Ortopedia, traumatologia, rehabilitacja
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Ortop Traumatol Rehabil · May 2010
Controlled Clinical TrialComparative analysis of analgesic efficacy of selected physiotherapy methods in low back pain patients.
Low back pain syndromes are one of the most frequent causes of movement limitation in populations of highly industrialized countries. They are listed as the main cause of inability to work among people of working age. Chronic pain and the associated limitation of movement underlie the quest for effective therapies. The use of ultrasound, LLLT, vacuum therapy with Ultra Reiz current in physical therapy of these patients prompts research over their effectiveness in the therapy of patients with low-back pain. The aim of the work was to evaluate the analgesic efficacy of LLLT, ultrasound, and vacuum therapy with Ultra Reiz current in patients with low back pain. ⋯ 1. The study showed slightly higher analgesic efficacy of laser biostimulation in comparison to vacuum therapy combined with Ultra Reiz current in patients with low back pain. 2. A more prominent increase in lumbosacral spine mobility was observed after vacuum therapy combined with Ultra Reiz current and ultrasound therapy.
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Ortop Traumatol Rehabil · May 2010
Tibio-talo-calcaneal arthrodesis by a retrograde intramedullary nail.
The paper presents the results of tibio-talo-calcaneal fusions using Retrograde Nailing System and Bone Grafting. ⋯ 1- Arthrodesis should be considered only after all conservative treatments fails; it is one of the most challenging surgical procedures that must be undertaken with care in order to provide the best possible outcome. 2- Thorough evaluation and examination will help the surgeon to find the correct indication and identify patients who are not suitable for the procedure. It is crucial to assess the vascular and neurological status and to obtain weight-bearing radiographs (possibly CT) of the ankle to evaluate the deformity. 3- The optimal position of the ankle is in neutral flexion, 0-5 degrees valgus, and 10 degrees external rotation, similar to the contralateral foot and posterior translation of the talus under the tibia (5mm). 4- Tibio-talo-calcaneal fusion with retrograde nailing and bone grafting is a successful salvage procedure in severe ankle and hind foot arthrosis with deformity.
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Ortop Traumatol Rehabil · Mar 2010
Comparative StudyRetransfusion of shed blood collected in drains after Total Knee Replacement.
Total knee arthroplasty is associated with a perioperative blood loss, which is usually addressed with transfusion of allogenic blood. The possible risks of such treatment include viral infection, immunologic complications and occasional lack of blood products. Recently, retransfusion of blood recovered from the operative field or drains has become an effective treatment for blood loss. The purpose of this study was to evaluate the clinical usefulness of autologous transfusion of blood recovered from drains and to determine if the retransfusion alone is sufficient for treatment of the perioperative blood loss. ⋯ Retransfusion of shed blood from drains decreases the demand for allogenic blood. However, it does not eliminate the need for transfusion. The method is simple and relatively safe. It does not increase surgery time. No serious adverse effects were noted apart from elevated body temperature. A low preoperative haemoglobin level was a risk factor for additional allogenic transfusions in patients who have received retransfusion.
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Ortop Traumatol Rehabil · Mar 2010
Digital computed tomography evaluation of spinal canal and dural sac before and after surgical decompression of lumbar stenosis.
Advances in digital computed tomography prompted the authors to use this technique to measure correlations between the lumbar spinal canal and the dural sac. The aim of the study was to: 1. Evaluate the value of surgical decompression of neural structures using digital computed tomography. 2. Establish mathematical correlations between the surface area of the dural sac and the narrowed spinal canal before and after the operation. MATERIAL AND METHODS. The analysis involved 33 patients who underwent lumbar stenosis surgery. Complete clinical records and imaging examination reports were available for this group of patients. ⋯ 1. The ratio of the surface area of the spinal canal to the vertebral body surface area at L4 and L5 after surgery was statistically comparable to the value obtained for a normal spine. 2. The ratio of the surface area of the dural sac to the spinal canal surface area at L4 and L5 after surgery was statistically comparable to the value obtained for a normal spine.
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Ortop Traumatol Rehabil · Mar 2010
Case ReportsTracheal laceration associated with cervical spine injury-case report.
Mortality as a result of cervical spine injuries is predominantly associated with respiratory complications. Besides atelectasis, pneumonia, or respiratory failure, possible complications also include damage to anatomical structures of the respiratory tract. ⋯ We present the case of a 44-year-old man who suffered a cervical spine injury with associated tracheal laceration after a fall from a height of about 2 meters. Vertebrae C3, C4, C5 were damaged with anterior dislocation at the C3/C4 level. Because of the development of respiratory failure, the patient was intubated and mechanical ventilation was commenced. In view of a complete and irreversible spinal cord injury, the patient was not qualified for an emergency stabilisation of the vertebral fractures. Surgery was further delayed because of increasing signs of a respiratory infection. On the 12th ICU day, a perforation of the anterior tracheal wall was identified during an elective tracheotomy. Due to the presence of pus at the tracheostomy site and air leakage around the tracheostomy tube cuff, the patient was intubated with a double-lumen endotracheal tube. On the 23th ICU day, acute problems with mechanical ventilation developed due to persisting air leakage around the tube cuff accompanied by signs suggestive of a tracheo-oesophageal fistula. Replacement of the double-lumen tube with a single-lumen one and a bronchoscopy was followed by cardiac arrest. Resuscitation led to the return of circulation over four hours, followed by death of the patient in the setting of increasing shock. The cervical spine injury suffered by the patient can be classified as Magerl's B1.2.3 and additionally as a Category C injury. These are the most severe injuries which may be accompanied by tracheal or oesophageal damage. In such cases, it is advisable to carry out detailed work-up to detect any damage to structures adjacent to the spine, in particular the trachea and oesophagus. Early stabilisation of severe spinal fractures allows for intraoperative assessment of the adjacent structures. A delay in diagnosing damage to the trachea or oesophagus is associated with poorer prognosis and a potential inability to treat the injuries due to developing inflammatory complications.