Zeitschrift für Orthopädie und ihre Grenzgebiete
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Z Orthop Ihre Grenzgeb · Nov 2002
Randomized Controlled Trial Comparative Study Clinical Trial[Use of peridural catheters in the treatment of postoperative pain after spinal instrumentated fusion--an experience report].
In a prospective randomized clinical study we investigated in a group of 20 patients after spinal instrumentation surgery the analgesic efficacy and the safety of epidural analgesia. Intraoperatively an epidural catheter was placed by the orthopedic surgeons for postoperative pain control. ⋯ The epidural lumbal analgesia is an effective and safe method to control postoperative pain after spinal instrumentation surgery. Precondition is the knowledge about the safe and standardized technique of intraoperative catheter placement by the orthopedic surgeon, the choice of the appropriate analgesic drugs and a good cooperation between the departments of anesthesiology and orthopedic surgery and nursing staff.
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Z Orthop Ihre Grenzgeb · Nov 2002
Comparative Study[Primary hip- and knee arthroplasty--comparison of the actual costs with the Australian diagnosis related groups (DRG)-].
With the introduction of the Australian DRG system in Germany the question arises which current procedures remain reasonable in cost. The present study compares the actual costs with the expected DRG reimbursement. ⋯ To cover the current costs for patients free of complications, an enormous reduction of the length of stay is required. Otherwise complicated cases may result in a loss of quality or selection of patients. The present cost analysis outlines a guideline for an individual calculation and assessment of the necessary DRG reimbursement.
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Z Orthop Ihre Grenzgeb · Nov 2002
[Spinal cord stimulation (SCS) using an 8-pole electrode and double-electrode system as minimally invasive therapy of the post-discotomy and post-fusion syndrome--prospective study results in 34 patients].
Therapy of a pronounced post-discotomy (PDS) and post-fusion syndrome (PFS) is often unsatisfactory because of the complexity and multifactorial pain genesis. If surgical interventions cannot promise relief and if the entire interdisciplinary spectrum of conservative treatment measures is inadequate, the area of neuromodulative procedures offers spinal cord stimulation (SCS). The objective of this study was to examine the therapeutic possibilities of SCS using an 8-pole electrode and double electrode system in PDS and PFS with extensive back-leg pain areas. ⋯ The SCS is an minimally invasive surgical procedure which can enlarge the therapeutical possibilities of pronounced PDS and PFS resistant to other modes of treatment. Special technical possibilities of parameter setting are required to cover the pain areas.
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Lumbar disc herniation is rare in adolescents and often misread. The difference of etiology, symptoms and therapy in comparison to adults were investigated and the long-term outcome of conservative and surgically treatment evaluated. ⋯ The etiology of lumbal disc herniations in adolescents has a multifactoral basis. Conservative treatment should be pursued as a mainstay of treatment. Only if conservative treatment fails, surgical treatment should be considered.