Saratov JOURNAL of Medical and Scientific Research

Sertakova A.V.

Saratov State Medical University n.a. VI. Razumovsky, Scientific and Research Institute of Traumatology, Orthopedics and Neurosurgery, Senior Research Assistant, Candidate of Medical Science

Significance of estimation criteria in pediatric flatfoot

Year: 2020, volume 16 Issue: №4 Pages: 905-911
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Sertakova A.V., Rubashkin S.A., Timaev M.Kh., Dokhov M.M., Korshunova G.A., Zvereva K.P., Agafonova N.Yu.
Organization: Saratov State Medical University
Summary:

Objective: to analyze a set of versatile criteria for assessing flatfoot in children and identify the most significant for flatfoot diagnosis. Material and Methods. We conducted a cross sectional study that involved 150 patients with flatfoot diagnosis (mean age 9.5 ±0.8 у. o.) and 50 patients with neutral feet (mean age 10.1 ±1.3 у. o.). The examination of the children suggested a set of methods including the clinical one, quality-of-life questionnaire survey, X-ray and computed tomography, biomechanical and electroneuromyography (ENMG) methods. The findings of the conventional diagnostic tests underwent clustering and mathematical simulation. Results. The statistically significant X-ray indicators for flatfoot diagnosis are: astragalus horizontal angle (p<0.001), longitudinal arch angle (p=0.038), arch height (p=0.053). The valid biomechanical indicators are the foot transfer time (p=0.044) and the support time (p=0.042) as the temporal characteristics of the gait. Electroneuromyography detected significant changes in the M-response and F-waves as well as F/M ratio with the calf muscle. In most cases, high-amplitude M-responses (13.4±1.6 mV, 7.7±0.8 mV in health) and F-waves (1603±235.4 mV, 360±115 mV in health) were registered from the calf muscles, exceeding the data in healthy children 5 times. 8 statistically significant indicators of 18 X-ray and 13 biomechanical criteria were assigned; they provide 77.3% of the correct diagnosis when used for the mathematical model. Conclusion. We established the most sensitive and statistically significant criteria for the flatfoot diagnosis in children. They enable the assessment of the changes severity in flatfoot and designing the medical decision making support system for choosing the proper treatment method when these criteria are used for the data base and the artificial intelligence predicative model.

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Comparative analysis of surgical outcomes for achondroplasic children receiving PRP-therapy (a case-control study)

Year: 2020, volume 16 Issue: №3 Pages: 757-761
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Timaev M.Kh., Sertakova A.V., Alieva A.V.
Organization: Saratov State Medical University
Summary:

Objective: To assess surgical outcomes in achondroplasic pediatric patients receiving PRP-therapy (Platelet-Rich Plasma therapy) for lengthening long bones. Material and Methods: 27 achondroplasic patients had been examined and operated in the pediatric trauma orthopedic department of the Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University n. a. V.I. Rasumovsky in 2014-2018, their mean age 4.7±2.1 у. o. (4-11 у. o. range). The examination involved conventional clinical examination as well as X-ray examination. All patients were divided into 2 groups, the division criteria being intraoperative application of PRP-therapy (autoplasma therapy or plasmolifting). Group 1 (n=14) was made up of patients who had underwent transosseous compression distraction osteosynthesis with no PRP employed while all patients of Group 2 (n=13) had received PRP injections. Results: The distraction consolidation index (DCI) in Group 1 (n=14) was 72±7 days/cm (good and satisfactory results) and the average length of the grown distraction was 4.5±2.5 cm. In PRP-therapy employed Group 2 DCI was 65±10 days/cm (good results) and the distraction length was 6.5±2.5 cm. In patients of Group 1 sectioned, lateral and central forms of the distraction prevailed while in patients who had received PRP-therapy spindle and cylinder forms of the distraction were observed. Conclusion: PRP-therapy employed in all stages of the elective distraction at limb osteotomy allows significant DCI improvement as well as activation of bone tissue remodeling in the osteotomy area, the geometric type of trabeculae formation being more beneficial.

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Methods of tendomus-cular plasty for the management of upper extremity deformities in children with infantile cerebral palsy (review)

Year: 2020, volume 16 Issue: №3 Pages: 752-756
Heading: Traumatology and Orthopedics Article type: Review
Authors: Dokhov M.M., Zvereva К.Р., Ehdalov Kh.R., Timaev M.Kh., Rubashkin S.A., Sertakova A.M., Norkin I.A.
Organization: Saratov State Medical University
Summary:

The review covers the published studies on the management of upper extremity deformities in children with infantile cerebral palsy distributed in PubMed, PubMed Central, eLibrary resources. The concept of 'spastic arm' includes 'inward rotation' contracture of the shoulder joint, flexion contracture of the elbow joint, ulnar contracture of the wrist joint as well as finger joints. The pathology pattern of the upper extremity impedes grasping, gripping, manipulating, and lowering the objects, inhibits the development of individual skills for daily routine and full participation in social life, education, and leisure. The methods of tendomuscular plasty are a part of the comprehensive treatment of children with this diagnosis. However, the choice of the patients and the type of the surgery as well as the assessment of the outcomes remain unsettled issues. The contemporary researches on the subject are retrospective and descriptive. Designing the detailed algorithms for the management of the patients with spastic upper extremity is a promising trend aimed at facilitating the practice for orthopedic surgeons and enhancing the outcomes in this cohort of patients.

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Quality of life in children with fat feet (planovalgus foot, longitudinal platypodia)

Year: 2019, volume 15 Issue: №2 Pages: 271-274
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Dokhov M.M., Sertakova A.V., Rubashkin S.A., Timaev M.Kh.
Organization:
Summary:

Objective: to evaluate the quality of life in children with fat feet using standard quality of life questionnaire technique. Material and Methods. 97 children with fat feet (mean age 9.7±1.2 y. o.) and 32 children with neutral position of the feet (control group) participated in the research. Both the fat foot and neutral position of the foot diagnoses were based on patients» clinical examination and instrumental methods of diagnosis. The questionnaire survey was conducted using the Oxford Ankle Foot Questionnaire (OAFQ) for children (7–17 y. o.) designed for evaluation of potential cost for treatment of children with foot and ankle joint pathologies. It is made up of 15 questions showing the quality of life (physical development, school life and exercise, emotional development) as well as problems with shoes selection. General central module of the Kiddy-KINDL Questionnaire covers various aspects of children»s life providing a fexible modular psychologically applicable method. The structure of the questionnaire scales consists of 24 questions united in evaluation groups. Results. In the group of fatfoot children the quality of life is reliably lower in terms of physical development and shoes selection. Flat feel has almost no impact on children»s emotional development as well as their social function; it doesn»t usually lead to fxation on disfguration. Conclusion. To evaluate every individual clinical case of decline in physical development quality and worsening of the emotional state in pediatric patients trauma orthopedists are recommended to employ various questionnaires that allow for detailed defning of lesions degree and quality for individual selection of the treatment method.

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The method of controlled growth for the correction of axial deformities of lower extremities in children

Year: 2018, volume 14 Issue: №3 Pages: 529-532
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Dokhov M.M., Mashukov T.S., Sertakova A.V., Rubashkin S.A., Timaev M.Kh., Kurkin S.A.
Organization:
Summary:

Aim: to estimate the outcomes of the method of controlled growth in the correction of axial deformities of lower extremities in children. Material and Methods. We fulfilled the analysis of surgical results of 37 children aged 3-13 yrs. with leg axial deformities, valgus (20) and varus (17) leg deformities at the level of knee joints. All patients were operated in the growth area with the method of controlled growth — temporary epiphysiodesis of external portions of distal growth areas in femoral bones. The assessment of controlled growth method was conducted at 3-14 months for valgus and 6-15 months for varus leg deformities. Results. The assessment of controlled growth method use indicated clinically and X-ray proved reduction in femoral-tibial angle before the elimination of metal construction in valgus deformity 4.1 times, in varus 3.8 times. Conclusion. The method of controlled growth is highly effective correction method for axial deformities of lower extremities in children, and is minimally traumatizing.

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Anatomic and functional disorders in children with flatfoot

Year: 2018, volume 14 Issue: №3 Pages: 396-401
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Sertakova.A.V., Dokhov M.M., Rubashkin S.A., Timaev M.Kh.
Organization:
Summary:

Aim: to analyze anatomic and functional changes in children with flatfoot. Material and Methods. We analyzed foot state in 40 children (34 boys and 6 girls, aged 5-14, mean age: 9.6±2.3 yrs), comparison group consisted of 30 healthy children aged 5-14 (mean age 8.5±2.5 yrs) without foot pathology. Patients were diagnosed on the basis of clinical examination: complaints, functional stress tests, QL questionnaire Oxford Ankle Foot, instrumental methods (X-ray, biomechanical investigation). Results. Right from early age (5 yrs) children start experiencing discomfort in feet in the course of various physical exercises, in our experiment 77% of patients have discomfort complaints. Mean indexes of OAFQ were 30.8±12.5. All children had signs of astragalus erection with respect to calcaneum which stipulates disturbance of longitudinal arch of foot joints and of normal function in talocalcaneal coalition. The disturbance of gait time indexes results in its decreased function. Conclusion. At present the problem of flatfoot in children did not get proper attention. The surgeons should focus on the features of pathology development in children 7-14 yrs applying all modern diagnostic methods.

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Anatomic and functional disorders in children with flatfoot

Year: 2018, volume 14 Issue: №3 Pages: 396-401
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Sertakova.A.V., Dokhov M.M., Rubashkin S.A., Timaev M.Kh.
Organization:
Summary:

Aim: to analyze anatomic and functional changes in children with flatfoot. Material and Methods. We analyzed foot state in 40 children (34 boys and 6 girls, aged 5-14, mean age: 9.6±2.3 yrs), comparison group consisted of 30 healthy children aged 5-14 (mean age 8.5±2.5 yrs) without foot pathology. Patients were diagnosed on the basis of clinical examination: complaints, functional stress tests, QL questionnaire Oxford Ankle Foot, instrumental methods (X-ray, biomechanical investigation). Results. Right from early age (5 yrs) children start experiencing discomfort in feet in the course of various physical exercises, in our experiment 77% of patients have discomfort complaints. Mean indexes of OAFQ were 30.8±12.5. All children had signs of astragalus erection with respect to calcaneum which stipulates disturbance of longitudinal arch of foot joints and of normal function in talocalcaneal coalition. The disturbance of gait time indexes results in its decreased function. Conclusion. At present the problem of flatfoot in children did not get proper attention. The surgeons should focus on the features of pathology development in children 7-14 yrs applying all modern diagnostic methods.

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Coxar-throsis in infancy and adolescence: opportunities of preventive treatment

Year: 2017, volume 13 Issue: №3 Pages: 751-755
Heading: Traumatology and Orthopedics Article type: Review
Authors: Norkin I.A., Sertakova A.V., Rubashkin S.A., Zotkin V.V., Gerasimov V.A., Timaev M.Kh., Chibrikova Yu.A., Kupina E.S.
Organization:
Summary:

The review systematizes scientific data on the major groups of heterogeneous diseases which have infant and adolescence coxarthrosis as their outcome and contains materials on etiology, pathogenesis, diagnostic, treatment and precaution methods of complication (dystrophic changes in hip joints) for each disease.

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Biomechanical criteria of orthopedic status of patients with dysplastic coxarthrosis (Crowe) IV before and after treatment

Year: 2017, volume 13 Issue: №3 Pages: 520-526
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Yusupov K.S., Barabash Yu.A., Pavlenko N.N., Romakina N.A., Anisimova E.A., Letov A.S., Sertakova A.V., Anisimov D.l.
Organization: Scientific Research Institute of Traumatology Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky
Summary:

The aim: to analyze locomotor function of lower limbs in patients with dysplastic coxarthrosis Crowe IV type before and after single-step hip joint endoprosthesis and femoral bone osteotomy conducted by our own technology. Material and Methods. 42 patients with one-side dysplastic coxarthrosis Crowe IV type were examined and operated. The mean age at the time of admission in men was 47.3±1.2 years, women — 46.1 ±1.1 years. Static and kinematic function of lower limbs was evaluated with the help of stabilometrics and podometry before and one year after the operation. Results. Before treatment, the patients had deviations of static and dynamic function of locomotor system stabilometri-cally seen as instability in upright position and podographically as a compromised gait. One year postsurgically we indicated static balance between the limbs within the normal range, expanded motoring mode, which was supported by significant improvement in the biomechanical characteristics of locomotor function of the patients. Conclusion. Total hip replacement in combination with modifying osteotomy of the hip conducted by a unique technique restores static and kinematic function of lower limbs in patients with high congenital hip dislocation (dysplastic coxarthrosis Crowe type IV) which is proved by stabilographic and podographic indices one year after operation.

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Comprehensive approach to the assessment of the functional status of patients with degenerative joint diseases of the lower extremities

Year: 2017, volume 13 Issue: №3 Pages: 510-514
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Romakina N.A., Korshunova G.A., Kireev S.I., Sertakova A.V., Norkin I.A.
Organization: Scientific Research Institute of Traumatology Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky
Summary:

Aim: development of an integrated biomechanical index that reflects the state of kinematic and static function in patients who need replacement of large joints as well as evaluation of the myoneural complex of lower extremities activity of category of patients. Material and Methods. 103 patients with osteoarthrosis of the hip and knee joints. A biomechanical survey included podography, stabilometry and dynamometry. An electrophysiological study of the peripheral nerves of the lower extremities with the determination of the amplitude of the muscle response and late neuronal responses was carried out. The level of activity of the gluteal muscles was determined. Results. The most sensitive indicators reflecting the state of biomechanical status were identified, specialized software for the integral biomechanical index calculation was developed. Conclusion. Methods of clinical biomechanics allow specialists to assess the state of kinematic and static function of the musculoskeletal system, matching of the integral biomechanical index with the data of neurophysiological monitoring makes possible to select individual tactics of treatment.

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