Beitrage zur Orthopadie und Traumatologie最新文献

Based on experiences made with the arthroscopy of the knee joint in our hospital since 1985 and also based on studies made in treatment of plicae synovialis, 155 patients were operated between 1. January 1987 and 31. December 1989 by an arthroscopy, where only synovial changes are found and treated. In 135 cases the anamnesis, the result of the clinical examination and the operation report are analyzed. 110 patients could be examined postoperative. In listing the results there is made a difference between patients, where a synovial change at the medial condylus is operated and such where synovial changes round the femoropatellar joint are treated. All patients were investigated by a questionnaire action. A discrimination by intraoperative foundings was not made, it should rather be clarified, whether the arthroscopic operative treatment of those synovial changes leads to a removal or a clear reduction of the pain in the knee joint, which exists preoperative and leads to the operative treatment. Especially was asked for changes in sporting activities, because the pain mostly appears at physical exercise.

The treatment of chondromalacia of the patella is a medical problem. There are no sure concepts of therapy. We have analysed the value of the only lateral release or shaving by motorizised instruments or the combination of both methods. After lateral release have many patients no pain but the other methods also helped many patients. The comparison of these groups is impossible because of the different structure. A prospective randomised study has to bring the answer to this question.

Articular changes in Chron's disease represent extraintestinal organic manifestations which generally take the form of so-called enteropathic synovitis. Articular alterations - diagnosed as non-specific arthritis in the great majority of cases--may precede the intestinal disease. In very rare cases it can be shown that the joints display histological changes typical of Morbus Crohn. The etiology and pathophysiological mechanisms of the articular changes are not clear. Probable factors are: autoimmune disease, stimulation of the immunological system by exogenous antigens, induction of a self-sustaining inflammatory process, and demonstrable circulation of antigen-antibody complexes. Genetic factors seem to play a role (familial disposition). A pure "colonic Crohn" (= colitis granulomatosa) leads to a higher degree of articular alteration than a pure "small-intestine Crohn" (= ileitis terminalis). The joints preferentially affected are in the region of the lower extremities (knee and ankle joints). Concomitant Bekhterev's disease (spondylitiis ankylopoietica) is found in 7-10% of cases. Osteomyelitis represents a rare and serious complication: it can appear in the course of chronic Chron's disease (mainly with intestinal fistulas), especially in the region of the pelvic bones. Further aspects of interest from an orthopedic viewpoint are hypertrophic osteoarthropathy with periossal neoformation, granulomatous changes in the bone itself, and aseptic osteonecrosis.

Fifty-five patients who underwent lower spine surgery were preoperatively evaluated with myelography and postmyelography CT. ENMG was done on 23 patients. CT had the highest accuracy in finding the affected level (F = 75,5; p less than 0,0005) as compared to myelography (F = 46,5; p less than 0,0005) or to ENMG (F = 11,4; p greater than 0,15). We did not find statistical differences in diagnostic accuracy in different disc spaces nor was there a difference between primary and recurrent low-back disease.

Up to now Dacron-Ligaments have been used in repair of the cruciat ligaments of the knee with good success. Specially the good toleration of Dacron by tissue has led us to reconstruct other ligament injuries by Dacron-Ligaments. Seldom but very hindering is an isolated rupture of the syndesmoses for in the first time it will be not diagnosed. But previous ruptures of the syndesmoses can only be treated by reconstruction. In 11 patients we tried to reconstruct the syndesmoses by a special guided Stryker Dacron-Ligament with good results. The operation takes only a short time and is not very invasive. Our following explorations overlook about 4 years and the results will show up a new method for a functional construction.

Results of refixation in 17 cases of meniscus ruptures are presented. The operation was an open arthrotomy. The follow-up examination is described. There are found 7 very good, 7 good and 3 satisfactory results. These results allow the attempt to preserve meniscus under certain preconditions by means of suture.

Results of surgical treatment of the congenital dislocation of the hip in 40 children (2-5 years) are presented. The mean observation period was 8 years. 80% of very good and good results were obtained in the included material. One-stage hip reposition -reconstruction with Dega's transiliacal osteotomy, applied to children of 2-3 years, gives positive results, adding to further development of the hip joint.

In one hospital the operative treatment of fractures within ten years had been critically analysed. The established mistakes and risks unambiguously show reserves for the improvement of the results in the treatment. Despite the avoidable operational-tactic and -technic mistakes the result of the medical attendance often ist negative.

A review of 45 hips with disorders (congenital dislocation of the hip, subluxation of the hip, hip dysplasia with or without secondary pertheslike changes) treated by pembertons pelvic osteotomy with femur osteotomy is shown. Its a followed-up about two years. Many of them (85%) had satisfactory roentgenographic results and its showed the effectiveness of this procedure. We think the best time for treatment is the age between 2 and 4 years.