PURPOSE: Treatment outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease (LCPD) have been shown to be conditioned by a number of factors that may vary across different populations. This retrospective study aimed to evaluate factors affecting radiographically assessed treatment outcomes in patients treated surgically or conservatively for LCPD at Faculty Hospital Motol, Prague, Czech Republic, between the years 2006 and 2019. METHODS: Data of forty-seven children comprising 52 hips were analysed. Treatment outcomes were evaluated according to Stulberg classification. Predictors included the initial stage of fragmentation of the hip joint according to Herring classification, type of treatment (conservative or surgical), age at the time of diagnosis and sex. RESULTS: Older age and severity of LCPD according to Herring classification but not the type of treatment were the strongest factors determining treatment outcomes. Treatment outcomes were comparable in patients treated conservatively or surgically both across the whole cohort of patients and a group of young children < six years of age. CONCLUSIONS: Results strengthen the roles of severity of the LCPD at onset of treatment and age of the patient in predicting treatment outcomes in patients with LCPD. Conservative and surgical treatments appear to yield similar treatment outcomes irrespective of age of patients.
- MeSH
- dítě MeSH
- kyčelní kloub MeSH
- lidé MeSH
- osteotomie metody MeSH
- Perthesova nemoc * diagnostické zobrazování chirurgie MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
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Skluz proximální femorální epifýzy (coxa vara adolestentium, SCFE - slipped capital femoral epiphysis) je hormonálně podmíněné onemocnění definované jako netraumatická separace v růstové chrupavce krčku stehenní kosti s dislokací hlavice femuru mediodorzálně. Postihuje pacienty v období růstového spurtu, a pokud není správně dignostikováno a léčeno, často vede k rozvojí sekundární koxartrózy cestou femoroacetabulárního impingementu (FAI). Klinicky se pacient často manifestuje bolestivostí přední strany stehna nebo kolene, což může vést k diagnostickým rozpakům a oddálení stanovení správné dignózy. Z léčebného pohledu je skluz hlavice vždy indikací k operačnímu výkonu, který volíme podle délky trvání a rentgenologického nálezu. Při akutních skluzech je snaha o šetrnou repozici a epifyzeodézu, v případě chronických a závažnějších skluzů je pak metodou volby vícerovinná korekční osteotomie.
Slipped capital femoral epiphysis is a disorder defined as non-traumatic separation in the capital femoral growth plate and dislocation of the head of the femur medially and dorsally. The condition is caused by hormonal imbalances and affects adolescent patients undergoing a rapid growth acceleration. If the disease is misdiagnosed or mistreated, it will ultimately lead to secondary osteoartritis via femoroacetabular impingement. In the clinical examination, pain in the anterior region of the thigh or knee is frequent and can lead to a late diagnosis. Treatment options for SCFE are always surgical, and the Sumery method is chosen according to both X-ray findings and the course of the disease. In acute slips, surgeons try to gently reduce the deformity with subsequent in situ fixation. Appropriate multiplanar proximal femoral osteotomy is used in patients with chronic and more pronounced slips.
Úvod: Avulzní zlomeniny jsou u dětí a dospívajících vzácné úrazy vznikající následkem prudké kontrakce svalového úponu příslušného výběžku pánve, který je u rostoucího skeletu jeho nejslabší komponentou. Léčba avulzních zlomenin může být konzervativní nebo operační. Metody: V práci hodnotíme skupinu 69 pacientů s avulzními zlomeninami spina iliaca anterior superior a inferior, trochanter minor a major, crista iliaca a tuber ischiadicum. Srovnáváme výsledky hojení, délku léčby, čas imobilizace a komplikace konzervativní a operační léčby. Výsledky: Průměrná doba vertikalizace byla 24,5 dne u konzervativně a 8,5 dne u operačně léčebných pacientů. U operované skupiny byly známky hojení již v 6 týdnech. Od 4. měsíce nebyl klinický ani rentgenologický rozdíl mezi oběma skupinami. Závěr: Výsledky obou metod jsou dlouhodobě srovnatelné. Operace je indikována u dislokace nad 1 cm a její výhodou je rychlejší rekonvalescence a možnost návratu k vrcholové sportovní aktivitě. Nevýhodou operačního postupu je nutnost celkové anestezie a nutnost extrakce osteosyntetického materiálu. Metoda léčby zůstává individuální v závislosti na typu poranění a zvyklosti pracoviště.
