The aim of the study was to analyze a group of patients who had undergone multilevel osteotomy of long bones and medication therapy for osteogenesis imperfecta (OI). MATERIAL AND METHODS: The group included 14 OI patients (nine girls and five boys) operated on in the years 1996 to 2006, who ranged in age from 3 to 17 years (average, 8.2 years). Due to residual deformation following a fracture of or because of treatment for acute trauma to long bones of the lower extremities, the patients underwent multilevel osteotomy with the use of osteosynthesis (Prevot's rod, six patients; Kirschner's wire, three patients; Küntcher's nail, three patients; Rush's nail, one patient; condylar plate, one patient). A special working and rehabilitation program played an important role in the therapeutic protocol. Four patients treated after 2003 received Pamidronate. RESULTS: Sufficient correction of axil deformity of the legs and equal leg length resulting in gait improvement were achieved in 11 patients. In one patient, osteosynthesis with a condylar plate failed and it was necessary to apply intramedullary elastic fixation. In one patient, tibia vara developed following Küntcher's nail osteosynthesis. In one patient, disunion of bone from osteosynthetic material, with a subsequent supracondylar fracture under the Küntcher's nail, was recorded. Pamidronate administered in pre- and post-operative periods to the four patients treated after 2003 reduced the need for their immobilization from 6 to 3 weeks, which permitted early rehabilitation and, in one patient, first standing and walking at the age of 12 years. DISCUSSION: The treatment of long bone fractures in OI patients is based on the assumptions that bone healing is not affected and that long immobilization leads to deterioration of osteopenia and to a risk of further fractures. For these reasons, surgical procedures using intramedullary fixation have recently been preferred. Pamidronate administration alleviates pain, improves muscle tonus, reduces the period of immobilization and enhances bone density. CONCLUSIONS: The multidisciplinary, rational approach, which involves early surgical intramedullary fixation of fractures with subsequent rehabilitation and Pamidronate administration, is considered to provide a more effective therapy with better results and therefore better quality of life in patients with osteogenesis imperfecta.
- MeSH
- bisfosfonáty terapeutické užití MeSH
- dítě MeSH
- fraktury femuru chirurgie komplikace MeSH
- fraktury spontánní chirurgie MeSH
- fraktury tibie chirurgie komplikace MeSH
- hojení fraktur MeSH
- inhibitory kostní resorpce terapeutické užití MeSH
- intramedulární fixace fraktury MeSH
- lidé MeSH
- mladiství MeSH
- osteogenesis imperfecta farmakoterapie komplikace MeSH
- osteotomie MeSH
- předškolní dítě MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
Východisko: Valgózna deformita nohy je častým nálezom u pacientov s detskou mozgovou obrnou (DMO) a meningomyelokélou (MMC). Jednou z možností operačného riešenia tejto deformity neurogénneho pôvodu je extraartikulárna subtalárna artrodéza podľa Gricea v rôznych modifikáciách a kombináciách. Súbor a metódy: Hodnotený súbor tvorilo 23 pacientov (30 valgóznych deformít nohy) s diagnózou detskej mozgovej obrny a meningomyelokély operovaných na Detskej ortopedickej klinike LFUK a DFNsP v Bratislave v období od roku 1999 do roku 2006. Súbor tvorilo 10 dievčat a 13 chlapcov vo veku 5-14 rokov (priemerný vek 8,5 roka). U siedmych pacientov bola vykonaná modifikovaná operácia podľa Gricea bilaterálne, v 11 prípadoch bola operácia doplnená Youngovou operáciou a v 9 prípadoch elongáciou Achillovej šľachy. Pacienti boli pred a po operačnom zákroku hodnotení Leidingerovým bodovacím skóre (LBS), na podklade ktorého sme posudzovali operačnú úspešnosť metódy. Výsledky: Priemerná predoperačná hodnota LBS bola 6,7 bodu. Pooperačne priemerná hodnota LBS u všetkých pacientov (Griceho operácia, Griceho+Youngova operácia) stúpla o 4,2 bodu. V skupine pacientov so samostatnou Griceovou operáciou priemerná hodnota stúpla o 3,9 bodu, v skupine s kombináciou operácie Grice + Young bola priemerná hodnota LBS vyššia o 4,5 boda. U jedného pacienta bola zaznamenaná luxácia distálnejšieho zo štepov. K infekcii a rezorbcii štepu nedošlo ani u jedného zo sledovaných prípadov. Záver: Na základe výsledkov našej štúdie považujeme kombináciu modifikovanej Griceovej extraartikulárnej dézy s Youngovou operáciou za výhodnú predovšetkým u pacientov s pes planovalgus neurogenes.
Background: Valgus leg deformity is a frequent finding in patients with cerebral palsy or meningomyelocele. One option for surgical treatment of this neurologically based deformity is an extraarticular subtalar arthrodesis by Grice and its various modifications and combinations. Patients and methods: The examined group consisted of 23 patients with cerebral palsy and meningomyelocele (30 valgus leg deformations overall) treated at Pediatric orthopedic clinic Medical Faculty of the Comenius University and Children's University Hospital, Bratislava in Bratislava between 1999 and 2006. In the group there were 10 girls and 13 boys aged 5-14 years (average age 8.5). Seven patients were treated with modified operation by Grice bilaterally, in eleven cases this was complemented with Young operation and in 9 cases the prolongation of Achilles tendon was conducted as well. The patients were evaluated according to Leidinger´s ranking score pre- and postoperatively to consider the success ratio. Results: The average preoperative value of Leidinger´s score was 6.7 points. Postoperative (Grice only, Grice and Young combined) average value increased by 4.2 points. In group where only Grice operation was conducted, the average value raised by 3.9 points, in the Grice + Young operation group the average score value raised by 4.5 points. Luxation of the distal graft occurred in one patient. Neither infection nor graft resorption was observed in the groups. Conclusion: Based on the outcomes of our study, we consider the combination of modified Grice extraarticular desis and Young surgery beneficial for all patients with pes planovalgus neurogenes.
- MeSH
- artrodéza metody využití MeSH
- dítě MeSH
- interpretace statistických dat MeSH
- lidé MeSH
- meningomyelokéla komplikace MeSH
- mozková obrna komplikace MeSH
- ortopedické výkony metody využití MeSH
- pooperační komplikace etiologie MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- získané deformity nohy (od hlezna dolů) etiologie chirurgie terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
