Chirurgia narzadow ruchu i ortopedia polska最新文献

Introduction: Total knee replacement in knees with severe valgus and defects of the medial tibial condyle are at higher risk complications than in knees with a correct axial allignement.

Material and methods: The study group included 10 patients (11 knees) with with severe valgus and defects of the medial tibial condyle in which TKR was performed. In 8 cases bone defects were filled with bone autograft in 3 cases defects were filled with metal augments. The mean follow-up was 37 months (26 months to 4 years). Clinical results were measured with the knee society score, the level of activity was evaluated with the UCLA score. Radiographic evaluation was based on radiograms taken preoperatively, postoperatively and at the follow-up examination.

Results: In All cases an improvement in clinical results was noted, the mean KSS result rised from 25.3 preoperatively to 87 postoperatively and the level of activity rised from 3.4 to 5.4 postoperatively. No signs of loosening were found in radiographic evaluation.

Conclusions: TKR in joint with severe varus and medial tibial condyle defects creates a need for the reconstruction of defects. In lesser defects reconstruction with bone autografts is sufficient, in severe cases filling the defect with metal augments is needed. When indicitions are followed both methods provide good clinical results.

Background: This is a retrospective study of 15 cases of acute septic arthritis of the hip in older children treated from 1995 to 2007.

Materials and methods: All treated children were over 2 years old. The average follow-up period was 7 years (2-16 years). Among patients, there were 11 males and 4 females. None of them had bilateral disease presentation. All cases met the diagnostic criteria including bacteriological results, clinical or radiographic changes. The average duration of symptoms before admission to the hospital was 6,5 days (1-35 days). Pain in affected hip was observed in all patients, other symptoms were: limited range of motion (12 patients), fever (14 patients), abdominal or thigh pain (4 patients). Only one-third of the patients had a leukocyte count of over 12 000/mm3, the erythrocyte sedimentation rate was elevated in all cases--average 80/125, CRP ranged from 3.1-205 mg/l. 13 cases underwent emergency arthrotomy and debridement, two patients received only intravenous antibiotic treatment without arthrotomy. Pathogens had been isolated from blood only in 3 cases (20%), from arthrocentesis fluid in 8 patients (62%). Staphylococcus aureus was the most common pathogen (54%).

Results: All patients had been succesfully treated. 10 of them had good result, 3 satisfactory and 2 unsatisfactory according to Kiepurska criteria.

Conclusions: A delay in definite treatment was the important factor associated with poor prognosis. One patient who received only intravenous antibiotic treatment showed satisfactory result - early diagnosis and significant response to antibiotics contributed to this favorable outcome.

Injuries of flexor tendons are one of the most common injuries that need surgical treatment at emergency room. Technique and quality of the surgery was performed are two factors of the utmost importance. The aim of the study was to determine influence of basic surgical training on the quality of suture. Research was divided into four surgical sessions which were held each once a week. Sutures were put by three medical students. Material that was used were deep flexor tendons dissected from fresh pig's legs. Sessions 1st, 2nd and 4th were preceded by training done by experienced surgeon. During study 90 modified-Kessler sutures without additional running suture were made. Breaking strength was assesed by tensile machine (INSTRON 4481). Time of each suture was also recorded. Outcomes were analyzed by tests: ANOVA and post-hoc LSD tests. Time significantly dropped by 64% after the first session and was held on the same level. Strength of sutures rises in each session preceded by training. There was statistically significant difference between session 1 (mean 13.58; SD 9.86N) and 2nd (mean 42.69; SD 9.27N) and 3rd (mean 38.42; SD 12.28N) and 4th (mean 57.12; SD 12.78N). Conclusions. Time of procedure significantly dropped after first teaching course and was held on the same level despite further training. Breaking strength rise in every session that was preceded by teaching course.

Introduction: Most common disorder in patients with cerebral palsy (CP) is spasticity. It is a result of non-progressing damage of Upper Motor Neuron system, causing imbalance signals, and consequently increasing muscle activity. Spasticity decreased activity of daily living of the patient and their caregivers. It may cause many medical and social problems. Baclofen is a synthetic analog of gamma-aminobutryacid, admistrated in intrathecal space by pump. It inhibits both monosynaptical and polisynaptical spinal reflexes. First time baclofen pump (ITB) were applied by Penn and Kroin in 1984 to treat spasticity. ITB is indicated in severe children cerebral palsy, especially in tetraparesis. The purpose of this study is attempt for objective and subjective evaluation of the quality of life after implantation of ITB.

Material and methods: In this research data of 161 children were analyzed with spastic tetraparesis (GMFCS V). Evaluation was based on an analysis of the quantity of additional surgical procedures before and after ITB implantation. Subjective assessment was made using questionnaires addressed to parents on fundamental aspects of everyday activities and quality of life after implantation of ITB. RESULTS. The average age AT the time of surgery was 12 year and 2 months (SD 4.7). The average follow up was 3 years and 2 months (SD 2.4). During ITB implantation additional surgical procedure were performed in 43% of Children. During the next scheduled ITB pump exchange indication to addictional surgical procedure was reduced to 20%. The average questionnaire score was 13 points (0-16 max.). Fifty eight percents of caregivers of children who had any kind of device related complication scored with average score 13.5.

Conclusion: 1) ITB implantation in the treatment of children with severe CP improves their quality of life. 2) Indication to perform surgical procedures were reduced in patients treated with ITB. 3) ITB implantation correlates with the high level of caregivers satisfaction as the potential for improvements, however one have to think about the complication.

We describe the use of vertebroplasty as an effective method to treat osteoporotic vertebral changes. Scant reports in the literature of national expertise and low penetration of this method in Poland has led the author to conduct their own research demonstrating the effectiveness of the method on the basis of treatments performed in Spine Surgery, Oncology Orthopedics and Traumatology Department W. Dega at University Hospital Poznań, Poland and to collect literature describing the topic. 47 patients were enrolled unambiguously confirmed osteoporosis (T score <2.5) on the basis of Dual energy X-ray absorptiometry (DXA) of the femoral bone. Clinical and radiological examination confirmed the compression fracture of the vertebrae, which was not effectively treated conservatively for at least 6 weeks. The pain was objectified as a major factor in the deteriorating quality of life using an analog scale for assessing pain VAS. To evaluate other clinical indices there were used: scale of disability due to back pain named Ostwestry and scale for assessing quality of life RAND-36 before surgery and long-term testing of the period from 2 months to 4 years after vertebroplasty. On the basis of a comprehensive radiological assessment of the vertebral height and the angle formed by lines of adjacent vertebral median--the angle of lordosis and kyphosis. It was observed a significant reduction in pain of patients, improving quality of life and disability in the testing of the vertebroplasty. Also it was observed a slight reduction of the collapsed vertebrae in some patients immediately after vertebroplasty. Proved the efficiency of the vertebroplasty in preventing further collapsing of futher fractured vertebrae.

Unlabelled: The uncemented total hip replacement became a standard in treatment of the severe hip osteoarthritis. Its long term efficiency is based on the correct osteointegration which depends on the adequate implantation. Material. The study group consisted of 49 patients (52 hips) following total hip replacement with ABG II stem and Trident PSL cup. The follow-up ranged between 6 months and 2 years.

Methods: In each case the Harris hip score was performed and high resolution x-rays were taken. On X-ray the fit and position of the stem, linear osteolysis around the stem and bone atrophy at the greater trochanter were evaluated. Results. The mean HHS at the last follow up was 90.4 (50-99). The mean angle of the stem position was 2.9 varus. The mean fit index was was 0.75. The significant correlation was found between the fit index and the varus stem position angle. The linear osteolysis surrounding the stemin the 1st Gruen zone was found in 70% of cases. The phenomenon of the linear radiolucenecy surrounded by linear densification was found in the 76% of cases. Bone atrophy at the greater trochanter was found in the 42% of cases. Conclusions. The use of ABG II stems provided very good clinical results. The stem has a tendency to a varus position, which seems to be connected with the use of the too small stems. Specific radiographic observations create a need of futher follow-up, but existed without the influence on the clinical results.

Background: Total hip replacement (THR) is at present an accepted treatment in patients with severe deformity of the hip caused by advanced ankylosing spondylitis. The aim of this paper is to evaluate the results of THR in patients suffering from ankylosing spondylitis, operated from 1987 to 2007 at the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences. Material. Material included 26 patients, 2 females and 24 males, on whom 34 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 27 to 77 years (mean 57). Follow-up ranged from 3 to 21 years (mean 10.5 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cemented totalhip arthroplasty was used during 16 of the THR, 17 of them were cementless and 1 as a hybrid.

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 27.3, WOMAC score 78.5. After an average of 10 years follow-up all hips and knees were considered excellent, with average Harris score of 91.4, WOMAC Score of 5.0. 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. No ectopic ossification concentrations were found.

Conclusion: Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of severe deformity of the hip caused by advanced ankylosing spondylitis 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 spondylytis deformans.

Fracture of the tibial eminence in children is a condition in which there is no widely accepted and approved therapeutic scheme. The greatest divergence of treatment options concerns type II according to Mayers and McKeever classification. Described therapeutic options range from cast immobilisation of the lower extremity without attempt of closed reduction to open reduction with internal fixation. Paper shows the results of treatment of tibial emienence fractures in children treated at our institution. Cohort of patients consists of 21 children at age 7 to 16 years of age (mean 12.2 years). There were three cases of type I, five cases of type II and thirteen cases of type III fracture according to Mayers and McKeever classification. Operatively 16 patients were treated with type II and III fracture, and the rest of them were treated nonoperatively. Open reduction and internal fixation was performed according to modified technique described in 1937 by H. Lee. The results were evaluated by X-ray, clinical examination of stability and range of motion of the affected knee and by subjective clinical outcome with use of modified Lysholm knee scale. All patients treated operatively presented very good and good clinical outcome. Nonoperatively treated patients was a small and no homogenous group. Results of treatment ranged from very good to poor. Worse outcomes were associated with additional injuries to the affected knee (poor result in patient with type II fracture) and qualification for the conservative treatment in patient with type III fracture.

Metatarsus adductus is usually a morphologic feature of the clubfoot or occurs as an isolated defect. Such deformation causes shortening of the medial foot column and lengthening of the lateral. The purpose of the study is a retrospective evaluation of long-term therapeutic effects in a group of patients, who underwent closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy. Surgery was performed in 19 persons, procedure was applied to 26 feet, of which 3 presented congenital metatarsus adductus and 23 presented recurrent clubfoot. During ostoetomy we performed additional corrective procedures on soft tissues. Foot and gait deformation, pain associated with activities, presence of calluses on the lateral plantar surface of the foot, difficulty in footwear were evaluated before and after surgery on clinical examination. The pre- and post operative X-rays were used to determine: in AP view the Kite's angle and the angle between the calcaneal bone and the 5th metatarsalbone (forefoot adduction evaluation), in lateral view the Kite's angle, the angle between the calcaneal bone and the 1st metatarsal bone (forefoot supination evaluation) and the angle between the talus and the 1st metatarsal bone (cavus evaluation). An early recurrence of the deformation after the removal of wire fixation occurred in 2 patients. Late complications taking the form of adduction and supination of the forefoot occurred in 5 cases. In general recurrences of adduction of the metatarsus occurred in 27 % operated feet. Radiographic evaluation proved a significant statistical effect of the "plus-minus" osteotomy limited to the reduction of the adduction angle of the forefoot and not affect improvement of the supination of the forefoot and the foot excavation.

Background: Femoral neck fractures in children occur 130 times more seldom than in adult's population. According to specific vascularisation the most common complication is avascular necrosis (AVN) of the femoral head. Purpose of the study was the treatment's results analysis of the 15 children and adolescent's femoral neck fractures.

Methods: 15 patients at a mean age of 12.7 years (5-17 years) presenting with femoral neck fractures were analyzed. On the pre- and postoperatively X-rays we have determined the type of fracture in Delbet classification and compared femoral-neck angle with the healthy side. In the final clinical examination ROM, the equality of leg's length and quality of walking were checked. The results were determined in the Harris hip score and Ratliff score. We divided the patients into 3 groups that depended on the time of surgery: 1) operated up to 24 hours after injury (6 patients), 2) 24-72 hours post fracture (5), 3) after 72 hours (4).

Results: 10 fractures were classified to type 2, 3 fractures to type 3 according to Delbet scale (X-rays of 2 patients are missed). The final outcome after 7-163 months (57 on average) could be precised at 13 patients. Significant ROM decreasing was confirmed in 4 patients. The highest restriction was noticed in internal rotation (on average 14 degrees comparing with the healthy side). Other motions were slightly restricted. Inequality of limb's length amounted 0.5 cm on average. The average Harris hip score amounted 92.58 (76-100). The final results were assessed as very good at 8 patients, good at 4 and moderate in 1 patient. We haven't noticed bad results. AVN were suspected in 3 patients, 2 of them were scintigraphically confirmed.

Conclusions: In order to avoid AVN the most important thing is an early (up to 24 hours since the injury) anatomic reposition and proper bone fragments stabilization.