Degree Of Derotation Research Articles

CORRECTION OF SCOLIOSIS IN CHILDREN WITH CONGENITAL HEART DEFECTS

ABSTRACT Objective: The purpose of this study was to evaluate the results of treatment in patients with deformities of the spine and congenital heart defects. Methods: Eighty-seven children aged 10 to 18 years old (27 males and 60 females) were treated surgically due to scoliosis. Results: The minimum angle of the curvature arc was 68°. The deformity parameters were evaluated on the basis of the spine x-ray. In patients with combined and rigid forms of scoliosis, correction was performed using dorsal segmental instrumentation. Where there was rigid deformity and it was not possible to perform a front release according to the somatic indications, a one-stage dorsal correction was performed in conditions of halo traction in combination with SPO or Ponte osteotomy. In patients with moderate impairment of blood circulation in the presence of rigid curvature of the main arch, two-stage surgery was performed, with ventral release at the apex of deformation, followed by halo traction. As a second stage, dorsal correction and stabilization of the spine was performed. In the operated patients, the mean correction with dorsal instrumentation was 64.2%. An average of 12 vertebrae were included in fusion. The degree of apical vertebral body derotation was found to be up to 30% of the initial rotation. With the use of hybrid and hook systems, the average degree of derotation was 18%. According to the physical examination within one year, the parameters of the function of external respiration and bronchial permeability increased significantly, from 10% to 30%, which indicates the functional nature of changes in cardiorespiratory disorders. Level of evidence IV, Case series.

Evaluating the use of an electronic inclinometer in correcting rotational disorders of the hip in children

BackgroundFemoral derotation osteotomies are commonly performed to correct rotational disorders of the hip in children. Surgical correction is typically assessed visually with the use of a goniometer or osteotomy template, but these methods have been shown to be inaccurate. In this study, we aimed to determine the accuracy of an electronic inclinometer in performing derotation osteotomies of 2 different magnitudes in comparison to commonly used visual techniques. MethodsWe performed derotation osteotomies of 15°and 30° in a synthetic femur model using a goniometer, triangle osteotomy template, and electronic inclinometer. The degree of derotation was assessed by computed tomography (CT) and measured by a musculoskeletal radiologist. Statistical analyses included descriptive statistics, as well as t-test, analysis of variance (ANOVA), and Fisher’s exact test to determine differences between osteotomy techniques. ResultsWe performed 40 proximal femoral derotation osteotomies. The mean difference from the planned derotation was 5.9° for the goniometer technique, 3.8° for the osteotomy triangle technique, and 3.2° for the electronic inclinometer technique (p-value = 0.048). There was no difference between the techniques for 15° derotation osteotomies (p-value = 0.28); however, there was a trend towards significance for 30° derotation osteotomies (p-value = 0.07). Fewer osteotomies had a difference greater than 3° from the planned derotation using the electronic inclinometer technique (p-value = 0.04). ConclusionsThe accuracy of derotation osteotomies can be improved with the use of an electronic inclinometer. This technology has the potential to improve surgical technique, minimize surgical error, and possibly improve patient outcomes.

The Impact of Direct Vertebral Rotation (DVR) on Radiographic Outcome in Surgical Correction of Idiopathic Scoliosis

Introduction: Recent developments of spinal instruments allow to address nearly all components of idiopathic scoliosis. Direct vertebral rotation (DVR) maneuver was introduced to correct apical axial vertebral rotation. It is however still not well established how efficiently DVR affects results of scoliosis correction. The object of the study was to evaluate en bloc apical vertebral rotation (DVR) and its impact on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis treatment. Material and methods: 36 consecutive patients who underwent posterior fusion with pedicle screws only constructs for idiopathic scoliosis. 15 patients (20 curves) were corrected by rod derotation only and 21 patients (26 curves) had both rod derotation and DVR. Curve measurements were performed on x-rays obtained before and post operatively - coronal curves, kyphosis (T2-T12, T5-T12). Spine flexibility was assessed on prone bending x-rays. Apical axial rotation was determined on CT scans obtained intraoperatively and postoperatively. Rotation angle (RAsag) was measured according to Aaro and Dahlborn. Results: We observed reduction of RAsag in all patients, however in DVR group decrease was greater, by 31.8% comparing to non-DVR group, by 8.6% (p=0.0003). Mean coronal correction in DVR group was 68.8% and in rod derotation group without DVR 55% (p=0.002). No significant correlation was found between degree of derotation obtained and coronal correction. In DVR group T2-T12 kyphosis has increased in 28 (65%) patients whereas in non DVR group in 31 (69%) cases. Mean value of T2-T12 kyphosis growth was 16.7% in DVR and 22.1% in non DVR group. These differences however did not occur statistically significant. Conclusions: Direct vertebral rotation (DVR) manoeuvre reduces significantly apical rotation of the spine, enhances ability of coronal correction and it does not reduce thoracic kyphosis.

