OBJECTIVES: The aim of the analysis was to determine the probable places of coronavirus transmission in association with the work and compare the situation between 2020 and 2021. METHODS: The work analysed data from the Information System of Infectious Diseases managed by the Institute of Health Information and Statistics of the Czech Republic in the period from March 2020 - December 2021. RESULTS: 2,483,219 COVID-19 cases were officially confirmed (732,202 during 2020 and 1,338,790 in 2021), from them 140,368 (6%) represented work-related disease, 520,830 cases (21%) work-related contact, and 1,822,021 (73%) out-of-work contact. There were identified 13 occupations with the highest incidence of COVID-19 in the observed period (458,341 cases), in descending order - clerk, machinist, teacher, craftsman, worker/agency worker, driver, sales worker/cashier, warehouse worker/expediter, nurse, manager, food worker, paramedic, and social worker. Comparing 2020 and 2021, there was a difference in the ranking of occupations by incidence of disease. In 2021, the risk of infection acquiring increased for the occupations clerk, machinist, craftsman, worker/agency worker, manager, and food worker, while it decreased for the health professions (nurse, other paramedic, physician) and for social worker; 5,514 cases of COVID-19 were recognized as an occupational disease in 2020 and 2021, from them 5,483 cases (99.4%) in the health and social care economic activity sector. CONCLUSION: The available data show probable exposures to an infectious agent (without proof of specific contact with the source of the infection), of which 27% cases of COVID-19 are related to work (cases of work-related disease and work-related contact represented together the closest relationship to work). Different relevant anti-epidemic measures in the workplace have considerable practical importance for epidemic control. The use of personal protection of the mouth and nose with respirators/muffs is essential to reduce the risk of airborne transmission.
- MeSH
- COVID-19 * epidemiologie MeSH
- lidé MeSH
- nemoci z povolání * epidemiologie MeSH
- přenos infekce z pacienta na zdravotnického pracovníka prevence a kontrola MeSH
- SARS-CoV-2 MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Poranění m. pectoralis major (MPM) patří mezi vzácná svalová poranění. Malá zkušenost a neznalost problematiky tak vede často k přehlédnutí či chybně vedené léčbě. K poranění dochází nejčastěji nepřímým mechanismem při silových sportech, typicky při benchpressu. Z klinického vyšetření je typická porucha přední axilární řasy a přítomný hematom. Po odeznění otoku dále defigurace s medializací svalového bříška. Ze zobrazovacích metod je nejpřínosnější MR vyšetření s důrazem na správně zvolený protokol. Podle Cordascovy klasifikace rozlišujeme distenze, izolované a kompletní ruptury MPM. Nejčastější lokalizací ruptury je oblast muskulo-tendinozní junkce a inzerce. Operační léčba je indikována u izolované kompletní ruptury jedné porce a kompletní ruptury obou porcí m. pectoralis major, především u mladých aktivních pacientů s vysokými funkčními nároky. Operační výkon je vhodné provádět akutně, maximálně do 6 týdnů, kdy lze očekávat nejlepší výsledky. Nejčastější operační technikou je reinzerce svalu pomocí implantátů nebo přímá sutura. U chronických ruptur je pro retrakci svalu často nutné provést rekonstrukční výkon s použitím šlachového štěpu. Výsledky rekonstrukcí jsou dobré, avšak horší než u časného ošetření.
Injuries of pectoralis major (PM) muscle are among rare muscle injuries. Due to the lack of experience and knowledge in this field, they are often missed or improperly treated. Most often they are caused by an indirect mechanism, during strength sports, typically using the bench press. In clinical terms, they are typically characterized by specific disorder of the anterior axillary fold and a hematoma and, after subsidence of the swelling, disfiguration with medial retraction of the muscle belly. The most beneficial imaging method to examine these injuries is MRI with an emphasis on a properly set protocol. According to the Cordasco classification, they are categorized as PM distensions, isolated and complete ruptures. Ruptures involve most frequently the musculotendinous junction and tendon insertion. Operative treatment is indicated in isolated complete ruptures of one portion and complete ruptures of both portions of the pectoralis major tendon, predominantly in young active patients with high functional demands. Surgery should be preferably performed without delay, within no more than 6 weeks, in order to ensure the best results. The most common operative technique is reinsertion of the muscle by means of implants or direct suture. In chronic ruptures, it is often necessary to perform a reconstruction with a tendon graft. The results are good, although worse as compared to an early treatment.
- Klíčová slova
- Cordascova klasifikace, Bakova kritéria, kortikální knoflík,
- MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- poranění šlachy * diagnóza klasifikace terapie MeSH
- prsní svaly * zranění MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
OBJECTIVES: The authors evaluate situation in the field of musculoskeletal disorders (MSDs) and working risk factors in the Czech Republic. METHODS: Analysis of selected data from the Czech National Registry of Occupational Diseases during 2008-2018, description of criteria for recognition of occupational MSDs and risk factors associated with MSDs. RESULTS: 6,152 cases of 6 selected recognized occupational musculoskeletal diseases represent 47% of all recognized occupational diseases. The main proportion formed diseases of peripheral nerves in the extremities in terms of compressive neuropathies due to long-term and stereotyped overload, diseases of tendons, tendon capsules or insertions of muscles or joints in the extremities due to long-term and stereotyped overload and diseases of peripheral nerves in the upper extremities in terms of ischaemic and compressive neuropathies due to work with vibrating tools and devices. The authors discussed decreasing trend of the exposure time in three main diagnoses and association of the incidence of MSDs with the risky work related to overload of the musculoskeletal system of the upper extremities. CONCLUSIONS: Important factors for the prevention of MSDs are directly related to the technical provision of production, the organization of work and the regime of work and rest, the length of working hours and the setting of production standards, and generally to the work related stress.
- MeSH
- incidence MeSH
- lidé MeSH
- muskuloskeletální nemoci * epidemiologie MeSH
- nemoci z povolání * epidemiologie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
V článku je podán přehled nejznámějších rtg a CT klasifikací zlomenin zadního malleolu u luxačních zlomenin hlezna. Jejich analýza ukázala, že zlomeniny zadního malleolu jsou z hlediska velikosti a tvaru značně variabilní. Prosté rtg snímky jsou pro jeho diagnostiku nedostatečné. Pro detailní posouzení tvaru fragmentu a průběhu lomných linií je nezbytné CT vyšetření ve všech třech rovinách a následné 3D CT rekonstrukce.
The study presents an overview of the most common radiography and CT-based classifications of posterior malleolar fractures in ankle fracture-dislocations. Their analysis has shown that posterior malleolar fractures largely vary in size and shape. Evaluation of fractures by plain radiographs is inadequate. A detailed assessment of the fragment shape and course of fracture lines requires CT examination in all three projections, followed by 3D CT reconstructions.
- MeSH
- dislokace kloubu MeSH
- fraktury kotníku * diagnostické zobrazování klasifikace MeSH
- fraktury tibie * MeSH
- hlezenní kloub diagnostické zobrazování MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- tibie anatomie a histologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- souhrny MeSH
Úvod: Cílem prospektivní randomizované studie bylo porovnání tahové cerkláže a hákovité dlahy při léčbě AC luxací, především z hlediska funkčních a radiologických výsledků. Metoda: Soubor tvořilo 80 pacientů s akutní akromioklavikulární (AC) luxací typu 3, 4 a 5 Rockwoodovy klasifikace. Diagnóza byla stanovena na základě klinického (defigurace a instabilita) a rtg vyšetření (AP a zátěžové rtg). Tahovou cerkláží (TC) bylo ošetřeno 40 pacientů a hákovitou dlahou (HD) rovněž 40 pacientů. Hodnocení bylo prováděno v průběhu jednoho roku po operaci na základě rtg snímků a Constant score. Výsledky: Constantovo skóre 3 měsíce od operace činilo průměrně u TC 84 bodů a u HD 88 bodů. Po 1 roce od operace byl výsledek shodně 93 bodů u obou skupin. V souboru HD se hodnota skóre zvýšila mezi 2 a 4 týdny od operace z 56 na 78 bodů. V 71 případech bylo pooperační postavení AC kloubu a implantátu hodnoceno jako správné. U 6 případů jsme nalezli malpozici Kirschnerových drátů a ve 3 případech horizontální rozšíření AC kloubu. Redislokace v rozsahu 50–100 % šíře kosti akromia byla na rtg snímku patrná u 4 pacientů (10 %) ze skupiny TC a u 5 pacientů (13 %) ze skupiny HD. Viditelnou osteolýzu distální plochy akromia jsme nalezli u 83 % pacientů s HD. Komplikace jsme zaznamenali u 30 % pacientů s TC a u 5 % pacientů s HD. Závěr: Hákovitá dlaha i tahová cerkláž jsou srovnatelnými metodami při léčbě AC luxace hodnocené radiologicky a klinicky po 3 měsících a 1 roce od operace. Hákovitá dlaha má nižší počet komplikací a umožňuje časnější plnou zátěž a hybnost než TC. U TC doporučujeme odstranění implantátu za 8 týdnů, dobu 6 týdnů považujeme za příliš krátkou pro zhojení měkkých tkání. U HD je vhodné odstranění do 3 měsíců vzhledem k subakromiálnímu dráždění a tlakové osteolýze.
Introduction: The aim of the prospective randomized study was to compare tension wire cerclage and hook plate in the treatment of AC dislocation, primarily from the viewpoint of functional and radiological results. Method: The cohort comprised 80 patients with acute acromioclavicular (AC) dislocation of types 3, 4 and 5 of Rockwood classification. The diagnosis was based on the clinical (disfiguration and instability) and radiographic examination (AP and stress radiograph). Forty patients were treated with tension band wiring (TBW) and another 40 with a hook plate (HP). Evaluation was performed during one year after the surgery based on radiographs and the Constant score. Results: The mean Constant score 3 months after the surgery was 84 points for TBW and 88 points for HP. One year after the surgery, the result was the same in both groups: 93 points. In HP group the score increased from 56 to 78 points between 2 and 4 weeks from the surgery. In 71 cases the postoperative position of the AC joint and implant was assessed as correct. Malposition of Kirschner wires was recorded in 6 cases and horizontal widening of the AC joint in 3 cases. Redislocation of up to 50−100% of the width of acromion was shown by radiograph in 4 TBW patients (10%) and in 5 HP patients (13%). A visible osteolysis of the distal surface of acromion was found in 83% of patients with HP. Complications were recorded in 30% of TBW patients and in 5% of HP patients. Conclusion: Based on radiological and clinical results assessed 3 months and 1 year after the surger, the hook plate and tension band wiring are comparable treatment methods for AC dislocation. The hook plate is associated with a lower complication rate and allows earlier full weight bearing and mobility than tension wire cerclage. In TBW we recommend to remove the implant after 8 weeks; 6 weeks are in our view too short a period for the healing of soft tissues. In HP it is suitable to remove the hardware by 3 months due to potential subacromial irritation and pressure-induced osteolysis.
- Klíčová slova
- hook plate,
- MeSH
- akromioklavikulární kloub * chirurgie radiografie zranění MeSH
- dislokace kloubu * chirurgie radiografie MeSH
- dospělí MeSH
- hojení fraktur MeSH
- kostní destičky škodlivé účinky využití MeSH
- kostní dráty škodlivé účinky využití MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- osteolýza etiologie komplikace MeSH
- pooperační komplikace MeSH
- prospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- senioři MeSH
- vnitřní fixace fraktury * metody přístrojové vybavení statistika a číselné údaje MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- senioři MeSH
- Publikační typ
- srovnávací studie MeSH
Současné možnosti týkající se jak výběru implantátů, tak přístrojového vybavení nám dávají dobré předpoklady úspěšně ošetřit převážnou většinu trochanterických zlomenin. Základem je správné zhodnocení typu zlomeniny a respektování jejích biomechanických charakteristik. Na základě této analýzy volíme implantát a správnou operační techniku. U vlastního výkonu stojí na prvním místě kvalita. Řada pacientů snese pouze jeden výkon a je lépe, trvá-li o 10 minut déle, než když je proveden špatně. Tzv. selhání implantátu je většinou selhání operatéra.
The current possibilities concerning selection of implants and the respective devices provide us with good prerequisites for a successful treatment of almost all trochanteric fractures. The basis is a proper evaluation of the type of the fracture and respecting its biomechanical features. Based on this analysis we select the implant and the proper operative technique. Quality is the highest priority as concerns the actual operation. A number of patients tolerate only one operation and it is better if it takes 10 minutes more than if it is performed improperly. The so called implant failure is in most cases the surgeonęs failure.
- MeSH
- fraktury kyčle * diagnóza klasifikace terapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY The aim of this study is to present a simple rotator cuff lesion classification that provides guidelines as to their treatment, and to evaluate the results of palliative arthroscopic resection of rotator cuff residues known as unreconstructible lesions. In addition, our therapeutic approaches were ascertained in view of their applicability to the types of lesions studied. MATERIAL In a five-year period (January 1, 2000 to December 31, 2004), a total of 181 arthroscopic procedures were performed on the shoulder joints of patients diagnosed with impingement or rotator cuff syndromes. In 130 cases, a tear or irritation of the rotator cuff was recorded. Rotator cuff lesions were categorized on the basis of our modification of the Gschwend classification. In 15 of the patients, in whom unreconstructible lesions were detected, arthroscopic palliative resection of rotator cuff residues was performed. The average age of these patients was 65 years, and they were followed up for 6 to 60 months. METHODS All surgery was carried out in a "beach-chair" position, either under general anesthesia or with an interscalene brachial plexus block. The arthroscope was inserted through the "soft-spot". Continuous irrigation was provided with an arthroscopic pump. In the first place, the glenohumeral joint was explored, and resection of rotator cuff residues was performed via ventral and lateral ports. The procedure was completed by subacromial decompression and partial resection of the acromion.The results were evaluated by the Constant Functional Score, as modified by us. Clinical examination was supplemented with subjective information from questionnaires provided by the patients. RESULTS In a total of 130 shoulder joints with rotator cuff tears examined by arthroscopy, type I lesions were found in 90, and these were treated by arthroscopic subacromial decompression. Twenty-five type II and type III lesions underwent open rotator cuff repair and 15 type IV and type V lesions were treated by palliative arthroscopic resection of residual rotator cuff lesions, using the Apoil method. These fifteen patients were followed up for 6 to 60 months and their outcomes were evaluated. No excellent results were achieved (Constant Score, 80-100 points), but this is implicit in the nature of a palliative operation. Good (65-79 points) and satisfactory (51-64 points) results were recorded in 11 (73.3 %) and four (26.7 %) patients, respectively. No poor results were found. The average improvement in Constant scores was 21 points. DISCUSSION A total of 130 rotator cuff lesions diagnosed arthroscopically were categorized on the basis of a modified classification system. We will continue to treat type I lesions by arthroscopic subacromial decompression, which has provided good results, as reported in our previous study. We consider the arthroscopic repair of rotator cuff tears to be an optimal procedure for type II lesions; for type III lesions we will keep using open repair surgery. The most complex problem is presented by type IV lesions. While palliative arthroscopic resection of the rotator cuff is one option, muscle transfer has also shown satisfactory outcomes, as has partial reconstruction. The use of either allografts or cadaver grafts did not give good results. Type V lesions, in our opinion, are unambiguously indicated for palliative arthroscopic resection of the rotator cuff. Their treatment by the Apoil method and detailed evaluation of the outcomes are described here; the results of this study are in agreement with those reported in the relevant international literature. CONCLUSIONS Good and satisfactory results were achieved by palliative arthroscopic resection of the rotator cuff, in combination with subacromial decompression, in patients with unreconstructible lesions. The average improvement in the Constant Functional Score was 21 points. This suggests that the method can be recommended for wider use in the future. However, exact diagnosis and correct indication, i.e., type V lesion, are essential.
