Q95399713
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- MeSH
- kyčelní kloub * anatomie a histologie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY The aim of this prospective randomised study was to compare and statistically analyse two methods of condylar twist angle (CTA) measurement in total knee arthroplasty in order to assess their applicability in routine practice. MATERIAL AND METHODS The study included 238 patients with 256 sites undergoing total knee arthroplasty (TKA) in the period from January 2009 to May 2011. There were 93 men (nine with bilateral TKA) and 145 women (nine with bilateral TKA) with an average age of 69.3 years and a range of 47 to 88 years. The implants NexGen (Zimmer) and ADVANCE? Medial-Pivot Knee (Wright) were used. In each patient, CTA was measured before surgery by the radiologist on a multidetector CT SOMATOM 64 (Siemens) using the Yoshioki method. The other CTA measurement was made intra-operatively by the surgeon using our modification of the Hofmann method which involved the identification of a reference line for optimal rotational alignment of the femoral component. A STATISTICA 9.0 software package was used for statistical analysis. In addition to basic statistical data, selected data were presented in graphical forms as Box and Whisker's plots and histograms. Changes in CTA and differences between the groups were evaluated using the Wilcoxon signed-rank test. Relationships among the variables were studied using Spearman's correlation coefficient. RESULTS The statistical analysis showed that the pre-operative CTA value obtained from CT scans was, on the average, higher by 0.5 degrees than the value from intra-operative measurement, as assessed at the level of significance p = 0.001 (signed-rank test). The intra-individual variability was lower than the inter-individual one (14.4% and 30.8%, respectively). This means that both methods are suitable for CTA measurement in the knee joint replacement procedures. Spearman's correlation coefficient was 0.6, which is the value of medium strong correlation. The post-operative CTA assessed on CT scans was in the range of 0 to 2 degrees in 87.5% of the patients. Both the pre-operative and intra-operative CTA values were significantly higher in women than in men (Wilcoxon two-sample test). There was no statistical difference between the left and the right side. DISCUSSION Malrotation of the femoral component is one of the causes leading to patellar subluxation and pain in the front part of the knee. The post-operative CTA value should be zero. Optimal rotational alignment of the femoral component varies with each patient; in our study it was found in the range of 0 to 7 degrees on the basis of CTA values. We do not recommend 7 degrees of external rotation to be exceeded because of the risk associated with balancing the flexion gaps; nor do we recommend to set internal rotation of the femoral component for the risk of patellar complications. The difference of 0.5 degree found in the CTA value between the two measuring methods can be explained by individual differences in the anatomy of the medial epicondylar region, and by the use of only selected whole numbers (0, 3, 5, 7) in intra-operative measurements. This difference does not play any role in routine surgical procedures. CONCLUSIONS The statistical evaluation of the results of CTA measurement with the two methods showed that both were equally suitable for routine total knee arthroplasty. The results of intra-operative CTA measurements are comparable with those obtained on CT scans; in addition, the intra-operative method is less expensive and eliminates exposure of the patient to radiation. CT-based CTA measurements are useful in the patients with chronic problems afterTKA in whom femoral component malrotation needs to be either confirmed or ruled out.
- Klíčová slova
- CTA, condylar twist angle, Advance Medial - Pivot Knee, NexGen,
- MeSH
- chirurgie operační metody využití MeSH
- financování organizované MeSH
- interpretace statistických dat MeSH
- kolenní kloub chirurgie patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- peroperační péče statistika a číselné údaje využití MeSH
- počítačová rentgenová tomografie statistika a číselné údaje MeSH
- prospektivní studie MeSH
- protézy a implantáty využití MeSH
- protézy kolene statistika a číselné údaje využití MeSH
- reprodukovatelnost výsledků MeSH
- rotace škodlivé účinky MeSH
- rozsah kloubních pohybů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) statistika a číselné údaje MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- MeSH
- diferenciální diagnóza MeSH
- dna (nemoc) chirurgie klasifikace MeSH
- dnavá artritida chirurgie patologie MeSH
- fibula chirurgie patologie MeSH
- krystalizace MeSH
- lidé středního věku MeSH
- lidé MeSH
- loketní kloub patologie MeSH
- ortopedické výkony metody MeSH
- patela chirurgie patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
By presenting the results of treatment of secondary pyomyositis of deep hip muscles, to draw attention to the seriousness of this complication occurring in association with pelvic and lumbo-sacral infections. MATERIAL AND METHODS: The course of disease was evaluated retrospectively in a group of 13 patients with an average age of 65.8 years treated in the period from April 2004 to June 2007. The imaging methods used included native radiography, ultrasonography (SONO), computed tomography (CT) and magnetic resonance imaging (MRI). Markers of inflammation, i.e., C-creative protein, erythrocyte sedimentation rate and WBC differential count, were used to assess the intensity of inflammation. At stage 1, patients were treated conservatively, with appropriate antibiotic therapy. At stages 2 and 3, surgical procedures were used (incision, abscess evacuation and drainage) or abscess was treated by CT-guided needle puncture and pigtail drain insertion. The evaluation took into account survival of the patients in relation to the stage of their disease, early detection of origin of infection, therapy initiation, and other factors putting patients at risk. RESULTS: Of the 13 patients treated, 10 had stage 3 pyomyositis with beginning or developed multiple-organ failure when they were referred to our institution from outside hospitals; three admitted at stage 2 pyomyositis were in relatively good state. Ten patients were cured, two died due to multiple-organ failure and one due to pulmonary embolism after lower-extremity phlebothrombosis. The success of treatment appeared to be related to early surgical intervention. DISCUSSION: A good outcome of therapy depends on an early diagnosis and treatment of the underlying infection and pyomyositis. To establish the diagnosis of pyomyositis, repeated clinical, laboratory and bacteriological examinations are necessary, as well as the use of imaging methods, namely SONO, CT and MRI. Treatment may be complicated when small multiple abscesses develop deep in the hip muscles where surgical intervention is difficult. CONCLUSIONS: Secondary pyomyositis is a serious, life-threatening complication of the underlying infection. The outcome of the disease depends on early diagnosis, therapy and the patient's overall state. Stage 1 pyomyositis (muscle oedema) is treated conservatively with antibiotics. Stage 2 pyomyositis needs surgical intervention with abscess aspiration and drainage; in some cases CT-guided needle puncture with pigtail drain insertion is sufficient. An appropriate antibiotic course is obligatory. Stage 3 pyomyositis associated with septic shock or multiple-organ failure requires a comprehensive care in an acute medicine department. In polymorbid patients prognosis is poor and treatment is expensive and often unsuccessful.
- MeSH
- absces diagnóza radiografie terapie MeSH
- kyčel MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- počítačová rentgenová tomografie MeSH
- pyomyozitida diagnóza etiologie radiografie terapie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Klíčová slova
- mrzioborová spolupráce,
- MeSH
- artróza kolenních kloubů chirurgie terapie MeSH
- klinická studie jako téma MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- poranění kolena chirurgie terapie MeSH
- předoperační péče metody MeSH
- protézy kolene kontraindikace využití MeSH
- radiografie metody využití MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- časná diagnóza MeSH
- dospělí MeSH
- lidé MeSH
- liposarkom diagnóza MeSH
- nádory měkkých tkání diagnóza MeSH
- pracovní lékařství MeSH
- primární zdravotní péče MeSH
- sarkom diagnóza MeSH
- služby zdravotní péče o pracující MeSH
- zdravotnický personál MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
The authors describe the concomitant presence of plantar fibromatosis and Dupuytren's disease in a 33-year-old man. A lesion located under the sesamoid bones of the first metatarsophalangeal joint on the right showed an aggressive tendency (rapid growth, pain, impossibility to put weight on the medial side of the foot). Another lesion located proximal to the first one was smaller and painless. Neither plain radiography nor computed tomography showed any structural changes of the skeleton. Contrast-enhancement on magnetic resonance imaging revealed two lesions on the sole of the foot. Since a concurrence of plantar fibromatosis and malignant tumour could not be ruled out, an excision of both lesions and the adjacent plantar aponeurosis was made for biopsy examination. The operative procedure was carried out from two incisions. The intra-operative findings included proliferative growth and bleeding in the lesion located under the first metatarsophalangeal joint, and delimited growth without noticeable bleeding in the other lesion. Based on histological examination, the diagnosis of plantar fibromatosis was made for both lesions. The differential diagnosis and therapy of plantar fibromatosis is discussed.
- MeSH
- dospělí MeSH
- Dupuytrenova kontraktura diagnóza chirurgie komplikace MeSH
- fibrom diagnóza chirurgie klasifikace MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nemoci nohy (od hlezna dolů) diagnóza chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
