Assessment of the quality of life in patients with varying degrees of equalization of lower limb length discrepancy treated with Ilizarov method.

BACKGROUND: Inequalities in leg length result in functional disorders, as they impair the biomechanics of the musculoskeletal system, significantly reducing the quality of life (QoL). This study used the WHOQoL-BREF questionnaire in patients with varying degrees of lower leg shortness who had undergone treatment by the Ilizarov method, compared to a healthy control group. METHODS: Fifty-eight patients treated with the Ilizarov method for discrepancies in lower limb length were grouped by degree of limb equalization (group 1, 37 treated individuals with limb length discrepancy < 1 cm; group 2, 21 individuals with discrepancy ≥ 1 cm but not more than 4 cm). The control group 3 contained 61 healthy individuals. Patient quality of life (QoL) was assessed using a shortened version of the WHOQoL-BREF questionnaire, at least 24 months after the end of Ilizarov therapy. RESULTS: Control subjects obtained higher scores in all domains than subjects in both treatment groups, as well as significantly higher self-assessed QoL, and health, in the physical, psychological, social, and general lifestyle domains, as compared to those with inequalities ≥ 1 cm. Furthermore, patients with inequalities ≥ 1 cm had higher odds ratios of low self-assessment (3.28 times; p = 0.043), low self-assessment of health (4. 09 times; p = 0.047), and low physical and psychological domains (respectively 6.23 times; p = 0.005 and 8.46 times, p = 0.049) compared with patients with inequality < 1 cm. The shortened version of the WHOQoL questionnaire was used. CONCLUSIONS: After at least 24 months of treatment with the Ilizarov method, patients with limb length discrepancy < 1 cm did not differ significantly from healthy individuals in the WHOQoL self-assessment of mental functioning, social, or life satisfaction.

Myoelectrical activity of muscles stabilizing the sacroiliac joints before and after the use of elastic tapes in women suffering from Pregnancy-related Pelvic Girdle Pain.

OBJECTIVES: The aim of this study was the analysis of activity of selected muscles stabilizing the sacroiliac joints in pregnant women suffering from pelvic pain and changes in the pattern in response to the implementation of Kinesio Taping (elastic tape). MATERIAL AND METHODS: Seventeen women with Pregnancy-related Pelvic Girdle Pain and 20 pregnant women without pain in the lumbar-pelvic complex were enrolled into the study. In patients with pelvic pain, the parameters describing the action of the muscles were assessed: before the tape was applied, immediately after application, 3 days into application and 5 days after the cessation of taping. In the control group, the test was carried out one time. The activity of the muscles was measured during extension of the hip from a four-point kneeling position. RESULTS: The gluteus maximus muscle shows higher resting activity values than in the control group, before and after application of the tape as well as five days after the removal of the tape. Before application, the gluteus maximus activates quicker than in the control group while the ipsilateral extensor spinae had a delayed activation when compared to the control group. CONCLUSIONS: The patterns of activation of tested muscles and their action potential values are different in the group of women with pelvic pain compared to the group without pelvic pain. The application of KT in the lumbar region appears to alter the activation of the GM muscle as well as improve activation of IES muscle during hip extension from the four-point-kneeling position.

Impact of Kinesio Taping application on pregnant women suffering from pregnancy-related pelvic girdle pain - preliminary study.

OBJECTIVES: The aim of the study was to assess the impact of pregnancy-related pelvic girdle pain on every day functioning and evaluate how effective Kinesio Taping is in reducing pain for pregnant women. MATERIAL AND METHODS: 24 women filled the author's questionnaire, Oswestry Disability Index Questionnaire and Pelvic Girdle Questionnaire before starting the therapy. Elastic tape was applied onto the lumbosacral area for 5 days and was evaluated 1st day of the test immediately before application, day 2, 3, 4, 5, 6 and 10 day of the examination. RESULTS: ODI score was 20.09 and showed major disability resulting from severity of the pain. PGQ score was 19.909. Sig-nificant pain reduction was registered on the 3rd day after tape was applied, significant pain reduction on the day of tape removal, and 5 days after tape removal. CONCLUSIONS: Elastic tape decreases pain in pregnancy-related pelvic girdle pain. Pelvic girdle pain deteriorates the quality of life for pregnant women.

Lower extremity muscles activity in standing and sitting position with use of sEMG in patients suffering from Charcot-Marie-Tooth syndrome.

There is very limited, evidenced data about movement possibilities in patients with high level of lower limb muscles atrophy and fatigue in patients suffering from Charcot-Marie-Tooth syndrome. Patient (age 46) suffering from Charcot-Marie-Tooth disease for 30 years with multiple movement restrictions and muscles atrophy above knees took part into the study. Tests were performed for 8 muscles of the lower limb and pelvis. Muscles electrical activity was tested in sitting and standing position (for knees extended and hyperextended). In the right leg rectus femoris, vastus lateralis obliquus, gluteus medius and semitendinosus muscles activated at first and were working the longest time. The highest activity was observed in standing position with knees extended. In the left leg rectus femoris and biceps femoris muscles activated at first and biceps femoris was working the longest time. Activity level in left lower limb is much lower than in the right one. Muscles weakness is asymmetric. Left leg is much weaker and engages antagonists and synergists muscles to compensate weaker rectus femoris, vastus medialis obliquus and vastus lateralis obliquus.

Pedobarographic analysis of body weight distribution on the lower limbs and balance after Ilizarov corticotomies.

BACKGROUND: Symmetrical distribution of the load of the lower limbs and balance are among the determinants of proper biomechanics of the musculoskeletal system. So far, it has not been elucidated whether the correction of the axis and the equalization of the length of the lower limbs allow for achieving proper balance and load distribution. The aim of the present study was to compare load distribution and balance of patients who underwent Ilizarov method corticotomies with healthy controls. METHODS: The clinical studies evaluated 57 patients, who underwent corticotomy with the Ilizarov method. The control group consisted of 59 healthy volunteers. The evaluation assessed the distribution of the load of the lower limbs and balance using pedobarographic platform. FINDINGS: In the study group operated limb bore 48.02% of the load on average, while the healthy limb 51.98%. These differences were not statistically significant. The average percentage of load in limbs in treated and control groups did not differ significantly. In the study group, the average length of path of the center of gravity was 145.47cm. In the control group, the average length of path of the center of gravity was 112.69cm. In the study group, the average area of the center of gravity was 7.54cm(2), while in the control group it was 5.19cm(2). INTERPRETATION: Ilizarov method corticotomy allows for the obtainment value of the load distribution of the lower limbs in the study group not significantly different from those in a control group, but does not ensure the achievement of completely normal balance.

Results and biomechanical consideration of treatment of congenital lower limb shortening and deformity using the Ilizarov method.

One of the applications of the Ilizarov apparatus is the correction of congenital shortening and deformities. Ilizarov external fixator produces biomechanical structure with surrounding tissue, which is the reason why very important is correct stability of fixator. Large distraction in the case of high value of lengthening, and large deformity corection result in shear stresses that occur additionally in the regenerate, which can potentially lead to damage of the regenerating nutritive microcirculation of bone tissue and bone fragment displacements. Our objective was to assess the results of the Ilizarov method in the treatment of congenital shortening taking into account treatment strategy and the size of the axis of lengthening and correction. Our research problems include presenting the effects of biomechanics of musculoskeletal deformations on treatment results, presenting complications and their treatment. Between 1989 and 2009, 62 patients underwent surgery to correct congenital lower limb deficiencies at our Clinic; 33 patients were followed-up. In total, there were 70 surgeries (2.12/patient). Axial correction was performed in 26 patients (78.79%). Average age at the start of the treatment was 15.58 years. Mean follow-up was 8.58 years. Mean lengthening per surgery was 3.17 cm with the lengthening index of 50.7 day/cm. Results were very good for 23 patients, good for 7 patients, satisfactory for 3 patients. Complications appeared in 24 patients, problems occurred in 74.42% of the cases, obstacles in 4.65% of cases, and true complications in 20.93% of the cases. The best results were achieved in the treatment of patients with two-stage and two-segment lengthening with a total elongation of less than 7 cm, and without correction of the axis. Congenital shortening of the lower limb should be treated comprehensively because the shortening applies to all segments, and disturbs biomechanics of all lower limb. In the case of axial correction and large amount of elongation high soft tissue forces counteract the distraction forces. Hybrid construction may help to shorten treatment time, increase fixator stability and decrease rate of complications. We suggest use of hybrid Ilizarov fixator, especially when large elongation and axis corection are planned.

Estimation of patient knowledge on rheumatoid arthritis in the range of their own disease--preliminary study.

BACKGROUND: Knowledge is an essential element of treatment which allows patients to take care of themselves, to undertake every day activities and to make decisions essential from the point of view of health. A patient suffering from rheumatoid arthritis needs support, assistance from his family and from medical staff. It depends on him how much the disease will change his life and how he will cope with all the problems related to the psychological, physical and social aspects of life. Each patient should know what his disease is. If he does not receive this information from the qualified staff, he will try to find some information from different sources and then the information may be incomplete and may provoke negative reactions which will make the process of treatment more difficult. OBJECTIVES: Defining the source of the patient's knowledge about his disease and the role and tasks of health education in transferring knowledge to the patient and in building his attitude to the treatment. Increasing participation of a therapeutic team in health education in order to propagate the awareness and need of prevention and physical effort for bringing back normal state of health. MATERIAL AND METHODS: The subject of studies included 270 people with rheumatoid arthritis. The patients examined were treated in the Clinic of Rheumatology and Internal Diseases of the University of Wroclaw since 1st February, 2010 till 15th February, 2011. A self-made questionnaire was used for studies, aimed at obtaining basic information about patients with a diagnosed rheumatoid arthritis. Statistical calculations were made with package Statistica 9 PL. Tests on essentiality of differences were calculated with T-Student test for quantitative data and chi2 test for qualitative data. Abroad, the level of significance was a value of 0.05. RESULTS: The examined patients were divided into 2 groups according to gender. These groups were similar in respect of age, place of residence, professional activity, working time and co-existing diseases excluding osteoporosis which was more frequent in women. A higher level of education was represented by women who were single or widowed or suffered from rheumatoid arthritis for a longer time than men. In women there were more frequent cases of rheumatoid arthritis in the family. In the group of men there were more patients smoking cigarettes and among the smokers they smoked more than women. Women more often realized preventive procedures such as: regular taking medicines, gymnastics and healthy diet. CONCLUSIONS: The condition of knowledge of women on their own disease is definitely higher and relatively high. It was revealed that the interest in obtaining information on the disease is higher in people with higher education both in women and men. Independently of the age, the main source of knowledge on the disease is a doctor, physiotherapist or a nurse. Educational deficiency in therapeutic teams was revealed, which indicates the necessity of developing information programmes and of running trainings, talks aiming at increasing knowledge on rheumatoid arthritis among patients.

[The usefulness of the latest diagnostic and therapeutic criteria ACR/EULAR in the treatment of rheumatoid arthritis]. / Przydatnosc najnowszych kryteriów diagnostycznych i terapeutycznych ACR/EULAR w leczeniu reumatoidalnego zapalenia stawów.

In Poland nearly 400 thousand people are treated for rheumatoid arthritis and each year there are about 8 to 16 thousand new patients with this disease. Rheumatoid diseases constitute and enormous health problem which statistically encounters every the third person of the population. The condition for effective treatment of rheumatoid arthritis is early diagnosis and aggressive treatment of disease. So it became necessary to develop in 2010, the new ACR/ EULAR, much simpler than the ACR criteria of 1987, intended to enable the rapid implementation of appropriate intensive treatment, both conventional disease modifying drugs and biologicals.

Assessment of functional abilities of patients with contraindications to operative treatment of femoral neck fractures.

BACKGROUND: Major obstacles to operative treatment of elderly patients with femoral neck fractures frequently encountered in clinical practice include poor overall health, lack of consent to have an operation, and general medical or anaesthesiological contraindications. In such cases, conservative treatment is the only possibility. This aims at maximally improving the patient's functional status, an approach best termed "movement-oriented patient management". MATERIAL AND METHODS: The study population consisted of 51 patients (31 F, 20 M) with femoral neck fractures in whom surgery was contraindicated. The patients took part in a movement-oriented management programme. The study consisted in evaluating movement abilities, self-care and locomotion of the patients using the Harris and Lazansky scales. Patients were evaluated twice: at discharge from hospital and at three months after discharge. RESULTS: In patients assessed using the Lazansky score, Evaluation 1 revealed 88% poor results and 12% satisfactory results, compared to 63% poor results and 37% satisfactory results at evaluation 2. Harris scores did not differ between Evaluations 1 and 2, with 100% of the patients achieving the lowest scores. CONCLUSIONS: 1) The study population of patients with femoral neck fractures in whom surgery was contraindicated did not demonstrate a definite improvement or deterioration of their functional status following "movement-oriented management"; 2) "movement-oriented management" cannot be regarded as having any effect on change in functional status, which should therefore be improved using a more beneficial method of treatment.

Our experiences in the reconstruction of bone stock deficiency with allogenous lyophilized bone graft after surgical resection of the giant-cell tumour.

Introduction. The aim of this work is to evaluate lyophilized bone graft addressed in deficiency of bone stock after surgical resection of the giant-cell tumour. The adaptive remodeling of the graft in a function of time was screened as well.
Material and Methods. Research is based on 12 patients who underwent resection of the giant-cell tumour. Postresectional bone stock deficit was reconstructed with autogenous lyophilized bone graft. In 4 cases the changes was situated in distal part of femur, in 5 cases in proximal femur and in 3 cases in distal radius. Mean observation time was 5,1 years (1-11 years). The functional outcome was evaluated on the scale proposed by Enneking and al. The adaptive remodeling and osseointegration of the graft has been evaluated by densitometric analysis of X-rays.
Results. In the functional outcome we gained good and very good results in 9 cases after resection of tumor from knee joint ends, two fair and one poor results after tumour resection from distal radius. In one case of reconstruction in distal radius we could not identify osseointegration. The rests of the cases have had full bone remodeling with graft osseointegration 12 month after operation.
Conclusions. Solid, lyophilized human bone grafts osseointegrate with surrounded bone and are very good biological material for bone reconstructive surgery.

Problems in the rehabilitation of patients treated with the Ilizarov method.

The implementation of the Ilizarov method in the treatment of diseases and post-traumatic injuries to the locomotor system has opened up new possibilities for the management of unequal limb length and limb deformity. The final treatment outcome depends on many factors, one of the most important of which is proper and systematic rehabilitation. Among the essential problems entailed in this process are spastic contractures, limitations in the range of mobility in joints adjacent to the lengthened segment, and the lack of patient cooperation.The solution of these problems in the course of rehabilitation improves limb function and esthetic appearance, thereby eliminating the feeling of being cut off from the environment.