Der Orthopäde
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Despite frequent involvement, the rheumatoid shoulder is neglected in operative treatment of the upper extremities. The slow course of omarthritis, the compensation mechanism of scapulothoracic motion and neighbouring joints as well as dominating disabilities of the lower extremities and the rheumatoid hand are possible explanations. The pattern of destruction of the rheumatoid shoulder is characterized by progressive joint and soft tissue deterioration. ⋯ Patients with irreparable rotator cuff tears and severe glenohumeral arthritis remain a difficult challenge in shoulder surgery and the ideal procedure has not yet been found. Pain relief and a modest increase in active motion are the main goals in operative treatment. Bipolar shoulder arthroplasty represents an adequate alternative to currently favoured hemiarthroplasty in patients with cuff-deficient shoulders.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Sympathetically maintained pain (SMP): phentolamine test vs sympathetic nerve blockade. Comparison of two diagnostic methods].
The objective of our study was to clarify whether the phentolamine test is as suitable as sympathetic blockade in diagnosing cases of sympathetically maintained pain. The specificity and the sensitivity of both procedures were examined within a prospective and randomized study. Both a local sympathetic blockade and an intravenous phentolamine infusion were carried out in 29 patients with persistent pain in the area of the upper or lower extremities. ⋯ The phentolamine test, on the other hand, can be realized very easily and safely. Therefore, based on the results obtained, it is recommended that the phentolamine test be applied for primary diagnosis. In case of a negative result, further diagnosis should follow subsequently, for example with local sympathetic blockade.
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The scope of the LINK SB Charité Artificial Disc is to replace degeneratively changed, symptomatic intervertebral discs and to restitute the fundamental functions of the lumbar mobile segment. Biomechanical static- and dynamic test results as well as postoperative controls of a patient-group with uniform indications are presented. The options of an intervertebral disc replacement with the SB Charité Artificial Disc are discussed. ⋯ The stated general and specific complications (n = 9) had a definite influence on the results of the postoperative control in one patient and a questionable influence in another patient. Based on biomechanical static and dynamic testing, the SB Charité Artificial Disc is suited to replace the fundamental functions of the lumbar intervertebral disc. Patients suffering from a postnucleotomy-syndrome can be rendered pain free with the implantation of this prosthesis.
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Comparative Study
[Accuracy of fluoroscopic navigation of pedicle screws. CT-based evaluation of bone screw placement].
While the advantages of C-arm navigation in computer-assisted spine surgery are obvious, the accuracy of pedicle screw placement with virtual fluoroscopy still needs to be verified. The C-arm-based ION system (Medtronic Sofamor Danek) was used to navigate pedicle screw insertion in patients undergoing spinal surgery for various conditions. ⋯ Computed tomography (CT) scans were performed postoperatively by two independent radiologists to control the accuracy of screw placement at the level of the pedicles after reconstruction of axial images according to Laine et al. The comparison of the calculated accuracy rate of pedicle screw placement using virtual fluoroscopy with reported results achieved with CT-based navigation shows similar results for virtual fluoroscopy and a remarkable increase of accuracy in comparison to reports on conventional pedicle screw placement.