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Comparison of the long-term results of conservative and surgical therapies in children's hip pathology according to the type and degree of the disease
Stančák, Andrej ; Trč, Tomáš (advisor) ; Šponer, Pavel (referee) ; Kokavec, Milan (referee)
Legg-Calvé-Perthes (LCP) disease is associated with non-vascular necrosis of proximal epiphysis of the femur resulting in resorption of necrotic bone and subsequent remodelling of femoral head. The risk factors of the disease and factors affecting the treatment outcomes following conservative or surgical therapy are not completely understood. The first part of the thesis outlines the clinical and research problems pertaining to conservative and surgical treatment of LCP disease. The second, clinical part retrospectively analysed the predictors of treatment outcomes in patients treated conservatively or surgically, with emphasis on children younger than 6 years of age. The experimental part of the thesis analysed 3D kinematic data of the gait and hip range-of-motion data in patients treated conservatively or surgically. Age of the patient at the time of diagnosis and the shape of the lateral pillar of femur were significant predictors of treatment outcomes, and treatment outcomes after surgical treatment were comparable in children below and above the age of 6. Gait analysis showed a larger displacement of the pelvis in sagittal plane during the initial 25% of the standardised gait cycle and a larger extent of knee flexion during initial 13% of the gait in patients treated surgically compared to...
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Problems of the hip in patients with childhood cerebral palsy in childhood and adolescence. Experimentally influenced centering of the hip by a combination of operational tactics
Schejbalová, Alena ; Trč, Tomáš (advisor) ; Koudela, Karel (referee) ; Karpaš, Karel (referee) ; Kokavec, Milan (referee)
Cerebral palsy it must be nonprogressive brain lesion or lesions. The original lesion must occur prenatally, at birth, or early in the postnatal period. The primary disorder involves the musculoskeletal systém and lack of motor control, mental retardation or defects of hearing, language. Prevalence of cerebral palsy is different - between 0,6- 5,9 per 1000 births. In Western countries, the birth prevalence rate is about 2,0 per 1000. In children with cerebral palsy the hip joint appears to be relative nornmal at birth. There is abnormally increased femoral anteversion and neck-shaft angle. Increasing adduction-flexion contractures of the hip, acetabular dysplasia, subluxation eventual dislocation of the hip.Adduction deformity of the hip is caused by spasticity and contracture of the hip adductors and the medial hamstrings. Flexion deformity of the hip is primarily caused by spasticity and contracture of the iliopsoas and secondarily by rectus femoris muscles. When the rectus femoris is the cause, hip flexion deformity is increased with the knee in flexion and decreased with the knee in extension. When it is due to the iliopsoas muscle, the position of the knee has no effect on the degree of hip flexion contracture ( Thomas test). On passive flexion of the knee, if the test is positive, the pelvis will...
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Effectiveness of Sonographic Examinations in Prevention and Treatment of Developmental Hip Dysplasia
Zídka, Michal ; Džupa, Valér (advisor) ; Kokavec, Milan (referee) ; Šponer, Pavel (referee)
Purpose: The aim of the study is to demonstrate the success of early detection and the efficacy of early hip dysplasia treatment within neonatal hip screening in the Czech Republic. Measures are proposed to optimize follow-up and maintain long-term sustainability of the newborn care. Materials and Methods: 316 children with various degrees of hip involvement were detected by "triple sieve" orthopedic screening system. Diagnosis and treatment were monitored by clinical and sonographic examinations (according to Graf). The risk factors, their influence on the treatment course, the effectiveness of outpatient treatment using abduction devices, timing and duration of treatment and participation in follow-up were evaluated. Furthermore, data analysis on national hip arthroplasty register was performed in patients treated for sequels of hip dysplasia. These data were correlated (in order to assess their efficacy) with methods of dysplasia detection at the time these patients were born. Results: Conservative treatment was successful in 98.7 % of 316 treated children. Only 31 % of children had a positive clinical finding. Positive family history showed no significance either for detection or treatment course. The breech position correlated significantly with the incidence of hip dysplasia - OR = 2.80 (99%...
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Problems of the hip in patients with childhood cerebral palsy in childhood and adolescence. Experimentally influenced centering of the hip by a combination of operational tactics
Schejbalová, Alena ; Trč, Tomáš (advisor) ; Koudela, Karel (referee) ; Karpaš, Karel (referee) ; Kokavec, Milan (referee)
Cerebral palsy it must be nonprogressive brain lesion or lesions. The original lesion must occur prenatally, at birth, or early in the postnatal period. The primary disorder involves the musculoskeletal systém and lack of motor control, mental retardation or defects of hearing, language. Prevalence of cerebral palsy is different - between 0,6- 5,9 per 1000 births. In Western countries, the birth prevalence rate is about 2,0 per 1000. In children with cerebral palsy the hip joint appears to be relative nornmal at birth. There is abnormally increased femoral anteversion and neck-shaft angle. Increasing adduction-flexion contractures of the hip, acetabular dysplasia, subluxation eventual dislocation of the hip.Adduction deformity of the hip is caused by spasticity and contracture of the hip adductors and the medial hamstrings. Flexion deformity of the hip is primarily caused by spasticity and contracture of the iliopsoas and secondarily by rectus femoris muscles. When the rectus femoris is the cause, hip flexion deformity is increased with the knee in flexion and decreased with the knee in extension. When it is due to the iliopsoas muscle, the position of the knee has no effect on the degree of hip flexion contracture ( Thomas test). On passive flexion of the knee, if the test is positive, the pelvis will...
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