RU2472441C1 - Method of early diagnostics of bone formation impairment in infants and young children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine. In the course of diagnostics quantitative ultrasonometry in cortical layer of tubular bones is carried out. Examination is carried out in critical periods of bone formation, namely at 4, 8, 18 and 24 months. At the age of 4 months reduction of index sound rate lower than 2776 m/s is considered to be impairment of bone formation. At the age of 8 months, reduction of index sound rate lower than 2970 m/s is considered to be impairment of bone formation. At the age of 18 months, reduction of index sound rate lower than 3223 m/s is considered to be impairment of bone formation. At the age of 24 months, reduction of index sound rate lower than 3235 m/s is considered to be impairment of bone formation.

EFFECT: method makes it possible to detect presence of development of bone system pathologies in infants and young children due to estimation of bone strength in physiological critical periods of its formation.

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Description

The invention relates to medicine and can be used in medical practice in the provision of medical care for children in an outpatient setting.

Known methods for determining bone density include dual X-ray absorptiometry, quantitative computed tomography, and nuclear magnetic resonance imaging. Existing modern methods of x-ray diagnostics are based on a clear relationship between the degree of absorption of x-rays and bone mass, but to a very small extent reflect structural changes that affect bone strength (L.A., Scheplyagina, T.Yu. Moiseeva, M.V. Kovalenko and other manual "Osteopenia in children (diagnosis, prevention and correction)", Moscow, 2005, p.6-7).

The disadvantage of these methods is the impossibility of determining the strength of the bone, using them for screening in healthy young children and monitoring the dynamics of the correctional measures due to radiation exposure. The impossibility of widespread use of these methods on an outpatient basis due to the lack of expensive equipment, specially trained personnel and radiation protection.

For the diagnosis of impaired bone strength reduction in children using quantitative ultrasonometry (CUS). The procedure of ultrasound diagnosis is short, painless, can be repeated many times, has no contraindications. Instruments for quantitative ultrasound examination take up little space and do not require radiation protection. The ultrasonic method provides registration of even minor changes in the density of biological media. Due to its simplicity, harmlessness and effectiveness, it can be used for early diagnosis of decreased bone strength in newborns and young children. All methods of CLC are non-visualizing, based on the interaction of ultrasound with the bone tissue through which it passes, resulting in a quantitative result characterizing such properties of the bone as mass, structure or quality. The interaction between ultrasonic waves and bone tissue leads to a change in the speed of sound and to a decrease in the power of sound conduction. In relation to the KUS methods, the speed of sound is usually called the “speed of sound” (Speed of Sound - SOS) and it is measured in units - meter per second (m / s). Bone strength is assessed by quantitative ultrasonometry using an Omnisense 7000S instrument (Sunlight Medical Ltd, Israel). Bone strength in infants is diagnosed in the middle of the diaphysis of the tibia, using a special sensor and a pediatric program. The duration of the measurement of one section of the skeleton is at least 1 min. The data obtained are compared with percentile tables for this device. Decrease in bone strength is diagnosed at a sound speed below 10 percentile (Z-score below -1 standard deviation (SD)). A decrease in the speed of sound of less than 5 percentile (Z-score below -2 SD) is regarded as a pathology (Scheplyagina L.A., Kruglova I.V. Bone densitometry in pediatric practice // Russian Pediatric Journal. - 2002; 2: p. 57 -61).

At the present stage in pediatric practice there is no possibility of early prediction of violations of bone formation by the screening method on an outpatient basis in children of difficult and young age with the aim of timely correction of the pathological development of the skeletal system.

The objective of the invention is the early rapid forecasting of the pathology of the development of the skeletal system in children of difficult and young age on an outpatient basis by measuring bone strength in physiological critical periods of its formation. The expected technical result of the claimed invention will be the allocation of a dispensary troupe of monitoring children in a children's clinic for therapeutic and preventive measures to reduce bone strength.

The essence of the proposed method consists in determining the speed of the ultrasonic wave in the cortical layer of tubular bones in infants and young children in critical age periods of bone formation: 4,8,18,24 months, with a decrease in the speed of sound less than 2776 m / s in 4 months, less 2970 m / s - at 8 months, less than 3223 m / s - at 18 months and less than 3235 m / s - at 24 months, adverse bone formation is predicted.

The age periods during which the study of bone strength of young children is conducted is selected on the basis of our KUS study and the results obtained: a physiological critical decrease in bone strength in infants during growth and mineralization at 4 and 8 months and a quick set of bone strength in the second year life (figure 1, 2). Figure 1 presents the average SOS of the tibia in boys, depending on age. In figure 2. - average SOS of the tibia in girls, depending on age. Critical indicators of the speed of the ultrasonic wave in these age periods determined during our study on a statistically significant cohort of the child population.

The method is as follows. The measurement of sound speed is carried out in accordance with the instructions that came with the Omnisense 7000S (Sunlight Medical Ltd, Israel). A special pediatric device sensor is installed in the middle of the tibia diaphysis in the infant. The sensor is moved across the bone with a deviation of 45 ° from the longitudinal axis. The duration of the measurement of one section of the skeleton is from 30 seconds to 1 min. In total, such studies are carried out from 3 to 5 times. If the speed of sound is less than 2776 m / s at the age of 4 months, at the age of 8 months - less than 2970 m / s, at the age of 18 months - less than 3223 m / s, and at 24 months - less than 3235 m / s, then adverse formation is predicted bones. And these children form a follow-up group with treatment and preventive measures and an in-depth examination.

Example 1

Patient P., age 4 months. There are no clinical manifestations of rickets. When conducting quantitative ultrasonometry, the speed of sound (SOS) in the bone is 2765 m / s (below the critical threshold). The child was taken under control, but no corrective measures were taken. When conducting CUS after 2 months, the speed of sound is 2765 m / s (below the age norm). In addition, the child showed distinct clinical signs of rickets II (photo 1 - from the screen of the Omnisense 7000S).

Example 2

Patient L., age 4 months. When conducting quantitative ultrasonometry - SOS indices of 2689 m / s (below normal), corrective measures were taken (the dose of vitamin D was increased and the vitamin-mineral complex “Friso” was added to the diet - an enrichment of difficult milk containing three additional types of calcium salts, phosphorus and others essential trace elements and vitamins for a period of 2 months). During the examination after 2 months, the sound velocity in the bone was within the age norm of 3060 m / s. Pathologies from the autonomic nervous system and musculoskeletal system are not diagnosed. At the age of 8 months, sound speed indicators are within normal limits (3049 m / s) (photo 2).

Example 3

Patient P., 18 months. In the first year of life, a clinical diagnosis of rickets was not made. When conducting CUS, a decrease in bone strength was found below the threshold value of 3180 m / s. No corrective actions were taken. In dynamics, the child is examined again, the child did not gain normal bone strength. The speed of sound in the bone became equal to 3178 m / s, which is lower than the normative values (photo 3).

Example 4

Child N., 18 months old, with low rates of sound speed in the lower leg bone (3080 m / s) was prescribed corrective treatment. When examining the dynamics, the speed of ultrasound in the bone increased and amounted to - 3316 m / s (within normal limits) at the age of 24 months (photo 4).

Example 5

Baby P., 24 months old. Revealed low rates of sound speed in the leg bone (3210 m / s) prescribed correctional treatment. During the examination in dynamics, the speed of ultrasound in the bone increased and amounted to - 3526 m / s (within normal limits) (photo 5).

In total, the proposed method (CLC) examined 2316 children from 0 to 3 years old. The decreed period for conducting a study from 0 to 1 year was 1 month, from 1 year to 2 years - 3 months, from 2 to 3 years - 6 months. During the study, critical periods of bone formation were established (4, 8, 18, 24 months). When analyzing the data of middle-aged indicators of the speed of sound of the bone, it was found that the physiological decrease in the speed of sound in the lower leg bone occurs from 1 month to 4 months as much as possible, and then increases by the year, both in boys and girls. Therefore, the age of 4 months is the “critical moment” of bone formation and is the “cutting-off” point for diagnosing the strength of bed tissue in the first year of life. The second physiological peak of bone mass reduction was recorded at 8 months, which we took as the second “cut-off” point for monitoring bone strength.

At the age of 4 months, 109 children were examined (average sound velocity 2873 ± 79 m / s). 14 of them (12.8%) were diagnosed with low ultrasonic wave velocity (below 2776 m / s). The control group (n = 40) consisted of children with normal bone strength at 4 months (average tibial sound velocity of 2892 ± 134 m / s). Subsequently, the data of the group of children were examined at the age of 8 months, where the sound wave velocity indices remained low in the main group (average sound velocity 2965 ± 107 m / s), and in the control group the average shin sound velocity was 3102 ± 124 m / s, which is significantly higher (p <0, () 5).

In the second year of life, when examining children of these groups by the method of quantitative ultrasonometry, it was found that in 10 (71.4%) children, bone strength indicators remained below normal, and in 6 children (42.9%) were very low (below the allowed values ) In the control group, 7 (17.5%) children had lower indices below the reference values.

Using the proposed method for early diagnosis of bone formation disorders in infants and young children in critical periods of bone formation by quantitative ultrasonometry provides the following advantages:

1) allows you to allocate a dispensary group monitoring children in a children's clinic for timely treatment and preventive measures to reduce bone strength;

2) the method is easy to examine and interpret the results. It can be used by a wide range of pediatricians. Allows you to monitor the quality of ongoing preventive measures.

Claims (1)

A method for early diagnosis of bone formation disorders in infants and young children by determining the speed of ultrasound by quantitative ultrasonometry in the cortical layer of tubular bones, characterized in that the study is carried out in critical periods of bone formation, namely: at 4, 8, 18 and 24 months and with a decrease in the speed of sound of less than 2776 m / s at 4 months, less than 2970 m / s at 8 months, less than 3223 m / s at 18 months and less than 3235 m / s at 24 months, adverse bone formation is predicted.

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