摘要:

This article reviews the use of spinal cord monitoring in neuromuscular scoliosis, a condition having a higher incidence of true positive results than idiopathic scoliosis. While somatosensory cortical evoked potentials (SCEP) are unreliable, somatosensory spinal evoked potentials (SSEP) are possible to obtain in most cases and a method using an epidural electrode is described. The '50% rule' is satisfactory having good specificity and sensitivity with it rare for post-operative paralysis to have occurred undetected. The spinal cord in these cases appears to have increased susceptibility particularly during the passage of sublaminar wires with the incidence of complications reduced using modern instrumentation.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The natural history of scoliosis in cerebral palsy as well as the treatments that include observation, bracing, and surgery are reviewed. If surgery is indicated, a careful preoperative evaluation is essential, focusing especially on the patient's nutritional, gastrointestinal, neurologic, and orthopedic systems. Intraoperative and perioperative issues such as blood loss control are reviewed. The Luque-Galveston method of instrumentation for scoliosis secondary to cerebral palsy is our preferred method of treatment. Our recent results compare favorably with the literature with fewer complications.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A retrospective analysis of 54 patients with paralytic scoliosis due to myelomeningocele, who underwent surgical treatment, was performed. The aim of this study was to compare different surgical techniques and to identify clinical parameters influencing primary and midterm results. Three surgical techniques were used: 1) group I, posterior fusion/instrumentation; 2) group II, anterior fusion/no instrumentation combined with posterior fusion/instrumentation; and 3) group III, anterior and posterior fusion/instrumentation. Average age at surgery was 13.1 years. A preoperative scoliosis angle of 90° [interquartile range (25th-75th percentile) (IQR), 76-106°] was primarily reduced to 38° (IQR, 30-50°). At final follow-up (mean, 3.3 years), correction deteriorated to 44° (IQR, 38-65°). The group III procedure resulted in a better midterm correction of scoliosis compared with group I (P= 0.02). The extension of anterior fusion correlated with primary and midterm correction of scoliosis (P< 0.03). Patients with a thoracic level of paralysis had a higher relative loss of correction compared with patients with a lumbar level (P< 0.06). This finding can be attributed mostly to group I patients (P= 0.011). Hardware complications occurred in 16 patients (30%). Relative loss of correction among these patients was high (P< 0.01) and relative midterm correction low (P= 0.001). We recommend anterior and posterior fusion, each with instrumentation for the treatment of paralytic scoliosis in myelomeningocele. In patients with a thoracic level of paralysis, the two-stage procedure is mandatory to reduce the risk of hardware complications and subsequent major loss of correction.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The aim of this study was to report results of prophylactic spinal stabilization in patients with Duchenne muscular dystrophy. There is still debate regarding the ideal instrumentation. A prospective study of a consecutive series of 31 patients stabilized with the ISOLA® system from D2 to S1 will be presented. The mean follow-up was 22 months (range, 1-60 months). The evaluation of the Cobb angle and pelvic obliquity revealed the following: 1) Cobb angle: preoperation, 48.6° (range, 22-82°); postoperation, 12.5° (range, 0-30°); follow-up, 12.5° (range, 0-42°); and 2) pelvic obliquity: preoperation, 18.2° (range, 3-40°); postoperation, 3.8° (range, 0-13°); follow-up, 5.1° (range, 0-14°). Spinal stabilization with the ISOLA® system was found to be a suitable treatment for scoliosis owing to Duchenne muscular dystrophy. It should be carried out after loss of ambulation as soon as a progressive curve of more than 20° is documented. The complication rate was found to be high.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This study was conducted to evaluate the risk factors for epiphyseal changes suggestive of osteonecrosis after proximal femoral osteotomy for hip subluxation associated with cerebral palsy. Forty-eight children with 94 hips were reviewed. Two observers rated the radiographs using a written protocol on two occasions each so that reproducibility of these observations could be assured. Concomitant pelvic osteotomy proved to have the greatest association with risk of epiphyseal changes. These findings, suggestive of osteonecrosis, were present in 7 of 68 (10%) hips that had isolated femoral osteotomy, and in 12 of 26 (46%) hips that had concomitant pelvic osteotomy.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Serial radiographs of 44 hips in 39 patients undergoing Salter innominate osteotomy for the treatment of dysplastic acetabulum owing to developmental dysplasia of the hip were reviewed. The hips were also evaluated clinically at the last follow-up examination, 7 years to 13 years postoperatively. At 7 years to 13 years postoperative, excellent or good clinical results were assessed in 43 hips (98%), and excellent or good radiographic results in 32 hips (73%). In patients with a postoperative center edge (CE) angle >24°, the CE angle remained significantly greater throughout the follow-up period compared with patients with a postoperative CE angle ≤ 24°. A positive correlation was found between the degree of operative CE angle correction and radiographic findings 7 years to 13 years postoperatively.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

From 1972 to 1991, 50 Chiari procedures were performed in 41 patients. The follow-up period ranged from 3 years to 24 years and 3 months, with an average of 7 years. Age of the patients at operation averaged 10 years and 6 months (3 years and 1 month to 28 years and 6 months). The best results were obtained in patients older than 10 years of age. There was no statistical relationship between the technical details of Chiari osteotomy (angle of Chiari, displacement and distance to the femoral head) and the results.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In 1978, Wagner described a technique using multiple Kirschner wires (K-wires) to stabilize an intertrochanteric osteotomy performed for the correction of coxa vara in small children. Multiple K-wires are used to create a custom high-angle blade plate for valgus osteotomy. The authors have evaluated a retrospective series of 17 Wagner intertrochanteric osteotomies that were performed in 10 children with coxa vara between the ages of 1 year and 8 years. The neck-shaft angle was corrected from 93.5° to 129.5° at long-term follow-up, and the Hilgenreiner epiphyseal angle was corrected from 71° to 37.6° at long-term follow-up. Revision surgery was performed on five hips with inadequate initial surgical correction. Complications included a single broken K-wire, a femur fracture after hardware removal, and one hip developed avascular necrosis postoperatively.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The purpose of this study was to evaluate the sensitivity and predictive value of early postoperative bone scan for detection of avascular necrosis (AVN) of the femoral head after surgical treatment of slipped capital femoral epiphysis. We reviewed records of 49 patients (64 hips) operated on between 1980 and 1997 with a mean follow-up of 3 years. Sixty-one out of 64 hips went through an early postoperative bone scan. The three hips that developed AVN showed significant loss of radionuclide uptake. There were neither false-positive or false-negative cases in this series. Early postoperative bone scan has an excellent sensitivity and predictive value for detection of AVN after surgical treatment of slipped capital femoral epiphysis.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Some authors have widened the indications for surgical management of isolated femoral shaft fractures in children between 4 years and 10 years of age. We address this study to evaluate the results of such femoral fractures treated conservatively in 41 children. All fractures were closed, isolated, and diaphyseal. The mean age was 6.5 years (standard deviation, 1.7 years) and the mean follow-up was 2.3 years (standard deviation, 1.7 years). All fractures were managed conservatively with skin traction (mean hospitalization time, 20.7 days), alignment of the fragments was serially followed by X-ray, and a spica cast was applied (9.7 weeks), usually without a general anesthesia. Angular deformity was assessed by measurement of the fracture-site diaphyseal angle as well as by measurement of the interphyseal angle described by Wallace and Hoffman. No significant complications were recorded regarding leg-length discrepancy, deformity, refractures, etc. Mean cost is not a factor in determining method of treatment at our hospital. We feel that this type of fracture in the 4 years to 10 years age group can be safely treated with a conservative approach.

ISSN:0271-6798    

出版商:OVID    

年代:2001

数据来源: OVID