Chirurgia narzadow ruchu i ortopedia polska最新文献

Introduction: The aim of the study is assessment of ambulatory status in skeletally mature patients with myelomeningocele and scoliosis, as well as analysis of walking abilities on general physical function, quality of life, self-perception and motivation.

Material and methods: Prospective study was done on 19 patients in the mean age of 21.4 years. Those treated operatively for spinal deformity were excluded from the study. Several questioners were used for assessment of: dysfunction related to spinal deformity, general physical function, quality of life, self-perception and motivation. To describe ambulatory status Hoffer classification was used. Motor neuron level was assessed according to International Myelodysplasia Study Protocol.

Results: There was no correlation between walking abilities and Cobb angle, general physical function, quality of life, self-perception and motivation. Older patients and those with higher spine dysfunction had less chances for independent ambulation. Odds ratio shows, that independent walkers have 2.5 less chances for skin problems than sitters.

Conclusions: The most important factor that determines walking ability is level of spine dysfunction. Walking ability may deteriorate with age. Patients general physical function, quality of life, self-perception and motivation in not related to ambulatory status.

Pelvic and acetabular fractures are common injuries in the time of rising traffic level and often affect young people, that's why this kind of injury during pregnancy must be considered. Despite lapse of years this subject is seldom raised in literature. Conservative treatment was usually recommended. We came across a single case report of surgical treatment of acetabular fracture during pregnancy, it was 18th week of pregnancy at the moment of accident. The aim of this study is detailed description of surgical treatment of hip joint acetabular fracture with fragment dislocation of 29 years old female at 27th week of pregnancy. Patient was involved in road accident, car passenger, she suffered: transverse fracture of the hip acetabulum with central dislocation of the femoral head, left distal radius fracture, head injury with concussion, numerous face injuries. Patient was treated surgically in 15 day after accident: open reposition and synthesis of a fracture. Course of operation as planed. Patient was discharged and advised to walk with crutches. Patient delivered healthy child by caesarean section at full-term afterwards. The outcome of acetabular fracture treatment was very good (18 points on a scale Merle d'Aubigne-Matta).

Unlabelled: Shoulder arthroscopy used since sixties of the XXth century, becomes now dominating operative technique. Surgeon's skills are most important that's why perfect training model is still needed. Ideal training model for shoulder arthroscopy should combine best possible image of human anatomical structures, good accessibility and low price. Despite of great similarity, animal shoulder joint differs from human one. More spherical shape of animal glenoid gives better support for humeral head. As a result of different shape of glenoid, labrum is significantly less developed, and can actually be clearly seen on dorsal part of the glenoid rim. Glenohumeral ligaments are visible but not as well developed as in human joint.

Methods: We have used pig shoulder joints, all of the muscles externally surrounding joint capsulewere resected. Classical 30 degrees optical equipment and standard arthroscopy tools were used. Labrum stabilization was achieved using anchors and screws. Cannulas were used only in a few cases, in others, joint access was very easy and did not require one.

Results: Animal shoulder model is useful only in case of arthroscopic practice of instability treatment. Implants can be snapped back after practice.

Introduction: Metal-on-metal bearings characterize lower wear than metal-poly, lower fracture risk than ceramics and they allow for the manufacturing of large diameter heads. The metal ion release from the bearings is the the major concern of these articulations.

Material: The study group consisted of 16 patients who underwent hip resurfacing with Durom implant and had minimum 1 year follow-up period. Blood from the patients was collected 4 times: before the surgery, 2, 6 and 12 months postoperatively.

Methods: Clinical examination was done according to HHS, Radiographic image was used to measure the cup inclination, evaluation of chromium and cobalt ion blood levels was performed using graphite furnace atomic absorbtion spectrometry (GFAAS).

Results: The levels of cobalt and chromium increased postoperatively significantly to decrease slightly at 6 months. At 1 year cobalt levels increased to the similar level like at at 2 months. The chromium level decresed to the values as low as preoperatively. The mean cup inclination angle measured on X-rays was 48 degrees(range 39 degrees - 56 degrees). The mean HHS result was 89.86 (range 64.43 to 98.73). The mean activity level measured with UCLA scale was 6 (range 3-9).

Conclusions: The metal ion blond levels increase sigficantly in the period 2-6 months following hip replacement with large diameter metal-on-metal articulation. In further examinations at 1 year post-op ion levels decrease.

Since November 1989 till the end of 2007 year we have been operatively treating 752 of acetabular hip fractures. We have analised 750 operated patients, two patients bilateral fractures. The follow up span lasts from 2 till 20 years. The age of treated patients is from 14 till 79 years old. These fractures were divided into those operated to 21 days after trauma--569 operated acetabulum. And those operated after 21 days after trauma--183 patients with the delayed reconstruction of acetabular fractures from 22 till 229 days. Both groups were provided detailed assesement. And next we compared fracture reduction of broken acetabulum and assesement of clinical treatment. The types of fractures were defined according to classification of Judet-Letournel. The criteria of fracture reduction due to Letournel. The clinical result was based on Merle d'Aubigne-Matta scale. In the group of treated patients till 3 weeks after trauma, we have received 83.8% of very good and good results, 6.9% fair results and 9.3% poor results. During fracture reduction: 75% very good, 4% in secondary joint congruence, 17.8% fair and 3.2% poor. After fair reduction there was always the right congrugence between the head and acetabulum. The displacements to 3 mm were left in more cases as a part after weight-bearing area. In trauma fracture trated after 3 weeks, the result was very good and good 66.1%, fair 14.8% and poor 19.1%. During fracture reduction: 49.7% very good, 4.4% secondary joint congruence, 32.8% fair and 13.1% poor. We have noticed the crucial corelation between fracture reduction and the final result of treatment. Additional traumae, especially head with long time loss of consciousness and the traumae of chest with insufficient breathing have indirect infulence on treatment results causing the longer operation waiting. The complexity fractures also indirectly influence on the result of treatment decreasing the chances on anathomical fracture reduction.

On the basis of 60 cases authors analyze treatment results of the humeral lateral condyle fractures in children. This type of fracture is a second most common elbow fracture in children after supracondylar fracture of the humerus. Authors consider this fracture to be the most difficult to diagnose among all elbow injuries. Analyzed cohort of patients consists of 54 at age between 1.5 to 10 years and 6 patients between 12 to 17 years of age. In 75% of cases operative treatment was delayed due to late referral from other hospitals. According to appearance of the fracture line on X-rays there were 53 cases of type II and 7 cases of type 1 according to Milch classification system. The amount of displacement was evaluated according to Jakob scale and there were 35 cases of III degree, 17 cases of II degree and 8 cases of I degree of displacement. All patients were evaluated with antero-posterior and lateral distal humerus x-rays. In some cases other diagnostic techniques were used. In older children computerized tomography and in younger children ultrasound examination was performed. The treatment results were evaluated according to Hardacre scale. Follow-up time was 1 to 13 years. There were 27 very good and 27 good results in a 54 cases group of patients who underwent surgery within 15 days since injury. In other group which consists of 6 patients who underwent surgery more than 5 weeks after injury there were 2 cases of very good, 2 cases of good; and 2 cases of bad results. Authors believe that putting a proper diagnosis of humeral lateral condyle fracture in children and performing an operative treatment results in a good and a very good outcomes. Basing on the analysis of treatment results of authors cohort of patients, they claim that precise diagnosis and proper determining of degree of displacement increases the number of patients qualified to operative treatment.

Continuous passive motion (CPM) is frequently used method in the early post-operative rehabilitation in patients after knee surgery. Aim of this study was to evaluate the effectiveness of CPM after primary total knee arthroplasty. Efficacy was assesed in terms of clinical score and functional recovery. 93 patients (101 knee joints) undergoing total knee replacement were assigned into two groups. The experimental group received continuous passive motion and active exercises. A control group received conventional physical therapy only. CPM was initiated in the first day after surgery, for 120 minutes, starting with 0-40 degrees range of motion, increased as tolerated (mean 10 degrees per day) and maintained during the hospital stay. Outcome measures were those included in Knee Society Score (KSS). Functional recovery was evaluated using WOMAC. All subjects were evaluated once before the surgery and on 10th day postoperatively. Mean clinical score (KSS) at the day 10 was 70 +/- 15 points in the experimental group and 74 +/- 12 in a control group. There were no statistical difference between the two groups for any outcome measures. CPM group mean range of motion was 83 degrees +/- 14 degrees and a group without CPM 77 degrees +/- 21 degrees. KSS functional score was 66 +/- 9 points in the experimental group compared to 62 +/- 7 points in a control group. Subjective estimation of pain level, joint stiffness and function showed no statistical difference between the two groups regarding total and subscale scores. Mean total score was 24 +/- 19 points in the CPM group and 22 +/- 17 in a group without CPM. These findings show that CPM had no significant advantage in terms of improving clinical measurements. However, there was beneficial effect on subjective assessment of pain level, joint stiffness and functional ability.

On 15th May 2010 in Poland first computer planned total knee arthroplasty Vanguard Signature was performed and until now, including Orthopedic Traumatology Department of Central Clinical Hospital Ministry of Interior and Administration in Warsaw and Orthopedic Surgery Department of Promienista Clinic in Poznan, 65 patients have been operated with this method. The new system includes programming technical parameters of operation on the basis of diagnostic analysis of lower extremity using CT or MRI scans. Data are transmitted on Signature Positioning Guides (SPG) which implements function of navigation during surgery. Minimal bone resection, implants sizing and placement with reconstruction of mechanical axis of the limb provides proper functioning of the knee joint and reduces the risk of implants loosening. Further benefits include: instrument reduction, lower degree of femur trauma and reduction of average postoperative blood transfusion volume. The operator using Signature technology is required to have advanced knowledge in the conventional method TKR and medium level computer skills. Access to the program and materials and online communication with the Signature team in the USA allows the surgeon to modify the parameters of the operation and the necessary expert feedback. The rapid increase in the number of registered surgeons in Signature system shows a considerable interest in this technology.

We present the case of spontaneous damage to the patellar tendon in a patient with pathologic obesity (BMI = 41), without comorbid conditions. Damage occurred during normal load combined with the movement of the knee extension when inserting a foot in flip-flops. Surgical treatment was performed in a matter of urgency and the patellar tendon was sutured in half the length of. Six weeks of immobilization was used and then rehabilitation. After four months efficient gait and a good range of motion was achieved. Please note that obesity is a disease of civilization and cause further disease. These include acute injuries resulting from a sudden overload.

Congenital clubfoot is one of the most common congenital skeletal defects. Its aetiology remains unclear. Due to its high incidence and social consequences, the therapy of congenital clubfoot presents an important medical issue. Non-surgical treatment methods are preferred. Many publications confirmed the efficacy of the Ponseti method. The aim of this study was to present early results of congenital clubfoot treatment using the Ponseti method in a one-year follow-up. The therapy protocol was in accordance with guidelines presented by the inventor. The necessity of surgical treatment was a criterion for negative treatment outcome. One hundred and sixteen feet of 92 children were analysed. A Dimeglio-Bensahel classification was used for the evaluation of the defect advance. Seventy-one feet (61.2%) were assessed as grade II, 43 feet as grade III (37.1%) and 2 feet as grade IV deformation. No patients with grade I deformation were included into the study. A positive treatment outcome was observed for 96 feet (82.7%), whereas a negative result for the remaining 20 feet (17.3%). Our results are therefore not consistent with the literature data. It could have resulted from the too precipitate qualification for surgery by the physician and problems with compliance. The Ponseti method is an effective and less straining treatment modality of the congenital clubfoot. In most cases it allows for avoiding extensive surgery and associated complications. A necessity of wearing an orthosis and a risk treatment failure, if not worn systematically, should be emphasised. A longer follow-up period is required for complete result analysis.