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  • Хирургическое пособие при повреждениях сухожилий сгибателей пальцев кисти у детей

    "Хирургическое пособие при повреждениях сухожилий сгибателей пальцев кисти  у детей."

    Продолжение статьи "Повреждение сухожилий сгибателей пальцев кисти  у детей"

    По метериалам "Аспекты проблемы повреждений сухожилий сгибателей пальцев кисти  у детей." Александров А.В., Рыбченок В.В., Львов Н.В.
    Лечение больных с повреждением сухожилий сгибателей кисти как в остром, так и в отдаленном периоде остается одной из актуальных проблем кистевой хирургии.

    Отдельным, не решенным вопросом стоит проблема отсутствия единой, адекватной системы послеоперационного ведения и реабилитации детей с травмой сухожилий.

  • Лечение больных с врожденными ложными суставами длинных трубчатых костей

    Лечение больных с врожденными ложными суставами длинных трубчатых костей конечностей является актуальной проблемой современной реконстуктивно-восстановительной хирургии и ортопедии детского возраста.
    Традиционные варианты костной ауто- и гомо-пластики, компрессионно-дистракционный метод далеко не всегда приводят к положительным результатам, так как помимо диспластических изменений костной ткани существует аномалия развития сосудов микроциркуляторного русла, приводящая к нарушению кровообращения в области псевдоартроза. В этих условиях только пересадка васкуляризованного костного трансплантата с нормально сформированным микроциркуляторным руслом, является патогенетически обоснованным методом и может гарантировать благоприятный исход. Использование данного метода значительно сокращает срок стационарного лечения и реабилитации пациента.
    В отделении реконструктивной и пластической микрохирургии ДГКБ № 13 им. Н.Ф.Филатова свободная пересадка аутокости с применением микрохирургической техники была осуществлена у 27 больных в возрасте от 2-х до 15 лет. Из них у 22 пациентов был псевдоартроз голени, у 2-х патология локализовалась в предплечье, у 2-х больных были ложные суставы плечевой кости, у 1 ребенка – ключицы. Большинство детей до поступления в отделение микрохирургии были неоднократно безуспешно оперированы традиционными методами (костная ауто или гомопластика). В большинстве случаев предыдущие неудачные оперативные вмешательства или отсрочка лечения привели к выраженной вторичной деформации конечностей и значительному распространению зоны остеосклероза, что требовало выполнения более обширной сегментарной резекции материнской кости. В качестве трансплантата нами использовался фрагмент диафиза малоберцовой кости. В предоперационном периоде всем пациентам проводилось ангиографическое исследование сосудов конечностей. Для оценки жизнеспособности трансплантированного костного фрагмента в послеоперационном периоде, нами использовалась компьютерная сцинтиграфия.