Der Orthopäde
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This paper presents guidelines for indications, risks, and technical aspects of removal of metal works. The indications comprise the general condition of patient, age, location of the implant, risks and disadvantages of the procedure. Problems concerning removal of metal are for example: lesions to nerves and re-fracture. ⋯ The issue of obtaining the consent of a patient to an operation, often not an operation for novice, may not be neglected. Lesions to nerves are amongst the most common complications. The technical guidelines refer to the specific locations and to the problem of broken intramedullary nails.
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Clinical Trial Controlled Clinical Trial
[Minimally invasive percutaneous epidural neurolysis in chronic radiculopathy. A prospective controlled pilot study to prove effectiveness].
The treatment of chronic back pain with sciatica is still an unsolved therapeutic challenge. Percutaneous minimally invasive neurolysis according to the Racz technique is increasingly applied and discussed controversially. So far there is no prospective randomized controlled study for evaluation of a possible treatment effect. ⋯ The results are being used to design a clinical trial in accordance with good clinical practice guidelines to analyze the therapeutic efficacy of the procedure. The described technique is still a clinically experimental procedure. However, due to a low probability of side effects and due to the good results reported so far by most authors, the Racz catheter technique may be applied in certain patients with chronic radiculopathy refractory to conservative treatment.
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Functional diagnostics of the dorsal root are especially effective via nociceptive fibers on account of less intersegmental overlap compared to large-diameter fibers of the mechanoreceptive afferents. Laser-evoked potentials (LEP) are induced by short, painful heat stimuli. The aim of this work was to describe changes of the LEP in cases of dorsal root damage. ⋯ Which mechanisms are responsible as concerns deafferentiation and neuropathy of the dorsal root fibers are discussed. With regard to the LEP changes, a prognostic relevance in patients with dorsal root affections is likely. This question will be addressed in a prospective study soon.
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Clinical Trial
[Microsurgery of acquired degenerative lumbar spinal stenosis. Bilateral over-the-top decompression through unilateral approach].
Degenerative lumbar spinal stenosis is diagnosed with an increasing incidence. Clinical and radiological signs of progression often result in a significant decrease in the patient's quality of life. The indication for surgical treatment follows the spectrum of clinical symptoms. ⋯ A complete decompression of the spinal canal with preservation of the "tension band" of the posterior spinal column could be achieved. Although this type of surgery is adequate for patients with "predominantly leg symptoms" only, low back pain improved as well in nearly 50% of the patients. However, in cases with dynamic spinal stenosis and/or disturbed curvature with predominant low back pain, a combination of the described procedure with stabilizing surgery (spinal fusion, dynamic fixation etc.) is recommended.
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Superior labral anterior-to-posterior (SLAP) lesions can cause shoulder pain partly by causing glenohumeral instability. The purpose of this study was to examine the effect of a simulated type II SLAP lesion and subsequent repair on glenohumeral translation of the vented shoulder. In eight cadaver joints, a robotic/UFS testing system was used to measure joint translation by applying an anterior, posterior, or inferior load of 50 N to each shoulder. ⋯ There were no significant increases in translation after SI/AP combined external rotation torque or posterior-anterior combined internal rotation torque loading. In this study the repair of a type II SLAP lesion only partially restored translations to the same degree as an intact vented shoulder joint. Therefore, improved repair techniques or an anteroinferior capsulolabral procedure in addition to the type II SLAP lesion repair might be needed to restore normal joint function.