Beitrage zur Orthopadie und Traumatologie最新文献

Severe and fixed scoliosis needs a preoperative extension treatment to attain a good result of correction by spondylodesis. Halo-up-extension is a very simple, comfortable and successful method to prepare patients with a severe scoliosis for operation. From January 1981 to July 1989 we carried out the preoperative halo-up-Extension treatment at 45 patients. 39 of them had a severe scoliosis with a cobb-angle of more than 70 degrees. The correction by halo-up-Extension runs on an average of 35% of the total correction.

Adequate treatment of scoliosis requires from the managing doctor a detailed knowledge about the natural history of the disease for correct indication of the various possibilities for treatment and favourable influence of the spontaneous history. Essential prognostic factors of idiopathic scoliotic forms and congenital or neuromuscular scolioses will be demonstrated.

Idiopathic scoliosis under 20 degrees were treated by physiotherapeut methods alone. At scoliosis with curves between 20 and 45 degrees a correction by means of Chêneau type orthosis; is additionally used during growing age. The over all results of this combined therapy are good.

The development of the aseptic necrosis of the lunate bone is so far not fully understood. Therapeutical problems result from the very late discovery of the disease and from the central position in the carpal bone system. Bad long-term-results come out of therapies not able to revitalize the lunate bone. Therefore the therapeutical goal attempted must be to keep the structures of the bone alive and to avoid major pathological changes of the whole carpal bone system. More or less good results could be shown for these patients with a total break-down of the lunate bone treated with the intercarpal-arthrodesis described by Graner.

Lateral electrical surface stimulation (LESS) was used for treatment of idiopathic scoliosis in 20 children and adolescents (mean age 10.9 years, mean Cobb angle 26 drs.). Six patients were treated until skeletal maturity showing a mean curve progression of 8 degrees at follow-up. In 14 patients treatment failed due to skin irritation, sleeping disturbances or progression. Five patients had to be operated on. Twenty patients of a control group treated with Boston brace (mean age 11.9 years, mean Cobb angle 34 drs.) showed mean curve improvement of 2 degrees at follow-up. Only one patient of the control group had to be operated on. Brace treatment was superior to stimulation in this small patient group presented.

The complications of 97 patients who were operated with anterior spinal instrumentation were frequent, but insignificant. 22 of these patients with lumbar and thoracolumbar curves in whom the VDS instrumentation was used were reviewed. A 79% correction was obtained in the coronal plane. Loss of correction was 11% in the first year and further 2% at 56 months average follow up. In the sagittal plane a mild tendency to increased kyphosis was found. A permanent "adding on" phenomenon occurred in one case. The VDS-instrumentation appears the apparatus of choice for treatment of thoracolumbar and lumbar scoliosis, other indications are discussed.

At the orthopaedic University Hospitals of Mainz and Münster more than 200 patients were treated surgically according Cotrel and Dubousset procedure. By means of this operation average corrections of the curves of 50.7% to 56.7% could be reached in the first 150 patients, depending of the localisation of the curve. Operative procedure, duration of operation and blood loss are adequate to known procedures. Pre- and postoperative CT's in 24 patients with idiopathic scolioses showed a mean correction of the rotation angle in the apex vertebra of 28.5% in relation to the anterior midline of the body and of 23.8% in relation to the sagittal plane. The best corrections could be observed in lumbar curves and in the lumbar curves of double major scoliosis. A postoperative therapy with cast or braces is not necessary.

From 1978 till 1989 at the Department of Orthopaedics (University of Graz, Faculty of Medicine, Division of Surgery) 25 patients were operated for the reason of an avascular necrosis of the lunate bone when the bone structures were already destroyed. The form of therapy was the intercarpal-arthrodesis, developed by Orlando Graner 1966, in a slightly modified way. On the one hand through creating an intercarpal block it is possible to create more or less plain sides of the radiocarpal joint and on the other hand one can stop the carpal collapse what explains long-term-results rather acceptable. The most important disadvantage of this form of therapy is the often found loss of range of movement in the operated radiocarpal joint.

Melorheostosis, Osteopoikilosis and Osteopathia striata Clinical Relevance and Bone Scintigraphy Melorheostosis, Osteopoikilosis and Osteopathia striata are rare conditions. Although there is no casual therapy for any of the three diseases, differential diagnosis is important because concomitant or resulting impairments deserve orthopaedic or medical treatment. The analysis of typical cases with their clinical, roentgenological and radionuclide presentation shows the need of an accurate diagnosis to prevent senseless treatment or lost therapeutic opportunities.

In osteofibrous channels of the hand a disproportion of capacity and contents may cause either a restriction of the gliding of the tendon or a lesion of nerves by pressure. During a 5 year period 362 narrow pass and compression syndromes were operated. Trigger fingers were most frequent with 224 cases, followed by 85 de Quervain's diseases, 49 carpal tunnel syndromes and 4 ulnar nerve compression syndromes. These diseases can be operated in a bloodless field and under regional anaesthesia, mostly under outpatient conditions. The manifold reasons of compression syndromes call for differentiated operative procedures.