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1.
Stephanie Böhm Andreas H. Krieg Fritz Hefti Reinald Brunner Carol C. Hasler Mark Gaston 《Journal of children's orthopaedics》2013,7(4):289-294
Purpose
The eight-plate system for angular deformity correction is well known, reliable and effective at any age during growth. Due to high implant costs, we sought to evaluate the effectiveness and safety of a less expensive alternative.Methods
Between 2006 and 2011, 41 children with angular deformities were managed using a two-hole one-third tubular plate in cases where an eight plate would normally be indicated. Inclusion criteria in this retrospective study were: genu valgum and genu varum. X-ray documentation was performed before and after surgery and patients were followed clinically every 3 months after surgery. The cost per implant was 361.40 Sfr (Swiss Francs) compared to the eight plate at 737 Sfr.Results
Mean time for correction was 13 months. A mean LDFA/MPTA after correction of 89.9°/86.8° was recorded, as well as a mean correction angle of 6.8°/6.6°. The complication rate was 6.6 % (one superficial wound infection and one insufficient correction in an older child). These results compare favourably with published data on the eight plate.Conclusion
The two hole one-third tubular plate seems to be a clinically and also cost effective alternative to the eight plate. Full deformity correction is gained for a fraction of the cost. Level of Evidence: Level III 相似文献2.
Stéphane Tercier Hitesh Shah N. D. Siddesh Benjamin Joseph 《Journal of children's orthopaedics》2013,7(3):205-211
Background
Though there is an impression that proximal femoral varus osteotomy (FVO) can result in a valgus deformity at the knee there is no agreement on this issue. This study was undertaken to ascertain whether a FVO predisposes to the development of genu valgum in children with Legg–Calvé–Perthes disease (LCPD).Methods
One hundred and one children with unilateral LCPD who underwent a FVO during the active stage of the disease and 32 children who were treated non-operatively were followed till skeletal maturity. The FVO was performed with a 20° varus angulation in all the patients and weight-bearing was not permitted till the stage of reconstitution. The alignment of the knee was assessed clinically at skeletal maturity. A subset of 33 operated children also had full length standing radiographs of the limbs. The mechanical axis deviation, femur-tibial angle, lateral distal femoral angle and the medial proximal tibial angle of both limbs were measured on these radiographs.Results
The frequency of clinically appreciable mal-alignment of the knee was not greater on the affected side in patients who had undergone FVO when compared to the unaffected limb and also when compared to the affected limb in non-operated patients. The mechanical axis of the lower limb of operated children was relatively in more valgus than that of normal limbs but they fell within the normal range.Conclusion
This study does not support the impression that a proximal femoral osteotomy for LCPD predisposes to clinically discernable degrees of genu valgum in children who have had 20° of varus angulation at the osteotomy site and who have avoided weight-bearing for a prolonged period following surgery. Further studies are needed to clarify if genu valgum would develop if early post-operative weight-bearing is permitted.Level of evidence
III. 相似文献3.
Raju Vaishya Malkesh Shah Amit Kumar Agarwal Vipul Vijay 《Journal of Clinical Orthopaedics and Trauma》2018,9(4):327-333
Introduction
Genu valgum is an angular deformity of the knee, often treated surgically by osteotomy or by growth modulation (using tension band, staples, transphyseal screws and eight-plate which require removal after correction). With this study, we attempt to evaluate the efficacy, rate of correction and complications with the use of 8-plate in the correction of genu valgum deformity in children.Material and method
In a retrospective study of 24 patients with 11 bilateral and 13 unilateral (35 knees) genu valgum deformity which required surgical corrections were included. There were 11 males, and 13 females and all of them were treated with Steven’s technique (Stevens, 2006) using eight-plate and monitored closely.Result
Twenty-four patients with an average age of 10 years and 8 months (range: 5 yrs, 7 months–14 yrs, 2 months), with the mean preoperative & post-implant removal (Post-IR) tibiofemoral angle of 22.02° ± 5.15° (range 14°–31°) & 6.14° ± 1.92° (range 2°–10°) respectively, required an average time period of 1yr & 5m ± 5 m (range 10 months–28 months) for correction after which implants were removed. Of the 35 limbs, we achieved excellent results in 91.6%. One case (4.16%) had a partial correction of the deformity, and one case (4.16%) had reported with a superficial infection which was taken care. There were 2 cases (8.33%) of over-correction, which was gradually self-corrected during follow-up.Conclusion
Our results reflect the efficacy of flexible titanium eight plate which corrects angular deformity by acting as a tension band on one side of the growth plate and offers the advantage of reversible Hemi epiphyseal growth modulation. Guided growth modulation is a best available alternative for the treatment of an angular deformity in the patients with open physis. 相似文献4.
