Kontrolirani rast - privremena epifizeodeza - po Stevensu ("eight plate") u liječenju aksijalnih deformacija u djece

master's thesis

• Title (english): Controlled growth - a temporary epyphiseodesis - Stevens method ("eight plate") in treatment of axial deformations in children
• Author: Matea Pirša
• Mentor: Darko Antičević (mentor)
• Committee member: Tomislav Đapić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Darko Antičević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Orthopedics); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Orthopedics

Abstract

Epifizeodeza pločicama osmicama, tzv. kontrolirani rast, nova je tehnika u liječenju deformacija udova koja se na Klinici za ortopediju KBC-a Zagreb počela primjenjivati sredinom 2007. godine. Ideja leži u privremenoj inhibiciji rasta hemiepifize korištenjem tenzije stvorene pločicom u obliku broja osam postavljenom okomito na ploču rasta i dvama vijcima kojima je ona učvršćena ispod i iznad ploče rasta. Cijeli postupak se radi pod kontrolom rendgena intraoperativno. Cilj ovog rada bio je... More prikazati prve rezultate u liječenju pacijenata s deformacijama koljena i gležnjeva na Klinici od svibnja 2007. do lipnja 2013. godine. Ukupno je operirano 49 pacijenata, ali potpunu dokumentaciju dostatnu za obradu imalo je njih 26. Uzorak se sastojao od 2 pacijenta s idiopatskim deformacijama, a ostalih 24 imalo je patološke ploče rasta zbog kongenitalnih displazija i sindroma ili zbog stečenih uzroka. Bilo je 17 dječaka i 9 djevojčica. Ukupno je operirano 38 koljena i 10 gležnjeva. Srednja dob pri operaciji bila je 10,66+/-3,82 godina. Mjerenja kutova rađena su na rendgenskim slikama pune dužine udova u stojećem stavu pacijenta prije i nakon korekcije. Sva mjerenja izvedena su po Paley-u. Korekcija je završena na 23 koljena od kojih 3 koljena zbog prirode bolesti nisu postigla korekciju deformacije. Prosječno trajanje korekcije koljena bilo je 22,2+/-9,1mjeseci. Vrijednosti nakon korekcije bile su: MAD/mm 12,83+/-15,13; mLDFA/° 90,04+/-13,23; MPTA/°86,7+/-6,04 i JLCA/°3,26+/-2,86. Postupak je završen za 7 gležnjeva. Korekcija je prosječno trajala 28,67+/-10,6 mjeseci, a LDTA nakon korekcije bio je 90,57+/-6,53. Komplikacije su se pojavile na 9 koljena. Vjerojatan uzrok toliko visokom broju komplikacija (23,7%) leži u anatomiji i fiziologiji ploča rasta naših pacijenata, odnosno u samom uzorku. Kontrolirani rast kombiniran s inovativnošću, kliničkim iskustvom, dobrom operacijskom tehnikom i procjenom ima široke mogućnosti za razvoj u budućnosti i potencijalan je razlog osmjeha malih pacijenata već sada ali i u budućnosti, zbog manje boli, smanjenja ograničenja kretanja, a kasnije i manje endoprotetskih operacija u starijim godinama. Less

Abstract (english)

Eight plate epiphysiodesis, i.e. controlled growth, is a new technique in treatment of limb malalignment that was first performed at the Clinic for Orthopaedic Surgery in Zagreb in 2007. The idea is to apply tension on hemiepiphysis using eight-plate system to achieve temporary growth inhibition. The procedure is performed under fluoroscopic control during surgery. The aim of this study was to show the first results in treatment of children with knee and ankle malalignment at the Clinic... More between May 2007 and June 2013.
Procedure was performed on total of 49 patients of which only 26 had complete documentation sufficient for processing. Sample was combined from two patients with idiopathic deformities and 24 patients with sick physes, either congenital syndromes and dysplasias or acquiered diseases. There were 17 males and 9 females and total of 38 knees and 10 ancles were treated. Mean age at the time of surgery was 10.66+/-3.82 years. All measurments were performed on full-length X-ray scans in stand-up position following Paley's instructions. 23 knees finished correction and 3 of them showed insuficient or no improvement. Mean duration of correction was 22.2+/-2.1 months and the results showed following means: MAD/mm 12.83+/-15.13; mLDFA/° 90.04+/-13.23; MPTA/°86.7+/-6.04 i JLCA/°3.26+/-2.86. Seven ankles finished correction. Mean duration of correction was 28.6+/-10.6 months and mean LDTA after correction was 90.57+/-6.53. Complications involved nine knees. Probable cause of high complication rate (23.7%) could be our patients growth plate pathology. Combining controlled growth with creativity, clinical experience, solid operating technique and judgement has broad possibilities for future development and is a potential cause of our little patients smiles regarding to decreased pain level, reduced movement limitations and, later in life, fewer endoprothetic operations. Less

• Keywords: kontrolirani rast; epifizeodeza; pločice osmice; deformacije koljena
• Keywords (english): guided growth; epiphysiodesis; eight – plate; knee malalignment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:962475
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-10-12 15:00:44