyze publications containing information on the methods of surgical treatment used for children with pectus excavatum. MATERIALS AND METHODS: The study presents the results of literature review on the methods of surgical correction of pectus excavatum. Information was retrieved in PubMed, Google Scholar, and eLibrary scientific databases using keywords. Consequently, 63 foreign and domestic scientific sources over the period from 1609 to 2022 were identified. Among them, 29 publications refer to the latest decade. RESULTS: Given the variety of methods used for chest deformity correction, thoracoplasty by D. Nuss has become the gold standard for the treatment of pectus excavatum. However, according to the search results, it is impossible to name one universal method of surgical intervention that could solve all the urgent problems at present. Modern surgery methods used for pectus excavatum correction can be considered only as modifications of treatment methods having been used before. CONCLUSIONS: The shortcomings of modern thoracoplasty determine the necessity to keep searching for new techniques and improve those available at present. Besides, the standard suitable for both surgeons and patients should be elaborated.

In 2022, H. Turner National Medical Research Center for Childrens Orthopaedics and Trauma Surgery of the Ministry of Health of the Russian Federation celebrates its 90th Anniversary. It is a unique and the only specialized institution in the world that treats children with orthopedic pathologies. The Center is known not only for its medical achievements, innovations and developments, but also for the amazing atmosphere of care and attention to children. The result of the activities of H. Turner National Medical Research Center is thousands of children who regained their ability to move and enjoy their childhood.

BACKGROUND: Treatment of children with congenital deformity with unsegmented rod and rib synostosis is an important and topical problem to date. Topical publications present the results of surgical correction efficacy and analysis of treatment complications. The extremely important aspect of treatment efficacy assessment regarding changes in the function of external respiration is still topical. AIM: This study aimed to analyze the treatment results of children with congenital scoliosis and unilateral segmentation disorder of the lateral surfaces of the vertebral bodies and rib synostosis. MATERIALS AND METHODS: This is a retrospective monocenter cohort study of the treatment outcomes of 30 patients aged 114 years. In the preoperative period, external respiration was evaluated by pulse oscillometry, multi-slice computed tomography, digital X-ray imaging of the craniopelvis in two projections. All patients underwent expanding thoracoplasty with osteotomy of the rib synostosis and fixation with a rib-costal or rib-vertebral distractor. Control studies were performed every 6 months after the surgical intervention. The average follow-up period was 2 years. Nonparametric analysis was applied to estimate the obtained data. RESULTS: The median (Me) age at the start of treatment was 6 years (interquartile range, 4.25; IQR hereafter). The Me scoliosis before treatment was 74 (IQR, 22.75). The Me scoliosis correction after the first stage of treatment was 16 (IQR, 11) and the second correction achieved 6 (IQR, 13). The Me kyphosis was 15 (IQR, 32), the first intervention improved kyphosis by 4 (IQR, 16), and the second by 6 (IQR, 11). Complications were represented by the destabilization of the metal construct in six cases, and trophic disorders of soft tissues were noted in four. The assessment of external respiratory function using IOM demonstrates reliable improvement of resistive component, reactive component, and frequency dependence of the resistive component (p 0,01). CONCLUSIONS: The assessment of the external respiratory function in young children and analysis of reference values may allow their use as absolute indications for surgical treatment in children with congenital scoliosis with unsegmented bar and rib synostosis.

BACKGROUND: Erythromelalgia is a rare hereditary disorder manifesting the basic triad of symptoms: erythro redness, melos limb, and algos pain. It was first described by the American neurologist, S. Weir Mitchell in 1878. Clinical manifestations of the disease worsen the physical and psychological condition of the patient leading to reduced quality of life, increased morbidity and mortality. Currently, etiotropic therapy for erythromelalgia that demonstrates high efficacy in individuals with this pathology, has not been developed. Moreover, there is no consensus on treatment strategies for this category of patients, emphasized by the absence of clinical guidelines for the treatment of erythromelalgia. Treatment of patients with erythromelalgia is currently based on sequential pharmacotherapy in order to select the most effective therapy. CLINICAL CASE: We presented the result of surgical treatment of erythromelalgia in a 15-year-old adolescent using invasive spinal cord stimulation. DISCUSSION: Erythromelalgia remains an understudied condition with the lack of sufficient understanding of its etiology and pathogenesis. For the first time in Russia, a technique of invasive spinal cord stimulation was used in a pediatric patient with erythromelalgia, which resulted in a significant reduction of neuropathic pain, restoration of vasomotor regulation in the form of reduced edema and hyperemia. CONCLUSIONS: In a patient with prolonged and pronounced refractory neuropathic pain caused by erythromelalgia, spinal cord stimulation was the only effective treatment technique alternative to symptomatic and drug therapy. Spinal cord stimulation should be considered as a method of treating neuropathic pain associated with pharmacoresistant forms of erythromelalgia.

BACKGROUND: Among the orthopedic consequences of cerebral palsy, instability of the hip joints is one of the most common. Most children with cerebral palsy at birth have close to normal relationships in their hip joints that gradually deteriorates. Progressive instability of the hip joint leads to subluxation and then dislocation of the hip, to a decrease in the range of motion in the joints, to movement disorders and a defect in the ability to sit, as well as an impairment in hygienic care of the child. AIM: To analyze the X-ray anatomical structure of the acetabulum in unstable hip joint in children with cerebral palsy. MATERIALS AND METHODS: We examined 42 hip joints in 23 patients with cerebral palsy. Participants were divided into two groups. The main group included the results of the examination of unstable hip joints (31 studies), and the control group included the results of the examination of stable joints (11 studies). RESULTS: The average index of anteversion of the acetabulum in the main group with a functioning Y-shaped cartilage was 2.5 more than the average value of the norm (p = 0.029), with a nonfunctioning Y-shaped cartilage at 6 less than the normal value (p = 0.017). There was a positive moderate correlation between the anteversion of the acetabulum and the anterior margin angle (r = 0.424, p = 0.017), and a positive moderate correlation between the acetabular index and the anterior margin angle (r = 0.398, p = 0.027). CONCLUSIONS: The study showed that changes in the acetabulum in patients with pathological dislocation or subluxation of the hip against the background of spastic cerebral palsy were manifested by deformation in the horizontal plane due to retroversion of the acetabulum.

BACKGROUND: Erythromelalgia is a severe, chronic, progressive disease with periods of exacerbation and remission. A triad of symptoms characterizes the disease: reddening of the extremities, a local increase in skin temperature, and pronounced neuropathic pain syndrome. There are sporadic works in the Russian literature that present data on erythromelalgia, particularly in children. The publications are descriptions of clinical observations with the assessment of the clinical picture of the patient regarding cutaneous manifestations and surgical care at the time of hospitalization, time spent in the hospital, and during the period of his chronic disease exacerbation. CLINICAL CASE: A clinical case of hereditary erythromelalgia in a 15-year-old adolescent with a detailed description of the disease course since the initial manifestation is presented. DISCUSSION: During three and a half years, despite early diagnosis and application of consistent pharmacotherapy including nonsteroidal anti-inflammatory drugs, antidepressants, anticonvulsants, antihistamines, opioids, hormonal therapy, local use of lidocaine, ointment with silver content, the disease was progressive, with the resistance of pain syndrome to the treatment, with periods of exacerbation and partial remission. CONCLUSIONS: The presented clinical observations show the need to assess the patient as a chronic and intractable patient. Considering the lack of understanding of the apparent cause of this disease and its diverse manifestations in the clinical picture, a multidisciplinary approach with a search for new treatment methods, including neurosurgical techniques of chronic pain treatment, is required for patients with erythromelalgia.

BACKGROUND: Segmentation disorder of the vertebral body lateral surfaces and rib synostosis are severe variants of congenital pathology of the spine and thorax. They lead to the development of thoracic insufficiency syndrome and are manifested by the inability of the thorax to provide normal respiratory mechanics. AIM: This study presents the preliminary results of functional and radiological (CT-morphometric) methods of lung examinations in patients with congenital thoracic spine scoliosis with impaired segmentation of the lateral surfaces of the vertebral bodies and unilateral rib synostosis. MATERIALS AND METHODS: This design is represented by a small clinical series. This study is a prospective study of 10 patients aged 3 to 7 years with congenital spinal deformity, with impaired segmentation of the lateral surfaces of vertebral bodies and unilateral rib synostosis. This paper presents the preliminary results of the pulmonary function assessment by pulse oscillometry and CT morphometry in a 3D reconstruction of multispiral computer tomography (MSCT) of the thorax. RESULTS: The study of respiratory function using pulse oscillometry revealed no respiratory impairment in seven observations, also reflected in the CT morphometry results. According to the Institute of Medicine (IOM), three children with detected ventilatory abnormalities showed the following parameters with the most significant changes: total respiratory impedance, resonance frequency, and frequency dependence of the resistive component. In all patients, the morphometric indexes of the lung scoring revealed during 3D modeling of the lung were completely consistent with the results of the lung function study by the IOM method. CONCLUSIONS: Further study of the problem of respiratory function assessment in children with congenital scoliosis seems promising in diagnostic terms and for evaluating effective surgical treatment.

BACKGROUND: Reconstruction of extensive defects to bone tissue is one of the important problems of orthopedics and traumatology. Especially in acuteis, the problem is associated with the restoration of bone tissue in conditions of its deficiency in pediatric patients. AIM: The aim of the study is to analyze modern methods of surgical treatment in children with extensive bone tissue injuries based on the published literature. MATERIALS AND METHODS: Our report presents a review of the literature of methods of surgical treatment of extensive bone defects. The literature search was carried out in several databases such as PubMed, ScienceDirect, E-library, GoogleScholar for the period from 2005 to 2020, using the keywords given below. As a result of the search, 105 foreign and 37 domestic sources were found. After exclusion, 56 articles were analyzed, all presented works were published in the last 15 years. RESULTS: The gold standard for replacing bone defects is still the use of autografts, including the use of technologies on a vascular pedicle. Various types of xenografts and allografts of bone tissue are increasingly being replaced by various kinds of synthetic implants. CONCLUSIONS: To date, there is no single generally accepted standard for the surgical treatment of extensive bone defects. The option of surgical treatment of extensive bone tissue defects using tissue-engineered bone implants with axial blood supply seems to be extremely interesting and promising.

BACKGROUND: Congenital disorders of vertebrae formation are a common pathology in children. Intraoperative neurophysiological monitoring is a mandatory procedure, although it may not be effective enough due to the immature neural structures and the use of inhalation anesthetics in young children. AIM: To study aims to investigate the characteristic features of intraoperative neurophysiological monitoring in children with a congenital deformity of the spine during dorsal resection of the hemivertebrae. MATERIALS AND METHODS: 42 patients aged 117 years with a congenital deformity of the spine underwent 46 resections of the abnormal vertebra from an isolated dorsal approach (egg-shell technique). Intraoperative neurophysiological monitoring at the stages of the operation included a muscle relaxant test (TOF), transcranial electrical stimulation of the motor cortex (TCeMEP), control of the approach to the nerve (N. Proxy), correct placement of the pedicle screw (Screw Integrity), and EMG recording of the electromyogram. The accuracy of the screw placement was assessed by the Gerzbien method, and the presence of neurological disorders was tested by the Frenkel scale. The effect of inhalation anesthetic (sevoran) on motor evoked potentials was monitored by regulating its delivery, and the dependence on the age of patients was evaluated. RESULTS: The average age of patients was 7.7 4.5 years, and the TOF value was 80.5 17%. In 41 patients, the N. Proxy test was unremarkable, while in one patient, the 812 mA value did not require a change in the trajectory of the screws. From the beginning of sevoran and intraoperatively, motor evoked potentials from all tested muscles were recorded in 54.8% of patients; in children over 8 years old, this was observed in 92.8%, in children under 8 years old in 35.7% of cases in their age groups. In other patients, motor evoked potentials were most often not recorded from the muscles of the thigh and lower leg after sevoran administration. In children over 8 years old in 7.2%, under 8 years old in 83.3% of patients; Interestingly, in 7.2% of patients who are under 8 years of age, motor evoked potentials were not initially recorded from any muscle. Withdrawal of sevorane in 30.9% of patients allowed intraoperative motor evoked potentials to be obtained from all tested muscles in 100% of cases. For adequate management of anesthesia, 5 patients (50%) 14 years old and one patient 6 years old (5.6%) did not receive sevoran, and motor evoked potentials were recorded from the abdominal muscles. This allowed to assess the conduction only at the thoracic level and are required increased vigilance of surgeons when carrying out any corrective manipulations. CONCLUSIONS: Intraoperative neurophysiological monitoring with dorsal hemivertebra resection is an effective method that allows controlling the neurological complications during manipulations on the spine.

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.

BACKGROUND: Due to the spread of the novel coronavirus infection (COVID-19) and the introduction of restrictive measures to prevent its spread, there has been a change in the organization and work of medical institutions. New rules for admitting patients with injuries, limiting hospitalization of planned patients, examining patients for coronavirus infection, examining parents of children with injuries, conducting remote consultations, and identifying areas without COVID-19 for repeated outpatient care have been introduced in trauma centers and hospitals. New conditions for the organization and functioning of outpatient and inpatient departments have had an impact on the picture of child trauma. AIM: This study aims to conduct a comparative analysis of the level and nature of musculoskeletal injuries in children who sought medical care during the COVID-19 pandemic and injuries that occurred during the same period of the previous year. MATERIALS AND METHODS: The analysis of the medical history data of 3820 patients aged 0 to 17 years, who were admitted to the City Center for Outpatient Surgery and Trauma of St. Petersburg St. Mary Magdalene Childrens City Hospital No. 2 during the period from March 16, 2020, to May 31, 2020, and for the same period in 2019. RESULTS: The number of initial visits with trauma in 2019 was 2851 patients, whereas during the same period in 2020, 969 patients came with trauma. In general, during the study period in 2020, the trauma rate decreased by 66% compared with the same period in 2019. Despite the general decrease in the level of injuries in the study period in 2020, in the injured structures of the musculoskeletal system, the proportion of limb fractures was 35% and exceeded the same indicator in 2019 (p = 0.004, 2 criterion). In 2020, the level of street injuries (p 0.0001) decreased by 83%, while there was a 61% increase in domestic injuries (p 0.0001) and a 47% increase in traffic injuries (p 0.0001). CONCLUSION: The relationship between the outbreak of a pandemic and a decrease in the number of visits to the trauma center of Childrens Hospital No. 2 was revealed and a change in the structure of injuries depending on their cause. This change may be associated with restrictive measures, the transfer to distance learning, the ban on organized sports events, and the reduced usage of playgrounds. This information can be useful for planning the work of health authorities and distributing resources during future pandemic situations.

BACKGROUND: After surgical treatment of congenital spinal deformities, we can see the progression of deformities of the spinal column segments free from metal structures, which leads to the need for reoperation. Without sufficient scientific evidence, several specialists after surgical treatment use various orthoses on the body to prevent scoliotic compensatory changes. AIM: This study aims to assess the results of body orthosis after surgical treatment of children with congenital spinal deformity with the impaired formation of the vertebrae, using orthoses, compensatory deformity after one year of treatment. MATERIALS AND METHODS: Twenty-five patients aged 2 to 12 years (10 boys and 15 girls) after surgical treatment of congenital deformity of the spine in the thoracic regions (13) and lumbar regions (12), wearing body orthoses. The results were assessed at 3, 6, and 12 months using thermal sensors for the orthosis wearing time by X-ray and statistical methods. RESULTS: After three months of wearing the brace, we saw a correction of about 50% of the value of the initial compensatory deformity. After six months, both thoracic and lumbar, the correction was 60%. After one year, when performing an X-ray image without an orthosis, in thoracic deformities without a brace, the correction stabilized and remained at the level of 40%. In lumbar deformities without a brace, the original deformity returned, i.e., the correction occurred but was not fixed without the orthosis. Only one of 25 patients (4%) required a second operation to increase the fixations duration. CONCLUSION: The results of observing a group of patients (25 children) for one year after surgical treatment of congenital spine deformity showed a positive effect of a functionally corrective orthosis on the body to correct secondary deformities.

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.

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.

Background. Superior mesenteric artery syndrome is a rare pathological condition caused by an abnormal transposition of the superior mesenteric artery from the abdominal part of the aorta. It results in compression of the distal part of the duodenum between the aorta and the superior mesenteric artery. It is clinically manifested by signs of acute intestinal obstruction, including pain in the epigastric region, nausea, and profuse vomiting. In the absence of timely treatment, patients may experience electrolyte disturbance, severe nutritional deficiency, the risk of perforation of the stomach, aspiration pneumonia, bezoar formation, thromboembolism, and the development of other life-threatening complications that can lead to death. Case study. In the presented case study, superior mesenteric artery syndrome developed in a 17-year-old girl after surgical correction of a spinal deformity in the treatment of idiopathic scoliosis. This was due to postoperative loss of body weight, as well as a rapid change in the patients ratio of growth to body weight. Discussion. Significant clinical improvement was achieved as a result of an integrated approach to the treatment of this complication. However, despite the successful result from conservative therapy, the patient remains at risk of developing chronic duodenal obstruction of varying severity, which may require surgical treatment. Conclusion. With the untimely and incomplete treatment of superior mesenteric artery syndrome, the risk of developing chronic intestinal obstruction increases. Treatment of this complication begins with conservative therapy. In the absence of the effect of conservative therapy, and in the case of disease progression, the development of life-threatening conditions (such as bleeding and perforation) requires surgical treatment.

Background. Currently, there are many studies on the evaluation of the results of surgical intervention and the comparative analysis of various surgical techniques for treating children with congenital spinal deformities. However, there is no consensus regarding the choice of surgical access to the abnormal vertebra that considers the duration of surgery, the volume of intraoperative blood loss, the degree of correction achieved during the intervention, the length of metal fixation, and the preservation of the result in the long-term observation period. Aim. The goal is to identify the advantages and disadvantages of the dorsal and combined approaches to the surgical treatment of preschool children with congenital deformities of the thoracic and lumbar spine against the background of an isolated violation of the vertebral formation. Materials and methods. A retrospective analysis of 56 patients under the age of five with congenital spinal deformities and a history of an isolated hemivertebra in the thoracic and lumbar regions who underwent one-stage hemivertebral extrusion from a dorsal approach (1st group: n = 30) or from a combined approach (2nd group: n = 26) was conducted. Results. All patients showed improvement in the sagittal and frontal profiles of the spine. However, during separation in the first group of patients, a progression of the kyphotic component of the deformity in the lumbar spine from 19 to 8 was noted, while the correction value of the curvature of the scoliotic component remained stable. Intraoperative blood loss in the first group of patients was less (234 mL) compared with that in the second group (319 mL), while the duration of surgery was longer (310 min and 185 min, respectively). On average, in the first group, a longer metal structure was used to correct the spinal deformity compared with the second group. Conclusions. The correction of the patients congenital spinal deformities with a single hemivertebra from a combined access approach allows a complete correction of the congenital curvature, the fixation of a smaller number of vertebrae, and the maintenance of a stable result in the long-term observation period compared with the dorsal approach. Isolated dorsal access to the hemivertebral body is characterized by less intraoperative blood loss compared with the combined approach, although the length of surgical intervention is increased.

Introduction The incidence of compression spine injuries account for 0.49 % to 0.9 % of total pediatric trauma victims. Spine fractures constitute 7.5 % to 14.6 % of all inpatient hospital admissions and require conservative treatment. The aim of the study is to analyze the system of outpatient rehabilitation of pediatric compression vertebral fractures at follow-up care provided in St. Petersburg. Material and methods Medical records of 1230 children and adolescents who sustained compression fractures of the vertebral bodies and were followed up by orthopaedic surgeons in St. Petersburg between 2011 and 2017 have been reviewed. Results and discussion Pediatric bone fractures constituted 24.8 % of total injuries registered in St. Petersburg in 2017. From pediatric vertebral body victims, 53 % were boys and 47 % were girls. Vertebral fractures were most common in children aged nine, ten and eleven years (range, 13% - 14 %). A system of consistent non-operative treatment performed for the patients at trauma departments of children's hospitals, through inpatient and outpatient services of rehabilitation and restorative treatments, follow-up care in the outpatient setting is presented. Conclusion The incidence of pediatric bone injury and vertebral body compression fractures is higher in St. Petersburg than the average incidence reported in the Russian Federation. Questions of overdiagnosis of vertebral body compression fractures in pediatric population are considered to be important and relevant. An overview of treatment options and strategies, utilization of braces, follow-up term required for children with compression vertebral body fractures suggests revised approaches to treatment methods, length of inpatient management and follow-up care.

Idiopathic scoliosis is a common orthopedic disease of unknown etiology in childhood that limits the patient’s activity for a lifetime. Treatment of idiopathic scoliosis includes both conservative and surgical methods and requires psychological consideration, which is important for the rehabilitation of patient with chronic disease. Systematic research on the psychological aspects of the treatment and rehabilitation of patients with idiopathic scoliosis in the form of analysis allows us to evaluate the medical and psychological approaches to the problem and to identify the factors contributing to the successful adaptation of the patient to chronic disease situation. Methodology. We selected the articles related to the psychological aspects of scoliosis and its treatment between 2017 and 2018. The primary selection included 16 publications, of which 2 were survey studies. Earlier foreign and domestic publications were also included in the analysis in order to compare the changes in treatment and rehabilitation approaches. Literature analysis. Idiopathic scoliosis was considered as a risk factor for psychological discomfort in the forms of stress, negative emotions, anxiety, distortion of the image of “I,” reduced self-esteem, and communication problems. These increase the risk of mental disorders, such as depression, suicidal tendencies, and psychological disadaptation. Discussion. Analysis allows us to highlight the most important topics in the studies of adolescent idiopathic scoliosis in recent years: topic on mental health/ill health in adolescent idiopathic scoliosis (AIS), theme of the psychological component of pain, topic on clinical psychological and social psychological factors that determine the course of the disease of the patients with AIS, quality of life of a child or adolescent with AIS, issues of psychological resources for adaptation to a chronic disease, topic on parents’ perception of their child’s illness, and topic on the psychological accompaniment of patients suffering from AIS. Conclusions. A modern approach to the study of idiopathic scoliosis suggests a point of view from a biopsychosocial model of the disease; therefore, it is necessary to consider various factors affecting the patient’s quality of life, including the psychological component of the disease. Psychological support of the treatment should focus on the formation of the patient’s active position in relation to his or her own life and active coping strategies with chronic disease.

Introduction. Triple pelvic osteotomy is an effective surgical treatment for dysplastic subluxation of the hip in children aged above 12 years. However, modern studies did not assess the indicators of spine-pelvis ratios, sagittal profile of the spine in children with dysplastic subluxation of the hip following surgical treatment, and possibility of change on these values during the operation. Aim. This study aimed to evaluate the effectiveness of the improved technique of performing triple pelvic osteotomy on children with dysplastic subluxation of the hip. Materials and methods. We analyzed the x-ray images and surgical treatment of 35 female patients (44 hip joints) aged 13 to 18 years with dysplastic subluxation of the hip between 2016 and 2018. The patients were divided into two groups: the main group consisted of 20 patients (25 hip joints) who underwent surgical treatment that had taken into account the state of sagittal spine-pelvis ratios according to the improved method using personalized navigation templates, and the control group consisted of 15 patients (19 hip joints) who received surgical treatment according to the generally accepted method. Results. In addition to the typical clinical and radiological abnormalities of the dysplastic subluxation of the hip in 90% of patients in both groups, there were changes in the sagittal balance in the form of excessive pelvic anteversion and lumbar hyperlordosis. One year postoperatively, patients in the main group showed significant changes (p < 0.05) in the state of sagittal spine-pelvis ratios in the form of a decrease in the pelvic base angle, which led to the achievement of the average values of the angle of inclination of the sacral slope (SS) and the value of global lumbar lordosis. On the other hand, these radiological parameters in patients in the control group remained within the preoperative values. Conclusion. The improved technique of triple pelvic osteotomy provides conditions for the reduction of pelvic anteversion and restoration of the sagittal profile of the spine (p < 0.05). The use of personalized navigation templates allows for the most accurate multiplane correction of the acetabulum. It is necessary to include a specialized x-ray examination in the preoperative planning to assess the state of sagittal spine-pelvis ratios.

Introduction. The task of preserving the psychological health of children and adolescents is recognized as most important in the complex conditions of the modern world. Interdisciplinary research addresses the psychological aspects of mental health. For psychological health, understanding the highest level of mental health is an integral characteristic of the well-being of the individual, and the prerequisites for the development of personal maturity. Among the adverse factors in relation to mental and psychological health is what is known as somatic suffering, which occurs in orthopedic diseases. Cognitive, emotional, and behavioral responses to orthopedic disease, eliminating maladaptive manifestations in difficult life situations due to the disease, can be important indicators of psychological health of adolescents. Aim. We identify specific indicators of psychological health in adolescents with various orthopedic diseases. Materials and methods. The study involved 90 adolescents: 60 aged 1217 years with orthopedic diseases (30 with articular juvenile chronic arthritis and 30 with long-term consequences of mechanical trauma of the upper and lower limbs, resulting from an accident due to negligence) and a control group consisting of healthy adolescents of the same age. The characteristics of the self-esteem personality component (satisfaction with various aspects of their own lives) in adolescents with orthopedic diseases and their healthy peers were considered traditional indicators of psychological health. We used PiersHarris scale modified by V.I. Gordeev Y.S. Aleksandrovich and test of attitude to disease. Results. In adolescents with various forms of orthopedic disorders, the formation of stable variants of the attitude to the disease with a violation of adaptation of inter- and intrapsychic types is accompanied by the experience of discomfort, difficulties of self-regulation during treatment, and signs of a negative attitude. Formation of stable variants of emotional, cognitive, and behavioral responses without expressed disorders of mental and social adaptation is accompanied by a feeling of comfort and self-satisfaction. The prevailing reaction at harmonic, allopathic, and anosognosic types of mogutt act as a sanogenic effect. Emerging resistant variants of the attitude to the disease with a violation of adaptation of inter- and intrapsychic types can represent risk factors for breach of psychological health in adolescents with orthopedic diseases.

Introduction. Stenosis of the spinal canal can be accompanied by abnormalities of gait and body balance. At the same time, changes occurring in the postural control in children with spinal stenosis remain unexplored. Aim. To study postural stability in children with spinal stenosis and assess the imbalance of the body depending on the level of stenosis localization. Material and methods. This study investigated 14 patients, aged 10–17 years, with stenosis of the spinal canal. The first group consisted of seven patients with spinal stenosis due to congenital deformity of the thoracic spine with spinal cord compression at the stenosis level. The second group consisted of seven patients with spondylolisthesis of the L5 vertebra body of grades 3–4, accompanied with spinal cord root compression. The control group consisted of seven healthy children of the same age. We used stabilometry, and statistical study included correlation-regression analysis. Results. A significant deviation of the stabilometric parameters was noted only in the first group of patients (p < 0.05). In the same group, a strong correlation was found between the parameters of statokinesiogram: area S, length L, amplitude A, and mean power level of the spectrum of f 60%, which were much higher than those of healthy children, which may indicate a pathologically high synchronization of the vertical balance control system of the body. Other changes were revealed, such as a strong relationship between L/S and A at normal stabilometric parameters and a moderate force between L/A and f 60%, indicating postural deficiency in the group of patients with stenosis at the level of the lumbosacral spine. Correlation-regression analysis for assessing the postural balance in both groups of patients showed a correlation between parameters L, S, A, and f 60%, which were significantly higher than those in healthy children and most pronounced in the thoracic localization of stenosis. Conclusion. The system of maintaining vertical balance of the body in children with stenosis of the spinal canal at the level of the thoracic spine has a more pronounced deficiency than that in patients with stenosis of the canal at the lumbosacral level. To reveal hidden violations of the postural balance, the relationship between length, area, amplitude, and mean power of the statokinesiogram must be evaluated.

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.

Objective. To evaluate accuracy between pedicle screw placement in vertebral bodies achieved in vivo with freehand techniques versus their placement in vertebrae plastic models achieved in vitro with the use of guide templates, in toddlers and preschool children with congenital kyphoscoliosis of the thoracolumbar transition and lumbar spine amid the vertebral malformation.Material and Methods. The research is based on a retrospective analysis of the results of treatment of 10 patients with congenital kyphoscoliosis of the thoracolumbar transition and lumbar spine amid the vertebral malformation. Age – from 2 years 2 months to 6 years 8 months old (mean 3 years 8 months old), gender – 6 boys, 4 girls. Based on the postoperative multi-slice spiral computed tomography (MSCT) of the spine, the pedicle screws placement accuracy of the correcting multi-support metalwork was evaluated. These patients constituted the 1st research group (in vivo group). The 2nd research group (in vitro group) was formed from 27 vertebrae plastic models with pedicle screws inserted in them with the use of guide templates. The placement accuracy of the installed pedicle support elements was assessed based on the S.D. Gertzbein et al. scale (1990).Results. In the 1st group, there were 52 pedicle screws placed. The screw placement accuracy according to the rate of misplacement, as follows: 53.8% in Grade 0, 25% in Grade I, 11.6% in Grade II, 9.6% in Grade III. The number of screws with the rate of misplacement in Grade 0 + Grade I was 41 (78.8%). In the 2nd group, there were 54 screws placed and slightly larger than the 1st group. The screw placement accuracy according to the rate of misplacement was 94.4% in Grade 0, 1.9% in Grade I, 3.7% in Grade II, respectively. The number of screws with the rate of misplacement in Grade 0 + Grade I was 52 (96.3%).Conclusions. Comparative analysis showed that the number of pedicle screws successfully placed in vertebrae plastic models in children with congenital deformities of the thoracolumbar transition and lumbar spine achieved with the use of guide templates was significantly higher than the number of screws successfully placed with freehand techniques (96.3% versus 80.8%, p = 0.011). The results obtained with method of navigation templates in vitro showed high precision and accuracy of pedicle screw placement which gives the prospect for using this type of navigation in clinical practice in toddlers with congenital scoliosis.

Introduction.Based on the state statistics and in-house research the rates of child injury in SaintPetersburg in 2015–2017 were examined. As compared with the previous years, the rates of injury prevalence in children of 0–14 years (145.2%) and adolescents of 15–17 years (247.5%) don’t tend to the decrease and exceed the overall rates for Russia.Materials and methods.The structure of child injury by gender, age, type of injury, injury localization, and number of bone fractures in various locations as per chapter XIX of ICD-10 were presented.Results and discussion.External causes include road accidents, physical assault (chapter XX of ICD-10). Low disability index associated with musculoskeletal disorders in children is an advantage (0.7 per 10 thousand). The activity of outpatient and inpatient medical facilities providing specialized aid to children with musculoskeletal diseases in Saint-Petersburg was analyzed. The unique research centers for treatment of severe injuries of the musculoskeletal system and their consequences in children located in the municipal and federal institutions of Saint-Petersburg were presented.

Aim of the study — to identify clinical and roentgenological criteria of the sagittal profile status of spine-pelvis segment in children with dysplastic femur subluxation. Material and Methods . The present study included 40 female patients (50 hip joints) aged from 12 to 17 years (14.7±1.58) with unilateral and bilateral hip joint instability due to dysplasia. Children were divided into two groups – the first group included 30 patients (30 hip joints) with unilateral femur subluxation, the second group – 10 patients (20 hip joints) with bilateral femur subluxation. All patients underwent a standard orthopaedic clinical examination using a specialized scale to objectify complaints. All patients underwent X-ray examination of hip joints in AP and Lauenstein projections, CT scanning as well as lateral panoramic roentgenography of C1-S1 including femoral bones in standing position of the patient. Results . The authors observed a strong positive correlation between sacrum inclination and lumbar lordosis curvature, antetorsion angle of proximal femur and sacrum inclination angle, severity of pain syndrome during impingement test and sacrum tilt: Pearson correlation coefficient was 0.71, 0.81 and 0.88 respectively. The authors reported in all patients a thoracic normokyphosis and lumbar hyperlordosis with excessive pelvis anteversion. Global sagittal disbalance was observed in all patients. Conclusion. Apart from typical anatomical and roentgenological changes in pelvic and femoral componentsof the joint the children with dysplastic femur subluxation are characterized by excessive pelvic anteversion. Criteria of above parameters are identical and do not depend on the number of joints involved into the pathological process. Cranial dislocation of femoral head results to abnormalities of sagittal spine-pelvis ratios. Pathological process in hip joints and abnormality of spine-pelvis ratios results in negative changes of sagittal spine profile in the form of hyperlordosis, of physiological criteria of thoracic kyphosis and of the global sagittal disbalance. All of the above leads to overload of spinal motion segments and development of spine degenerative and dystrophic changes at early age.

