Study Design: A prospective, observational case series of eighteen children with early onset scoliosis undergo spine manipulation and casting. Objective: Determine if respiratory system compliance decreases during cas...Study Design: A prospective, observational case series of eighteen children with early onset scoliosis undergo spine manipulation and casting. Objective: Determine if respiratory system compliance decreases during casting warrants tracheal intubation in all Derotational casting procedures. Background: Children with early onset scoliosis with a Cobb angle greater than 25 degrees will have significant progression of their scoliosis. Surgical techniques cannot result in spine fusion as growth retardation will ensue. Serial thoracolumbar casting may correct the scoliosis or delay the need for surgery. The cast, however, is highly restrictive until the cast is appropriately cut. Does respiratory system compliance decrease a significant degree to require tracheal intubation in all Derotational casting procedures? Methods: Eighteen children (mean age: 4.5 years, mean weight: 16.9 kg) undergoing initial scoliosis casting were enrolled. Anesthesia was induced with sevoflurane in oxygen, an intravenous catheter was inserted, intravenous propofol administered and tracheal intubation performed. Baseline measurements of heart rate, blood pressure, SpO2, peak inspiratory pressure (PIP), and pulmonary compliance were made before casting, immediately after casting, and after cast cut-out. Results: PIP increased from 15.8 cm H2O to 42.6 after cast application and decreased to 20.2 after cast cut-out. Compliance decreased from 1.08 ml/cm H2O/kg to 0.21 after cast application and increased to 0.61 after cast cut-out. There were no clinically significant changes in heart rate, blood pressure, or SpO2. Conclusion: The thoracolumbar cast applied for scoliosis treatment causes severe restriction of chest wall movement and subsequent deterioration of pulmonary function. The time of severe restriction of chest wall motion is short and is relieved once cast cut-outs are performed. The marked increase in PIP and decrease in compliance that occurs during the casting process necessitates tracheal intubation.展开更多
Background: There are at least 5 very popular methods described for the correction of mild to moderate hallux valgus deformities. Despite of reported and self experienced good results in favorable fitting preoperative...Background: There are at least 5 very popular methods described for the correction of mild to moderate hallux valgus deformities. Despite of reported and self experienced good results in favorable fitting preoperative anatomical conditions of some of these methods;it seems that no one is really satisfying under “difficult” or non favorable preoperative anatomic conditions. How could an optimum operation method for a satisfying correction of a mild to moderate hallux valgus look like? The well known criteria for an optimally satisfying method to achieve full normalization of important forefoot parameters under all conditions should be a lateralization, plantarization and derotation of the Ist metatarsal head and also a normalization of the distal metatarsal articular angle (DMAA) in combination with a soft tissue correction. Methods: In order to achieve this outcome without the disadvantages of shortening or the need for unloading, we developed a new operation technique and new fixation devices. We performed a simple transverse lazy-L subcapital osteotomy and after an additional soft tissue release the Ist metatarsal head was restored to its preplaned optimum position in terms of narrowing the IM angle, plantarization, correction of the hallux valgus angle, derotation of a pronation l malrotation and improvement of the DMAA. Fixation was achieved with an intramedullary angel-stable transfixed 30 mm titanium plate. The rigidity of the implant rendered interfragmental compression or solid bone contact unnecessary. The goal was only an optimal correction. All patients were allowed to ambulate with full weightbearing immediately after the operation. Results: We retrospectively reviewed 346 patients (433 feet) who underwent subcapital osteotomy between May 2007 and December 2011;308 were women and 38 men;their mean age was 65 years. The follow-up investigation was performed on average after 6.5 years (78 months);range 5.5 to 10 years (66 to 120 months). The AOFAS Score improved from 61.18 to 96.82 (t = 55.13, p ° to 4.21° (t = 89.70, p ° to 7.75° (t = 51.68, p ° to 6.61° (t = 29.34, p < 0.001). Minimal shortening of the first metatarsal (0.33 mm) and no recurrence of the deformity was observed. Conclusion: A new access to hallux valgus surgery is presented. Our results show that interfragmental compression between the osteotomy partners or good interfragmental contact is not necessary when a rigid intramedullary fixation device is used. The goal of this approach to hallux valgus surgery was to achieve excellent correction and a very rigid intramedullary angle-stable locked implant. The procedure yielded excellent results and was associated with no recurrence of hallux valgus.展开更多
文摘Study Design: A prospective, observational case series of eighteen children with early onset scoliosis undergo spine manipulation and casting. Objective: Determine if respiratory system compliance decreases during casting warrants tracheal intubation in all Derotational casting procedures. Background: Children with early onset scoliosis with a Cobb angle greater than 25 degrees will have significant progression of their scoliosis. Surgical techniques cannot result in spine fusion as growth retardation will ensue. Serial thoracolumbar casting may correct the scoliosis or delay the need for surgery. The cast, however, is highly restrictive until the cast is appropriately cut. Does respiratory system compliance decrease a significant degree to require tracheal intubation in all Derotational casting procedures? Methods: Eighteen children (mean age: 4.5 years, mean weight: 16.9 kg) undergoing initial scoliosis casting were enrolled. Anesthesia was induced with sevoflurane in oxygen, an intravenous catheter was inserted, intravenous propofol administered and tracheal intubation performed. Baseline measurements of heart rate, blood pressure, SpO2, peak inspiratory pressure (PIP), and pulmonary compliance were made before casting, immediately after casting, and after cast cut-out. Results: PIP increased from 15.8 cm H2O to 42.6 after cast application and decreased to 20.2 after cast cut-out. Compliance decreased from 1.08 ml/cm H2O/kg to 0.21 after cast application and increased to 0.61 after cast cut-out. There were no clinically significant changes in heart rate, blood pressure, or SpO2. Conclusion: The thoracolumbar cast applied for scoliosis treatment causes severe restriction of chest wall movement and subsequent deterioration of pulmonary function. The time of severe restriction of chest wall motion is short and is relieved once cast cut-outs are performed. The marked increase in PIP and decrease in compliance that occurs during the casting process necessitates tracheal intubation.
文摘Background: There are at least 5 very popular methods described for the correction of mild to moderate hallux valgus deformities. Despite of reported and self experienced good results in favorable fitting preoperative anatomical conditions of some of these methods;it seems that no one is really satisfying under “difficult” or non favorable preoperative anatomic conditions. How could an optimum operation method for a satisfying correction of a mild to moderate hallux valgus look like? The well known criteria for an optimally satisfying method to achieve full normalization of important forefoot parameters under all conditions should be a lateralization, plantarization and derotation of the Ist metatarsal head and also a normalization of the distal metatarsal articular angle (DMAA) in combination with a soft tissue correction. Methods: In order to achieve this outcome without the disadvantages of shortening or the need for unloading, we developed a new operation technique and new fixation devices. We performed a simple transverse lazy-L subcapital osteotomy and after an additional soft tissue release the Ist metatarsal head was restored to its preplaned optimum position in terms of narrowing the IM angle, plantarization, correction of the hallux valgus angle, derotation of a pronation l malrotation and improvement of the DMAA. Fixation was achieved with an intramedullary angel-stable transfixed 30 mm titanium plate. The rigidity of the implant rendered interfragmental compression or solid bone contact unnecessary. The goal was only an optimal correction. All patients were allowed to ambulate with full weightbearing immediately after the operation. Results: We retrospectively reviewed 346 patients (433 feet) who underwent subcapital osteotomy between May 2007 and December 2011;308 were women and 38 men;their mean age was 65 years. The follow-up investigation was performed on average after 6.5 years (78 months);range 5.5 to 10 years (66 to 120 months). The AOFAS Score improved from 61.18 to 96.82 (t = 55.13, p ° to 4.21° (t = 89.70, p ° to 7.75° (t = 51.68, p ° to 6.61° (t = 29.34, p < 0.001). Minimal shortening of the first metatarsal (0.33 mm) and no recurrence of the deformity was observed. Conclusion: A new access to hallux valgus surgery is presented. Our results show that interfragmental compression between the osteotomy partners or good interfragmental contact is not necessary when a rigid intramedullary fixation device is used. The goal of this approach to hallux valgus surgery was to achieve excellent correction and a very rigid intramedullary angle-stable locked implant. The procedure yielded excellent results and was associated with no recurrence of hallux valgus.
