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Цель исследования: улучшение результатов хирургического лечения многоплоскостных деформаций у детей с сохранившимися зонами роста при рахитических деформациях. Материалы и методы. В ГУ «Институт травматологии и ортопедии НАМН Украины» с 2013 по 2019 год пролечено 6 пациентов с витамин-D-зависимым (2) и витамин-D-резистентным (4) рахитом в возрасте от 3 до 9 лет с многоплоскостными деформациями нижних конечностей, в значительной мере нарушающими функцию ходьбы и биомеханику нижних конечностей. С целью коррекции деформаций нижних конечностей у всех пациентов проведены сегментарные коррекционные остеотомии каждого из сегментов нижних конечностей (24). Фиксация проводилась интрамедуллярным «растущим» стержнем, который давал возможность зафиксировать конечность после оперативного вмешательства, не влияя в дальнейшем на рост ребенка. В 2 случаях использовался запатентованный стержень украинского производства, в 4 — прототип интрамедуллярного телескопического стержня Fassier-Duval. Результаты. У оперированных пациентов до начала лечения функция ходьбы и опоры была значительно ухудшена, после оперативных вмешательств с применением интрамедуллярных «растущих» конструкций восстановлена функция ходьбы и опоры, устранены многоплоскостные деформации. Всем пациентам проводилось консервативное лечение метаболических нарушений костной ткани. Во всех случаях остеотомий получено сращение в соответствующие сроки, рост бедренной и большеберцовой костей в длину не нарушался, раздвижение интрамедуллярных конструкций проходит удовлетворительно, ни у одного пациента за период наблюдения не было повторных переломов и деформаций длинных костей нижних конечностей, миграции элементов металлоконструкций. Максимальный срок наблюдения послеоперационного периода у наших пациентов составлял 1,5 года с начала оперативных вмешательств. Выводы. При хирургическом лечении многоплоскостных деформаций нижних конечностей мы рекомендуем использовать многоуровневые остеотомии с металлоостеосинтезом телескопическим интрамедуллярным стержнем, позволяющим провести одномоментную коррекцию рахитической деформации и избежать повреждений зоны роста.

Background. The difficulties of diagnosis that arise when choosing therapeutic measures aimed at preventing sublu-xation, dislocation, and contractures of the hip joint in patients with cerebral palsy are a topical object of the research. The purpose was to improve the results of the diagnosis of the hip joint pathology by establishing objective radiographic parameters. Materials and methods. The total number of patients was 20 (40 joints), 10 boys and 10 girls aged 3 to 15 years. Sixteen joints were operated. Radiographically, we have determined neck-shaft angle and torsion of the thigh, projection and true according to Koval (using tables), acetabular angle, angle of inclination (Sharpe’s angle). Hip torsion was determined clinically according to Ruwe. Torsion was evaluated intraoperatively in our own way (patent No. a200512793). All patients were examined using our method (patent No. 137567). Results. Using the Student’s t-test for independent samples, the parameters of the hip joints were compared and significant differences were found between the neck-shaft angle in the standard position and the neck-shaft angle in our own position (p < 0.05), as well as between the neck-shaft angle in the standard position and the neck-shaft angle true according to Koval (p < 0.05). According to Fisher’s test, it was found that the torsion according to Ruwe and the torsion according to Koval are significantly different (p < 0.05): Femp 1.87 > Fkr 1.7. Using the method of odds ratio (OR), we determined that the sensitivity of torsion measurement by Ruwe was 0.7, the specificity of torsion measurement by Ruwe was 0.83 (OR = 11.67, confidence interval [1.94–70.18]) indicating that the chance of getting a coincidence by measuring torsion by Ruwe is 11.67 times higher than accor-ding to Koval, compared with intraoperative data. A well-defined amount of torsion of the thigh according to Ruwe provides true indicators of the hip joint using our own method. Conclusions. The own method provides the determination of objective clinical and radiographic (diagnostic) parameters in patients with patho-logy of the hip joint. When performing one roentgenogram, it is possible to define all basic parameters of the hip joint (torsion of the hip, neck-shaft angle, Wiberg’s angle, Reimers’ index, index of vertical migration, acetabular angle, angle of inclination) and to standardize examinations of patients with cerebral palsy who are subject to screening throughout the whole period of their development. In this way, you can get radiographic indicators of patients with severe neuromuscular disorders (Gross Motor Function Classification System levels III and IV).

Summary. There is no doubt that obtaining the true parameters of the hip joint makes it possible to determine the tactics of treatment of patients with cerebral palsy and it is a relevant object of studying. Objective: to improve the results of diagnostics of pathology of the hip joint in patients with cerebral palsy by developing our own method. Materials and Methods. The study included 20 patients (40 joints): 10 boys and 10 girls. Sixteen joints were operated on. The patients were 3-15 years of age. Femoral torsion according to Ruwe was clinically determined in all the patients; also, our own method for determining the clinical and roentgenogrammetric parameters of the hip joint (utility model patent No. 137567) was used. Results. Our own method is simple, available and cheap; it may be used in all medical institutions with X-ray rooms for the diagnosis of hip joint pathology, as well as for screening. Conclusions. Our own method is simple and reliable for determining the parameters of the hip joint in patients with cerebral palsy (femoral torsion, neck shaft angle, Wiberg's angle, Reimer's index, vertical migration index, acetabular angle, the angle of inclination of the acetabulum) in patients with cerebral palsy. Obtaining radiographic parameters of both hip joints after only one radiograph also significantly reduce the radiation load on the patient, since patients with cerebral palsy are the subject of screening throughout the entire period of their development. This method can be also applied during the examination and screening the patients with developmental disorders and other diseases of the hip joint.