Length Changes of the Hamstrings and Adductors Resulting from Derotational Osteotomies of the Femur

Derotational osteotomies of the femur are frequently performed to treat persons with cerebral palsy who walk with excessive internal rotation of the hip. However, whether these procedures stretch or slacken the surrounding muscles appreciably is unknown. Determination of how muscle lengths are altered by derotational osteotomies is difficult because the length changes depend not only on the osteotomy site and the degree of derotation, but also on the anteversion angle of the femur and the rotational position of the hip. We have developed a three-dimensional computer simulation of derotational osteotomies, tested by anatomical experiments, to examine how femoral anteversion, hip internal rotation, and derotation affect the lengths of the semitendinosus, semimembranosus, biceps femoris long head, adductor longus, adductor brevis, and gracilis muscles. Simulation of derotational osteotomies at the intertrochanteric, subtrochanteric, or supracondylar levels decreased the origin-to-insertion lengths of the hamstrings and gracilis in our model by less than 8 mm (1.8%). Hence, the lengths of the hamstrings and gracilis are not likely to be altered substantially by these procedures. The origin-to-insertion lengths of the adductor longus and adductor brevis decreased less than 4 mm (1.9%) with subtrochanteric correction in our model, but the length of adductor brevis increased 8 mm (6.3%) with 60 degrees of intertrochanteric derotation. These muscles are also unlikely to be affected by derotational osteotomies, unless a large degree of intertrochanteric derotation is performed.

Length changes of the hamstrings and adductors resulting from derotational osteotomies of the femur.

Derotational osteotomies of the femur are frequently performed to treat persons with cerebral palsy who walk with excessive internal rotation of the hip. However, whether these procedures stretch or slacken the surrounding muscles appreciably is unknown. Determination of how muscle lengths are altered by derotational osteotomies is difficult because the length changes depend not only on the osteotomy site and the degree of derotation, but also on the anteversion angle of the femur and the rotational position of the hip. We have developed a three-dimensional computer simulation of derotational osteotomies, tested by anatomical experiments, to examine how femoral anteversion, hip internal rotation, and derotation affect the lengths of the semitendinosus, semimembranosus, biceps femoris long head, adductor longus, adductor brevis, and gracilis muscles. Simulation of derotational osteotomies at the intertrochanteric, subtrochanteric, or supracondylar levels decreased the origin-to-insertion lengths of the hamstrings and gracilis in our model by less than 8 mm (1.8%). Hence, the lengths of the hamstrings and gracilis are not likely to be altered substantially by these procedures. The origin-to-insertion lengths of the adductor longus and adductor brevis decreased less than 4 mm (1.9%) with subtrochanteric correction in our model, but the length of adductor brevis increased 8 mm (6.3%) with 60 degrees of intertrochanteric derotation. These muscles are also unlikely to be affected by derotational osteotomies, unless a large degree of intertrochanteric derotation is performed.

脳性麻ひ児の内旋歩行に対し大腿骨減捻骨切り術と下肢短縮筋群解離術を行なった１０例の検討

Proximal femoral derotational osteotomy was performed bilaterally on 10 children who had spastic diplegia with internal rotation gait, in combination with simultaneous multiple operations for soft tissue contractures of the lower extremities.The degree of derotation was determined intraoperatively and about 10° internal rotation at the hip was expected after surgery. Soft tissue release was followed about 4 weeks after osteotomy.The mean age at operation was 6 (4-10) years.The average follow-up was 1 year and 11 months (4 months-5 years).The average femoral anteversion was preoperatively 62° (55-70°) and improved to 24° (0-50°) in the final examination.The average derotation measured intraoperatively was 56° (45°-70°) and the average internal rotation at the hip reduced from 77° (55°-105°) to 32° (15°-50°) with a similar increase in external rotation after operation. All patients except one showed improvement of the internal rotation gait.One showed a mild recurrence of the unilateral internal rotation gait.The average time to regain preoperative ambulatory status was 5.3 (3.5-9) months. No children got worse in terms of walking ability.We realized that derotational osteotomy is necessary for correcting internal rotation gait in addition to soft tissue release.