3 Санкт-Петербургское ГКУЗ «Диагностический центр (медико-генетический)» Актуальность. Врожденный передний вывих голени (ВПВГ) -это редкое заболевание опорно-двигательной системы с частотой встречаемости 1 на 100 000 живых новорожденных. Своевременная пренатальная диагно-стика и лечение, начатое в первые дни жизни, позволяют избежать инвалидизации ребенка. Цель исследования: изучить возможности пренатальной ультразвуковой диагностики и оценить эффектив-ность ранней ортопедической коррекции с применением консервативных методов лечения. Материалы и методы. За период с января 1988 по февраль 2016 г. были пролечены 37 новорожденных (50 нижних конечностей) с ВПВГ. Первичная оценка пораженных конечностей осуществлялась сразу после рождения. Для определения тяжести вывиха использовались классификации Seringe и Tarek. Всем пациентам проводилось консервативное лечение. Возраст детей в момент начала лечения составил от 2 часов до 5 дней. Были использованы различные методики: этапные гипсовые повязки (10 нижних конечностей), коррекция на шине Розена (8 нижних конечностей); с 2003 г.применялся единый протокол лечения, разработанный авторами исследования. Результаты. Пренатальный УЗ-скрининг позволил выявить ВПВГ до рождения ребенка в 21 % случаев. Отда-ленные результаты (катамнез от 3 до 28 лет) оценивались по шкале Seringe и были отличными в 60 % случаев, хорошими -в 32 % и удовлетворительными -в 8 % случаев. Плохих результатов не было. Все дети, вклю-ченные в исследование, начали самостоятельно ходить в возрасте 9-18 месяцев. Заключение. Пренатальная УЗИ-диагностика позволяет выявить ВПВГ. Лечение новорожденных, начатое в первые часы жизни по протоколу, разработанному авторами, позволяет в короткие сроки, без длительных этапных гипсовых повязок вправить вывих голени. Отдаленные результаты демонстрируют эффективность предложенной методики.Ключевые слова: врожденный передний вывих голени, пренатальная диагностика.

Backgrоund. Congenital clubfoot or congenital equino-cava-varus deformity of the feet is one of the most common pathologies of the musculoskeletal system in children. Numerous articles in global literature have been published about changes in clubfoot severity during treatment; however, there are very few reports on how the severity of foot deformities with congenital clubfoot changes during the first week of life in the absence of deformity correction. Aim. To analyze changes in the severity of congenital clubfoot in the first week of life without any treatment. Materials and methods. The study group included 28 newborns with idiopathic congenital clubfoot (a total of 40 feet). The severity of clubfoot was evaluated on days one and seven after birth using the Dimeglio and Pirani scores. Results. During the initial examination of the newborns on the first day of life, the clubfoot severity recorded on the Pirani score was between 2 to 3 points and between 9 to 15 points on the Dimeglio score. Thus, in the first seven days of life in all patients who did not receive treatment, there was a significant increase in the severity of the equino-cava-varus deformity of the feet (p 0.05). The results of this study confirm that the severity of congenital clubfoot increases in the first week of life. This necessitates the beginning of the correction of severe idiopathic clubfoot in the first days after birth. Conclusions. The severity of congenital clubfoot during the first week of life significantly increased in all feet studied (p 0.05: 2 higher than in the table). If left untreated in the first week after birth, the equinus deformity progresses followed by varus deformity, anterior forefoot reduction, and, to a lesser extent, rotation.

Introduction. Jacobsen syndrome, characterized by multiple developmental anomalies, is a rare genetic syndrome caused by a partial deletion of the long arm of the 11th chromosome. The incidence is 1 : 100,000 live births. Patients of this group have malformations of the heart, kidneys, gastrointestinal tract, central nervous system, and skeleton. The severity of clinical features is diverse. Jacobsen syndrome rarely combines with a congenital clubfoot. Case report. The clinical case of using the Ponseti method for the treatment of congenital clubfoot in combination with Jacobsen syndrome is presented. As a result, a complete primary correction of the foot was obtained, which did not relapse within 2 years. Discussion. Only brief references to this pathology were found in the literature. In the case of our patient, a greater number of gypsum dressings were required to complete the primary correction of the foot. Conclusion. Painless foot has been achieved, which has a full range of motion, which confirms the success of the application of the Ponseti method for the treatment of non-idiopathic congenital clubfoot and the need for using it as a starting method.

BACKGROUND: Congenital knee dislocation is a very rare musculoskeletal disease, and it occurs in approximately 1 per 100,000 live births. Many researchers note that the treatment of congenital knee dislocation should begin with conservative methods, during which various complications arise. AIM: This study aimed to compare the clinical and radiological classifications of congenital knee dislocation and show the results of the treatment of this deformation using a Von Rosen splint and plaster corrections. MATERIALS AND METHODS: The study included 58 patients (34 boys and 24 girls) with congenital knee dislocation (83 knee joints). Congenital knee dislocation with arthrogryposis and other systemic pathologies were not included in the study. Before treatment, all patients were assessed for the severity of congenital knee dislocation according to the Tarek and J. Leveuf system. To evaluate the obtained results, nonparametric statistics were used. To search for differences between groups, the KruskalWallis test and the median test were used. To search for correlations, Spearman coefficients were used. Statistica v10 was used for statistical analysis. RESULTS: Clinical and radiological data were compared. In both groups, after conservative treatment, excellent and good results were obtained in nearly 98% and satisfactory in 2%. After conservative therapy, surgical treatment was required in 2 of 37 knee joints with the initial severity of Tarek III deformity. CONCLUSIONS: The severity of the deformity according to the Tarek system makes it possible to predict the effectiveness of the conservative treatment of congenital knee dislocation at a statistically significant level.