Yazar "Miller, Freeman" seçeneğine göre listele

Listeleniyor 1 - 3 / 3
  • Küçük Resim Yok
    Öğe
    The associated effects of untreated unilateral hip dislocation in cerebral palsy scoliosis
    (LIPPINCOTT WILLIAMS & WILKINS, 2006) Senaran, Hakan; Shah, Suken A.; Glutting, Joseph J.; Dabney, Kirk W.; Miller, Freeman
    Introduction: The presence of a unilateral-hip dislocation in children with cerebral palsy (CP) may cause problems with sitting imbalance, pressure ulcers, and hip pain. There is a dynamic interplay between hip dislocation, pelvic obliquity (PO), and scoliosis. The effect of an untreated unilateral hip dislocation on the rate of curve progression of CP scoliosis has not been defined in the literature. The purpose of this study is to investigate the effect of unilateral hip dislocation on PO and the rate of curve progression in children with spastic quadriplegic CP. Methods: Patients with spastic quadriplegic CP who had spine radiographs at the time of initial presentation with scoliosis and at the latest follow-up were evaluated. Twenty-three children with spastic CP who had an untreated unilateral hip dislocation and scoliosis constituted the study group. The control group consisted of 83 quadriplegic CP patients with scoliosis and well-located hips. The rate of curve progression, incidence of PO, and the rate of PO progression at follow-up were compared between the 2 groups. Results: The mean ages of patients with a unilateral dislocation and with well-located hips at initial radiograph were 10.4 and 10.5 years, respectively. The mean follow-up was 3.5 years. The mean rate of scoliosis curve progression in patients with a unilateral hip dislocation was 12.9 degrees per year. In the control group, the mean progression rate was 12.2 degrees per year. The incidence of PO at follow-up was 74% in scoliotic patients with a dislocation and 63% in scoliotic patients with normal hips. Using repeated-measures analysis of variance, unilateral hip dislocation was found to have no significant effect on scoliosis progression; however, progression of PO was significantly increased in the hip dislocation group (P < 0.05). Pelvic obliquity was corrected after posterior spinal fusion to the sacrum with pelvic fixation, without reducing the hip(s) at the same surgery. Conclusion: Unilateral hip dislocation causes a significant increase of PO but does not affect the rate of scoliosis curve progression.
  • Küçük Resim Yok
    Öğe
    The risk of progression of scoliosis in cerebral palsy patients after intrathecal Baclofen therapy
    (LIPPINCOTT WILLIAMS & WILKINS, 2007) Senaran, Hakan; Shah, Suken A.; Presedo, Ana; Dabney, Kirk W.; Glutting, Joseph W.; Miller, Freeman
    Study Design. Retrospective radiographic and medical chart review with matched control group. Objective. To identify the effect of intrathecal baclofen on the incidence of scoliosis, rate of curve progression, and pelvic obliquity compared with a matched cohort. Summary of Background Data. Although intrathecal baclofen therapy (ITB) has been shown to be effective in decreasing spasticity, case reports have described some children receiving ITB in whom progressive scoliosis was noted; other authors have described no effect on the spinal column. A controlled study has not been performed. Methods. All patients with spastic CP treated with ITB between 1997 and 2003 at a single institution were reviewed. A total of 107 patients undergoing ITB for a minimum of 2 years were identified, of which 26 patients subsequently developed or had progression of scoliosis. Twenty-five age, gender, and gross motor function classification system (GMFCS) score-matched quadriplegic CP patients with scoliosis who did not receive ITB constituted the control group used to compare the rate of curve progression and pelvic obliquity. Results. The average curve progression for the baclofen group after pump implantation was 16.3 per year; and for the control group was 16.1 per year. Both groups' curves progressed over time during growth ( P = 0.001), but baclofen did not have an independent effect on curve progression ( P = 0.181). Average pelvic obliquity for the 2 groups increased over time ( P = 0.001), but there was no difference between the groups ( P = 0.536). Twelve of 57 patients (21%) developed scoliosis after pump implantation during a mean of 3.6 years of follow-up. Thirty of 92 matched control patients (32%) not treated with ITB within the same time interval had scoliosis by maturity. Conclusion. This study demonstrates that ITB has no significant effect on curve progression, pelvic obliquity, or the incidence of scoliosis when compared with an age, gender, and GMFCS score-matched control group of patients with spastic CP without ITB.
  • Küçük Resim Yok
    Öğe
    Subtalar Fusion in Cerebral Palsy Patients Results of a New Technique Using Corticocancellous Allograft
    (LIPPINCOTT WILLIAMS & WILKINS, 2011) Senaran, Hakan; Yilmaz, Guney; Nagai, Mary K.; Thacker, Mihir; Dabney, Kirk W.; Miller, Freeman
    Background: Valgus deformity of the hindfoot in cerebral palsy (CP) patients is common and causes functional deterioration and shoe fitting problems together with skin ulcerations. Our aims in this study are, to present an intra-articular technique of subtalar fusion using allograft and internal fixation to achieve stabilization and second to report the results and clinical outcome of a series of intra-articular subtalar arthrodesis performed in CP children. Methods: We performed a retrospective review of radiographs and medical records of 145 children with CP who underwent intra-articular subtalar fusion from January 1994 to December 2004. The subtalar joint was fixed through the anterior facet with a cannulated screw whereas the anterior aspect of the calcaneus was parallel to the anterior aspect of the head of the talus. Tricortical iliac crest allograft was placed into the sinus tarsi and the denuded posterior facet area. Results are grouped as good, satisfactory, and poor according to the radiographic and clinical outcomes. Results: The mean age at the time of surgery was 12.7 years (range: 5 to 20 y) and the average follow-up was 4.8 years (range: 2 to 11 y). Good results were obtained in 242 feet (96%). Satisfactory results were obtained in 6 feet (2%) which were painless pseudoarthrosis of subtalar joint in 2 feet and screw removal was required in 4 feet because of pain. Nonunion of the subtalar joint together with recurrence of deformity was observed in 5 feet (2%) which is accepted as poor result and required revision surgery. No deep infections, implant failure, allograft failure were observed in a mean of 4.8 years. Conclusions: Our described technique of intra-articular subtalar joint fusion is safe and reliable in CP children with high rate of satisfactory results.