scholarly journals Surgical treatment of thumb adduction contracture in children with infantile cerebral palsy

2015 ◽  
Vol 3 (2) ◽  
pp. 25-31
Author(s):  
Vladimir Alexandrovich Novikov ◽  
Valery Vladimirovich Umnov
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Tendon Transfer ◽  
Positive Outcome ◽  
Metacarpophalangeal Joint ◽  
Infantile Cerebral Palsy ◽  
Main Criterion ◽  
Abductor Pollicis Longus ◽  
Selection Of Patients ◽  
Selection Of

The purpose of the work is to evaluate the effectiveness of different methods of surgical treatment of thumb adduction contracture in children with infantile cerebral palsy.Materials and methods.The present study is based on diagnostic results of children with infantile cerebral palsy with affected upper limb. The main criterion for selection of patients was the presence of thumb adduction contracture, the absence of significant positive outcome in a patient after conservative treatment, the impossibility of active thumb abduction more than 30° and the instability of the first metacarpophalangeal joint. Total we examined and treated 9 patients with spastic types of cerebral palsy.Results and conclusions.We evaluated the results of the following types of surgical treatment: release of adductor pollisis muscle, release of adductor pollisis muscle and tendon shortening of m.abductor pollicis longus, release of adductor pollisis muscle and tendon transfer of m.extensor indicis in the tendon m. abductor pollicis longus, the fixation of the first metacarpophalangeal joint with extramedullary plate. Based on these data, we were able to confirm the effectiveness of surgical treatment of thumb adduction contracture.

scholarly journals SURGICAL TREATMENT OF PRONATION CONTRACTURE OF THE FOREARM IN PATIENTS WITH INFANTILE CEREBRAL PALSY

2014 ◽  
Vol 2 (1) ◽  
pp. 39-45
Author(s):  
Vladimir Alexandrovich Novikov ◽  
Valery Vladimirovich Umnov ◽  
Alexei Vasilievich Zvozil
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Specific Method ◽  
Upper Limbs ◽  
Infantile Cerebral Palsy ◽  
Operative Techniques ◽  
Main Criterion ◽  
Methods Of Treatment ◽  
Wrist Joints ◽  
Early Surgical Treatment

The objective of the work was to evaluate the efficiency of the existing methods of surgical treatment of pronation contracture of the forearm, the modification of the existing methods of treatment, the development of the indications for each specific method of treatment. Materials and methods. This study is based on a survey of children suffering from infantile cerebral palsy affecting the upper limbs. The main criterion for the patient selection was the presence of a fixed pronation contracture of the forearm, both isolated and combined with other contractures of the joints of the upper limb. Total 42 patients with spastic forms of cerebral palsy were examined. Results and conclusions. With age of the patient, the pronation contracture is usually increased, the contractures of the elbow and wrist joints may develop, which leads to the necessity for more and more radical operative techniques. Therefore, the early surgical treatment allows obtaining optimal results with its minimum scope. The investigation data gave an option to simplify, but to increase the efficiency of surgical treatment methods of pronation contractures in children with infantile cerebral palsy.

scholarly journals Preliminary results of surgical treatment of flexion-adduction contracture of the first ray of the hand in combination with dislocation in the metacarpophalangeal joint in patients with infantile cerebral palsy

2021 ◽  
Vol 8 (4) ◽  
pp. 417-426
Author(s):  
Dmitry V. Umnov ◽  
Valery V. Umnov ◽  
Vladimir A. Novikov ◽  
Margarita V. Savina
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Upper Limb ◽  
Metacarpophalangeal Joint ◽  
Infantile Cerebral Palsy ◽  
Positive Effects ◽  
Surgical Methods ◽  
First Ray ◽  
Temporary Arthrodesis ◽  
Intermetacarpal Space

Background. Surgical methods of treating flexionadduction contracture of the first ray of the hand in combination with dislocation in the metacarpophalangeal joint in patients with infantile cerebral palsy are divided into surgical interventions on soft tissues and bone surgeries aimed at stabilizing the metacarpophalangeal joint. We have developed a technique of temporary arthrodesis of the metacarpophalangeal joint in combination with the previously used operation to widen the first intercarpal space, combining the positive effects of both groups of operations: stability of arthrodesis with an installed metal structure that enable active movements in the joint in sufficient amplitude after its removal and early postoperative rehabilitation with a stabilized joint. Aim. This study aimed to evaluate the effectiveness of a new method of surgical correction of flexionadduction contracture of the first ray of the hand in combination with metacarpophalangeal joint dislocation in the form of temporary arthrodesis of this joint and widening of the intermetacarpal space in patients with cerebral palsy. Materials and methods. The study analyzed treatment outcomes of patients (n = 11) who underwent temporary arthrodesis of the metacarpophalangeal joint with an extra-bone plate for a period of 1 year and expansion of the first intermetacarpal space. Comparative analysis of the results was carried out 6 months after the operation, 1 year after the operation, and after hardware removal. The amplitude of passive and active movements in the metacarpophalangeal joint was analyzed. The functionality of the upper limb was assessed according to the international classification system MACS 2002 and the block and box test. Results. At 1 year after surgery and removal of the fixation structure, the amplitude of both passive abduction (32.0) and extension (9.5) in the metacarpophalangeal joint increased, and the amplitude of the same movements (leads) increased by 25.5 in abduction and by 4.0 in extension when performed actively. The MACS indicator improved by 1 point. The average dynamics of the block and box test was seven additional cubes. Conclusion. The proposed technique for temporary extra-articular arthrodesis of the metacarpophalangeal joint does not affect the intra-articular structures, unlike intra-articular arthrodesis, and therefore has clear advantages over the latter. This surgical treatment method is effective in increasing the amplitude of active and passive movements of the first ray of the hand and reduces muscle imbalance, which ultimately improves the function of the upper limb as a whole.

