• MeSH
• chování MeSH
• molekulární biologie MeSH
• nemoci nervového systému MeSH
• nervový systém MeSH
• neurochemie MeSH
• neurofyziologie MeSH
• neurony MeSH
• neurovědy MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Fyziologie člověka a srovnávací fyziologie
• NLK Obory
• neurovědy
• biologie

PURPOSE OF THE STUDY The aim of this study is to assess the mid-term results of this specific ultra-short, cementless stem in patients younger than 60 years with regard to clinical and radiographic outcomes, survivorship, complication rate and revisions. MATERIAL AND METHODS A consecutive series of one hundred and twenty-one patients (130 hips) younger than 60 years at the time of surgery was enrolled in the study. Primary arthritis (33.8%) and dysplastic hips (30%) were the most common diagnoses. The patients used crutches for 6 weeks to protect femoral components against subsidence and rotational stress. The mean follow-up was 118 months (range 96-156 months). RESULTS At the final evaluation, the mean Harris Hip Score was 98.8. A perioperative periprosthetic fracture occurred in two hips and a perioperative ceramic insert breakage was observed in one hip. One hip had ceramic insert fracture 3.5 years postoperatively. In one hip a dislocation occurred. These two hips (1.5%) were revised due to reasons not associated with the stem. One hip has aseptic asymptomatic polyethylene inlay wear. In two hips squeezing was reported. There were two cases of loosening and migration of stems (1.5%) with osteolysis all around the stems. These patients have moderate thigh pain. The radiological survival is 98.5% and the clinical survival is 100% after 10 years on average. DISCUSSION Although improved clinical results were reported in younger patients with standard cementless stems, some problems still prevail: thigh pain, proximal stress shielding, difficult removal of the stem. In an effort to reduce these problems, Proxima ultra-short anatomical cementless stem was developed. Several studies show that this stem design provides good short- and mid- term results, but only in a limited number of patients and relatively short follow-up. Furthermore, the initial fears of early aseptic loosening due to the absence of diaphyseal fixation were not confirmed. CONCLUSIONS Proxima ultra-short anatomical cementless stem provided excellent mid-term clinical and radiographic results in patients younger than 60 years. Key words: total hip arthroplasty, ultra-short cementless anatomical stem.

• MeSH
• kyčelní protézy * MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   MeSH
• následné studie MeSH
• periprotetické fraktury * chirurgie   MeSH
• protézy - design MeSH
• selhání protézy MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION The purpose of our paper is to evaluate the mid-term to long-term results and to confirm the basic criteria of a high-quality revision implant: safe bridging of bone defects, achievement of reliable primary fixation of revision acetabular cup, achievement of good secondary stability with documentable osteointegration of cup and demonstration of remodelling of transplanted bone tissue in the area of defects and in spaces between the implant ribs. MATERIAL AND METHODS Altogether 36 patients (38 cups) were evaluated who had undergone revision hip arthroplasty in the period from 2004 to 2010. The mean follow-up was 8.2 years (5.1-11.6 years after the reimplantation, more than 10 years in 16 patients who underwent surgery). The position and osseointegration of the implant were assessed by digital radiography, the remodelling of transplanted bone tissues in the area of defects and between the implant ribs by computed tomography with reducing artefacts around the metal implant (Aquilion 64 - Toshiba Medical Systems), and for the clinical outcomes the Harris Hip Score was used. RESULTS Preoperatively, the condition of the hip joint based on the Harris Hip Score was in 30 cases evaluated as poor, in 8 patients as satisfactory. At the time of final evaluation, 8 patients achieved excellent results, in 19 patients the condition of the joint was very good (in 2 patients bilaterally), in 6 patients it was considered satisfactory and in 3 patients poor. The mean value for HHS increased from 39.5 to 84.5. Based on the radiography evaluation, in 27 patients (in 2 patients bilaterally) the osseointegration of the revision cup was good, in 8 cases with a radiolucent line of 2-4 mm in width in DeLee zone III, in one case proximal migration of the cup occurred caused by deep infection. The informed consent form for pelvic CT was signed by 25 patients of our cohort. Remodelling of bone tissue in the space between the ribs of the implant was always detected, the presence of bone cysts was not reported, the bone defects following the application of autologous spongioplasty in the monitored patients were healed. In 6 patients, an ingrowth of fibrous tissue of 2-4 mm in width in the convexity of the cup was detected. The mean survival of the revision oval-shaped cup - TC type with a follow-up of 8.2 years after the reimplantation based on Kaplan-Meier analysis was 91.4 %. DISCUSSION The number of revision total hip arthroplasties due to a younger age of patients who undergo alloplasty keeps growing. The choice of a revision implant should always match the intraoperative finding and the bone tissue quality. The standard uncemented implants with osteoactive surface can be opted for when anterior and posterior column of the acetabulum are intact (IIA and IIB according to Paprosky). Starting from type IIC, also the proximal part of acetabulum shall be considered. At our department, preference is given to the revision cup - TC type. The oval shape facilitates a lower degree of bone resection and easier restoration of the anatomical centre of rotation. Careful debridement of granulating and necrotic tissue, thorough treatment of bone defects and osteoactive surface of implants in case of adequate primary fixation of the cup substantially contribute to the quality of its osseointegration. Greater rigidity of fixation verified by pull-out tests enables to insert angular stable screws into the gaps in the proximal part of the cup. There is still room for improvement in treating the bone defect. The application of allogenic bone grafts into the defects and spaces between the ribs of the TC cup is more challenging than the use of augmentation in the systems with trabecular titanium. Based on the evaluation of CT scans, remodelling of the transplanted bone occurs, therefore the defect zone is reduced. CONCLUSIONS The oval-shaped uncemented cup - type TC meets the requirements placed on a state-of the art revision implant, moreover its specific construction helps improve the conditions where another re-operation of acetabulum is necessary. By evaluating mid-term to long-term results of non-homogenous group of 36 patients (38 cups) we have obtained data on joint function comparable to similar groups with revision uncemented implants presented in our and foreign literature. Key words: revision oval-shaped cup, bone remodelling, pull-out tests, angular stable screws, computed tomography.

• MeSH
• acetabulum chirurgie   MeSH
• časové faktory MeSH
• Kaplanův-Meierův odhad MeSH
• kyčelní kloub chirurgie   MeSH
• kyčelní protézy * MeSH
• lidé MeSH
• náhrada kyčelního kloubu * mortalita   MeSH
• následné studie MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• artroplastika MeSH
• ramenní kloub MeSH
• rameno MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie

• Konspekt
• Fyzioterapie. Psychoterapie. Alternativní lékařství
• NLK Obory
• rehabilitační a fyzikální medicína
• rehabilitační a fyzikální medicína

Úvod: V rámci pravidelných revizí Seznamu nemocí z povolání v České republice je snahou rozšířit tento seznam o položku, která by umožňovala uznat onemocnění bederní páteře z přetěžování jako nemocí z povolání, a to za dodržení všeobecně platných národních pravidel, tedy po splnění klinických kritérií a objektivním průkazu takových pracovních podmínek, za nichž nemoc z povolání vzniká (hygienická kritéria). Cíl: Cílem předkládaného sdělení je pomocí objektivní metody hodnocení pracovní zátěže bederní páteře na individuální úrovni přiblížit způsob praktického ověřování pracovních podmínek v případě podezření na souvislost středně těžkého chronického vertebrogenního syndromu s vykonávanou prací. Metodika: Soubor tvořilo 21 pracovníků (7 mužů, 14 žen, průměrný věk 46,5 roku, průměrná délka expozice 17,5 roku), kteří podle pracovní anamnézy pracovali v podmínkách, které mohou vést podle obecných pracovnělékařských předpokladů k přetěžování bederní páteře. Na jejich pracovištích bylo provedeno hodnocení pracovních podmínek, a to na základě celosměnového pozorování a záznamu potenciálně rizikových pracovních úkonů do kontrolních listů. Získané údaje byly zadány do speciálního výpočtového modulu, přičemž výstupem byla hodnota odhadu tlaku na meziobratlovou ploténku L4/5 jako základní ukazatel pro posouzení míry zatížení bederní páteře. Výsledky: U 11 osob (6 mužů, 5 žen) bylo zjištěno splnění navržených hygienických kritérií. V případě zařazení onemocnění bederní páteře do seznamu nemocí z povolání a po splnění řady přísných vstupních expozičních a klinických podmínek by v těchto případech byly z hygienického hlediska splněny podmínky vzniku onemocnění pro účely posuzování nemoci z povolání. Ve všech těchto případech se jednalo o profese s výskytem pracovních úkonů spojených se vzájemnou kombinací ručních manipulací s břemeny a ohybů nebo rotací trupu. Přetěžování bederní páteře bylo zjištěno ve zdravotnictví, dřevozpracujícím průmyslu, lesnictví, dále u nejrůznějších dělnických profesí v lehkém i středně těžkém průmyslu.

Introduction: Within the framework of regular revisions of the List of occupational diseases in the Czech Republic there are efforts to extend the List by an item, which could enable to acknowledge diseases of lumbar spine from overload as an occupational disease, specifically with adherence to generally valid national rules, i.e. after fulfilling clinical criteria and objective demonstration of such working conditions, when the occupational disease originates (hygienic criteria). Objective: The communication was intended to clarify the connection between medium severe chronic vertebrogenic syndrome and the work performed, on the basis of an objective method for evaluation of working load exerted on lumbar spine at the individual level. Methods: The cohort included 21 workers (7 men, 14 women, mean age 46.5 year, and average exposure 17.5 year) who have been working (according to work case history) in conditions, which might (according to occupational medical presumptions) to overload of lumbar spine. The evaluation of working conditions was made at their workplaces on the basis of all-shift observation and recording potentially risky working operations in the control lists. The obtained data were entered into a special computation module, while the output was represented by the value of estimated pressure on intervertebral disk L4/5 as the basic index for evaluating the load exerted on lumbar spine. Results: In 11 subjects (6 men and 5 women) the authors determined fulfillment of suggested hygienic criteria. In cases where the diseases of lumbar spine were included in the List of occupational diseases, and after fulfillment of a series of rigorous entry exposure and clinical conditions, the conditions for accepting the origin of the disease in evaluating the disease as caused by occupation were fulfilled from the hygienic point of view. In all these cases the occupations were associated with working acts or operations which included manipulation with loads or burdens and trunk flexion or rotation. The repetitive strain injury of lumbar spine was determined in medical services, wood processing industry, forestry, and in various workman occupations in the light and medium heavy industry.

• Klíčová slova
• přetěžování bederní páteře, rizikové pracovní úkony, kontrolní listy,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lumbalgie MeSH
• nemoci páteře * MeSH
• nemoci z povolání * MeSH
• poranění z opakovaného přetěžování MeSH
• pracovní expozice * MeSH
• rizikové faktory MeSH
• výzkum MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY Supracondylar humerus fracture (SCF) with dislocation is indicated for closed reduction and osteosynthesis. The method achieving the best stability is CRCPP (closed reduction and crossed percutaneous pinning), even though there is a risk of iatrogenic ulnar nerve injury. The CRLPP (closed reduction and lateral percutaneous pinning) method eliminates this risk at the cost of less stable osteosynthesis. The purpose of this study is to compare the SCF stabilisation by CRLPP with the stabilisation by CRCPP in rotationally stable fractures and to identify the risk of iatrogenic ulnar nerve injury, or the failure of osteosynthesis with recurrent dislocation of fragments. MATERIAL AND METHODS The prospective group of the patients with SCF type 1/2 (classification according to Havránek) treated in the period 2016-2018, in whom the method of osteosynthesis (number of implants, method of their insertion), resulting condition and complications (nerve injury, failure of osteosynthesis) were evaluated. In the second half of the study, in CRLPP one of the implants was inserted "quadricortically", i.e. through the olecranon fossa of the humerus (hereinafter referred to as fossa), while until then both the implants had been inserted through the radial column outside fossa. RESULTS In the period 2016-2018, 791 patients with SCF were treated at our department. In 225 cases (28.5%) the patients sustained the type 1/2 fracture and in all the cases closed reduction and percutaneous osteosynthesis were performed, namely CRCPP in 185 cases (82.2%) and CRLPP in the remaining 40 cases (17.8%). Signs of ulnar nerve injury after osteosynthesis were observed in 35 patients (15.6% of SCF 1/2), always after the use of at least one ulnar implant (18.9% of CRCPP). A failure of osteosynthesis occurred in 2 cases (0.9% of SCF 1/2), always when only lateral implants were used (5% of CRLPP). DISCUSSION In both the patients in our study in whom after CRLPP a failure of osteosynthesis with rotational dislocation occurred, the original CRLPP was performed by inserting both the implants through a single column outside fossa. Both the patients were indicated for revision reduction and osteosynthesis was subsequently performed through CRCPP. The patients healed with no further complications. In the group of patients with an ulnar nerve injury, the original condition was fully restored, after 3.6 months (range of 1-10, median 3) on average. The results of our study show the need to guide the implants inserted through the radial column divergently so that they are at the fracture line level as far apart as possible (with adequate fixation of fragments). One of the implants is inserted through fossa, i.e. quadricortically. Based on our experience, the compliance with these principles alone shall ensure adequate rotational stability of SCF of type 1/2. In CRLPP, after the insertion of implants the stability is tested under the Xray image intensifier intraoperatively so that a medial implant can be added in case of unstable osteosynthesis. CONCLUSIONS Based on the results of our study we recommend to stabilise the rotationally stable SCF (type 1/2 according to Havránek) only from the radial column (and thus eliminate the risk of iatrogenic ulnar nerve injury), provided the fracture characteristics allows so. Nonetheless, the CRLPP has its own specific rules for implant entry which have to be adhered to. Key words: supracondylar fracture of the humerus, paediatric fractures, closed reduction, percutaneous pinning, lateral percutaneous pinning, iatrogenic ulnar nerve injury, osteosynthesis failure.

• MeSH
• dítě MeSH
• fraktury humeru * chirurgie   MeSH
• humerus MeSH
• intramedulární fixace fraktury * MeSH
• lidé MeSH
• prospektivní studie MeSH
• vnitřní fixace fraktury škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• muskuloskeletální nemoci terapie   MeSH
• ortopedické výkony MeSH
• sportovní úrazy terapie   MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• tělovýchovné lékařství
• NLK Publikační typ
• kolektivní monografie