Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2012
[Evolution of the technique of arthroscopic reinsertion of the rotator cuff. Our experience from the years 1998 to 2008].
A rotator cuff tear is a relatively frequent cause of pain and restricted motion of the shoulder. Some orthopaedists believe that any attempt at rotator cuff reconstruction will fail. The aim of this paper is to present our experience with arthroscopic reconstruction of rotator cuff tears. ⋯ The arthroscopic reconstruction of a rotator cuff tears results in a marked relief of pain and improved joint function. An ideal candidate for this treatment should show passive free motion at the shoulder joint, no clinical signs of bursitis, and mobilisable tendon stumps of the torn rotator cuff. In addition, these patients should be highly motivated for post-operative rehabilitation. A suture device was most effective in rotator cuff repair. For good fixation into the bone it is recommended to use special implants that have a minimal risk of dislodgement or anchor thread failure.
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Acta Chir Orthop Traumatol Cech · Jan 2012
[Percutaneous dynamic interspinous stabilisation for the treatment of juxtafacet cysts of the lumbar spine: prospective study].
To present the authors' philosophy on the surgical treatment of juxtafacet cysts of the lumbosacral (LS) spine, with its primary aim of dynamic lumbar stabilisation with an interspinous implant, inserted by a minimally invasive approach, without concurrent exploration of the spinal canal and cyst removal. ⋯ 1. The original method of treating juxtafacet cysts of the LS spine by an In-Space interspinous spacer, as presented here, was efficient in all patients and resulted in complete, or at least partial, resorption of the cyst. 2. Segmental mobility and spondyloarthritis are the major aetiological factors of juxtafacet cyst development. 3. Dynamic interspinous stabilisation will reduce loading of the intervertebral joints and will thus allow for cyst resorption and clinical symptom resolution. 4. Percutaneous implantation of an "In-Space" interspinous spacer is a minimally invasive method of dynamic stabilisation that means no restrictions in patients' activities and reduces the length of hospital stay.
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Acta Chir Orthop Traumatol Cech · Jan 2011
[Arthroscopic findings concerning rotator cuff lesions and their operative management].
Our objective is to introduce our simplified, easy-to-use classification of rotator cuff (RC) lesions, describe the frequency of individual findings in a considerably large series of shoulder joints examined by arthroscopy, evaluate the results of the operative management of individual lesion types, and recommend optimal surgical approaches. ⋯ Out of a total of 516 RC lesions, type I was the most prevalent (54%), followed by type V (16%). The prevalence of lesion types II, III and IV was about 10% each. In type I, the mean improvement measured by the Constant score was 36 points. As for type II, open reconstruction, ASK-assisted reconstruction and ASK reconstruction resulted in mean improvements of 31, 34, and 35 points, respectively. While open reconstruction of type III lesions was associated with a 27-point improvement on the Constant score, the use of ASK-assisted reconstruction resulted in a 29-point improvement. In type IV, the use of ASK palliative resection of RC remnants, muscle transfer (Karas), partial reconstruction (Burkhart), and a combination of the last two methods led to the mean 19-, 25-, 22-, and 22- point improvements respectively. Following ASK palliative resection, the mean Constant score improvement in type V lesions was 17 points, while the use of resurfacing, if performed, was associated with a 21-point improvement. DISCUSSION In type I lesions, favourable long-term outcomes are achieved through ASK SAD, which removes RC irritation within the narrowed subacromial space. RC reconstruction or sutures, which can be performed arthroscopically quite easily, are indicated in type II lesions. The situation is similar in type III lesions, where, from a technical point of view, reconstruction is facilitated by ASK-assisted reconstruction with mini-incision. Since type IV lesions are the most complex ones, the largest number of surgical management methods is described here. As for muscle transfer, the subscapularis and latissimus dorsi muscles are used most often, the latter requiring wider surgical access. Partial non-anatomical reconstruction is useful, too. New synthetic prostheses, as well as biosynthetic or biologic prostheses prepared with cultures of pluripotent stem cells, have been developed recently. Unlike some other authors, we prefer open surgery. Attempts at ASK reconstruction increase surgical time considerably, while the cosmetic effect is negligible if many ASK ports are used. Reconstruction is contraindicated in type V lesions; good outcomes are being achieved with ASK palliative resection of RC remnants (Apoil). Type I lesions are successfully managed with ASK SAD. The method of choice in type II lesions is ASK reconstruction. In type III lesions, we have been getting good results with ASK-assisted RC reconstruction with mini-incision. As for type IV lesions in older patients, we have good experience with muscle transfer of a part of the intact subscapularis muscle tendon (Karas); partial non-anatomial reconstruction (Burkhart) is deemed more beneficial in younger and more active patients. For anatomical reasons, a combination of both above-mentioned methods had to be used in some cases. ASK palliative resection of RC remnants, rarely followed by resurfacing when unsuccessful, remains the method of choice in treating type V lesions. Key words: shoulder arthroscopy, rotator cuff lesions, classification, subacromial decompression, reconstruction, open surgery, palliative resection, Constant Functional Score.
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Acta Chir Orthop Traumatol Cech · Jan 2011
[Reduction of radiation exposure by the use of fluoroscopic guidance in transpedicular instrumentation].
The variability in width, height, and orientation of spinal pedicles makes pedicle screw insertion a delicate operation. Fluoroscopic guidance often exposes the patient and especially surgeons to relatively high doses of ionising radiation. The use of pulsed fluoroscopy is safer, as compared to continuous fluoroscopy, because of reduced radiation exposure. There are increasing numbers of literature reports regarding the high doses of radiation to which orthopaedic and spine surgeons are exposed during surgical procedures. Spine surgery can be associated with significant radiation exposure to the surgical staff. The purpose of this prospective study was to compare a computer-assisted navigation with a conventional procedure in order to assess if it is possible to reduce radiation exposure while preserving the accuracy of screw placement. ⋯ Navigation allows us to keep the same accuracy of pedicle screw placement while reducing radiation exposure of the surgeons and operating room staff by about one quarter. In multiple-level vertebral instrumentations this reduction is more pronounced. In centres where many procedures involving spine instrumentation are done every day, the "saved" exposure time can amount to hours.
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Acta Chir Orthop Traumatol Cech · Jan 2011
[Fractures of the L5 transverse process in pelvic ring injury].
The aim of the study was to record the frequency of L5 transverse process fractures associated with pelvic injuries and to find out whether in unstable pelvic fractures the frequency is significantly higher. ⋯ The study shows a significantly higher occurrence of L5 transverse process fractures in patients with unstable pelvic ring injuries. The finding of such a fracture should focus attention to looking for trauma to the dorsal pelvic structures.