Surgical treatment of bilateral temporal lobe pharmacoresistant epilepsy

2020 ◽  
pp. 60-82
Author(s):  
Igor Sergeevich Trifonov ◽  
Mikhail Vladimirovich Sinkin ◽  
Elena Vladimirovna Grigoryeva ◽  
Rashid Abdurakhmanovich Navruzov
Keyword(s):  
Surgical Treatment ◽  
Temporal Lobe ◽  
Clinical Picture ◽  
Clinical Manifestations ◽  
Epileptogenic Zone ◽  
Pharmacoresistant Epilepsy ◽  
Modern Methods ◽  
Selection For ◽  
Selection Of Patients ◽  
Selection Of

Surgical treatment of bilateral temporal lobe pharmacoresistant epilepsy is associated with some difficulties: particularly, the lack of stereotypical clinical picture in the same patient and controversial data on modern methods of diagnostics — all these statements make identifying epileptogenic zone more difficult and lack of clear criteria for the selection of patients for surgical treatment. In this review, issues of aetiology, pathogenesis, clinical manifestations and criteria for the selection for surgical treatment suggested by different authors are presented.

Why is joint range of motion limited in patients with cerebral palsy?

2012 ◽  
Vol 38 (1) ◽  
pp. 8-13 ◽  
Author(s):  
M. de Bruin ◽  
M. J. C. Smeulders ◽  
M. Kreulen
Keyword(s):  
Cerebral Palsy ◽  
Range Of Motion ◽  
Muscle Tone ◽  
Surrounding Tissue ◽  
Spastic Cerebral Palsy ◽  
Joint Angles ◽  
Joint Range Of Motion ◽  
Joint Range ◽  
Selection Of Patients ◽  
Selection Of

Patients with spastic cerebral palsy of the upper limb typically present with various problems including an impaired range of motion that affects the positioning of the upper extremity. This impaired range of motion often develops into contractures that further limit functioning of the spastic hand and arm. Understanding why these contractures develop in cerebral palsy will affect the selection of patients suitable for surgical treatment as well as the choice for specific surgical procedures. The generally accepted hypothesis in patients with spastic cerebral palsy is that the hyper-excitability of the stretch reflex combined with increased muscle tone result in extreme angles of the involved joints at rest. Ultimately, these extreme joint angles are thought to result in fixed joint postures. There is no consensus in the literature concerning the pathophysiology of this process. Several hypotheses associated with inactivity and overactivity have been tested by examining the secondary changes in spastic muscle and its surrounding tissue. All hypotheses implicate different secondary changes that consequently require different clinical approaches. In this review, the different hypotheses concerning the development of limited joint range of motion in cerebral palsy are discussed in relation to their secondary changes on the musculoskeletal system.

MAGNETIC LASER THERAPY OF IRRITATIVE URINARY DISORDERS AFTER SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

Vestnik ◽  
2021 ◽  
pp. 166-168
Author(s):  
А.М. Жаксыбергенов ◽  
А.А. Марат ◽  
Ф.Ж. Хатамов ◽  
Ж.К. Нарманов ◽  
Ж.К. Сырлыбек
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Laser Therapy ◽  
Prostate Gland ◽  
Prostatic Hyperplasia ◽  
Correct Selection ◽  
Urinary Disorders ◽  
Magnetic Laser Therapy ◽  
Selection Of Patients ◽  
Selection Of

Цель: Несмотря на четко определенные критерии отбора пациентов для лечения доброкачественная гиперплазия предстательной железы (ДГПЖ), часть больных остается неудовлетворенной результатами операции. Это вынуждает искать дополнительные методы лечения, которые могли бы войти в комплекс реабилитационных мероприятий для этой категории больных. Методы: В настоящем исследовании мы проанализировали группу пациентов из 69 больных, перенесших оперативное лечение по поводу ДГПЖ (как трансуретральную резекцию предстательной железы, так и открытую аденомэктомию), имевших в послеоперационном периоде выраженную ирритативную симптоматику. Результаты: Эффекты магнитно-лазерной терапии в зоне оперированной предстательной железы способны воздействовать на те звенья патогенеза ирритативных расстройств мочеиспускания, которые недоступны другим методам. Выводы: При правильном отборе пациентов применение магнитно-лазерной терапии на зону оперированной железы, задней уретры и мочевого пузыря позволяет достичь удовлетворяющего пациента результата операции в гораздо ранние сроки, нередко существенно сократить послеоперационной койко-день, в ряде случаев избежать длительного курса антибактериальной терапии или дорогостоящих α--адреноблокаторов. Purpose: Despite the clarity of the selection of patients for the treatment of benign prostatic hyperplasia (BPH), some of the patients are unsatisfied with the results of the operation. This forces us to look for additional methods of treatment that could be included in the complex of rehabilitation measures for this category of patients. Methods: In this study, we analyzed a group of patients from 69 patients who underwent surgical treatment for BPH (both transurethral resection of the prostate gland and open adenomectomy) who had severe irritative symptoms in the postoperative period. Results: The effects of magnetic laser therapy in the area of the operated prostate can affect those links in the pathogenesis of irritative urinary disorders that are inaccessible to other methods. Conclusions: With the correct selection of patients, the use of magnetic laser therapy on the area of the operated gland, posterior urethra and bladder allows achieving a satisfactory surgical result at a much earlier time, often significantly shortening the postoperative bed-day, in some cases avoiding a long course of antibiotic therapy or expensive α-adrenergic blockers.

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