BACKGROUND: Alternative methods of hip arthroplasty as a result of the complete destruction of the epiphysis and femoral neck using the preserved part of the apophysis of this segment are not widely reported, which may be useful for specialists who are faced with the choice of providing such assistance. AIM: To present the long-term results of treating children with the hip joint reconstruction method developed in the clinic using trochanteric arthroplasty by utilizing the intact cartilaginous part of the greater trochanter apophysis for the treatment of defects resulting from osteolysis of the femoral head and neck after epiphyseal osteomyelitis. MATERIALS AND METHODS: The results of the surgical treatment of seven children (two of them had a bilateral process) who underwent reconstruction of nine hip joints according to the proposed method were analyzed. The procedures were performed at the age of 210 years. The intervention involved the surgical preparation of the acetabulum with repositioning of the greater trochanter after proximal angulation osteotomy of the hip at the metadiaphyseal level. In four patients with a unilateral process, Salter innominate osteotomy was additionally performed in one or two stages. In five patients with a unilateral process with further growth, limb lengthening was performed. The efficiency index was evaluated using both anatomical and functional results. In a bilateral process, the assessment considered the function of the worst operated joints. RESULTS: In six children, good and, in one child with a bilateral process, satisfactory long-term clinical and functional results were obtained (assessed 1020 years after the first reconstructive surgery). All of them had restored limb support without pain, with a sufficient range of motion. The method was organ-preserving, which enabled an opportunity for walking, and an anatomically favorable situation for further arthroplasty has been created, the timing of which has been postponed to a mature period. CONCLUSIONS: The method developed in the clinic for the surgical use of the greater trochanter for the reconstruction of the hip joint after infectious osteolysis of the head and neck of the femur is effective, allowing for a long time to maintain leg support using the patients tissues.
Background: The origin and prevalence of cerebral palsy can hardly be considered fully understood. The relationship between orthopedic and neuropsychiatric disorders in children with cerebral palsy in the available literature is also insufficiently presented.Material/Methods: Authors conducted a clinical and epidemiological analysis and examined the nature of motor disorders in 267 children with cerebral palsy aged from 3 to 16 years old. The monitoring period of patients ranged from 3 to 7 years. They underwent clinical neurological examination, radiography of the spine and joints, ultrasound examination of the joints and periarticular structures, electroencephalography and electroneuromyography in dynamics, with the help of a variational cardiointervalography characterized by an autonomic dysfunction (Veyn AM, 2000), studied the biomechanical parameters of walking, using scorecards, questioning and evaluate the effectiveness of the treatment using the special system to cerebral palsy (Pinchuk D Yu, Dudin MG, 2002).Results: In 80% of cases, brain damage occurred during fetal development. The authors distinguished primary and secondary disorders of movements. 71 persons (26.6%) had neurogenic and myogenic contractures, and in 196 people (73.4%) contractions were exacerbated by bone deformities. In the rehabilitation system 163 people (61 %) had a need for a surgical operation.Conclusions: The efficiency ratio of the functional status after rehabilitation in different age groups has improved by 10-22% more than before the treatment. It was shown objectively that improvement in the motor capacity in patients with cerebral palsy due rehabilitation has a positive effect on the function of the cerebral cortex
1 ГБОУ ВПО «Пермский государственный медицинский университет им. акад. Е.А. Вагнера» Минздрава России, Пермь, Российская Федерация, 614900; 2 ГБУЗ Пермского края «Городская детская клиническая больница №15», Пермь, Российская Федерация, 614066Цель -совершенствование комплексной нейроортопедической реабилитации детей с церебральным параличом в раз-личные возрастные периоды. Пациенты и методы. Изучены 267 больных церебральным параличом в возрасте от 1 года до 16 лет. Мальчиков было 158 (59,2%), девочек -109 (40,8%). Результаты и обсуждение. Ортопедическое лечение двига-тельных нарушений проводили с учетом возраста, психоневрологического статуса, вегетативной дисфункции. Консерва-тивное лечение проведено у 104 (39%) детей, оперативное -у 163 (61%). У детей до 3 лет вегетативное рассогласование было наиболее выражено. В процессе лечения преобладала ортопедическая коррекция мышечного тонуса. Использовали иммобилизацию этапными гипсовыми повязками с последующим ношением ортезов и ортопедической обуви, массаж и ЛФК. В возрастной группе от 4 до 7 лет доминировало хирургическое лечение, направленное на нормализацию работы мышечно-связочного аппарата. Консервативное лечение было связано с коррекцией вегетативной дистонии. Дифферен-цированно применяли методы аппаратной физиотерапии. В группах детей от 8 до 12 лет и от 13 до 15 лет хирургическая коррекция была направлена на ликвидацию грубых деформаций. Дифференцированное лечение, различные модели обо-рудования оказались эффективными в ликвидации мышечной спастичности и гипотрофии, коррекции деформаций, спо-собствовали восстановлению или улучшению движений, стимулировали физическое и умственное развитие ребенка. Objectives. The present study was aimed at the improvement of comprehensive neuro-orthopedic rehabilitation of the children of different age presenting with cerebral palsy. Material and methods. A total of 267 patients with infantile cerebral paralysis at the age from 1 year to 16 years were available for the observation including 158 (59.2%) boys and 109 (40.8%) girls. Results. The orthopedic treatment of locomotor disorders was adjusted for the patients' age, the neuropsychiatric status, and the type of autonomous dysfunction. The conservative treatment was given 104 (39%) patients and the surgical intervention performed on 163 (61%) ones. Vegetative disbalance was the predominant condition in the children aged up to 3 years. Orthopedic alignment of the muscle tone was one of the most common methods of the treatment. We used milestone plaster bandages for immobilization followed by wearing the orthoses and orthopedic shoes in combination with massage and therapeutic physical exercises. The surgical treatment aimed at the normalization of the musculo-ligamentous apparatus was the predominant strategy for the age group of 4-7 years. The conservative treatment was most frequently prescribed for the correction of vegetative dystonia. The physiotherapeutic methods were applied differentially. In the groups of children aged from 8 to 12 years and from 13 to 15 years, th...
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