Ergebnisse zementfreier Endoprothesen bei der nichttraumatischen Hüftkopfnekrose

AIM OF THE STUDY The results from 56 patients with osteonecrosis of the femoral head who underwent 66 uncemented total hip replacements were analyzed and compared with current reports in the literature on cemented endoprosthesis. METHODS In the retrospective study in 30 of those cases the Zweymuller and in 25 cases the HA-coated ABG prosthesis were used. In addition the results of 11 patients with a polyethylene Endler cup in combination with a Zweymuller stem are presented. The mean age at surgery was 48 years, the mean follow-up was 5.9 years. Clinical examination, registration of the Merle d'Aubigne score and a radiological examination were performed. RESULTS The clinical results did not…

Verlaufsbeobachtung des Kollagen- und Knochenstoffwechsels bei Patienten mit zementfreier Hüfttotalendoprothese*

Introduction This study investigated the influence of concentration and activity of several markers of the collagen and bone metabolism and their impact on ingrowth of non-cemented total hip arthroplasty. Methods 40 patients underwent an implantation of a ABG-prosthesis. Before surgery and 1, 2, 12 and 24 weeks after it serum concentrations of PICP, ICTP, IGF-1, ON, b-AP, Calcium, Phosphate, GPT and Creatinin were measured and a collagen ratio (CQ) was calculated. Results PICP decreased until 1st week, increased at 2nd week and decreased again after that time. ICTP increased significantly in 1st week, reached a maximum in 2nd week and decreased after that. b-AP decreased in 1st week but inc…

Effects of a 21 days space flight on the mechanical performance and the EMG power spectrum of the leg muscles

Vergleich der prognostischen Aussagefähigkeit der Catterall- und Herring-Klassifikation bei Patienten mit Morbus Perthes

QUESTION Investigation of the predictive value of the Catterall- as compared to the Herring-classification in patients with Perthes disease. METHOD A radiological follow-up study including 53 patients with a total of 59 affected hips was carried out. In the initial diagnosis the Catterall-, Waldenstrom- and Herring-stages were assessed. The epiphyseal ratio, the head-neck ratio and the lateral subluxation were measured and compared at the time of diagnosis, fragmentation stage and in a follow-up examination, which was carried out 4, 9 years after diagnosis on the average. The results of the follow-up examination were assessed using the Mose-classification and compared as well. In addition t…

Metastatic spinal cord compression--options for surgical treatment.

Fourty-three cases with metastatic spinal cord compression were reviewed post-operatively to clarify the usefulness of the procedures concerning restoration of neurological function, and pain relief. Only patients with pathological spinal instability and neurological sequelae were included. Posterior decompression and stabilization was performed in all but six patients. All but four patients (91%) reported decrease of pain symptoms. Amelioration of neurological function was achieved in 58%. Re-establishment of walking ability was obtained in 57%. Post-surgery life expectancy averaged 11 months. In patients with widespread metastatic disease and/or multi-level instability of the spine restri…

Sagittal static imbalance in myelomeningocele patients: improvement in sitting ability by partial and total gibbus resection

The progression of kyphosis in myelomeningocele is independent of skeletal growth and requires early operative correction and stabilization to prevent a loss of sitting ability. In severe cases, only vertebrectomy makes it possible to achieve correction, stability and skin-closure without tension. In 14 patients with myelomeningocele gibbus, kyphectomy was performed, removing two vertebral bodies on average. The average kyphosis angle decreased from 128 degrees to 81 degrees, enabling most of the patients to participate again in social life by restoring wheelchair mobility. Nevertheless, a significantly higher complication rate was found compared to other correctional operations, lengthenin…

Rechnerunterstützte Auswertung elektromyographischer und goniometrischer Meßsignale mit statistischen Signalanalyseverfahren

ANALGESIC EFFECT OF EXTRACORPOREAL SHOCK-WAVE THERAPY ON CHRONIC TENNIS ELBOW

We report a controlled, prospective study to investigate the effect of treatment by low-energy extracorporeal shock waves on pain in tennis elbow. We assigned at random 100 patients who had had symptoms for more than 12 months to two groups to receive low-energy shock-wave therapy. Group I received a total of 3000 impulses of 0.08 mJ/mm2 and group II, the control group, 30 impulses. The patients were reviewed after 3, 6 and 24 weeks. There was significant alleviation of pain and improvement of function after treatment in group I in which there was a good or excellent outcome in 48% and an acceptable result in 42% at the final review, compared with 6% and 24%, respectively, in group II.

Okkulte Fraktur einer Achillessehnenossifikation ohne begleitende Sehnenruptur

Ossification of the Achilles tendon is the result of a traumatic, hypoxic injury of the tendon. The usually asymptomatic ossification has a clinical importance only in case of a new trauma. We report about a patient with an isolated fracture of the ossification without an accompanying rupture of the Achilles tendon. Because of the radiologically "occult" fracture the diagnosis could only be verified by MRI. With a conservative treatment without resection of the ossification we could reach painless recovery.

Einige vermeidbare Behandlungsfehler bei der Therapie von Erkrankungen des Bewegungsapparates

Vermeintlich vermeidbare Fehler bei der Behandlung von Patienten besonders in operativen Fachgebieten sind der Grund fur die standig steigende Zahl der Haftpflichtprozesse und Antrage an die Schlichtungskommissionen der Arztekammern. Typische Fehlermoglichkeiten liegen zum einen in der Indikationsstellung zu operativen Eingriffen, ebenso mussen Patienteninformation und Aufklarung mit aller Sorgfalt und unter Berucksichtigung der Rechtslage erfolgen. Daruber hinaus konnen naturlich Fehler auch im Rahmen des operativen Vorgehens und der Nachbehandlung unterlaufen. Der vorliegende Uberblick soll unter Hinweis auf die empfohlenen Richtlinien einzelner Institutionen und unter Berucksichtigung de…

Metastatic instability at the proximal end of the femur

A retrospective study was performed of the surgical treatment of metastatic lesions of the proximal femur in 50 patients. In 25 consecutive cases a megaprosthesis was implanted; compound plate osteosynthesis was performed in another 25 consecutive patients. Indications for surgical treatment were pathological fractures or, for prophylactic treatment, lesions of the femoral cortex exceeding 2.5 cm in diameter or affecting half the diameter of the bone or more. In all patients capable of walking preoperatively mobility was regained. Immediate full weight-bearing stability was obtained in all patients. Group analysis showed that the functional rating of the hip joint was unchanged, i.e., good …

Decompression/Stabilization of the Metastatic Spine: Cotrel-Dubousset-Lnstrumentation in 50 Patients Jan

50 patients with metastatic disease of the spine underwent dorsal decompression and stabilization with the Cotrel-Dubousset-Instrumentation from 1987 to 1991. Indications for surgical treatment were neurologic deficit, spinal instability, and/or pain resistant to medical or radiation treatment. No external orthotics were used postoperatively. Pain was relieved dramatically in 45 patients. Among 25 patients suffering from neurologic deficit preoperatively, 13 improved, 15 remained unchanged, whereas 2 developed an incomplete, transient paraplegia. 15 (7) patients were alive after 1 (2) years. Postoperative complications were frequent, but there were only 2 failures of the stabilization devic…

Die Hochenergetische Extrakorporale Stoßwellentherapie (ESWT) in der Behandlung von Pseudarthrosen

PROBLEM The success rate of high-energy extracorporal shock wave therapy in the treatment of non-unions in comparison to the "golden standard" surgery is still unclear. METHOD In a prospective study, 3000 impulses with an energy density of 0.6 mJ/mm2 were applied with an experimental device to the pseudarthrosis in 52 patients. RESULTS The mean duration of pseudarthrosis was 13 months. A mean of 2.5 surgical interventions had already been performed. Bony union was achieved in 52% of our patients after an average of 3.3 months. Failures especially were found in the atrophic type of pseudarthrosis as well as in congenital bone disorders like fibrous dysplasia or osteogenesis imperfecta. No se…

Ensemble Averaging and Multiple Statistical Testing of EMG Activities of Cyclically Repeated Body Motions. A Tool for Muscle Function Analysis in Experimental and Clinical Orthopaedics. Ensemblemittelung und multiple statistische Analyse von EMG-Aktivitäten zyklisch wiederholter Körperbewegungen. Ein Instrument der Muskelfunktionsanalyse in der experimentellen und klinischen Orthopädie

Coupled with suitable computerized signal recording and processing methods surface electromyography can be a powerful tool for the analysis of muscle activity in specific body movements. It can be used for this purpose in experimental and in clinical diagnostic orthopaedics as well as in physiotherapy. We describe in this paper a motion analysis system comprising this feature. It has been employed for the diagnosis of the basic angular kinematics and muscle function in human gait and other cyclically repeatable movements of the human locomotive system. Changes in the temporal characteristics of the movements and the muscle activity due to changed physical or experimental conditions can be s…

Analyse der Pfannenveränderungen bei Morbus Perthes mittels Radiomorphometrie

AIM Decreases in depth and irregularity are typical changes of the acetabulum in patients with Perthes disease and develop secondary to the femoral head involvement. Optimal timing of therapy plays an important role to prevent these secondary changes. The present study investigates the influence of the amount of femoral head involvement and the patients' age on the acetabulum and the outcome. METHODS 66 patients with 76 affected hip joints were included in the study. 20 hips had a conservative therapy, 22 an operative therapy (IVO). 34 hip joints underwent a conservative therapy at first, followed by an operative intervention. The radiomorphometric analyses at the time of diagnosis, pre- an…

Biochemical bone markers compared with bone density measurement by dual energy X-ray absorptiometry

In contrast to medical imaging, the biochemical markers allow a more frequent determination and are not as invasive as histomorphometric methods. We investigated biochemical markers of type I collagen compared with bone density measurements in 85 females between 41 and 89 years of age (median: 57 years). The bone density measurements were performed by dual energy X-ray absorptiometry (DXA) on the lumbar spine (L1-4). The bone density measurements were stated as a percentage of the norm. All patients were divided into three groups: I =80%; II = 80-130%; III =120%. Based on this classification the median concentration of the I-carboxyterminal propeptide of type I collagen in serum (S-PICP) as…

Der Einsatz der Tumorprothese bei sekundär-neoplastischer Destruktion des proximalen Femurendes

Total hip arthroplasty was performed with PMMA-augmented tumor prostheses in 42 individuals suffering from metastatic destruction of the proximal end of the femur at the Orthopedic University Hospital Mainz from 1980 to 1992. Neoplastic lesions had been triggered by carcinomas of the breast in 25 female patients. 24 of our patients presented with pathologic fractures. In all patients capable of walking preoperatively early mobilization could be attained by total hip arthroplasty. Pain relief was achieved in each patient. Resection of the major trochanter and, partially, of the pelvitrochanteric muscle sleeve entailed luxation of the prosthesis six times in 5 individuals during the first pos…

Experimentelle Untersuchungen zur Reproduzierbarkeit von Ensemble-gemittelten elektromyographischen Ganganalysedaten im Bereich der experimentellen und klinischen Orthopädie / Experimental Investigation on the Reproducibility of Ensemble Averaged Electromyographic Gait Analysis Data in Experimental and Clinical Orthopaedics

With suitable application and signal processing methods, surface electromyography is a comparatively simple instrument for investigating the temporal pattern of the muscular activity of a walking subject. The influence of changes both in the external experimental conditions (e.g. orthopedic shoe design) and in the human locomotor system (due to disease or therapy) on the individual muscular gait characteristics can be documented in this way. The usefulness of this kind of investigation is basically limited by the reproducibility of the gait analytical findings of the subject, who is examined at different times with unchanged bodily state and under identical experimental conditions unchanged…

Operative management of epidural tumors of the spine

Seventy-two patients with neoplastic involvement of the vertebral column were operated on between 1986 and 1991. In the course of 79 operations anterior decompression and stabilization alone were performed in 3 cases, while ventrodorsal spondylodesis was carried out in 10 individuals. The remainder of the patients underwent exclusively dorsal decompression and stabilization, mainly with the Cotrel-Dubousset instrumentation (CDI). No external spinal support was required following posterior fixation by CDI alone or in combination with ventral spondylodesis. Forty patients suffered from neurological deficits preoperatively, 20 of them being unable to walk, in most cases owing to severe vertebr…