The Management Duchenne Muscular Dystrophy : Establishing an early Straight or Hyperextended Spine
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1 2006 ; : The Management Duchenne Muscular Dystrophy : Establishing an early Straight or Hyperextended Spine Jun MINATO, Jiro MINATO, Masami MINATO Abstract : Since 1989, we have been actively involved in the prevention of progressive spinal deformity in Duchenne Muscular Dystrophy. We have targeted our treatment specifically towards establishing an early straight or hyperextended spine, which was found to be the most stable condition in D.A. Gibson's study. From 1989 to 2005, nine patients with Duchenne Muscular Dystrophy have successfully gone through our target-treatment program. Nine patients from this group, ranging in age from 20 to 30 years, and seven other patients, who had never gone through the target-treatment program, were selected for the comparison study. The incidence of straight or hyperextended spines and the Cobb method were used to determine spinal deformity. In terms of overall success rate in establishing of a straight or hyperextended spine, the first group was 88.9 and the second group, Especially, a comparison of the lateral curvature was quite remarkable, in which the first group showed degrees on average, and the second group, on average. This treatment is very effective for the management of spinal deformity in Duchenne Muscular Dystrophy. Jpn J Rehabil Med Key words : DMD Fukushima Institute for Children s Orthopaedic Disease jun@ryogoen.jp 438 Jpn J Rehabil Med VOL. 43 NO
2 GibsonWilkins DMD Group V Group I unstable pathway Group V stable pathway Group V straight or hyperextended spine 6,7 43 DMD Group V straight or hyperextended spine GibsonWilkins straight or hyperextended spine DMD DMD Cobb pathway 6 Gibson 6 VOL. 43 NO
3 DMD 9 facet locking 2 OT WheelessTextbook of Orthopaedics 25 9 DMD / 440 Jpn J Rehabil Med VOL. 43 NO
4 PT 20 A Kyphotic Index A/B C7 C7 C7 C7 B B A A B S S S S Kyphotic index straight or hyperextended spine Cobb 20 straight or hyperextended spine X Cobb Cobb S Straight or hyperextended spine straight or hyperextended spine Fishers exact probability test p kyphotic index KIKI 7 1 A A B A/B straight hyperextended VOL. 43 NO
5 GibsonWilkins straight hyperextended KI kyphotic 1 erect 1 straight 1 6 hyperextended Cobb Cobb Mann-Whitney U p Cobb 20 8 Cobb Cobb Cobb DMD Wilcoxon p Straight or hyperextended spine straight or hyperextended spine GibsonWilkins straight or hyperextended spine Group V 14 Cobb 35 KI KI 0 12 KI 2 10 KI 50 KI erect hyperextended straight or hyperextended spine 442 Jpn J Rehabil Med VOL. 43 NO
6 A straight or hyperextended spine Cobb 20 KI KI 0 16 KI Cobb 20 straight or hyperextended spine 8 Cobb GibsonWilkins straight or hyperextended spine 2 kyphotic 1 8 straight or hyperextended spine straight or hyperextended spine straight or hyperextended spine facet locking posterior element A Cobb 20 Cobb 9 6 Cobb posterior element 4 5 VOL. 43 NO
7 24 DMD 5 DMD 6 PT OT DMD DMD NIPPV DMD 25 DMD QOL 444 Jpn J Rehabil Med VOL. 43 NO
8 Kurz LT, Mubarak SJ, Schultz P, Park SM, Leach J : Correlation of scoliosis and pulmonary function in Duchenne muscular dystrophy. J Pediatr Orthop1983 ; : Galasko CS, Delaney CM, Morris P : Spinal stabilisation in Duchenne muscular dystrophy. J Bone Joint Surg 1992 ; - : Miller F, Mosely CF, Koreska J : Spinal fusion in Duchenne muscular dystrophy. Dev Med Child Neurol 1992 ; : Garanata C, Merilini L, Cervellati S, Ballestarazzi A, Giannini S, Corbascio M, Lari S : Long-term result of spine in Duchenne muscular dystrophy. Neuromuscul Disord 1996 ; : Rideau Y, Glorion B, Delaubier A, Tarle O, Bach J : The treatment of scoliosis in Duchenne muscular dystrophy. Muscle Nerve 1984 ; : Gibson DA, Wilkins KE : The management of spinal deformities in Duchenne muscular dystrophy. Clin Orthop Relat Res 1975 ; : Wilkins KE, Gibson DA : The patterns of spinal deformity in Duchenne muscular dystrophy. JBone Joint Surg 1976 ; - : ; WheelessTextbook of Orthopaedics : DMD : scoliosis. Available from: URL : ortho/dmd_scoliosis cited 2005 Nov 15 VOL. 43 NO
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