PURPOSE: Three surgical approaches in total hip arthroplasty (THA) were compared concerning: 1) clinical and radiological results; 2) innervation of the tensor fasciae latae and gluteal muscles; 3) clinical outcome of the nerve lesions; 4) sensitivity of the EMG analysis. METHODS: A total of 70 patients aged 39-79 years were evaluated clinically and electromyographically before and 3-9 months after THA in 2 centres using the anterolateral approach in 22, transgluteal approach in 33 and posterior approach in 15 patients, respectively. RESULTS: 1) Hip flexion, external rotation and Trendelenburg lurch were reduced and the centre of the rotation was higher after the anterolateral approach. 2) The inferior branch of the superior gluteal nerve of the tensor fasciae latae muscle was mostly damaged in the anterolateral approach (73% of lesions), whereas innervations of gluteus medius (9% of lesions) and maximus muscles (no lesion) were preserved. The transgluteal approach most often caused a partially denervated gluteus medius (81.8%) and the tensor fasciae latae (48%) and the gluteus maximus muscle only in 29%, respectively. After the posterior approach, partial denervation in the gluteus medius and maximus muscles were noted in 53.3% and 71.4%, respectively, whereas in the tensor fasciae latae muscle in only 14%. 3) The power of the abductors was not significantly reduced in partially denervated muscles. 4) The EMG examination is not sensitive enough to determine the relevant power of hip abductors. CONCLUSIONS: Despite some disadvantages associated with the anterolateral approach, the transgluteal and posterior approaches are often connected with a partial lesion of the gluteus medius and maximus muscles. In all approaches, clinical sequelae are not significant in primary THA.

• MeSH
• dospělí MeSH
• elektromyografie metody   MeSH
• hodnocení rizik MeSH
• hýždě inervace   chirurgie   MeSH
• kosterní svaly zranění   inervace   MeSH
• kyčelní kloub chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu škodlivé účinky   metody   MeSH
• nervus femoralis zranění   MeSH
• nervus peroneus zranění   MeSH
• pooperační péče metody   MeSH
• předoperační péče metody   MeSH
• referenční hodnoty MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

PURPOSE OF THE STUDY: Percutaneous plating of the distal tibia via a limited incision is an accepted technique of osteosynthesis for extra-articular and simple intra-articular distal tibia fractures. The aim of this study was to analyze structures that are at risk during this approach. MATERIAL AND METHODS: Thirteen unpaired adult lower limbs were used for this study. Thirteen, 15-hole LCP anterolateral distal tibial plates were percutaneously inserted according to the recommended technique. Dissection was performed to examine the relation of the superficial and deep peroneal nerves and anterior tibial artery relative to the plate. RESULTS: The superficial peroneal nerve was found to cross the vertical limb of the LCP plate at a mean distance of 63 mm (screw hole five) but with a wide range of 21 to 105 mm. The neurovascular bundle (deep peroneal nerve and anterior tibial artery) crossed the plate at a mean of 76 mm (screw hole six) but also with a wide range of 38 to 138 mm. The zone of danger of the neurovascular structures ranges from 21 to 138 mm from the tibial plafond. In one specimen, a significant branch of the deep peroneal nerve was found to be entrapped under the plate. CONCLUSION: Caution is advised when using anterolateral minimally invasive technique for plate insertion and screw placement in the distal tibia due to great variability in the neurovascular structures that course distally in the lower leg and cross the ankle.

• MeSH
• arteriae tibiales anatomie a histologie   zranění   MeSH
• fraktury tibie chirurgie   MeSH
• kostní destičky * MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony škodlivé účinky   metody   MeSH
• mrtvola MeSH
• nervus peroneus anatomie a histologie   zranění   MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tibie anatomie a histologie   chirurgie   MeSH
• vnitřní fixace fraktury škodlivé účinky   metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

AIM: The aim of the presented work was to assess the causes of injury to great nerves during varicose vein surgery and comment on the consequences. METHODS: This was a retrospective study of 2344 patients operated on for primary varicose veins between the years 1980 and 2005. RESULTS: In three patients out of 2344 the peroneal nerve was injured. The three patients underwent neurosurgery. In the first patient transplantation of the sacral nerve was performed. In the second patient the nerve was released from ligatures, and in the third patient the nerve was first released from the cicatrice and the transposition of the tendon of the posterior tibial muscle followed. All three patients went through intensive rehabilitation. The first patient still wears peroneal splint, the limb is atrophic. In the second patient the function has been well restored and he is not disabled anymore. However, the restitution of the lower limb function is not sufficient for him to work as a teacher of physical education. The third patient still suffers from serious paresis of the peroneal nerve. CONCLUSIONS: Even a frequent and relatively simple intervention such as varicose vein surgery may be accompanied by serious complications affecting patients for the rest of their lives. Serious motor nerve injuries are encountered only in operations in the popliteal fossa and the fibula head. Complications are more frequent when operations are performed by young general surgeons than when they are performed by an experienced surgeon or an expert in vascular surgery. The affected patients should be referred for neurosurgery; however, results are unpredictable. In spite of an intensive rehabilitation and possible plastic surgery the patients are permanently affected.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• klinické kompetence MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nervus peroneus zranění   patofyziologie   chirurgie   MeSH
• neurochirurgické výkony MeSH
• neuropatie nervus peroneus etiologie   patofyziologie   rehabilitace   chirurgie   MeSH
• obnova funkce MeSH
• retrospektivní studie MeSH
• varixy chirurgie   MeSH
• vena saphena transplantace   MeSH
• výkony cévní chirurgie škodlivé účinky   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
• Geografické názvy
• Česká republika MeSH

BACKGROUND: In the submitted retrospective study the authors present the results of 40 operations in 40 patients who were treated in the course of 15 years (from 1985-1999) on account of 40 injuries of the fibular nerve, historically known as an injury difficult to treat. The paper gives a basic outline of the surgical treatment. MATERIAL AND METHODS: From a total number of 40 in 20 patients external neurolysis was performed. In the remaining 20 patients reconstruction operations of the injured nerves were made whereby 8 operations involved suture of the peripheral nerve, and 12 operations were made using a nerve graft in case of complete and persisting neurological deficiency and absence of action potentials on EMG. The mechanism of injury comprised nerve injury caused by elongation with or without fracture, "sharp" or "blunt" injuries, shotgun injuries, compressions and iatrogenic injuries. If spontaneous repair did not occur within 2-6 months after injury the patients were operated and in 27 of 40 improvement was achieved preventing instability of the foot and in 25 of 40 protective sensitivity developed. Analysis of the effectiveness of surgery was focused on the following indicators: time of operation after injury, patient's age, character of injury, level of injury, type of surgical operation. RESULTS: After neurolysis in 18 of 20 patients (90%) a useful grade of improvement was achieved despite severe preoperative motor deficiency. In 8 patients an "end to end" suture was made and in 6 (75%) the restoration was grade 3 or more. 12 patients needed a reconstruction operation by means of nerve grafts, the length of the graft varied from 4 to 20 cm. The grafts were shorter than 5 cm and in 2 patients, with a cut in 1 and with a iatrogenic injury in 1 patient. In both these patients the function was restored to grade M4. In 1 of 4 patients (20%) with a graft of 6 to 12 cm and in none of 6 with grafts from 13 to 20 cm restoration grade 3 or more was achieved. In those instances the authors observed however partial restoration of the trophics and tonus but without motor restoration. CONCLUSION: Similarly as in other nerve injuries thorough preoperative examination and early surgery are necessary to achieve optimal results. It worth mentioning that excellent results were attained in proximal injuries of the fibular nerve as compared with injuries in the more distal area of the knee.

• MeSH
• dospělí MeSH
• lidé MeSH
• nervus peroneus zranění   chirurgie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

• MeSH
• elektromyografie MeSH
• fraktury krčku femuru komplikace   MeSH
• lidé MeSH
• nervus peroneus zranění   MeSH
• neurologické vyšetření MeSH
• paralýza etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• lidé MeSH
• nervus peroneus zranění   MeSH
• poranění kolena komplikace   MeSH
• regenerace nervu MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH