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[Update on 3D printing in the surgery of musculoskeletal tumors]. 【3D打印在肌肉骨骼肿瘤手术中的最新进展】。
4区 医学 Q2 Medicine Pub Date : 2022-05-01 Epub Date: 2022-03-21 DOI: 10.1007/s00113-022-01160-5
Mohamed Omar, Martin Schulze, Nico Bruns, Daniel Kotrych, Georg Gosheger, Max Ettinger

The importance of 3D printing applications in the surgery of musculoskeletal tumors has increased in recent years. Even prior to the era of 3D printing, computer-assisted techniques, such as navigation, have proved their utility. Due to the variable appearance of bone tumors, there is a need for individual solutions. The 3D printing can be used for the development of anatomical demonstration models, the construction of patient-specific instruments and custom-made implants. For these three applications, different regulatory hurdles exist. Especially for the resection of pelvic tumors, 3D printing technologies seem to provide advantages due to the complicated anatomy and the proximity to relevant neurovascular structures. With the introduction of titanium printing, construction of individualized implants that fit exactly into the defect became feasible.

近年来,3D打印在肌肉骨骼肿瘤手术中的应用越来越重要。甚至在3D打印时代之前,计算机辅助技术,如导航,已经证明了它们的实用性。由于骨肿瘤的表现是多变的,因此需要个别的解决方案。3D打印可用于解剖演示模型的开发,患者特定器械的构建和定制植入物。对于这三种应用,存在不同的监管障碍。特别是对于盆腔肿瘤的切除,3D打印技术由于解剖结构复杂,且接近相关神经血管结构,似乎提供了优势。随着钛打印技术的引入,精确适应缺陷的个性化植入物的构建变得可行。
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引用次数: 1
[The role of color-coded duplex sonography in preoperative vascular diagnostics in plastic surgery]. 彩色编码超声在整形手术术前血管诊断中的作用
4区 医学 Q2 Medicine Pub Date : 2022-05-01 Epub Date: 2022-03-21 DOI: 10.1007/s00113-022-01166-z
Adrian Matthias Vater, Rafael Jakubietz
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引用次数: 0
[Evaluation of the current research structures in trauma surgery : A survey of the scientific committee of the German Society for Trauma Surgery]. [对目前创伤外科研究结构的评价:德国创伤外科学会科学委员会的调查]。
4区 医学 Q2 Medicine Pub Date : 2022-05-01 Epub Date: 2022-03-21 DOI: 10.1007/s00113-022-01169-w
Frank Hildebrand, Christine Höfer, Klemens Horst, Benedikt Friemert, Dietmar Pennig, Richard Stange

Background: To improve research in orthopedics and traumatology (O&T) in Germany, the implementation of comprehensive research collaborations and enhanced communication pathways among different institutions are necessary. This survey was initiated to collect data regarding the current research structures in O&T.

Material and methods: A subject-specific questionnaire was sent via email to collect data regarding demographics, on-going and past research activities and the funding. Naming of current and future research topics and problems regarding realization of projects were determined. All results were submitted electronically, anonymously and voluntarily.

Results: Of 229 participants, 83% worked as clinicians and 59.6% of the participants were working in departments with joint structures (O&T). Industry and universities were found to be the essential funding sources. Future research topics tend to concentrate on digital health issues (artificial intelligence, big data, 3D-printing). Resource scarcity in time and staff as well as administrative barriers but also insufficient funding were identified as major impediments of research activity.

Conclusion: Future research development in O&T will cause an expansion of techniques and methods. At the same time aggravated personnel, financial, administrative and legal framework conditions can only be managed with an intensively increased effort. Cooperation projects and collaborative research structures might be a solution to these challenges.

背景:为了提高德国骨科和创伤学(O&T)的研究水平,实施全面的研究合作和加强不同机构之间的交流途径是必要的。这项调查的目的是收集有关O&T目前研究结构的数据。材料和方法:通过电子邮件发送特定主题的调查问卷,收集有关人口统计,正在进行和过去的研究活动以及资金的数据。确定了当前和未来研究课题的命名以及项目实现中存在的问题。所有结果均以电子方式、匿名和自愿提交。结果:229名参与者中,临床医生占83%,关节结构科室占59.6%。工业和大学被认为是主要的资金来源。未来的研究主题倾向于集中在数字健康问题上(人工智能、大数据、3d打印)。时间和工作人员的资源短缺以及行政障碍和资金不足被确定为研究活动的主要障碍。结论:未来O&T研究的发展将导致技术和方法的扩展。与此同时,恶化的人事、财政、行政和法律框架条件只有加紧努力才能加以管理。合作项目和合作研究结构可能是解决这些挑战的办法。
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引用次数: 1
[The crucial role of color-coded duplex sonography before planning microvascular tissue transfer in the lower extremities]. [彩色编码双工超声在计划下肢微血管组织移植前的关键作用]。
4区 医学 Q2 Medicine Pub Date : 2022-05-01 Epub Date: 2022-03-21 DOI: 10.1007/s00113-022-01164-1
Uwe Wahl, Tobias Hirsch
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引用次数: 0
[Bifid median nerve as a coincidental finding in traumatology : Case report and review of the literature]. [双裂正中神经作为创伤学的巧合发现:病例报告和文献回顾]。
4区 医学 Q2 Medicine Pub Date : 2022-05-01 Epub Date: 2021-07-01 DOI: 10.1007/s00113-021-01031-5
T Zafeiris, S Heidenreich, J Rödig

The median nerve is an important sensory and motor nerve of the arm and is not infrequently associated with diagnostic and therapeutic misjudgements. A bifid median nerve as a coincidental finding in traumatology is another rarity and is mostly found during various elective procedures, such as carpal tunnel splitting. We report on a patient with a bifid median nerve who sustained a laceration wound near the carpal tunnel due to a domestic accident.

正中神经是手臂重要的感觉和运动神经,常与诊断和治疗误判有关。在创伤学中偶然发现的二裂正中神经是另一种罕见的现象,通常在各种选择性手术中发现,如腕管分裂。我们报告一个病人的二裂正中神经谁持续撕裂伤口附近的腕管由于家庭事故。
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引用次数: 0
[Implementation of a standardized clinical test kit for diagnostics of periprosthetic infections in the clinical routine. German version]. [在临床常规中实施义肢周围感染诊断标准化临床检测试剂盒。]德国版)。
4区 医学 Q2 Medicine Pub Date : 2022-05-01 Epub Date: 2021-06-29 DOI: 10.1007/s00113-021-01017-3
Y Gramlich, M Kremer, Chr Brüning, J Breuer, L Hofmann, A Klug, R Hoffmann

Background: The number of primary arthroplasties is increasing and the proportion of revision arthroplasties is becoming increasingly more important. The need for standardized and guideline-based diagnostics for the safe detection of a periprosthetic joint infection (PJI) is becoming apparent. In the past 10 years various organizations have published definitions and diagnostic guidelines. The implementation of an inhouse standard test kit could help to simplify the process and could improve the diagnostic quality.

Method: In 2016 a test kit was compiled in a monocentric prospective study, taking the International Consensus Meeting (ICM) criteria 2014 and the Infectious Diseases Society of America (IDSA) criteria into account, which also fulfils the definitions of the ICM criteria 2018 and criteria of the European Bone and Joint Infection Society 2021. The test kit was implemented in the clinical setting of a special department for aseptic and septic revision arthroplasty. The usability and accuracy of the test kit were examined.

Results: The test kit was implemented using blood samples (leukocyte count; C‑reactive protein, CRP), samples for examining the synovial fluid (white blood cell count, PMN cell differentiation, microbiological culture for incubation over 14 days, alpha-defensin enzyme-linked immunosorbent assay, ELISA, leukocyte esterase test strips) together with information and request forms. Between April 2016 and February 2020 a total of 405 patients were investigated. Within 3 calendar years, the use of the test kit increased from 59% initially to 86%, and finally to 96% of cases in the third calendar year. The leukocyte esterase test strip was reliable in only 72%, due to undifferentiated readability or blood contamination. The costs increased by the only commercially available alpha-defensin ELISA test by approx. 52€ per puncture. The best individual test showed a sensitivity/specificity of 92.8%/95.2% with alpha-defensin. It was calculated which combinations showed a similar test quality and different combinations, such as CRP+ cell count+ microbiology showed a sensitivity/specificity both of around 90%. Metallosis is a challenge for preoperative PJI diagnostics.

Discussion: In a prospective study it was shown, that the implementation of the standardized test kit lead to a guideline based PJI diagnostic in all cases and thus to a significantly increase of the diagnostic quality. There is currently no single test that reliably excludes or proves an infection. The alpha-defensin laboratory ELISA test showed the best test accuracy, whereby the consideration of test combinations is obligatory and at the same time safe.

背景:原发性关节置换术的数量越来越多,翻修性关节置换术的比例越来越重要。为安全检测假体周围关节感染(PJI),对标准化和基于指南的诊断的需求日益明显。在过去的10年里,各种组织发布了定义和诊断指南。内部标准检测试剂盒的实施有助于简化流程,提高诊断质量。方法:2016年,在单中心前瞻性研究中编制了一套检测试剂盒,同时考虑了2014年国际共识会议(ICM)标准和美国传染病学会(IDSA)标准,该标准也符合2018年ICM标准和2021年欧洲骨关节感染学会标准的定义。该测试试剂盒在无菌和脓毒症关节置换术的特殊部门的临床环境中实施。对试剂盒的可用性和准确性进行了检验。结果:检测试剂盒采用血样(白细胞计数;C反应蛋白(CRP)、用于检查滑液的样品(白细胞计数、PMN细胞分化、培养超过14天的微生物培养、α -防御素酶联免疫吸附试验、ELISA、白细胞酯酶试纸条)以及信息和请求表格。2016年4月至2020年2月,共调查了405例患者。在3个日历年内,检测试剂盒的使用率从最初的59%增加到86%,最后在第三个日历年增加到96%。由于未区分的可读性或血液污染,白细胞酯酶试纸的可靠性仅为72%。唯一的市售α -防御素酶联免疫吸附试验的成本增加了大约。每次52欧元。最佳个体检测对α -防御素的敏感性/特异性分别为92.8%/95.2%。计算出哪些组合具有相似的检测质量,以及不同的组合,例如CRP+细胞计数+微生物学的敏感性/特异性均在90%左右。金属中毒是术前PJI诊断的一个挑战。讨论:在一项前瞻性研究中显示,标准化检测试剂盒的实施导致在所有病例中基于指南的PJI诊断,从而显著提高了诊断质量。目前还没有一种检测方法可以可靠地排除或证实感染。α -防御素实验室ELISA测试显示出最好的测试准确性,因此考虑测试组合是强制性的,同时也是安全的。
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引用次数: 0
[3D printing in spinal surgery-Update]. [3D打印在脊柱手术中的应用-更新]。
4区 医学 Q2 Medicine Pub Date : 2022-05-01 Epub Date: 2022-02-17 DOI: 10.1007/s00113-022-01150-7
S Roth, S Sehmisch, S Decker

The technique of 3D printing offers a high potential for further optimization of spinal surgery. This new technology has been published for different areas in the field of spinal surgery, e.g. in preoperative planning, intraoperative use as well as to create patient-specific implants. For example, it has been demonstrated that preoperative 3‑dimensional visualization of spinal deformities is helpful in planning procedures. Moreover, insertion of pedicle screws seems to be more accurate when using individualized templates to guide the drill compared to freehand techniques. This review summarizes the current literature dealing with 3D printing in spinal surgery with special consideration of the current applications, the limitations and the future potential.

3D打印技术为进一步优化脊柱手术提供了巨大的潜力。这项新技术已经在脊柱外科领域的不同领域发表,例如术前计划,术中使用以及创建患者特定植入物。例如,已经证明术前脊柱畸形的三维可视化有助于计划手术。此外,与徒手技术相比,使用个性化模板指导钻孔时,椎弓根螺钉的插入似乎更准确。本文综述了目前有关脊柱外科3D打印的文献,并特别考虑了目前的应用、局限性和未来的潜力。
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引用次数: 1
[Functional outcome of 111 metatarsal fractures following conservative in comparison to operative treatment]. [111例跖骨骨折保守治疗与手术治疗的功能结果对比]。
4区 医学 Q2 Medicine Pub Date : 2022-04-01 Epub Date: 2021-05-22 DOI: 10.1007/s00113-021-01006-6
Patrick Pflüger, Michael Zyskowski, Christopher Völk, Chlodwig Kirchhoff, Peter Biberthaler, Moritz Crönlein

Background: Fractures of the metatarsal bones are common injuries of the foot and particularly occur in patients aged 40-50 years. Especially multiple metatarsal fractures can lead to permanent limitations. Therefore, the aim of this study was to investigate the functional outcome of metatarsal fractures after conservative and surgical treatment using a validated self-reported patient-based outcome questionnaire.

Material and methods: All patients suffering from metatarsal fractures between 2003 and 2015 were enrolled in this retrospective analysis. The following data were collected: demographic data, AO classification, treatment, reoperation rate and the foot and ankle outcome score (FAOS). For outcome analysis, the nonparametric Mann-Whitney U‑test and Fisher's exact test were performed.

Results: In total the functional outcome of 111 patients with metatarsal fractures were analyzed, 81 patients suffered of an isolated metatarsal fracture and 30 of multiple fractures. The mean age of the patients was 45 ± 15.2 years with a total of 48 men (43%) and 63 women (57%). Patients with an isolated metatarsal fracture had an FAOS of 88 ± 17.1, while patients with multiple metatarsal fractures achieved an FAOS of 78 ± 17.7 (p = 0.046). In the group of isolated metatarsal fractures 43 patients (53%) were surgically treated and of these 36 patients showed a type C fracture (84%). In the group of multiple metatarsal fractures 16 patients (53%) underwent operative treatment.

Conclusion: Overall, the functional outcome of isolated metatarsal fractures following operative as well as conservative treatment is good to very good. Simple fractures can be successfully treated conservatively and complex multifragment fractures can be safely managed surgically. If more than one metatarsal bone is fractured, the functional outcome is significantly worse with patients reporting lasting limitations involving the range of motion and stiffness.

背景:跖骨骨折是足部常见的损伤,尤其多发于 40-50 岁的患者。尤其是多发性跖骨骨折可导致永久性的功能受限。因此,本研究旨在使用经过验证的基于患者自我报告的疗效问卷,调查跖骨骨折在保守治疗和手术治疗后的功能疗效:2003年至2015年期间所有跖骨骨折患者均被纳入此次回顾性分析。收集的数据包括:人口统计学数据、AO分类、治疗方法、再手术率以及足踝结果评分(FAOS)。结果分析采用非参数曼-惠特尼U检验和费雪精确检验:结果:共对111名跖骨骨折患者的功能结果进行了分析,其中81名患者为孤立性跖骨骨折,30名患者为多发性骨折。患者的平均年龄为 45 ± 15.2 岁,其中男性 48 人(占 43%),女性 63 人(占 57%)。孤立跖骨骨折患者的 FAOS 为 88 ± 17.1,而多发性跖骨骨折患者的 FAOS 为 78 ± 17.7(P = 0.046)。在孤立跖骨骨折组中,43 名患者(53%)接受了手术治疗,其中 36 名患者的骨折类型为 C 型(84%)。在多发性跖骨骨折组中,16 名患者(53%)接受了手术治疗:总的来说,孤立性跖骨骨折经过手术和保守治疗后,功能效果良好或非常好。简单的骨折可以成功地进行保守治疗,复杂的多段骨折可以安全地进行手术治疗。如果有一块以上的跖骨骨折,功能效果就会大打折扣,患者的活动范围和僵硬程度都会受到长期限制。
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引用次数: 0
[Targeted muscle reinnervation and targeted sensory reinnervation : Role of complex neurotization after amputation]. [针对性肌肉神经再支配和针对性感觉神经再支配:截肢后复杂神经化的作用]。
4区 医学 Q2 Medicine Pub Date : 2022-04-01 Epub Date: 2022-02-23 DOI: 10.1007/s00113-022-01151-6
Richarda Böttcher

In association with major amputations of the upper and lower extremities, surgical procedures with nerve transfer are increasingly being introduced. In order to examine the value of these procedures the currently available data were analyzed and related to the corresponding insights from conventional amputation surgery as well as confirmed aspects of microsurgery of peripheral nerves. Mainly retrospective observations of low case numbers and sometimes individually different surgical approaches can be found. Risk analysis and sufficient long-term follow-up periods are lacking as well as comparisons with appropriate control groups. The published results on operative procedures with selected nerve transfers after or during amputation do not currently allow any conclusions about the advantages. Systematic influences in the assessment of the results are probable. Implementation of these treatment options outside controlled clinical trials cannot be recommended.

随着上肢和下肢的重大截肢,神经转移的外科手术越来越多地被引入。为了检验这些手术的价值,我们分析了目前可用的数据,并将其与传统截肢手术的相应见解以及周围神经显微手术的确认方面联系起来。主要是回顾性观察,病例数少,有时单独不同的手术入路可以找到。缺乏风险分析和足够的长期随访期以及与适当对照组的比较。已发表的关于截肢后或截肢期间选择神经转移的手术程序的结果目前还不能得出任何关于其优点的结论。评估结果时可能会有系统的影响。不建议在对照临床试验之外实施这些治疗方案。
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引用次数: 0
[Bone stimulation 4.0-Combination of EMTT and ESWT in humeral nonunion : A case report]. [骨刺激4.0- EMTT和ESWT联合治疗肱骨不连1例报告]。
4区 医学 Q2 Medicine Pub Date : 2022-04-01 Epub Date: 2021-06-16 DOI: 10.1007/s00113-021-01025-3
Karsten Knobloch
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引用次数: 1
期刊
Unfallchirurg
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