ABSTRACT
OBJECTIVES: To describe our experience in the management of patients with osteogenesis imperfect (OI). MATERIAL AND METHODS: We conducted a retrospective study of a series of cases affected with OI treated in the Clínica Univesidad de Navarra from 1980 to 2007, with a mean follow up of 17.3 years (7-27 years). We collected descriptive data of the sample, the fractures and the deformities, and the treatments given. The complications presented and the functional outcomes at the end of follow-up were also reviewed. RESULTS: The sample included ten patients. Approximately two-thirds (65%) of fractures were sustained in the lower limbs. One patient received medical treatment only. Three patients had combined medical and surgical treatment. Some type of surgical treatment was performed on 6 patients. The most common surgery was the Sofield-Millar performed on 37 occasions, with a third of them requiring revision surgery due to migration of the nails. There were 17 episodes of re-fracture. Complications such as non-union, iatrogenic fractures, and infections, were also observed. The functional outcome, according to the Hoffer-Bullock scale, at the end of follow-up was grade I/II in 7 patients. CONCLUSIONS: Despite the need for multiple interventions and complications presented during follow up, the appropriate treatment of patients with OI can provide acceptable functional outcomes.
Subject(s)
Osteogenesis Imperfecta/therapy , Adolescent , Adult , Child , Child, Preschool , Fractures, Bone/etiology , Humans , Osteogenesis Imperfecta/complications , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Objetivos. Analizar el sustrato anatomopatológico del raquis escoliótico humano durante el crecimiento. Material y métodos. Estudiamos el raquis, obtenidos en la necropsia, de 2 pacientes afectados de escoliosis. Muestra A (niña de 13 años y 2 meses) y muestra B (niño de 14 años y un mes). Se estudiaron las piezas anatómicas obtenidas en la necropsia. Se realizó un estudio radiológico convencional; se valoró la intensidad de las curvas con los grados de Cobb y la rotación vertebral con el método de Pedriolle, cortes de tomografía computarizada (TC) y análisis de la asimetría posterior (giba). Además, en el estudio histológico se valoró la estructura ósea, los cartílagos de crecimiento, el hueso subcondral, la presencia y la distribución del tejido fibroso. Resultados. Se estudiaron los niveles de C7 a L5 de la muestra A y de T2 a L4 de la muestra B. No se evidenció deformidad de los cuerpos vertebrales en el plano frontal, sagital ni axial, salvo en T5 de la muestra A, con acuñamiento en el plano frontal hacia la convexidad. La deformidad se originaba en los discos intervertebrales. La osificación encondral de los cartílagos epifisarios presentaba una mayor actividad en el lado de la convexidad de la curva. El cartílago neurocentral estaba presente a nivel torácico y cervical, habiendo desaparecido a nivel lumbar. No observamos asimetría en los cartílagos neurocentrales. Conclusiones. La deformidad se inicia en los discos intervertebrales produciéndose alteraciones en los cartílagos epifisarios que pueden condicionar, al final del crecimiento, la deformidad de las vértebras escolióticas, básicamente acuñamiento y rotación (AU)
Objectives. To analyse the pathological substrate of human scoliotic spine during growth. Material and methods. We studied two spines obtained at the autopsy of two patients suffering from untreated scoliosis. Sample A (a girl of 13 years and 2 months) and sample B (a boy of 14 years and one month). On the conventional radiological study the curves were measured using the method of Cobb, and the vertebral rotation with the Pedriolle method. A CT scan and analysis of the posterior asymmetry were also performed. The bone structure, growth plate, subchondral bone were evaluated in the histological study, as well as the presence and distribution of fibrous tissue. Results. Levels from C7 to L5 were studied in sample A, and levels from T2 to L4 in sample B. There was no evidence of vertebral deformity in the frontal, sagittal or axial planes, except for T5 in sample A, where wedging into the concavity in the frontal plane was observed. The deformity originated in the intervertebral discs. Endochondral ossification of the epiphyseal cartilage showed increased activity on the side of the convexity of the curve. Neurocentral cartilage was present at thoracic and cervical level, having disappeared at lumbar level. No asymmetry was observed in the neurocentral cartilage. Conclusions. The deformity begins in the intervertebral discs, producing distortions in the epiphyseal cartilage. Those changes may influence the end of growth and therefore the deformity of the scoliotic vertebrae, basically resulting in wedging and rotation of the vertebrae (AU)