Barakat Sayed El-Alfy 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(6):639-645
Background
Angular deformity around the knee joint is a common orthopedic problem. Many options are available for the management of such problem with varying degrees of success and failure. The aim of the present study was to assess the results of hemi-wedge osteotomy in the management of big angular deformities about the knee joint.Materials and methods
Twenty-eight limbs in 21 patients with large angular deformities around the knee joint were treated by the hemi-wedge osteotomy technique. The ages ranged from 12 to 43 years with an average of 19.8 years. The deformity ranged from 20° to 40° with a mean of 30.39° ± 5.99°. The deformities were genu varum in 12 cases and genu valgum in 9 cases. Seven cases had bilateral deformities. Small wedge was removed from the convex side of the bone and put in the gap created in the other side after correction of the deformity.Results
At the final follow-up, the deformity was corrected in all cases except two. Full range of knee movement was regained in all cases. The complications included superficial wound infection in two cases, overcorrection in one case, pain along the lateral aspect of the knee in one case and recurrence of the deformity in one case. No cases were complicated by nerve injury or vascular injury.Conclusion
Hemi-wedge osteotomy is a good method for treatment of deformities around the knee joint. It can correct large angular deformities without major complications.5.
Arvind Kumar Sahil Gaba Alok Sud Pushpvardhan Mandlecha Lakshay Goel Mayur Nayak 《Journal of children's orthopaedics》2016,10(5):429-437
Purpose
To compare two commonly used methods of temporary hemiepiphysiodesis (staples and figure of eight plate) in the management of coronal plane deformities of the knee in skeletally immature children.Methods
This prospective study was conducted between November 2012 and November 2015. A total of 40 patients with 67 affected knee joints, having at least 1 year of skeletal growth remaining, were included in the study. Angular correction was measured by recording the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and anatomical tibio-femoral angle (TFA) (for the overall alignment of lower limbs). Implant removal was done after 5° of overcorrection was achieved. The rate of correction (° per month) and complications related to each technique were recorded.Results
The most common diagnosis was idiopathic genu valgum. The overall rate of correction (TFA) was 1.2° for staples and 1.4° for eight plate (p = 0.70, not statistically significant). The correction in mLDFA was statistically better in the eight plate group, whereas an opposite trend was recorded in mMPTA. Implant-related complications were present in two cases of the staples group.Conclusion
Although the overall correction rate was similar in both groups, implant-related complications were lower with figure of eight plate. In idiopathic genu valgum (the most common diagnosis), the correction was statistically better in the eight plate group. We recommend figure of eight plate over staples in managing these deformities.6.
Objective
Femoral medial closing wedge osteotomy for the correction of valgus malalignment to unload the cartilage in the lateral compartment and/or correction of symptomatic torsional malalignment.Indications
Lateral unicompartmental osteoarthritis of the knee with genu valgum in young patients. Symptomatic torsional malalignement of >?30° and <?0°.Contraindications
Grade 3 and 4 cartilage damage in the medial compartment. Heavy smoking. Medial meniscectomy. Extreme obesity. Inadequate soft tissue conditions.Surgical technique
The operation begins with arthroscopy of the knee joint. In case of grade 4 lateral cartilage damage, a microfracture is performed. The distal femur is exposed via an anteromedial longitudinal incision starting 10 cm above the patella and ending in the upper third of the patella. The medial femoral cortex is exposed using Hohmann retractors and an oblique closing wedge osteotomy is performed with an oscillating saw. In case of valgus correction, the lateral cortex is left intact. In case of correction of torsional malalignment, the osteotomy plane is horizontal and the lateral cortex is cut. The wedge height is determined preoperatively based on full leg x-rays. The leg axis is controlled intraoperatively with a long metal rod and the use of an image intensifier. The osteotomy is manually closed and stabilized with a locking plate.Postoperative management
The patient is mobilized under load with 20 kg body weight for the first 6 postoperative weeks. Full range of motion is permitted.Results
We treated 23 patients with lateral cartilage damage (grades 3 and 4) and genu valgum with medial closing osteotomy of the distal femur (6 men and 17 women). After 3.5-years follow-up, the KOOS increased from 48.4 points to 84.9 points. In one case, there was an early loss of correction, with subsequent revision with bone grafting and lateral osteosynthesis. No peri-or postoperative complications such as infection, thrombosis, and embolism occurred [24]. In 5 cases a torsional osteotomy was performed. The torsional osteotomy was performed 4 times due to chronic patellofemoral instability, and once due to a medial tibiofemoral instability. Healing complications were not observed in this population. Recurrent instability was not observed. 相似文献7.
Francesco Leonardi Fabrizio Rivera Alessandra Zorzan Syed Mohsin Ali 《Journal of orthopaedics and traumatology》2014,15(2):131-136
Background
Torsional malalignment syndrome (TMS) is a well defined condition consisting of a combination of femoral antetorsion and tibial lateral torsion. The axis of knee motion is medially rotated. This may lead to patellofemoral malalignment with an increased Q angle and chondromalacia, patellar subluxation and dislocation. Conservative management is recommended in all but the most rare and severest cases. In these cases deformity correction requires osteotomies at two levels per limb.Materials and methods
From 1987 to 2002 in our institution three patients underwent double femoral and tibial osteotomy for TMS bilateral correction (12 osteotomies). All patients were reviewed at mean follow-up of 16 years.Results
At final follow-up no patients reported persistence of knee or hip pain. At clinical examination both lower limbs showed a normal axis and a normal patella anterior position. Pre-operative femoral version measurement showed an average hip internal rotation of 81.5° (range 80°–85°) and average hip external rotation of 27.2° (10°–40°). Thigh–foot angle measurement showed an average value of 38.6° (32°–45°). At final follow-up femoral version measurement showed an average hip internal rotation of 49° (range 45°–55°) and average hip internal rotation of 44.3° (20°–48°) (Figs. 1, 2, 3, 4, 5, 6). Thigh–foot angles measurement showed an average value of 21.6° (18°–24°) outward.Conclusion
We recommend a clinical, radiographical and CT scan evaluation of all torsional deformity. In cases of significant deformity, internally rotating the tibia alone is not sufficient. Ipsilateral outward femoral and inward tibial osteotomies are our current recommendation for TMS, both performed at the same surgical setting. 相似文献8.
Dennis S. Weiner David Jonah Bonnie Leighley Martin S. Dicintio D. Holmes Morton Steven Kopits 《Journal of children's orthopaedics》2013,7(6):465-476
Background
Ellis–van Creveld is a dwarfing syndrome transmitted as an autosomal recessive trait. The constant features of the condition include acromelic–micromelic dwarfism, ectodermal dysplasia involving the nails, teeth and gums, postaxial polydactyly of the hands and congenital heart disease. Congenital heart disease affects 50–60 % of all patients and nearly 50 % of patients die by 18 months of age from cardiopulmonary complications. This study is intended to characterise the orthopaedic manifestations of Ellis–van Creveld based on the authors’ unique opportunity to interview and examine the largest group of patients to date in the literature.Methods
Detailed interviews, physical examinations and/or radiographs were available on 71 cases of Ellis–van Creveld syndrome. Data were collected from physical examinations, radiographs, computed tomography (CT) reconstruction and magnetic resonance imaging (MRI) of the knee. Pathoanatomy of the knee was reinforced by the direct surgical observation of 25 limbs surgically managed during adolescence and puberty.Results
A number of interesting clinical and radiographic abnormalities were noted in the upper extremities and lower extremities, but by far the most significant orthopaedic finding was a severe and relentlessly progressive valgus deformity of the knee. Although many patients had difficulties making a “fist” with the hand, no patient reported any functional disability. The severe valgus deformity of the knee is the result of a combination of profound contractures of the iliotibial band, lateral quadriceps, lateral hamstrings and lateral collateral ligament, leading to lateral patellar subluxation and dislocation. The lateral portion of the upper tibial plateau presents with cupping and progressive depression of the lateral plateau, along with severe valgus angulation of the proximal tibia and fibula. A proximal medial tibial exostosis is seen in nearly all cases.Conclusion
This is the largest group of Ellis–van Creveld syndrome patients identified in the literature. An understanding of the orthopaedic pathoanatomy of the knee deformity is critical to determining the appropriate surgical management. This paper characterises the orthopaedic manifestations of Ellis–van Creveld syndrome and especially identifies the pathoanatomy of the severe and progressive valgus knee deformity.Level of evidence
Level II. 相似文献9.
P. D. McGovern M. Albrecht S. K. Khan S. D. Muller M. R. Reed 《Journal of orthopaedic science》2013,18(6):1027-1030
Background
Arthroplasty surgeons are increasingly using personal protection systems with helmets. It is theoretically possible for the fans in these helmets to blow squames, sweat droplets and orobronchial fomites onto the surgical site. A controlled experiment was set up to investigate the effect of different surgical gowns on counts of airborne particles measuring ≥0.3 μm, using a hand-held particle counter.Methods
The clothing that was sequentially tested included the following:- Barrier® surgical gown (single use) made from nonwoven polypropylene (Mölnlycke Health Care Ltd, Dunstable, UK)
- Stryker® T5 Helmet (reusable) covered with a disposable Stryker® T4/T5 urethane hood worn separate to and enclosed by the Barrier® surgical gown both at the front and back
- Stryker® T5 Helmet (reusable) worn within a disposable Stryker® T4/T5 urethane zippered toga (Stryker Corporation, Kalamazoo, MI, USA)
- Gown: surgeon with surgical gown and face mask
- Hood: surgeon with surgical gown and hood, maximum fan speed
- Toga: surgeon with toga, maximum fan speed
Results
The mean particle counts (over more than 5 L of air) for the three set-ups were: gown: 1178 (least protective), hood: 328, toga: 42 (most protective). There was a significant reduction in particle counts for the toga versus gown (p = 0.007) and toga versus hood (p = 0.037); differences in particle counts were not significant between the hood and gown (p = 0.140).Conclusions
The fans in the helmets do not increase contaminants by blowing particles from the head area. A significant reduction in surgeon-originated contaminants was seen with the toga compared to both the hood/gown separate ensemble and gowns alone. 相似文献10.
11.
E. Stanley Crawford M.D. 《World journal of surgery》1988,12(6):805-809
Progress in the management of thoracic aortic aneurysm includes the following aspects:
- the concepts of the disease itself, which is frequently generalized so that the second most common cause of late death is rupture of another aneurysm;
- the diagnostic techniques used: computed tomographic scanning as well as aortography;
- the medical treatment: with beta blockade and antihypertensive drugs in stable aortic injury in the patient with multiple critical injuries;
- that hypothermic circulatory arrest with cardiopulmonary bypass and brain temperatures down to 16–20°C has increased successful aortic arch replacement from 50–75% to over 90%;
- that rapid autologous transfusion by means of a modified Hemonetics machine can collect and process a unit of shed blood in 2–3 minutes and has reduced transfusion requirements by more than half;
- the vigorous treatment of both consumptive and dilutional coagulopathies;
- the new reconstructive techniques: involving composite valve graft replacement of the aortic valve, root, and arch as well as coronary artery reattachment;
- that the use of viable tissue flaps in the treatment of infected aortic grafts as well as intravenous and local irrigation with antibiotics was successful in 8 of 9 of our cases;
- that graft replacement with intensive antibiotic therapy was effective in 19 of 22 of our patients with mycotic thoracic aortic aneurysm.
12.
J. H. M. Wöltgens Prof. Dr. S. L. Bonting O. L. M. Bijvoet 《Calcified tissue international》1970,5(1):333-343
- Some properties of inorganic pyrophosphatase (PPi-ase) and alkaline phosphatase (p-NPP-ase) in the molars of 3-day-old hamsters are described.
- The pH optimum for inorganic pyrophosphatase is 8.7, for alkaline phosphatase 10.3.
- The ratio of Mg2+: PPi for optimal inorganic pyrophosphatase activity is 1∶1. There is no clear optimal ratio in the case of p-NPP-ase.
- The ratio of the enzymic activity of the membrane bound fraction to the soluble fraction is 3.4∶1 (S.E. 0.37) for PPi-ase and 3.2∶1 (S.E. 0.42) for p-NPP-ase activity.
- A mutual substrate competition for the pyrophosphatase and alkaline phosphatase activities is demonstrated.
- Both enzymatic activities have similar temperature-activity curves with the same maximum at 38°.
- Microdissection of ameloblasts and stratum intermedium cells from lyophilized sections showed the same activity ratio for both enzyme activities: Stratum intermedium: ameloblasts for PPi-ase 4.7 (S. E. 0.93) and for p-NPP-ase 4.2 (S.E. 0.79).
- High-voltage, free-flowing electrophoresis of the homogenate gave equal distribution patterns for p-NPP-ase and PPi-ase greatly different from the protein distribution pattern.
- It is concluded that the two activities are due to the same enzyme.
13.
Bertrand Moal Frank Schwab Jason Demakakos Renaud Lafage Paul Riviere Ashish Patel Virginie Lafage 《European spine journal》2013,22(8):1800-1809
Purpose
Non-fusion treatment for adolescent idiopathic scoliosis generates interest due to the potential for growth preservation and mobility. Using an established porcine scoliotic model, this study aims to evaluate the global alignment and the morphology of the spine with and without application of a non-fusion corrective tether.Methods
At 12 weeks of age, 21 immature Yorkshire pigs had an induction of scoliosis. Once a 50° Cobb angle was obtained; animals were placed into one of the following groups: a scoliosis model group (SM, n = 11) where animals were euthanized, tether release group (TR, n = 5) where the inducing tether was removed, and an anterior correction group (AC, n = 5) where the inducing tether was removed and non-fusion corrective tether was applied. TR and AC were observed for a further 20 weeks and then euthanized. Post-mortem CT scans were used to create 3D spinal reconstructions to obtain global and morphologic parameters.Results
Maximal Cobb angle of the scoliotic deformity was significantly lower for AC (27.9° ± 12.0°) than for the two other groups (TR 52.7° ± 10.0°, SM 48.3° ± 7.6°). AC experienced an increase in kyphosis (24.2° ± 15.9°) compared to TR (7.1° ± 6.4°). Correction in the axial plane was also observed in AC versus TR. Correction of vertebral wedging was found for AC compared to SM and TR in the three apical vertebrae.Conclusions
3D realignment of scoliotic curves was observed with application of the corrective tether. The correction was the product of both mechanical action and growth modulation. These findings are encouraging for future development of a non-fusion device for the treatment of immature scoliotic curves. 相似文献14.
Yoram Anekstein Yigal Mirovsky Vitaly Arnabitsky Yael Gelfer Ira Zaltz Yossi Smorgick 《European spine journal》2012,21(10):1942-1949
Purpose
To show the radiological results of adolescent idiopathic scoliosis (AIS) patients treated with posterior fusion using all-pedicle-screw construct with correction carried out using a convex rod reduction technique.Methods
Between October 2004 and June 2007, 42 AIS patients were treated with posterior fusion using all-pedicle-screw construct with correction done through the convex side. Two patients were lost to follow-up and were not included in the study. Forty patients had a minimum follow-up of 2 years. Patients were evaluated for the deformity correction in coronal and sagittal planes and for spinal balance.Results
The mean preoperative Cobb angle of the major curve and secondary minor curves was 60° and 41°, respectively. Immediate postoperative mean Cobb angle of the major curve and secondary minor curves was 17° and 13°, respectively. Postoperative 2-year average major curve loss of correction was 7 %. Postoperative 2-year average minor curve loss of correction was 5 %. Preoperative thoracic kyphosis of 28° was changed to 22° in 2-years follow-up. The loss of thoracic kyphosis was most noted in hyperkyphotic patients.Conclusions
The correction of AIS by convex-sided pedicular screws yields a coronal correction comparable to what is described in the literature for segmental concave-sided screws. 相似文献15.
D. Krappinger MD PhD M. Zegg MD V. Smekal B. Huber MD 《Operative Orthopadie und Traumatologie》2014,26(5):520-531
Objective
Correction of posttraumatic lower leg deformities using percutaneous osteotomy, external fixation with a ring fixator, and computer-assisted gradual correction with the Taylor Spatial Frame (TSF).Indications
Posttraumatic lower leg deformities not suitable for acute correction and internal fixation or deformities that are suitable but have a significantly increased risk for complications: deformities with poor soft tissue coverage, rigid deformities that require gradual correction, complex mulitplanar deformities, deformities with shortening, and periarticular juvenile deformities.Contraindications
Posttraumatic lower leg deformities which are suitable for acute correction and internal fixation are also suitable for deformity correction using the TSF. In these cases, however, we recommend acute correction and internal fixation in order to improve the patient comfort. Lack of patient compliance for self-contained correction and pin care.Surgical technique
Percutaneous fixation of the TSF rings to the main fragments using transosseous K-wires and half pins (hybrid fixation). Percutaneous osteotomy of the tibia either by drilling across both cortices and completion of the osteotomy using an osteotome (DeBastiani method) or by using the Gigli saw with preservation of the periostal envelope. Connection of both rings with six oblique telescopic struts via universal joints (hexapod platform). Computer-assisted planning of the correction.Postoperative management
Gradual postoperative correction of the deformity by changing the strut lengths according to the correction plan. Strut changes, if required. Osseous consolidation of the osteotomy site with the TSF or revision to internal fixation.Results
The correction of posttraumatic lower leg deformities using the TSF was performed in 6 cases. The mean deformity was 15° (12–22°) in the frontal plane and 6° (4–8°) in the sagittal plane. The correction time was 19 days (14–22 days). The deviation between planned and achieved correction was 0–3° in the frontal plane and 0–2° in the sagittal plane. The osseous consolidation of the osteotomy site was carried out in the TSF in 5 cases with a mean external fixation time of 112 days (94–134 days). In one case, the TSF was removed after the correction and the osteotomy site was fixed using an intramedullary nail. Pin site infections were observed in 3 cases. There were no further complications. The treatment goal was achieved in all cases. The examination at final follow-up was performed after 1 year. All patients were able to walk without walking aids and with no pain at that time. They were able to perform all of their activities of the daily life and their leisure activities without limitations. 相似文献16.
17.
Prof. Dr. W. Strecker M. Müller C. Urschel 《Operative Orthopadie und Traumatologie》2014,26(2):196-205
Objective
Well-balanced charge of femoral and tibial cartilage by lateral transfer of the mechanical leg axis in osteoarthritis of the medial compartment and of genu varum.Indications
Symptomatic medial compartment osteoarthritis (MCOA). Posttraumatic varus deformity. Varus malalignment and planned reconstructive procedures of the cartilage in the medial knee compartment.Contraindications
Cartilage lesion grade ≥III° (according to Outerbridge, 1961) in the lateral compartment. State after lateral meniscectomy. Patellofemoral osteoarthritis with extension lag >?10°. Femoral varus deformity. Knee instabilities. Advanced osteoporosis. Neurological disorders. General risks of adequate bone healing. Obesity (BMI >?30 kg/m2).Surgical technique
Preoperative planning according to true-nominal analysis (according to Strecker, 2002) including a maximum and minimum extent of mechanical axis correction (according to Müller and Strecker, 2008). Arthroscopy of the knee to determine the cartilage status. In high tibial closed wedge valgus osteotomies >?10° an oblique osteotomy of the distal diaphyseal fibula is mandatory. Lateral approach and preparation of the tibial head. Partial osteotomy of the proximal tibial tuberosity. Defined angle of valgisation fixed by two laterally introduced K-wires. Bending of a 5-hole DC-plate (DCP). Transversal osteotomy with oscillating saw, medial cortex of tibial head remaining intact. Fixation of pre-bent DCP in the proximal hole. Gentle closing of osteotomy gap with distal cortical “play screw” in plate hole 5. Compression of the osteotomy gap with two interfragmentary screws in holes 2 and 3. Completion of internal fixation and change of “play screw”. In case of fibula osteotomy, further resection and internal fixation.Postoperative management
First day after surgery: removal of drainage, x-ray control, mobilization. Partial weight bearing of 20 kg during 4 weeks postoperatively followed by 20 kg additional load per week according to clinical and radiological findings. Physical training with active and passive motion exercises. Low-molecular-weight heparin for at least 4 weeks.Results
Between January 2006 and December 2008, procedure performed in 50 patients (27 men, 23 women, mean age 44 years); arthroscopic treatment in 43 patients, and osteotomy of the fibula in 10 patients. The valgus correction was 8.4° (6–13°). No complication during surgery. One non-union was treated by cancellous bone grafting. 相似文献18.
Benjamin Bouyer Manon Bachy Redoine Zahi Camille Thévenin-Lemoine Pierre Mary Raphaël Vialle 《European spine journal》2014,23(1):163-171
Background
We present the results of a prospective series of 60 patients treated for neuromuscular spinal deformities with an original spinopelvic construct using two sacral screws and two iliac screws. Clinical and radiological results obtained with this new surgical technique were studied and discussed according to the epidemiological data and relevant literature.Methods
From January 2008 to June 2010, the clinical data of every patient who underwent spinopelvic fixation for treatment of a neuromuscular spinal deformity were recorded prospectively.Results
Sixty patients were operated on during the study period. Spinal correction and fusion was performed by posterior approach. In six patients with a residual spinopelvic imbalance more than 15° on lateral preoperative bending films, an anterior release of the thoracolumbar junction was performed on the same day, before posterior correction. Preoperative pelvic obliquity (PO) ranged from 4° to 44° (mean 21.6°). Postoperative pelvic obliquity ranged from 0° to 14 (mean 4.6°). No significant loss of correction was noted at the last follow-up. One patient died 3 months after the initial procedure due to respiratory compromise. 11 patients had early postoperative infections of the posterior approach.Conclusions
Despite a high rate of infectious complications, optimal correction of pelvic obliquity requires extension of spinal instrumentation to the pelvis. Spinopelvic fixation remains a difficult challenge in neurological patients with hypotrophy. We think that pelvic fixation with the “T construct” did provide effective and improved spinal stabilization in these patients, while reducing the need for a postoperative cast or brace. As a result, patients had a favourable postoperative course with early mobilization and return to a comfortable sitting position. 相似文献19.