Sergei V. Vissarionov’s research while affiliated with The Turner Scientific Research Institute for Children's Orthopedics and other places

Idiopathic scoliosis (IS) accounts for 2% to 5% of cases in orthopedic pathology. Surgical treatment of severe, rigid IS forms remains an important and pressing problem. The purpose of this research was to evaluate the efficacy and safety of the surgical correction method of severe kyphoscoliotic deformity of the thoracic spine in children with the use of the active optical three-dimensional computer navigation technology. Materials and methods used: a retrospective, single-center cohort study of the surgical treatment results of 30 children aged 14 to 18 y/o with grade 4 IS was conducted with V (C) Level of Evidence. The inclusion criteria were as follows: the scoliotic deformity magnitude of over 80°, simultaneous discopphysectomy, mobilizing dorsal osteotomies and deformity correction with a multi-support metal structure. Results: the scoliosis magnitude in the preoperative period was 100.5° (min 82; max 130; SD=13.21), after surgery 27° (min 4; max 47; SD=12.53). Pairwise comparison demonstrated statistically significant differences (p=0.013). The kyphosis magnitude in the preoperative period was 39.4° (min 3; max 61; SD=16.61), after surgery - 37.7° (min 3; max 49; SD=6.59). The abovementioned data comparison demonstrated the absence of statistically significant differences (p=0.154). The vertebral rotation magnitude in the preoperative period was 35.5° (min 20; max 60; SD=8.73), after surgery - 20° (min 9; max 32; SD=6.54). When comparing the results, statistically significant differences were revealed (p=0.010). Neurological disorders after the surgical interventions were not noted in patients included in the study. Conclusion: the use of the method of surgical correction of severe kyphoscoliotic deformity of the spine from a combined approach using active optical three-dimensional computer navigation technology allows the complete correction of the spinal deformity, indirectly improving both the shape and the size of the chest and restoring the frontal and sagittal profiles of the spine.

BACKGROUND: Congenital anomalies of vertebral development account for 2%–11% of cases in the general structure of nosologies that cause spinal deformity. An unsegmented rod (unilateral violation of vertebral segmentation) is attributed to a prognostically unfavorable malformation. Rib synostosis causes the development of thoracic insufficiency syndrome. AIM: To analyze the results of treatment of children with congenital scoliosis caused by an unsegmented rod and rib synostosis by vertebrotomy. MATERIALS AND METHODS: This cohort, retrospective, monocenter study evaluated the treatment results of 55 patients. The patients were divided into two groups: group 1, children aged 2–8 years, the scope of intervention was wedge-shaped osteotomy of a non-segmented rod at the apex of the deformity, and group 2, children aged 8–18 years, the scope of intervention was wedge-shaped osteotomy at the apex of the deformity and two linear osteotomies of a non-segmented rod in the cranial and caudal directions. Clinical, radiological, and statistical research methods were used. RESULTS: Significant correction of scoliosis was achieved in 65.5% of patients aged 2–7 years (group 1) and 56.3% in children aged 8–18 years (group 2). Hypokyphosis of the thoracic spine was observed in the patients. The percentage of correction of kyphosis was 21.1% in group 1 and 19.1% in group 2. Lung volume increased by 27.9% (p = 0.01776) in group 1, and lung volume on the concave side increased by 23.5% (p = 0.04975) and on the convex side by 29.6% (p = 0.01073). Improvement in the overall respiratory impedance reached 47.3% (p 0.05). In group 2, a insignificant increase was found in VVC by 12.6% (p = 0.3509) and FEV1 by 8.7% of the initial (p = 0.1534), as well as an increase in total lung volume of 13.3% (p = 0.1527) and the contribution of the lung along the concave side of 18.8% (p = 0.1535), and the lung along the convex side was 8.4% (p = 0.169), indicating no significant impact on lung development and function. CONCLUSIONS: In children with spinal deformity caused by a non-segmented rod with normal respiratory function, vertebrotomy at the apex of the deformity with subsequent correction and stabilization of the spinal deformity is recommended. Performing simultaneous multilevel osteotomies of a non-segmented rod allows for significant correction of rigid spinal deformity.

BACKGROUND: Burns remain a crucial part of the structure of injuries in Russia and abroad. Therefore, providing high-quality medical care to burn victims is relevant. Despite the large number of proposed solutions to this condition, developments in the field of tissue engineering and medical materials science still lack standardization and consideration of specific features of animal burn models for their testing. Many studies showed minor and major disadvantages from a technical and descriptive point of view. AIM: To analyze and identify the main disadvantages of existing burn models to assess the effect of wound healing agents. MATERIALS AND METHODS: This article examines the search results in the databases Google Scholar and PubMed using the keywords “burns,” “rats,” “animal model,” and “wound healing.” Sixty publications were analyzed. RESULTS: Seven quality criteria for the animal burn model have been determined, which allow obtaining reliable results and reproducing the described experiment: indication of the terms of quarantine and conditions of keeping laboratory animals, detailed description of the technique of applying burn injury, presence of one burn on a laboratory animal, presence of a control biopsy, indication of the absolute value of the initial burn area, presence of surgical treatment of burn wounds, and correct use of formulas for the planimetric assessment of wound healing. CONCLUSIONS: A solution to the problem of creating a standardized model may be a more detailed description of techniques and following the proposed quality criteria.

BACKGROUND: Conservative treatment of children with carinatum is currently an urgent and unresolved problem despite the wide range of techniques available. Conservative treatment stops the progression of deformation and reduces the degree of deformation or eliminates it. Methods of evaluating treatment results include clinical (photo–video assessment, questionnaire survey, and chest measurements) and instrumental diagnostics (radiography, computed tomography [CT], and 3D scanning); however, no method of correction and orthosis that would consider all the tasks of conservative treatment, method of evaluating conservative treatment, and uniform protocol have been established. AIM: This study aimed to analyze the literature containing information on the conservative treatment of patients with pectus carinatum. MATERIALS AND METHODS: The study presents the results of a search in PubMed, Cochrane, and eLibrary using combinations of operators and keywords. A total of 54 foreign and domestic sources were extracted, and the search was not limited retrospectively. RESULTS: Orthosis is effective and positively perceived by doctors and patients. The most modern designs in the treatment of carinatum included dynamic orthoses FMF-DCS and Braceworks (Calgary). Recent studies have reported a strong correlation between 3D scanning and CT to assess treatment outcomes. However, no single option for conservative correction of deformity allowed for achieving all treatment goals. The assessment of the effectiveness of orthosis using photos, videos, and questionnaire, and chest measurement is subjective. CONCLUSIONS: The disadvantages of prosthetics determine the need to develop a clear treatment algorithm, methodology, and objective assessment of treatment outcomes, requiring further research.

BACKGROUND: In children, progressive congenital deformities of the thoracic spine combined with thoracic anomalies require surgical intervention to correct the curvature and prevent further progression during the child’s growth. Surgical correction of congenital deformity caused by segmentation disorders of the lateral surfaces of the vertebral bodies with unilateral rib synostosis aims at full correction of the existing curvature using the transpedicular spinal system and is an effective and reliable treatment option for these patients. However, this technology requires precise and correct installation of the supporting elements of the metal structure to exclude possible irreversible complications. A solution is the use of template guides in the installation of the support elements of the spinal metal structure. AIM: This study aimed to conduct a comparative analysis of the results of using template guides for the placement of transpedicular screws with the free-hand method in children during surgical correction of congenital spinal deformities combined with thoracic anomalies. MATERIALS AND METHODS: The results of surgical treatment of 20 patients, aged 3–9 years, were analyzed retrospectively to compare the time and accuracy of spinal metal support element placement with and without the use of template guides. The data collected included demographic information, time of bone canal formation, accuracy of spinal transpedicular screw placement, and various complications. RESULTS: Compared with the free-hand method, the use of template guides in the surgical correction of congenital spinal deformities combined with thoracic anomalies in children reduces the time of bone canal formation and increases the accuracy of metal screw placement. These results confirm the efficacy and safety of using template guides during spinal surgery in children with these congenital malformations. CONCLUSIONS: The use of template guides is an effective and reliable method of inserting transpedicular metal screws in the correction of congenital spinal deformities combined with thoracic anomalies in children, which increases the accuracy of implantation of support elements and reduces the surgical time. These results confirm the necessity of using template guides in the correction of congenital spinal deformities in children.

BACKGROUND: Fractures of the distal metaepiphysis of the radius are among the most common injuries in pediatric patients. This results from the peculiarities of the anatomical structure and structure of the radial tissue in this area. AIM: This study aimed to analyze the literature on the treatment of children with fractures of the distal metaepiphysis of the radius. MATERIALS AND METHODS: Literatures on the treatment of children with fractures of the distal metaepiphysis of the radius were extracted from PubMed, eLibrary, and Google Scholar without language restrictions for the period from 1990 to 2024. RESULTS: In fractures of the distal metaepiphysis of the radius without displacement, the limb is immobilized. Displaced fractures require closed reduction and/or surgical treatment. For the treatment of stable fractures, specialists adhere to conservative techniques. The method of choice for the surgical treatment of unstable fractures should be minimally invasive osteosynthesis. The current gold standard for the surgical treatment of fractures of the distal metaepiphysis of the radius in children is closed reduction and intramedullary metal osteosynthesis with Kirschner wires, followed by plaster cast application. CONCLUSIONS: Currently, no consensus has been reached on the method of choice for the surgical treatment of fractures of the distal metaepiphysis of the radius in children. The results of treating children using the presented surgical techniques are contradictory, and high risks of developing intra- and postoperative complications are noted. Thus, conducting more research in this area and developing new and most effective surgical methods that can reduce the risk of complications and optimize the rehabilitation process for these patients remain relevant.

BACKGROUND: A feature of the disease course in patients with spastic cerebral palsy is a combination of motor neurological disorders with contractures in extremity joints. Neurosurgical methods are currently the main treatment for correcting the pathological tone of the “spastic hand.” However, the decreased tone does not affect secondary (fixed) contractures; therefore, the effectiveness of this type of treatment is extremely dependent on the accurate selection of a certain category of patients. Presumably, diagnostic blockade of the median nerve can create a reversible model for planned neurosurgical treatment. The inclusion of this technique as a standard for examining a patient with spastic cerebral palsy before invasive tone-lowering treatment can radically promote treatment effectiveness. AIM: This study aimed to assess the prognostic effectiveness of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy. MATERIALS AND METHODS: A longitudinal prospective study enrolled 39 children (aged 5–18 years) with spastic cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic n. medianus under electrical stimulation and ultrasound control. After a diagnostic blockade, only patients who had a good functional and goniometric response were selected for the study, which served as an indication for selective neurotomy of the median nerve, and orthopedic treatment was performed in children with a negative event. Patients referred for neurotomy underwent a standardized examination before treatment during the diagnostic blockade and after neurosurgical treatment. The examination included the assessment of the amplitude of passive and active movements in the joints of the upper extremities, muscle tone, and functional capabilities of the upper extremities and dynamometry. RESULTS: In comparison with the initial data, a significant increase in the amplitude of passive and active hand extension, passive and active abduction of the first finger, and upper limb functional capabilities according to the MACS classification and the Miller scale was determined both after the diagnostic blockade and after selective neurotomy of the motor branches of the median nerve. CONCLUSIONS: Based on the results of the study, the effect of the diagnostic blockade and neurosurgical treatment outcomes are unidirectional, which allows the use of blockade as a method for modeling the possible result in clinically complex cases of spastic hand. The use of diagnostic blockade in clinical practice makes it possible to adequately assess the severity of fixed contractures and reduce the pathological hypertonicity of the target muscles. Diagnostic blockade allows for the collection of sufficient information to make an objective decision about which type of treatment is most preferable for each patient – neurosurgical, orthopedic, or sequential use of both methods.

