摘要:

The goal of orthopaedic interventions is to improve the functional health of patients, particularly physical function. The American Academy of Orthopaedic Surgeons and the Pediatric Orthopaedic Society of North America (POSNA) commissioned a work group to construct functional health outcomes scales for children and adolescents, focusing on musculoskeletal health. The work group developed scales assessing upper extremity function, transfers and mobility, physical function and sports, comfort (pain free), happiness and satisfaction, and expectations for treatment. Parent and adolescent self-report forms were developed and tested on 470 subjects aged 2-18 years. The POSNA scales demonstrated good reliability, construct validity, sensitivity to change over a 9-month period, and ability to outperform a standard instrument, the Child Health Questionnaire physical functioning scale. They were useful for a wide variety of ages and diagnoses. They appear to be ideally suited for orthopaedic surgeons to assess the functional health and efficacy of treatment of their patients at baseline and follow-up.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Chronic graft-versus-host disease (GVHD) is a well-recognized complication of allogeneic bone marrow transplantation (BMT). Musculoskeletal manifestations include joint contractures, polymyositis, polyserositis, and fasciitis. We present 14 patients with orthopaedic complications of chronic GVHD. Long-term conservative management of joint contractures with physical therapy and orthotics was generally successful in restoring patients' premorbid functional status. Surgical release of joint contractures yielded poor results and rendered the affected joints unresponsive to further conservative treatment. Surgical intervention in the treatment of joint contractures resulting from chronic GVHD does not appear qualitatively to improve functional status in patients affected with this disease process.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We studied 73 children with chronic or recurrent musculoskeletal pain of ⩾6 weeks' duration. Thirty-six children had no identifiable organic etiology for their pain, with a minimum follow-up of 2 years for ongoing symptoms. Thirty-seven children had an organic etiology for their pain. Use of an Inappropriate Symptom Checklist was helpful in distinguishing between children with chronic pain who were found to have an organic disease and those without an identifiable organic disease. Seventy-seven percent of children with no inappropriate symptoms had an organic diagnosis ultimately made. Conversely, 79% of children with two or more inappropriate symptoms ultimately had no organic diagnosis to explain their pain. Behavioral self-report measures testing could not differentiate between children with chronic pain with or without organic disease. Intervention by a psychologist skilled in pain management was helpful.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The elastic modulus and hardness of the mineralized bone around the growth plate was measured to determine its regional micromechanical properties. Multiple nanoindentation tests, >10 sessions, with depths ranging from 100 to 1,000 nm at loading rates of 12.5 and 750 μN/s, were performed on the trabecular bone in the epiphysis, trabecular bone at the junction of the physis and epiphysis, primary spongiosa in the metaphysis, and surrounding cortical bone of the distal femur of 300-gm Sprague-Dawley rats. The indentation load-displacement data obtained in these tests were analyzed to determine the elastic modulus and hardness of the tissues. The nanoindentation results highlighted the regional variations in the material properties of the mineralized tissues around the growth plate. The primary spongiosa had a lower elastic modulus and hardness than both epiphyseal trabecular and cortical bone (p< 0.01). A relatively well-defined thick trabecular band at the physeal-epiphyseal junction had modulus and hardness values comparable to those of cortical bone (p> 0.05). These findings support the hypothesis that the primary spongiosa has micromechanical properties that are significantly lower than the epiphyseal trabecular bone. On this basis, it is speculated that the fracture patterns commonly seen in patients with physeal injuries are influenced by the micromechanical properties of these tissues, as well as by the nature and direction of the applied force.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The purpose of this investigation was to determine whether induced micromovement during the elongation period could improve the consolidation of diaphyseal elongation obtained by callus distraction. Two series of paired rabbit hindlimbs were studied. The surgical procedure and the waiting period were identical. During elongation, one hindlimb was stimulated, and the other was the control. The consolidation period was 2 days. Reproducible tibial osteotomy and lengthening of the two tibiae was confirmed radiographically. The mineralized callus was quantified by dual-beam x-ray absorptiometry. The callus diameters were measured. Bones were axially compressed to failure. Callus volume, mineral quantity, mineral density, and resistance to failure were not different on the stimulated side compared with the unstimulated side, so micromovement applied during elongation had no effect on bone consolidation. For all tibiae, resistance to failure of the callus was significantly correlated to callus volume, to callus mineral content, and to callus mineral density.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Measurement of oxygen use is helpful in determining energy consumption in children with walking abnormalities; however, no statistically valid measurements of nondisabled children have been established using a telemetric system. Data from 94 nondisabled children, ages 5-15 years, were collected using the Cosmed K2 oxygen analysis system. Oxygen cost, measured in milliliters O2/kg/m walked, and oxygen consumption, measured in milliliters O2/kg/min, were correlated to inverse body surface area (IBSA) measured in meters−2. Linear relationships between oxygen cost and IBSA and between oxygen consumption and IBSA were best described by the following equations: oxygen cost = 0.256 (IBSA) + 0.052 (r= 0.806) and oxygen consumption = 17.635 (IBSA) + 4.956 (r= 0.758). From these data, equations were derived to calculate predicted oxygen cost and predicted oxygen consumption for each child. Indices were developed to express the difference between a measurement and the predicted mean in reference to the normal variation. These equations and indices can help quantify the variation of energy use of children with walking abnormalities when compared with their nondisabled peers. Additionally, the indices enable multiple tests from one subject to be compared, regardless of a change in age, height, and weight between measurements.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A low-volume autotransfusion device, Haemocell System 350, was used for four consecutive pediatric orthopaedic patients. Although the initial patient evidenced no hematuria, transient hematuria was noted in three consecutive patients. Follow-up blood urea nitrogen, electrolytes, and creatinine levels were all within normal limits. After discontinuation of the device, no further hematuria has occurred in subsequent patients. Although intraoperative low-volume cell savers may have a role in pediatric orthopaedic surgery associated with low total blood volume loss, we observed three cases of postoperative hematuria by using this device in cases with large total blood volume loss [>28% estimated blood volume (EBV)]. Although all of these cases were transitory, we recommend caution in the use of low-volume intraoperative blood-salvage devices in pediatrics at this time.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In the Department of Pediatric Surgery, Uludağ University Medical Faculty in Bursa, during the last 11 years, the Peter G. Jones technique for the surgical correction of muscular torticollis in older children has been introduced. Twenty children between 4 and 13 years of age were treated for muscular torticollis. They were followed up from 3 months to 10 years after surgery. All patients had a middle-third open transection of the sternocleidomastoid muscle. Preoperative and postoperative assessment by a rigid scoring system showed that all patients improved in terms of function as well as cosmesis. Children younger than 10 years showed the most improvement, with 90% excellent and good results. Late middle-third open transection of the sternomastoid in muscular torticollis may give acceptable results.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A new genetic syndrome is reported of congenital lordoscoliosis due to lumbar segmentation defects and incomplete formation of lumbar vertebrae. The defect arose as a spontaneous mutation and was transmitted in an autosomal dominant fashion. The kindred included a mother and her three offspring. These affected individuals had several dysmorphic features including cavus feet and micrognathia. In addition the syndrome was associated with multiple hernias including inguinal, ventral, and diaphragmatic. These associated problems led to the early death of the first child at age 7 months. The lumbar scoliosis was already evident by that time. The progressive nature of the scoliosis was documented, especially in one child who was lost to follow-up and who was initially seen with a severe spinal deformity. Surgical management was required in members of the kindred, but because of differences in age and severity at the time of surgery, the techniques varied.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID