Background. Patients with haematogenous and non-bacterial osteomyelitis have similar clinical symptoms (pain in the nidus area, soft tissue swelling, fever) and laboratory signs (increased erythrocyte sedimentation rate, leukocyte count, C-reactive protein concentration). The criteria for distinguishing these two states are not determined.Objective. Our aim was to determine diagnostic criteria to differentiate haematogenous and non-bacterial osteomyelitis.Methods. The study included data of patients under the age of 18 years with non-bacterial or haematogenous osteomyelitis hospitalised to two clinical centres from 2009 to 2016. The diagnosis was established and re-verified according to archival data (medical history) and after two years of observation (at least once a year). Clinical, anamnestic and laboratory data (haemoglobin, leukocytes, leukocyte formula, platelets, ESR and C-reactive protein, CRP) as well as the results of radiation diagnostics (X-ray, CT scan, MRI or osteosyntigraphy) obtained at the disease onset were taken into account as potential diagnostic criteria.Results. Out of 145 patients with non-bacterial or haematogenous osteomyelitis, the diagnosis was re-verified in 138, of them non-bacterial osteomyelitis — in 91, haematogenous osteomyelitis — in 47. The following criteria had the highest diagnostic value for establishing cases of non-bacterial osteomyelitis: detection of bone destruction foci surrounded by osteosclerosis area [sensitivity (Se) 1.0; specificity (Sp) 0.79]; absence of fever (Se 0.66; Sp 0.92); the number of bone destruction foci > 1 (Se 0.73; Sp 1.0); CRP 55 mg/L (Se 0.94; Sp 0.73); negative results of bacteriological examination of the material from the bone destruction focus (Se 1.0; Sp 0.67).Conclusion. Diagnostic criteria for differentiation of non-bacterial and haematogenous osteomyelitis have been described. Further research on the efficacy of using these criteria to reduce the risk of diagnostic errors, decrease the diagnostic pause, reduce the risk of non-bacterial osteomyelitis complications is needed.

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BACKGROUND:Osteochondritis dissecans of the femoral condyles is characterized by subchondral bone lesions, with subsequent formation ofanosteonecrosis area. In nearly half of the cases, gonarthrosis developed in the long-term period despite timely treatment of such patients, including children. The development of new techniques and the improvement of existing ones will help enhance the treatment results of patients with this pathology. AIM:To evaluate the efficacy of treatment inasmall clinical series of pediatric patients with osteochondritis dissecans by triple injections of platelet-rich plasma (PRP) according to the developed scheme in combination with revascularizing tunnelization of the lesion area. MATERIALS AND METHODS:Seven patients with stage I or II osteochondritis dissecans were treated by revascularizing stimulation of the osteonecrosis center by triple injections of PRP (the first procedure was conducted intraoperatively intraosseously and the two other injections subsequently intraarticularly). The follow-up period was10 (611)months, withamaximum duration of 12 months. RESULTS:The observation results demonstrateahigh efficacy of PRP therapy to enhance the effect of mechanical methods of osteochondrogenesis stimulation in children with osteochondritis dissecans. CONCLUSIONS:The use of orthobiological technologies isanactively developing and promising approach in the complex treatment of children with osteochondritis dissecans of the femur condyles. However, further observation is required to evaluate the long-term results.

Objective. To analyze the literature on cervical spine tumors located in the region of the vertebral artery. Material and Methods. Sixty five publications containing data on the surgical treatment of 101 patients with tumors of the cervical spine located in the area of V1-V3 vertebral artery segments were selected for the literature review. Results. The analysis of publications was performed according to the following criteria: demographic data, complaints, histological type of tumor, involvement of the vertebral artery, the performed occlusion test, final embolization or ligation of the artery during surgery, and postoperative complications. The group of patients described in selected publications consisted of 66 men and 35 women, whose average age at the time of surgery was 38.7 years. Acute development of neurological symptoms at the prehospital stage caused by vertebral artery compression was observed in two cases. The C2-C4 vertebrae were most often affected, and the malignant process was confirmed in 70.3 % of cases. In 27 cases, patients underwent an occlusion test of the involved vertebral artery. At the preoperative stage, the final embolization of the artery was performed in 9 cases, the artery was tied during the main operation and removed together with the tumor-in 25, and damaged-in 7. Neurological disorders associated with stopping blood flow through the vertebral artery were noted in two cases. In a number of cases, patients underwent vascular anastomosis with preservation of blood flow at follow-up examination. Conclusion. Taking into account the obtained data and careful preoperative planning will improve the treatment of this group of patients, increase survival, and reduce the risks of possible neurological disorders and tumor recurrence.

Деструктивные поражения осевого скелета встречаются относительно редко в повседневной практике детского травматолога-ортопеда. Вместе с тем, клинико-лучевая симптоматика деструктивных изменений костной ткани характерна для опухолевых и инфекционно-воспалительных поражений костей. Данная симптоматика не всегда четко указывает на конкретную нозологическую единицу, а дифференциальная диагностика без исследования биологического материала из патологической зоны сложна. Данные утверждения особенно актуальны для поражений грудины, опухолевые процессы которой в 85 % имеют злокачественный характер. В статье представлены два редких клинических наблюдения детей с первичным злокачественным новооб-разованием грудины. Проведен анализ клинико-лучевых и патоморфологических данных. Показана важность ранней гистологической верификации процесса для определения тактики и выбора адекватного лечения. Про-веден краткий обзор литературы, посвященной злокачественным опухолям грудины у детей.Ключевые слова: поражение грудины, лимфома Ходжкина, дети, хондросаркома. Destructive changes in the bones are rarely observed in daily practice of pediatric orthopedic surgeons. Clinical and X-ray signs of destructive changes in the bone tissue are characteristic of tumoral, infectious, and inflammatory damages of bones. These signs do not always correspond to a specific disease, and differential diagnostics without histological evaluation is difficult. This is especially true for tumors of the sternum, 85% of which are malignant. Two rare clinical cases of primary malignant sternal neoplastic lesions in pediatric patients, and a detailed analysis of their clinical, radiologic, and morphologic data are presented. The importance of early histological verification for determining the choice of treatment is demonstrated. A short literature review is also presented. MALIGNANT TUMORS OF THE STERNUM IN PEDIATRIC PATIENTS: REPORT OF TWO CASES AND LITERATURE REVIEWKeywords: sternum malignant tumor, Hodgkin's lymphoma, children, chondrosarcoma.Хронические деструктивные поражения ске-лета относительно редко встречаются в практике детских хирургов и ортопедов. Возможно, имен-но поэтому каждый случай такого заболевания представляет серьезную проблему, сопровождает-ся длительным наблюдением, поздно диагности-руется, нередко при этом выполняются неодно-кратные и не всегда оправданные хирургические вмешательства. Дифференциальный ряд таких деструкций, как правило, ограничивается инфек-ционными (чаще -туберкулезными) и опухо-левыми процессами, и, хотя первые встречаются несравнимо чаще, именно онкологическая насто-роженность позволяет раньше диагностировать опухоли, прежде всего благодаря лучевым и мор-фологическим методам.