SummaryThe treatment of femoral head necrosis of adults is still rather problematic. Conservative treatment has been reported relatively unsuccessful and surgical treatment does not show convincing results either. The most effective seems to be a surgical treatment in early stages of the disease, however, the diagnosis still remains relatively complicated. For the late stages (2B and above) the most effective treatment option is represented by core decompression and vascular grafting. However, drilling and plombage (especially when using press-fit technique) seems to be successful, although not excellent. The authors describe their own method of drilling and plombage of the necrotic zone of the femoral head in 41 patients with X-ray detected necrotic changes of the femoral head. The pain measured by VAS was seen to decrease after surgery in all patients significantly. The Jacobs score was also observed to have increased (from fair to good outcome). We have not observed any large femoral head collapse after surgery, moreover, in some cases an improvement of the round shape of the femoral head was seen. It is important to mention that in all cases femoral heads with existing necrotic changes (flattening or collapse) were treated. Although the clinical improvement after surgery was not significantly high, the method we describe is a safe and simple method of diminishing pain in attempt to prepare the femoral head for further treatment in a future, without significant restriction of the indication due to necrosis (osteochondroplasty, resurfacing, THR).
Operační terapie je nejčastěji indikovaná u spastického typu (formy) dětské mozkové obrny (DMO). V oblasti kyčelních kloubů je nejčastěji addukční postavení s různě vyjádřenou flexí a vnitřní rotací. Kolenní klouby bývají ve flexi, méně často v extenzi, v oblasti hlezna je základní deformitou pes equinus. Vzpřímený stoj je umožněn plantigrádním postavením nohou, extenzí kolen a kyčlí. Vzhledem k tomu, že se jednotlivé oblasti navzájem ovlivňují, je třeba hlezna, kolena a kyčle léčit jako jeden celek Nejčastějším problémem, který musíme řešit v oblasti kolenních kloubů jsou flekční kontraktury, méně často extenční, které jsou způsobeny spasticitou musculus (m.) quadriceps femoris. Dalším problémem je chybění aktivní extenze kolenního kloubu vytažením ligamentum patellae, s tím související vysoký stav pately, která se dostává proximálně mimo interkondylický žlábek. Všechny svaly a jejich nerovnováha může ovlivňovat vývoj kolenního kloubu, způsobit distenzi vazivového aparátu a ovlivňovat sklon kloubních ploch tlakem na epifyzární ploténky (8, 23, 348/PŮVODNÍ PRÁCE ORIGINAL PAPER
PURPOSE OF THE STUDYThe study aimed to draw up a diagnosis and treatment guidelines for the management of the most common compression fractures of the thoracolumbar spine in children. MATERIAL AND METHODSBetween 2015 and 2017, pediatric patients with a thoracolumbar injury aged 0-12 years were followed up in the University Hospital in Motol and the Thomayer University Hospital. The age and gender of the patient, injury etiology, fracture morphology, number of injured vertebrae, functional outcome (VAS and ODI modified for children), and complications were assessed. An X-ray was performed in all patients, in indicated cases also an MRI scan was done, and in more severe cases a CT scan was obtained as well. RESULTSThe average vertebral body kyphosis in patients with one injured vertebra was 7.3° (range 1.1°-12.5°). The average vertebral body kyphosis in patients with two injured vertebrae was 5.5° (range 2.1°-12.2°). The average vertebral body kyphosis in patients with more than two injured vertebrae was 3.8° (range 0.2°-11.5°). All patients were treated conservatively in line with the proposed protocol. No complications were observed, no deterioration of the kyphotic shape of the vertebral body was reported, no instability occurred, and no surgical intervention had to be considered. DISCUSSIONPediatric spine injuries are in most cases treated conservatively. Surgical treatment is opted for in 7.5-18% of cases, in dependence on the evaluated group of patients, age of the patients and philosophy of the department concerned. In our group, all patients were treated conservatively. CONCLUSIONS 1. To diagnose F0 fractures, two unenhanced orthogonal view X-rays are indicated, whereas MRI examination is not routinely performed. In F1 fractures, an X-ray is indicated, and an MRI scan is considered based on the age and extent of injury. In F2 and F3 fractures, an X-ray is indicated and subsequently the diagnosis is confirmed by MRI, in F3 fractures also a CT scan is performed. 2. In young children (under 6 years of age), in whom an MRI procedure would require general anaesthesia, MRI is not routinely performed. 3. In F0 fractures, crutches or a brace are not indicated. In F1 fractures, verticalization using crutches or a brace is considered in dependence on the patient's age and extent of injury. In F2 fractures, verticalization using crutches or a brace is indicated. 4. In F3 fractures, surgical treatment is considered, followed by verticalization using crutches or a brace. In case of conservative treatment, the same procedures as in F2 fractures are applied. 5. Long-term bed rest is contraindicated. 6. Duration of spinal load reduction (restriction of sports activities, or verticalization using crutches or a brace) in F1 injuries is 3-6 weeks based on the age of the patient, it increases with the age, with the minimum being 3 weeks. 7. Duration of spinal load reduction (verticalization using crutches or a brace) in F2 and F3 injuries is 6-12 weeks based on the age of the patient, it increases with the age, with the minimu...
PURPOSE OF THE STUDYTo evaluate the efficacy of magnetic resonance (MR) examination in intra-and extra-articular shoulder disorders, in comparison with arthroscopic findings, in patients with both acute injuries and chronic problems of the shoulder. MATERIAL AND METHODSConventional MR images and MR arthrograms of the shoulder were obtained in 35 patients treated between January 2004 and January 2006. Each MR image was evaluated by five radiologists experienced in assessing findings on the musculoskeletal system. Subsequently, the patients underwent shoulder arthroscopy performed by shoulder arthroscopy surgeons. Each detailed arthroscopic report was compared with the pre-operative MR findings, and the sensitivity and specificity of MR examination were calculated. The arthroscopic findings served as standards of reference for comparison. RESULTSSLAP lesions were found intra-operatively in seven out of the 35 patients (20 %). MR sensitivity was 43 % (3 to 7 patients) and specificity was 96 % (27 to 28). The accuracy of MR for SLAP lesion diagnosis was 86 % (30 of 35 patients). Tears in the anterior labrum were diagnosed by arthroscopy in 16 of 35 patients (46 %); MR sensitivity was 44 % (7 of 16 patients) and specificity was 89 % (17 of 19). The accuracy of MR for diagnosing labral tears was 68 % (24 of 35 patients). DISCUSSIONWhen designing our study, we tried to avoid limitations of similar investigations. We employed a nuclear magnetic resonance system with high resolution and standardized both the arthroscopic technique and the evaluation of MR images. Our results of diagnosing rotator cuff disorders and SLAP lesions are in agreement with those of other relevant studies. The limitation of our study was a small size of the group. CONCLUSIONSAlthough MR imaging is a sensitive method suitable for diagnosing some shoulder disorders, the MR imaging of SLAP lesions and labral tears does not give results accurate enough to be used for pre-operative planning.
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