V práci je podán popis šikmé rotační osteotomie v oblasti diafýzy. Operace je určena pro řešení angularních deformit v této oblasti. Princip metody navržené O. Čechem spočívá v provedení neúplné Šikmé osteotomie v rovině deformity. Poté je přes provedenou osteotomii zaveden tahový šroub. Ten však není plně dotažen. Po zavedení šroubu je osteotomiie dokončena a korekce deformity provedena rotací úlomků na ose, kterou tahový šroub představuje. Po dosažení správné korekce je tahový šroub dotažen a stabilizace dokončena přiložením dlahy.

The article describes oblique rotational osteotomy in the region of diaphysis. The surgery is indicated in the treatment of angular deformities in this reaion. The principle of this method developed by O. Čech consists in the performance of partial oblique osteotomy at the level of the deformity. Subsequently, lag screw is inserted through the osteotomy. However, the screw is not fully tightened. After the insertion of the screw the osteotomy is finished and deformity corrected by rotation of fragments on the pivot represented by the screw. As soon as the correction is adequate, the lag screw is fully tightened and stabilization finished by the application of a neutralization plate.

• MeSH
• chirurgie operační metody   MeSH
• diafýzy abnormality   chirurgie   MeSH
• lidé MeSH
• osteotomie metody   MeSH
• Check Tag
• lidé MeSH

Cíl: Cílem práce bylo vyhodnocení klinických výsledků implantace torické nitrooční čočky Acrysof IQ Toric SN6AT3_8 (Alcon Laboratories, Inc., Fort Worth, TX, USA) včetně zhodnocení její rotační stability. Materiál a metodika: Do retrospektivní studie jsme zařadili 30 očí 16 pacientů (4 muže, 12 žen; průměrný věk 68 let) s hodnotou pravidelného rohovkového astigmatismu od -1,5 do -4,0 Dcyl. Všichni pacienti podstoupili nekomplikovanou operaci katarakty s implantací torické nitrooční čočky (TIOL) na Oční klinice LF UP a FN Olomouc během roku 2020. Kontrolní vyšetření proběhlo v rozmezí 3–6 měsíců po operaci katarakty. Sledovali jsme výslednou nekorigovanou zrakovou ostrost do dálky (UDVA), pooperační refrakci, rotační stabilitu implantované čočky a subjektivní spokojenost pacientů. Výsledky: Průměrná hodnota předoperačního rohovkového astigmatismu byla -2,41 ±0,67 Dcyl. UDVA se zlepšila z průměrné hodnoty 0,45 ±0,25 (vyjádřeno v decimálních hodnotách Snellenových optotypů) na hodnotu 0,91 ±0,16. Hodnota sférického ekvivalentu 0,41 ±2,92 se po operaci zlepšila na -0,11 ±0,27. Průměrná hodnota reziduálního pooperačního astigmatismu byla -0,52 ±0,49 Dcyl. Průměrná odchylka od plánované osy byla 4,87 ±4,75. Subjektivní spokojenost hodnotili pacienti ve škále známek 1–5, průměrná známka byla 1,5. Závěr: Implantace TIOL představuje u pacientů s rohovkovým astigmatismem a kataraktou bezpečné a efektivní řešení. Naše výsledky dokládají zlepšení UDVA, rotační stabilitu TIOL a subjektivní spokojenost pacientů s výsledkem operace.

Purpose: The aim of the study was to evaluate the clinical results of the implantation of the toric intraocular lens Acrysof IQ Toric SN6AT3_8 (Alcon Laboratories, Inc., Fort Worth, TX, USA), including an evaluation of its rotational stability. Material and methods: 30 eyes of 16 patients (4 males, 12 females; mean age 68 years) with regular corneal astigmatism ranging from -1.5 to -4.0 Dcyl were included in this retrospective study. All the patients underwent uncomplicated cataract surgery with the implantation of a toric intraocular lens (TIOL) at the Department of Ophthalmology of the Faculty of Medicine and Dentistry of Palacký University in Olomouc and University Hospital Olomouc during the course of 2020. Follow-up examinations were performed 3–6 months after cataract surgery. We monitored the resulting uncorrected distance visual acuity (UDVA), postoperative refraction, rotational stability of the implanted lens and subjective patient satisfaction. Results: mean preoperative corneal astigmatism was -2.41 ±0.67 Dcyl. UDVA improved from a mean value of 0.45 ±0.25 (expressed in decimal Snellen optotype values) to 0.91 ±0.16. The spherical equivalent value of 0.41 ±2.92 improved to -0.11 ±0.27 postoperatively. The mean deviation from the planned axis was 4.87 ±4.75. Subjective satisfaction was rated by patients on a scale of 1–5, with a mean score of 1.5. Conclusion: TIOL implantation is a safe and effective solution for patients with corneal astigmatism and cataract. Our results demonstrate improved UDVA, rotational stability of the TIOL and subjective patient satisfaction with the outcome of the surgery.

• MeSH
• astigmatismus diagnóza   etiologie   prevence a kontrola   MeSH
• implantace nitrooční čočky * klasifikace   metody   statistika a číselné údaje   MeSH
• katarakta terapie   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• spokojenost pacientů MeSH
• výsledek terapie MeSH
• zrakové testy klasifikace   metody   přístrojové vybavení   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY Knee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODS All the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least). All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTS The mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSION The double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONS The obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint. Key words: anterolateral ligament, anterior cruciate ligament, internal rotational stability, objective measurement.

• MeSH
• biomechanika MeSH
• kolenní kloub chirurgie   MeSH
• lidé MeSH
• mrtvola MeSH
• nestabilita kloubu * etiologie   chirurgie   MeSH
• poranění předního zkříženého vazu * chirurgie   MeSH
• rekonstrukce předního zkříženého vazu * MeSH
• rozsah kloubních pohybů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: The objective of this study was to evaluate knee rotational stability at least 2 years after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction (SB) and double-bundle ACL reconstruction (DB) in comparison with the contralateral healthy knee joint. The Cincinnati, Lysholm and IKDC scores were analysed too. METHODS: There were 40 patients in both groups, the mean follow-up was 27 months. For all measurements, the navigation system OrthoPilot was used. Measurement started with the patient in the standing position in neutral rotation. Then, the patient achieved in 30° knee flexion under weight-bearing maximal external trunk rotation and returned to the neutral position. The same measurement was done for the internal trunk rotation. For the anterior-posterior stability, KT-1000 arthrometer was used. All measurements were repeated three times for each knee joint. RESULTS: After the DB reconstruction, the mean external rotation of the tibia (ER) was 8.2° and the internal rotation (IR) was 10.2°. In the contralateral healthy knee joint, ER was 8.5° (p = 0.597) and IR was 12.1° (p = 0.064). After the SB reconstruction, ER was 9.4° and IR was 13.1°. In the contralateral healthy knee joint, ER was 7.7° (p = 0.066) and IR was 9.8° (p = 0.005). Anterior-posterior translation was to the same extent for both groups. CONCLUSIONS: The DB reconstruction of the ACL restores the rotational stability of the knee joint without any significant difference in comparison to the contralateral healthy knee (p > 0.05). The main finding of this study is that the internal rotational stability of the knee joint after the anatomic SB technique is not sufficient.

• MeSH
• biomechanika MeSH
• dospělí MeSH
• kolenní kloub patofyziologie   chirurgie   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• nestabilita kloubu patofyziologie   chirurgie   MeSH
• poranění předního zkříženého vazu patofyziologie   chirurgie   MeSH
• rekonstrukce předního zkříženého vazu * MeSH
• rotace MeSH
• rozsah kloubních pohybů fyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The purpose of this study was to evaluate the influence of both bundles of the anterior cruciate ligament (ACL) on knee stability, anterior-posterior translation (APT) and internal (IR) and external (ER) rotation in cadaveric knees using a computer navigation system. METHODS: The APT, IR, and ER of the knees were recorded in the intact condition, the anterolateral bundle (AM) or the posterolateral bundle (PL) deficit condition and in the ACL-deficient condition. The KT-1000 arthrometer was used for APT evaluation. The measurement of rotational movements was done using a rollimeter. All tests were performed at 30°, 60° and 90° of flexion. RESULTS: At 30° of flexion: In the intact knee APT was 5.8mm, IR 12.1°, ER 10.1°. After the AM was cut, the APT increased to 9.1mm, IR to 13.9° and ER to 12.6°. After the PL was cut, the APT was 6.4mm, IR 13.1° and ER 10.6°. After the AM and PL were cut, the APT was 10.8mm, IR 15.7° and the ER was 12.9° on average. CONCLUSIONS: The AM has a greater impact on the APT than the PL in all knee joint flexion angles. The PL does not resist the rotational stability more than the AM. The rotational stability is better controlled by both bundles of ACL as compared to one bundle of the ACL. CLINICAL RELEVANCE: This study acknowledges the fact that the both bundles of the ACL are importants for AP and rotational stability of the knee joint.

• MeSH
• biomechanika MeSH
• diagnóza počítačová * MeSH
• kloubní artrometrie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• ligamentum cruciatum anterius fyziologie   MeSH
• ligamentum cruciatum posterius fyziologie   MeSH
• mrtvola MeSH
• nestabilita kloubu diagnóza   MeSH
• rotace * MeSH
• rozsah kloubních pohybů fyziologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Objectives: The aim of this study was to assess the clinical outcomes, predictability of results, efficiency of astigmatism correction, and rotational stability of the Bi-Flex 677TAY (Medicontur Medical Engineering Ltd., Zsámbék, Hungary) monofocal toric intraocular lens (IOL) designed for cataract patients with astigmatism. Methods: The IOLs were implanted either mono- or binocularly, following routine cataract surgery. Visual and refractive outcomes, as well as off-axis rotation were assessed throughout a 1-year follow-up period. All clinical data for this work were collected retrospectively. Vector analysis based on the Alpins method was performed to assess the efficiency of astigmatism correction. Results: No complications or adverse events occurred during surgery or the follow-up period. IOL implantation brought 88% of eyes into the ±0.50 D, and 100% into the ± 1.00 D range compared to the target spherical equivalent refraction, emmetropia. Astigmatism correction brought similar results: 94% of eyes had a residual cylindrical error of not higher than ±0.50 D, and 97% were within ±1.00 D. Vector analysis resulted in a correction index of 0.96 and a difference vector of 0.17. Both refractive and visual outcomes showed long-term stability. During the 12-month follow-up period, no eyes had a rotation of >5°. Absolute rotation after 1 year was 1.42 ± 1.89° (median = 0°), while signed rotation was 1.06 ± 2.12° (median = 0°). Conclusion: The Bi-Flex 677TAY monofocal toric IOL, designed by Medicontur Medical Engineering Ltd., represents an efficient and safe solution for cataract patients with astigmatism. Clinical and refractive outcomes are predictable, and rotational stability ensures long-term visual comfort.

