Použití drénů v chirurgii má bohatou historii. Od antických dob drenáž prošla dlouhým vývojem a přetrvala i do dnešní doby. Za posledních cca 2500 let se měnily jak indikace k ní, tak i materiál chirurgických drénů. Tak, jak ji známe dnes, ale nebyla zcela samozřejmá nebo všeobecně jednotná. K její současné podobě vedlo nejen mnoho úspěchů, ale i slepých cest a omylů lékařské vědy a praxe.
The use of drains in surgery has a rich history. Since ancient times, drainage has experienced a long progress, and its development has continued all the way to the present era. Both the indications for drainage and the material of surgical drains have changed over the last 2500 years. Indeed, drainage as we know today, was not always a practice so common or generally so well accepted, as it is today. The current concept of surgical drainage has witnessed not only periods of success, but also dead ends and mistakes of both science and medicine.
PURPOSE: Treatment of pelvic fractures is often complicated. Here, we intended to evaluate the intraoperative benefits of using 2D computer navigation when compared with traditional fluoroscopy on X-ray burden, surgical time and screw placement accuracy. METHODS: In this study, we retrospectively evaluated the records of 25 patients who underwent osteosynthesis of a posterior pelvic fracture using fluoroscopy at the University Hospital Ostrava, Czech Republic between 2011 and 2019, and 32 patients from the same department and period in whom 2D computer navigation was used. RESULTS: Intraoperative X-ray burden was significantly lower in the group with 2D computer navigation (median 650 vs 1024 cGy/cm2), as was the duration of the surgery (41 vs 45 min). This was most obvious where two screws were inserted (X-ray dose of 994 vs 1847 cGy/cm2 and 48 vs 70 min, respectively). Correction of the path for wire placement after the original drilling was necessary in 2 patients (6%) from the 2D computer navigation group and 15 patients from the fluoroscopy group (60%). Still, no malposition of the screws nor dislocation of the posterior pelvic segment after 12 months was observed in any patient of either group; of complications, only three superficial infections in the 2D navigation group and 2 in the fluoroscopy group were observed. CONCLUSION: 2D computer navigation is a safe and accurate method for placement of screws during posterior pelvic fracture osteosynthesis, associated with lower intraoperative radiation burden and shorter surgical times compared to standard fluoroscopy, especially if two screws are inserted.
- MeSH
- chirurgie s pomocí počítače * metody MeSH
- fluoroskopie metody MeSH
- fraktury kostí * diagnostické zobrazování chirurgie MeSH
- kostní šrouby MeSH
- lidé MeSH
- počítače MeSH
- retrospektivní studie MeSH
- vnitřní fixace fraktury metody MeSH
- zobrazování trojrozměrné metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Data on the effectiveness of arthroscopic arthrolysis and extraction of osteosynthetic material after osteosynthesis of the proximal humerus in patients with persisting problems are rare and insufficient. In this study, we performed arthroscopic arthrolysis and extraction of fixation screws, and, where protruding, extraction of the nail in 34 patients with problems persisting 12 months after osteosynthesis of the proximal humerus using an intramedullary nail. The effectiveness of the treatment was assessed using the Constant-Murley shoulder score and forward flexion difference between the treated arm and the contralateral one. A median increase of 16 points in CMS score and 30 degrees reduction in the arm forward flexion difference was recorded 12 months after the arthroscopy. The improvement was significantly higher in the patient group with intramedullary nail extraction (however, this group had worse pre-operative values and the screw was only extracted where likely to cause problems). The median time to heal was 11 weeks; no serious peri- or post-procedural complications occurred. Mini-invasive arthroscopic arthrolysis combined with extraction of osteosynthetic material proved to be a safe and effective method for treatment of patients after osteosynthesis of the proximal humerus using an intramedullary nail with persisting pain and/or mobility limitation.
- Publikační typ
- časopisecké články MeSH
Introduction: Reports on the use of computer-assisted trauma surgery of comminuted scapula fracture are still quite rare. In this article, we present a case of comminuted scapula fracture, the surgical reconstruction of which was pre-operatively planned using a complex software solution. Materials and methods: For surgical planning of the fracture, we used the TraumaTech software facilitating virtual reconstruction (both manual and automatic), surgery planning, design of the implant, planning of screw placement and lengths, and production of a 3D print model of the fracture and the implant. The software also supported ordering such custom-made plate from a plate producer who was capable of fast and precise production of the plate. Results: The surgery using the custom-ordered plate was successful. The actual used screw lengths did not differ from the planned ones by more than 2 mm. One year after the surgery, the patient was capable of more demanding activities and doing sports activities. Conclusion: This approach provides a great way to prevent complications of the surgery and to shorten its duration. To the best of our knowledge, this is the first description of the treatment of a scapula comminuted fracture utilizing computer-assisted preoperative planning.
- Publikační typ
- kazuistiky MeSH
ÚVOD: Distální cílení intramedulárních hřebů má celosvětově různá řešení, avšak žádné z nich není standardně používané. Nejčastější používanou metodou v praxi je cílení pomocí zmíněné peroperační skiaskopie, což zvyšuje dávky RTG záření jak pro pacienta, tak pro personál. V roce 2018 byl registrován v České republice intramedulární hřeb pro osteosyntézu zlomenin diafýz humeru s možností cílení distálních jistících šroubů pomocí elektromagnetického systému pro distální cílení. CÍL PRÁCE: Popis nové metody a prvních zkušeností distálního cílení intramedulárního hřebu humeru pomocí elektromagnetického systému pro distální cílení. MATERIÁL A METODA: Na Klinice úrazové chirurgie FN Ostrava jsme doposud provedli šest osteosyntéz zlomenin diafýz humeru pomocí intramedulárního hřebu s elektromagnetickým distálním cílením u šesti pacientů - pěti mužů a jedné ženy. Průměrný věk pacientů byl 38 let (24–52). K osteosyntéze jsme indikovali zlomeniny typu 12 A (n-4) a 12B (n-2) dle AO/OTA klasifikace. VÝSLEDKY: Průměrný operační čas byl 56 minut, průměrný čas přípravy elektromagnetického cílení byl 13,33 minut, průměrný čas distálního jištění byl 8,33 minut, průměrný skiaskopický čas během operace byl 4,05 minut. ZÁVĚR: Systém pro distální cílení dlouhých humerálních hřebů Ezy-aim firmy Austofix představuje možnost inovativního cílení a vrtání otvorů pro distální jistící šrouby. Jeho výhodou je minimalizace rentgenového záření během operace a také přesnost vrtání. Nevýhodou je složitější příprava ramene pro distální cílení a jeho kalibrace a také propojení s řídící jednotkou kabely.
- Klíčová slova
- distální cílení hřebu, elektromagnetický systém, Ezy-aim,
- MeSH
- diafýzy chirurgie zranění MeSH
- fraktury humeru chirurgie MeSH
- intramedulární fixace fraktury * metody MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
INTRODUCTION: Distal targeting of intramedullary nails has different solutions worldwide, but none of them is used as a standard. The most common method used in practice is targeting by means of the aforementioned peroperative skiascopy, which increases the dose of Xrays for both the patient and the staff. In 2018, an intramedullary nail for osteosynthesis of humeral diaphyseal fractures with the possibility of targeting the distal locking screws using an electromagnetic system for distal targeting was registered in the Czech Republic. AIM OF THE STUDY: Description of a new method and first experience with distal targeting of the intramedullary humeral nail using an electromagnetic system for distal targeting. MATERIAL AND METHOD: At the Department of Trauma Surgery, Ostrava University Hospital, we have so far performed 6 osteosyntheses of humeral diaphyseal fractures using an intramedullary nail with electromagnetic distal targeting in 6 patients - 5 men and one woman. The average age of patients was 38 years (24-52). Osteosynthesis was indicated for type 12A (n-4) and 12B (n-2) fractures according to the AO/OTA classification. RESULTS: The average operative time was 56 min, the average electromagnetic targeting preparation time was 13.33 min, the average distal fixation time was 8.33 min, the average skiascopic time during the operation was 4,05 min. CONCLUSION: The Austofix Ezy-aim distal targeting system for long humeral studs offers an innovative way of targeting and drilling holes for distal locking screws. Its advantage is the minimization of X-ray radiation during the operation and also the accuracy of drilling. The disadvantage is more complex preparation of the arm for distal targeting and its calibration, as well as connection to the control unit by cables.
- Klíčová slova
- distální cílení hřebu, elektromagnetický systém, Ezy-aim,
- MeSH
- diafýzy chirurgie zranění MeSH
- fraktury humeru chirurgie MeSH
- intramedulární fixace fraktury * metody MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
PURPOSE OF THE STUDY Fractures of the scapula are less frequent, with the incidence reported in literature of approximately 1% of all fractures and 3-5% fractures of shoulder. These fractures are predominantly treated non-operatively. Osteosynthesis is indicated in displaced intra-articular fractures and severely displaced extra-articular fractures of the scapular body, its lateral border in particular. Apart from open reposition and osteosynthesis, also minimally invasive osteosynthesis under fluoroscopic and arthroscopic control has recently been used to treat intra-articular fractures of the scapula. The arthroscopy facilitates debridement of the fracture line in the intra-articular region and control over the insertion of the osteosynthesis material in the subchondral bone of the glenoid and it also makes visible the accuracy of reduction of fractures of the glenoid articular surface. MATERIAL AND METHODS In 2013-2017, osteosyntheses of 9 intra-articular fractures of the scapula were performed with the use of both perioperative fluoroscopy and arthroscopy. The group included 7 men and 2 women, with the mean age of 37 years (range 24-52 years). 4.5 mm cannulated screws inserted in the subchondral bone either from the cranial or dorso-caudal part of the glenoid in dependence on the type of the fracture were used as osteosynthesis material. Postoperatively, the extremity was fixed by Desault type shoulder brace for 4 weeks. Rehabilitation using standard procedures for shoulder joint followed. The patients were followed up at regular intervals, namely on 10th day, at 4 weeks, 3, 6, 12 and 24 months postoperatively. The clinical outcomes and radiologic signs of healing were evaluated continuously and two years after the surgery the clinical outcomes were assessed using the Constant score. Arm elevation was assessed separately, as a dominant indicator of shoulder joint function. RESULTS No perioperative complications were reported, the operative times ranged from 45 to 120 minutes. Reduction was always performed in fractures with intra-articular displacement of less than 2 mm, which was measured both arthroscopically and on perioperative and postoperative radiographs. No complications of wound healing were observed. One patient experienced temporary paresthesia in the innervation zone of the sensitive branch of the radial nerve. The mean healing time of fractures was 121 days (range 107-146 days). The mean Constant score at two years after surgery was 83 points (range 78-87 points), the resulting restriction of elevation was 12° on average (range 0-23°). DISCUSSION There are not many papers covering a similar topic in world literature, most of them present the benefits of arthroscopy in some types of osteosyntheses of intra-articular fractures of the scapula. Most frequently mentioned are osteosyntheses of the anterior portion of the glenoid in case of a bony Bankart lesion. These papers highlight the benefits of minimal invasiveness of this procedure. CONCLUSIONS By visualising the fracture line, the arthroscopy facilitates a more accurate reduction of fragments and a minimally invasive osteosynthesis of some intra-articular fractures of the scapula when compared to closed reduction with fluoroscopic intraoperative control only. The use of arthroscopy in these interventions is conditional on perfect mastering of the surgical technique and also the use of special instruments both for arthroscopy and minimally invasive osteosynthesis. If these criteria are observed and the surgical technique mastered, the authors consider this method beneficial in treating the glenoid fractures. Key words: minimally invasive osteosynthesis, glenoid fractures.
- MeSH
- artroskopie MeSH
- dospělí MeSH
- fraktury proximálního humeru * MeSH
- intraartikulární fraktury * MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka diagnostické zobrazování chirurgie MeSH
- mladý dospělý MeSH
- vnitřní fixace fraktury MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
ÚVOD: Osteosyntéza poranění zadního segmentu pánve iliosakrálními šrouby je jedna z nejčastěji používaných metod v současné době. Nejpřesnější metodou kontroly těchto typů operací je CT navigace. Cílem práce bylo zhodnotit použití počítačové CT navigace během osteosyntézy zadního segmentu pánve na kazuistice. METODA A VÝSLEDKY: U 58letého pacienta s poraněním pánve byla provedena osteosyntéza dysjunkce levého sakroiliakalního kloubu pomocí kanylovaného šroubu. Tato operace byla provedená pod kontrolou počítačové CT navigace. Byl sledován čas jednotlivých částí operačního výkonu a také dávka peroperačního RTG záření. DISKUZE: V současné době není počítačová CT navigace v traumatologii pánve běžně používaná, větší zkušenosti jsou s CT navigovanou operaci pánve. Ve světové literatuře existují práce na menších souborech pacientů, kde je prokázán její přínos oproti standardním metodám. ZÁVĚR: Použití počítačové CT navigace u osteosyntézy zadního segmentu pánve umožňuje lepší orientaci v sakroiliakální oblasti. Je možné přesné zacílení šroubů do křížové kosti v segmentech S1, S2.
- MeSH
- chirurgie s pomocí počítače metody MeSH
- kostní šrouby MeSH
- lidé středního věku MeSH
- lidé MeSH
- pánev * chirurgie zranění MeSH
- polytrauma MeSH
- pozitronová emisní tomografie MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
INTRODUCTION: Osteosynthesis of posterior pelvic segment injuries with iliosacral screws is one of the most commonly used methods today. The most accurate method of checking these types of operations is the CT navigation. The aim of this study was to evaluate the use of computer-assisted CT navigation during osteosynthesis of posterior pelvic segment in a case report. METHODS AND RESULTS: A 58-year-old patient with pelvic injury underwent osteosynthesis of the left sacroiliac joint disjunction using a cannulated screw. This operation was performed under the control of computer- assisted CT navigation. The time of individual parts of the surgery as well as the dose of perioperative X-ray irradiation were monitored. DISCUSSION: Currently, computer-assisted CT navigation is not commonly used in pelvic trauma; there is more experience with CT-guided pelvic surgery. In the world literature, there are papers on smaller cohorts of patients where its benefit over standard methods is demonstrated. CONCLUSION: The use of computer-assisted CT navigation in posterior pelvic segment osteosynthesis allows better orientation in the sacroiliac region. Precise targeting of screws to the sacrum in segments S1, S2 is possible.
- MeSH
- chirurgie s pomocí počítače MeSH
- kostní šrouby MeSH
- lidé středního věku MeSH
- lidé MeSH
- pánev * chirurgie zranění MeSH
- PET/CT MeSH
- polytrauma MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
