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A Schejbalová

Publications and source records attributed to A Schejbalová.

14 recordsLinked to original sources
PubMed2006

[Derotational subtrochanteric osteotomy of the femur in celebral palsy patients].

PURPOSE OF THE STUDY: Derotational subtrochanteric osteotomy as an independent surgical procedure is one of the options for treatment of hip anteversion in adolescent patients with cerebral palsy. In other indications it is one of combined surgical procedures for hip joint reconstruction. MATERIAL: During the 1992-2005 period, derotational subtrochanteric osteotomy was indicated in 74 cases, in ambulatory patients 9 to 18 years old, with diplegic or hemiplegic cerebral plasy. In 63 cases it was used a part of combined surgery. METHODS: The postoperative evaluation was based on clinical and radiographic findings, migration rates and Wiberg's CE angle obtained at 2 and 6 months, and then at each 6 months following surgery. RESULTS: Derotational subtrochanteric osteotomy alone always resulted in improvement of clinical status and an increase in Wiberg's CE angle by 10 degrees on average. Patients with marginal or high dislocation showed best results when the hip joint was reconstructed before the age of 9 years. In three hips a recurrent dislocation occurred gradually within one year of surgery. These patients fell back to stage II of the Vojta classification found preoperatively. During the next three years, three more hips developed a recurrent dislocation and two showed lateralization (20 %). DISCUSSION: Reconstructive surgery for neurogenic dislocation in patients over 10 years of age is associated with problems, as is derotation combined with varus osteotomy in abductor insufficiency. On the other hand, derotational subtrochanteric osteotomy alone is indicated particularly in children over 10 years, in whom it corrects hip joint anteversion and improves gait. CONCLUSIONS: Complete reconstructive procedures should be considered in the first 10 years of life when neither the femoral head nor the acetabulum are markedly changed. Derotative osteotomy alone is preferred to procedures combined with varus osteotomy. In walking adolescent patients, derotative femoral osteotomy alone is recommended; this can exceptionally be used at earlier age if marked asymmetry is present.

Cerebral Palsy↗
PubMed2004

[Palliative Schanz osteotomy for irreducible hip dislocation in adolescent patients with cerebral palsy].

PURPOSE OF THE STUDY: Palliative Schanz osteotomy is one of the options for treatment of irreducible hip dislocation in adolescent patients with cerebral palsy. MATERIAL: In 1992 to 2002, Schanz osteotomy was indicated on 46 occasions in 27 nonambulatory patients with the quadriplegic form of cerebral palsy aged 9 to 18 years. METHODS: In the postoperative evaluation, emphasis was placed on the clinical presentation, i.e., improved motion of the hip joints and pain alleviation. X-ray examination was carried out at 2 to 6 months after surgery. RESULTS In all patients, the range of motion in the hip increased in abduction or flexion according to the osteotomy technique used. Because of severe pain, one patient (2.17 %) had to undergo subsequent resection of the femoral head. Transient pain in the hip persisted in four patients (8.7%). DISCUSSION In patients older that 10 years, reconstructive surgery for neurogenic dislocations has an uncertain outcome and a palliative procedure is often the only method of choice for treatment of irreducible dislocations. Schanz angulation osteotomy can provide a better range of motion, alleviate pain and facilitate the care of patients, particularly if they are nonambulatory. CONCLUSIONS Schanz osteotomy is a less invasive method than resection of the proximal femur and should be used preferably in older children with neurogenic hip dislocation in whom reconstructive surgery is not indicated.

Adolescent↗
PubMed2003

[Orthopedic treatment of a boy with Larsen's syndrome].

A case of Larsen's syndrome in a boy is presented. The syndrome is characterized by flattened facies, multiple congenital dislocations and foot deformities as a result of connective tissue maldevelopment during gestation. The importance of early intensive conservative therapy is emphasized. In the case reported, conservative therapy led, in the first stage, to the management of subluxation of both hips and improvement in left foot position and in the state of both knees. Subsequently, dislocations of the right and the left knee joint were surgically treated at 16 and 20 months, respectively, by reduction and transfixation with Kirschner's wires according to Niebauer and King. After six weeks of plaster immobilization, the wires were removed and the knee position was corrected with laminate splints. The authors point out that the syndrome is often associated with cardiovascular anomalies. Although these were not present in the case reported, due to the repeated occurrence of pericardial exudates from 2 years of the child' age, it was not possible to manage his left foot (pes equinovarus) surgically earlier than at 36 months. For that procedure, the method of posteroplantar release was used. The authors also discuss the occurrence of vertebral anomalies in Larsen's syndrome that may lead to cervical kyphosis and, potentially, to cervical spine instability. In our case, the signs of kyphosis were observed in the C1-C3 region but magnetic resonance imaging did not show any signs of either myelopathy or narrowing of the spinal canal. The intensive conservative and surgical treatment with subsequent thorough rehabilitation enabled the patient to stand up and walk without any support or orthotics. The fact that the boy was able to integrate in healthy children's playgroups can be considered a great achievement of orthopedic therapy.

Abnormalities, Multiple↗
PubMed2002

[Posterior plantar release in the treatment of congenital pes equinovarus].

PURPOSE OF THE STUDY: The study present one of the possible surgical strategies of the therapy of the congenital varus club foot in the youngest patients, most frequently in infants and toddlers. This strategy is used in rigid varus club feet of Dimegli Group 1 and 2. It is possible also to use it in the rebelling varus club feet, however, the reconstruction is more difficult in these cases. MATERIAL: In the period of 1983-2000 the method of posteroplantar release was used 93 times, of which 59 times as a primary surgery and 34 times during revision surgery. The youngest patients were 8 months old, the oldest children were during the revision surgery 8 years old. METHODS: In case of the persisting adduction and varus deformity after conservative therapy of the congenital varus club foot first of all plantar release of the forefoot was performed and subsequently from a slightly oblique longitudinal approach a radical posterior capsulotomy with the lengthening of the Achilles tendon, by means of talocalcanear reduction with transfixation by K-wires. Plaster of Paris is applied during 3 months after the operation with the replacement of correction plaster casts after each 3-4 weeks. The shortest interval after the surgery was 9 months. The group comprised 47 patients (in total 62 feet). RESULTS: The followed-up group of patients was examined clinically with the simultaneous evaluation of radiographs. Excellent result--anatomical position of the foot was obtained in 68%, good result was recorded in 26%. Poor result was recorded in 2 patients in bilateral varus club foot with meningomyelocele. Radiographs showed during the evaluation of the mutual position of talus and calcaneus an increase of the angle in the lateral projection on average by 12 degrees, in anteroposterior projection by 10 degrees. DISCUSSION: The numbers of patients, indication and results of the followed-up group of patients are comporable with literary data. Excellent and good results of the posteroplantar release are even better than those of the complete release included in the literatury studies. The procedure starting by the release first the plantar structures is to a certain extent an original strategy. Usually after the operation on posterior structures the plantar release was used only subsequently in case of persisting adduction and varus deformity of the forefoot. Surgery even in case of a rebelling defect allows to use in future subsequent surgical procedures which is problematic after a complete release where there occurs in a certain percentage also necrosis of talus and calcaneus. CONCLUSION: Posteroplantar release is one of the possible surgical procedures in the solution of the rigid congenital varus club foot. Although the operation may be included in the so called procedure of small steps in most patients it solves finally the defect.

Child, Preschool↗
PubMed2001

[Transposition and hemitransposition of the anterior tibial muscle in the treatment of pes equinovarus].

PURPOSE OF THE STUDY: Authors present transposition and hemitransposition of anterior tibial muscle as one of the supporting surgeries in the treatment of neurogenous but also congenital club foot. MATERIAL: In the period of 30 years they indicated and performed transposition of anterior tibial muscle 79 times in 75 patients and hemitransposition of anterior tibial muscle in 27 patients. Most frequently they used this method in patients with childrens' cerebral palsy, least frequently in patients with congenital club foot. METHODS: The authors prefer hemitransposition of anterior tibial muscle (Biesalski-Mayer) at the younger age and transposition of the whole anterior tibial muscle in children above the age of 9 years and in cases where the foot is more rigid or where bone changes already have developed. From the medial approach they expose the distal origin of the tendon of anterior tibial muscle, separate one or both origins of the tendon in compliance with the nature of the transposition, transpose over a supporting section above the ankle and fix the tendon to base V or IV of the metatarsal. The evaluated group included patients who at the given period attended the control check, i.e. 14 patients after hemitransposition and 45 patients after complete transposition. The shortest interval after the surgery was 9 months. RESULTS: In the evaluated group the authors performed clinical examination and radiograph. They report excellent results in hemitransposition in 57.1% with achieved plantigrade position of the foot and the function of transposed muscle 4 according to the muscle test. In 42.9% of cases the result was good. Similar results they recorded in complete transposition, excellent result in 23 cases (48.9%), good result in 8 patients (38.2%), in 2 patients there occured valgus overcorrection (4.3%), in 8.5% of patients with progressive disease the position subsequently worsened. Radiograph examination showed in the younger age group until the age of 8 years an increased value of the talocalcanear angle. DISCUSSION: By the number of patients, indication and results the evaluated group is comparable with literary data. The authors present reasons for the localization of transposition to Vth or IVth metatarsal in contradiction to biomechanical studies. This operation is not usually indicated as a separate surgery, most often it is performed simultaneously with the operation on m. triceps surrae and operation after Steindler. CONCLUSION: The method of transposition of anterior tibial muscle is recommended by authors mainly in neurogenous club foot where a combined operation on muscles may result in the final remedy of the defect. The method of complete transposition of anterior tibial muscle may be used also in progressive neurogenous diseases with the purpose of postponing resection sub talo.

Adolescent↗
PubMed1994

[Personal experience with the Grice operation in patients with cerebral palsy].

The authors give an account of Grice's operation, i.e. extraarticular, talocalcaneal arthrodesis as one of the basic operations in infantile cerebral palsy in children and adolescents which can be used in the spastic as well as paretic form of the disease. It is valuable as after reposition it stabilizes the position of tarsal bone sub talo. The 65 operations by Grice's method in infantile cerebral palsy with very favourable results (failure or partial failure in five operations, i.e. 9.2%) and the authors' experience with this operations also in other neurogenic disorders indicates that the operation is justified in children and adolescents. It may be performed also in adults. According to the authors' experience this operation does not lead during subsequent development to deformities of the sole and does not merely substitute the well known triple arthrodesis sub talo. Its application is much wider. It can be combined with other surgical procedures on soft parts as well as bones, in particular with Young's operation and with temporary fixation of tarsal bones with Kirschner wires after reposition.

Adolescent↗
PubMed1993

[Personal experience with treatment of congenital pes equinovarus].

The authors evaluated a group of 256 children operated in 1983-1992 at the Orthopaedic Clinic of the Faculty Hospital on account of congenital pes equinovarus. These children account for 25% of the total number of children treated because of this inborn defect by conservative treatment. The authors draw attention to the lack of uniformity of contemporary treatment of congenital pes equinovarus, and based on their own experience, they recommend an exact therapeutic plan. They emphasize the importance of early treatment by means of corrective plaster bandages, they describe the tactics of treatment by this method, as any deviation from this therapeutic pattern leads to incomplete elimination of the defect and to relapses. The authors present also a general review of possible surgical treatment and emphasize the tactics of postoperative treatment, incl. intensive rehabilitation and correction by footwear. They emphasize in particular the necessity of systematic and uninterrupted conservative treatment which is essential as preoperative preparation, as only by intensive care before and after surgery, incl. a correctly indicated and implemented operation, the desired goal, i.e. an anatomical position of the foot can be achieved.

Clubfoot↗
PubMed1993

[The Strayer surgical technic as the basic operation for treatment of pes equinus in cerebral palsy].

The authors describe the technique of Strayer's operation (gastrocnemius recession) in the spastic form of cerebral palsy and draw attention to its indications, possible combinations with other operations and technical errors associated with its implementation. They evaluate 644 operations made by Strayer's method. In 361 regularly followed-up patients they evaluate from the long-term aspect combined operations of the lower extremities (which form a functional unit), using as a basis their own locomotor and position standards. They emphasize the necessity of a correct strategy, i.e. selection and sequence of surgical procedures. They recommend Strayer's operation (gastrocnemius recession) as the basic operation in pes equinus spasticus and in genu flectum spasticum. In the conclusion they present their own modification of Strayer's operation elaborated by the first author.

Adolescent↗
PubMed1993

[Genu flectum in cerebral palsy, elongation of the flexors of the knee joint and our modification].

The authors evaluate the results of prolongation of the flexors of the knee joint in 175 patients with a flexed position of the knee joint associated with the spastic form of cerebral palsy. They draw attention to the interrelationship of the position of the lower extremities in the area of the sole, knee and hip joint and emphasize the necessity of correct assessment of primary contractures. They emphasize also the evaluation of correct concurrent function of flexors and extensors of the knee and their balanced functioning. The authors prefer a single surgical operation in combined affections of the lower extremities to the system of so-called minor steps. They emphasize the importance of postoperative rehabilitation and prosthetic support. In the authors' opinion surgery of the knee joint in manifestations of cerebral palsy on the lower extremities is the most controversial area associated with the highest percentage of failures and complications. Contrary to data in the literature, they refute the necessity of capsulotomy of the knee joint and recommend their own modification how to treat severe forms of genu flectum spasticum.

Adolescent↗
PubMed1993

[Importance of tenotomy of the adductors in the treatment of cerebral palsy manifestations in the lower extremities].

The authors evaluate 303 tenotomies of adductors performed in patients with cerebral palsy (CP) in 1970-1992. They emphasize the correct diagnosis of adduction contracture of the hip joint and correct treatment, incl. early surgery, not only because of the influence of adductors on standing and gait but also on the development of the hip joint in children. The authors draw attention to the increased incidence of subluxations and luxations of the hip joint in recent years in children with CP who were not operated or where the muscular balance and contractures of the hip joint were not modified. They emphasize the fact that in children where tenotomy of the adductors was performed in time before the age of 8 years, with a single exception luxation did not develop. In the authors' opinion tenotomy at the age of cca 11 years is an essential operation but in view of the development of skeletal changes it is late. The authors recommend to pay increased attention to the problem of adductors in CP as regards diagnosis and technical aspects of the operation.

Adolescent↗
PubMed1993

[Orthopedic surgery in children with cerebral palsy].

The authors present their experience with orthopaedic surgical treatment of children with cerebral palsy. The paper is based on a group of 630 patients where they performed 1882 operations of the lower extremities in 1970-1992. The authors evaluate the long-term results in regularly checked 361 patients (205 boys and 156 girls), mostly with the spastic form of cerebral palsy, with regard to different types of affections which markedly influence the prognosis of surgery (monoparesis, hemiparesis, diparesis, triparesis, quadruparesis). The authors emphasize the primary importance of rehabilitation and team work where the orthopaedist's work is guided by efforts to make further rehabilitation training possible and to facilitate it. They consider surgery an integral part of comprehensive treatment of cerebral palsy which must be followed immediately by further rehabilitation. The authors emphasize the part played be the orthopaedic surgeon to prevent the genesis and development of deformities of the locomotor apparatus.

Adolescent↗
PubMed1990

[Surgical treatment of patients with juvenile cerebral palsy at the orthopedic clinic of the Charles University Medical School in Prague-Motol].

In the period of 1976-1987 there were in total 181 patients operated on with the diagnosis of infantile cerebral palsy at the Orthopaedic Clinic of the Faculty of Pediatrics of Charles University in Prague-Motol. 412 operations were performed in total in these patients. The indication was mainly the improvement of the statics and gait, therefore operations on lower extremities prevailed. Within the preoperative preparation it is essential to precisely classify the type of affection of the patient from the neurological viewpoint and mainly estimate the future physical and psychical abilities of the child which is of substantial importance in the postoperative treatment. The surgical solution is always individual and respects the specificity which need not be symmetric on both extremities. Therefore the range of orthopaedic operations is wide. The surgeon has to treat the equinus position of the foot, the valgus position, flexion contractures of knees, adduction position in hip joints. In case it is necessary to operate the affection of the entire lower extremity the specialists at the above mentioned Orthopaedic Clinic prefer a single solution to the stepwise one. Recently the surgical treatment of patients suffering from spasm has achieved a certain progress. Substantial is the contribution for patients who on the basis of the operation regain the ability to walk. Therefore the authors emphasize the importance of the cooperation of the neurologist and the rehabilitation worker with the orthopaedic surgeon when considering comprehensive therapeutical possibilities.

Cerebral Palsy↗