• MeSH
• fraktury kostí * komplikace   terapie   MeSH
• lidé MeSH
• malá pánev chirurgie   zranění   MeSH
• miniinvazivní chirurgické výkony metody   využití   MeSH
• ortopedické výkony * metody   využití   MeSH
• osteoporóza diagnóza   etiologie   komplikace   MeSH
• pánev * chirurgie   zranění   MeSH
• pánevní kosti chirurgie   zranění   MeSH
• počítačová rentgenová tomografie metody   využití   MeSH
• pooperační komplikace MeSH
• prognóza MeSH
• radiografie metody   využití   MeSH
• rehabilitace metody   MeSH
• Check Tag
• lidé MeSH

Purulent inflammation of the pubic symphysis is a rare condition involving the symphysis and parasymphyseal parts of the pubic bones. It is usually found in immuno-compromised patients and its most frequent cause is Staphylococcus aureus. Conservative treatment is based on long-term administration of antibiotics and has been efficient, as reported, in about 50% of the patients. The authors treated five patients with a late diagnosis of purulent infection of the pubic symphysis in whom the antibiotic therapy had to be completed by surgical intervention. Three patients undergoing surgery with removal of the infected necrotic tissue healed fast and well. One patient required repeated surgery because of recurrent purulency; eventually, the infection cleared up. One patient was treated only conservatively because she refused surgical treatment. Consequently, pubic diastasis developed and she suffered from persistent pelvic pain. One year after treatment her condition became complicated by pelvic fracture following a fall. The patient refused surgery again. However, the development of non-union and progression of complaints made her agree to a surgical treatment; fixation of the non-union had a satisfactory outcome. In the literature, infection in the symphysis region is referred to by several different names. One - in the authors' opinion incorrect use - is "arthritis" (septic arthritis of the pubic symphysis; pubic symphysis septic arthritis; infectious osteoarthritis of the pubis). Another term is "osteomyelitis" (acute pubic osteomyelitis; pubic osteomyelitis; osteomyelitis of the pubis; osteomyelitis pubis; osteomyelitis of the pubic symphysis; osteomyelitis of the symphysis pubis). None of the names shows clearly whether it is primary an infection of the symphysis or of the parasymphyseal bone. A combination of the term "osteitis" with "infectious" (infectious osteitis pubis) is an attempt to distinguish purulent symphysitis pubis from osteitis pubis. The authors completed both the Czech and English title of this paper with the Latin designation symphysis pubis purulenta. A possibility of using a new name, such as "pubosymphysitis", in analogy to "spondylodiscitis" can also be discussed. However, the use of simple terms "infection of symphysis" or "infection of pubic symphysis" seems to be most practicable. Based on the experience with the treatment of five patients with infection of the pubic symphysis, the authors suggest that the late phase with abscess formation or purulent discharge should be managed by surgery. This treatment has good clinical outcomes although it may be complicated by slow healing of soft tissues around the symphysis and instability of the anterior pelvic segment with its sequelae. Key words: infection of the symphysis, infection of the pubic symphysis, septic arthritis of the pubic symphysis, pubic osteomyelitis.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• artroskopie metody   MeSH
• infekční artritida terapie   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• stafylokokové infekce terapie   MeSH
• symphysis pubica mikrobiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

PURPOSE OF THE STUDY To evaluate the results of the dorsal longitudinal tendon-splitting approach for surgical treatment of Haglund?s deformity and associated conditions. MATERIAL The group comprised patients who underwent surgery for Haglund?s deformity and related conditions between January 2003 and June 2007. There were 15 patients, six women and nine men, with 17 treated heels (one man and one woman had bilateral surgery). METHODS Using the tendon-splitting approach, a prominence of the posteriosuperior border of the calcaneus was resected and the associated conditions were treated. The evaluation was based on a 1-to-5-degree scale and included the patient?s clinical state before and after surgery (pain, shoe-wearing and load tolerance) , and pre-operative radiography (presence of Haglund?s deformity, ossification of the Achilles tendon and/or adjacent tissues). The study was retrospective. RESULTS The average age of the patients at the time of surgery was 44.5 years (range, 16 to 60). The minimum follow-up was 6 months (range, 6 to 65 months). X-ray and intra-operative findings showed Haglund?s deformity in 13 cases, calcaneal bursitis in six, ossified mass at the insertion of the Achilles tendon in six, intratendinous ossification in two, and partial tendon degeneration and subcutaneous bursitis in one case each. Post-operative relief was recorded in 16 treated heels. The condition in one patient deteriorated, as manifested by heel swelling after exercise and a feeling of tension at the insertion site of the Achilles tendon in forced dorsiflexion of the ankle. An average preoperative score of 4.1 improved to 2.1 post-operatively. No serious complications either overall or at the site of surgery (Achilles tendon rupture, poor wound healing) were found. Three heels retained a slight restriction of motion (up to 10 degrees). One heel showed impaired sensitivity in the region treated. DISCUSSION The tendon-splitting approach provides a good view of and easy access to the structures to be operated on. The risk of incomplete resection of the prominence or of leaving sharp edges because of an insufficient view is small. Compared with other methods, this approach allows for concurrent treatment of other conditions that may be present at the insertion site of the Achilles tendon. The tendon-splitting approach does not result in any structural changes of the Achilles tendon. CONCLUSIONS The dorsal longitudinal tendon-splitting approach for surgical treatment of Haglund?s deformity is an efficient, undemanding and safe method alternative to lateral or medial approaches used more often. It allows for concurrent treatment of several pathological conditions at the insertion site of the Achilles tendon, such as subcutaneous bursitis, ossified mass at the tendon insertion, tendon degeneration, intratendinous ossification, calcaneal bursitis and Haglund?s deformity.

• MeSH
• Achillova šlacha chirurgie   MeSH
• deformity nohy (od hlezna dolů) chirurgie   komplikace   patologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• ortopedické výkony metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH