Kratak sadržajUvod. Uvođenje ultrazvuka u dijagnostiku razvojnog poremećaja kuka (RPK) osamdesetih godina prošlog vijeka doprinijelo je njegovom ranom otkrivanju, a time i liječenju ovog poremećaja. Klinički pregled se pokazao nedovoljnim za uspješno liječenje. RPK je češći kod djevojčica, a različito je zastupljen i regionalno. Na nastanak RPK utiču egzogeni i endogeni faktori. Cilj rada je bio da se utvrdi učestalost RPK dijagnostikovanih u Klinici za ortopediju i traumatologiju KC Banja Luka kod djece do navršene jedne godine i uspješnost liječenja neoperativnim putem.Metode. U kabinetu za ultrazvuk (UZV) Klinike za traumatologiju aparatom "LOGIQ 5" od januara do juna 2008.godine pregledano je 506 beba standardnom metodom po Grafu. Kod djece sa nestabilnim kukovima korišten je četverofazni sonoscrining (Harcke-Graf-Clarke). U postupku kontrole djece nakon aplikacije Pavlikovih remenčića primjenjivan je i prednji pristup po Suzukiju. Pored UZV dijagnostike korištena je i radiografija. Za statistič-ku obradu podataka korišten je analitičko-statistički sistem SPSS verzija 18.Rezultati. U prvih šest mjeseci pregledano je 506 djece među kojima je uzrasta od jednog mjeseca bilo 350 (69%), dva mjeseca 9 (17,9%), između drugog i četvrtog 48 (9,4%), preko četvrtog 17 (3,3%). Od ukupnog broja pregledanih više je bilo ženske djece, 293 (58%). Dominantan tip kuka je bio Ib po Grafu, 342 (67,2%), a tip IIIb i IV nisu nađeni u ispitivanoj grupi. Dodatna dijagnostika je bila potrebna kod 68 (13,4%) djece. Praćeno je 56 (11,06%) odojčadi, od toga 53 (10,47%) djevojčice. Liječenje Pavlikovim remenčićima provedeno je kod 9 (17,78%) odojčadi, gips u humanom položaju kod 2 (3,57%) odojčeta, a u jednom slučaju (1,78%) je primjenjivana trakcija, a potom gips u humanom položaju. Srednja vrijednost ugla alfa na kraju liječenja desno 62°, lijevo 60°, a beta 53° desno i 58° lijevo.Zaključak. Klinička incidenca RPK u ispitivanoj grupi bila je 11,06%, a ultrazvučna 1,77%. Dodatna dijagnostika je rađena kod 68 (13,4%) djece, a liječenje RPK je bilo isključivo neoperativno.Ključne riječi: razvojni poremećaj kuka, rana dijagnoza, ultrazvučna dijagnostika
Introduction. Thoracolumbar spinal injuries indicated for surgical intervention specify the necessity of intervention within 24 hours. The traumatologists working in a structure without a Spinal Unit must be able to evaluate such injury and set indications for surgical treatment, that is, nonoperative treatment. The purpose of this study is to evaluate if Thoracolumbar Injury Severity Score (TLISS) is still a good base for the classification of thoracolumbar spinal injuries and to give a correct indication for nonoperative, that is, surgical treatment. Patients and Methods. Six Orthopaedics and Traumatology residents from Siena (Italy), five Orthopaedics and Traumatology residents from the Clinical Centre of Banja Luka (Bosnia and Herzegovina) and five Orthopaedics and Traumatology residents from the Alta Val d'Elsa Hospital, Siena (Italy) were presented 24 clinical cases from professional literature where the following data were indicated: patient's age, neurological conditions, description of the injury, mechanism of the injury and radiological findings (RTG, MR). The abovementioned 24 patients were chosen from the literature based on the injuries mostly seen by an orthopaedist with a lack of experience in the problems of spinal column trauma (low energy trauma, with partial or without neurological impairments, with the TLISS score of 4). The residents from the three groups had to classify all patients according to the TLISS score and to define the most appropriate method of treatmentconservative or surgical, and after that, all classifications, as well as the therapeutic decisions, were compared. The statistical methods used in this study include: statistical significance, reliability (P<0.05), the validity of the decision, the percentage of accuracy and Cohen's kappa coefficient. The best results in evaluation of the mechanism of the injury were demonstrated by the group of doctors from the Orthopaedic Hospital with an accuracy of 78.8% (P<0.05) and with an average correlation (K = 0.598). The best description of the injury was presented by the doctors from Siena with 87% accuracy (P<0.05) and with correlation (K=0.749). The doctors from Siena responded best at evaluating the neurological status with 97.6% accuracy (P<0.05) and with correlation (K=0.936). The assessment of the injury of the PCL residents from Siena was 64.7% accurate (P<0.05) with correlation (K=0.426). The total TLISS score was best calculated by the residents of Siena with 82% accuracy (P<0.05) and correlation (K=0.718). The most appropriate therapeutic decision was made by the residents from Siena with 80.3% accuracy (P<0.05) and with correlation (K =0.707). Conclusion. Currently, the Denis classification and the AO classification are the most widely used classification algorithms for the fractures of thoracolumbar spine but some defects have also been identified in both of them. The value of TLISS evaluation is by the three groups of residents in presented 24 patients from the professional literature. Significant differences in accuracy w...
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