• Publikační typ
• časopisecké články MeSH

Úvod: Cílem této prospektivní studie bylo zjistit objektivně rotační stabilitu kolenního kloubu po augmentaci předního zkříženého vazu (PZV) kolenního kloubu za pomoci štěpu z m. gracilis 2 roky po operaci. Metodika: Do studie bylo zařazeno 20 mladých sportovně aktivních pacientů po augmentaci PZV štěpem z m. gracilis při poranění posterolaterálního (PL) svazku. Tibiální i femorální kostní kanál byl cílen do anatomického úponu PL svazku. Doba vyšetření byla v průměru 28 měsíců po operaci (min. 24 měsíců). Všechna měření byla realizována za pomoci počítačového systému navigace a byla prováděna pro zdravé i operované koleno. Po určení potřebných dat pro navigaci zůstal pacient stát v pozici s oběma nohama plantou pevně na podložce s intermaleolární distancí 20 cm. Poté provedl pacient 30st. flexi v kolenních kloubech a provedl nejprve rotaci vnitřní v kloubu torzí trupu, poté rotaci vnější. Hodnocena byla i subjektivní spokojenost s operovaným kolenem za pomoci ortopedických dotazníků. Výsledky: Vnitřní rotace v kolenním kloubu byla u poraněného kolena v průměru po operaci 7,7st, u zdravého kolena 9,5st. Zevní rotace dosahovala hodnoty u operovaného kolena po operaci 8,3st. a 9,2st. u zdravého kolena. Subjektivní hodnocení obou kolenních kloubů 2 roky po operaci neprokazuje statisticky významný rozdíl. Závěr: Naměřené hodnoty poukazují na fakt, že augmentace PZV za pomoci štěpu m. gracilis poskytuje dobrou rotační stabilitu v porovnání s kontralaterálním zdravým kolenním kloubem. Subjektivně vykazuje operovaný kolenní kloub stejnou funkci jako kolenní kloub neoperovaný.

Purpose: The objective of this study was to evaluate knee rotational stability at least 2 years after augmentation of the anterior cruciate ligament (ACL) with using of musculus gracilis graft. Methods: There were 20 patients after the tear of posterolateral (PL) bundle of the ACL reconstructed by m.gracilis grafting. The mean follow-up was 28 months. For all measurements, the navigation system OrthoPilot was used, the operated and the healthy knee joins were analysed. Measurement started with the patient in the standing position in neutral rotation. Then, the patient achieved in 30° knee flexion under weight-bearing maximal external trunk rotation and returned to the neutral position. The same measurement was done for the internal trunk rotation. All measurements were repeated 3 times for each knee joint. The orthopaedics scoring systems were analysed too. Results: After the augmentation of the ACL, IR was 7,7° and ER was 8,3°. In the contralateral healthy knee joint, IR was 9,5° and ER was 9,2°. The analyse of the orthopaedic scores were in the same extend for both knee joints. Conclusions: The augmentation of the PL bundle of the ACL restores the rotational stability of the knee joint without any significant difference in comparison to the contralateral healthy knee (p < 0.05). The function of the knee joint is similar with the contralateral healthy knee too.

• Klíčová slova
• rotační stabilita, augmentace předního zkříženého vazu,
• MeSH
• biomechanika MeSH
• dospělí MeSH
• lidé MeSH
• ligamentum cruciatum anterius * chirurgie   patofyziologie   MeSH
• mladiství MeSH
• ortopedické výkony * metody   MeSH
• pooperační komplikace MeSH
• pooperační období MeSH
• prospektivní studie MeSH
• sportovci MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

INTRODUCTION: The aim of this prospective randomised study was to evaluate clinical results and rotational stability at least 2 years after single-bundle anatomic anterior cruciate ligament reconstruction using a quadriceps tendon graft with bone block (BT) and bone-patellar tendon-bone graft (BTB). MATERIALS AND METHODS: In both groups (BT and BTB), 40 patients selected prospectively at random were evaluated. The mean follow-up after the surgery was 28 months (range 24-33 months). A navigation system was used to measure rotational stability of the knee joint. Cincinnati, Lysholm, and IKDC scores and visual analog score (VAS) were used to evaluate clinical results and the non-parametric Wilcoxon test was used for the statistical analysis. RESULTS: After the BT reconstruction, the mean internal rotation of the tibia (IR) was 9.5°. In the contralateral healthy knee joint, IR was 8.6° at average. After the BTB reconstruction, the mean IR was 9.9°. In the contralateral healthy knee joint, IR was 8.7° at average. We did not find any statistically significant difference in IR stability between BT and BTB reconstruction. In terms of clinical results, regarding the VAS, patients perceive significantly more pain after the BTB reconstruction (p < 0.05). Kneeling was reported more difficult and painful after BTB reconstruction. CONCLUSIONS: The BT reconstruction of the ACL provides similar clinical results, less pain, better flexion and the same rotational stability of the knee in comparison with the BTB reconstruction.

• MeSH
• bolest chirurgie   MeSH
• kolenní kloub chirurgie   MeSH
• lidé MeSH
• nestabilita kloubu * chirurgie   MeSH
• poranění předního zkříženého vazu * chirurgie   MeSH
• prospektivní studie MeSH
• rekonstrukce předního zkříženého vazu * metody   MeSH
• šlachy chirurgie   MeSH
• štěp kost-čéškový vaz-kost MeSH
• štěp z vazu čéšky chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Massive posttraumatic bleeding is the leading cause of potentially preventable death among patients with severe trauma. Immediate diagnosis and treatment of traumatic coagulopathy and its differentiation from surgical bleeding after major trauma are critical in the management of such patients. In this case report, we present a 33-year-old woman who had multiple injuries to the head and trunk in motor vehicle collision, resulting in severe bleeding and necessitating emergency surgery. We demonstrate how repeated rotational thromboelastometry and thromboelastography analyses were used to direct the choice of therapy to stabilize her circulatory system for surgery and to differentiate surgical bleed from coagulopathy. Therapy based on massive transfusion protocol and on laboratory coagulation tests would be insufficient to stop bleeding. We conclude that rotational thromboelastometry/thromboelastography analysis plays a critical role in the management of traumatic bleeding and helps us provide more aggressive and targeted therapy for coagulopathy both in the acute and later phases of treatment of severe bleeding.

• MeSH
• dospělí MeSH
• fraktury femuru komplikace   MeSH
• koagulopatie diagnóza   etiologie   MeSH
• kraniocerebrální traumata komplikace   MeSH
• krvácení etiologie   terapie   MeSH
• lidé MeSH
• polytrauma komplikace   MeSH
• poranění břicha komplikace   MeSH
• poškození plic komplikace   MeSH
• tromboelastografie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Benigní paroxysmální polohové vertigo (BPPV) je periferní vestibulární porucha, při které dochází k uvolnění otokonií z utrikulární makuly do chodbiček polokruhových kanálků. BPPV je nejčastějším onemocněním labyrintu vnitřního ucha v dospělém věku a je příčinou závratí až u jedné pětiny pacientů přicházejících k lékaři. U pacientů, kde v anamnéze nenajdeme předchozí poškození vnitřního ucha, označujeme BPPV jako idiopatické. Často však BPPV vzniká na terénu předchozího onemocnění labyrintu, tuto variantu označujeme jako sekundární. Pacienti si nejčastěji stěžují na epizody krátké rotační závrati, které se objevují po změně polohy hlavy, typicky při záklonu, uléhání či otáčení se v posteli. Některé studie z posledních let však ukazují, že pacienti s BPPV trpí poruchami stability stoje a chůze, které jsou přítomny i v období mezi záchvaty závratí. Tyto poruchy jsou detekovatelné přístrojovými metodami i klinickými testy. Podstatné však je, že úspěšná léčba BPPV pomocí repozičních manévrů vede i k úpravě posturální instability.

Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disorder in which otoconia are released from the utricular macula into the semicircular canals. BPPV is the most common disorder of the inner ear in adult and is the cause of vertigo in up to one-fifth of patients presenting to a physician. In patients where there is no history of previous inner ear disease, we refer to BPPV as idiopathic. Often, however, BPPV arises on the terrain of previous labyrinthine disease; we refer to this variant as secondary. Patients most commonly complain of episodes of brief rotational vertigo that occur after a change in head position, typically when bending, lying down or turning over in bed. However, some studies in recent years have shown that patients with BPPV suffer from impairments in standing and walking stability that are also present in between epizodes of vertigo. These disorders are detectable by instrumentation and clinical tests. Importantly, however, successful treatment of BPPV with canalith repositioning procedures also leads to improvement of postural instability.

• Klíčová slova
• repoziční manévry,
• MeSH
• benigní paroxysmální polohové vertigo * diagnóza   etiologie   rehabilitace   MeSH
• lidé MeSH
• posturální rovnováha fyziologie   MeSH
• vestibulární aparát anatomie a histologie   fyziologie   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH