RESUMEN
The need for a screening programme for spinal stenosis in children with achondroplasia undergoing limb lengthening was identified in a tertiary limb reconstruction service. The aim of this study was to evaluate whether screening would identify the 'at risk' group. A total of 26 achondroplastic patients underwent our screening programme. Canal diameters were measured by MRI. Neurosurgical interventions were recorded. Of the patients, 13 had severe foramen magnum narrowing. Six patients required single or multiple surgical decompressions. We identified female sex, delayed milestones and a tight cervicomedullary junction as high risks. We stress upon the importance of developing a nationalized screening programme with guidelines to identify a high-risk group.
Asunto(s)
Alargamiento Óseo , Diferencia de Longitud de las Piernas/cirugía , Tamizaje Masivo/métodos , Estenosis Espinal/diagnóstico , Adolescente , Niño , Femenino , Humanos , Incidencia , Diferencia de Longitud de las Piernas/diagnóstico , Diferencia de Longitud de las Piernas/etiología , Masculino , Osteocondrodisplasias/complicaciones , Osteocondrodisplasias/diagnóstico , Osteocondrodisplasias/cirugía , Reproducibilidad de los Resultados , Estudios Retrospectivos , Estenosis Espinal/complicaciones , Estenosis Espinal/epidemiología , Reino Unido/epidemiologíaRESUMEN
We retrospectively reviewed the results of joint distraction and reconstruction in complex knee contractures in 6 patients with 9 knees. The circular Ilizarov fixator was used in all cases. Extensor mechanism alignment with frame in situ was performed in 4 cases and alignment of mechanical axis of the lower limb was done in 2. All patients had a mean total arc of movement of 79 degrees before operation; however, this was nonfunctional because of the degree of flexion contracture. Three of the 6 patients were nonambulant before surgery. After joint distraction and reconstruction, mean total arc of movement remained unchanged, but this was more functional with improvement in the mobility status. At an average follow-up of 53 months, the mean flexion contracture was 100 degrees (range, 0-70 degrees), with further flexion possible up to 90 degrees (range, 60-120 degrees). Four patients had no recurrence. All 6 patients were ambulant with or without orthosis. Rebound phenomenon with loss of achieved correction was observed in 2 patients. Four patients were quite satisfied with results of surgery. Realignment of the extensor mechanism and mechanical axis is an important part that needs to be addressed in flexion contractures of the knee. Proper preoperative planning and staged procedures reduce the risk of recurrence. A treatment protocol is proposed to help in planning and further management.
