Статьи журнала - Гений ортопедии
Все статьи: 2083
Hallux valgus: рентгенометрия костей стопы до и после хирургической коррекции
Статья научная
Результаты лечения 63 больных Hallux valgus изучены методом полипозиционной рентгенографии, которую выполняли до, после операции и на различных этапах фиксации аппаратом, а также в отдаленном периоде. У всех больных проводили рентгенометрические исследования. В зависимости от степени деформации первого луча больным производили различные виды остеотомий с фиксацией остеотомированных фрагментов устройством наружной фиксации. После устранения деформации отмечался длительный процесс перестройки в первой плюсневой кости, который можно разделить на два периода: ближайшие два месяца и год после окончания лечения. У 48 больных через год после окончания лечения процесс перестройки первой плюсневой кости был близок к завершению, были сформированы хорошо выраженные кортикальные пластинки, в области основания кости прослеживалась ячеистая структура, форма первой плюсневой кости приближалась к нормальной. У остальных больных процесс перестройки был незавершен, отмечались участки уплотнения в зонах остеотомий, кортикальная пластинка имела различную толщину и плотность, в области головки и основания кости ячеистая структура чередовалась с участками уплотнения и разрежения.
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Ilizarov method in treatment of neurological foot deformities
Статья научная
Introduction Diseases related to the lesions of upper or lower motor neurons, such as spina bifida, myopathy, and residual polio, often cause severe deformities of the foot and ankle. The treatment goal is to convert a deformed and rigid foot into a plantigrade foot. Matherial and method We treated 51 neurological feet from 2001 to 2018 with the Ilizarov method. They were polio outcomes in 27 cases, 17 feet were affected by spina bifida, 6 other patients had Charcot-Marie-Tooth disease. Results Results were assessed by comparing appearance and function before and after surgery described by Dimeglio, and modified by Dong Y.L. et al. Before surgery, there were 33 moderate and 28 severe deformities (average preoperative scores, 6.3). The mean time required to correct a deformity was 37.1 days (range, 22-58 days) and the mean time for stabilization was 67.2 days (range, 45-98 days). At latest follow-up (mean 7.42 years, from 13 month to 16 years), clinical outcomes and patient satisfaction were considered acceptable. 28 patients achieved an excellent outcome and 21 patients had a good outcome, two feet were classified as having a poor result. Nearly 86 % of patients (44 patients) were satisfied with their outcomes and replied they would repeat their procedure. Complications include infection in 15 % of K-wire tracts, Dysesthesia in 5 cases, superficial necrosis in 3. One patient developed knee contracture. 2 patients were re-operated with V osteotomy. Conclusions The Ilizarov method represents a great resource in the treatment of severe neurological deformities of the foot.
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Статья научная
The Ilizarov technology was honored as a "milestone" in the history of orthopedics in the 20th century, benefiting tens of thousands of patients around the world, including Chinese patients. The paper presents an analysis of the integration of the method into Chinese medicine, taking into account national traditions, culture and clinical thinking. Ilizarov technology has revolutionized the orthopaedic surgery and clinical limb regeneration medicine in China. Ilizarov's methodology arose suddenly and brought about revolutionary changes in terms of theoretical guidance, methods of thinking, tools used and medical procedures. For the first time, Ilizarov's discovery made people realize that the human body, natural selection in biology and joint symbiotic evolutionary characteristics are common, namely, as long as the levers activate the tissue regeneration switch and changes in regulation, any tissue at any age and to any degree can complete the self-healing process in according to the requirements of doctors and the expectations of patients, similar to the growth of children. The process of working with an external Ilizarov fixator is like playing chess and changing a kaleidoscope, and the countless number of free combinations of stress configurations can be changed in accordance with the needs of the treatment. In China, Qin Xihe integrated the Chinese culture into the Ilizarov technology, thus forming the Chinese Ilizarov technology. He proposed new concepts such as the concept of natural reconstruction, evolutionary orthopedics, interpretation of body language, one walk, two lines, the principle of three balances, happy orthopedics, etc., which were introduced into clinical practice in the field of limb deformity correction and functional reconstruction. As of December 31, 2018, 35,075 cases of various deformities and disorders of the limbs were entered into the Qinsihe orthopedic database, of which 8113 cases were treated with external fixation (Ilizarov technology). The statistics of a large number of cases showed striking results: diseases treated with this technique covered almost all sections of orthopedic pathology and more than 10 sections of non-orthopedic and traumatological pathology, including vascular, nervous, genetic, metabolic, and skin diseases. In addition to orthopedic, there are more than 170 diseases in total. When Ilizarov's technology is applied, it can magically transform the old into the young. Therefore it is known as a "lifeboat". Conclusion Over the past 70 years, Ilizarov's ideas and technologies have been preserved, updated and augmented. Ilizarov's technology serves as an evolutionary phenomenon that transcends bone science. If you understand this technique, you will understand the direction of modern orthopedic surgery and regenerative medicine. Professor Ilizarov's morale and the spirit of fighting to alleviate the suffering of patients were transferred to the Chinese medical community. This awakened many Chinese doctors who followed the norms of the old and stereotyped medicine. After celebrating the centenary of the birth of Professor Ilizarov, ASAMI China will also prepare for the “Sixth ASAMI & ILLRS-BR World Conference (Beijing - 2023)”. We believe that orthopedics and allied disciplines around the world have a bright future.
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Статья научная
Цель. Оценить результаты сравнительного анализа антимикробной in vitro активности полимерных гидрогелей и ПММА, импрегнированных антибиотиками, в отношении тест-культур ведущих возбудителей ортопедической инфекции. Материалы и методы. Проведен сравнительный анализ антимикробной активности полимерного гидрогеля и ПММА, импрегнированных антибиотиками. Оценена бактерицидная эффективность и пролонгированность действия следующих пар «микроб-антибиотик»: MSSA - гентамицин, MSSE - цефазолин, MRSA и MRSE - ванкомицин, A. baumannii - тобрамицин. Длительность исследования - 7 суток. Статистическое сравнение групп проведено при помощи критериев Манна-Уитни, Уилкоксона, для описания данных использовали медиану и 95 % ДИ. Результаты. Полученные показатели зоны ингибирования роста микроорганизмов вокруг полимерного гидрогеля в несколько раз превосходили результаты ПММА (p
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Статья научная
Цель. Изучить динамику и длительность элюции антибактериальных препаратов из образцов на основе полимерного гидрогеля и ПММА. Материалы и методы. Сравниваемые образцы, импрегнированные ванкомицином, рифампицином и цефазолином в различных концентрациях, помещали в фосфатно-солевой буфер, инкубировали при 37 °C. На 1, 3, 7, 14, 21 и 28 сутки проводили полную замену среды. Концентрацию препаратов в растворе и их профили высвобождения определяли спектрофотометрическим методом. Для статистического описания данных 5 параллельных исследований использовали медиану и 95 % ДИ. Результаты. На протяжении всего периода исследования концентрации всех протестированных антибиотиков, элюированных из полимерного гидрогеля, превышали концентрации, высвобожденные из ПММА, в среднем в 7 раз на 1-е сутки, в 15 раз - на 2-е и 3-и сутки, в 6,6 раза - на 7-е сутки, в 3 раза и более - в последующие дни наблюдения. Заметно отличалась и скорость релиза антибиотиков из объема гидрогелей. Обсуждение. Для всех гидрогелевых образцов релиз препаратов составил более 70 % от его общего количества, в отличие от ПММА, элюция которого не превышала 10 %. Несмотря на то, что, как и в случае костного цемента, наблюдался бёрст-релиз, и до 80 % антибиотика высвободилось в первые 5 суток наблюдений, концентрация элюированного препарата из гидрогелей была кратно выше и превышала МПК в течение всего периода наблюдения. Высвобождение противомикробного агента из гидрогелей обусловлено диффузией частиц из вcего объема матрицы, что является важным преимуществом по сравнению с ПММА, потенциал которого ограничен поверхностным истощением. Заключение. На данном этапе нами показана возможность создания потенциальных депо-систем на основе ненасыщенных производных ПВС с контролируемым релизом антибиотиков, которые превосходят по своим характеристикам ПММА.
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In vitro оценка антимикробной активности модифицированных костных ксеноматериалов
Статья научная
Цель. Оценка антимикробных свойств оригинальных костных имплантационных ксеноматериалов, импрегнированных по разным технологиям ванкомицином. Материалы и методы. Костный ксеноматрикс модифицировали по двум технологиям: адсорбция ванкомицина на поверхности материала и абсорбция ванкомицина в объеме материала с использованием промежуточного носителя. При импрегнации антибиотика использовали метод сверхкритической флюидной экстракции диоксидом углерода. Изучена кинетика высвобождения антибиотика из модифицированного ксеноматериала. В исследовании in vitro изучена его антимикробная активность по отношению S. aureus. Результаты. Обнаружено, что выход ванкомицина из материала, выполненного по технологии адсорбции, после 24 часов инкубации составил более 98 % от исходного содержания в матриксе. Остаточное содержание антибиотика в среднем составляло 1,75 %. Использование промежуточного носителя (L/D изомер полилактида) позволяет получить материал с дозированным пролонгированным выходом ванкомицина...
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Статья научная
Введение. Полиметилметакрилат (ПММА) является распространенной депо-системой при лечении хронического остеомиелита. Однако множество существующих недостатков не позволяет считать его идеальной.Цель. В условиях in vivo изучить эффективность купирования хронического остеомиелита большеберцовой кости на модели кроликов полимерным гидрогелем, содержащим антибиотик, и сравнить с ПММА.Материалы и методы. Исследование выполнено на голени 25 половозрелых кроликов породы Шиншилла. Была создана модель хронического остеомиелита большеберцовой кости. Инфекционным агентом выбран метициллинчувствительный штамм Staphylococcus aureus (MSSA), высокоактивный в отношении цефазолина. Через 21 день после клинико-лабораторного, рентгенологического имикробиологического подтверждения диагноза приступали к хирургической санации, методика для всех животных была одинаковой. Опытной группе (n = 11) имплантировали полимерный гидрогель, сравнительной (n = 11) - ПММА, контрольной (n = 3) - имплантация не производилась. В послеоперационном периоде проводили мониторинг локального статуса, веса и температуры тела животных, микробиологическое и рентгенологическое исследование. Животных выводили поэтапно. Биоптаты направляли на бактериологическое и гистоморфометрическое исследование. Статистическое сравнение групп выполнено при помощи критериев Манна - Уитни, Краскелла - Уоллиса и Тьюки, для контрольной группы использовали описательную статистику.Результаты. В опытной группе во всех случаях послеоперационные раны зажили своевременно, уровни WBC и СРБ значимо (p = 0,040) снизились с 14 и 21 суток соответственно. Микробиологически роста микрофлоры из отделяемого раны и биоптатов не выявлено, рентгенологически прогрессирование хронического остеомиелита не наблюдалось, гистоморфометрически отмечено достоверное (p = 0,002) эффективное купирование воспалительного процесса. В случае сравнительной группы с 7-х послеоперационных суток потребовалась системная антибиотикотерапия. Уровни маркеров воспаления снижались менее эффективно, чем в опытной группе. MSSA верифицировался из отделяемого раны и биоптатов почти на каждом контрольном сроке. Рентгенологически и гистоморфометрически (p = 0,001) в среднем наблюдалась картина обострения остеомиелита. В контрольной группе системная терапия не дала положительной динамики.Обсуждение. Сравнительный анализ показал, что гидрогель в отличие от ПММА достоверно купирует хронический остеомиелит без дополнительной вспомогательной системной антибиотикотерапии и не вызывает материал-ассоциированную резорбцию костной ткани. При этом клинико-лабораторная картина полностью соответствует данным микробиологии, рентгенологии и гистоморфометрии.Заключение. Гидрогель, импрегнированный антибиотиком, достоверно и эффективно купирует хронический остеомиелит по сравнению с ПММА.
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Статья научная
Introduction Swelling is a common complication following a foot and ankle surgery, and is one of the most prevalent complaints that patients present at the clinics. While it affects patients’ satisfaction, the relevance between the swelling and clinical outcome remains unclear. Material and Methods This study assessed volume of foot and ankle swelling in 112 patients with history of ankle fusion, the patients’ Foot Function Index (FFI) score, and patients’ satisfaction. The relationships between swelling volume and early outcomes were analysed with Pearson’s correlation coefficient and a scatter plot. Results The mean of swelling volume increase was 120.0 ± 96.2 ml (range 5 ~ 400 ml); pre-operative FFI score mean was 73.7 ± 4.8 % (range 68 % ~ 81 %), 3 months post-operative FFI score mean was 32.8 ± 5.0 % (range 22 % ~ 56 %) and satisfaction scale’s median was 1 (satisfied). In the correlation analysis, while the meaningful Pearson’s correlation coefficient was found with satisfaction scale, swelling volume showed a weak correlation of Pearson’s correlation test with FFI scores (R value = 0.190; p value = 0.045). Conclusions This study revealed that the swelling of the foot and ankle following ankle fusion surgery are not associated with functional clinical outcome. However, because it affects the patients’ satisfaction, we emphasize the need to identify the problem and management of the swelling, while assuring them that the swelling does not correlate with the early functional outcome.
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Статья научная
Introduction Whereas hip joint destroying trauma and diseases are difficult situations, the problem is more complex when it is complicated by hip instability. This could be a sequel of several hip affections such as trauma, septic or tuberculous arthritis, neglected developmental dysplasia of the hip, postoperative conditions, and neurologic pathologies (cerebral palsy, myelomeningocele, poliomyelitis). Purpose The purpose of this study is to evaluate long-term radiographic and clinical outcomes of the Ilizarov hip reconstruction for the treatment of painful and unstable hips in adolescents and young adults. Materials and methods The study included 136 patients with an average age of 18.3 years (range, 6 to 34 years); 75 patients were males (55.1%) and 61 females (44.9%). The primary causes of the hip instability were untreated or unsuccessfully treated cases of septic arthritis (40 cases; 29.4 %), congenital hip dislocation (28 cases; 20.6 %), paralytic hip dislocation (36 cases; 26.5 %), proximal femoral focal deficiency (14 cases; 10.3 %), neglected fracture of the femoral neck (10 cases; 7.4 %), osteoarthritis (6 cases; 4.4 %), and tuberculous hip arthritis (2 cases; 1.5 %). The intervention consisted in the performance of two osteotomies (proximal and distal) of the femur with pelviс support and placement of the Ilizarov apparatus of a specific assembly. Results The external fixation period ranged from 4 to 12 months (6.5 months on average). Patients were followed up for an average of 17.4 years (range, 5 to 27 years). Multiple clinical parameters at final follow-ups showed significant improvement, including pain relief, pain-free walking distance, lameness, hip flexion and abduction, hip contracture, and lumbar lordosis. Functionally, the mean Harris Hip Score improved with a statistically significant difference from 48 points (range, 35-65) before surgery to 83 points (range 70-90) after surgery. The pain disappeared in all patients, with the exception of six cases of pain in the early postoperative period. In all cases, supportive walking aids were no longer necessary, with the exception of two cases of persistent pain by physical activities. Walking ability and painless walking distance improved in all patients from an average of 35 m (range, 10 to 50 m) before surgery to 1,150 m (range, 1,000 to 1,500 m) after surgery, showing significant difference. Conclusion Ilizarov pelvic support osteotomy provided a multi-purpose solution to the complex challenging problem of hip instability in adolescents and young adults with variable primary etiologies. The improvements in the hip motion, mechanical axis, and correction of limb-length discrepancy lead to good functional outcomes over a long-term follow-up. This treatment modality might avoid or postpone the need for total hip arthroplasty for several years.
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Management of congenital radial club hand by gradual correction
Статья научная
Introduction Severe congenital radial club hand is aesthetically unacceptable. This paper represents our experience in treating early and late diagnosed cases using gradual distraction by Ilizarov external fixator. Methods We treated 34 cases of congenital radial club hand with an age ranged from 1 to 15 years. There were 20 girls and eight bilateral cases. Three had been treated on both sides. So, we have treated 37 limbs. Nine cases had been operated before. Centralization alone was done in 12 cases and followed by lengthening in eight cases. Ulnar lengthening and gradual correction of wrist deformities were done for the rest of cases. The patients were followed clinically and radiographically with the following parameters: hand forearm angle, range of motion, daily functional activities, extent of lengthening achieved, and cosmetic improvement. Results The follow up ranged from 1 to 10 years. The magnitude of lengthening achieved ranged from 5 to 11 cm. The average healing index was 52.02 days/cm with cosmetic appearance satisfaction in all cases. Complications included; pin tract infection in 24 cases, flexion contractures of the elbow and fingers in 26 cases [which mostly disappeared during follow up], and spontaneous ulnocarpal fusion in 2 cases. Two cases suffered fracture in the regenerate zone. Conclusions The use of the Ilizarov method with gradual distraction of bone and soft tissues in treatment of radial club hand was effective in forearm lengthening with functional and cosmetic improvement.
