0000000000323119
AUTHOR
J.-d. Rompe
Lithotripsie bei femoralen oder tibialen Pseudarthrosen
Zusammenfassung Im Rahmen eines Vortrags bei der Unfallmedizinischen Tagung des Landesverbandes Rheinland-Westfalen der gewerblichen Berufsgenossenschaften wurden die Vor- und Nachteile der Stoswellentherapie bei Patienten mit Pseudarthrosen der langen Rohrenknochen diskutiert. Unter strengen Selektionskriterien wurde eine Erfolgsquote von 70% erzielt. Patienten mit einer positiven Szintigraphie sowie nach Osteotomie schnitten am besten ab. Bei ausgewahlten Pseudarthosen mus die Rolle einer chirurgischen Revision in Zukunft sorgfaltiger bedacht werden, solange komplikationsfreie nicht-operative Alternativen wie zum Beispiel die Extrakorporale Stoswellentherapie, bereitstehen.
Die Sonographie der Lendenwirbelsäule und des lumbosakralen Überganges - Sonoanatomie und Möglichkeiten der sonographisch gesteuerten Facettengelenksinfiltration
QUESTION Is sonography helpful in facet joint infiltration of the lumbar spine? METHOD The sonoanatomy of the lumbar spine and the of lumbosacral junction was examined and described in a skeleton and in 10 volunteers. One representative cross section and 3 longitudinal sections were defined. According to these results (no neurological symptoms) the possibilities of ultrasound guided infiltration of the facet joints was examined in 78 patients (36 female, 42 male, average age 55 y., 38-78 y.) with chronic low back pain and increase of pain by hyperextension. 5 ml Carbostesin partially in combination with steroids were applied to each joint. In all cases the tip of the syringe could be placed…
Bedeutung der Kalkdepot-elimination bei Tendinosis calcarea der Schulter
Aim: To evaluate the effect of complete elimination of the calcific deposit on the clinical outcome in patients with a recalcitrant calcifying tendinitis of the shoulder. Patients and methods: 50 patients with a chronic calcifying tendinitis of the shoulder (Type Gartner I or II) underwent a single application of extracorporeal shock waves (3000 impulses, energy flux density 0.60mj/ mm 2 ). After one year 45 patients were evaluated radiologically and clinically. Results: Radiologically a complete absorption of the calcific deposit was observed in 21 patients (47%). In 9 patients there was no radiological change. The radiological success was closely related to the radiomorphology of the depo…
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.
Stellenwert bildgebender Verfahren in der Diagnostik des lumbalen Bandscheibenvorfalles
As a seeming law of nature the possibility of making use of various multiplanar sectional imaging techniques is accompanied by diagnostic exaggeration. Simple and cost effective procedures with low radiation dosage such as plain x-rays of the spine are being thrust into the background. Not seldom are patients referred to the spine surgeon with MRI or Cat scan at hand but lacking standard radiographs. As far as the assessment of intervertebral disc disease is concerned the combination of plain X-rays of the spine and computed tomography of the level in question turned out to be sufficient for indication of the operation in more than 90% of 450 patients after nucleotomie at the Orthopedic Uni…
Evidenz-basierte Überprüfung der Therapieempfehlungen bei Epicondylopathia humeri lateralis (Tennisellenbogen) - eine Übersicht
The guidelines of the German Orthopaedic Societies regarding the treatment of lateral elbow epicondylitis were analysed on the ground of recently published reviews or randomised placebo-controlled trials (RCT). For the acute phase, reviews or RCTs failed to show a clinical effect beyond placebo if follow-up was extended over 6 weeks. For the chronic phase a current Cochrane review failed to identify any controlled trial regarding surgical procedures during the last decades. Without an adequate control group, it is not possible to draw any meaningful conclusions about the value of this modality of treatment. Therefore surgery is not indicated before repetitive low-energy extracorporeal shock…
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…
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…
Überprüfung der Läsionsgefahr des N. ischiadicus des Kaninchens durch die Applikation niedrig- und mittelenergetischer extrakorporaler Stoßwellen
Aim The aim of the study was to evaluate the likeliness for peripheral nerve lesions following extracorporeal shock wave application. Material and method 82 rabbit sciatic nerves were randomized to undergo low-energetic (0.08 mJ/mm2), middle-energetic (0.28 mJ/mm2) or no (controls) shock wave therapy. After 1 to 28 days an independent neuropathologist checked the specimen for signs of neural lesions. Results Only after 14 and 28 days vacuolic swelling of the axons was noted, somewhat pronounced in the middle-energetic group. In no case was there any disruption of the nerve's continuity. We did not observe any neurapraxia. Conclusion Shock wave application does not threaten peripheral nerve …