摘要:

We report an infant with a thoracic intradural extramedullary tumor to illustrate the presentation of an infantile spinal cord tumor and the difficulty in establishing a diagnosis. An infant presented with edema of the legs, motor loss in the lower extremities, and anuria at 3 months of age. Magnetic resonance imaging of the lumbar region did not reveal any abnormalities. At 1 year of age, the patient underwent surgery to correct urinary incontinence of unknown etiology. The patient developed gait disturbance and had abdominal pain at 17 months of age. Magnetic resonance imaging of the thoracic spine revealed an intradural extramedullary tumor at T2-T5. The spinal cord tumor was completely resected and pathologic findings indicated an endodermal cyst. All symptoms improved after the operation. Infants who present with weakness of the lower legs, urinary incontinence and unknown abdominal pain should be evaluated for a spinal cord tumor.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This retrospective study was made to illustrate the rare occurrence of neurologic deficits resulting from intervertebral disc calcification (IDC) in a child. Most authors agree that juvenile IDC is usually a benign, self-limiting disease with excellent prognosis. The symptoms subside spontaneously in 95% of patients. Conservative treatment is therefore usually sufficient. Reviewing the English-speaking literature, only two further cases of operated juvenile IDC with myelopathy have been published. In the current report, we describe a case of permanent thoracic myelopathy resulting from juvenile IDC treated by urgent decompressive thoracic laminectomy. At the 3-year follow-up examination, the patient had not recovered fully. Persisting deficits in motor and sensory function were observed.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

An accurate interpretation of radiographs is crucial in determining therapeutic choices in Legg-Calvé-Perthes disease. The aim of this study was to measure the interobserver reliability of a group of surgeons in this condition. Twenty-three radiographs were shown to nine pediatric orthopedic surgeons at nine different medical centers. Differences in coding between members of the group was assessed using a two-way random factor analysis of variance. Reliability was excellent for the Catterall classification [intraclass correlation coefficient (ICC) = 0.94], and good for the stage of disease and Head at Risk signs (ICC ranging from 0.74 to 0.85) except for lateral subluxation, whose reliability is fair (ICC = 0.68). Analysis of results shows that lateral subluxation should be expressed in a quantitative measurement rather than a binary answer. The reliability of Gage's sign would be improved if multiple definitions did not exist in the literature. In experienced hands, Catterall's classification can be used with reliability. Difficulties are still noted in separating group II from group III.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This is a roentgenographic and retrospective study comparing the results of two different operative procedures used in the treatment of Legg-Calvé-Perthes disease: Salter innominate osteotomy, and Augmented Acetabuloplasty. Group 1 comprised 43 patients (50 hips) who underwent Salter osteotomy. Another 40 patients (40 hips) were treated by Augmented Acetabuloplasty and formed Group 2. In Group 1, 11 (25.58%) patients were girls and 32 (74.42%) were boys. In Group 2, there were 4 (10%) girl and 36 (90%) boy patients. The average age was 6.62 years in Group 1 and 6.35 years in Group 2. Follow-up varied from 2 years to 10 years in both Groups 1 and 2. In Group 1, 18 (36%) hips were in the stage of necrosis, 28 (56%) in fragmentation, and 4 (8%) in reossification; in Group 2, 16 (40%) hips were in necrosis, 23 (57.5%) in fragmentation, and only 1 (2.5%) in reossification. All hips in necrosis were included in Salter and Thompson group B; all hips in fragmentation were classed as Catterall group 3 or 4. Preoperative arthrographs of the 50 hips in Group 1 were graded according to Laredo: 29 (58%) in group III, 18 (36%) in group IV, and 3 (6%) in group V. Only 23 of the 43 hips of Group 2 had preoperative arthrographs; there were 14 (60.87%) in group III, 8 (34.78%) in group IV, and 1 (4.35%) in group V. The preoperative Wiberg's Center-Edge (CE) angle of Group 2 (19.4°) was significantly greater than that of Group 1 (16.7°). The percentage difference (Δ%) between immediate postoperative and preoperative CE angle was significantly greater in Group 2. The Δ% between final and immediate postoperative CE angle was significantly greater in Group 1, and within Group 1 it was significantly greater at age 4 years to 6 years. The Δ% between final and preoperative CE angle was statistically the same in both Group 1 and Group 2. The distribution of good, fair and poor Mose ratings did not differ in Group 1 and Group 2, but there was a tendency of better results after Augmented Acetabuloplasty in children older than 6 years. Younger patients of Group 1 (4-6 years) ended up with good results at a significantly higher frequency than the older ones. Group 1 children with preoperative Laredo III arthrography had good results in a significantly greater number of cases, as compared with Laredo grade IV. The Δ% between final and immediate postoperative CE angle was greater in those hips with good Mose rating.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

During the 18-year period 1980-1997, 1103 patients were treated as in-patients for slipped capital femoral epiphysis (SCFE) in Scottish hospitals. This paper reports a significant seasonal variation, especially in male patients, with an excess admitted in the autumn. Examining the physiological seasonality of the monthly increment of growth in height and weight in childhood, we hypothesised that these physiological rhythms, while not pathogenetic, may be responsible for the timing of the seasonal features of SCFE. Previously published studies suggest that the average time between first symptoms and diagnosis is 3 to 5 months. The condition may start with the spring peak in growth and become more symptomatic with the autumn peak in weight. In conclusion, we report a new epidemiological finding, but, in accordance with other studies, we cannot provide a certain aetiological explanation. The timing, but not the pathogenesis, of admission to hospital for a SCFE might be related to the timing in the year of seasonal increments of height in spring and weight in autumn. It is tempting to draw attention to associations with environmental features. For example, in autumn there is the most rapid annual fall in temperature, and the hours of darkness are increasing from the autumn equinox to the winter solstice. However, there is no reason to conclude that these associations have anything to do with aetiology.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Retroversion of the acetabular dome has been associated with hip pain and osteoarthritis in several studies. Nevertheless, this acetabular alignment received little attention when studying the radiological outcome of pelvic osteotomies in childhood. We therefore reviewed the charts and X-rays of 73 patients with congenital dislocations, who underwent 97 pelvic osteotomies in childhood. We focussed our attention on anterior overcoverage or retroversion of the acetabular dome, respectively. Eighty-six Salter and 11 LeCoeur osteotomies were performed on patients with a mean age of 4.8 years. The mean age at last X-ray documentation was 16.5 years. The version of the acetabular dome was estimated qualitatively from the relationship of the anterior and posterior border to each other and measured semiquantitatively using templates developed by Hefti. According to Lequesne's criteria 94% of the hips were normal or borderline at maturity. A retroverted acetabular dome was present in 27% and averaged −15°. It was more frequent (60% versus 24%) and more pronounced (−16° versus +5°) after Le Coeur's than after Salter's osteotomy and in the residually dysplastic hips (83% versus 22%; −15° versus +3°). It is suggested that anterior overcoverage of the femoral head results from ignorance, when choosing the type and performing the pelvic osteotomy, of where coverage needs to be improved in an individual hip. We question the long-term outcome of these hips because such rotational misalignment has been suggested to be associated with early hip pain and osteoarthritis. In order to avoid such misalignment, preoperative evaluation of where coverage needs to be improved in an individual hip and efforts for better intraoperative control of acetabular reorientation should be made.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Sixty-seven dysplastic hips of 54 infants with an average age of 11.9 months were treated by the same surgical technique, including iliopsoas and adductor tenotomies via medial approach and arthrography for verification of the concentric reduction. The average follow-up period was 44.5 months. The rate of overall avascular necrosis (AVN) was 27% and that of severe AVN was 7%. With the numbers available in the study, a statistically significant relationship could not be found between the rate and severity of AVN and several preoperative and intraoperative components such as age, sex, side, dislocation grade, development of the ossific nucleus and quality of intraoperative reduction. Nevertheless, hips of infants treated between 13 months and 15 months of age, hips of male patients and left hips had slightly higher ratios of ischemic changes that were not statistically significant.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The operative treatment of congenital pseudarthrosis of the tibia, especially when associated with neurofibromatosis type I (Recklinghausen's disease), often leads to failure. Frequently, regardless of the type of deformity, multiple operative procedures end in the amputation of the affected limb. Soft tissue coverage of the amputation stump may confront the surgeon with new problems. Secondary perforation of the soft tissue envelope of the stump owing to terminal overgrowth is not a rare complication. A new technique of stump capping is demonstrated in a 10-year-old boy and a 14-year old girl, both with congenital pseudarthrosis of the tibia of the right leg and neurofibromatosis. During this procedure, a radical resection of the pseudarthrotic tissue is performed although all neurovascular structures supplying the calcaneus are carefully maintained (Arteria, vena et nervus tibialis posterior et peronealis). Subsequently, the tibia and fibula are inserted into the calcaneus. This construct is stabilized with two crossed Kirschner wires. Afterwards, the skin of the lower limb and the hindfoot are sutured together covering the neurovascular bundles, which are arranged in a loop-like fashion. The documented active range of motion was similar to that of the unaffected knee joint. Twelve weeks after operation in both patients, full weight bearing was achieved with a lower-leg prosthesis. This new procedure leads to a durable, full weight-bearing stump with complete sensitive innervation without the risk of future soft tissue perforation caused by the growing bone. The stump fits with an end-bearing lower-leg prosthesis.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The rates of successful knee arthroplasties according, for example, to Brown in patients with congenital total absence of the tibia are disappointing. A new form of knee arthroplasty is demonstrated in a 15-month-old infant with a congenital total absence of the tibia. With the help of two crossed capsular flaps and a Z-plasty of the quadriceps tendon, the patella is transposed under the femoral condyles to function as a tibial plateau. The proximal fibula is fused centrally to the external, cortical surface of the patella. A mini-ringfixator construction is used to stabilize the components, although permitting mobilization of the knee arthroplasty in the immediate postoperative period. This new type of knee arthroplasty offers distinct advantages compared with the previously published procedures.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Seventeen feet of 12 patients with congenital vertical talus, which were treated with a single-stage surgical correction of complete subtalar release and peritalar reduction by using the Cincinnati incision, were reviewed. Five of the feet were associated with neuromuscular disorders, four with neural tube defects, and eight were idiopathic. All patients were operated on by the same surgeon and all were available for clinical and radiographic follow-up averaging 42.9 months (range 19-81) from the time of surgery. There were no wound complications or avascular necrosis of the talus. None required subsequent reoperation. At final follow-up, results were based on clinical and radiographic outcomes and included five excellent, eight good, two fair, and two poor. All families were satisfied with the results and appearance of the feet. Radiographically, there was a significant improvement in the anteroposterior and lateral talocalcaneal and talo-first metatarsal angles, and at follow-up, the group averages for each of these angles were within the normal ranges. In the treatment of congenital vertical talus, good clinical and radiographic outcomes can be obtained, with a low incidence of complications, using this single-stage surgical correction procedure.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID