PURPOSE OF THE STUDY To evaluate the effect of acromial morphology, as assessed on radiographs, on rotator cuff tears. MATERIAL A total of 200 patients surgically treated for shoulder disorders were enrolled. All were older than 40 years and had good quality shoulder radiographs. Two groups were composed: First, a clinical model group of 136 patients to be investigated for three parameters of rotator cuff injury that was divided into two subgroups. One included 68 patients, with an average age of 53.5 years, in whom surgery revealed no injury to the rotator cuff; the other subgroup of 68 patients, with an average age of 58 years, had a ruptured supraspinatus tendon. Subsequently, a control group of 64 patients (32 with rotator cuff injury and 32 without it) was used to verify the results of the model group. METHODS Three parameters describing the acromion, i.e., acromion index (Al), lateral acromion angle and acromial slope, were measured on standard radiographs. Tangential antero-posterior and scapular "Y" (supraspinatus outlet) views were taken, the images were digitalised and evaluated using a TomoCon 3.0 Viewer programme, and the results of the two groups were statistically analysed and compared. RESULTS The difference between the patients with rotator cuff injury and those without it was best shown, in both groups, by significant differences in the acromion index. This was true for both the men and women. The Al values for the patients with rotator cuff injury were 0.66 and 0.65 in the model and control groups, respectively. The same Al value of 0.76 was found for uninjured rotator cuffs in both groups. The two other parameters investigated did not appear to be of any significant validity for assessment of rotator cuff tears. DISCUSSION The aetiology of injury to the rotator cuff has not been fully understood yet but, undoubtedly, the causes will be many. The shape of the acromion is regarded as one of the important factors. We agree with Nyffeler et al. that a lateral extension of the acromion is most often associated with rotator cuff tears and that the acromion index proposed by these authors is a good parameter to assess this morphological change. CONCLUSIONS A lateral extension of the acromion plays an important role in the aetiology of degenerative tears of the supraspinatus tendon. The acromion index appears to be the best instrument for assessing this morphological change.
- MeSH
- akromion anatomie a histologie radiografie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění rotátorové manžety MeSH
- ramenní kloub radiografie MeSH
- rotátorová manžeta radiografie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Cílem práce je posouzení kvality života u pacientů jeden rok po implantaci totální náhrady kyčelního kloubu novou miniinvazivní metodou. Posouzení kvality života doplňuje hodnocení metody, která byla na našem pracovišti zavedena jako první v České republice. K hodnocení jsme použili standardizovaný dotazník SF-36 v neanonymní korespondenční formě. Hodnocení bylo provedeno po zvládnutí operační techniky u 60 po sobě operovaných pacientů od podzimu r. 2006 do léta r. 2007. Hodnotitelné odpovědi jsme získali od 59 respondentů s průměrným věkem 66 let. Poměr mužů a žen byl vyvážený – 29 : 30. Pacienti byli hodnoceni bez ohledu na způsob fixace endoprotézy. Dosažené výsledky jsme porovnali s hodnotami publikovanými Sobotíkem (1998) pro běžnou populaci ve věkové kategorii 65–74, kam podle průměrného věku patří naši sledovaní pacienti. Vzhledem ke známému rozdílu ve výsledcích u mužů a žen jsme provedli jejich vzájemné porovnání. Dále jsme provedli porovnání s oxfordskou studií a normálními hodnotami pro středoevropský region publikovanými Petrem et al. (2001), který hodnotil dotazník u příslušníků Policie České republiky. Pro potřeby srovnání byla získána také data od 60 pacientů operovaných standardní technikou v roce 2009. Získané výsledky jsou překvapivě pozitivní a lepší než výsledky populace 65–74, a dokonce i než výsledky běžné populace bez ohledu na věk, publikované Sobotíkem (1998). Výsledky miniinvazivní a standardní techniky se statisticky neliší. Naše výsledky jsou dle očekávání horší než výsledky příslušníků PČR. Limitujícím faktorem zůstává, že pomocí dotazníku hodnotíme spíše výsledky implantace kloubní náhrady na kvalitu života a ne samotný miniinvazivní přístup, který lépe hodnotí specifické dotazníky. Ani tento fakt však nesnižuje velmi pozitivní efekt operační metody na kvalitu života našich pacientů a sledování této kvality by podle našeho názoru mělo být součástí všech prováděných studií v této oblasti.
The purpose of the work was an assessment of the quality of life in patients one year after the implantation of the total replacement for the hip joint with the use of a new mini-invasive method. The assessment of the quality of life presents a supplementation to a method, which was first introduced in the Czech Republic in our institution. For the assessment, we employed the SF-36 standardized questionnaire in a non-anonymous, correspondence form. The assessment was implemented after managing the surgery technique in 60 consecutively operated patients from autumn 2006 to summer 2007. Answers suitable for evaluation were received from 59 respondents at their average age of 66 years. There was a balanced relationship between numbers of men and women – 29 : 30. The patients were evaluated regardless the method of the endo-prosthesis fixation. The results obtained were compared with those published by Sobotík (1998) for the general population in the age category of 65–74 years, into which the patients followed fell in accordance with their average age. Given known differences between results in men and women, we provided their comparison. We furthermore provided a comparison with the Oxford study and normal values for the central-European region published by Petr et al. (2001), who evaluated the questionnaire in members of the Czech Police. Data from 60 patients operated by a standard technique in 2009 were also obtained for comparison. The results acquired are surprisingly positive and better than results of the population 65–74 and even better than results of the general population regardless the age as published by Sobotík (1998). The results of mini-invasive and standard techniques exert no statistically significant differences. As expected, our results are worse than those in members of the Czech Republic Police. There is still a limiting factor that with the help of the questionnaire, we evaluate rather effects of the implantation of the replacement for the joint on the quality of life and not the mini-invasive approach itself, which can be more properly evaluated by specific questionnaires. However, this fact does not reduce the importance of finding very positive effects of the surgical method on the quality of life of our patients and, in our opinion, following of this quality should form a part of all the studies implemented in this field
- Klíčová slova
- endoprotéza kyčelního kloubu - kvalita života, SF-36,
- MeSH
- hodnocení výsledků zdravotní péče metody statistika a číselné údaje MeSH
- kvalita života MeSH
- lidé MeSH
- náhrada kyčelního kloubu MeSH
- postoj ke zdraví MeSH
- průzkumy a dotazníky normy MeSH
- senioři MeSH
- stupnice dopadu nemoci na kvalitu života MeSH
- ukazatele zdravotního stavu MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Účel: Od roku 2003 používáme ke zpevnění horního hlezenního kloubu artroskopickou metodu. Postupně jsme v indikovaných případech nahradili dříve používané metody otevřených operačních procedur. Metoda artroskopicky asistované dézy hlezna se jeví jako perspektivní alternativa a účelem sdělení je vysvětlit princip a výhody této metody. Metoda: Pracujeme se standardní artroskopickou výbavou. Používáme 2 až 3 vstupní porty. Po mobilizaci hlezna, resekci měkkých tkání a kl. povrchů stabilizujeme postavení talu a vidlice dist. bérce 3–4 šrouby. Po operaci nakládáme sádrové „T“ a „U“ fixační dlahy na 6 týdnů. Podle průběhu hojení na rtg po 6 týdnech povolujeme postupnou zátěž a rehabilitaci kloubů sub talo. Výsledky: AS dezu hlezna jsme provedli u 27 pacientů. 2× jsme zaznamenali nevyhovující valgózní postavení, 1× opožděné kostní hojení. Došlo k rychlému prohojení linie dézy u většiny pacientů. Nezaznamenali jsme infekt povrchní ani hluboký, ani případ flebotrombózy. Závěr: Artroskopicky provedená déza talokrurálního kloubu se nám díky miniinvazivitě přístupu jeví jako velmi účinná operační technika, která je velmi výhodná zejména v terénu častých kožních změn, jizev a trofických změn na distálním bérci.
Purpose: Since 2003 we have used arthroscop as an assisted procedure for ankle arthrodesis. The arthroscopicaly assisted arthrodesis has successively replaced the open surgical procedures used in the past. This procedure seems to be a profitable method and the purpose of the article is an explanation of the principles and bendit of it. Method: We use the standard arthroscopic equipment. We use 2 or 3 ports. After joint mobilisation, debridement and cartilage and bone resection is the correct position stabilised using 3 or 4 screws. After the procedure the ankle is fixed in plaster bandage for 6 weeks and then the excercise and gradually weightbearing is allowed. Results: AAA of the ankle joint we have done in 27 cases. We registered 2 cases with unacceptable valgus deformity and a protracted bone healing. There were no other complications. Conclusion: The arthroscopicaly assisted arthrodesis of the ankle joint is an effective surgical method which is very useful in region of scars and trophic changes of soft tissue and skin of distal calf.
- Klíčová slova
- artrodéza hlezna,
- MeSH
- artrodéza metody využití MeSH
- artroskopie metody využití MeSH
- chirurgické fixační pomůcky využití MeSH
- dlahy využití MeSH
- fixace fraktur MeSH
- hlezenní kloub chirurgie MeSH
- kostní šrouby využití MeSH
- lidé MeSH
- ortopedické výkony metody využití MeSH
- osteoartróza chirurgie MeSH
- pooperační komplikace MeSH
- rentgendiagnostika využití MeSH
- Check Tag
- lidé MeSH
To evaluate the results of arthroscopic capsular release for the treatment of severe frozen shoulder syndrome. MATERIAL Between 2006 and 2008, 27 patients with severe frozen shoulder syndrome were treated by arthroscopic capsular release. The average age of the patients was 54 years (range, 34 to 75), 15 were men and 12 were women. The right shoulder was operated on more frequently (16 patients). The average pre-operative flexion was 73 degrees (range, 10 degrees to 150 degrees ) and pre-operative abduction was 56 degrees (10 degrees to 140 degrees ). The average Constant score was 35 points. METHODS With the patient in a lateral recumbent position, arthroscopic release of the joint capsule is performed with the Mitek VAPR 3 radiofrequency system, using a hook or an LPS electrode. The rotator interval, coracohumeral ligament, superior and middle glenohumeral ligaments and anterior part of the inferior glenohumeral ligament are gradually released, as well as the anterior glenohumeral joint capsule along its full width at the anterior rim of the labrum.To avoid damage to the axillary nerve, the axillary part of the joint capsule is released along the edge of the glenoid cavity. When internal rotation in abduction still remains restricted, release is extended to the posterior glenohumeral joint capsule.The procedure also involves exploration of the subacromial space and, if necessary, subacromial bursectomy or acromioplasty. Subsequently, the range of motion after release is tested and, when necessary, the remaining fibres of the joint capsule are disintegrated by careful manipulation (redress). The surgery is followed by analgesic and rehabilitation therapy. RESULTS All treated patients reported an improved range of motion. The average post-operative flexion and abduction extended to 160 degrees and 155 degrees, respectively, and 23 patients gained the motion range necessary for normal shoulder function.The average Constant score was 80.3 points and the University of California at Los Angeles (UCLA) score was 28.6 points. When using the school marking system, the average result evaluation was 1.75. All patients were satisfied with the outcome and were willing to undergo surgery on the other side if need be. No complications were recorded. DISCUSSION Therapy for frozen shoulder can be conservative or surgical. Most of the cases can be managed by correct conservative treatment. In accordance with the current literature data, we are using arthroscopic capsular release in resistant cases. This technique allows us to release contracted structures without the risk of iatrogenic injury and offers possibilities for the treatment of co-existing lesions. In the majority of patients this procedure can remedy their complaints, although the affected shoulder joint rarely remains asymptomatic. The aim of this approach is to accelerate the treatment of this disability; the long-term results are similar to those of conservative therapy. CONCLUSIONS Arthroscopic capsular release is the method of choice for the treatment of frozen shoulder syndrome in patients who have failed to respond to conservative therapy. It provides marked improvement in the range of motion and is associated with a minimum of post-operative complications. However, some patients may complain of persisting discomfort in the joint treated. Key words: frozen shoulder, arthroscopy, capsular release.
