- MeSH
- ekonomika nemocniční normy organizace a řízení MeSH
- finanční řízení nemocnic * normy organizace a řízení MeSH
- financování zdravotní péče MeSH
- lidé MeSH
- nemocnice krajské organizace a řízení MeSH
- poranění páteře chirurgie MeSH
- řízení nemocnice ekonomika MeSH
- traumatologická centra organizace a řízení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- rozhovory MeSH
- MeSH
- bederní obratle * patofyziologie zranění MeSH
- cementování metody škodlivé účinky MeSH
- chirurgie operační metody MeSH
- dospělí MeSH
- fraktury kostí chirurgie komplikace patofyziologie terapie MeSH
- fraktury páteře * chirurgie komplikace patofyziologie terapie MeSH
- hrudní obratle * patofyziologie zranění MeSH
- kosti a kostní tkáň patofyziologie zranění MeSH
- lidé MeSH
- ortopedické výkony metody MeSH
- osteoporotické fraktury chirurgie komplikace patofyziologie terapie MeSH
- páteř patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY The aim of this study is to evaluate the first experience gained with the new type of anatomical symphyseal plates intended to stabilise ruptured symphysis and closely located fractures. MATERIAL AND METHODS A retrospective evaluation was performed in 5 patients who had undergone surgery in the period from July 2015 to the end of 2016 using a new anatomical symphysial plate for pelvic ring injury. In four cases a stabilisation of symphyseolysis was carried out and in one case osteosynthesis of bilateral rami fracture near the symphysis was performed. The posterior pelvic segment was fixed 3 times by iliosacral screws and 2 times by a transsacral bar. All the surgeries in symphysis region were performed via a modified anterior suprapubic approach. A total of 3 men and 2 women with the mean age of 54.6 years (range 19-77 years) were operated. The mean follow-up period of five patients was 12.6 months. Also, preliminary evaluation of postoperative clinical and radiological outcomes was conducted on a very heterogenous group of patients. RESULTS The postoperative radiological outcome assessed by Pohlemann score was excellent in all the cases. After 3-6 months, screw loosening was reported in 3 cases, with no impact on the overall result of the surgery, in one case the symphysis widened 2 mm with simultaneous loosening of two screws, with no impact on the clinical result either. Clinical evaluation of the results was conducted in 4 patients using the Majeed score with the mean follow-up of 12.6 months, the score achieved was 98, 86, 72 and 49 points. In one patient the results could not be evaluated due to concurrent spinal cord injury with quadriplegia. Nonetheless, even this patient has no difficulty in sitting in a rehabilitation wheelchair. No serious intraoperative or early postoperative complications were reported. As regards late complications, one female colostomy patient developed deep infection three months after the primary surgery. DISCUSSION The first clinical as well as radiological outcomes in our small group of patients are comparable to the outcomes of larger groups using multi-hole plates to stabilise the anterior segment, or the application of 2 plates. In agreement with other authors, the new plates can be applied through a less invasive operative approach avoiding the necessity to transect rectus abdominis muscles. The results of earlier biomechanical studies suggest that their strength will equal 2 inserted plates, or will be comparable to multi-hole plates. CONCLUSIONS The first experience with the use of new anatomical symphysial plates are promising. The new types of plates intended for anterior pelvic segment facilitate fixation by screws inserted at two levels. They significantly improve the stability of fixation and can replace the commonly used 2 plates. The only limiting factor of our group of patients is its small size. Comparative weight-bearing tests shall be performed in the future. Key words:symphysis pubic disruption, pelvic ring fractures, pelvic instability, new symphyseal plates.
- MeSH
- fraktury kostí diagnóza chirurgie MeSH
- hodnocení výsledků zdravotní péče MeSH
- kostní destičky * MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- nestabilita kloubu * diagnóza chirurgie MeSH
- pánevní kosti diagnostické zobrazování zranění MeSH
- radiografie metody MeSH
- symphysis pubica * zranění patofyziologie chirurgie MeSH
- vnitřní fixace fraktury * škodlivé účinky přístrojové vybavení metody rehabilitace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
UNLABELLED: PURPOSE OF THE STUDY The aim of the study was to analyse the options for sustentacular screw placement in osteosynthesis of intra-articular fractures of the heel bone and to assess the effect of various screw positions on failure to maintain the reduction in the postoperative period. In addition, problems related to screw-end protrusion over the medial cortical bone or to screw penetration into the talocalcaneal joint were assessed. MATERIAL AND METHODS The group comprised 23 patients with a total of 25 intra-articular fractures of the heel bone treated by surgery. The procedure involved insertion of a sustentacular screw under fluoroscopic guidance. Post-operatively, screw position in the sustentacular fragment was evaluated on CT scans. During follow-up, attention was focused on the effect of screw placement on maintenance of fracture reduction, and clinical symptoms potentially associated with screw malposition were recorded. RESULTS All sustentacular screws were fixed sustentacular fragments. Seven screws (28%) were inserted in the talar shelf, seven (28%) were placed under and nine (36%) over the sustentaculum tali. Two screws penetrated into the talocalcaneal joint (8%). The end of a screw projecting by 2 mm over the medial wall of the calcaneus was found in 11 cases (44%). Two patients with screws penetrating into the talocalcaneal joint had problems. On the other hand, no clinical effect of a screw extending over the medial wall of the calcaneus was recorded. No significant association of screw position with late //delayed failure of fracture reduction was detected. DISCUSSION Although the ideal trajectory for a sustentacular screw have been defined using a model of the calcaneus, it is not easy to achieve optimal screw placement due to the complex anatomy of the calcaneus and limited possibilities of intra-operative control of screw insertion. Any sustentacular screw malposition is a potential risk factor, particularly if the screw has penetrated into the talocalcaneal joint. Therefore, it will be useful to seek methods allowing for safer screw insertion and elimination of risks associated with screw misplacement. The technique of sustentacular screw insertion by means of a compression-based device, described by the authors, designated to allow for screw placement in distal humerus fractures is one of the options. CONCLUSIONS Optimisation of techniques for sustentacular screw insertion in the osteosynthesis of calcaneal fractures should contribute to reduction of risks related to screw malposition. The assessment of effects which the position of a screw may have on delayed failure of fracture reduction should be based on a thorough biomechanical study. KEY WORDS: sustentacular screw, calcaneal fracture, insertion, malposition.
- MeSH
- fixace fraktury přístrojové vybavení metody statistika a číselné údaje MeSH
- fluoroskopie MeSH
- intraartikulární fraktury diagnostické zobrazování chirurgie MeSH
- kostní šrouby * MeSH
- lidé MeSH
- patní kost diagnostické zobrazování zranění chirurgie MeSH
- počítačová rentgenová tomografie metody MeSH
- vnitřní fixace fraktury přístrojové vybavení metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Periferní primitivní neuroektodermální tumor (pPNET) je vysoce maligní sarkom měkkých tkání vycházející pravděpodobně z primitivních buněk zárodečné neurální lišty. Pro některé společné cytologické, imunohistochemické a cytogenetické rysy s kostním Ewingovým sarkomem bývá také někdy nepřesně označován jako Ewingův sarkom měkkých tkání, kdy se může jednat o různou morfologickou expresi stejného nádorového typu. Objevuje se převážně u mladých nemocných v různých lokalizacích, vždy v intimním spojení s periferním nervem. Jeho výskyt v průběhu spinálního kořene je velmi vzácný a literární výčet je v tomto případě omezen pouze na několik kazuistických sdělení. V naší práci představujeme případ 35leté pacientky, u které byl odhalen pPNET v oblasti extraforminálního výstupu kořene L5. Díky časné diagnostice a léčbě zahrnující radikální resekci v kombinaci s agresivní chemoterapií a ozářením lůžka nádoru nebyla dosud zaznamenána recidiva nádorového růstu, přičemž doba sledování činí více než pět let.
Peripheral primitive neuroectodermal tumor (pPNET) is a highly malignant soft tissue sarcoma probably originating from embryonic neural crest cells. For some common cytological, immunohistochemical and cytogenetic features with bone Ewing's sarcoma, pPNET is also sometimes inaccurately referred to as Ewing's sarcoma of soft tissues. pPNET probably is a different morphological expression of the same tumor type. pPNET mainly occurs in younger patients in various locations, always in close proximity to a peripheral nerve. However, its occurrence within a spinal nerve root is very rare and, so far, only a few cases have been described in the literature. In our report, we present a case of 35-year-old woman with pPNET in extraforaminal projection of L5 root. As a result of early diagnosis and treatment, including radical surgery combined with aggressive chemotherapy and irradiation of the tumor bed, no recurrence has been reported so far. The follow-up period is more than five years. Key words: peripheral primitive neuroectodermal tumor – spinal nerve root – neurosurgery – chemotherapy – radiotherapy The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
- MeSH
- časná diagnóza MeSH
- chemoradioterapie * metody využití MeSH
- diagnostické techniky neurologické využití MeSH
- dospělí MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- míšní kořeny chirurgie patologie MeSH
- neurochirurgické výkony * metody využití MeSH
- periferní primitivní neuroektodermové nádory * diagnóza etiologie chirurgie MeSH
- pozitronová emisní tomografie metody využití MeSH
- statistika jako téma MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
Úvod: Kvalita ošetření zlomenin páteře s neurologickým postižením spočívá ve volbě správné operační strategie, ve správném načasování její realizace a ve správném technickém provedení. Selhání kterékoliv z uvedených složek ošetření výrazně negativně ovlivňuje další péči o zraněného. Korektnost technického provedení je v řadě případů velmi sporná. Je třeba věnovat pozornost zdokonalení techniky použití spinálních implantátů, aby mohla postakutní i chronická fáze péče o pacienty s neurologickým postižením probíhat nerušeně. Materiál a metoda: Retrospektivní analýza kvality primárního chirurgického ošetření pacientů s traumatickou míšní lézí hospitalizovaných na spinální jednotce Krajské nemocnice Liberec v letech 2003–2012 a na spinální jednotce FN v Motole v letech 2004–2012. Výsledky: V průběhu sledovaného období bylo nevhodné ošetření zjištěno u 191 pacientů ze 775 (24,6 %). V suboptimálním ošetření dominovala chybná repozice u 111 případů (58,1 %) a chybné zavedení pedikulárních šroubů v 78 případech (48,8 %). Následovala chybná dekomprese v 52 případech (27,2 %). U 85 pacientů (44,5 %) bylo nutné kompletní přepracování stabilizace. Nebyl zaznamenán žádný vývoj v počtu nesprávně ošetřených pacientů v jednotlivých letech. U suboptimálně ošetřených pacientů s poraněním v krční, hrudní i bederní oblasti se shodně prodloužila hospitalizace v průměru o 9,58 dne. Závěr: Autoři doporučují důsledné dodržování operační techniky a kritické pooperační rentgenové kontroly. Další pokrok spatřují v kvalitním vzdělávacím systému ve spondylochirurgii.
Introduction: Right surgical strategy, optimal timing and correct surgical technique are crucial for the quality of treatment of spinal fractures associated with neurological deficit. Failure of any of these parts of treatment has an immensely negative effect on subsequent patient care. In many cases, the quality of technical performance of the surgery is controversial. It is desirable to improve the use of spinal implants to achieve undisturbed course of subacute and chronic phases of treatment. Material and methods: Retrospective analysis of the quality of primary surgical treatment of patients with posttraumatic spinal cord injury treated at the Spinal Unit of the Regional Hospital Liberec between 2003 and 2012 and at the Spinal Unit of the University Hospital Motol in Prague between 2004 and 2012. Results: Incorrect surgical treatment was delivered in 191 of 775 cases (24.6%). Wrong fracture reduction was preformed in 111 cases (58.1%). Incorrect pedicle screw insertion was found in 78 cases, followed by insufficient decompression of the spinal channel in 52 cases. A revision surgery with complete reinstrumentation was required in 85 patients (44.5%). We identified no development in the number of suboptimally treated patients over the analyzed years. The length of hospital stay in suboptimally treated patients was prolonged by the mean of 9.58 days. Conclusion: The authors recommend strict compliance with the surgical technique and rigorous post-operative X-ray follow ups. This field could further be improved with high-quality spinal surgery educational system. Key words: spinal cord injury – spinal cord decompression – spinal fracture reduction – spine stabilization The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
- Klíčová slova
- dekomprese míchy, stabilizace páteře, repozice zlomenin páteře,
- MeSH
- bederní obratle chirurgie zranění MeSH
- chirurgická dekomprese metody škodlivé účinky statistika a číselné údaje MeSH
- chybná zdravotní péče * statistika a číselné údaje škodlivé účinky MeSH
- délka pobytu statistika a číselné údaje MeSH
- dospělí MeSH
- fraktury páteře chirurgie MeSH
- fúze páteře škodlivé účinky MeSH
- hrudní obratle chirurgie zranění MeSH
- interní fixátory škodlivé účinky MeSH
- kostní šrouby statistika a číselné údaje škodlivé účinky MeSH
- krční obratle chirurgie zranění MeSH
- lidé MeSH
- manipulace ortopedická škodlivé účinky MeSH
- pedikulární šrouby MeSH
- pooperační komplikace MeSH
- poranění míchy * etiologie chirurgie MeSH
- reoperace statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- řízení kvality MeSH
- vnitřní fixace fraktury škodlivé účinky MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) * statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
PURPOSE OF THE STUDY: The aim of the study was to assess the average length of a proximal and a distal incision, to verify the location of the axillary nerve and to identify risk factors for nerve injury during minimally invasive plate osteosynthesis. MATERIAL AND METHODS: During cadaver study a total of 24 implantations using the Philos angular stable plate were performed from the minimally invasive anterolateral approach. A five-hole plate inserted with the aid of new Philos aiming device was used in all cases. The plate was fixed with four screws proximally and with three screws to the diaphysis. After implantation either of the incisions were joined and the axillary nerve was exposed on the lateral side of the arm. RESULTS: The nerve was not found to be injured during plate implantation in any of the cases. The average length of the proximal incision was 56 ± 2.8 mm (52-64 mm) and that of the distal incision was 32 ± 2.5 mm (28-35 mm). The middle free part covering the axillary nerve was on average 45 ± 4.3 mm (38-54) long. The average width of the nerve was 1.9 ± 0.35 mm (1.4-2.8 mm). The average distance of the axillary nerve was 39 ± 2.9 mm (37-44 mm) from the superior facet of the greater tubercle and 53 ± 3.9 mm (48-60) from the lower edge of the acromial process. In 80% of the cases the nerve was located in the area determined for the screws going to the medial calcar region; in 20% it was over a hole for the screw directed towards the centre of humeral head. Nerve location above the first six most proximally placed screws was not recorded in any of the cases. DISCUSSION: The minimally invasive anterolateral approach is an alternative technique for osteosynthesis of proximal humerus fractures using angular stable plates. Advantages reported by a number of authors include lower incidence of avascular necrosis of the humeral head, an easier way of reduction and a better view of the rotator cuff. On the other hand, this approach is associated with a higher risk of damage to the axillary nerve. Distance of axillary nerve from acromion is very variable. It may be located in the range of 30 to 85 mm from the acromial edge. CONCLUSION: The anterolateral approach is, when respecting the anatomical position of the axillary nerve, a safe alternative to the conventional deltoideopectoral approach.
- MeSH
- axila inervace MeSH
- fraktury humeru * diagnóza chirurgie MeSH
- hodnocení výsledků zdravotní péče MeSH
- humerus patologie patofyziologie MeSH
- kostní destičky MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony škodlivé účinky přístrojové vybavení metody MeSH
- peroperační komplikace prevence a kontrola MeSH
- poranění periferního nervu * etiologie prevence a kontrola MeSH
- vnitřní fixace fraktury * škodlivé účinky přístrojové vybavení metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE OF THE STUDY: The aim of the study was to describe a novel Omega plate and the procedure for obtaining an accurate pelvic inlet view, the mode of pre-operative plate contouring, the surgical procedure used and the evaluation of results in the first 15 patients treated using this method. MATERIAL AND METHODS: In the period 2009-2011, a total of 232 patients underwent osteosynthesis for pelvic fractures. Out of them, 52 were treated by the modified Stoppa approach and 12 with the original Omega plate. Between July 2010 and January 2014, a novel 3.5-mm Omega plate was used in 12 men and 3 women. The average duration of follow-up was 8.5 months in 11 patients; four were shortly after surgery. The multi-functional Omega plate is described in detail. An exact pelvic inlet projection, named the "computer tomography-defined (CTD) view", was based on pre-operative CT examination. It facilitates pre-operative contouring of the plate according to a mirror image of the uninjured half of the pelvis. The surgical procedure enables us to apply the contoured plate to the correct position; the plate completes reduction, restores normal pelvic anatomy and makes operative time shorter. The radiographic evaluation of post-operative results was done using the Matta classification and functional outcome was assessed by the Harris Hip Score. RESULTS: Surgery using the isolated Stoppa approach was carried out in 11 patients and a procedure combining the Stoppa approach with another method was used in four patients. All operations were successfully completed, during two of them the external iliac vein was injured and treated by vascular suturing. No other vascular or nerve injury occurred. One deep wound infection successfully healed was recorded. The post-operative radiographic results were excellent or satisfactory in 12 and poor in three patients. At follow-ups of 6 to 12 months, no failure of fracture reduction or osteosynthesis was recorded in 11 patients. Neither avascular necrosis of the femoral head nor heterotopic ossification was found. One patient showed signs of post-injury arthritis at 6 months after surgery. The functional result assessed by the Harris Hip Score was excellent in seven patients, good in two (one of them with gonarthrosis), satisfactory in one patient with contralateral total hip replacement and ipsilateral gonarthrosis, and poor in one patient with hemiparesis after a stroke. DISCUSSION: Shape and size variability in CTD pelvic inlet views do not allow us to create a unified anatomically correct implant. Contouring during the operative procedure may not be accurate enough and significantly prolongs the time of surgery. Therefore, a custom-made plate for each patient seems to be an optimal method. It has been demonstrated on a group of 50 patients that CTD images of the right and left halves of the pelvis are identical in 68% and very similar (variation in length up to 5 mm and in curvature up to 3 mm) in 18%. At present plate contouring according to a mirror image of the acetabulum, which will be obtained by 3D printing, is prepared. CONCLUSIONS: Pre-operative contouring of an Omega plate based on a post-injury CT scan of the uninjured half of the pelvis is over 80% accurate or almost accurate. The multi-functional 3.5-mm pelvic plate Omega allows us to stabilise complicated fractures of the superior ramus of the pubic bone, anterior acetabular column or quadrilateral plate as well as fractures above the linea arcuata or uncomplicated fractures of the posterior column. The stabilisation of all fragments of the anterior column and quadrilateral plate is very firm and the Omega plate is resistant to fragment redisplacement. Also, it is its advantage that it can remain in situ if total hip arthroplasty is required later.
- MeSH
- acetabulum zranění radiografie MeSH
- design vybavení MeSH
- fraktury kostí radiografie chirurgie MeSH
- kostní destičky * MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- předoperační období * MeSH
- vnitřní fixace fraktury přístrojové vybavení metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