Subject(s)
Humans , Male , Female , Adolescent , Scoliosis/physiopathology , Scoliosis , Spinal Diseases/physiopathology , Spinal Diseases , Spine/pathology , Spine , /methodsABSTRACT
OBJECTIVES: To analyse the pathological substrate of human scoliotic spine during growth. MATERIAL AND METHODS: We studied two spines obtained at the autopsy of two patients suffering from untreated scoliosis. Sample A (a girl of 13 years and 2 months) and sample B (a boy of 14 years and one month). On the conventional radiological study the curves were measured using the method of Cobb, and the vertebral rotation with the Pedriolle method. A CT scan and analysis of the posterior asymmetry were also performed. The bone structure, growth plate, subchondral bone were evaluated in the histological study, as well as the presence and distribution of fibrous tissue. RESULTS: Levels from C7 to L5 were studied in sample A, and levels from T2 to L4 in sample B. There was no evidence of vertebral deformity in the frontal, sagittal or axial planes, except for T5 in sample A, where wedging into the concavity in the frontal plane was observed. The deformity originated in the intervertebral discs. Endochondral ossification of the epiphyseal cartilage showed increased activity on the side of the convexity of the curve. Neurocentral cartilage was present at thoracic and cervical level, having disappeared at lumbar level. No asymmetry was observed in the neurocentral cartilage. CONCLUSIONS: The deformity begins in the intervertebral discs, producing distortions in the epiphyseal cartilage. Those changes may influence the end of growth and therefore the deformity of the scoliotic vertebrae, basically resulting in wedging and rotation of the vertebrae.
Subject(s)
Scoliosis/pathology , Spine/pathology , Adolescent , Female , Growth , Humans , Male , Scoliosis/diagnostic imaging , Spine/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Humans , Male , Child , Legg-Calve-Perthes Disease/diagnosis , Legg-Calve-Perthes Disease/epidemiology , Legg-Calve-Perthes Disease/surgery , Arthrography/methods , Anti-Inflammatory Agents/therapeutic use , Prognosis , Legg-Calve-Perthes Disease/genetics , Legg-Calve-Perthes Disease/physiopathology , Legg-Calve-Perthes Disease , Arthrography/trendsABSTRACT
The evolution of muscular contractures and skeletal deformities in cerebral palsy, and criteria for prevention or therapeutical decisions are analized. Developmental brain damage produces a disbalance between bone and muscular growth. Orthopaedic palliative treatments try to avoid malposition of the extremities and to compensate mechanical disbalance during the entire skeletal growth. Therapeutical options are based is on the distinction between dynamic situations and rigid ones; and also on the presence or absence of articular fixed deformities.
Subject(s)
Cerebral Palsy/surgery , Orthopedics , Cerebral Palsy/pathology , Cerebral Palsy/physiopathology , Child , Clinical Medicine , Humans , Orthopedics/ethics , Orthopedics/standardsABSTRACT
No disponible
Subject(s)
Child, Preschool , Male , Humans , Sacrum , Thoracic Vertebrae , Syndrome , Abnormalities, Multiple , Lumbar Vertebrae , Leg Bones , Foot BonesABSTRACT
Revisa a 60 pacientes con tumores malignos a nivel de columna vertebral que fueron tratados entre 1984 a 1990 en la Clínica Universitaria de Navarra. El grupo estudiado (20 pacientes) consistió en 14 varones y 6 mujeres, de 7 a 72 años (promedio:38 años). En 12 pacientes el tumor fue localizado a nivel de la región lumbar, 6 a nivel de columna dorsal, y en un caso a nivel sacro. En todos los casos fueron tratados con radioterapia intraoperatoria mediante el uso de acelerador lineal. La energía usada varía entre los 6 y 20 Mev. La dosis total recibida varía entre los 10 y 20 Grays. Adicionalmente los pacientes recibieron radioterapia externa. No se observaron complicaciones relacionadas con la radioterapia intraoperatoria. En conclusión: La RIO es una técnica factible para el tratamiento de tumores óseos. La toxicidad de RIO es mínima. Es una alternativa para el control local del tumor, en lugares de difícil acceso para tratamiento radical. La RIO es parte del tratamiento multidisplinario en esta patología.
