BACKGROUND:Posture disorders and spinal deformity in the sagittal plane (kyphotic deformity of the thoracic region and lumbar hyperlordosis in combination with pelvic inclination) are quite common in patients with cerebral palsy. However, their relationship with the frontal indicators of the hip joint is not reported in the scientific literature.
AIM:To reveal the relationship between the radiographic frontal indicators of the hip joint and the indicators of the spinal-pelvic sagittal balance in patients with cerebral palsy.
MATERIALS AND METHODS:Atransverse study of the X-ray parameters of the hip joints in the frontal plane and sagittal vertebral-pelvic profile was performed in 46 patients with cerebral palsy aged 515 (mean age, 8.2 3.6) years.
RESULTS:Asignificant difference from the norm was found in the following parameters: cervical-diaphyseal angle, pelvic tilt angle, pelvic tilt angle, sacral tilt angle, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis deviation (p 0.05). The Sharp angle, migration index, Wiberg angle, and thoracic kyphosis were normal. Measurements of the frontal radiographic parameters of the right and left hip joints do not differ significantly from each other. The pelvic tilt showedapositive and strong correlation with pelvic tilt (p= 0.71).Apositive and moderate correlation was found determined betweenasequential chain of related elements of the axial skeleton, namely, sacral inclination-lumbar lordosis (p= 0.66) and lumbar lordosis-thoracic kyphosis (p= 0.41). The deviation of the sagittal vertical axis negatively correlated with lumbar lordosis (p= 0.69) and thoracic kyphosis (p= 0.38). The results demonstrateanegative and weak correlation between SDA and sacral tilt (p= 0.40).
CONCLUSIONS:The results of this study indicateacorrelation between the inclination of the sacrum and the lumbar spine in patients with cerebral palsy, which confirms the main theories of the formation of excessive lumbar lordosis of the spine in these patients and allows us to develop pathogenetic preventive measures against spinal deformities. In this study, we failed to identifyasignificant relationship between the frontal radiographic parameters of the hip joint and sagittal pelvic-vertebral profile. However, hip joint instability inachild with cerebral palsy can playasignificant role in the occurrence and development of sagittal spinal deformities.
This paper considers the fundamental problem of artificial lighting in various types and scales of industrial facilities, focusing on exterior lighting design solutions. There is a lack of interest from investors, customers and society in highquality lighting design for industrial facilities in Russia, which in many cities are very imaginative structures, practically unused in the evening. Architectural lighting of various types of installations is illustrated with photographs. The purpose of the article is to draw attention to the aesthetic value of industrial structures, provided not only by the architectural, but also by a welldesigned lighting solution.
Background. The considerable incidence of kyphosis in patients with cerebral palsy (CP) causes back pain and aggravates movement disorders. However, few studies have investigated the pathogenesis of this condition.Aim. To identify the relationship between patient motor abilities, the severity of flexion contractures of the knee and hip joints and spinal sagittal profile changes, and the impact on the latter by surgical correction of flexion contracture of the knee joint.Material and methods. The study cohort included 17 pediatric CP patients (11 boys and 6 girls) with a mean age of 13.1 ± 1.3 (range, 10–16) years and level 2–4 spastic diplegia according to the Gross Motor Function Classification System. The relationship between radiological indicators of the spine sagittal profile and motor abilities of children, as well as the severity of flexion contractures at the hip and knee, and the degree of insufficiency of the active extension of the knee were investigated. Of these 17 patients, 12 underwent surgery to correct flexion contracture of the knee, which involved lengthening of leg flexors, to analyze the impact of contracture on the sagittal profile of the spine. The following radiological indicators were assessed: angle of thoracic kyphosis (CC), lordosis angle (UL) of the lumbar spine, and sacral inclination angle (SS). The study included patients with a CC of at least 30°.Results. Results of an X-ray study showed that the severity of kyphosis was 50.7° ± 2.1°, lordosis was 30.3° ± 4.3°, and SS was 30.5° ± 3.3°. There was a significant association between kyphosis and flexion contracture of the knee joint, as well as between lordosis and insufficient active extension of the knee joint. After elimination of the flexion contracture of the knee, the degree of severity of the CC (thoracic kyphosis) was unchanged, while UL (lordosis angle) and SS (sacral inclination angle) increased by approximately 10°.Conclusion. The severity of kyphosis in patients with CP is mainly dependent on the degree of flexion contracture of the knee joint. Although elimination of contractures does not lead to kyphosis correction, it increases the degree of lumbar lordosis and tilting of the sacrum.
В рамках синдрома «спастической руки» сгибательная контрактура локтевого сустава встречается реже прочих, однако нередко именно она ограничивает ребёнка в передвижении с дополнительными средствами опоры, в самообслуживании, а также в обучении и других сферах деятельности. Описание клинического случая лечения пациента с ДЦП с тяжелой комбинированной сгибательной контрактурой локтевого сустава. Пациент в возрасте 17 лет со спастической диплегией. Фиксированная сгибательная контрактура левого локтевого сустава, пассивное разгибание до 90°, активное разгибание до 110°. Функциональная возможность левой руки резко снижена (MACS VI) за счет сгибательной контрактуры локтевого сустава. Спастичность мышц сгибателей предплечья слева по шкале Ashworth IV балла. С учетом клинической картины нами было запланировано нейрохирургическое тонус понижающее лечение, а с целью прогнозирования его результата осуществлена диагностическая блокада мышечно-кожного нерва. Мы расценили результат диагностической блокады как положительный, и это послужило показанием к проведению нейрохирургического лечения. В результате проведённого вмешательства: снизилась спастичность мышц сгибателей левого локтевого сустава до II баллов по шкале Ashworth, пассивное и активное разгибание в левом локтевом суставе увеличилось на 45°, движения в суставе безболезненные. Таким образом, ориентируясь на полученные в нашем клиническом случае данные, можно считать, что селективная невротомия n. musculocutaneus является эффективным методом понижения патологического тонуса мышц, сгибающих локтевой сустав. Методика консервативного послеоперационного лечения, включающая в себя этапные гипсовые коррекции, позволяет значительно повлиять на фиксированную составляющую сгибательной контрактуры и снизить вероятность последующего ортопедо-хирургического лечения. Ключевые слова: ДЦП, верхняя конечность, спастическая рука, нейрохирургическое лечение, локтевой сустав, диагностическая блокада, мышечно-кожный нерв.
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