Introduction: Paediatric avulsion fractures of the pelvis and hip joint are rare injuries most commonly associated with a rapid muscle contraction of the respected apophysis, which is the weakest component of the growing skeleton. The chosen therapy option can be either conservative or surgical. Methods: We present a cohort of 69 patients treated for an apophyseal avulsion fracture of the anterior superior / inferior iliac spine, the lesser and greater trochanters iliac crest and the ischial tubercle. We compared the treatment outcomes, treatment time, need for immobilisation, and complications of conservative vs. surgical treatment. Results: The mean time to mobilisation was 24.5 days in the conservative and 8.5 days in the surgical group of patients. In the group of surgically treated patients, healing signs were observed as early as in week 6. As of month 4, no difference was observed between the groups in terms of the clinical and radiological outcomes. Conclusions: The treatment outcomes of both methods are comparable in the long term. Surgery is indicated in dislocations exceeding 1 cm. Faster recovery and return to sports activities is the main advantage of the surgical treatment method. Disadvantages include the necessity of general anaesthesia as well as the risk of infection and the need of the osteosynthetic material removal. The choice of the treatment method remains individual depending on the type of injury and habitual practice of the centre.
- MeSH
- avulzní fraktury * diagnostické zobrazování diagnóza chirurgie terapie MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- fraktury kyčle * diagnostické zobrazování diagnóza terapie MeSH
- interpretace statistických dat MeSH
- konzervativní terapie MeSH
- lidé MeSH
- pánevní kosti * diagnostické zobrazování patofyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
We report a case of a 14-year-old patient with rare dorsal sternoclavicular dislocation caused by a sports injury. The patient was admitted to our department for further investigation and treatment. After a series of examinations, an open reduction and fixation using K-wires was used as a treatment modality. A satisfactory outcome was achieved, the patient returned to full sports activity 3 months after the surgery, with no limitations of movement. The necessity of early diagnosis and treatment options of this rare injury has been discussed. Key words: sternoclavicular joint, dorsal dislocation, open reduction.
PURPOSE OF THE STUDY: Avulsion fractures of the anterior superior iliac spine (ASIS) and anterior inferior iliac spine (AIIS) are rare injuries to the skeleton in children. They are most frequent in adolescent athletes, such as sprinters and long-distance runners, and football players. The authors present a group of patients treated at their department and compare the results of procedures used to manage different pelvic avulsion fractures. MATERIAL AND METHODS: Between 2005 and 2012, 38 patients (31 boys and seven girls) with an average age of 15.1 years (range, 4-17 years) were treated. Fourteen patients with minimally displaced fractures were treated conservatively, 24 patients with fractures displaced more than 1 cm underwent surgery. All patients had a standard rehabilitation protocol. Post-operative assessments included: the range of motion in the hip; X-ray at 6 weeks, 3 months and 1 year; duration of bed rest; return to previous activities; occurrence of complications (heterotopic ossification, infection, etc). RESULTS: All patients returned to the pre-injury level of sports activities. Recovery was faster and early rehabilitation was better tolerated in patients treated surgically (p = 0.03), particularly in those with AIIS avulsion fractures. Ambulation with partial weight bearing was possible on average at 7.2 days (range, 2-10 days) in surgically treated patients and at 24.1 days (18-27 days) in conservatively treated patients; the difference was statistically significant (p = 0.02). The range of motion markedly improved in surgically treated patients as early as at 6 weeks while, in conservatively treated patients, the comparable outcome was achieved at 3 months of follow-up (p = 0.02). The time necessary for radiographic evidence of fragment union as well as full recovery was comparable in both patient groups. No deep wound infection was recorded; minor heterotopic ossification was detected in five patients, but no further treatment during follow-up was required. CONCLUSIONS: Indications for surgical treatment are based on the degree of fragment displacement and the patient's demands for sports activities. Although long-term outcomes of both operative and conservative procedures are comparable, the patients treated surgically show faster recovery and need a shorter time of immobilisation. However, removal of osteosynthesis material may be associated with some risk of complications.
- MeSH
- avulzní fraktury chirurgie MeSH
- dítě MeSH
- fraktury kostí diagnostické zobrazování terapie MeSH
- lidé MeSH
- mladiství MeSH
- os ilium diagnostické zobrazování zranění MeSH
- pánevní kosti diagnostické zobrazování zranění MeSH
- předškolní dítě MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Publikační typ
- abstrakt z konference MeSH
Previous EEG studies reported the presence of synchronised 15-30 Hz oscillations in vertex electrodes following innocuous somatosensory stimulation and noxious laser stimulation. The purpose of the present study was to analyse the sources of poststimulus increases of 15-30 Hz oscillations during noxious laser stimulation of four different body regions and to compare the sources of the poststimulus synchronisation with the sources of the N2 component of laser-evoked potential (LEP). In 10 healthy subjects, moderately painful laser stimuli were applied to the dorsum of the right hand, dorsum of the right foot, right groin, and right side of the face. EEG data, recorded from 111 scalp sites, were analysed using event-related desynchronisation method and source dipole analysis. A profound amplitude increase of 15-30 Hz oscillations peaking 1-2 s after noxious laser stimulation was found during stimulation of each body part. The sources of these oscillations were located in the dorsal posterior cingulate cortex and showed no somatotopic arrangement. The sources of the N2-LEP component were located in the anterior mid-cingulate cortex 25-30 mm rostral to the sources of 15-30 Hz oscillations. The amplitude of the poststimulus synchronisation of 15-30 Hz oscillations correlated (P<0.05) with the amplitude of N2-LEP component. Results show that noxious laser stimuli induce bursts of 15-30 Hz oscillations in the posterior cingulate cortex. The poststimulus increases of 15-30 Hz oscillations may stand for transient cortical inhibition possibly aiding temporary suppression of motor programs that have been primed by noxious stimulation.
- MeSH
- bolest patofyziologie MeSH
- časové faktory MeSH
- cingulární gyrus patofyziologie MeSH
- dospělí MeSH
- elektroencefalografie MeSH
- evokované potenciály MeSH
- funkční lateralita MeSH
- korová synchronizace MeSH
- lasery škodlivé účinky MeSH
- lidé MeSH
- mapování mozku MeSH
- mozek patofyziologie MeSH
- noha (od hlezna dolů) patofyziologie MeSH
- obličej patofyziologie MeSH
- periodicita MeSH
- počítačové zpracování signálu MeSH
- ruka patofyziologie MeSH
- třísla patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Spinal cord stimulation (SCS) consisting of electrical stimulation of the dorsal spinal cord using epidural electrodes has been shown to relieve chronic neuropathic pain. To analyze the cerebral activation patterns related to SCS, and to evaluate the effects of SCS on the processing of acute experimental pain, we performed functional magnetic resonance imaging (fMRI) on eight patients suffering from failed back surgery syndrome who were also being treated with SCS for severe pain in their legs and lower back. Three types of stimulation were used, each lasting 36s: (i) SCS, (ii) heat pain (HP) applied to the leg affected by neuropathic pain, and (iii) simultaneous HP and SCS. During SCS, we found increased activation of the medial primary sensorimotor cortex somatotopically corresponding to the foot and/or perineal region, contralateral posterior insula, and the ipsilateral secondary somatosensory cortex (S2). Decreased activation was seen in the bilateral primary motor cortices and the ipsilateral primary somatosensory cortex corresponding to the shoulder, elbow and hand. Compared to separately presented HP and SCS, simultaneous HP and SCS showed statistically significant activation of the bilateral inferior temporal cortex and the ipsilateral cerebellar cortex. The activation of the primary motor cortex, insula and S2 during SCS may directly interfere with the processing of neuropathic pain. When SCS is associated with heat pain, the paralimbic association cortex and cerebellum show activation exceeding the sum of activations resulting from separate SCS and heat pain stimulation. The explanation of this could possibly rest with the continuous comparisons of simultaneous pain and somatosensory sensations occurring in a single dermatome.
- MeSH
- bérec MeSH
- bolest etiologie MeSH
- dospělí MeSH
- elektrostimulační terapie škodlivé účinky metody MeSH
- financování organizované MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mícha patofyziologie MeSH
- motorické korové centrum patofyziologie MeSH
- mozek patofyziologie MeSH
- neuralgie terapie MeSH
- somatosenzorické korové centrum patofyziologie MeSH
- vysoká teplota škodlivé účinky MeSH
- záda chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
