Chirurgia narzadow ruchu i ortopedia polska最新文献

Case report of application of Ponseti method in treatment of neglected congenital talipes equinovarus in boy with DiGeorge syndrome who was 4 years and 9 months of age at the beginning of the treatment. Foot was classified as very severe, scored 4.5 points according to Pirani and 15 points according to DiMeglio classification. After 9 casts set according to Ponseti protocol good correction of all components was achieved accept for the equinus deformity. Achilles lengthening procedure was done, but there was necessity to perform posterior release to achieve good dorsiflexion. Finally, goals of treatment were achieved: the foot is flexible, well shaped, pain free, ready for weight-bearing and use of commercial shoes. At current stage of treatment the foot scores 0.5 points according Pirani and 4 points according to DiMeglio classifications.

Treatment of musculoskeletal injuries in children and adolescents during the Bone and Joint Decade 2000-2010 has changed substantially. This is connected both with the increasingly accurate and rapid diagnostics, as well as the emergence of specialized centers. The experiences gained from various centers to help choose the best and most effective method of supplying injuries. To review a set of patterns of conduct in individual locomotor injuries in children and adolescents, from the scene by emergency departments, to establish guidelines for specialist units. A more radical approach to the treatment of fractures can be justified in getting faster and better function, greater comfort without use of plaster casts and a short stay in hospital, which is extremely important for young patients.

The role of transcription factors and signalling pathways important for differentiation of bone marrow mesenchymal stem cell differentiation toward osteogenic and adipogenic lineage are briefly outlined.

There is still some disagreement about which anatomical structures are involved in tennis elbow pain, as well as its pathomechanics. In many papers attempting to explain the tennis elbow pathomechanics, most often the authors would point out to degenerative changes (of various background), which could be inflammatory in nature only initially. It is believed that the chronic patients are the most problematic cases, the origin of their ailment probably caused by many factors.

The aim of the study was to compare clinical and radiological results of treatment thoraco-lumbar spine fractures by short segment transpedicular stabilization accompanied by three techniques of reconstruction: posterior lumbar interbody fusion, vertebral body Daniaux reconstruction and combination of both methods. AO system was used to classify the fractures. Frankel's grade system was used for assessment of neurological deficit on admission and subsequently in the postoperative and follow-up period. The height of the fractured vertebral body and angle of segmental kyphotic deformation was measured on lateral X-ray pre- and post-operatively and at last follow-up. To the retrospective analysis we included 167 patients operated in the Orthopaedic and Traumatology Department, Medical University of Lublin in years 1998-2007. Posterior lumbar interbody fusion was performed in 69 patients (41%), isolated vertebral body Daniaux reconstruction in 82 patients (49%) and combination of both methods was performed in 16 patients (10%). The follow-up period has ranged from 3 to 13 years (mean 6.9 years). The most common type of the fracture was a B type (104 patients -62%), followed by type A (43 patients--26%), and type C (20--patients 12%). The neurological deficit was present in 80 patients. The postoperative neurological improvement was noticed in 37 patients (46%), whereas in 46 patients (54%) neurological status has not changed after the treatment. From 87 patients without neurological symptoms, we observed postoperatively contemporary neurological complications in 11 (12.6%) cases. The biggest correction of fractured vertebral height (mean 0.15) and correction of segmental kyphotic deformity (mean 6.3 degrees) we have noticed in the group of isolated vertebralbody Daniaux reconstruction with use of bone grafts. However in every group of patients we observed significant loss of correction during follow-up period. At the latest follow-up assessment there were no differences in vertebral body height of segmental kyphotic deformation between the analyzed groups of patients. None of analyzed methods of treatment: posterior lumbar interbody fusion, vertebral body Daniaux reconstruction or combination of these methods did not protect from recurrence of kyphotic deformity.

Shortcomings of tennis elbow treatment have raised medical interest in pathomechanics of this condition. In 2009, a new theoretic model was proposed, one that has integrated the current knowledge about tennis elbow pathophysiology, with aim to improve the effectiveness of therapeutic methods. It was suggested that tennis elbow patients should be grouped by severity of local tendon pathology, change in pain perception and degree of motor apparatus malfunction when deciding on the most suitable treatment method or when designing scientific research on the subject. It is believed that by employing detailed diagnostics of these lesions (either separate or clustered) in order to confirm or eliminate their presence, the effectiveness of their treatment should increase.

Background: It is unusual for the hips to be affected by psoriatic arthritis. But in that rare cases, totalhip replacement (THR) is at present an accepted treatment in patients with severe and painfull deformity. The aim of this paper is to evaluate the results of THR in patients suffering from psoriatic arthritis of the hip, operated from 2000 to 2008 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences.

Material: Material included 4 patients, 2 females and 2 males, on whom 5 THRs were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 48 to 61 years (mean 53). Follow-up ranged from 2 to 10 years (mean 6 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cementeless total hip arthroplasty was used during all of the THRs.

Method: The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system.

Results: The average preoperative Harris score for the group of patients was 31, WOMAC score 77. After an average of 6 years follow-up all hips were considered excellent, with average Harris score of 90, WOMAC Score of 5. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 30-48 (mean: 39 degrees) and the acetabular opening angle was 3-20 degrees (mean: 4 degrees). The stem was neutral-oriented in all hips. No ectopic ossification concentrations were found.

Conclusion: The hip may be involved by the psoriatic arthritis. Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of psoriatic arthritis allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. Ectopic ossification is not the clinical problem during THR in patients who suffer from psoriatic arthritis.

Introduction: Intramuscular injection of botulinum toxine (BTX-A) is important method of spasticity treatment in cerebral palsy (CP) children.

Research and method: Research group consisted of 60 children, aged 2-8 with diagnosed diplegic form of CP treated in years 2002-2004 with BTX-A. Research was conducted before and approximately four weeks and three months after injections. Third examination was performed just before another injection. Patients on the functional level II to IV according to GMFCS were qualified for study. Level of spasticity, range of motion (ROM) and course of rehabilitation were assessed each time. Effectiveness of therapy was also studied based of parent's opinions.

Research outcomes: According to GMFCS 14 children (23.3%) were classified to level II, 29 children (48.4%) to level III and 17 (28.3%) to level IV. In all children spasticity decreased. ROM measured by fast and slow movement in hip, knee and ankle joints increased significantly. During treatment Reimers index was bilaterally normal in 38%, unilaterally in 11% of patients. Index value was normalized in 7.7% of patients. Therapeutic effect of applied treatment method was observed by 96.7% of parents. No side effects have been observed.

Conclusions: By means of BTX-A injections temporary reduction of spasticity in selected muscle groups can be achieved. Injections of BTX-A to hip adductors influence Reimers index helping to prevent norm value. After subsequent injections of BTX-A time period of therapeutic effect changes. Parents of treated children assess BTX-A therapy as highly effective.

Summary We present two cases of successful microsurgical replantation and revascularization of the thumb of dominating extremity in young men performed in orthopedic department, to whom operative treatment in specialized replantation center could not be performed. Microvasculature of the finger was restored anastomosing microsurgically its artery and vein under operative microscope, and bone fracture was stabilized intramedullary with Kirschner wires. In both cases vitality of the finger was restored, which enabled proper healing of soft tissues and bone, leading to restoration of satisfactory function of the thumb. Due to high value for the function of the hand, thumb injuries threading with its loss should be managed primarily. Due to small vessel diameter those procedures require special instrumentation and trained personnel, and thus shouldbe done in replantation centers. Nevertheless, when treatment in an appropriate center is unavailable, those procedures could also be successfully performed by trained orthopedists.

Rapid Prototyping and CT based 3D modelling implementation in orthopaedic reconstructive surgery is presented in the article. Bone models rendered in SLS (Selective Laser Sintering) were used in pre-operative planning. Physical models were made based on imaging data obtained in standard CT scans. Better pre-planning, surgical team preparation and an insight into possible difficulties are the obvious advantage of the method as well as resulting reduced complication rate. Its clinical applicability was confirmed during surgical procedures.