Souhrn: Syndrom míšního epikonu je velmi vzácný syndrom projevující se motoricko-senzitivním deficitem dolních končetin a přidruženou sfinkterovou a erektilní dysfunkcí. Prezentujeme kazuistiku raritního iniciálního projevu syndromu epikonu v podobě izolovaného unilaterálního oslabení pronace nohy. Klinická manifestace pacienta odpovídá již dříve publikovanému kořenovém typu syndromu epikonu, avšak bez přidružené neurologické symptomatologie. Následný vývoj topického nálezu podporuje závěry předchozích studií o dominujících projevech syndromu epikonu v podobě progresivního svalového oslabení a atrofie bércových svalů.
Summary: The epiconus syndrome is a rare disorder presenting with symptoms of motor deficit and sensory disturbance in the leg as well as bladder, bowel and erectile dysfunction. In this case report, we present a patient with isolated unilateral weakening in ankle pronation as a rare initial manifestation of epiconus syndrome. This case corresponds to epiconus syndrome presenting with radicular-type features previously published in literature; however, with the absence of other neurological symptoms. Progressive motor weakness as well as muscular atrophy of the lower leg were dominant symptoms in further development as well as in previous epiconus syndrome studies.
- Klíčová slova
- syndrom epikonu,
- MeSH
- dolní končetina patologie MeSH
- ependymom chirurgie diagnóza MeSH
- komprese míchy * chirurgie diagnóza etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- neuropatie nervus peroneus MeSH
- paréza etiologie MeSH
- svalové atrofie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY The authors evaluate the long-term results of metacarpophalangeal joint (MCP) arthroplasty of the second to fifth digits in the rheumatoid hand in relation to the factors that have a long-term effect on implant function. MATERIAL In a group of 41 patients, 52 hands were treated with a total of 166 Swanson silastic MCP implants in the period from 1988 to 2005. The average follow-up was 3.2 years (range, 6 months to 17 years). Arthroplasty was carried out exclusively for the indication of rheumatoid destruction of MCP joints. METHODS The patients were assessed for the range of motion, MCP joint alignment and functional and radiographic findings. X-ray images were examined for osseous lesions at the margins of resected parts, implant position and its state and joint alignment. Radiography was performed from the standard distance in anteroposterior and oblique projections. Subjective satisfaction of the patients was evaluated on the basis of a questionnaire, in which hand function, pain and cosmetic appearance were recorded. RESULTS The function and mobility of the fingers improved after surgery, with an increased range of motion in MCP joints towards extension (average range, 3°to ° flexion), and correction of an ulnar drift of the MCP joint of each finger (average, 5.8°). Radiographs showed destruction of silastic implants in .3 % of the fingers treated. The subjective evaluation by patients was satisfactory. Long-lasting pain relief was reported by % and satisfaction with hand function by % of the patients. Improvement in a cosmetic appearance of the hand was also significant. DISCUSSION At long-term follow-up, a gradual decrease in the range of motion of MCP joints and a partial recurrence of ulnar drift usually occur at about 2 years. However, in most cases, they do not result in either subjective complaints or functional restriction. These findings are in agreement with the results published in the relevant literature. CONCLUSIONS The silastic implant remains a standard procedure in surgical reconstruction of the MCP joints in the rheumatoid hand. Improvements in the range of motion and joint alignment and alleviation of pain result in a markedly improved hand function and patients' satisfaction. The long-term outcome of MCP joint arthroplasty is significantly influenced by the severity of rheumatoid arthritis.
- MeSH
- lidé MeSH
- protézy a implantáty ekonomika statistika a číselné údaje MeSH
- protézy kloubů ekonomika statistika a číselné údaje využití MeSH
- zápěstní kloub MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