Background. Total hip arthroplasty (THA) is one of the most frequently performed and effective surgical procedures in patients with hip osteoarthritis of various origin. According to a variety of large arthroplasty registries, in 10-33% of cases, the causes of end-stage hip osteoarthritis in people under the age of 25 are such orthopedic diseases of the hip as dysplasia, SCFE and Perthes disease. However, there are practically no scientific publications examining the causes of the development of end-stage hip osteoarthritis in patients under the age of 21, as well as in children, in the foreign literature and there are none at all in the domestic literature. The aim of the study is to analyze the causes of the development of end-stage hip osteoarthritis requiring total hip arthropasty in children who had suffered major orthopedic diseases of the hip. Methods. The retrospective study is based on the medical records of 500 patients (530 hip joints) aged between 10 and 18 years (15.1±1.5) who had underwent total hip replacement at the Department of Hip Pathology of the G.I. Turner National Research Medical Center for Pediatric Traumatology and Orthopedics, in the period from 2008 to 2023. The main subject of the study was the anamnesis of the course of the orthopedic disease and previous treatment. Results. After studying the medical records and archival X-rays, we have identified the main diagnostic and tactical errors in the treatment of patients with major diseases of the hip, which are specific to childhood. Additionally, according to these nosological entities we have identified the most “endemic” federal regions and subjects of the Russian Federation. Conclusions. The main causes of the development of end-stage hip osteoarthritis requiring total hip arthroplasty in patients under the age of 18 with major orthopedic diseases of the hip are: diagnostic defects, methodological choice of both conservative and surgical treatment, and iatrogenic damage to the joint components.

Schizophrenia is a disorder with a heterogeneous etiology, involving a complex interaction between genetic and environmental risk factors. The immune system is now known to play a vital role in the function and pathology of the nervous system by regulating neuronal and glial development, synaptic plasticity, and behavior. In this regard, the immune system is positioned as a common link between the seemingly diverse genetic and environmental risk factors for schizophrenia. Synthesizing information about how the brain's interactions with the immune system are influenced by multiple factors and how these factors may interact in schizophrenia is necessary to better understand the pathogenesis of this disease. This article provides an overview of the genetic risk factors for schizophrenia that modulate immune function and how the consequences of these risk factors relate to microglial function and dysfunction. It is hypothesized that the morphological and signaling deficits of the blood-brain barrier observed in some people with schizophrenia may act as a gateway between peripheral and central nervous system inflammation, thereby affecting essential microglial functions. In addition, the various roles that microglia play in response to neuroinflammation and their impact on brain development and homeostasis, as well as the pathophysiology of schizophrenia, are reviewed.

Introduction The upper limb functional limitations in congenital radioulnar synostosis may significantly affect the daily activities of patients. Classifications of the condition are descriptive and have limited practical application. Purpose Determine a functionally significant quantitative criterion for anatomical changes in the forearm. Material and methods 92 children (136 forearms) with congenital radioulnar synostosis were examined for limitations in activities of daily living (ADL), health-related quality of life measured with PedsQL questionnaire; pronation of the forearm and radiographic parameters. A comparative and correlation analysis, ROC analysis were performed to determine the relationship between the forearm pronation and limitations of ADL. Results Statistically significant correlations were revealed between symptoms and the forearm alignment (p < 0.01, rxy = 0.5); subluxation of the ulnar head and forearm alignment (p < 0.001, rxy = 0.6); bowing deformity of the radius, forearm alignment and subluxation of the ulnar head and between the length of the forearm bones and bowing deformity of the radius (p < 0.05, rxy = 0.4 and rxy = 0.5). A statistically significant inverse correlation was revealed between symptoms and PedsQL scores (p = 0.038, rxy = –0.4). Pronation of 45° was the threshold value of the forearm alignment with a high risk of ADL limitation. The area under the ROC curve corresponding to the relationship between symptoms and the forearm alignment was 0.955 ± 0.021 (95 % CI: 0.915–0.995). There was a statistically significant (p < 0.01) decrease in the lumen of the medullary canal in the middle third of the ulnar shaft with the radius lumen being unchanged. Dorsal subluxation of the ulnar head was detected In 30 % of cases. Discussion The characteristics identified demonstrated changes in the forearm bones with functional impairments being correlated with the forearm pronation. Conclusion The correlation between the patient’s symptoms and the forearm alignment must be taken into account in the classification and when determining indications for surgical treatment distinguishing between functional (< 45° pronation) and dysfunctional (≥ 45° pronation) options.