18 - neuro-ortopedia i
TRANSCRIPT
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Neuro-ortopedia 1
Tema 18
•
¿Por qué el término?
• ¿Por qué parte del programa?
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Problemas comunes
• Alt del SNC o P: repercusión
• Pacientes a través de COT
• … o de neuro
• Necesidad de tto conjunto
• Necesidad de tto Ortopédico
o quirúrgico
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Importancia de
• Diagnóstico por la clínica
• Estudios electrofisológicos
• Estudios de imagen…
¡ Y su peligro!
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Problema
de laatomización del saber
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Problemas del SNC
• ACV - PCI
• EM, ELA..
• Tumores
• Traumatismos
• Malformaciones
•
Infecciones
• Intoxicaciones• Artrosis…
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Resultado
• Parálisis• Espasticidad, distonías
• Deformidades
• Dolor
• Impotencia funcional
• Cojera, dificultad para marcha
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Problema diagnóstico
• Distonías - Cuadros dolorosos
• Enf. degenerativas - Artrosis,Tx
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Tratamiento•
Medicación• Toxina botulínica
• Fisioterapia - Indefinida?• Ortesis, férulas correctoras
• Cirugía tendinosa - Secc., trans.
• Descompresión, artrodesis y…
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Lesión cerebral
• PCI
• ACV
• Coma
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Tratamiento•
Medicación• Toxina botulínica
• Fisioterapia - Indefinida?• Ortesis, férulas correctoras
• Cirugía tendinosa - Secc., trans.
• Descompresión, artrodesis y…
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Dpto. de C.O.T.
Clínica Universitaria.
Universidad de Navarra
Osificaciones Heterotópicas
de Cadera en Traumatismos
del SNC.
Tratamiento Quirúrgico
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Osificaciones cadera coma
O ifi i d
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Osificaciones cadera coma
O ifi i d
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Osificaciones cadera coma
Dr JM Saló
1985
O ifi i d
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Osificaciones cadera coma
Dr JM Saló
1985
O ifi i d
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Osificaciones cadera coma
?
O ifi i d
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8/3/2019 18 - neuro-ortopedia I
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Osificaciones cadera coma
• Afección poco conocida,
•
Patogenia desconocida• Posibilidad de prevención
• Tto médico y Rhb inútil
• Posibilidad quirúrgica...
muy limitante
O ifi i d
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Osificaciones cadera coma
367.968
290.531
O ifi i d
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Incidencia
• Garland y cols. JBJS 62A: 1143, 1980
- 11 - 20% de traumas cerebrales
o medulares graves
Osificaciones cadera coma
• Tibone y cols. JBJS 60A: 769, 1978
- 10 - 25 % osificaciones en cadera
- 3 - 8 % con limitación funcional
O ifi i d m
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Osificaciones cadera coma
Osificaciones cadera coma
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Osificaciones cadera coma
Rx a veces más difícilde valorar aún...
Osificaciones cadera coma
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Osificaciones cadera coma
Osificaciones cadera coma
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• Prevención (3 primeros meses)
• Tratamiento
- Indometacina, aspirina
- Ineficacia de difosfonatos y Rtx
Osificaciones cadera coma
- Resección amplia de las osific.
- Doble vía frecuente
- Girdlestone? No PTC*
NO SIRVE LA FISIOTERAPIA
Osificaciones cadera coma
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8/3/2019 18 - neuro-ortopedia I
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Osificaciones cadera coma
No perder el tiempo!
No dar rodeos!
Ir al grano!
Rehabilitación,
radioterapia ...
...¡son inútiles!
Osificaciones cadera coma
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Osificaciones cadera coma
248.690
1990
Osificaciones cadera coma
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Osificaciones cadera coma
Osificaciones cadera coma
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Osificaciones cadera coma
Osificaciones cadera coma
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Osificaciones cadera coma
367968
2 cad. + 1 rod.