A comprehensive approach to the diagnosis and treatment of children with bone

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Zykin, V. E., Panteleev V. G., R. V. Slyunyayev
NUZ “Otdelencheskoy hospital at the station of fish of JSC “RZD”

The Report on the health status of children in the Russian Federation (results of the all-Russia prophylactic medical examination of 2002) it was noted that over the last decade in the health status of children and adolescents is a strong negative trend is the increased prevalence of risk factors of formation of health disorders and development, increasing morbidity and disability.

Experience of national health care shows that the solution to this problem is possible only when the organization continuously monitoring the health and development of children on the basis of periodic medical examinations, and continuous monitoring of children with deviations in health status, integrated therapeutic and rehabilitation measures.

The functioning of the body is determined by the stability of all systems. In this article the problems of interaction of the musculoskeletal system, the visual analyzer and the Central nervous system in children.

As you know, in the body there is a rising control system – vertical power: the lower extremity > pelvic ring > the spine. The top of the pyramid is the brain and its analyzers. The most significant of these is the visual analyzer, which delivers up to 80% of information about the world.

Results of all-Russian medical examination of children in 2002 showed the highest growth rate (2.6 times) the number of children under the age of 14 children with diseases of the musculoskeletal system and connective tissue. In 2002, this pathology ranks sixth in the structure of total morbidity. The same trend is observed among adolescents 15 to 18 years, with the incidence higher than among children up to 14 years.

The incidence of eye pathology in children and adolescents is markedly higher than that of the adult population and tends to increase, which is associated with the increase of myopia, amounting to about a quarter of all children with identified diseases of the eye and almost a third are among adolescents.

According to various studies, the incidence of myopia in schoolchildren 7-8 years 1-4,5%, and high school graduates is about 20-25%. At the same time in 6-8% of cases revealed high myopia, leading to significant visual impairment and sharply limiting the possibilities of subsequent professional activity. Diseases of organs of vision was included in the leading group of diseases in children, and is a 3 – 4th place in the neighborhood with such pathology, as diseases of the musculoskeletal system, nervous system, gastrointestinal tract and upper respiratory tract [1].

During the period 2003-2009 in our clinic underwent a comprehensive examination and treatment of 554 patients aged 6 to 16 years, as well as dynamic monitoring from 1 year to 5 years.

Examination of patients seeking consultation was undertaken by each specialist (traumatologist-orthopedist, neurologist, ophthalmologist) according to accepted standards and consists of physical parts (history taking, clinical examination, according to the testimony of laboratory examination) and special diagnostic methods.

Orthopedic conclusion was based on data from x-ray examination of the spine in a straight line projection standing and lying in the lateral projection is indicated. The stop condition was evaluated on the basis of x-ray with a load of plantography, evaluation of prognostic characteristics and hereditary factors.

A comprehensive examination of the organs of vision included the examination of visual acuity of each eye at the table Sivtseva-Golovin according to standard methods; state of accommodation ( as determined by the reserve of relative accommodation by the standard method); refraction (subjective method and skiascopic), refractometry; examination of anterior and posterior segments of the eye (using slit lamps and ophthalmoscopes OR-3A and O3-5). Methods biomicroscopy and ophthalmoscopy were studied the condition of the refractive media and fundus.

Neurological diagnosis consisted of radiological examination (craniography in the lateral projection), reoentsefalografii, Doppler ultrasound, Echoes, MRI of brain and cervical thoracolumbar spine (if indicated).

It should be noted that not all types of surveys it is possible to perform the polyclinic, so some of them were produced in other hospitals.

The results of complex examination of children and adolescents do not inspire enthusiasm, as in the majority of patients was identified combined pathology of these organs and systems in different proportions (Fig. 1).

As mentioned above, the “vertical of power muscle-bone unit” determines the degree of deviation of the upstream structures from the norm. In this pathological deformity of foot has a pathogenic effect on the axis of the spine and, consequently, leads to distortion of the pelvis. Neurological pathology, of course, exacerbates the overall picture that the total impact on the functioning of the higher brain structures.

The nosological spectrum is highly variable. So, in orthopedics in the first place, this pathology of the feet and spine, ophthalmology, myopia, asthenopia, spasm of accommodation; in neurology and youth osteochondrosis, vascular and neuro-muscular dystonia.

From the point of view of a combination of pathology is indicative of the following diagram (Fig. 2).

Myopia refractive (Mr) and axial myopia (MO) is correlated with scoliosis and pathology of the arch of the feet in different proportions. It determines the further tactics of correction. However, note that almost 42% of the cases, their impact on the health status of the child imposes a neurological pathology.

The complex of therapeutic measures based on the findings of all specialists. It includes the procedures designated orthopedist, such as massage of the back muscles and abdominal wall, therapeutic exercise, physiotherapy, hydrotherapy, stoptherape individual, rational wearing shoes with insoles-arch supports, declination etc.

The ophthalmologist conducts a comprehensive medical therapy, and special visual training with the aim of normalizing the accommodative apparatus of the eye replacement lens by Avetisov-mats exercises, accomodo trainer, according to testimony, the treatment of children with myopia individually.

In medical tactics by a neurologist based on a neck massage, exercise therapy and, if necessary, fixing the bandage on the cervical spine (collar Trench), manual therapy, sparing Wellness regime, water-salt bath. In drug therapy: vascular drugs, nootropil, b vitamins, sedatives.

Analysis of the effectiveness of the complex therapy shows that the end result is determined jointly developed a patient management by doctors and duration of treatment. We believe that to achieve the desired goal in the rehabilitation of patients with combined pathology should make full use of human resources of medical institutions. This allows on the basis of collectively taken decisions to choose the most rational treatment is that, ultimately, contributes to the entry of a teenager into adulthood a productive member of society.

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