Chirurgia narzadow ruchu i ortopedia polska最新文献

Aim: The aim of this study is to find weak link or links of musculoskeletal system (locoutor system) occurred in fencers' body diagnosed by Performance Matrix Tests.

Analysis: The particular aim of this research is to estimate: if some weak links occur in a fencers' group, if all fencers in a group have the same weak links, if there is a correlation between weak links and training period length and if there is a connection between weak links and fencers' age.

Materials and methods: Our research covered 14 f female and 14 male fencers from the Fencing Section at the Warta Club from Poznań. An average age of fencers was 13.81 +/- 2.84.Performance Matrix Test was used there as a research tool, due to which the presence of musculoskeletal system's weak links was measured.

Conclusion: The obtained results allow us to formulate the following conclusions: weak links of musculoskeletal system occur in a fencers' group, but it can not be given the exact answer if all fencers suffer from the same weak links. The research has not shown any evidences that there is a correlation between training period length and a number of weak links. Fencers' examination has not confirmed any correlations between fencers' age and the number of weak links. The tests have indicated that the most weak links appeared in a group of 12 years old fencers. Performance Matrix Tests are an easy and cheap tool for diagnosis of musculoskeletal system's weak link appearance. The early diagnosis of weak link/links can protect the fencer from musculoskeletal system's injuries. A lot of weak links found in fencers point out the need for undertaking work on local and global stabilization within a trunk and distal joints.

Introduction: The aim of the study was a preliminary report of the use of large diameter alumina femoral heads in total hip arthroplasty.

Material and methods: In the years 2005-2008 50 THRs were implanted in 48 patients with the use of 36 mm alumina femoral heads. 5 women and 43 men in the age from 35 to 75 years (average 61 years) were operated on. Primary osteoarthritis was the cause of 41 arthroplasties, and AVN of femoral head of 9 surgeries. 18 alumina/alumina and 32 polyethylene/alumina THRs were implanted. The prospective study consisted of clinical examination with Harris Hip Score and X-ray evaluation. AP and lateral view X-rays were evaluated. The incidence of radiolucent lines around acetabular cups were noted with DeLee and Charnley zones and around stems with Gruen's zones.

Results: The follow up is from 24 to 58 months (average 40 months). There was an increase in Harris Hip Score from average 37 points (from 25 to 49 points) before operation to average 94 points (from 90 to 100 points) after the surgery. The incidence of postoperative dislocation have not been noted. Long-term postoperative X-ray examination have showed proper geometry of endoprostheses without radiolucent lines. Neither visible wear of bearing surfaces nor breakage of alumina components have been noted.

Conclusions: 1) The use of 36 mm femoral heads in total hip arthroplasty decrease the risk of postoperative dislocation. 2) Innovative biomaterials: alumina ceramics and cross-linked polyethylene give chance for decrease the incidence of osteolysis.

Background: Total hip replacement (THR) is at present an accepted treatment in patients with severe osteoarthritis of the hip after slipped capital femoral epiphysis. The aim of this paper is to evaluate the results of THR in patients suffering from secondary osteoarthritis, operated from 1987 to 2004 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences.

Material: Material included 16 patients, 9 females and 7 males, on whom 18 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 32 to 70 years (mean 50). THR was carried out after 33 years afterwards slippage of capital femoral epiphysis. Follow-up ranged from 6 to 23 years (mean 11 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cemented total hip arthroplasty was used during 5 of the THR, 13 of them were cementless.

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 32, WOMAC score 74. After an average of 11-years follow-up all hips were considered excellent, with average Harris score of 91, WOMAC Score of 6. 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 22-49 degrees (mean: 36 degrees) and the acetabular opening angle was 0-10 degrees (mean: 4 degrees). The stem was valgus-oriented in 1 hip, and neutral-oriented in 17 hips. No ectopic ossification concentrations were found.

Conclusion: . Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of osteoarthritis secondary to slipped capital femoral epiphysis allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. The results of THR are good regardless of the type of prosthesis and the type of fixation. Importantly, THR was carried out after a quite long time after slippage of capital femoral epiphysis.

The aim: Evaluation of children with intervertebral disc calcification (IDC) and own experience.

Materials and methods: A retrospective analysis of 7 patients (2 girls and 5 boys) with detected, in the years 1990-2009, IDC. Age at the onset of symptoms (neck pain in 6 patients, torticollis in 4, hip pain in one) was on average 8.7 years (5-13 years). The diagnosis was based on review of radiographs of the spine, which revealed the presence of calcifications within the intervertebral discs in the cervical (4 patients), cervical and thoracic (2 patients) and thoracic spine (1 patient). The mean level of IDC on average was 3.3 spaces (1-6).

Results: After conservative treatment, including use of nonsteroidal anti-inflammatory drugs and rest, the symptoms subsided within 1-2 weeks. 4 patients had a return of pain in the neck, in one year, but the symptoms were milder and resolved within a few days. The mean observation period was 9 years (3.5-16 years). In 4 patients, changes disappeared completely, while in the remaining three there was a very discrete calcifications. One patient, after 6 years, had a pain in the neck, and CT showed minor lytic changes on the surface of the vertebral bodies between which calcification occurred.

Discussion: ś IDC is a rare disease of the spine in children, but should be taken into account in cases of vertebral pain. Usually the disease affects children before the age of 10 and locates in the cervical spine. But it can be located in every segment of the spine. Most patients have multilevel location. Acute phase of the disease requires conservative treatment. Rarely used surgical treatment should be considered only in patients with persistant neurological symptoms. The natural course of the disease is mild, and over the years calcification gradually disappear spontaneously.

According to recent WHO reports, body traumas are ranked third with respect of frequency of occurrence right after cardiovascular diseases and tumours, and are considered one of the major medical problems. Trauma is a kind of energy (mechanical, thermal or chemical) affecting the human body. After crossing the threshold of tissue endurance, an injury or damage occurs. A common problem of all the centres that treat traumas is a reliable and comparable assessment of injury severity. Constant improvement of the trauma scores, contributes to increased objectivity of the assessment of injury severity and makes trauma research easier. To a large extent, commonness of the scores enables the exchange of experiences with respect to treating patients after trauma. An ideal scale should be reliable, easy to use, and most of all commonly used, thus enabling the employment of a common "traumatologic" language. In the following research, the test group was comprised of 137 adult patients including 113 men (82%) and 24 women (18%). Most patients were aged from 20 to 60 years, that is, in the productive age. Appropriate trauma treatment results in the reduction of the costs of hospitalisation time of those patients and their recovery. An accident or worse still death of a young person is not only a personal tragedy for the family. It is also a big economic loss for the society which results from "lost years of life" and thus "lost years of work". Quick and appropriate treatment, done in a proper centre with appropriately trained staff and highest quality equipment will allow not only to reduce the victim's suffering and return to their daily life, but also minimise the social costs connected with disability pensions, benefits and compensations. Most injuries happened at work--61% were probably due to haste but most of all not complying with occupational health and safety regulations, which all employees should know and comply with. It involves doctors writing a sick note for the injured which undoubtedly involves much bigger losses for the employer and social costs in a form of increased premiums for healthcare plans. The most common mechanism of the injuries was self-injury (66.7%). In the study population, even 87% of the victims suffered from isolated body injuries. As is apparent from the analysed data, one should provide money for short-term health care, i.e. up to 2 days. The average treatment time for the study population was 4 days, with the maximum of 23 days. Most patients (60%) were brought by emergency medical services.

This article summarizes important advantages, disadvantages and the process of treatment of patients after lower limb amputation on the level of the femur, with osseointegrated prosthesis. In the process of treatment bone-integrated material is implanted to the femur, with allows for structural and functional connection between live tissue and the prosthesis. This solution allows the patient for easy usage and direct steerage of the prosthesis, transferring of body weight to the floor and detection of sensation in the moment of contact between prosthesis and the ground. Osseointegrated prostheses in the femur gives the opportunity not to use the traditional solutions and socket-related problems as: mobility difficulties, skin sores, rush, pain during weight bearing, temporary changes of the stump volume, difficulty donning the prosthesis, unreliability of prosthesis being securely suspended. Osseointegration is possible even in cases, when quality of skin and short stump enables to use the traditional prosthetic socket. It is used after lower and upper limbs amputations. This kind of prosthetic solutions has some disadvantages and limitations. It is expensive and demanding. It can be used in cooperative patients, who take active part in the process of implantation, rehabilitation and in future usage if the prosthesis.

The aim of the study was to analyze the repeatability of selected radiological parameters in the assessment of mild forms of developmental dysplasia of the hip and to evaluate the changes of the parameters according the position of the pelvis. Retrospective review of radiographs of 98 hips (49 children) was done in antero-posterior and Lauenstein position. Among them 59 hips were treated for type II hip dysplasia according to Graf. At the latest follow-upthe mean age was 9.1 years (range from 4 to 15 years). On radiographs in antero-posterior position of the hips mean rotation index (Tönnis-Brunken index) was 1.0, and on radiographs in Lange position was 0.98 and had no influence on measured parameters. On radiographs in antero-posterior position pelvis was more in forward rotation than in Lange position. With the pelvis in more forward rotation (measured using Ball-Kommend index) the value of Lequesne and Ullmanna-Sharp angles were decreased and Wiberg angle was increased. The angles had good repeatability. The other parameters: acetabular index, decentration distance and Idelberg-Frank angle were not statistically related to Ball-Kommend index. Idelberg-Frank angle had satisfactory repeatability but acetabular index and decentration distance had poor repeatability. Considering above mentioned characteristics of Idelberg-Frank angle, this parameter may be a useful tool for assessment of the hip.

In last years on the whole world violently grows up the number of patients at which occurrence productive degenerative changes of osteoarticular system. Actually these diseases more and more concern the young persons, active professionally. This consequences of these changes lead to limiting the functional functions of pond, pain as well as they worsen the quality of life. Pain in degenerative joint disease of various aetiology can be combated with the new surgical techniques offered by contemporary orthopaedics. Hip alloplasty is the only effective treatment method facilitating the restoration of physical fitness, correct mobility and the eradication of chronic pain. After operating introduces the different methods of improving finally. This work presents physiotherapeutic procedures, commenced on admission to the orthopaedic ward, involved in hip joint alloplasty with the J&J Proxima stem. The disseminating of introduced model of improving as well as the initiation him to program of the treatment confirms the legitimacy of choice, and it influences on improvement of the state of health also and the patients' functional efficiency with degenerative disease of hip joint.

The aim of the study was the assessment of results after acetabular revision arthtoplasty with the use of reinforcement ring ReconShell (BBrown - Aesculap) and homogenous bone grafts. There were 49 patients in the study (42 women and 7 men) in the age from 30 to 88 years. The follow-up period ranged from 4 to 48 months. Before operation the mean Harris hip score was 31.14 and at last follow-up 71.64 points. Aseptic loosening of reconstruction ring was found in 3 patients. During next revision good integration of bone grafts, that were implanted into acetabulum at previous operation was found. In one hip revision of loose polietylen cup was performed. Three patient had early dislocation of hip endoprothesis, that were treated successfully in abduction casts. Next 2 patients had re-revision performed for recurrent dislocations. One patient had implants removal for septic loosening. Prolonged wound healing was noticed in 5 patients. Two patients had temporary and one permanent common peroneal nerve palsy. Two patients had temporary femoral nerve palsy. The use of reconstruction rings in massive bone loss of the acetabulum after cup loosening gives satisfactory clinical results. After the procedure patients have stabile joint that allows for weight bearing. Despite relatively high number of complications (most of which are temporary) this procedure is worth recommending.

The aim of the study was identification and assessment of factors influencing quality of life in children with spina bifida. There were 33 children in the study (19 girls and 14 boys) in the age from 5 to 20 years. They were divided into 2 groups: first in the age from 5 to 12 years (17 patients) and second in the age from 13 to 20 years (16 patients). The Health-related Quality of Life in Spina Bifida Questionnaire and questionnaire done by us were used for the study. Younger children had average score of 158 points and older children average 186 points. In the whole group 64% of children assessed they quality of life as good, 30% as very good, 6% as average. None of our patients think that they quality of life is poor or very poor. Presence of visual perception difficulties in younger group and non-ambulation in alder children is related to poorer assessment of quality of life. Alder children that live in a house had better assessment of quality of life than children living in blocks of flats. Vast majority of children with spina bifida have good specialist medical care. Most common concomitant diseases are hydrocephalus and neurogenic urinary bladder.