ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryProtrusio acetabuli [center-edge (C/E) angle >60°, teardrop collapsed, and pelvis invaded by acetabulum beyond ilioischial line (Köhler's)] was identified in 22 patients with classic Marfan syndrome. All had a preponderance of the syndrome's cardinal features (positive pedigree and musculoskeleta, ocular, and cardiovascular manifestations). Fifty-two immature patients with the syndrome's skeletal expressions predominating were studied for deep acetabuli. Half of these individuals (26 patients) had true protrusio acetabuli. Thirty-one percent (16 patients) had abnormal acetabular deepening (C/E angle >50°; teardrop partially collapsed without acetabular protrusion); 19% (10 patients) had normal pelves with C/E angle <40° and normal teardrop. To arrest the protrusio, the triradiate physis was closed surgically in 11 patients (21 hips), one unilaterally. In 19 operated-on hips followed-up to maturity by using teardrop, C/E angle, and acetabular relation to the ilioischial line as criteria, architecture was restored to normal in 12 hips and reduced from true protrusio to simply acetabular deepening in four. Three were unchanged. The youngest child operated on was 8; the oldest was 12 years. Laboratory examination of the physes was unrewarding.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummarySeven patients with osteogenesis imperfecta who have undergone humeral rodding were reviewed. Satisfactory functional results were obtained in six of seven patients. We discuss the indications for surgery in our unit, the complications, and the results in comparison with those of other centres.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryKlippel-Trenaunay syndrome is a triad of cutaneous hemangiomas, varicose veins, and hypertrophy of soft tissue and bone; when combined with arteriovenous fistulas, the syndrome is known as Klippel-Trenaunay-Weber syndrome. Orthopaedic surgical management of localized limb-length discrepancy or hypertrophy in these conditions is frequently indicated, especially in the lower limb. Forty orthopaedic procedures in 21 patients were retrospectively reviewed. Nine (22.5%) wound complications were identified in this study group. All the complications were associated with transverse amputations. All required significant further treatment and extension of hospital stay. Wound complications should be anticipated in patients with Klippel-Trenaunay syndrome having orthopaedic surgical procedures, especially terminal amputations.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryPelizaeus-Merzbacher disease (PMD) is a degenerative leukodystrophy of the central nervous system resulting in progressive spasticity and neurologic deterioration. Seitelberger(13)divided this rare disease into six types. Five patients with the type I and two patients with the type II form of PMD have been treated at the Children's Hospital of Eastern Ontario. Our study sought to identify the orthopaedic manifestations of PMD and to develop a common orthopaedic profile for these patients. All children with types I and II PMD developed spastic quadriparesis, truncal hypotonia, thoracolumbar scoliosis, soft-tissue contractures of the adductors and hamstrings, osteopenia, bilateral coxa valga, and associated hip dislocation.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryHurler's syndrome is an autosomal recessive metabolic storage disease with distinct skeletal manifestations, which include progressive hip dislocation. Enzyme-replacement therapy by bone marrow transplantation improves life expectancy but does not prevent hip dislocation. We describe the features of hip dysplasia in a series of eight successfully engrafted patients with Hurler's syndrome. The primary pathologic condition appears to be a failure of ossification of the cartilaginous acetabulum. Five patients underwent bilateral hip-containment surgery, and all operated-on hips were reduced at a mean follow-up of 17 months. Innominate osteotomy would appear to be an essentail part of the surgical procedure.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThirty-one patients with cerebral palsy and neuromuscular scoliosis underwent instrumentation with a unit rod fixed with sublaminar wires and posterior spine fusion. The mean curve measured 79° preoperatively, 19° immediately postoperatively, and 18° at final follow-up of 2.8 years, excluding two patients who died and four who were lost to follow-up after <12 months. The preoperative pelvic obliquity was 25°, which was initially corrected to 3° and remained unchanged at 4° at final follow-up. Twenty-four patients underwent a one-stage posterior fusion, and seven patients underwent both anterior and posterior fusions. Complications included one acute deep-wound infection and one late deep-wound wound infection seeded from the urinary tract. No pseud-arthroses or hardware failures have occurred to date. Seven children with open triradiate cartilages had a posterior spinal fusion only and were followed up to skeletal maturity with a 3° loss of correction of the scoliosis and a 0° loss of correction of pelvic obliquity. Questionnaries filled out by primary caretakers demonstrated that the objective of improving the child's ability to sit more comfortably was accomplished for the majority (65%) of patients. Spinal fusion was recommended for other children by 86% of interviewed caretakers.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThirty-three ambulatory patients with spastic cerebral palsy underwent evaluation and gait analysis an average of 9.6 years after bilateral posterior adductor transfers to the ischium. All patients showed functional improvement postoperatively, which was maintained at long-term follow-up in 94%. Gait analysis, however, documented pelvic obliquity in 85% of this group of patients. Associated with pelvic obliquity was a 36% incidence of unilateral hip subluxation. These complications of posterior adductor transfers have been difficult to treat and have resulted in the abandonment of this procedure at our institution.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryTwenty-six ambulatory children underwent preoperative and 1-year postoperative assessments after selective dorsal rhizotomy. These included spasticity, passive range of motion, tone, three-dimensional motion analysis, and electromyography. Independent and dependent ambulators were evaluated separately. A decrease in spasticity was found in all lower extremity muscle groups. An increase in passive range of motion was found only at the hip for both independent and dependent ambulators. Gait changes included increases in velocity and stride length in the independent ambulators. An improvement in hip extension during stance was found in the dependent ambulators only; however, an increase in knee extension and dorsiflexion in stance were seen in both groups. Selective dorsal rhizotomy improves both passive and dynamic range of motion in children with spastic diplegia.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe study was designed to determine the strategies used by diplegic subjects to change walking speed. Two groups, limited community ambulators and community ambulators, were compared with controls to determine if ability to increase speed would decrease as a function of motor impairment. Compared with matched controls, diplegic subjects were slower and relied more on cadence to increase speed. The ability to change velocity and stride length was significantly less in the diplegic groups than in controls and accounted for the wider difference in their fast walking velocity. Velocity and stride length decreased, whereas stance time increased as a function of motor involvement. In the limited community ambulators, pelvic excursion was increased, whereas hip and knee excursion was reduced. By assessing fast speed, differences between controls and diplegic groups became more apparent.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID