Aim. To retrospectively assess treatment outcomes of long bone deformities of the lower extremities accompanied by shortening in pediatric patients using a software-assisted Ortho-SUV Frame.Materials and methods. The accuracy of deformity correction (AC), period of deformity correction (PDC), external fixation index (EFI), and number of complications in 213 patients were retrospectively analyzed.Results. According to different parameters, AC of femur deformity correction (group 1) varied from 90% to 96%. The average length increase was 47 ± 12 mm. The average distraction duration was 38 ± 14 days. The average PDC was 8 ± 6 days for simple deformities (SDs), 14 ± 7 days for moderate deformities (MDs), and 23 ± 12 days for complex deformities (CDs). EFI was 26 ± 8 days/cm for SDs, 31 ± 6 days/cm for MDs, and 35 ± 12 days/cm for CDs. According to different parameters, AC of the lower leg deformity correction (group 2) varied from 89% to 95%. The average length increase was 52 ± 20 mm. The average distraction duration was 45 ± 18 days. PDC was 11 ± 5 days for SDs, 16 ± 9 days for MDs, and 27 ± 16 days for CDs. EFI was 32 ± 14 days/cm for SDs, 42 ± 12 days/cm for MDs, and 49 ± 8 days/cm for CDs. There were 48 (50.5%) complications in group I with the majority (71%) classified as Caton grade I and 29% as grade II. There were 62 (45%) complications in group 2, where 50% were Caton grade I and 50% were Caton grade II. There were no serious complications (Caton grade III) in either group that influenced the final functional results.Conclusion: Use of a software-assisted Ortho-SUV Frame increased the efficiency of treatment of pediatric patients with long bone deformities because of the great accuracy of deformity correction.
Цель работы -ретроспективно проанализировать результаты двух методов лечения детей с деформациями голени, являющимися следствием парциального синостоза зоны роста. Материалы и методы. Группу I составили 15 пациентов, которым выполняли остеотомию с одномоментной гиперкоррекцией деформации и чрескостный остеосинтез аппаратом Илизарова с последующим дозирован-ным удлинением сегмента. Группу II составили 13 пациентов, которым выполняли гемиэпифизиодез функцио-нирующей порции поврежденной зоны роста, остеотомию, чрескостный остеосинтез аппаратом Орто-СУВ с последующей коррекцией деформации и удлинением сегмента во времени. Результаты. В группе I выявлено, что при коррекции варусных деформаций гиперкоррекция по девиации ме-ханической оси (ДМО) составила 18,28 ± 5,25 мм, гиперкоррекция по мМПрББУ (механическому медиальному проксимальному большеберцовому углу) -14,86 ± 4,45°; по мЛДББУ (механическому латеральному больше-берцовому углу) -12,85 ± 3,02°. При коррекции вальгусных деформаций гиперкоррекция по ДМО составила 15,12 ± 8,28 мм, гиперкоррекция по мМПрББУ -10,38 ± 2,77°; по мЛДББУ -7,5 ± 3,9°. В 11 случаях (73 %) отмечался рецидив деформации. При этом минимальные сроки рецидива деформации составили 5 месяцев, максимальные -16 месяцев. В группе II точность коррекции (ТК) варусных деформаций по ДМО составила 98 %, по мМПрББУ и мЛДББУ -94 %; для вальгусных деформаций по ДМО -90 %, по мМПрББУ и мЛДББУ -96 %. ТК антекурвационных дефор-маций по анатомическому заднему проксимальному большеберцовому углу (аЗПББУ) и анатомическому переднему дистальному большеберцовому углу (аПДББУ) составила 96 %, рекурвационных -92 %. Только в одном случае через 6 месяцев после демонтажа аппарата отмечался рецидив деформации. В 2 случаях по мере роста ребенка по-требовалось повторное оперативное вмешательство, направленное на устранение неравенства длин конечностей. Заключение. Использование методики эпифизиодеза неповрежденной порции зоны роста в сочетании с остео-томией и чрескостным остеосинтезом на базе компьютерной навигации с последующими дозированными коррекцией деформации и удлинением достоверно снижает частоту рецидивов у пациентов с деформациями голени на фоне физарных синостозов.Ключевые слова: эпифизиодез; компьютерная навигация; гексапод; аппарат Орто-СУВ; коррекция деформа-ции; гиперкоррекция. TREATMENT OF PEDIATRIC PATIENTS WITH LOWER LEG DEFORMITIES ASSOCIATED WITH PHYSEAL ARREST: ANALYSIS OF 28 CASES
Introduction The incidence of forearm deformities in children with multiple hereditary exostoses (MHE) ranges from 30 to 80 %. There are few studies of deformities of the forearm in MHE patients in the literature that describe not only the location of exostoses and position of the head of the radius but also the true variants of forearm deformities. The aim of the study was to investigate forearm bone deformities in patients with multiple hereditary exostoses. Materials and methods Radiographs of the bones of the forearm in 84 patients (151 limbs) diagnosed with multiple hereditary exostoses in the age of four to 17 years who were treated at our institute from 2004 to 2018 were retrospectively analysed. The study involved 47 boys and 37 girls; 67 patients (80 %) had bilateral lesions, and 17 patients (20 %) had lesions of only one upper limb. Patients were divided into four groups depending on the type according to the Jo& Jung's classification. The deformities were evaluated based on radiological methods in accordance with the reference lines and angles for the forearm bones. Results The most common variants of forearm deformities were revealed: varus recurvatum at the border of the upper and middle third of the ulna (55 %), varus recurvatum at the border of the upper and middle third of the ulna associated with varus of the radius in the middle third (15 % of cases); as well as their combinations accompanied by dislocation or subluxation of the radial head (30 %). RAA (radial articular angle) and RB (radial bowing) did not have significant difference in various types of deformities of the forearm according to Jo&Jung's classification. Conclusion The study of the variety of forearm deformities in children due to multiple hereditary exostoses will assist in a differentiated approach to the choice of surgical treatment methods depending on the type of deformity.
BACKGROUND:Osteochondritis dissecans of the femoral condyles is characterized by subchondral bone lesions, with subsequent formation ofanosteonecrosis area. In nearly half of the cases, gonarthrosis developed in the long-term period despite timely treatment of such patients, including children. The development of new techniques and the improvement of existing ones will help enhance the treatment results of patients with this pathology. AIM:To evaluate the efficacy of treatment inasmall clinical series of pediatric patients with osteochondritis dissecans by triple injections of platelet-rich plasma (PRP) according to the developed scheme in combination with revascularizing tunnelization of the lesion area. MATERIALS AND METHODS:Seven patients with stage I or II osteochondritis dissecans were treated by revascularizing stimulation of the osteonecrosis center by triple injections of PRP (the first procedure was conducted intraoperatively intraosseously and the two other injections subsequently intraarticularly). The follow-up period was10 (611)months, withamaximum duration of 12 months. RESULTS:The observation results demonstrateahigh efficacy of PRP therapy to enhance the effect of mechanical methods of osteochondrogenesis stimulation in children with osteochondritis dissecans. CONCLUSIONS:The use of orthobiological technologies isanactively developing and promising approach in the complex treatment of children with osteochondritis dissecans of the femur condyles. However, further observation is required to evaluate the long-term results.
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