OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V) older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra) and valgus proximal osteotomy of the femur (VPOF) associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips) or VPOF (14 patients, 23 hips) were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints) and VPOF – in 14 patients (23 joints). Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices

Cluster based on mobile devices

The main goal o f this final project is to study the practical computational efficiency of a cluster based on mobile devicesye

Многоуровневые инъекции ботулинического токсина типа А (Абоботулотоксина) при лечении спастических форм детского церебрального паралича: ретроспективное исследование опыта 8 российских центров

Background: The contemporary application of Botulinum toxin A (BTA) in cerebral palsy (CP) implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals) in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections) for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months). Multilevel BTA injections were indicated for the majority (n = 634, 87.6%) of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U), the repeated injections doses up to 45 U/kg (1000 U) (in most centers). The median intervals between the repeated injections were 180–200 days in 484 (66.9%) patients and 140–180 days in 157 (24.7%) patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection.Современная концепция ботулинотерапии при детском церебральном параличе (ДЦП) предлагает использование многоуровневых инъекций в расширенное число мышц. Однако по-прежнему отсутствует консенсус относительно выбора оптимальных доз, мышц и интервалов между инъекциями.Цель исследования: изучить российский опыт применения однократных и повторных многоуровневых инъекций абоботулотоксина при лечении спастичности у пациентов с ДЦП.Методы: в ретроспективном исследовании проанализирован опыт ботулинотерапии при ДЦПв 8 специализированных центрах России. Изучали протоколы клинически эффективных инъекций. Оценивали общие дозы препарата БТА, дозы на единицу массы тела пациентов, на всю инъекционную сессию и отдельные мышцы, а также интервалы между инъекциями.Результаты: изучено 1872 протокола клинически эффективных инъекций, всего от 1 до 14 повторных инъекций, сделанных 724 пациентам в возрасте от 8 мес до 17 лет 4 мес (медиана возраста на момент первой инъекции БТА — 3 года 10 мес) на момент начала ботулинотерапии. Большинство пациентов (n = 634; 87,6% инъекций) получили многоуровневую ботулинотерапию. Во всех центрах при первичных инъекциях БТА медиана доз находилась в пределах 30–31 Ед/кг массы тела (общая — 500 Ед). При повторных инъекциях в большинстве учреждений максимальные дозы превышали 45 Ед/кг (1000 Ед). Средние интервалы между повторными инъекциями колебались в пределах 140–180 сут для 157 (24,7%) и 180–200 сут для 484 (66,9%) пациентов. В 2 из 8 центров пациенты с наиболее выраженными двигательными нарушениями (GMFCS IV–V) требовали более частых повторных инъекций БТА.Заключение: в специализированных центрах большинству пациентов с ДЦП ботулинотерапию проводили по многоуровневой схеме. Общая доза абоботулотоксина при первичных инъекциях составляла 30–31 Ед/кг; при повторных инъекциях она могла быть увеличена до 40 Ед/кг и более. Вопрос о повторном проведении инъекции БТА рассматривался в интервале 140–200 сут после предшествующей инъекции

Rating of intra-operative neuro-monitoring results in operative correction of the spinal deformities

Purpose of the work was filing the electrophysiological phenomena observed in the process of intra-operative neuromonitoring followed by development of the results’ scale of intra-operative neuro-physiological testing of the pyramidal tract. Materials and мethods. The selection for evaluation included data of 147 protocols of intra-operative neuromonitoring in 135 patients (53 males, 82 females), aged from 1 y. 5 m. to 52 years (14,1±0,7 years) with spinal deformities of different etiology who underwent instrumentation spinal correction followed by fixation of thoracic / thoracolumbar spine segments using various variants of internal systems of trans-pedicular fixation. Intra-operative neuro-monitoring was performed using system «ISIS IOM» (Inomed Medizintechnik GmbH, Germany). The changes of motor evoked potentials were evaluated according to this scale. Results. Five types of pyramidal system reaction to operative invasion were revealed. According to neurophysiological criteria three grades of the risk of neurological disorders development during operative spinal deformity correction and, correspondingly, three levels of anxiety for the surgeon were defined. Conclusion. Intra-operative neurophysiological monitoring is the effective highly technological instrument to prevent neurological disorders in the spinal deformity. Offered rating scale of the risk of neurological complications gives the possibility to highlight three levels of anxiety during operative invasion

Cluster based on mobile devices

yesThe main goal o f this final project is to study the practical computational efficiency of a cluster based on mobile device

Surgical treatment of children with non-traumatic old atlanto-axial rotatory fixation

Atlanto-axial rotatory fixation (AORF) develops on the background of acute torticollis. Widely adopted terms such as C1 subluxation or atlantooccipital rotational subluxation do not reflect the core of this pathology and carry negative weight in the diagnostics and treatment of AORF. Retrospective analysis of the diagnostics and treatment outcome of 5 children with confirmed AORF diagnosis and literature review were performed. Clinical method, radiography and functional computer tomography were used to verify the diagnosis. De-rotational halo-traction and open correction with screw fixation were applied for treatment. Head position was managed to be improved in all patients. In one case the reduction was performed using correction in suboccipital segments and in other 4 cases the correction and fixation by Harms and de-rotational halo-traction allowed to correct torticollis. The pain syndrome had been arrested completely. Disease outcome resulted in formation of C1-C2 fibrous or bone fusion regardless the method of treatment. The patients with neglected AORF represent a great challenge for diagnostics and treatment. When conservative treatment fails it is necessary to involve de-rotational halo-traction with possible application of open reduction and posterior fusion. The purpose of treatment is to eliminate torticollis and pain using creation of proper C1-C2 alignment. The motions in atlantooccipital joint do not restore due to formation of the fibrous or bone fusion