Die Beckenosteotomie nach Chiari

Operationsprinzip Osteotomie des Beckens knapp oberhalb des Azetabulums in aufsteigender Richtung in der Frontal- und in bogenf?rmiger in der Sagittalebene. Durch Medialverschiebung des distalen Fragments um einen Drehpunkt, der in der Symphyse liegt, kann einerseits eine stabile Hüftkopfüberdachung bei Hüftdysplasie, Hüftluxation und Morbus Perthes erreicht und andererseits eine Reduktion der Hüftbelastung durch Verkürzung des Lastarmes erzielt werden (Chiari 1953 [2]). Durch Interposition der Gelenkkapsel zwischen Hüftkopf und proximalem Beckenfragment entsteht ein neues, belastungsf?higes Azetabulum.      

Chiari畸形的研究进展

Chiari畸形是以小脑扁桃体下疝畸形为特，止的先天性疾患，目前较为公认的理论是起源于胚胎中胚叶轴旁的枕骨原节发育不良所敏，其诊断主要依赖于MRI。根据解剖上的异常，通常分为4型。临床分型有利于术式的选择，有Pillay、Bindal等分型，但尚无公认的分型。手术是治疗Chiari畸形的唯一有效方法，针对不同病情相位采取后颅窝减压、分流术或减压加分流手术，大部分患者的症状和体征可以得到改善。     

Die Beckenosteotomie nach Chiari

Ohne Zusammenfassung     

Die Beckenosteotomie nach Chiari

Ohne Zusammenfassung     

Chiari medial displacement osteotomy

The results of 36 Chiari medial displacement osteotomies of the pelvis were studied to determine the efficacy of the operation in the treatment of subluxated and/or painful dysplastic hips. Fifteen of 16 osteotomies performed for congenital hip dysplasia provided satisfactory coverage, pain relief, and increased function. The results were less consistent in patients with myelodysplasia, spasticity, and Perthes disease. The Chiari osteotomy is a technically exacting procedure capable of providing adequate femoral head coverage. This coverage facilitates pain relief and increased function. This procedure is most suited for those individuals with a painful hip subluxation in whom a concentric reduction is not possible.     

L'ostéotomie de Chiari

Summary This study compares osteotomy and total hip arthroplasty on advanced osteoarthrosis of the hip. A series of 10 Chiari pelvic osteotomies is presented with the essential prerequisites and the aims of the method. The technical difficulty in executing a cylindrical osteotomy prompted its modification in the oblique plane. This series is too short to permit original deductions, but confirms the conclusions of large reported series, that is, an immediate effect on the Merle d'Aubigné scores (4.6 points), in particular on pain.

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L'ostéotomie de Chiari

Résumé Le but du GECO est d'analyser la comparaison de résultats des ostéotomies et des prothèses totales sur les coxarthroses évoluées. Cette série de 10 cas d'ostéotomies du bassin selon Chiari est donc à intégrer dans ce rapport. Le but et les impératifs de la méthode sont rappelés. La difficulté technique de réaliser une ostéotomie cylindrique suggère la possibilité de la modifier en plane-oblique. La série, trop courte pour prêter à des déductions originales, permet cependant d'adhérer aux conclusions issues des grandes séries rapportées, soit un effet immédiat sur les éléments de la cotation de Merle d'Aubigné (4,6 points) et en particulier sur la douleur.

     

Adult Chiari malformation--five operative cases

Recently, the diagnosis of adult Chiari malformation seems to have easy, because of the development of high resolution CT. During the last two years, we experienced with five cases of adult Chiari malformation diagnosed by CT metrizamide myelography. There were two males and three females aged from 15 to 55 years. Three cases had both foramen magnum compression and cerebellar symptoms. One of them had lower cranial nerve symptoms too. Another case had central cord symptoms, and the rest of them complained only of headache and vertigo. All cases underwent suboccipital craniectomy and upper cervical laminectomy. After operation, the cerebellar symptoms improved remarkably. Some of the central cord symptoms improved too. In one case with headache and vertigo, the result was unsuccessful. All cases were followed up in the outpatient clinic more than one year after operation. One case unchanged. Another case deteriorated seven months after surgery. The other three cases were in good condition. Operated cases of adult Chiari malformation are relatively rare in Japan. However, this type of malformation can be found easily by CT metrizamide myelography. A good many patients should be operated on carefully in consideration of their symptoms and severities.     

Chiari I malformation in parturients

STUDY OBJECTIVE: To assess complications of regional as well as general anesthesia in parturients with Chiari I malformation. DESIGN: Retrospective chart review. SETTING: Academic medical center. PATIENTS: All parturients in our institution who had the diagnosis of Chiari I malformation and delivered in our hospitals over a 50-year period. MAIN RESULTS: 12 parturients delivered 30 babies. Three deliveries were facilitated with general anesthesia. Nine deliveries were facilitated with central axis anesthesia, six with epidural anesthesia, two with a single injection of a spinal anesthetic, and one with a continuous spinal catheter. The patient who received a continuous spinal catheter developed a postdural puncture headache that resolved with an epidural blood patch. None of the patients who received general, spinal, or epidural anesthesia for their deliveries developed symptoms or had exacerbation of preexisting symptoms of Chiari I malformation. CONCLUSIONS: General anesthesia, as well as spinal and epidural anesthesia, appeared to be safe and effective in our series of vaginal or cesarean delivery patients. The small number of patients in our series does not negate the cautious recommendations of others, but suggests that general anesthesia, as well as spinal or epidural anesthesia, can be used safely and effectively in these patients.