ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Free fat graft interposition has been used extensively in management of physeal injuries with established growth disturbances. The use of this technique as part of the management of acute physeal injuries has not been reported. Here we report on its application in acute physeal injuries, where it has prevented the formation of an anticipated physeal arrest.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

We retrospectively studied 43 adolescent boys treated with orthoses for idiopathic scoliosis to assess the usefulness of the timing of peak height velocity for predicting growth remaining and the likelihood of curve progression when compared with Risser sign, closure of the triradiate cartilage, and chronologic age. We compared the peak height velocity data in boys to our previous work for girls with adolescent idiopathic scoliosis. We found the median height velocity plots showed a similar high peak and sharp decline as is found in girls. All 13 patients with a curve magnitude >30° at the time of peak height velocity had progression of their scoliosis to >45° despite bracing. Four of 29 patients (14%) with curves ≤30° at peak height velocity progressed to 45°. These values generate a sensitivity of 76%, specificity of 100% and accuracy of 91% in predicting progression to 45°. Similar values have been found in female patients. The use of peak height velocity to predict the length of time for remaining growth was superior to Risser sign and chronologic age for boys with idiopathic scoliosis. Closure of the triradiate cartilage approximated the timing of peak height velocity in boys.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The purpose was to study epiphyseal plate growth after microvascular transplantation to sites of different growth potential. The hypothesis was that the growth potential of an epiphyseal plate transplant is a function of the donor irrespective of the recipient site to which it is transplanted. Immature rabbits were used in an experiment that transplanted microsurgically revascularized second metatarsal epiphyseal plates. There were three experimental groups in which transplants were made to (i) sites of the same growth potential (orthotopic), (ii) sites of higher growth potential (proximal tibia), and (iii) sites of lower growth potential (third metacarpal). Control groups were nonoperated animals, animals with an anteromedial proximal tibial osteotomy, and nonoperated contralateral limbs of all experimental animals. Postoperative graft viability was checked with fluorochrome labeling. Postoperative growth was measured from serial standardized radiographs. Follow-up was for either 5 or 8 weeks. Animals were then killed, and epiphyseal plate specimens removed for histomorphometric analysis. Results showed that the total growth of experimental second metatarsal transplants was not statistically different (p> 0.05) in any recipient site. It was noted, however, that transplanted epiphyseal plates in all experimental groups grew at lower rates than nonoperated controls.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

We studied the untreated pelvic deformity in 14 adult patients with bladder exstrophy to determine the relative hip-joint force and stress and their effects on the clinical status of the hip. Pelvic radiographs were used for biomechanical analysis to calculate joint force and joint stress (force/area) relative to partial body weight, which allowed comparison between patients and age-matched controls. IOWA hip ratings were used for clinical evaluation, and hips were scored radiographically for degenerative joint disease. The mean relative joint force and joint stress was significantly higher for exstrophy patients (p< 0.001). In addition, the mean distance from the body center to the center of the femoral head was significantly increased (p< 0.001) in bladder exstrophy patients. An increase in diastasis correlated with an approximate 30% increase in the distance from the center of the femoral head to the body midline. The mean distance from the greater trochanter to the femoral head center was significantly less (p< 0.02) and the center–edge angle was significantly decreased in exstrophy patients (p< 0.05). Two patients' hips showed significant subluxation, and one of these showed degenerative hip disease in association with poor IOWA and radiographic scores.The force and stress on the hip joint are increased in untreated adult bladder exstrophy patients. Further longitudinal study is indicated to validate these findings and to determine whether clinically important degenerative changes are occurring. This could affect treatment recommendations in childhood.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

A prospective trial was carried out to assess the outcome of children aged from 2 to 6 weeks with stable but dysplastic hips, treated with abduction splintage or by observation. Forty-four patients with 63 dysplastic hips were entered into the study and allocated into the two treatment groups at random. The ultrasound measured percentage acetabular cover in the splinted group improved in the first 3 months from an average of 32.8 to 54.3%. In the unsplinted group, the increase in cover was from 36.7 to 48.6%. The changes in cover for the splinted group were significantly more than those for the unsplinted group (p< 0.003) There was, however, no significant difference between the two groups in acetabular angle measurements on plain radiographs taken at 3 months. At 24 months, similarly, there was no significant difference in the acetabular angles of the two groups. These results support the view that stable dysplastic hips will correct with growth and that there is no sustained benefit from early splintage.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

In this prospective study, 41 dislocated hips in 40 patients were classified according to Graf's sonographic classification. Of them, 29 hips were Graf type III and 12 hips Graf type IV. All were treated in a Pavlik harness to relocate the dislocated hip dynamically. In type III hips, this was successful in 97% and 50% in type IV hips. We conclude that Graf's classification in dislocated hips has prognostic significance in treatment with the Pavlik harness.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

A series of 49 patients (55 hips) who had distal greater trochanteric transfer at the mean age of 13.9 years because of the deformity of the proximal femur after treatment for developmental dislocation of the hip was reviewed to verify the value of the procedure. Mean follow-up was 8.8 years. Clinical and radiologic assessment was supplemented with strain-gauging evaluation of the muscles involved. Good results were achieved in patients who had good range of movement or isolated restriction of abduction before the operation. After surgery, a 22% increase of abductors torque was found, the Trendelenburg sign disappeared in 30 individuals, and 15 patients regained normal gait. No complications were observed. Our study confirmed the value of distal transfer of the greater trochanter in treatment for proximal femur deformity owing to avascular necrosis after management of developmental dislocation of the hip and clarified indications for this procedure.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Fourteen children treated for developmental dysplasia of the hip with a Pavlik harness were evaluated at the time of harness application with clinical examination, hip ultrasonography, and anteroposterior radiography. Ten orthopedic surgeons with experience levels varying from residents to experienced pediatric orthopedic surgeons evaluated the studies to determine hip position in the harness. Clinical examination agreed with hip ultrasonography for hip position in 100% of hips. Interpretation of radiographs agreed with ultrasonography in only 49% of cases in which the hip was judged to be dislocated and in 82% of cases in which the hip was judged to be reduced. When imaging is used to aid in assessing hip position during treatment with a Pavlik harness, ultrasonography appears to be superior to anteroposterior radiography for assessing hip position.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

This study evaluated long-term clinical and radiologic results of Dunn's osteotomy carried out in 50 consecutive cases for severe slipped capital femoral epiphysis. The results of all the patients were analyzed with 4 years 6 months of follow-up. The clinical results were very good and good in 90% of the patients and were fair or poor in 10% of the patients. Seven patients had an important complication (total necrosis or chondrolysis), and the clinical evolution was studied. Dunn's procedure seems to be adequate to correct severe slips.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID