Instrumental correction of scoliolytic disease in children and teenagers in the Republic of Uzbekistan

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Instrumental correction of scoliolytic disease in children and teenagers in the Republic of Uzbekistan
Umarkhodjayev Fathulla Rikhsikhodjayevich, Department of Neurosurgery with traumatology and orthopedics course,
Tashkent Pediatric Medical Institute E-mail: skoliozdoc@rambler. ru
Instrumental correction of scoliolytic disease in children and teenagers in the Republic of Uzbekistan
Abstract: The article presents therapy results of 71 patients with scoliolytic disease treated by means of three-stage surgical correction method. It was noted that segment reconstruction and instrumental correction was more successful than other modern world analogies, and it was a selective method in the complex radical therapy of severe (95 -186 ° Cobb) forms of scoliolytic disease among children and teenagers. Keywords: scoliolytic disease, surgical correction, children and teenagers.
Topicality. The therapy of axis deformations of ver- (108-+36°). According to etiology there was prevalence
tebral collumn is one of the most difficult problems of the modern vertebrology. In spite of the significant success in the surgery of vertebral axial deformations in the recent decades, instrumental correction is still difficult for vertebrologists and the result of operations are not always satisfactory for orthopedists and the patients. The main reason is that the majority of surgeons make an accent on the application of various correction and fixation devices, paying little attantion to the whole impact complex [1].
The surgical method of instrumental correction of scoliolytic deformations most widely spread in Europe according to CDI [3] is not always effective and safe. The volume of correction after the application of that technology among the patients with average angle of scoliolytic drift equal to 55 ° deformation correction is only 54. 5%, and at the remote terms only 41. 9% of the corrections are preserved [1]. The number of complications is still high — 26% [2], among them acute neurological disorders can reach 17% [4].
Sometimes it is possible to stop progression of vertebral deformation, to prevent development of inner organs'- involvement, to protect a patient from various complications and to normalize social aiming only by means of complex surgical operations. For the successful salvation of these problems it is rational to follow the principle of step-by-step therapy.
The aim of the research was the estimation of three stage reconstructive correction method efficiency for the severe forms of scoliolytic vertebral deformations.
Materials and methods of the research. From 2001 to 2014 on the territory of Uzbekistan 71 patients were operated with the application of three stage surgical correction method. The average age of the patients was 16. 6±5.8 years (13−33 years old). The average angle of scoliosis in the group was 125. 4±2. 60 (from 95 ° to 186°) Cobb, Risser'-s symptom — 3.4.
It was mostly in thoracic-lumbar 57. 7% (41) and thoracic 42. 3% (30) location. Pathologic kyphosis was detected in 71. 8% (51) with average central angle of projection hyper-kyphosis 91. 6±1. 9° (42 °-181°), misbalance of corpus to co-cix in 71. 8% (51). The average kyphosis angle of T1-T12 was equal to 45±2.6 0 (5°-108°), L1-L5 lordosis (-) 49. 9±1. 2°
of idiopathic 49. 3% (35) and dysplastic 23. 9% (17) scoliosis. Congenital abnormalities and systemic pathology (neurofibromatosis, Ehlers-Danlos syndrome) was 14. 1% (10) and 12. 7% (9) correspondingly. 74. 6% (53) of the patients had complicated anamnesis, associated pathology and complications, such as pyelonephritis, cholecystitis, osteoporosis, syringomeylia, hypothyroids, hyposomia, myelopathy, myocarditis, sepsis and others.
Results of the research. At the first stage of three stage correction course we performed correction of vertebral deformation on the value of functional component of deformation mobility achieved in the process of conservative extension preparing. Single-shaft telescopic distractor with 4−5 hooks for sublaminar fixation to vertebrae was attached along concave side of deformation.
The second stage included transpleural mobilization disk ectomy (average 5.2 disks (from 3 to 7)) with segment reconstruction ofvertebral bodies and intervertebral spondylodesis with auto transplants. The procedure was finished by additional correction of deformation with periosteum resection of 3−6 ribs, segment resection of dorsal parts of vertebral column along the arch and dorsal spondylodesis with bone transplantants. For the correction of the deformation we applied singleshaft and double-shaft endocorrectors (patent № IAP 3 203. dated 22. 09. 2006).
The surgical correction was performed in three stages (totally 241 operations), average 3, 2 stage operations per a patient and 19.6 days (14−25days) for a stage. Average 49.2 days for the complete therapy term. The average mean for scoliosis correction was 46. 7% (31. 2−58. 6%) after the first stage and 64. 1% (43,7−79,2%) at the end of the correction. And the average remaining angle of scoliosis curve after correction was 44. 1° (23°-92°).
There was registered growth increase to 12. 5 cm (4−29) because of prolongation of body length.
Complications occurred in 10. 8% of the children. These were: 3 pyramidal disorders, 5 soft tissues fistulas (St. Aureus. Ps. aerugenosae), 1 liquorrhea, and 3 exacerbations of chronic diseases. All complications were eliminated by means of prolonging of hospitalization term to 4.3 days average.

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