The aim: To chose the best way treatment and achievement of 3-dimensional spinal correction in order to maximize its parameters to the physiological norms is a choice of the optimal surgical severe scoliotic spinal deformity correction technology. Materials and methods: Performed surgical treatments to 60 children of two patient’s groups, that were under surgical treatment for severe scoliotic spinal deformations with preliminary used halo-gravity traction and one-step correction; to establish an effective and safe protocol of the treatment for children with severe scoliotic spinal deformations (>100°). The results comparative analysis of 60 patients with severe scoliotic spinal deformations, with a two-step surgery treatments (first step – halo-gravity traction and second step – correcting spinal instrumentation) and patients with one-step correction. Patients were divided into 2 groups with 30 children in each of them. The first group treated with preoperatively HGT (halo-gravity traction) and after that a spinal instrumentation together with osteotomies (3-4 levels by Ponte; VCR (vertebral column resection) osteotomy 1 level) were performed. The second group – performed one-step spinal instrumentation with osteotomies (3-4 levels by Ponte; VCR osteotomy 1 level). Results: One-step implanted construction in children with severe scoliotic spinal deformations, compare to HGT treatment that were carried out in stages – is increasing the danger of neurological deficiency by 17%, HGT allows to make more corrections and to adjust spinal cord for the next correction treatment. . Conclusions: Halo-gravity traction as a first stage of severe scoliotic spinal deformations treatment allows to increase the mobility of the vertebral column and to adjust spinal cord step by step for the next correction treatment.
Purpose is to identify the factors that determine the clinical features of the LMs, their complications and the choice of treatment options. Materials and methods. 225 children with LMs who underwent treatment since 2011 to 2020 were enrolled. They were grouped according to ISSVA 2018 classification. Clinical presentation, treatment options, complications and outcomes were analyzed. One-variant analysis using Pearson’s χ2 test was used to evaluate qualitative data. Results. 214 (95.1%) patients had cystic LMs, 11 (4.9%) had combined LMs. 129 (57.3%) LMs were cervicofacial, 17 (11.9%) patients developed airways compression and 6 (4.2%) required tracheostomy. 8 (3.6%) patients developed 10 lymphatic leaks episodes, 3 were lethal. 112 (86.8%) patients with cervicofacial, 5 (11.6%) abdominal, 10 (84.6%) axillar, and 12 (92.2%) extremities LMs underwent sclerotherapy. Surgical resections prevailed in abdominal LMs, 32 (74.5%), versus 4 (3.1%) cervicofacial LMs. 10 (4.4%) patients with combined and complicated cystic LMs underwent systemic sirolimus therapy. Results of treatment were excellent in 116 (51.6%) patients, good in 82 (36.4%), satisfactory in 23 (10.2%), and unsatisfactory in 4 (1.8%), with 4 mortalities caused by sepsis (n=1) and by massive lymph leakage (n=3). Conclusions. The most life-threatening LMs complications are airways compression and uncontrollable lymphatic leakages. Several approaches were used, including surgery, sclerotherapy, and target therapy. Surgery is optional for abdominal LMs but potentially harmful in cervicofacial. Treatment of combined LM is continuous and requires a combination of different methods. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: lymphatic malformations, children, sclerotherapy, target therapy.
Мета: аналіз ефективності консервативного лікування вродженої клишоногості в дітей першого року життя за методами Т.С. Зацепіна та І. Понсеті з використанням запропонованих нами нововведень. Матеріал та методи роботи. Було проведено аналіз лікування 71 дитини (89 стоп) з ідіопатичною вродженою клишоногістю, які перебували на стаціонарному та амбулаторному лікуванні в національній дитячій спеціалізованій лікарні «Охматдит» за період з 2008 по 2015 рік. Висновок. За результатами лікування дітей першого року життя можна зробити висновок, що як при використанні методу як Зацепіна, так і при використанні методу Понсеті в найближчому періоді були отримані добрі результати в 91,0 та в 94,7 % випадків відповідно. Проте у віддаленому періоді при використанні методу Понсеті добрі результати відмічались у 83,3 %, а при лікуванні за Зацепіним — у 55,6 %. Отже, при лікуванні за Понсеті були отримані більш якісні результати, скорочено строк гіпсування (з 6–8 місяців до 4–7 тижнів), а також перебування в стаціонарі. Використання ультразвукового дослідження ахілового сухожилка до та після ахіллотомії дозволяє вірогідно підтвердити його перетин, дослідити етапи повного функціонального відновлення. Використання даного підходу забезпечує повну корекцію підошовного згинання стопи після виконання ахілотомії та дозволяє знизити відсоток рецидивів. Аналіз незадовільних результатів лікування показав, що чим старший пацієнт, тим нижча ефективність застосування традиційного методу Зацепіна.
Summary. Relevance. Health-related quality of life (HRQoL) is an important indicator of the treatment. Quality of life consists of functional, physical, emotional, social and spiritual states [1], and therefore has become a leading criterion in many researches, along with physical and economic factors. In the course of its development, the concept of quality of life has been correctly indicated as a parameter of the result in the recommendations of many medical societies [2]. Objective: to assess the quality of life of patients with adolescent idiopathic scoliosis who were treated conservatively. Materials and Methods. The study included 54 patients who were treated at the clinic of the Department of Pediatric Surgery of the Bogomolets National Medical University in the period from 2015 to 2019. The mean age of the patients was 12.6 years (range 10 to 15 years), the mean Cobb angle was 24.8° (range 20° to 37°), and the mean torso angle was 7.2° (range 6° to 17°). All patients underwent conservative treatment with continuous use of the Cheneau corset [6]. Indicators of quality of life were studied using Brace Questionnaire (BrQ) [8] at the beginning and at the end of treatment. The minimum duration of conservative treatment was 2 years. Results. Patients with adolescent idiopathic scoliosis at the end of treatment had lower scores in all domains of BrQ. This difference was statistically significant for the mean overall BrQ score and for the domains of general health perception, physical functioning, emotional functioning, self esteem and aesthetics, bodily pain, and social functioning. Assessments in the domains of vitality and school activity were not significant. Conclusions. It was found that the quality of life immediately after the end of conservative treatment of adolescent idiopathic scoliosis in the Cheneau сorset is gradually improving. Due to limitations in the design of the study, this finding highlights the importance of measuring quality of life indicators to assess how patients with adolescent idiopathic scoliosis perceive the impact of their disease.
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