Sažetak. Cerebralna paraliza je klinički entitet koji karakterizira poremećaj pokreta i položaja uzrokovan neprogresivnim oštećenjem nezrelog mozga. Mnogo je etioloških faktora zbog kojih dolazi do oštećenja mozga koje može uzrokovati cerebralnu paralizu. Posljedice oštećenja utječu na motoričku funkciju te mišićno-koštani i kognitivni razvoj, a javlja se i niz drugih pridruženih zdravstvenih poteškoća. Kada se govori o cerebralnoj paralizi uvijek treba naglasiti da cerebralna paraliza predstavlja ne samo medicinski problem, nego i psihološki i socijalni problem. Dijagnoza se postavlja kod djece kod koje je uočen usporeni razvoj motorike, koji se potvrđuje nalazima magnetske rezonancije. Terapija djeteta s cerebralnom paralizom usmjerena je na ostvarivanje zadanog cilja. Dva glavna cilja su smanjiti komplikacije uzrokovane cerebralnom paralizom i poboljšati sposobnost usvajanja novih vještina. Dodatni ciljevi su edukacija roditelja, smanjenje tjelesnih deformacija i poboljšanje pokretljivosti. Cerebralna paraliza zahtijeva interdisciplinarni pristup te ima velik utjecaj i na dijete i na čitavu obitelj i život njenih članova. Svaki terapijski pristup bazira se na individualnom pristupu. Vrlo je bitno terapiju započeti što ranije jer ranija terapija olakšava razvoj djeteta i pridonosi boljem ishodu terapije i kvaliteti života. Terapija cerebralne paralize ne treba biti usmjerena samo na motoričke tretmane, već i na tretmane i drugih poremećaja od kojih dijete pati. Postoji niz terapijskih sustava koji se primjenjuju u radu s djecom s cerebralnom paralizom. Rijetko se kad terapija oslanja na samo jedan, a najčešće se primjenjuje kombinacija terapijskih postupaka. Takav pristup omogućava fleksibilnost i individualizaciju, kako bi se ostvarili ciljevi postavljeni za dijete i obitelj.Abstract. Cerebral palsy is a clinical entity characterized by disorder of movement and posture caused by a non-progressive injury to the immature brain. There are many etiological factors that may cause brain injury that result in cerebral palsy. The consequences of brain injury may have an effect on motor function, musculoskeletal and cognitive development as well as on a range of other associated health issues. Also, when it comes to cerebral palsy, it should always be noted that it is not merely about a medical problem, but also the psychological and social components have to be taken into account. Diagnosis is made in children with slow motor development and is comfimed with findings from magnetic resonance imaging. In children with cerebral palsy, the treatment is aimed at achieving two main goals: reduce complications of cerebral palsy and improve the ability to acquire new skills. Additional goals are represented by parent education, reduction of body deformations and mobility improvement. Cerebral palsy has a major impact on the child, the whole family and their life, thus an interdisciplinary approach is required. It is important to begin the therapy as early as possible in order to facilitatee the patient's development and contr...

Background Anterior knee pain is the most common complication after total knee replacement and patellofemoral problems were recognized as a major cause. The question whether to resurface the patella or not during total knee replacement still remains controversial and unresolved. Most authors agree that in patients with rheumatoid arthritis (RA) patella should be resurfaced because it has been proposed that residual articular cartilage of the unresurfaced patella may continue to provide an antigenic stimulus for synovial inflammation. Objectives The aim of the study was to examine the effect of patellar non-resurfacing on clinical and radiological outcome in RA patients that underwent total knee replacement. Methods Patients were divided in two groups with 30 patients in each. The first group comprised patients with osteoarthritis (OA) and the second with RA. Standard medial patellofemoral approach was used in both groups. Majority of patients in OA group had varus, while in RA group had valgus knee deformity. Patella was denervated with electrocautery and shaped with rongeur regardless the shape. Patients were followed 5 years after surgery by x-ray and clinical examination using Hospital for Special Surgery Score (HSS), Knee Society Score (KSS) and Patellar (Bartlett) score. Subjective satisfaction with operation was also examined. Only knees with radiologically properly implanted femoral and tibial components were analysed. Position of the patella on x-ray skyline view was not used as excluding criteria. Results In OA group HSS score was 81,9 (70 – 90), the average KSS Score 82,5 (71-95) and Patellar score 23.4 (18 – 27). In RA group: the average HSS score was 82,3(50 – 89), average KSS was 80,6 (58 – 89) and Patellar score 21,7 (15 – 25). Comparison between examined groups using Mann-Whitney U-test (p > 0.05) did not show statistically significant differences. Interestingly, in spite of somewat lower scores in RA group of patients they described more satisfaction with operations. X-ray analysis of patellar position on skyline view showed that 10 (30%) patients in OA group showed some degree of hyperpression, while in the group of RA patients, 15 patients (50%) had lateral hyperpression. Conclusions According to our results based on 5 years follow up, patella non-resurfacing in RA group of patients showed no statistical difference regarding clinical and radiological results in comparison with OA group. References Rodriguez JA, Saddler S, Edelman S, Ranawat CS. Long-term results of total knee arthroplasty in class 3 and 4 rheumatoid arthritis. J Arthroplasty. 1996;11(2):141-5. Fern ED, Winson IG, Getty CJ. Anterior knee pain in rheumatoid patients after total knee replacement. Possible selection criteria for patellar resurfacing. J Bone Joint Surg Br. 1992;74(5):745-8. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br. 1996;78(2):226-8. Beaupre L, Secretan C, Johnston D, Lavoie G.A Randomized controlled trial comparing patellar retention ...

Danijela veljković vujaklija 1 , Tea Schnurrer Luke-vrbanić 2 1 department of radiology, clinical Hospital centre rijeka, rijeka / klinički zavod za radiologiju, kbc rijeka, rijeka; 2 department of Physical and rehabilitation medicine, clinical Hospital centre rijeka, rijeka / zavod za fizikalnu i rehabilitacijsku medicinu, kbc rijeka, rijeka corresponding author / Adresa autora za dopisivanje: Prof. dr. sc. Tea Schnurrer-Luke-Vrbanić department of Physical and rehabilitation medicine / zavod za fizikalnu i rehabilitacijsku medicinu clinical Hospital centre rijeka / kbc rijeka krešimirova 42, 51000 rijeka croatia / Hrvatska Phone /