Журнал «Травма» Том 15, №4, 2014

Introduction. Drug treatment of children with dysplastic scoliosis requires consideration of etiological, clinical, age and individual peculiarities of this polyethiologic and rapidly progressive disease [1,2,3,5,8]. Despite decades of research in this area, no consensus on a strategy for the treatment of dysplastic scoliosis genesis depending on the degree of spinal deformity has not yet been worked out [6,7]. Therefore, no claim to the final solution of the problem from the standpoint of assessing the immune response and metabolic processes try to justify differentiated in terms of the pathological process approach to treating children with dysplastic scoliosis.

The purpose. On the basis of studies to justify the tactics drug correction of immune status and metabolic processes in children with varying degrees of dysplastic scoliosis

Materials and methods. The paper describes the experience of the examination and treatment of 45 children with varying degrees of dysplastic scoliosis in age from 4 to 17 years under observation in the hospital for orthopedics and traumatology children NIITO Donetsk National Medical University. Age limit for patients divided into two groups: 4-12 years - 27 people (53.4%) and from 12 to 17 years - 23 people. (46.6%). By sex of patients showed the prevalence of girls - 68.1%. The diagnosis was verified by clinical-radiological examination. Radiographic studies included the standard projections of the spine. All patients prior to treatment conducted clinical and laboratory studies of the immune system and metabolic processes.

Results of the study. The formulation of the tactics of treatment of children with dysplastic scoliosis formed previously identified patterns of immune response [4] and changes in metabolic processes, depending on the degree of spinal deformity. It was established that the initial manifestation of dysplastic scoliosis in children occur on the background of aseptic inflammation, which is one of the compensatory mechanisms of pathological changes at the system level. In particular, it was confirmed increased levels of serum pro-inflammatory IL-1β (3,57 ± 0,52 pg / ml vs. 1,62 ± 0,16 pg / ml, P <0.05) and decreased level of IL-6 has both pro - and an anti-inflammatory action (1,28 ± 0,23 pg / ml vs. 2,10 ± 0,24 pg / ml, P <0.05), as well as minor and severe lymphocytosis leukocytosis. Activation of lymphoid mediated immunity in children condition changes in the subpopulation of regulatory T-lymphocytes, in particular, increasing the number of T-helpers and T-suppressors reduction, which is also characteristic of the inflammatory process. While noting the increased phagocytes activity of neutrophiles as compared with their low microbicidal activity that is characteristic of aseptic inflammation. The presence of inflammatory process and showed increased rates of circulating immune complexes in the serum (47,50 ± 3,14 opt. unit against 28,11 ± 3,4 opt.unit.;. P <0.05).

Development of inflammatory reaction and aseptic character determines changes in metabolism. In particular for all children with scoliosis characterized dysplastic increased level of potassium in the serum ALT activity and decreased alkaline phosphates activity and consequently an increased acid phosphates in the serum. These features indicate subclinical hypoxia, deficiency of energy metabolites and the weakening of osteoblastic processes.

In addition to the above features of metabolism in children with 1 degree of scoliosis was a decrease in serum lactate dehydrogenises activity, in combination with reduced ALT activity indicated a deficit of energy metabolites.

The results of correlation analysis between biochemical parameters and immune status indicators showed negative relation with IL-1β indicators coenocytes (r = -0,53; P <0.05), magnesium (r = - 0,69; P <0.05) creatinine (r = -0,58; P <0.05) and positively related to B-lymphocytes. Identified relationships suggest that the increased production of proinflammatory IL-1β is a compensatory response aimed at limiting inflammation in the muscles and production of coenocytes, which are precursors of osteoclasts. At the same time positive connection with the B-lymphocytes indicates the activation of the humeral immunity.

Naturally the question arises: are the revealed changes in the immune system and metabolic processes result of spinal deformity or physical illness? Unequivocal answer to this question is no, as the reactions are nonspecific, but we can assume that the starting factor of scoliosis is aseptic inflammation.

Thus, to obtain objective data on which to recommend drug treatments initial manifestations of dysplastic scoliosis in children. It is necessary to proceed from the feasibility of prolonging the reaction compensation inherent degree of disease 1. In particular, the use of an immunological complex treatment, stimulating cellular immunity (preparations of echinacea, lymphomyosot etc.), and micronutrients, as well as hepatic and antioxidants.

Changes in metabolism in children with II scoliosis degree increased level of potassium in blood serum, as well as lower than that of Group 1 children concentration of uric acid and creatinine in blood serum. Ice we can say that with the progression of the disease in children is reduced protein metabolism. The latter is confirmed by decreased activity of ALT and GGT in serum, indicating that the reduction process of transamination of amino acids and their transport into the cells. It should be noted and decreased alkaline phosphates activity and increase the activity of acid phosphates’ in the serum of children. Therefore, with increasing deformation of the spine children more than 20⁰ develop autoimmune reactions and decreases muscle energy metabolites software that requires a medical correction. In this situation, it is advisable to use in the complex treatment of ATP, antioxidants and anti-inflammatory drugs (Traumeel-S, Incena, Assaliks)

In children with scoliosis degree III immune response characterized by autoimmune reactions against the background of nonspecific activation of protective factors that can be considered as the result of pathological changes in other organs and systems. Has determined the progression of spinal deformity in children with grade III scoliosis violation ratio of calcium / phosphorus and calcium / magnesium deficiency due to calcium and magnesium. On the side was a decrease in protein metabolism of urea in serum compared with reference values, which is typical for violations urea formation liver function, resulting in the increased excitability of the autonomic nervous system. A significant decrease of the degradation products of proteins and nucleoprotein and transamination activity and transport of amino acids into the cells. Decrease in the activity of protein metabolism offset by an increase of amylase activity, ice carbohydrate metabolism. These data indicate that active during degenerative processes (chondrosis). Therefore, in this case it is advisable to use preparations in the treatment of calcium, magnesium, vitamin D, as well preparative hondroprotektory

 Thus, on the basis of tests revealed the specific metabolism and immune status by the various degrees of dysplastic scoliosis in children. The data allowed defining a strategy medical correction in children depending on the degree of scoliosis dysplastic genesis. Application of the proposed method of treatment has improved the results of treatment, stabilization received state without further increasing the amount of deformation observed in 63.4% of children.

Conclusions.

1. Medication dysplastic scoliosis in children should be carried out taking into account the degree of spinal deformity and features of immune response and metabolic processes. When spinal deformity correction to 20⁰ is suitable immunity aimed at activation of the cellular component and nonspecific defense factors, as well as improvement of metabolic processes by using the complex treatment of hepatic and antioxidants that will stimulate osteoblastic processes and contribute to the development of the regression of spinal deformity in children.

2. Children with grade II dysplastic scoliosis is expedient to use in the complex treatment of ATP, antioxidants and anti-inflammatory drugs that will better meet the muscle energy metabolites.

3. Medication children with grade III dysplastic scoliosis involve the use of drugs in the treatment of calcium, magnesium, vitamin D, as well preparative hondroprotektory