Method for differential diagnosis of perthes disease stages in children and youngsters

FIELD: medicine, orthopedics.

SUBSTANCE: method involves inspection of children and youngsters suffering from Perthes disease by convention methods that involve analysis of clinical symptoms of disease and results of the roentgenology study. In case of difficulties in assay of stages of pathological process method involves taking off venous blood sample, separation of red cells wherein activity of enzyme superoxide dismutase is determined. At value of activity of superoxide dismutase above 153.9 U/g Hb/min II-III stages of Perthes disease are diagnosed and at value of this index lower 142.6 U/g Hb/min IV-V stages of Perthes disease are diagnosed. Using the method allows enhancing safety of differential diagnosis of II-III and IV-V stages of Perthes disease.

EFFECT: improved method of diagnosis.

2 ex

 

The invention relates to medicine, more specifically, to a method for differential diagnosis of pathological process activity in the femoral head when the disease Perthes disease in children and adolescents, and can be used by orthopaedic surgeons specialized clinics.

There is a method of determining the stage of the disease based on the analysis of clinical manifestations and radiographic progression of the pathological process (Mineev PHD, L.A. Belyakova Clinical and theoretical substantiation of active surgical tactics in complex treatment of Perthes disease. - Ulyanovsk: Simbirsk book, 1997. - 112 C.). Often when using an existing method of differential diagnostics II-III stages of Perthes disease (active process of resorption of the trabecular bone, the fragmentation of the epiphysis and the formation of cysts in the cervix) is very difficult transition pathological changes in the IV-V stages (incase of bone resorption, increase in repair processes, revascularization of the epiphysis and the substitution for it of the newly formed bone). This is due to the slow flow of each of the stages of Perthes disease (from 0.5 to 1.5 years) and a smooth transition from one stage to another. However, the definition stage of the pathological process is essential for the adequate therapeutic measures that vary depending on the stage of the disease.

is the most close to the proposed technical solution is the way, based on the results of determination of the total proteolytic activity of the blood serum, which allow to judge the stage of Perthes disease (RF patent 2160899; G 01 N 33/48, And 61 In 5/00). However, this solution has a drawback: it can be used to implement the methodology for determining the total proteolytic activity of blood serum liquid bromine limits the possibility of wide use of the method due to its high volatility and toxicity of the drug.

The present invention is the elimination of the existing disadvantage of increasing the availability of the implementation of the biochemical methods of investigation of the blood by removing from the work of highly toxic compounds.

The problem is solved due to the fact that the patient is taken from a vein the blood, separate the red blood cells, which determine the activity of the enzyme superoxide dismutase, and if the value is higher than the other 153.9 units/g Hb min diagnosed stage II-III disease Perthes disease, when the value of the index below 142,6 units/g Hb min - IV-V stages of Perthes disease.

The method is as follows. Children and adolescents suffering from Perthes disease, examined with the use of traditional methods - analyze the clinical manifestations of the disease, conduct x-ray examination. When the difficulty of determining pathological stages the process of (indistinct clinical manifestations and radiographic data, characteristic for each of the stages of the patients is taken from a vein the blood, separate the red blood cells and in the latter determine the enzyme activity of superoxide dismutase using a known method (Nishimi M. et al. The occurrence of superoxid anion in the reaction of reduced phenazine // Biochem. Biophys. Res. Commun., 1972. - Vol.46. - N 2. - P.849-854; Gurkin A.T., Dubinin E.E. superoxide dismutase Activity in red blood cells of patients with viral hepatitis // lab. case, 1986. - N7. - S-423). When the value other 153.9 units/g Hb min and above diagnosed with II-III Tadei of Perthes disease, and 142,6 units/g Hb min and below - IV-V stages of the pathological process. In this case the correct judgment about the stage of Perthes disease (average value) constitute 66.6% (2/3 of cases).

The basis for establishing the boundaries of the activity of erythrocyte superoxide dismutase with the purpose of differential diagnosis stages of the pathological process in the femoral head when the disease Perthes disease was the results of the analysis of this index in children and adolescents suffering from this disease and for a long time under the supervision of an experienced orthopaedic surgeons specialized clinic Nizhny Novgorod research Institute of traumatology and orthopedics. Stage of the pathological process in these patients was established on the basis of the analysis of observation results in the dynamics of clinical and radiological manifestations of the disease.

Is FCP is dannogo indicator in patients suffering from Perthes disease in the stage of bone resorption and fragmentation of the epiphysis (stage II-III)was 196±15,8 units/g Hb min (M±m; M - arithmetic mean; m - error arithmetic average), while patients who were treated at the Institute about a similar pathological process in the stage of reparation (formation of bone tissue), - 126±to 11.5 units/g Hb minutes Average activity of erythrocyte superoxide dismutase in patients of both groups differed by 35.7% with a high degree of confidence (p<0,001). Variation range, including indicators analyzed patients first and second groups within M±0.67σ (M - arithmetic mean, σ- standard deviation, Sigma), in the first group (stage II-III) ranged from 142,6 to 248.8 units/g Hb min, and the second (IV-V stages) from 98,5 to other 153.9 units/g Hb minutes With indices of activity of erythrocyte superoxide dismutase, corresponding to stage II-III disease Perthes disease will be other 153.9% /g Hb min or more, and IV-V stage - 142,6 units/g Hb min or less. When the value of the index in the interval from 142,7 to 153.8 units/g Hb min judgment about the stage of Perthes disease is uncertain.

It is seen that in some cases, the diagnosis stages of the pathological process using the proposed method is difficult, because in some patients the disease Perth the CA II-III stage, values are in the area of the same parameter in patients with IV-V stages of pathological process. At the same time, some patients IV-V stages superoxide dismutase activity of erythrocytes coincides with that of patients with Perthes disease stage II-III (range activity of superoxide dismutase within 142,7-153,8 units/ g Hb / min).

Checking the efficiency of the test showed the following. In 9 out of 13 children and adolescents suffering from Perthes disease IV-V stages, the analyzed parameter was below 142,6 units/g Hb minutes In patients who have Perthes disease was in the II-III stages, in 16 cases out of 25 surveys are adequately testified to this stage of the pathologic process (the value of the analyzed parameters was more than other 153.9 units/g Hb / min), two patients (1 patient from each group) judgment about the stage of the pathological process according to the definitions in the blood activity of superoxide dismutase was uncertain, because the values of the examined parameters ranged from 142,7 to 153.8 units/g Hb minutes

The foregoing is illustrated by examples.

Example 1.

Patients To Y.N. 8 years (the East. b-nor N 176166) received NIETO on inpatient treatment of Perthes disease stage III-IV. Clinical and radiographic examination of the patient, and also determined the activity of super is kiddimoto erythrocytes, which amounted to 55.9 units/g Hb minutes the result of biochemical blood tests allowed us to pronounce on the IV stage of Perthes disease, which was confirmed by further observation of the patient is in the hospital. Ultimately, the correct diagnosis of the stage of the pathological process was the basis for the development of tactics adequate remedial measures.

Example 2.

Patient W s AV 12 (East. b-nor N 188356) received NIETO diagnosed with Perthes disease stage II. The results of the Institute's examination of the patient (clinical and radiological), and biochemical studies of the activity of erythrocyte superoxide dismutase (200,9 units/g Hb min) helped to confirm the diagnosis of stage II of Perthes disease. Information about the activity of erythrocyte superoxide dismutase have helped more able to judge the stage of the pathological process.

Thus, the proposed method of differential diagnosis stages of the disease Perthes disease in conjunction with other methods of diagnosis of this disease process, particularly in difficult cases, when the clinical manifestations of the disease and the data of x-ray examination does not accurately characterize the stage of Perthes disease, may be useful as an additional diagnostic laboratory test in a comprehensive manner the system diagnostic techniques for everyday use in the practice of pediatric clinics orthopedagogical profile.

The method of differential diagnosis stages of Perthes disease in children and adolescents, including the analysis of clinical symptoms and radiological findings of the patient, wherein the patient is taken from a vein the blood, separate the red blood cells, which determine the activity of the enzyme superoxide dismutase, and if the value is higher than the other 153.9 units/g Hb min diagnosed stage II-III disease Perthes disease, when the value of the index below 142,6 units/g Hb min - IV-V stages of Perthes disease.



 

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