卷 4, 编号 2 (2016)
- 年: 2016
- ##issue.datePublished##: 15.06.2016
- 文章: 11
- URL: https://journals.eco-vector.com/turner/issue/view/179
- DOI: https://doi.org/10.17816/PTORS42
Articles
Transposition of the acetabulum after iliac ischial osteotomy in the treatment of hip dysplasia in infants
摘要
Background. Transposition of the acetabulum after pelvic osteotomy is the most effective surgical method to treat dysplastic hip joint disorders in patients of different ages. According to Salter, iliac osteotomy of the pelvis is the main surgical method used to correct dysplastic acetabulum in 7- and 8-year-old children. In older patients, the pubic symphysis and pelvic ligaments become more rigid, which significantly limits the degree of rotation of the acetabulum. In these cases, a triple pelvic osteotomy is performed to enhance the mobility of the acetabular fragment. This pubic bone osteotomy is performed near the femoral neurovascular bundle, which may be damaged during the procedure.
Aim. To describe a technique for transposition of the acetabulum after iliac and ischial osteotomy of the pelvis, which was developed to reduce trauma, prevent vascular complications, and increase postoperative stability of the pelvic ring.
Materials and methods. A method developed by the authors for transposition of the acetabulum after iliac and sciatic pelvic osteotomy is described in detail. The surgical method was performed 99 times on 89 children with dysplastic hip joint disorders, and the results are presented.
Conclusion. Transposition of the acetabulum after iliac and ischial pelvic osteotomy is an effective treatment for dysplastic instability of the acetabulum in children aged 9–16 years. The procedure is indicated when it is necessary to rotate the acetabular fragment by more than 25°, and there is no need for hip medialization.Should arthroscopy in adolescents: Three years of clinical experience
摘要
Background.
Shoulder joint injuries and shoulder instability often occur in adolescents.
Materials and methods.
During a 3-year period, we performed arthroscopic surgery on 42 patients with shoulder joint injuries.
Results and discussion.
The majority (76.2%) of the patients on whom we performed arthroscopic shoulder joint surgery were male. This is likely due to more aggressive physical activity among males. Most of the patients were injured during exercise (n = 27, 64.3%). Arthroscopy is a highly effective surgical method for the treatment of shoulder joint injuries. Prolonged non-operative treatment with no well-established indications and an incorrect diagnosis can lead to rapid progression of degenerative and dystrophic changes of the shoulder joint and may result in shoulder joint dysfunction.
Reconstruction of the hip joint in children after septic coxitis
摘要
Background.
Surgical treatment of destructive dislocations is problematic, and controversial. Treatment options range from active monitoring to complex multistage reconstruction protocols.
Materials and methods.
The results of treatment of 17 children with disruptive dislocation of the hip (class IV according to the Choi classification) are presented. The mean age at which treatment was started was 6.3 ± 0.5 years (range: 3-9 years). Treatment strategies included formation of the weight-bearing contact of the proximal femur and acetabulum and ilium osteotomy using an Ilizarov frame. The follow-up period lasted from 2 to 11 years. Clinical results were assessed using Colton’s criteria. Assessment of the radiology findings included the anatomy relations and congruence of the articular surfaces. The patients were divided into two groups, according to age, for data analysis.
Results.
The majority (88%) of the children had positive anatomical and functional outcomes. The functional results were good (12-15 points), satisfactory (9-11 points), and unsatisfactory (8 points) for 3, 5, and 1, respectively, among 3-6 year olds and 2, 6, and 0, respectively, among 7-9 year olds. The distribution of joint congruence types I, III, and IV was 2, 4, and 3, respectively, in the younger group and 1, 6, and 1, respectively, in the older group.
Conclusion.
The use of reconstructive surgery using the Ilizarov apparatus in children with a defect of the proximal femur creates conditions for the adaptation of incongruent articular components without causing decompensation of the joint.
Mistakes and complications in the surgical treatment of ambulatory equino planovalgus foot deformities in patients with cerebral palsy using extra-articular subtalar arthrodesis
摘要
Aim.
To evaluate the results of a modified technique for extra-articular arthrodesis of the subtalar joint for patients with cerebral palsy with an ambulatory form of equine-planovalgus deformity of the foot. The mistakes and complications that occurred during treatment with this technique are discussed.
Materials and methods.
Between 2005 and 2015, this surgical method for performing arthrodesis of the subtalar joint, was performed on 544 patients (989 feet) between 4 and 15 years old. Correction of equinus contracture was performed using Achilles tendon plasty or dissection of the tendon of the gastrocnemius muscle. Abnormal muscle tone was reduced either by administering Dysport® in the calf muscle or by selective neurotomy of the tibial nerve.
Results.
Good results were achieved for 72% of cases, satisfactory for 23% of cases, and unsatisfactory for 5% of cases. Unsatisfactory results of treatment were associated with overvaluation of the degree of mobility of the deformity and with a number of technical and tactical mistakes.
Conclusion.
This analysis of mistakes and complications of extra-articular arthrodesis of the subtalar joint will allow surgeons to avoid these issues in the future and improve the quality of treatment for similar patients.
A multidisciplinary approach for the treatment of complication of hematogenous osteomyelitis in children
摘要
Background.
Severe orthopedic complications of osteomyelitis occurred in 22%–71.2% of children with osteomyelitis in previous studies. At the same time 26.5% of children with complications of osteomyelitis, according to data of The Turner Scientific and Research Institute for Children’s Orthopedics, have multiple bone lesions. The challenges involved in the orthopedic treatment of musculoskeletal system disorders are diverse and complex. In some cases, inadequate attention is paid to the need to treat the facial bones of the skull, temporomandibular joint (TMJ), and jaw bones.
Aim.
The aim of this paper is to demonstrate the need for a variety of options and to determine the best strategies for comprehensive medical rehabilitation, involving orthopedic and maxillofacial surgeons and other healthcare providers, for children with complications of osteomyelitis, who had destruction of the long tubular bones of the jaw.
Materials and methods.
Between 2011 and 2015 26 children (10 males and 16 females) aged 1.5–17 years with multiple localized lesions after osteomyelitis were treated in The Turner Scientific and Research Institute for Children’s Orthopedic. In addition to severe orthopedic disorders, there has been a loss of TMJ, which resulted in severe functional impairment and impaired development of the facial bones of the skull.
Results.
There was a individualized approach to the treatment of pediatric patients with complications of osteomyelitis. Early diagnosis and proper treatment prevented severe changes in the musculoskeletal system and maxillofacial area in pediatric patients.
Conclusion.
The modern concept of comprehensive medical rehabilitation of children with complications of osteomyelitis should include an interdisciplinary approach involving orthopedic and maxillofacial surgeons. Early diagnosis in children ensures the timely formation of individualized rehabilitation programs, designed to improve the anatomical and functional characteristics of the affected bones. Along with comprehensive orthopedic treatment, bone-reconstructive surgery of the facial bones of the skull should be focused on restoration of chewing function, external respiration, speech, and facial esthetics.Surgical correction of spinal deformity with the use of transpedicular screw spinal systems in children with idiopathic thoracic scoliosis
摘要
Aim.
To compare the results of surgical correction of spinal deformity in children with idiopathic thoracic scoliosis with the use of transpedicular screw spinal systems with different pedicle screw placement.
Material and methods.
Thirty-one patients (14–17 years) with spinal curvature with a Cobb angle from 40° to 79° were operated on. Surgical correction of the deformity was performed using two methods, depending on the possible placement of a pedicle screw. The first group included 16 patients for whom the transpedicular support elements were placed on both sides, throughout the completely deformed spine. The second group included 15 patients for whom the pedicle screws were not placed for two or more vertebrae on the concave side of the curve, at the top of the main curve.
Results.
The mean percent correction of the spinal deformity for the first and second groups was 92.5% and 82.6%, respectively. The mean percentage of derotation of the apical vertebra for the first and second groups was 73.9% and 23%, respectively.
Conclusion.
The use of data based on the anatomical and anthropometric features of the vertebral body with scoliosis facilitates selection of the best option for correction of thoracic curve in children with idiopathic scoliosis using pedicle multi-support metal construction. The use of the spinal pedicle system for correction of spinal deformity in children with idiopathic scoliosis enabled a uniform load distribution along the support elements of the metal construction and maintained the correction in the late postoperative follow-up period.