Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head. Key words: developmental dysplasia of the hip, posteromedial limited surgery, closed reduction, medial open reduction.

Purpose of the study: The purpose of this study is to compare the stability of different fi xation methods in high pediatric supracondylar humerus fractures with a fi nite element analysis method. MATERIAL AND METHODS Transverse, lateral oblique, and medial oblique fracture models were created in a ten years old boy's distal humerus. Eight different fi xation methods were applied to each fracture model. Displacement of the fracture models was measured under the translational and torsional forces. RESULTS In the transverse fracture model; the 6th method provided the best stability in internal rotation, external rotation, and extension loading. In varus 7th method, valgus 8th, and fl exion the 5th and 2nd methods had the best stability. In the lateral oblique fracture model; the 7th method had the best stability in all loading directions except fl exion and the 6th method had the best stability in fl exion and had acceptable values in all other directions except valgus and external rotation. In the medial oblique fracture model; the 6th method had the best stability in all directions except varus. 3rd method was the best fi xation type against varus and the second stable fi xation type in all other directions. CONCLUSIONS Combining lateral antegrade with lateral retrograde wire and lateral condylomedullary wire provides strong stability in the lateral oblique fracture. Two condylomedullary Kirchner wires and one antegrade lateral wire results in a strong stability in the medial oblique fracture. Medial-lateral condylomedullary and lateral antegrade wires provided the best stability against varus in transverse and lateral oblique fractures.

Key words: high pediatric supracondylar humerus fracture, percutaneous fi xation method, metaphyseal-diaphyseal junction, fi nite element analysis.

Purpose of the study: The aim of arthroscopic Bankart repair is restoration of the anterior block mechanism and regaining stability. There are few studies that have tested the adequacy of the angle made with the glenoid and the height from the glenoid level of the repaired labral tissue, but the correlation with the clinical results is not clear. The aim of this study was to defi ne the correlation of the height and slope of the repaired labral tissue in the glenoid anterior with the clinical results. MATERIAL AND METHODS This prospective study included 20 patients who underwent an arthroscopic Bankart repair. To evaluate the labrum anatomy of the affected shoulder, 4 measurement parameters were defi ned as axial height (Ah), axial slope (As), oblique coronal height (Ch), and oblique coronal slope (Cs) on non-contrast T2 MRI. The measurements were taken preoperatively of the affected shoulder and at 1 year postoperatively of both the affected shoulder and the contralateral asymptomatic shoulder. The measured values were compared with each other and with the contralateral shoulder. Correlations of the anatomic values with the Constant-Murley scores recorded at 1, 3, 6, and 12 months postoperatively were examined with the Wilcoxon test. RESULTS The mean preoperative Constant score of the patients was 57.7 (32-77) and postoperative scores at 1, 3, 6, and 12 months were 63.6 (44-79), 77.8 (61-90), 89.6 (77-100), and 95.2 (79-100), respectively (p=0.001). There was a statistically signifi cant difference in the preoperative MRI measurements of the axial and oblique coronal plane labral height and slope values compared to the postoperative values and those of the asymptomatic contralateral shoulder (p< 0.05 for all). There was no statistically signifi cant difference between the labral height and slope values of both planes postoperatively compared to the asymptomatic contralateral shoulder (p= 0.776, p= 0.910, p= 0.132, p= 0.589, respectively). These increases in the radiological data were not found to be statistically signifi cant in the correlation analysis with the increases in the Constant-Murley scores (Ah p=0.935, As p=0.587, Ch p=0.078, Cs p=0.105). CONCLUSIONS This prospective study was conducted using conventional T2 magnetic resonance imaging, which was suffi cient for the measurement of labral height and slope. This study results showed no signifi cant correlation between the radiological and clinical outcomes.

Key words: Bankart repair, labrum height, labrum slope, functional result.

PURPOSE OF THE STUDY A global bibliometric comparison of the level of scientific interest and output in the two research areas hip and knee arthroscopy (H-ASC and K-ASC) was carried out. In addition, the different degrees of publication activity in the countries and institutes performing this research were investigated. MATERIAL AND METHODS Publications from 1945-2020 listed in the Web of Science Core Collection were included in the study. Using the web application Science Performance Evaluation (SciPE), quantitative and qualitative aspects were evaluated. Subsequently, the date of publication, author information, and other metadata were analysed. RESULTS Since 1945, 3,924 studies have been published on K-ASC and 2,163 on H-ASC. The majority of the publications which have appeared since 2016 dealt with the topic of H-ASC (H-ASC: 241.2 publications/year; K-ASC: 217.4 publications/year). The USA published the most on both topics (H-ASC: 1,123 publications; K-ASC: 1,078 publications). More countries and institutes participated in K-ASC (3,008 institutes, 82 countries) than in H-ASC (103 institutes, 57 countries). The ten institutes with the most publications accounted for 36.71% and 12.34% of all publications on H-ASC and K-ASC, respectively. H-ASC received 78.12% of its funding from private sponsors while K-ASC was supported mainly by governmental/nonprofit sponsors (70.92%). CONCLUSIONS This study provides the first scientific comparison between H-ASC and K-ASC. Measured by qualitative and quantitative aspects, K-ASC was the most flourishing research area overall. In the last ten to five years, interest has shifted towards HASC with an increasing number of publications and a higher rate of citations. Key words: knee arthroscopy, hip arthroscopy, bibliometric comparison.

Acute traumatic intervertebral disc herniation of the thoracic spine is a rather rare injury with only a few reported cases to date. In this manuscript, we present a case of a 58-year-old male patient who sustained a car accident-related high-energy trauma, resulting in a disc herniation of the thoracic spine. Furthermore, we also discuss the possible implications of late diagnosis of such condition. The patient was initially referred from the Emergency Department as a case of head contusion with a left upper limb paresis. Due to only minimal bony trauma visible on the initial spine CT scan, the neurological deficit was attributed to the cranial trauma. The diagnosis of a traumatic disc herniation was therefore established only after the rapid onset of paraparesis, which gradually progressed into paraplegia, and a following spine MRI scan. Despite the subsequent urgent spinal decompression, the neurological functions of the lower limbs were not restored. This manuscript addresses the indications for performing MRI scans in polytrauma patients with a CT-verified spine trauma. Although it may be complicated to perform routine MRI scans in all such patients in daily practice, it can certainly help diagnose such injuries earlier and thus prevent potential permanent neurological damage to the patients. Key word: spine injury, traumatic disc herniation, thoracic spine, spine surgery.

PURPOSE OF THE STUDY Articular cartilage injury is a common disease in daily life, with a high incidence. The aim of this study was to investigate the effect and mechanism of miRNA-140-3p in bone mesenchymal stem cells (BMSCs)-derived exosomes under hypoxia on inflammatory articular chondrocytes. MATERIAL AND METHODS To simulate the pathological status of arthritis, rat chondrocytes were used to establish the osteoarthritis (OA) model by IL-1β (10 μg/ml) as a modulating in vitro, and exosomes were isolated by differential ultra-high speed centrifugation. The cell counting kit-8, wound healing and flow cytometry assays were utilized to assess proliferation, migration and apoptosis of chondrocytes, respectively. Lipogenic and chondrogenic differentiation of chondrocytes were detected by oil red O staining and toluidine blue staining individually. The expressions of miR-140-3p and chondrocyte-specific gene mRNA were investigated using qRT-PCR. Western blot was applied to assess chondrocyte associated proteins and BMSC-Exo surface protein markers, and immunohistochemistry was adopted to detect the staining of collagen I and II. RESULTS Under scanning electronic microscope, the shape of exosomes was almost round. Exosome treatment prominently impaired the inhibition of chondrocytes' proliferative and migrative ability by IL-1β. It was found hypoxia had a more marked impact on proliferation, expression of collagen II and apoptosis in OA chondrocytes than normoxia, as well as a stronger effect on weakening adipose differentiation and enhancing chondrogenic differentiation in inflammatory chondrocytes. Furthermore, incubation with BMSC-Exo overexpressing miR-140-3p can remarkably increase the survival rate and migration in inflammatory chondrocytes. In addition, overexpression of miR-140-3p was found to enhance the chondrogenic differentiation of inflammatory chondrocytes. Furthermore, we found that the healing effect of exosomes on inflammatory chondrocytes under hypoxic conditions was produced by a rise in miR-140-3p expression within them and that hypoxia-mediated upregulation of miR-140-3p expression occurred through HIF-1α. CONCLUSIONS Under hypoxia, BMSC-Exo enhanced the chondrogenic phenotype, increased the viability of inflammatory chondrocytes. The overexpression of miR-140-3p in BMSC-Exo is beneficial to protect joints and delaying the pathogenesis in OA. Key words: HIF-1α, apoptosis, lipogenic differentiation, chondrogenic differentiation.

PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.