


Vol 29, No 2 (2025)
- Year: 2025
- Published: 05.06.2025
- Articles: 7
- URL: https://jps-nmp.ru/jour/issue/view/53
- DOI: https://doi.org/10.17816/ps.2025-2
ORIGINAL STUDY
Subjective pediatric assessment scar scale — SPASS. Development and validation of the scale
Abstract
Background. A skin scar is an important component of satisfaction with surgical treatment. Both the patient’s comfort level and the possible treatment tactics depend on the variant of scarring changes.
Aim. Development of a new instrument for assessing a skin scar in a child. It should take into account the requirements of clinometric.
Methods. A total of 170 children participated in the study at various stages of the development and validation of the scale. The study period is from 2021 to 2024. The procedures of exploratory factor analysis and multiple regression analysis were carried out, taking into account all the standard criteria necessary for this.
Results. The Subjective pediatric assessment scar scale (SPASS) perception consists of three sheets with questions. Each of them is intended for personal filling by the child, his parent and, finally, the doctor. The questionnaire sheets for children are divided depending on the age periodization. The average level of inter–expert reliability among doctors was 0.96 (95% CI 0.93–0.99). Intra–expert reliability had a variation from 0.85 (95% CI 0.88–0.82) to 0.97 (95% CI 0.95–0.99). The overal convergent validity value for the questionnaire was 0.95. The overall Cronbach’s alpha level among parents was 0.83. The overall subjective assessment of a skin scar significantly correlates positively with the following indicators: social aspects of the presence of a scar (R0 = 0.899, p < 0.001), physical inconveniences (R0 = 0.835, p < 0.001), problems of aesthetics and treatment (R0 = 0.733, p < 0.001).
Conclusion. The developed SPASS is the first tool of its kind to be used among children. The questionnaire is adapted for children of different ages, taking into account the periodization of mental development. The scale is ready for use in clinical practice.



Computed and magnetic resonance imaging in the diagnosis of myositis ossificans in children
Abstract
BACKGROUND. Post-traumatic myositis ossificans (MO) is a complication of observation characterized by bone formation in soft tissues. The lesion, proceeding in stages, according to clinical and visual manifestations, manifests itself at each stage. The diagnosis is established based on anamnesis, features and research methods, which can be informative depending on the stage of the disease.
AIM: To present the possibility of computed and magnetic resonance imaging in the diagnosis of MO in children.
METHODS: In this study we analyzed data from 68 children who had signs of MO according to radiological diagnostic methods. The average age of patients was 12.3±4.9, from 2 months to 17 years. There were 42 boys (61.76%), girls — 25 (38.24%). The cause of OM in the studied patients was damage to the musculoskeletal system (fractures, bruises of soft tissues) and/or impaired blood circulation in the muscles as a result of prolonged forced immobility during their stay in the intensive care unit, as well as in connection with the consequences of trauma (vegetative state, lower paraplegia).
RESULTS: At the early stage of MO, classical radiographs in all 49 children were negative, at 4–6 weeks after injury, half of them had weak radiopaque changes in the surrounding space. CT showed initial soft tissue edema or volumetric changes, both with and without calcification at 4–6 weeks. In case of fuzzy zonal changes on CT and differential diagnosis MRI was performed in 34 children, which made it possible to solve problems with the diagnosis of MO. MO affected zones were identified in several anatomical areas: in 48 children out of 68, dysfunction of the muscles of the limbs was revealed, followed by the muscles of the pelvis (29 children) and upper limbs (14 children).
CONCLUSION: Traumatic MO is capable of affecting any extraskeletal muscles. Our study showed that MO is more common in the anterior region of the thigh, which includes the quadriceps muscle group. For correct and timely MO diagnosis it needs to use several detection methods. CT is currently the best method for MO diagnosing. If the symptoms are not obvious on CT and there is a need for additional differential diagnosis, MRI should be performed.



REVIEWS
Treatment of acetabular fractures in pediatric patients
Abstract
The present review of current scientific and practical literature is devoted to the analysis of modern diagnostics and management of acetabulum fractures in children. Systematized research and clinical findings have proven that computed tomography remains the “gold standard” for diagnostics (accuracy up to 80%) of acetabulum fractures in children. However, it is not available in some regional hospitals what increases the risk of intraoperative errors committed by an orthopedic traumatologist and a pediatric surgeon. Conservative management (plaster casts, skeletal traction) is acceptable in undisplaced fractures, but it is associated with a high risk of complications: thrombosis, deformities (including the extremity discrepancy in the growing organism), osteoarthritis, etc. Surgical intervention is indicated in dislocated fragments of more than 2 mm, joint instability or damage to the posterior wall of the cavity. The optimal access depends on the fracture location and surgeon’s experience. The key success factors for treating acetabulum fractures in children are: reposition of the dislocation within the first 6 hours, compliance with aseptic rules, and early rehabilitation. The authors emphasize the need to equip regional and district hospitals with computer/magnetic resonance devices, to develop unified protocols and to train surgeons in minimally invasive techniques. The results obtained in the study are important for improving pediatric traumatology.



CLINICAL PRACTICE GUIDELINES
Intestinal intussusception in children
Abstract
The new version of the clinical guidelines, developed by specialists from the Russian Association of Pediatric Surgeons, provides updated information on the diagnosis and management of the disease in line with recent advancements. These recommendations are based on the results of completed domestic and international randomised clinical trials, including systematic reviews and meta-analyses. For the first time, the guidelines highlight the role of nonspecific mesadenitis in the etiopathogenesis of ileocecal intussusception in children, as well as shifts in the disease’s age distribution from infancy to early childhood. This updated version also revises the long-standing national approach to age and time restrictions for conservative management. It now recommends conservative treatment for all uncomplicated cases of ileocecal invagination. Surgical intervention is advised in cases of complications such as intussusception necrosis, peritonitis, or small intestinal obstruction, as well as when an anatomical abnormality is suspected on ultrasound or if the disease recurs.
This publication is intended for practicing paediatric surgeons, anaesthesiologists, paediatricians, and specialists in related fields, as well as residents and postgraduate students in these disciplines.



CASE REPORTS
Robot-assisted ureterolithotomy and ureteroplasty in a child with a ureteral stone
Abstract
BACKGROUND. Urolithiasis is a very common disease in all age groups. The incidence of urolithiasis in children is rapidly increasing worldwide. In this study, we describe a case of robotic ureteral stone removal and present a literature review on robotic-assisted surgeries for treating urolithiasis in children.
CLINICAL CASE DESCRIPTION. An 11-year-old boy was admitted to the children’s hospital with complaints of recurrent urinary tract infection and pain on the left side for the last year. Computed tomography revealed a stone located at the level of the proximal left ureter and the ureteral stricture located right above the stone. The child had robot-assisted ureterolithotomy and ureteroplasty. During the surgery, intraoperative contact ultrasound examination was used to locate the stone. After dissection of the ureteral wall above the stone, the calculus was grasped with a clamp and removed externally. Longitudinal ureterotomy was closed transversely with interrupted absorbable sutures. No postopreative complications were registered after the surgery. The surgery lasted for 135 minutes. Foley catheter was removed next postoperative day. The drainage catheter was removed on the 2nd postoperative day. The patient was discharged home on the 5th postoperative day. The stent was removed in 4 weeks after the surgery. Repeated ultrasound examination performed 6 months after demonstrated less dilation of the renal pelvis and ureter, and no signs of stone formation.
CONCLUSION. Our study has demonstrated that robotic-assisted surgery is a feasible, safe and effective option for treating urinary tract stones in children in some cases, such as upper urinary tract stones which are accompanied by urinary tract obstruction and require simultaneous ureterolithotomy and ureteroplasty.



The use of rectal balloon compression in the conservative treatment of external hemorrhoids in children in Tashkent
Abstract
BACKGROUND. The main factors in the pathogenesis of hemorrhoids are vascular dysfunction and dystrophic changes in the fibromuscular framework of the anal canal. The main methods of surgical treatment of the disease are hemorrhoidectomy, sclerosis, infrared photocoagulation and ligation with latex rings. These methods, which are widely used in adult patients, are limited in use in children due to frequent side effects, possible complications, and difficulties in postoperative care. The pathogenetic aspects of hemorrhoid formation in children, taking into account the anatomical and physiological features of the fibrous-muscular framework and the vessels of the anal canal, determine the possibility of conservative treatment. Optimization and development of special methods of conservative treatment of hemorrhoids in children remains relevant.
OBJECTIVE. To improve the results of treatment of haemorrhoids in children by optimising diagnosis and developing tactics of complex approach using non-invasive method of rectal balloon compression (RBC).
METHODS. The study included 118 patients diagnosed with hemorrhoids. At the first stage, a retrospective analysis of the medical and epidemiological characteristics of the disease was performed. The gender, age, type of hemorrhoids, and treatment methods used were evaluated. At the second stage, a non-randomized comparative study was performed: The main group included 55 patients, who were treated the RBC method with traditional conservative therapy from 2020 to 2025. The comparison group consisted of 57 patients whose treatment in the period from 2014 to 2020 used only conservative methods. To assess the effectiveness of the RBC method in the complex conservative treatment of hemorrhoids in children, long-term results were studied in 88 (78.6%) patients in the study groups. To justify the use of RBC, a pathoanatomical examination of the autopsy material of the rectum with Van Gieson staining was performed. The RBC method consists in inserting a two-mantled Foley catheter into the rectum with sequential inflating of the cuffs. This creates compression of the hemorrhoidal node on both sides (outside and inside), which helps to repair the nodes and restore hemorrhoidal blood flow.
RESULTS. Our multicenter study conducted on the basis of children's surgical clinics in Tashkent showed that children of preschool age suffer from hemorrhoids most often (72.9%). The main trigger for the development of hemorrhoids in preschool children is dysplastic changes in the fibromuscular framework of the anal canal against the background of chronic constipation or diarrheal syndrome. Against the background of treatment of the underlying disease dysplastic changes in the anal canal in children are reversible, which determines the possibility of using the non-invasive RBC method in complex conservative treatment. Excellent and good results when using the non-invasive RBC method were obtained 1.7 times more often than in the control group, and indicate the high effectiveness of the noninvasive RBK method, especially in children of early and preschool age.
CONCLUSION. The RBC method in the complex conservative treatment of hemorrhoids in preschool children is pathogenetically justified and effective.



HISTORY OF PEDIATRIC SURGERY. MEMORABLE DATES
History of pediatric surgery opening speech dedicated to 34 years of activity by Head of the Department of Pediatric Surgery of Tver State Medical University, Honorary Professor G.N. Rumyantseva
Abstract
The assembly speech is dedicated to the formation of the pediatric surgical service in the Tver region. The history of the Department of Pediatric Surgery at Tver Medical University and its diverse activities are vividly presented. The methodological support of the students' educational process includes monitoring the initial level of knowledge, optional discussion of the results of scientific research, conducting webinars, abstract conferences, distance learning, as well as clinical analysis of newly admitted patients. The training programs developed at the department include recommendations on the care of children after surgical interventions in the primary level of pediatric services. The educational process covers all levels of medical care, including emergency and emergency room doctors for the diagnosis of urgent surgical conditions. The article describes the efforts spent on the creation of a pediatric surgical service, the close relationship between the Department of Surgery at the university and the surgical departments of the regional hospital, which the department regularly replenishes with trained specialists. Morality, morality, and professional ethics have been implemented at the department for more than 30 years. The department lives under the coat of arms, which depicts its postulate — work, faith, loyalty.


