Zeitschrift für Orthopädie und ihre Grenzgebiete
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Z Orthop Ihre Grenzgeb · May 1993
Review[Long-term results following percutaneous facet coagulation].
93 patients with a mean follow up of 73 months (30-133 months) after lumbar percutaneous radiofrequency denervation (PRFD) were evaluated. Mean age of the patients at time of surgery was 47 years (18-76 years). 54 patients had no lumbar spine surgery prior to facet denervation, 32 patients had one or multiple disc surgery prior to denervation, and 7 patients had spinal fusions. 51 patients were in the process of early retirement or already retired at time of surgery. Out of all 93 patients only 50% had significant pain relief immediately after PRFD. 3 months after PRFD the success rate dropped down to 38%. 6 years after surgery only 25% of all patients had long lasting good results. Patients who were pain free after facet infiltration had significant better initial results, but were similar to the others after 6 years. 6 out of 7 patients after lumbar spinal fusions demonstrated bad results. The worst results had those patients who had applied for early retirement (workmens compensation cases). In this group the recurrence rate was 74% 6 years after surgery. We found no correlation between the surgeon and the outcome. ⋯ Without pain reduction after facet infiltration the success rate after PRFD is low. Spinal surgery prior to PRFD significantly reduces the success rate. The worst prognosis have workmans compensation cases. The recurrence rate is high within the first 6 months after PRDF.
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Intensified adjuvant chemotherapy increased the 4-year metastasis-free survival probability from 50% (COSS-77) to roughly 80% (COSS-86). Preoperative chemotherapy was found without recognizable hazard and promoting conservative surgery. Following resection the local failure rate ist significantly higher than after demolitive procedures, including rotation plasty (10.5% vs. 2.5%). ⋯ The acute therapy related mortality is less than 3%. Late toxicities like ototoxicity and cardiotoxicity are intriguing and deserve increased attention. The management of the osteosarcoma patient is a complex and difficult interdisciplinary task which is best performed in centers experienced in the treatment of malignant musculo-skeletal tumors.
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Z Orthop Ihre Grenzgeb · Jan 1992
[Rupture of the distal tendon of the biceps--diagnosis and results].
The rupture of the distal tendon of the biceps brachii is a uncommon injury of the upper extremity. For this reason, the clinical patterns are quite unknown. ⋯ Aetiology, diagnostic efforts and operative treatment are demonstrated as well as the results of a follow-up of 12 patients. The results of operative treatment are quite good and point out the need for operative treatment.
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Z Orthop Ihre Grenzgeb · Jul 1991
[Etiology, diagnosis and therapy of tarsal tunnel syndrome--results of a retrospective study].
Tarsal tunnel syndrome is a rare entrapment neuropathy of the posterior tibial nerve. The compression of the nerve behind the medial ankle should be distinguished from that of the more distal compression syndrome of the plantar nerves, because of different anatomic conditions and pathogenesis. ⋯ Neurological deficits must be searched for. Decompression by cutting the flexor retinaculum and neurolysis is advised. 77% of the 30 patients having undergone this operation were satisfied with the results.
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Z Orthop Ihre Grenzgeb · Sep 1990
Review[Spondylodiscitis in kyphotic deformity of ankylosing spondylitis and its healing affected by dorsal correction osteotomies. Report of 33 patients].
Out of 144 patients with kyphotic deformities in Ankylosing spondylitis 33 (23%) had 45 disco-vertebral lesions of the spondylodiscitic type. They were characterized by osteolyses, scleroses and absence of syndesmophytes. 5 had additional arch fractures. All were localized in or below the apical vertebra in the lumber or the lower thoracic spine. ⋯ After a follow up of two years 98% were completely fused, also those with non-identical levels of correction and lesion. The loss of correction in the segments of lesion was negligibly more than in the total collective. 91% of the patients were pain-free compared to 12% preoperatively. The spondylodiscites were no hindrance for dorsal lordosing osteotomies and can be treated successfully by means of this static correction and the immobilisation.