Beitrage zur Orthopadie und Traumatologie最新文献

A report about our productions and experiences with the smooth wall of the body's bed from Polyurethanschaum EZ 7607 system. The material mark out trough permanent improvement of it's wear and economical properties. Recently useful technique will be further developed trough continuous improvements of the materials in addition to our experiences.

With the submitted study of 165 HVV-vessel-transplantations the marking properties like reduced immunogenity, primary athrombogenicity, form fixated vascular lumen, ability for punction, flow reduction and stability for storage were possible to prove. Few complications (thromboses, aneurysms, infections) and also low rate of revision marks the long-term progress of this bioprosthesis. It will be stated with emphasis, that the use of this vascular device is indicated, if the patient's veins for creation of an arteriovenous vascular access is not available. In long-term progress the rate of function is better in comparison with other similar or synthetic materials for prostheses.

Treatment of large and recurrent abdominal wall hernias represents a rather complicated problem in surgical tactics and technique. In an effort to overcome the shortage of autogeneic material for strengthening the abdominal wall it is possible to substitute the defect by different synthetic or biological materials. Our experience with the use of freeze-dried dura mater is dealt with. The total of 18 allogeneic grafts were used in 11 patients with ventral hernias. The therapeutic procedure and clinical results are reported. Minor complications have developed in 2 patients, but they did not influence the good results of surgical treatment.

50 operative procedures in capsular-ligamentous apparatus of knee joint were done from 1.9.1988 until 31.12.1989 among 209 in charged treated sports injuries. The multiplicity in pattern of injuries is the reason for individual procedure in reconstructive joint-surgery and because of this various indications for auto- and allogenic eg. synthetic materials, static and dynamic procedures else free or vascularized grafts. The lyophylized fascia lata "soft" is used in case of anteromedial instability, isolated medial rupture of collateral ligament of the first degree else for augmentation after primary treated medial injury of collateral ligament. Early results are proving the histocompatibility, the healing without complications else timely stability and recommending the fascia lata-plasty in given indications.

In 1983 to 1987 we operated 216 Patients on hallux valgus. In most of them we made the method of Keller/Brandes. This is a report about the results of 165 patients with 238 operated hallucis.

The VDS-method in accordance to Zielke and the Harrington-distraction-spondylodesis are proved as methods for correction of scoliosis lasting for decades, which late results are world-wide analysed and published. The both diametrical corrective principles and the fundamental different operative techniques settle their different indications, which doubtless depend on the experience of the surgeon. Both methods complete each other in operative spectrum of the spinal surgeon. A careful study of the bending properties and the general situation is the supposition for adequate differential indication, which details and results are reported.

The importance of transplantation in clinical medicine is still increasing. Risks by transmission of infections agents by virus contaminated transplants with following diseases are most feared. Anamnesis and course of spectacular cases by unconventual viruses (Creutzfeld-Jakob), pathogens of AIDS and rabies and transmission by different routes have been analysed. The necessity of legal directives for blood and tissue banks has to be stressed.

The different methods of local treatment of burns are still controversial. Aims of good local are the therapy prevention of fluid loss, loss of proteins, electrolytes, heat and energy, prevention eg. reduction of wound infections, preservation and acceleration of regeneration of remained own skin, influence on good formation of scars eg. preparing of high value as possible transplant-ground for eventual necessary skin transplantation. Experience in covering juvenile burn-injuries with lyophilized Human-Amnion were gathered in our department for more than 15 years. The treatment of patients with this "biological bandage" and results were demonstrated. In our opinion the method of primary amnion covering of juvenile burn-injuries is superior to other procedures.

Since 1983 the treatment of second-degree burns with glycerol-conserved allogenic split-thickness skin grafts is published. In case of actual problems with AIDS the gathering of split-thickness skin was modified and a new method for gaining split-thickness skin of organ-donors created to prevent the virus transfer. Because of these high security in contagiousness the skin graft transplantation with allogenic glycerol-conserved donor-skin in case of second-degree-burns was standardized in the Berlin Burn Center. To prevent the formation of granulation tissue after second-degree burns a tangential debridement of necrotic corium will be done in 1/10 mm thick slices on the third posttraumatic day and the defects covered with 1:1.5 mesh grafts extended. The results of 267 patients in 1988 and 1989, who were treated in accordance to this regimen, will be demonstrated. In 11% of cases the alloplastic skin graft in adults was not rejected 6 month after transplantation and in 2% of cases the depth of burn was not estimated properly and hypertrophic scars had to be excised and covered with autogenous split-thickness skin. General second-degree-burn healed after debridement and covering with allogeneic split-thickness skin without formation of hypertrophic scars.

In 15 years 63 Transplantations were done. 17 times with autogenous and 46 times with allogeneic transplants. Main indications were relapsed- and scar herniations, ruptures of achilles tendon and acromio-clavicular luxation. Advantages of allogeneic transplantation in comparison with autogenous transplantations will be demonstrated. It is referred to the consistent use of principles of aseptic, antiseptic and the careful atraumatic surgical technique in transplantation.