ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryOne of the problems facing the clinician is the differentiation between functional and structural limb-length inequality. This study investigated 20 subjects (mean age, 9.0 ± 3.9 years) with documented limb-length inequalities to determine the magnitude of discrepancies that result in gait abnormalities. The subjects were asked to walk on an 8-m walkway at a self-selected free pace. The contact time, first and second force peaks, and loading and unloading rates of the vertical ground-reaction force were measured for both limbs. These parameters were predictive for quantification of gait asymmetry. The asymmetry of these parameters increased as the limb-length inequality increased. In general, a limb-length inequality >2.0 cm (3.7%) resulted in gait asymmetry that was greater than that observed in the normal population. However, the amount of asymmetry varied for each individual. A static examination can document an anatomic deformity, but this deformity may be compensated for by functional adaptations. An analysis of the patient's gait should be performed to identify asymmetries during ambulation. Dynamic gait findings, such as demonstrated in this study, are needed to support static measurements.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryLoss of joint motion is a common complication of limb lengthening despite newer methods of incremental bone elongation. A pilot canine study has demonstrated that 30% femoral lengthening causes reproducible knee cartilage injury manifest by frank loss of cartilage substance or fibrillation. This study was undertaken to examine the potential of knee joint protection by apparatus extension to the tibia. Four dogs underwent application of a modified Ilizarov apparatus to the femur and tibia with coaxial hinges at the knee. After osteotomy, 30% lengthening was undertaken at 0.75 mm daily in three increments. At the completion of lengthening, experimental and contralateral knee joints were harvested, assessed grossly, decalcified, sagittally sectioned, and stained with safranin-O. All control joints were normal histologically. All experimental joints demonstrated a decrease in proteoglycan staining without evidence of fibrillation or necrosis. These findings suggest a protective effect of the tibial apparatus by avoiding joint compression.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe efficacy of somatosensory evoked potentials (SSEPs) to detect acute peripheral nerve injury during external-fixator application in the lower extremities was evaluated in 40 children with 42 Ilizarov surgical procedures. The study included patients who were either clinically normal or who had preexisting neuropathy but consistent and reliable SSEP responses preoperatively. SSEPs were recorded from the popliteal fossa and lumbar regions after alternating stimulation of the peroneal and posterior tibial nerves at the ankle. SSEP changes due to anesthesia, Ilizarov apparatus application, and other intraoperative variables are described. Significant deterioration or total loss of SSEP response during surgery occurred in four cases. Two of these patients were normal preoperatively and had symptoms of neurologic deficit postoperatively; the other two had exacerbations of preexisting neuropathy. In general, the peroneal nerve was at greater risk for injury during surgery. SSEP monitoring proved to be technically feasible in external-fixation procedures on the lower extremities and may be a practical tool for detection of intraoperative nerve compromise.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe authors reviewed 70 femoral lengthenings performed for limb-length discrepancy in 66 children and adolescents using gradual incremental distraction. Nine were performed using the Judet lengthener and 61, the Orthofix external fixator. Etiology of the femoral shortening was congenital in 22, posttraumatic in 17, postinfection in 13, neurologic in 12, and miscellaneous in six. There were 83 complications, which were assessed as to their relation to the etiology of shortening, amount of lengthening, and age. The incidence of joint complications did not seem to be less than that previously encountered with rapid distraction methods of lengthening. Bony consolidation was achieved without additional surgery in 88% of cases. Delayed consolidation was most commonly encountered in children younger than 8 years old with congenitally short femora. The authors believe that good results can be obtained by incremental distraction by using uniplanar fixation by aggressive physical therapy, proper fixator application, and appropriate dynamization of the fixator.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryBetween June 1987 and June 1992, 62 tibiae in 52 patients underwent lengthening by using the Ilizarov technique. Follow-up was from 18 months to 5 years. The mean age at surgery was 12.9 years (range, 5-19). The etiology of limb shortening was congenital in 53 and acquired in nine tibiae. Thirty-five tibiae had bifocal and 27 had unifocal treatment. Twenty-two of the 62 limbs had simultaneous treatment of other associated problems, including rotational or angular deformity or foot deformity. The average lengthening was 7.5 cm (range, 3.5-12), which was equivalent to a 32% average overall increase in limb-segment length (range, 6-96%). Complications required 28 (22%) unplanned procedures in the 62 tibiae, including nine osteotomies for iatrogenic malunion or deformation of regenerate bone (31%). Three tendo Achilles lengthenings and posterior ankle capsulotomies were required for persistent equinus contractures. Bony complications declined as experience with the technique increased. This technique allows simultaneous lengthening correction with control of the adjacent foot when required.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryA review of 71 epiphysiodeses with adequate orthoroentgenographic and skeletal-age data was carried out to compare the accuracy of predicting outcome among the methods of Anderson and Green, Menelaus, and Moseley. Differing the methodology did not have a meaningful effect on their similar but limited accuracy. We advocate the use of the Menelaus method, which is simple and based on chronologic age, as it proved as accurate as any other method. The routine use of serial Gruelich and Pyle skeletal-age data could not be shown to increase the accuracy in predicting outcome over serial chronologic-age data, and thus its value in limb-length inequality is limited. Regardless of the method used, unpredictable results occur in a proportion of patients. The patient and parents should be advised of this when planning strategies for limb-length discrepancy.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe results of 42 percutaneous epiphysiodeses of the lower extremity in 26 patients are reported. All patients achieved physeal arrest radiographically and clinically. No patient developed angular deformity from incomplete arrest. No neurovascular complications or fractures occurred. The average hospital stay for patients undergoing epiphysiodesis alone was 1 day. Percutaneous epiphysiodesis of the lower extremity provides a reliable and safe technique for growth plate arrest. The advantages of this technique include a cosmetic scar, short hospital stay, low incidence of complications, and reliable physeal arrest.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryDuring simulated manipulation of children's forearm fractures, levels of scattered radiation from both plain radiographs and an image intensifier in different modes were measured at various sites on the surgeon, anaesthetist, radiographer, and patient both with and without recommended shielding. By using fluoroscopy in the pulsed screening mode but allowing only single pulses to occur, radiation levels could be substantially reduced to the eye, thyroid, and gonads of all those exposed. The radiographer and the anaesthetist were so far from the source and guarded by various pieces of equipment that levels were almost unrecordable. Effective dose equivalent for the surgeon using pulsed mode, based on circa six pulses per manipulation, during 100 manipulations per year, would equate to 1 μSv even in the unshielded state (<0.1 μSv shielded), which is ≈1/1,000 of background radiation at sea level. Because the current dose limit is 50 mSv (50,000 μSv) per year for employees, we are many orders of magnitude in the safety zone.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryA prospective, randomized study of intravenous (i.v.) regional anesthesia compared with nitrous oxide gas was performed in a group of 28 pediatric patients with forearm fractures requiring manipulation in the emergency department. The groups were compared in terms of pain perceived by the patients, success of manipulation, safety, and duration of procedure. The methods showed no significant difference in amount of pain perceived by the patient for the total pain experience. No medical complication was seen in either group. Because of a technical problem with an i.v. regional block, fracture manipulation was not completed in one patient. Nitrous oxide treatment required significantly less time for completion of the procedure.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID