To assess the efficacy of surgical treatment of kyphosis of various etiology, and to develop a differential etiology-based approach to the choice of surgical correction technique. Material and Methods. Seventy four patients with extended kyphotic deformities were operated on, including 13 patients with posttraumatic kyphosis; 13-with congenital kyphosis and kyphoscoliosis with a prevalence of kyphotic component; 7-with Scheuermann's kyphosis; 12-with dysplastic kyphoscoliosis; 11-with neurogenic kyphosis and kyphoscoliosis; and 18-with iatrogenic kyphotic deformities. Various types of corrective vertebrectomy were performed in 68 patients. Results. Average Cobb angle in patients with extended kyphosis decreased from 65.78° ± 30.70° to 40.00° ± 19.93°. The application of corrective vertebrectomy in 61 patients allowed for rise in efficacy of intraoperative deformity correction by 32.0 ± 13.5 %. Differential approach to the choice of treatment technique resulted in good outcome in 66 patients (83.8 %), and in satisfactory-in 10 patients (13.5 %). Conclusion. Differential approach to surgical treatment of extended kyphotic deformities in thoracic and lumbar spine increases the efficacy of surgical correction, decreases the risk of neurologic disorder development and progression, and restores the spine support function.
Analysis of the literature data on the surgical treatment of feet deformities in children with cerebral palsy allowed determining of the first key pathogenesis aspects and management of surgical treatment. The main types of changes occurring in the feet under the influence of spastic disorders and the optimal methods of progressive deformities of feet surgical treatment were studied. The treatment management preference depends on intrapatient habits, age, the pattern of rescue, deformation gravity and mobility, level of the gross motor function (GMFCS). Various «soft tissue surgery» forms are effective provided sufficient deformation mobility for younger children group patients. The bone-cutting feet surgical measures are justified provided rigid deformations in more older children. A differentiated neurogenic feet deformities surgical treatment approach provides obtaining both early and long-term satisfactory treatment results.
Цель. Сравнительная оценка функции внешнего дыхания (ФВД) у детей с диспластическими и нейрогенными деформациями позвоночника и определение их корреляции с рентгенологическими параметрами тяжести и мобильности деформации. Материалы и методы. Проведено сравнительное клинико-рентгенологическое исследование с определением параметров ФВД у детей с тяже-лыми диспластическими (61 пациент), нейрогенными деформациями позвоночника (30 больных) и условно здоровых детей без деформаций по-звоночника (референсная группа – 30 детей) в возрасте от 6 до 17 лет. Пациенты госпитализировались в нейроортопедическое отделение НИИ детской хирургии ФГАУ «НМИЦ здоровья детей» с 2010 по 2020 г. для дообследования и выполнения хирургической коррекции деформации по-звоночника. Результаты. Выявлены достоверно более тяжелые нарушения ФВД у детей с нейрогенными деформациями позвоночника, которые сопровожда-лись снижением проводимости по бронхам всех калибров: крупным, средним и мелким, о чем свидетельствуют показатели МОС25(%Д), МОС50(%Д) и МОС75(%Д), в то время как диспластические деформации позвоночника характеризовались преимущественно нарушением проводи-мости в мелких бронхах – МОС75(%Д). Выводы. Установлена высокая корреляция рентгенологических показателей тяжести и мобильности деформации позвоночника с выявленными нарушениями ФВД, в большей степени у пациентов с нейрогенными сколиозами, что позволяет судить о тяжести течения сколиотической бо-лезни и своевременно принимать решение о необходимости хирургической коррекции. Ключевые слова: нейрогенный сколиоз, идиопатический (диспластический) сколиоз, вентиляционная функция легких. Для цитирования: Челпаченко О.Б., Фисенко А.П., Жердев К.В. и др. Нарушения вентиляционной функции легких у детей с тяжелыми нейроген-ными и диспластическими деформациями позвоночника. Педиатрия. Consilium Medicum. 2020; 1: 72–76. DOI: 10.26442/26586630.2020.1.200047
Нейроортопедические аспекты лечения детей с ДЦП включает хирургическую ортопедию, функциональную нейрохирургию и ортезирование. Патогенез двигательных нарушений в онтогенезе ребенка с ДЦП представляется следующим образом: перинатальное поражение головного мозга, нарушение редукции врождённых рефлексов, нарушение мышечного тонуса и патологические установки конечностей. При развитии вторичных контрактур суставов и вторичных деформаций скелета - эффективно воздействовать на данных этапах заболевания возможно только путем ортопедической хирургии. Фармакотерапия, функциональное ортопедическое лечение и ортезирование могут применяется на всех этапах развития двигательных нарушений при ДЦП. Препараты ботулотоксина типа А применяются от момента появления мышечного гипертонуса до патологической (постуральной) установки конечностей. К ортопедической хирургии мы прибегаем при наличии уже сформировавшихся вторичных контрактур суставов и деформаций скелета.
Термин детский церебральный паралич (ДЦП) обозначает группу нарушений развития движений и положения тела, вызывающих ограничения активности, которые вызваны непрогрессирующим поражением развивающегося мозга. Моторные нарушения при церебральных параличах часто сопровождаются дефектами чувствительности, когнитивных и коммуникативных функций, перцепции и/или поведенческими и/или судорожными нарушениями Это определение является на данный момент наиболее полным и современным. В целом, по данным статистики, в Москве проживает более 10 000 больных различного возраста с диагнозом ДЦП, из которых 4 500 составляют дети и подростки. Нейровизуализация позволяет нам увидеть поражения паренхимы мозга у детей с ДЦП чаще всего в виде перивентрикулярной лейкомаляции или лейкопатии, что представлено на данном слайде.
Background. The surgical treatment of congenital spinal deformity caused by hemivertebra is associated with high rate of complications. A research of a new surgery technique for operation time and blood loss decrease could potentially improve outcomes. The purpose — to evaluate the efficacy of ultrasonic bone scalpel in surgical treatment of pediatric congenital spinal deformities caused by monosegmental hemivertebra. Patients and Methods. Level of Evidence III. The study based on the data of 55 consecutively operated pediatric patients who underwent 59 posterior hemivertebra resection provided by ultrasonic bone scalpel from January 2015 to December 2019. The average age was 4 years and 4 months. 36 hemivertebra were located in thoracic spine and 23 were located in lumbar spine. Total duration of surgery, estimated blood loss (ml and % of circulated blood volume, CBV), complications rate and deformity correction were noted. The influence of posterior instrumentation length and patients age at time of surgery on evaluation parameters was analyzed. 5-year (2015–2019) systematic literature review was performed for compare with obtain results. Results. Total operation time was 131 min ± 33 min for thoracic spine and 165 min ± 50 min for lumbar spine (p = 0,005). Estimated blood loss was 105 ml ± 74 ml (Me 80 ml) for thoracic resection and 123 ml ± 59 ml (Me 120 ml) — for lumbar (p = 0,178). The length of posterior instrumentation were not influence on operation time and total blood loss (p = 0,957; p = 0,967), patients age at time of surgery were not influence on operation time (p = 0,458), but correlate with total blood loss (p = 0,023). Intraoperative complications was not observed. Four cases of transpedicular screw malposition without neurological deficit were noted (type C acc. Gertzbein-Robbins). Conclusions. Posterior hemivertebra resection with ultrasonic bone scalpel is safe and effective procedure provides decrease of operation time and estimated blood loss.
Introduction. Restoration of trunk balance is the basic task in surgical correction of spinal deformities and in hip joint instability of various etiology. Purpose. To analyze and to define the relevance of roentgen-anatomical parameters of spine-pelvis relationships for surgical correction of deformities in the thoracolumbar spine and of hip joint instability of dysplastic and neurogenic etiology. Material and methods. An X-ray analysis of parameters of the frontal and sagittal spine-pelvis balance was performed in 220 patients with dysplastic and neurogenic deformities of the thoracic and lumbar spine (n = 98) and with instability of hip joints (n = 122) but who were able to walk. They were operated in the neuro-orthopedic department with orthopedics in National Medical Research Center for Children’s Health. The reference group included 60 relatively healthy children without any scoliotic deformities of the spine and with stable hip joints. Dynamics of changes in X-ray parameters was analyzed using findings of orthostatic spondylograms from the indicated groups of children. The obtained data were compared with reference values. Results. The trial performed has revealed typical changes in spine-pelvis relationship parameters in patients with hip joint instability and spine deformities and in the reference group . The researchers also found out relations between various parameters of the trunk balance before and after surgical correction. Conclusion. While planning a surgical correction of trunk balance in spinal deformities, one should take into account parameters of spine-pelvis relationships, such as PI, SS, PT, SVA deviation and the mid-sacral line; and in case of hip joint instability - local roentgen-angulometric parameters of the femoral and acetabular components of instability. This is due to the fact that the lower the level of reconstructive surgical manipulation is located, the greater effect it has at the frontal and sagittal balance of the trunk.
Introduction. The balance of the torso is the result of the interaction of various systems of the body, which provides a stable vertical position in space, which includes such components as afferentation, integration, effectors, and the peripheral nervous system. Material and methods. A clinical and radiological study of the coronal and sagittal alignment was carried out: 220 patients with idiopathic and neurogenic deformities of the thoracic and lumbar spine (n = 98) and hip instability (n = 122), capable of walking. The reference group is represented by 60 relatively healthy children without scoliotic spinal deformities with stable hip joints. Radiological parameters were evaluated by orthostatic X-rays for the indicated groups of children when comparing the obtained data with reference values. Results. The features of changes in the pelvic incidence (PI) and other parameters of the spin alignment in patients with hip instability, significantly different from patients with spinal deformities and the reference group, were revealed. Conclusion. The obtained results of the study call us to pay more attention to the parameters of the coronal and sagittal alignment as a total. Assessment and preoperative planning of only local X-ray anatomical parameters in order to predict their postoperative changes does not take into account changes in the coronal and sagittal balance, which, according to most published data, determines the further quality of life of patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.