Osteoartróza (artróza, osteoarthritis) je nejčastějším onemocněním kloubů, jímž trpí miliony lidí na celém světě. Může postihnout dle etiologie primárně či sekundárně kterýkoliv kloub, nejčastěji se vyskytuje v nosných kloubech, tj. v kolenních a kyčelních kloubech, dále v drobných kloubech rukou, nohou či v oblasti páteře. Toto onemocnění progreduje v čase, pacientovi přináší omezení hybnosti kloubu (kloubů) a bolesti spojené s pohybem, následně i klidové. V současné době neexistuje kauzální léčba, můžeme však terapeuticky zpomalit rozvoj onemocnění a zlepšit funkčnost kloubů. Symptomatologické ovlivnění osteoartrózy spočívá v souboru opatření, od nefarmakologického působení v rámci rehabilitace, edukační činnosti spojené s ovlivněním patologických vzorců chování (obezita, mechanické přetěžování kloubů), přes farmakologické ovlivnění algických a zánětlivých projevů, chondroprotektivní působení až k viskosuplementaci, tedy intraartikulární aplikaci kyseliny hyaluronové – biopolysacharidu, který zlepšuje reologické vlastnosti artrotických kloubů.
Osteoarthritis is the most common disorder affecting joints causing suffering to millions of people worldwide. According to its aetiology, it can primarily or secondarily affect any joint, but is most commonly seen in weightbearing joints, i.e. knee and hip joints, further the small joints in the hands, feet or in the spine. This disorder is progressive over time and affected patients suffer from restricted joint mobility and pain, associated with movement, following movement, or at rest. There is no current causal treatment, but we can intervene therapeutically to slow down the development of the disease and improve joint function. Symptomatic modification of osteoarthritis includes the use of a set of measures, from non-pharmacological effects as part of physiotherapy, education targeting activities related to pathological behaviour patterns (obesity, mechanical joint overload), over pharmacological effects on the manifestations in terms of pain and inflammation, chondroprotective action, to viscosupplementation, that is intraarticular application of hyaluronic acid – a biopolysaccharide improving rheological properties of joints affected with osteoarthritis.
- MeSH
- artroskopie metody MeSH
- bolest farmakoterapie MeSH
- injekce intraartikulární metody přístrojové vybavení MeSH
- kloubní chrupavka * patologie účinky léků MeSH
- kyselina hyaluronová * aplikace a dávkování MeSH
- lidé MeSH
- osteoartróza * etiologie farmakoterapie MeSH
- viskosuplementace metody MeSH
- viskosuplementy terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
PURPOSE OF THE STUDY The authors describe the therapeutic utilization of separated/isolated autologous growth factors in semiconservative treatment of type III injury to the ankle ligamentous complex. MATERIAL Between October 2004 and March 2005 a group of 11 patients, two women and nine men, aged 18 to 41 (average, 25.09) years with acute injury to the lateral ligamentous complex of the ankle were treated by plasma rich in growth factors (PRGF) infiltration. On functional radiographic examination, the post-traumatic lateral opening of the tibiotalar intraarticular space was 17.45 degrees (range, 12.0-30.0; s = 5.68). METHODS The injured patients were clinically examined and standard forced inversion radiographs were made using topical anesthesia. Autologous PRGF activated with calcium chloride was used to infiltrate the injured tissues. The treatment was followed by immobilization of the joint and its subsequent rehabilitation. Clinical examination of injured tissues was carried out at 4 and 6 weeks of follow-up, using stability assessment tests and functional radiography of the ankle. Physical therapy included standard procedures, but faster regeneration of the soft tissues allowed for more exercises. RESULTS The average time of healing was 5.18 weeks. Five patients showed no signs of instability at 4 weeks after therapy and could return to their previous sports activities. One patient had lateral ankle instability at 5 weeks and therefore the therapy continued with prolonged immobilization and then rehabilitation at a slower pace. The average lateral opening of the tibiotalar intra-articular space at 4 or 6 follow-up weeks was 4.73 degrees (range, 3.0 - 7.0; s = 1.19). At 6 weeks after therapy, 90.9 % of the patients resumed their full sports activities. DISCUSION Ankle distortion with swelling, hematoma and pain, but with no radiographic findings of ligament lesions, is usually treated conservatively by ankle immobilization and early rehabilitation. When an injury to the fibular ankle ligaments occurs (i.e., opening of the tibiotalar intra-articular space laterally by more than 10 degrees), surgery and reconstruction of the injured tissues is indicated. An alternative treatment of acute injury to the ligamentous ankle complex includes application of growth factors into the injured tissues. The presence of growth factors facilitates the healing and remodeling of soft tissues and regenaration may begin before leukocytes infiltrate the affected site. At a relatively low level of interleukins, the inflammatory phase of healing is suppressed, pain is reduced and the process of reparation and regenaration is accelerated. CONCLUSIONS The use of bioinductive properties of growth factors is one of the options for treating injuries to the ligamentous complex of the ankle. It can be used alternatively to conventional surgery or as an adjunct accelerating and improving the healing of traumatic lesions and postoperative conditions.
The authors analyze one of the new therapeutic approaches - the use of autologous growth factors. Because the chemical structure of these proteins and their involvement in many functions of the organism affect the whole range of tissues, with a possibility to use them in human medicine. Growth factors, such as platelet-derived growth factor, transforming growth factor and others, exert effects on fibroplastic events during ontogenesis as well as on regeneration of tissues injured due to an accident or surgery. The preparation of therapeutic doses of growth factors consists of autologous blood collection, plasma separation and application of plasma rich in growth factors. The fibroplastic event insolves chemotaxis and proliferation of cells, proteosynthesis, reparation and remodeling of tissues. The paper describes the method and is an introduction to studies on the utilization of growth factors in orthopaedics and traumatology.
BACKGROUND: Rotator cuff tear--diagnosis; comparison of MRI, ultrasonographic and arthroscopic findings. MATERIALS AND METHODS: Retrospective study--20 patients treated for shoulder pain due to rotator cuff tear, initially conservatively and after more than 6 months by arthroscopic shoulder surgery. Comparison of intraoperative findings with preoperative US and MRI images. RESULTS: Sensitivity of USG--1.0, specificity 0.9. Sensitivity of MRI--0.92, specificity 1.0. DISCUSSION: Clinical examination and physical tests are not fully reliable diagnostic tools in patients with shoulder pain, because symptoms of different conditions overlap. Using ultrasound to visualize the shoulder area has some advantages to other imaging techniques such as CT scan or MRI, and has a very good sensitivity and good specificity. Many authors agree that MRI is one of the most effective methods for the diagnosis of rotator cuff tear. CONCLUSIONS: Ultrasound and magnetic resonance imaging are both very sensitive techniques for diagnosis of rotator cuff abnormalities. Ultrasonography can be used as a primary method owing to its fast procedure and affordable cost.
- MeSH
- artroskopie metody MeSH
- bolest ramene diagnóza etiologie ultrasonografie MeSH
- dospělí MeSH
- echoplanární zobrazování MeSH
- lacerace diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění ramene MeSH
- poranění rotátorové manžety MeSH
- poranění šlachy diagnóza ultrasonografie MeSH
- ramenní kloub ultrasonografie MeSH
- retrospektivní studie MeSH
- rotátorová manžeta ultrasonografie MeSH
- senzitivita a specificita MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
