Cieľ štúdie: Autori prezentujú výsledky liečby u skupiny 30 pacientov s 31 zlomeninami hlavičky radia, ktorí boli liečení v rokoch 2001-2005. Analyzujú možnosti liečby pri sólových i kombinovaných zlomeninách hlavičky radia, indikácie k operačnej resp. konzervatívnej liečbe a spôsoby operačného riešenia Materiál: Hodnotili 30 pacientov s 31 zlomeninami hlavičky radia. 14 bolo mužov a 16 žien. Priemerný vek mužov bol 42 rokov (21–71 rokov), žien 48 rokov (17–74 rokov). Priemerná doba sledovania bola 29 mesiacov. Metódy: Analyzovali typy zlomenín, mechanizmus ich vzniku a spôsoby ošetrenia rôznymi osteofixačnými materiálmi. Sledovali odstup medzi úrazom a operáciou, ktorý činil v priemere 7,1 dňa (0– 53 dní). Hodnotenie výsledkov realizovali pomocou Mayo Elbow Performance Score (MEPS). Výsledky: Výborný výsledok dosiahli u 18 lakťov (58 %), dobrý u 8 lakťov (25,8 %) a uspokojivý v 5 prípadoch (16,2 %). Zlý výsledok nezaznamenali ani v 1 prípade. U 3 pacientov bola potrebná s odstupom času 7–12 mesiacov deliberácia lakťa, po ktorej dosiahli zlepšenie MEPS na hodnoty 60– 70–100 bodov. Záver: Vytvorenie optimálneho liečebného modelu nie je možné. Ako ukázali porovnania viacerých postupov, výsledky boli približne rovnaké. Autori preferujú aktívny prístup, ktorý umožňuje skrátenie fixácie a včasnú funkčnú liečbu. Předmetom ďalšieho skúmania bude dlhodobé sledovanie tejto skupiny, hlavne z aspektu možnosti vzniku predčasnej posttraumatickej artrózy.
Purpose of the study: The authors present results of therapy in 30 patients with 31 fractures of radial head, with surgical intervention carried out between 2001 and 2005. The options of the treatment in both simple and combined fractures are analysed, indications for conservative therapy or surgical intervention and modes of surgery are discussed. Material: They evaluated 30 pacients with 31 radial head fractures. This group included 16 women and 14 men. Average age of women was 48 years (17-74 years), of men 42 years (21-71 years). Average follow-up was 29 months. Methods: The type of fractures, trauma origin and mechanism, as well as various osteofixation methods are described. In the above-mentione cases also the trauma – surgery interval (7.1 days on average) was monitored. The eavaluation of results was performed by Mayo Elbow Performance Score (MEPS). Results: Excellent results were achieved in 18 elbow fractures (58 %), good results in 8 (25,8 %) and satisfactory results in 5 cases (16,2 %). Poor results were not observed. Only in 3 patients deliberation of the elbow was necessery, after an interval of 7-12 months. This intervention led to a MEPS improvement of up to 60 to 80 pts. Conclusions: Suggesting a universally optimal therapy model is impossible. Comparing the results of different approaches the authors gained similar results. The authors prefer a proactive approach in therapy, which allows a shortening of the fixation period as well as an early start of functional therapy. Further research will concentrate on the follow-up of this patients group, especially with a view to development of posttraumatic arthrosis.
The author reports two cases of pediatrie patients with supracondylar humeral fractures complicated by concomitant vascular injury. One of the patients also presented with neurological symptoms from compression of the ulnar and median nerves. In the case of vascular injury only, it was necessary to resect a 1-cm segment of the brachial artery which was throm-bosed due to intimal disruption. In the other case, surgery was not indicated immediately; however, liberation of the nervus ulnaris and nervus medianus was later required because of nerve compression by the scar and bone. The author considers the exact diagnosis, precise reduction and stable fixation of a fracture to be most important for a good outcome of treatment. Any associated vascular injury is indicated for surgery only after a thorough diagnostic consideration, and may not be needed in every case. The most decisive factor is the clinical presentation. Injury to the nerve system is indicated for surgical treatment at a later period, at 3 months post-injury at the earliest.
- MeSH
- angiografie metody využití MeSH
- arteria brachialis chirurgie patologie zranění MeSH
- cévy patofyziologie patologie zranění MeSH
- fraktury humeru chirurgie komplikace MeSH
- nervus medianus chirurgie patologie zranění MeSH
- nervus ulnaris chirurgie patologie zranění MeSH
- ortopedické výkony metody využití MeSH
- trombóza chirurgie komplikace ultrasonografie MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY The author presents the results of treatment with total hip arthroplasty (THA), in the Aldinger modification, in 91 patients receiving a total of 98 custom-made total hip implants in the period from 1993 to 2002. Eighty-eight patients (96.9 %) with 95 THAs were available for evaluation at the last follow-up. MATERIAL The group comprised 26 men (27 total hip implants), at an average age of 33.8 years (range, 25-57), and 65 women (71 implants) at an average age of 38.5 years (23-57) at the time of surgery. The right hip was operated on in 43 patients (18 men and 25 women) and the left one in 55 patients (9 men and 46 women). One man and six women underwent bilateral THA. The average time between the operation and the last follow-up was 8.6 years (range, 3 years and 11 months to 13 years and 3 months). METHODS The author describes the complete procedure from indications, planning and manufacture of an custom made implant to its implantation in combination with different types of acetabulum. The evaluation based on the Merle d'Aubigne score system, as modified by Griss, was carried out for an average follow-up of 8.6 years. RESULTS The outcomes were excellent, good and satisfactory in 69 (72.7 %), 16 (16.8 %) and 8 (8.4 %) patients, respectively. Two patients with septic complications (2.1 %) reported poor results. The overall complications involved aseptic loosening of the acetabulum in five, septic loosening of the acetabulum with severe lesions due to polyethylene wear in three, and infection in four patients. Eight cases were associated with periarticular ossifications and three patients developed deep venous thrombosis in the post-operative period. DISCUSSION The prerequisite for good outcomes in total hip arthroplasty using cementless implants is, in the author's opinion, the attainment of high primary stability. One of the options to achieve this is a thorough analysis of proximal femoral morphology on CT scans, which permits the construction of an custom made implant to each individual femur on the form-fit principle. Other advantages include a possibility to adjust the torsion angle of the femoral neck, to plan correction of limb length and to restore femoral offset, which provides conditions for optimal geometry of the hip joint. The excellent and good outcomes recorded in nearly 90 % of our patients at an average of 8.6 years of follow up are in agreement with the literature results. The fact that most of our complications were due to aseptic loosening of the acetabulum suggests that the use of a custom-made hip implant does not resolve the problems associated with acetabular dysplasia. A true loosening of the custom made stem occurred in only two cases with septic complications, in which any other type of stem would have behaved in a similar way. The same findings are also reported by other authors. CONCLUSIONS The results of this study show that the idea of exact adjusting of an implant to the bone (not vice versa) could meet the requirement for the implant's long life span and could allow for better physical therapy in the post-operative period, particularly in young patients with secondary post-traumatic or post-dislocation arthritis of the hip. Cemented hip implants, however, remain the gold standard for patients over 70 years. In younger patients it is necessary to put more emphasis on stable primary fixation, which can be achieved by 3D reconstruction of the joint to be replaced, by imaging methods and a subsequent computer processing of the procedures for designing, manufacturing and inserting the hip prosthesis.
- MeSH
- lidé MeSH
- muži MeSH
- náhrada kyčelního kloubu metody trendy MeSH
- ortopedické výkony metody využití MeSH
- pooperační komplikace klasifikace MeSH
- výsledek terapie MeSH
- ženy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
Autori v práci predkladajú stručný prierez hodnotenia prednej instability ramenného kíbu z viacerých aspektov. Za clef práce si stanovili predstavenie jednotlivých typov morfologických zmien, ako ich navrhol Resch (6). Za obdobie 2 rokov (od júna 1995 doteraz) artroskopicky vyšetrili 96 pacientov s klinickým obrazom prednej instability humeroskapulárneho kĺbu. Z toho bolo 69 mužov a 27 žien, všetci v produktívnom veku. 1. typ lezie podľa Rescha zistili v 52 % prípadov, 2. typ v 21 %, 3. typ v 6 %, 4. typ v 13 %, 5. typ v 1 % a 6. typ v 7% prípadov, čo korešponduje s literárnymi údajmi. Za najťažšie diagnostikovateĺný považujú 5. typ lézie. Určitý stupeň rutiny vyžaduje aj odlíšenie 1. od 4. typu a 2. od 6. typu Reschovej schémy. Tretí typ považujú naopak za štandardný, nezameniteľný obraz.