In a retrospective study, to evaluate the results of surgical treatment of hallux rigidus on the basis of clinical rating, radiographic findings and visual analogue scale (VAS). MATERIAL: The group included 68 patients, 38 women and 30 men, treated at the orthopaedic ward of the Hospital Ceské Budejovice in the period from April 2004 to June 2007. The average age of the patients was 58.6 years (range, 34 to 79). Right and left feet were affected in 42 and 26 patients, respectively. Follow-up ranged from 3 to 30 months. METHODS: Surgery was undertaken only after all means of conservative treatment had been used. Indications for each type of operation were based on the severity of disorder of the first metatarsophalangeal joint (MTPJ), patient's age, toe's motion restriction and physical stress on the patient's big toe. In patients with moderate degenerative MTPJ disease, in 25 feet, a Moberg dorsal wedge osteotomy of the first proximal phalanx was carried out when plantar flexion was preserved; in 12 feet, a Youngswick sagittal V osteotomy was indicated when both flexion and extension were limited and the first metatarsus was long enough; in 14 cases cheilectomy alone was used. In patients with severe arthritis, the TOEFIT-PLUS modular joint replacement of th first MTPJ was used in seven, the Brandes-Keller resection arthroplasty was carried out in six and arthrodesis of the first MTPJ was performed in four. All patients were examined at 2 and 6 weeks after surgery. Those undergoing osteotomy, arthrodesis or joint replacement were X-rayed after surgery and then at 6 weeks of follow-up. RESULTS: The outcome of treatment was evaluated at 3 to 30 months after surgery by clinical and X-ray examination and using the VAS. The average range of MTPJ motion improved from 5 degrees to 22 degrees in dorsiflexion and from 17.5 degrees to 27 degrees in plantar flexion. Osteotomy or arthrodesis in all patients healed in correct alignment, without loosening or migration of prosthetic components. Based on the VAS (100-point scale), pain assessment was 34 preoperatively and 78 post-operatively; joint motion increased from 51 before to 82 after surgery; and ability for daily activities from 50 to 84. The overall VAS score was 42 before surgery and improved to 83 after surgery. Five patients were dissatisfied; two of them underwent repeat surgery (arthrodesis) with marked improvement and one achieved improvement by shoe modification. The rest of the group reported good or very good outcomes. DISCUSSION: Resection arthroplasty, widely used before, is now performed only in patients exerting minimal physical activity and with severe arthritic disease, because it results in loss of the big toe's supporting function. Osteotomies by Moberg or Youngswick procedures involve the use of screws (Barouk). Stable osteosynthesis allows for early post-operative rehabilitation and weight bearing in appropriate modified shoes. Dorsal wedge osteotomy is the method most frequently used in our department to the full satisfaction of our patients.TOEFIT joint replacement is indicated in elderly patients with severe degenerative disease who wish to maintain toe motion and have adequate weight bearing of the treated foot. Emphasis is placed on good post-operative rehabilitation of the joint and on co-operation with the patient. CONCLUSIONS: The hallux rigidus diagnosis covers several grades of degenerative disease of the first MTPJ and therefore its surgical treatment must necessarily involve more than one operative procedure. Even when an appropriate technique is used, the problems may not resolve completely. When the technique to be used is considered, good communication with the patient is necessary, because they should know the principle of treatment and an anticipated outcome of it. Our results show that the surgical treatment of hallux rigidus has good outcome if it is correctly indicated and technically well performed and completed with good post-operative care.
- MeSH
- artrodéza metody trendy MeSH
- artroskopie metody statistika a číselné údaje využití MeSH
- hlezenní kloub chirurgie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