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Management of forearm bone gap non-unions by Ilizarov technique
Статья научная
Purpose Proper treatment of forearm bone gap non-union should achieve both biological stimulation of the bone and elastic mechanical stability. The use of Ilizarov technique enhances the healing of a non-union providing osteogenic, osteoconductive and an optimal stability with the Ilizarov fixation. We retrospectively reviewed 26 patients affected by forearm bone non-union and treated with the Ilizarov fixation. Materials and Methods Twenty six patients were treated for gap non-unions of forearm bones with the Ilizarov compression distraction device from 2000 to 2015 in BARI-ILIZAROV ORTHOPAEDIC CENTRE. Results All the difficult non-unions healed in a mean of 7 months, ranging from 5 to 12 months. At the latest follow- up, forearm functions were satisfactory. Conclusion The Ilizarov compression distraction device is a fantastic tool in promoting the healing of forearm non-unions, even if the bones are very atrophic.
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Mechanical stimulation of distraction regenerate. Mini-review of current concepts
Статья обзорная
Introduction One of the key limitations of distraction osteogenesis (DO) is the absence or delayed formation of a callus in the distraction gap, which can ultimately prolong the duration of treatment.Purpose Multiple modalities of distraction regenerate (DR) stimulation are reviewed, with a focus on modulation of the mechanical environment required for DR formation and maturation.Methods Preparing the review, the scientific platforms such as PubMed, Scopus, ResearchGate, RSCI were used for information searching. Search words or word combinations were mechanical bone union stimulation; axial dynamization, distraction regenerate.Results Recent advances in mechanobiology prove the effectiveness of axial loading and mechanical stimulation during fracture healing. Further investigation is still required to develop the proper protocols and applications for invasive and non-invasive stimulation of the DR. Understanding the role of dynamization as a mechanical stimulation method is impossible without a consensus on the use of the terms and protocols involved.Discussion We propose to define Axial Dynamization as the ability to provide axial load at the bone regeneration site with minimal translation and bending strain. Axial Dynamization works and is most likely achieved through multiple mechanisms: direct stimulation of the tissues by axial cyclic strain and elimination of translation forces at the DR site by reducing the effects of the cantilever bending of the pins.Conclusion Axial Dynamization, along with other non-invasive methods of mechanical DR stimulation, should become a default component of limb-lengthening protocols.
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Microsurgical limb reconstruction utilizing Truelok TL external fixator:a case report
Статья научная
Coverage of lower extremity wounds, especially those in the distal leg, present challenges to the reconstructive surgeon. The present case illustrates a surgical technique utilizing a distally based reverse soleus muscle flap for coverage of an anterior leg wound deficit with exposed bone. The wound failed conservative wound care and was at risk of a below the knee amputation. The wound was first debrided to healthy bleeding tissue. The Truelok TL External Fixator was then applied for stabilization of the muscle flap. The medial portion of the soleus muscle was dissected with care to preserve its vascular supply and transposed to cover the wound defect. This was followed by utilization of the Integra Bi-Layer Matrix to control the vapor loss of the wound, act as a bacterial barrier, and provide a scaffold for cellular invasion and capillary growth. A wound VAC was applied to promote granular tissue formation. Following post-operative wound care, a split-thickness skin graft was later applied. The limb was salvaged and wound closure was achieved within three months. The patient began ambulating in a patella tendon bearing orthosis within four months. The reverse soleus muscle flap provides a viable option for ankle wound and anterior leg coverage, especially in medically frail patients. Due to a high degree of versatility, reliability, minimal donor site morbidity, less operating time, low cost and good functional gain; this procedure is highly suitable for the treatment of complex middle and lower leg defects. It should be considered in the reconstruction of soft tissue defects about the ankle, especially when the surgeon has exhausted all other conservative and surgical options.
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Musculoskeletal anomalies in children with mucopolysaccaridoses
Статья научная
Introduction The accumulation of glycosaminoglycan (GAGs) in the tissues in Mucopolysaccharidoses (MPS) can lead to skeletal anomalies (DYSOSTOSIS MULTIPLEX) and to soft tissue impairments (neural or medullar compression, joint stiffness, tenosynovitis). Here is a review of orthopedic issues frequently encountered in patients with MPS. Material and methods Surgery may be justified at different age and according to the type of MPS. Different surgical approaches and their indications are exposed in the article. Results The article exposes indications and techniques for orthopedic issues in MPS children: cervical stenosis, cervical instability, kyphosis, hip dysplasia and hip dislocation, genu valgum. Conclusion Various musculoskeletal anomalies can be found in patients with mucopolysaccharidoses. Neurological impairments are frequently seen due to cervical stenosis or instability and should be early detected with regular MRI of the cervical spine. Well-codified management should lead to favorable functional results and maintain functional and walking abilities.
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Mycobacterium abscessus как возбудитель перипротезной инфекции
Статья научная
Введение. Вид Mycobacterium abscessus относится к группе нетуберкулезных микобактерий, ответственных за хронические инфекции у лиц с ослабленным иммунитетом. M. abscessus способны колонизировать искусственные поверхности, в том числе медицинские и хирургические инструменты/устройства. В связи с низкой частотой встречаемости M. abscessus как возбудителя ортопедической инфекции он представляет несомненный интерес для практикующих врачей. Данный инфекционный агент является редким возбудителем, в отношении которого отсутствует отработанный лечебный алгоритм.Цель. Представить способ достижения успешного результата лечения пациента с перипротезной инфекцией, вызванной M. abscessus.Материалы и методы. Из историй болезни и выписных документов известно, что пациентке Х. по месту жительства выполнено тотальное эндопротезирование тазобедренного сустава. В раннем послеоперационном периоде манифестировали признаки острой инфекции послеоперационной раны.Результаты. Спустя три месяца пациентка госпитализирована в профильное учреждение с диагнозом хроническая глубокая перипротезная инфекция. При дообследовании установлена этиология процесса. Пациентке в две госпитализации последовательно выполнены 4 санирующие операции (в том числе мышечная пластика и установка антимикробного спейсера) и проводилась массивная парентеральная антибактериальная терапия в течение 8 месяцев, в том числе на амбулаторном этапе, с применением минимум 3-х антибактериальных средств. Спустя 4 года пациентка не предъявляет жалоб со стороны очага инфекционного процесса. Послеоперационный рубец 45 см без особенностей. Оставшееся укорочение правой нижней конечности 3 см компенсируется ортопедической обувью.Обсуждение. Лечение инфекции, вызванной M. abscessus, является сложной задачей вследствие природной устойчивости возбудителя к широкому спектру антибактериальных лекарственных средств. В литературе описаны единичные случаи ортопедической инфекции, вызванной данным патогеном. Все авторы сходятся в том, что залогом успешного лечения является комбинация радикальной хирургической санации и антибактериальной терапии с применением минимум трех антимикробных препаратов.Заключение. Длительная агрессивная антибиотикотерапия в комбинации с этапным хирургическим лечением позволила добиться успеха при лечении пациента с перипротезной инфекцией, вызванной Mycobacterium abscessus, после первичного эндопротезирования тазобедренного сустава.
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Neglected сlubfoot treated by Ilizarov and Ponseti methods
Статья научная
The Ponseti method has revolutionized clubfoot treatment. Though completely neglected clubfeet are now rare, partially or incompletely and improperly treated feet are not uncommon. Relapses after successful correction may occur due to non-compliance with bracing. In scarred soft tissues due to previous surgery, soft tissue distraction using external fixation helps achieve correction. The Ilizarov fixator permits us to follow the Ponseti protocol, using correction methods that may either be constrained or unconstrained by hinges. Applying force vectors perpendicular to the moment arm allows us to correct the equinus without damaging the ankle joint. All of the above is possible when the talus is round. Full correction of the deformity is possible. However, long-term follow-up of these patients has revealed stiffness of the ankle setting and frequently with tibio-talar osteophytes anteriorly. They are probably a reaction to excessive pressure developed in the joint due to the tight soft tissues. Hence the author has now added a mild shortening of the tibia and fibula to reduce soft tissue tension, rather than resorting to further soft tissue releases through scarred tissues. This allows faster correction with the Ponseti-Ilizarov protocol and allows good ankle range of motion to persist.
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Non-obvious and obvious signs of the thoracic spine pathology: a clinical study
Статья научная
Background The thoracic spine pathology can lead to severe disability and discomfort.This study aims to identify determinant characteristics in patients with thoracic spine pathologies who present with non-regional complaints such as lumbar/cervical pain and others.Methods A prospective observational descriptive study was conducted at Basrah Teaching Hospital from March 2020 to December 2021, enrolling 114 patients categorized into two groups. Group A included patients with thoracic spine pathology and thoracic pain, while Group B consisted of patients with thoracic spine pathology and non-local symptoms (such as lower lumbar pain, pain in extremities, etc.). Comprehensive clinical evaluations were performed using a specially designed questionnaire.Results The majority of patients were in the 60-79 age group, with females comprising 55 % in Group A and 60 % in Group B. Smoking was observed in 28.98 % of Group A and 26.66 % of Group B. Symptomatic patients with solitary back pain commonly exhibited dorsal root compression symptoms (49.27 %), lower limb weakness (18.84 %), and sphincter dysfunction (7.24 %). Patients with thoracic plus lower and/or neck pain frequently reported paraesthesia (42.22 %) and cervical root symptoms (48.38 %). Kyphotic deformity was present in 20.28 % of Group A and 11.11 % of Group B, while tenderness was observed in 23.18 % of Group A and 13.33 % of Group B. Plain radiograph changes, including disk space narrowing (44.44 %), subchondral sclerosis (29.63 %), curve alterations (29.63 %), and facet arthropathy (25.9 %), were more prevalent in those with symptomatic thoracic back pain (Group A).Conclusion Non-local symptoms in thoracic spine pathologies are common, with complicated and multi-site low back pain being more prevalent than isolated back or thoracic pain. Elderly individuals, females, obesity, and comorbidities appear to be predictive risk factors for low back pain development. Paraesthesia emerges as the most common neurological manifestation, while kyphosis and scoliosis are primary presentations of thoracic pathologies. Multi-modalities of imaging, including plain radiographs, MRI, CT scan, and DEXA scan, can aid in detecting back pathologies. The mainstay of managing symptomatic thoracic pathologies is surgical intervention.
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Outcomes using the Ilizarov external mini-fixator for Monteggia fractures in children
Статья научная
Objective To evaluate the use of Ilizarov external mini-fixation in the treatment of Monteggia fractures (dislocation of the radial head with an associated fracture of the proximal ulna) in children. Methods Children with proximal ulnar fracture were included and underwent fracture reduction surgery with Ilizarov external mini-fixators, followed by immobilization of the supinated forearm with plaster. The reduction was evaluated intra-operatively using arthrography. Mackay criteria were used to evaluate clinical outcomes at follow-up. Results A total of 15 children were included in the study. Mackay efficacy was 100 %, indicating excellent outcomes using the Ilizarov external mini-fixator. Conclusion Use of the Ilizarov external mini-fixator is particularly suitable in the treatment of children with comminuted and compression fractures of proximal ulna. It is easy to operate, low invasive and is worthy of promotion.
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Статья научная
Introduction Forearm fractures are common injuries in childhood. Completely displaced and unstable fractures require surgical intervention. Elastic Stable Intramedullary Nailing (ESIN) is widely used in treating these fractures. Although stainless steel and titanium implants are the most widely used, resorbable nails are becoming an option.Aim To present our initial experience in treating forearm fractures in children with Resorbable Stable Intramedullary Nailing (ReSIN).Methods The authors present several cases treated with ReSIN, their summarry and describe the techniqual steps. Results The series included 4 patients operated on with ReSIN. Bone union with anatomic and functional recovery was stated in all cases within the period of 5-7 months after surgery.Discussion More and more paediatric fractures can be treated with absorbable implants and result in good outcomes. It can be said that the new methods enabled similar stable fixation as with metal implants, which is considered the gold standard. A distinct advantage over metal implants is that there is no need to remove the implant, thus avoiding a second operation and reducing the risk of surgical complications. Another positive thing is that absorbable implants can be sunk the level of the cortical layer of the bone, they can easily be dropped under the skin. The only drawback of the method is the price of the implants.Conclusion The management of paediatric diaphyseal forearm fractures with bioabsorbable intramedullary nails is a promising emerging alternative to the gold standard ESIN technique.
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