Polymorphisms of neurotransmitter metabolism genes were studied in patients with prostate cancer (PC) characterized by either reduced or extended serum prostate-specific antigen doubling time (PSADT) corresponding to unfavorable and favorable disease prognosis respectively. The 'unfavorable prognosis' group (40 cases) was defined by PSADT ≤ 2 months, whereas patients in the 'favorable prognosis' group (67 cases) had PSADT ≥ 30 months. The following gene polymorphisms known to be associated with neuropsychiatric disorders were investigated: a) the STin2 VNTR in the serotonin transporter SLC6A4 gene; b) the 30-bp VNTR in the monoamine oxidase A MAOA gene; c) the Val158Met polymorphism in the catechol-ortho-methyltransferase COMT gene; d) the promoter region C-521T polymorphism and the 48 VNTR in the third exon of the dopamine receptor DRD4 gene. The STin2 12R/10R variant of the SLC6A4 gene (OR = 2.278; 95% CI = 0.953-5.444) and the -521T/T homozygosity of the DRD4 gene (OR = 1.579; 95% CI = 0.663-3.761) tended to be overrepresented in PC patients with unfavorable disease prognosis. These gene variants are regarded as protective against schizophrenia, and the observed trend may be directly related to a reduced PC risk described for schizophrenia patients. These results warrant further investigation of the potential role of neurotransmitter metabolism gene polymorphisms in PC pathogenesis.

Introduction. Spine congenital curvatures, which form from anomalies in the development of vertebral bodies, comprise 3.2% of the general structure of vertebral column deformities. Several such anomalies present during adolescence lead to severe and rigid curvature of the spinal column and are often accompanied by irreversible neurological disorders. The timely detection of the progressive forms of curvature and early surgical treatment are measures that prevent against neurological deficit development and gross congenital deformities of the spine in children. However, it is extremely difficult to predict the course of congenital spinal column deformation in infants based on clinical and radiological investigations alone. Therefore, the study of congenital malformation genetic markers is an essential and immediate task. Materials and methods. Two hundred 1.2–16-year-old children with congenital deformities of the thoracic and lumbar spine were examined using clinical and radiation diagnostic methods. Molecular genetic studies were performed by analyzing several polymorphic regions in the genes for the first and second stages of detoxification and DNA repair, which are of clinical importance as predisposing factors in several congenital malformations. Polymorphisms were determined using the polymerase chain reaction (PCR) method. The results were determined using gel electrophoresis of DNA in a polyacrylamide gel. Results and discussion. The polymorphisms of the genes CYP1A2, NAT2, GSTM1, GSTT1, GSTP1, XRCC1, XRCC3 and their frequency distributions among patients with congenital spine deformities (CSD) were studied. The results for each gene are presented in the digital diagrams, and their indicators are compared with the values of the control group. Conclusion. In most patients (83%) with spinal congenital deformations, there were mutations of candidate genes in the homozygous state; however, the simultaneous carriage of several mutant alleles in patients with CSD was more than twice that in the control group. Children with multiple and combined defects in spine development noted the presence of more mutations in the genes for detoxification and DNA repair. The obtained results already assume to a certain extent the course of the spine congenital deformity in patients at an early age. However, the final evaluation and identification of molecular genetic criteria for the progressive course of spine congenital deformities in children requires further study.

Introduction: Spine deformity formed as a result of anomalies in its development and this is one of the common orthopaedic pathologies of childhood. The results of some genetic studies did not show significant relationship between the different polymorphisms studied and the rate of progression of Idiopathic Scoliosis (IS). The study on new genetic markers for IS is an important and urgent task. Aim: To study the molecular genetic analysis of folate cycle genes and Interleukin 6 (IL-6) gene polymorphism in children with progressive type of IS. Materials and Methods: The case-control study was conducted on 110 children with IS between the age of 14 years to 18 years and 110 healthy volunteers without pathology of the spine. The study was carried out by the methods of molecular genetics analysis. Molecular diagnostics were carried out by analysing multiple polymorphic regions in the folate group and IL-6 gene, which are of clinical importance due to their predisposing factors in spine malformations. Genotyping of the gene polymorphism was performed using Polymerase Chain Reaction (PCR) in conventional and real-time method and the PCR products were analysed directly on the CFX96 Touch RealTime PCR Detection System or by gel electrophoresis. Statistical analysis was performed with software package Statistica 6.0. Results: The polymorphisms of the genes MTHFR, MTR, MTRR, IL-6 and their frequency distribution among patients with IS and control group were investigated. Some differences in the distribution of genotypes compared with the control group were found in the MTHFRA1298C, MTHFRC677T, MTRA2756G, MTRRA66G, and IL-6G (-174)C polymorphisms. The most significant differences were revealed for MTRA2756G polymorphism, and especially when dividing the group of patients with IS by gender. Conclusion: The results suggested that some polymorphisms of the folate group and IL-6 genes are involved in the pathogenesis of IS. This is also indicated by the well-known role that these genes do play in the ontogeny of the spine.