GENERAL CHARACTERISTICS OF CEREBRAL PALSY PATIENTS

Amaç: Çalışmanın amacı Dokuz Eylül Üniversitesi Tıp Fakültesi serebral palsi polikliniğinde izlenen hastaların genel özelliklerinin araştırılmasıdır. Gereç ve yöntem: Dokuz Eylül Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı ve Ortopedi ve Travmatoloji Anabilim Dalı tarafından yürütülen serebral palsi polikliniğinde 2002 - 2006 yılları arasında standart muayene yöntemleri ile izlenen 150 hasta retrospektif olarak değerlendirildi. Bulgular: Hastaların yaş ortalamaları 7,56 ± 4,68 yıl ve tanı konma yaşı 4,95 ± 4,86 ay olarak saptandı. Etiyolojik faktörler açısından bakıldığında %60,1 prenatal, %29,4 perinatal ve %11,5 olguda postnatal nedenler sorumlu olarak bulundu. Olguların fizik tedavi ve rehabilitasyona başlama yaşı 2,89 ± 5,96 yıl idi ve %80,5'inin bir rehabilitasyon merkezinde düzenli bir tedavi hizmeti aldığı saptandı. Serebral palsi tipi açısından yapılan değerlendirmede %20,7'sini hemiplejik tip, %42'sini diplejik tip ve %37,3'ünü de tüm vücut tutulumu olan kuadriplejik olguların oluşturduğu görüldü. Olguların 42 (%28)'sinde cerrahi ve 50 (% 33,3)'sinde botulinum toksin enjeksiyonu uygulaması yapılmıştı. Sonuç: Serebral palsi çocukluk çağında en sık görülen ve önemli sakatlık nedeni olabilen bir hastalıktır. Bu olguların düzenli olarak izlemi ve gerekli tedavi yaklaşımlarının zamanında uygulanması değerlendirme ve tedavisinde bir multidisipliner yaklaşım gerektirmektedir. Objective: The aim of this study was to investigate the general characteristic of cerebral palsy patients who observed cerebral palsy out patient clinic. Material and method: In this study, one hundred fifty cerebral palsy patients who followed cerebral palsy outpatient clinic between 2002-2006 in the Department of Physical Medicine and Rehabilitation and Department of Orthopaedics, Dokuz Eylul University School of Medicine, were retrospectively evaluated. Results: The mean age of the patients was 7.56 ± 4.68 years and mean age of diagnosis was 4.95 ± 4.86 months. Patients were grouped according to the etiological factors, 60.1% prenatal, 29.4% perinatal and 11.5% postnatal causes. Patients had begun rehabilitation program at 2.89±5.96 year and 80.5% of our patients were followed -on regular rehabilitation program. We classified patient according to the body involvement, 20.7% hemiplegic type, 42% diplegic type and 37.3% total body involvement. Forty-two (28%) of patients had been operated on and fifty (33.3%) of patients had been applied botulinum toxin injection. Conclusion: Cerebral palsy is one of the most common causes of disability in childhood leading functional limitation. Multidisciplinary approach is very important to evaluate and treatment of cerebral palsy patients

Apical instrumentation alters the rotational correction in adolescent idiopathic scoliosis

The aim of this study was to retrospectively evaluate the effect of apical vertebral instrumentation in the axial plane in the surgical treatment of idiopathic scoliosis. Seventy-six consecutive patients with King type 11 idiopathic scoliosis, treated with posterior spinal instrumentation, were included in the study. The mean age of the patients was 14.5 years (range 10-18 years), and the mean follow-up was 49 (range 28-74) months. Preoperative radiological evaluation was performed with postero-anterior, lateral, traction and side-bending radiographs. Vertebral rotation was measured with a Perdriolle torsion meter. Patients were retrospectively divided into two groups according to the presence of apical vertebra instrumentation. Group 1 consisted of 43 patients in whom the upper and lower neutral and intermediate vertebrae of thoracic curves had been instrumented on the concave side. Group 2 consisted of 33 patients who had received instrumentation of the apical vertebra on the concave side in addition to the instrumentation configuration of group 1. Posterior fusion was added in all patients. Cobb and Perdriolle measurements were compared between the two groups preoperatively and at the last follow-up. Preoperative age and gender distribution, Cobb angle and rotational measurements, and correction ratios on side-bending films were similar in the two groups. Although the differences between the two groups in preoperative mean values of both Cobb angle and apical rotation were not statistically significant (P>0.05), mean values of apical rotation were significantly different postoperatively (P<0.05). At the same time, apical derotation ratios differed significantly between the two groups (P=0.000). We conclude that instrumentation of the apical vertebra provides better derotation at the apex