The authors review briefly the evaluation of anterior instability of the shoulder joint from different aspects. The objective of their work was to present different types of morphological changes, as suggested by Resch (6). During the two-year period since June 1995 so far a )tal of 96 patients with the clinical picture of anterior instability of the humeroscapular joint were examined arthroscopically. The group comprised 69 men and 27 vomen, all in productive age. Type 1 lesions according to Resch were found in 52 %, type 2 in 21 %, type 3 in 6 %, type 4 in 13 %, type 5 in 1 % and type 6 in 7 % if the patients, which is consistent with data reported in the literature. In their opinion type 5 lesions are most difficult to diagnose. A certain amount of routine is needed also to differentiate type 1 and 4 and type 2 and 6 according to Resch's classification. Conversely, they consider type 3 findings standard and unequivocal.
Autori v práci predkladajú model záchytnosti, sledovania a liečby vrodených chýb pohybového aparátu, uplatňovaný v okrese Martin. Za sledované obdobie rokov 1972 - 1994 vyšetrili a spracovali celkovo 41 281 novorodencov, čo je 99,2% z celkového počtu živonarodených detí v okrese Martin, s osobitným zameraním na bedrový kĺb a v rodené chyby nohy. Z klinických príznakov dysplasio coxae congenita pripisujú najvyššiu diagnostickú cenu Ortolaniho fenoménu a obmedzeniu abdukcie pod 60°, ktoré sa vyskytli u 82 %, resp. u 52 % vyšetrených. Ako ukázali výsledky výskytu dysplázie a luxácie v Jednotlivých časových úsekov, zavedenie preventívne-liečebných opatrení vo včasnom novorodeneckom veku malo jednoznačne pozitívny vplyv na zníženie výskytu dysplázie a Iuxácie. Incidencia vrodených chýb nohy bola v sledovaných obdobiach na konštantnej úrovni. Významnú koincidenciu vrodených chýb nohy s dyspláziou bedrového kíbu v sledovanom súbore nezistili, čo je v zhode s literárnymi údajmi. V závere autori vyzdvihujú prínos prevencie vo včasnom novorodeneckom veku, ktorá prináša so sebou zníženie počtu tažkých sekundárnych koxartróz.
The authors submit a model of the detection rate, monitoring and treatment of inborn defects of the locomotor system used in the Martin district During the investigation period from 1972 - 1994 they examined and processed data from 41 281 neopates, i. e. 99,2 % of the total number of liveborn nfants in the Martin district, focused specially on the hip joint and inborn defects of the foot. As to clinical symptoms of dysplasia coxae congenita they ascribe the greatest diagnostic value to Ortolani's phenomenon and abduction restricted to less than 60 degrees, which was recorded in 82 % and 52 % of the examined infants resp. As revealed by the incidence of dysplasia and dislocation in different periods, the introduction of prevrntive and therapeutic measures in the early neonatal stage had an unequivocal positive effect on the ncidence of dysplasia and dislocation. The incidence of inborn defects of the foot was on a constant level during the investigation period. The authors did not record a significant coincidence of inborn defects of :he foot and dysplasia of the hip joint in the investigated group, which is consistent with data in the literature. In the conclusion the authors emphasize the importance of prevention in the early neonatal age /hich leads to a reduction of the number of severe secondary coxarthroses.
Autori v práci predkladajú stručný teoretický výklad a charakteristiku sarkoidózy so zameraním na jej prejavy na pohybovom aparáte, ktorý postihuje v 10 -14 % prípadov. Priebeh vefmi zriedkavej a raritnej formy sarkoidózy na pohybovom aparáte podrobne predsta /ujú na príklade 50-ročnej pacientky s ťažkou sarkoidóznou artropatiou karpu. Poukazujú hlavne na diagnostické problémy pri mimoplucnych formách sarkoidózy.
In the submitted paper the authors present a brief heoretical account and characteristics of sarcoidosis focused on its manifestations in the locomotor apparatus, found in 10 -14 % of the patients. The course of this very rare form of sarcoidosis of the locomotor apparatus is demonstrated on a 50-year-old female patient with severe sarcoid arthropathy of the wrist. They draw special attention to diagnostic problems in extrapulmonary forms of sarcoidosis.
- MeSH
- chirurgie operační MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci kloubů etiologie chirurgie patologie MeSH
- sarkoidóza MeSH
- zápěstí chirurgie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- dospělí MeSH
- kyčelní protézy metody MeSH
- lidé MeSH
- radioisotopová scintigrafie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
