Chirurgia narzadow ruchu i ortopedia polska最新文献

Degenerative joint disease is the most common joint pathology and the main cause of disability of elderly people in developed countries. It is caused by imbalance between degeneration and regeneration of articular cartilage accompanied by pathological changes of other joint structures. No generally recognizable description of the pathogenetic pathway of osteoarthritis (OA) exists so far, however recent studies have widened the knowledge of the underlying pathology. In this review views regarding the role of genetic and mechanical factors in OA pathogenesis were presented. The role of pro-inflammatory mediators such as cytokines (IL-1, TNF-alfa, IL-6), lipid mediators, NO, reactive oxygen species, were discussed. The contribution of adipokines (fat tissue derived hormones with cytokine activity) to the pathogenesis of degenerative joint disease was also described. The role of synovial membrane, articular cartilage, subchondral bone and such structures as osteophytes and infrapatellar fat pad in development of osteoarthritis were presented as well.

Objectives: To predict the final result of intertrochanteric osteotomy.

Materials and methods: 56 hips in 53 patients after intertrochanteric osteotomy without any change in neck-shaft angle were enrolled into the analysis. 26 hips with a good result of intertrochanteric osteotomy were included into A group and 26 hips with a poor result were included into B group. The follow up was 5 to 11 years. Such preoperative parameters as: age and body weight of patients, severity of arthritis, sphericity of the head, joint space width, center-edge angle, pain severity, walking capacity, range of motion- were analyzed in both groups of patients. Survival of the hips was estimated with a Kaplan-Meyer survival curve.

Results: At last follow up 27 hips (26 patients) were converted into hip prosthesis. The mean operative age of the patients in group A was 37.8 years and in group B 43.4 years. The severity of hip arthritis was similar in both groups of patients. Regular spherical head was found in 10 hips of group A and in 12 of B group. The center-edge angle was 15 degrees in group A and 18 degrees in group B. The joint space width was 2.6 mm in group A, and 2.5 mm in B group. Walking capacity, pain severity, range of motion of the affected hip was very similar in both groups of patients. Patients of group B had hip prosthesis already implanted 2.8 years after osteotomy.

Conclusions: No statistically significant difference was found between analyzed preoperative parameters in patients with good and poor results of intertrochanteric osteotomy. The final result of intertrochanteric osteotomy is not predictable.

Objective: To improve of the effectiveness of surgical procedures in the repair of rupture of the Achilles tendon, some surgeons use various augmented techniques. The purpose of this study was to evaluate the value of the use of graft from the fascia lata to add strength to the Bunnell suture in the treatment of subcutaneous tear of the Achilles tendon on the base of clinical and ultrasonographic results.

Materials and methods: 44 cases of the Achilles tendon lesion in 43 patients were included to the study. The patients were placed quasi-randomly into one of the two groups--group A of 26 tendons, repaired using the Bunnell suture with the reinforcement by a graft of the fascia lata, and group B of 18 tendons, repaired with simple end-to-end Bunnell suture. Results of the treatment were evaluated by the objective 100-point Hannover scale and subjectively by the modified Rupp scale. Results of the static and dynamic ultrasound examination were also analysed.

Results: There was no statistically significant difference due to Hannover and Rupp scales in results between the two repair methods. The analysis of results of ultrasound examinations demonstrated that the decreased visibility of internal structures was statistically greater in the patients whose tendon was sutured using a graft from the fascia lata. The treatment method did not, however, influence the presence of inflammatory changes or the quality of sliding ability, as seen in ultrasound.

Conclusions: Open reconstruction of the subcutaneous rupture of the Achilles tendon, regardless fascia lata was used or not, gives a high percent of positive results, both in subjective and objective evaluations. Use of the fascia lata in repair of the Achilles tendon increases the probability of ultrasonographically visible structural changes in the tendon without clinical consequences.

For many years early treatment of degenerative joint disease in hip joint included only conservative procedures or extraarticular surgery eg. pertrochanteric osteotomy, acetabular roof reconstruction. Discovery of femoro-acetabular impingement mechanism opened space for new advanced operative techniques. For the last few years these techniques are mastered using arthroscopic approach as well as open joint surgery. In this paper we are describing technique with osteotomy of the greater trochanter and joint luxation for open treatment of femoro-acetabular impingement.

The most common treatment option for postmenopausal osteoporosis are the bisphosphonates which inhibit osteoclast function. Bisphosphonates interfere with cellular metabolism and in large clinical trials reduce risk of vertebral and non-vertebral fractures. Zoledronic acid is a potent bisphosphonate also approved for the treatment of postmenopausal osteoporosis. In addition zoledronic acid reduce relative risk of any new clinical fracture after surgical repair of low-trauma hip fracture. Also the reduction in the relative risk of death was observed after repeated once-yearly intravenous infusion. In conclusion, this is another interesting option for the treatment of the patients affected with osteoporosis and previous hip fractures.

Fractures of the ulnar styloid commonly accompany fractures of the distal radius, but their effect on the final outcome and need of separate treatment are not precisely determined. The objective of this review was to present the issue based on current literature. To date, results of both experimental and clinical studies show potentially negative effect of ulnar styloid fracture due to possible avulsion of the attachment of triangular fibro-cartilage complex and instability of the distal radio-ulnar joint. These injuries are more common when the base of the ulnar styloid is broken and considerably displaced, as well as at comminuted fracture of the distal radius. However, results of clinical studies show optimal treatment of the distal radius fracture to be essential for final anatomical and functional outcome, while ulnar styloid fracture or union are of lesser importance. Minor and slightly displaced ulnar styloid injuries do not require separate treatment at distal radius fractures. There are not definitive recommendations for major and much dislocated fractures, involving ulnar head and resulting in distal radio-ulnar joint instability. However, excellent results after stable fixation of the distal radius fractures with locking palmar plates suggest this management optimal, regardless the severity of distal ulna damage.

The main aim of the research was to define the degree of independence among patients after operative treatment femoral neck fractures in the first day after the operation and on day previous to the release from hospital. Attempt was made to determine the degree of independence in the ten activities of life, functional status and emotional state of patients. Efforts have also tried to assess the impact of functional status and emotional autonomy to the degree subjects. The study was conducted in Hospital in Poznan and Hospital in Chodziez, in the period from August 2006 March 2007. The research concerned 30 patients after operative treatment femoral neck fractures. To assess functional status, 100-point scale Barthel, to assess the emotional state HADS scale was used. Degree of independence was assessed Scale of Deficit Self-Care. The lack of independence was bigger among older patients in life activities like: moving, feed, drinking, expelling, personal sanitation and dressing. These patients required increasingly bigger medical care. Functional condition introduces considerably worst in older patients equal in research I and research II. Emotional status does not affect the degree of independence of patients, but in the first day after surgery, patients showing symptoms of depression had demanded a bigger range of assistance from medical personnel. Hip fracture have a negative impact on many areas of life activity of the patient, therefore, these patients require particularly caring therapeutic and rehabilitation activities.

Results of grip reconstruction in two patients after severe crush-avulsion injuries of the hand were presented. Total destruction affected the first or the first and the second ray of the hand which was accompanied by soft tissue loss, finger amputations and complex bone fractures with vessels and nerves damage. Soft tissue reconstructions were performed using various methods. Pedicled groin flap followed by nerves reconstruction and tenolysis were done in one patient. In the second case soft tissues were rebuilt with distally pedicled adipo-cutaneous forearm flap supplied by distal radial artery perforators. In both thumb reconstructions the second toe with metatarsophalangeal joint (MTP II) were transferred onto preserved rerouting proximal parts of the second or the third metacarpal bones. In the second patient soft tissue reconstruction and thumb rebuilt were performed during one-stage operation. In both cases complete soft tissue coverage was obtained with restoration of wide and precise pinch grip.