Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
1.
J Med Life ; 8(3): 388-97, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26351546

RESUMO

Congenital scoliosis represents a spinal malformation due to defects of formation, segmentation or mixed ones. It is characterized by a longitudinal and rotational imbalance. 54 patients were analyzed and 39 out of them were operated by various approaches with anterior and posterior instrumentations during 2000 and 2012. The impossibility to appoint some patients encountered in the daily practice into the known classifications, allowed us to purpose two categories of congenital scoliosis related to the predominance of spinal deviances in the coronal and transversal views. No certain etiology of congenital scoliosis has been identified until today. The susceptibility of some polygenic defects is obvious due to the presence of a sum of defects associated to most of the congenital scoliosis cases and the rarity of the presence of a unique defect. The diagnosis requires a thorough clinical and imaging examination in order to establish an individualized therapeutic strategy. The treatment of congenital scoliosis is different from the adolescent idiopathic one. Therapeutic criteria are significantly different. It is essential to assess the difference in growth of the concavity related to the convexity when choosing a particular procedure. The magnitude of the curve and the progressive rate are fundamental issues to the surgeon.


Assuntos
Escoliose/congênito , Pré-Escolar , Humanos , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Escoliose/cirurgia , Fusão Vertebral
2.
J Med Life ; 8(2): 160-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25866572

RESUMO

BACKGROUND: Up to the middle of the last century, the thoracic spine, especially in its upper part, has been considered an unapproachable site, a no-man's land, but the constant evolution of medicine imposed techniques of the spine at these levels in order to solve a large area of pathology (infectious, tumoral, traumatic, and last but not least, deformative). This way, a series of anterior approaches allowed surgeons to gain access to the anterior part of the spine and the posterior mediastinum. The approaches described by Hodgson, Mirbaha or transthoracic transpleural approach (T4-T11), are enumerated. The idea to allow a more visible and extensive approach, but to avoid respiratory issues due to the lesion of the pleura, led to the description of a new anterior approach by Burnei in 2000. MATERIAL AND METHOD: Burnei's approach represents an anterior approach to the thoracic spine, being a transthoracic and retropleural one. This approach allows a large area of spinal pathology due to infectious, traumatic, tumoral and degenerative (idiopathic or congenital scoliosis) causes. Statistically, this approach has been performed more frequently in cases of spinal instrumentation after diskectomy, in order to perform a partial correction of severe, rigid idiopathic scoliosis with more than 70 degrees Cobb and in cases of congenital scoliosis for hemivertebra resection and somatic synthesis to correct the scoliotic curve. RESULTS: This kind of anterior approach allows the surgeon a large visibility of the anterior thoracic spine, diskectomies of up to 5 levels to tender the curve of the deformity and to ensure somatic or/ and transpedicular synthesis of up to 6 thoracic vertebrae. By performing a thoracotomy involving the resection of the posterior arches of the ribs, a thoracoplasty is also ensured with functional and aesthetic effects, by ameliorating the thoracic hump due to the scoliotic deformity. CONCLUSIONS: Burnei's approach joins all the other anterior approaches of the spine, addressing a large area of pathology of the thoracic spine. Even if difficult to be performed, requiring a thorough and perfect technique in the hands of a skilled surgeon, it will ensure satisfaction due to the detailed and visible exposure of the thoracic spine.


Assuntos
Procedimentos de Cirurgia Plástica/métodos , Pleura/cirurgia , Doenças da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia , Brunei , Humanos , Escoliose/cirurgia
3.
J Med Life ; 8(2): 239-44, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25866585

RESUMO

INTRODUCTION: The existent classifications of congenital scoliosis cannot contain all the cases encountered in the medical practice taking into account the complexity of the spine deformity in this pathology. PURPOSE: The paper represents a retrospective study that analyses a new classification of congenital scoliosis in comparison with the existing classification. MATERIALS AND METHOD: This study analyses 56 cases over a period of 14 years (2000-2013), based on the spine dominant deviation: longitudinal or rotational imbalance. RESULTS: This new classification contains not only the formation, segmentation and mixed defects, but also the formation failure with or without fusion failure of the ossification centers (wedged vertebra, hemivertebral body, segmented, hemisegmented, unsegmented hemivertebra, which may be successive, intermittent, alternant compensated or alternant decompensated). It also contains the congenital scoliosis with a rotational imbalance by spinal traction, spinal pushing or by a mixed effect. DISCUSSION: In comparison with the other classifications in literature: Winter, Imagama or Kawakami, this classification systematizes data according not only to the spatial disposition of the hemivertebrae, but also to the balance of the deformity. CONCLUSIONS: In conclusion, this classification of congenital scoliosis has a practical, diagnostic, therapeutical and prognostic use.


Assuntos
Escoliose/classificação , Escoliose/congênito , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Bloqueio Nervoso , Radiografia , Escoliose/diagnóstico por imagem
4.
J Med Life ; 7(4): 595-600, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25713629

RESUMO

INTRODUCTION: Supracondylar fractures of the humerus represent a current concern in the child's and adolescent's osteo-articular pathology. Even though orthopedic reductions are made correctly, fractures can become displaced when managed only by cast immobilization and complications may arise. The most frequent complications encountered in "Prof. Dr. Alexandru Pesamosca" Clinique, Bucharest, Romania, due to supracondylar humeral fractures, are valgus or varus deviations with angles that can sometimes exceed 40 degrees as a result of malunion. Varus or valgus deformations were rarely encountered after surgical treatment. The goal of this study is to present an alternative surgical technique to correct varus and valgus deformations as well as malrotation. MATERIAL AND METHOD: The study is a retrospective analysis of a 96 children study group surgically managed during 1985 and 2013. In the first period, various surgical techniques have been performed: cuneiform resections, step-cut osteotomies, open wedge osteotomies with external fixation, epiphysiodesis, hemichondrodiatasis and Pesamosca metaphyseal diaphyseal osteoplasty. Starting with 2005, all the cases that presented such complications--28 out of 96 (29.1%)--were managed with the Pesamosca procedure. Due to the malunion of supracondylar humeral fractures only varus or valgus deformities were admitted in the study. The malunion due to the pathologic fractures encountered in osteogenesis imperfecta or fibrous dysplasia was precluded. The experience accumulated with the other surgical techniques used in 68 out of 96 patients (70.9%) determined us to exclusively use the Pesamosca osteoplasty following the year 2005, seeing the simplicity and the efficiency of this procedure. RESULTS: The outcome was very good. In 5 cases out of the 28 (17%) an apparent residual elbow was encountered and one case of relapse (3%) was noted due to inadequate term of cast immobilization. The elbow's mobility was completely recovered, the thoracic member's axis was appropriate and the metaphyseal diaphyseal osteotomy site healed completely in 3 months' time. CONCLUSIONS: Compared to other surgical techniques, the Pesamosca technique offers to the surgeon the possibility of correcting the varus or the valgus deformity as well as the malrotation in a simple, secure and efficient manner.


Assuntos
Fraturas Mal-Unidas/cirurgia , Fraturas do Úmero/cirurgia , Úmero/patologia , Procedimentos de Cirurgia Plástica/métodos , Deformidades Congênitas das Extremidades Superiores/cirurgia , Criança , Fixadores Externos , Fasciotomia , Fixação de Fratura , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Fraturas do Úmero/diagnóstico por imagem , Úmero/diagnóstico por imagem , Músculos/cirurgia , Osteotomia , Periósteo/cirurgia , Cuidados Pré-Operatórios , Nervo Radial/cirurgia , Radiografia , Deformidades Congênitas das Extremidades Superiores/diagnóstico por imagem
5.
J Med Life ; 7(4): 493-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25729442

RESUMO

BACKGROUND: Varus or valgus deviations of the femoral neck in osteogenesis imperfecta have been an ignored chapter because the classic correction procedures were applied in medical practice with unsatisfying results. Until the use of telescopic rods, coronal deviations remained unsolved and the distal configuration of the proximal femoral extremity remained uncorrected or partially corrected, which required an extensive use of the wheel chair or bed immobilization of the patient. The concomitant correction of the complex deformities, coxa vara/valga and femoral integrated configuration, have been a progress which allowed the patients to walk with or without support. PURPOSE: The purpose of this study is to present the Burnei's technique, a therapeutic alternative in deformity corrections of the varus or valgus hip in children with osteogenesis imperfecta. STUDY DESIGN: The paper is about a retrospective study done in a single center, which analyses Burnei technique and other procedures described in literature. PATIENT SAMPLE: The content of the article is based on a 12 years experience on a batch of 51 patients with osteogenesis imperfecta from which 10 patients (13 hips) presented frontal plane deviations of the femoral neck. OUTCOME MEASURES: All the patients with osteogenesis imperfecta who presented coxa vara or valga were submitted to investigations with the purpose of measuring blood loss, the possibility of extending the surgical intervention to the leg, the association of severe deformities of the proximal extremity of the femur and the necessity of postoperative intensive care. Burnei's technique: The operation was first performed in 2002. A subtrochanteric osteotomy was made in an oblique cut, from the internal side to the external side and from proximal to distal for coxa vara, or by using a cuneiform resection associated with muscular disinsertions. Only telescopic rods were used for osteosynthesis. DISCUSSIONS: There are a few articles in literature, which approach corrections of vara or valgus deviations in osteogenesis imperfecta. Some of them are the techniques described by Finidori, Wagner and Fassier. CONCLUSIONS: Burnei's technique is simple; it corrects the varus and valgus deviations concomitantly with Sofield-Millar. Even though only a telescopic rod is used, no stress fractures were seen postoperatively, deviation recurrence or assembly loss.


Assuntos
Colo do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Osteogênese Imperfeita/cirurgia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/patologia , Humanos , Cuidados Intraoperatórios , Osteogênese Imperfeita/diagnóstico por imagem , Osteogênese Imperfeita/patologia , Osteotomia , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA