Magyar traumatologia, ortopedia, kezsebeszet, plasztikai sebeszet最新文献

Authors deal with a characteristic and frequent sport damage, not yet described in the professional literature of this country. The Syndrome "Jumper's knee" is a collective term comprising the insertiopathies in the knee region, developed in consequence of the overuse of the extensors. During 6 years 385 patients were treated for this problem at the National Institute for Sport Medicine, Department of Sport Surgery and operations were performed in 47 cases. The average age of the patients was 18.9 years, of the patients operated 23.4 years. The most frequent sports were: basket-ball, volley-ball, athletic jumping. Authors stress the importance of ultrasound examination in this disease, otherwise poor in symptoms. The conservative treatment was carried out according to clinical stages and its results are better in early stages, the interval to return to sport was also shorter. The operative procedure was the resection of the apex patellae with the degenerated part of the tendon, having its origin here. Based on 32 control examinations the results can be considered as good and the authors stress the importance of the exact operative indication and the time-sparing technique. Beside describing the possibilities of the prophylaxis authors think the adequate information given to sportsmen and the trainers essential.

Authors report on the results of 118 early operative reductions, performed with their own method in the treatment of the congenital dislocation of the hip. Postoperative functional treatment with Pavlik's harness or abduction splint belongs to their method. Secondary operations were performed in 21 per cent: derotation femoral osteotomy and Pemberton's operation. The younger the patient was at the reduction the rarer was secondary operation necessary. The age of the patients was 6-24 months at the operation (in average 13 months) The follow-up time was 2-12 years (in average 6.1 years). The results corresponded radiologically to Severin's I + II grades (excellent and good) in 98 per cent. Clinically 98 per cent were excellent, 2 per cent fair. The good results are first of all attributed to their postoperative treatment: 1. They avoided the stiff plaster bandage and so no tension of the soft parts could develop, that would endanger the blood supply. In consequence ischaemic damage, belonging to Kalamchi's and Mac Ewen's group I was found only in a few cases. No damage belonging to the severe forms II-IV was observed 2. Their treatment: secures the central reduction and allows spontaneous joint movements in functional position: factors meaning the maximal stimulus of joint development. The condition of this postoperative treatment is the stability of reduction, secured by their special plasty of the capsule.

In orthopaedics where a great number of implants are in use, the chance for infection is high. To keep up the aseptic condition and giving antibiotic in the perioperative time is necessary. According to the effect on postoperative bleeding authors did compare two second generation cephalosporin, the cefamandol and the cefuroxim, which are mainly used in antibiotic prophylaxis. The gamma carboxylation of glutaminic acid is inhibited by cefamandol in the liver, which is necessary in the prothrombin synthesis. The cefuroxim is without any effect on prothrombin synthesis. The postoperative bleeding was significantly higher following cefamandol administration. According to the authors in orthopaedics, where the blood loss could be high, that type of antibiotic prophylaxis is recommended, which has no effect on bleeding.

Authors analyse from the viewpoint of instability the radiological data of the fractures of the distal end of the radius. They state that the redislocation in conservative treatment is a process going together with the healing of the fracture, the measure of which is determined first of all by the instability. To achieve better results, in unstable fractures, attention is called to the necessity of operative treatment.

Authors give historical review of different classifications in the cases of distal radial fractures. They give analysis on advantage and disadvantage of three different classifications, based on 633 cases, according to the practical applicability, to the expected outcome and to the way of treatment. According to the analysis the Older classification gives good prognosis, but the Frykman classification is without any practical importance. The AO classification is prognostically more or less satisfactory.

The author gives a report on the indication, on the surgical technique and on the results of shoulder arthroplasty, following 30 porous coated, unconstrained, BIO-MODULAR total endoprothesis were implanted. The pain, which was uncurable with any other methods, was relieved by implanting the total shoulder prosthesis. The functional result is determined by the condition of rotator cuff and by the way of reconstruction, rehabilitation and cooperation of the patients. The experience in soft tissue surgery is absolute necessary to be successful.

Authors examined 18 cases of osteoclastoma chosen at random with different lectins. The fibroblast-like type I stromal cells taking part in the formation of the ground substance were Con A positive. The strength of the Con A bond and the number of positive cells increased with the progress of the stage. The PNA lectin bond following the digestion with neuraminidase was in the single stages of different character and intensity. Whereas in the Gr I osteeoclastomas 30 per cent of the reacting osteoclast was localized to a well defined segment of the membrane in the Gr III tumors the ratio of the negative cells moved around 1 per cent, and in 60 per cent of the positive cells strong diffuse intracytoplasmatic reaction could be observed. Authors think that the lectin histochemical examinations give help to the definition of the activity of the tumor forming cells.

Authors give a brief summary on necessity of antibiotic prophylaxis in orthopaedics, pointing out the hip, knee arthroplasty and the spinal fusion with Steffee plate. They introduce the applied antibiotic, called Zinacef and it's antibacterial spectrum and the way in prophylaxis is discussed. No any septic complication was observed out of one thousand surgical interventions.

With the spreading of the "minimal invasive surgery" the interest was attracted in the last years in hand surgery too by the endoscopic technique. Authors describe the closed operative treatment according to Chow of the carpal tunnel syndrome. The instruments are presented and the single steps of the method was first used in detail. After exercises on cadavera the method was first used in clinical praxis by them in this country. On the basis of early experiences and the literature, the indication, the possible complications, the advantages and disadvantages of the method are analysed. According their opinion, with sufficient practice and the careful choice of indication, the endoscopic liberation of the carpal tunnel promises to be a remarkable therapeutic possibility.

The results of 51 different combined operations for the treatment of CDH after the age of two years performed between 1980 and 1989 are presented. The age of the patients at the time of the operation ranged from 2 to 12 (mean 4.5 years. Follow-up was 2-12 (meean 6) years. Preoperatively 19 hips were untreated. Primary surgery included reduction alone in 6 cases, together with femoral osteotomy in 28 cases, reduction combined with Pemberton's operation in 1, and reduction supplemented by both correction techniques in 16 cases. Secondary acetabular correction was later necessary only in 14 cases (27%), thus in 63% of all cases. Radiologycally, the results were of Severin's grade I and II in 64% of the whole series, but in 88% in the 2-3-years-old group. The results in the different surgical groups correlated primarily with the incidence of avascular necrosis and not with the extent of surgery.