Рор V. Diagnostics and treatment hip joint diseases in children and adolescents with epiphyseal dysplasias

The object: pathology of hip joint in children and adolescents in case of epiphyseal dysplasias. The goal of investigation: to improve the results of children and adolescents treatment with the pathology of hip joint in case of epiphyseal dysplasias by means of development of diagnostic-and-treatment measures aimed at prevention and decrease of the number of hip joint degenerative-dystrophical affections. Methods: clinical, laboratory (pantoclinical, biochemical and morphological reseach); instrumental reseach methods (sonographic, rontgenologic, magnetic resonance tomographic and method of ultrasonic density sensitometry of heel bones) and statistical. Peculiarities of hip joint formation in patients with epiphyseal dysplasias were discovered for the first time and diagnostic criteria in case of hip joint affection with epiphyseal dysplasias were determined. Sonographic peculiarities of formation of centre (or centres) of ossification of epiphysis of femoral head in children with epiphyseal dysplasias were discovered. Peculiarities of manifestations of femoral head which is formed of multiple centres of ossification in patients with epiphyseal dysplasias according to computer tomography data were determined. Magnetic resonance tomographic description of epiphyseal aseptic necrosis of upper end of femur which is formed of multiple centres of ossification in patients with epiphyseal dysplasias was given. It was determined that in patients with epiphyseal dysplasias there is fall in concentration of noradrenaline in urine and lessening of its ratio to adrenaline. Rontgenologic criteria of effaced forms of epiphyseal dysplasias diagnostics were developed for the first time. It was determined that in patients with epiphyseal dysplasias there are structure functional transgressions of bone tissue state of a variable degree in the form of osteoporosis and osteopenia. Peculiarities of clinicorontgenologic manifestations of different forms of degenerative dystrophic affections of hip joint in children and adolescents with epiphyseal dysplasias were first discovered. The conceptual model of pathogenetic mechanisms of epiphyseal dysplasias development was worked out and on its basis the conceptual model of hip joint affection in case of epiphyseal dysplasias and the scheme of pathogeny of degenerative dystrophic affections of hip joint in case of epiphyseal dysplasias were made up. On the basis of the system approach, the conceptual model of pathogenetic mechanisms of development of hip joint pathology in case of epiphyseal dysplasias and clinicoinstrumental research the system of differential conservative and surgical treatment of patients with born hip dislocation in case of epiphyseal dysplasias was first worked out and the postoperative dynamics of spatial relationship in hip joint in case of the treatment of dysplasia, born hip dislocation and varus deformity of proximal end of the femur in children and adolescents of the reference group was studied. Usage of the proposed system of treatment of the patients with hip joint pathology in case of epiphyseal dysplasias in the growth period led to the decrease of the number of hip joint degenerative-dystrophical affections. The results of investigation are being used in the clinical practice of Public Institution "Institute of Traumatology and Orthopedics AMS of Ukraine", Kyiv regional clinical hospital and Alupka Bobrov sanatorium and during the teaching and educational process of the department of orthopedics and traumatology № 2 of National Medical Academy of Postgraduate Education named after P.L.Shupyk. Traumatology and orthopedy.