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Biomedical subjects

H Brattström

Publications and source records attributed to H Brattström.

At least 19 recordsLinked to original sources
PubMed1989

[Favourable surgery of cervical neck instability in rheumatism].

A team project commenced 20 years ago can now present results of 150 surgical stabilising procedures for cervical neck instability in rheumatoid arthritis. The favourable results indicate widened indications. MR examination demonstrated regression of soft tissue swelling ("pannus") after surgery, which possibly contributed to the good results.

Aged↗
PubMed1988

Realignment and surgical fixation of atlanto-axial and subaxial dislocations in rheumatoid arthritis (RA) patients.

One hundred consecutive patients with atlanto-axial dislocation(s) were subjected to posterior occipito-cervical fusion and followed up to 16 1/2 years postoperatively (mean: 4 1/2 years). The mean age at surgery was 60.3 years. At the time of follow-up, 45 patients had died, mostly due to cardiopulmonary disease. Out of the 100 patients, 67% showed a major improvement and in an additional 14% there was a slight or moderate improvement. Some patients with a stable fusion later developed subaxial dislocation(s) necessitating an anterior fusion which in patients with RA is difficult due to poor bone quality. MRI revealed pannus formation around the odontoid peg in many patients, in several to such a degree that cord compression was evident. Following the posterior fixation, the pannus disappeared or was reduced which may at least partly explain the generally favourable operative outcome following the fixation procedure. Early occipito-cervical fusion appears to prevent further vertical dislocation or upwards migration of the odontoid which is a more severe condition, and does not appear to result in increased incidence of subsequent subaxial dislocation(s). Such luxation(s) pose a technically difficult problem since the quality of the patients' own bone usually does not permit a common anterior fusion procedure with autologous graft. In such cases with cord compression, acrylic cement may be used to obtain a normalized realignment.

Adult↗
PubMed1988

Reduction of rheumatoid periodontoid pannus following posterior occipito-cervical fusion visualised by magnetic resonance imaging.

Nine patients (four females and five males) with chronic rheumatoid arthritis (RA) and atlanto-axial (AA) instability subjected to occipito-cervical fusion were evaluated clinically and radiologically. All of them had soft tissue formation (pannus) around the odontoid peg. The age ranged from 50 to 79 years (mean: 66). The duration of the RA disease was 3-48 years (mean: 18.5). All patients were seropositive. Both conventional radiography and magnetic resonance imaging (MR) were performed pre- and postoperatively. All fusions except one were stable. One patient was re-fused after 2 months because of wire break. With regard to pain all patients had improved and eight were pain free. Six patients who experienced signs of myelopathy prior to the fusion had improved at follow up. MR revealed reduction of pannus in all nine cases. This was obvious in one patient within 6 weeks postoperatively. The MR findings of a reduction or even disappearance of pannus following posterior fusion should decrease the need for transoral surgery.

Aged↗
PubMed1986

[Cervical spine in polyarthritis. Radiology, indications for surgery and results].

The rheumatoid changes in the spine that are of clinical importance are in the cervical part. They may cause dislocations in the cranio-vertebral region and - more uncommon - in lower levels. Most common is the horizontal dislocation between CI and CII, caused by destruction of the odontoid process and the area around it. This type can progress and give rise to the vertical dislocation caused by bone destruction in the joints between the occiput, CI and CII. The diagnosis is partly clinical and partially made by X-ray films. New radiological methods and new ways of using the old ones are discussed. Subaxial dislocations are not rare. Indications for surgery (fusion and possibly decompression) depend upon the progress of clinical symptoms and radiological findings, as do the surgical methods. The use of bone cement is increasing. Most authors advocate earlier surgical treatment. Subaxial fusion is difficult because of the poor condition of the bone.

Arthritis, Rheumatoid↗
PubMed1984

Seventy-four Attenborough knee replacements for rheumatoid arthritis. A clinical and radiographic study.

Seventy-four Attenborough total knee replacements in patients with severe classical rheumatoid arthritis were followed for 2-5 years. The preoperative radiograms were evaluated according to two different scoring systems. At follow-up, radiographic whole leg examinations were performed. Mean malalignment was 7 degrees. The overall results were not encouraging with definite failure in eight knees and probable failure in another 21 knees. Failure was significantly correlated with postoperative malalignment.

Adult↗
PubMed1983

Soft tissue release of the hip in juvenile chronic arthritis.

Adductor and/or subspinal tenotomies were performed on 17 patients (25 hips) with longstanding juvenile chronic arthritis and hip disability. The flexion contracture decreased after surgery from 28 to 18 degrees but had increased to the preoperative level by an average follow-up time of 48 months. The adductor contractures followed the same pattern. All but 3 of the patients were dissatisfied with the relatively small gain and the short-lasting effect of the operation. Knee contractures and insufficient release are probably some of the reasons for the poor results. A more extensive release is recommended and in the case of hip pain combined with synovectomy.

Adolescent↗
PubMed1983

Total hip replacement in juvenile chronic arthritis.

Fifty total hip replacements in 33 patients with juvenile chronic arthritis were performed over a 10-year period with good pain reduction, increased hip motion but only a moderate increase in walking capacity. The average age at operation was 26 years and the average follow-up time 77 months. Six hips (patients) have been reoperated, one for infection, one for suspected infection and four due to mechanical loosening. Loosening was revealed radiographically in 10 hips at follow-up. Lack of cement cover and varus position was the main reason for loosening of the femoral stem. Considering the high loosening rate it is probable that at least one revision arthroplasty will be necessary in the future.

Adolescent↗
PubMed1981

Arthroscopy of the hip in juvenile chronic arthritis.

After distension of the hip joint with physiological saline followed by traction, hip arthroscopy was performed in 13 patients (15 hips) with juvenile chronic arthritis. Arthroscopy gave better information about the cartilage than the roentgenograms and gave the same information about the synovial membrane as the operation. This diagnostic procedure should be performed early in the course of hip disability.

Adolescent↗
PubMed1981

The rheumatoid patient in need of a wheelchair.

The situation of 40 severely disabled arthritic patients who have received a wheelchair is reported. Most of the patients had had their rheumatoid arthritis for more than 15 years. Knee involvement was frequently the reason for needing a wheelchair. Most of the patients had general joint involvement. Orthopedic- or handsurgery as well as proper technical aids and a well adapted housing facilitated the maintenance of functional capacity. Wheelchairs with big wheels back, seat higher than normal, raisable and removable leg rests, neck-support and elongated brake handle will satisfy most patients. In our series most complaint was reported regarding back support and front wheels. The majority of the patients had an optimistic attitude to their situation. Eighteen of the 40 patients regretted not having accepted a wheelchair earlier.

Activities of Daily Living↗
PubMed1980

Multiple operations in the rehabilitation of patients with rheumatoid arthritis.

There is often a need for multiple orthopaedic operations and other interventions in rheumatoid arthritis. A material of 78 patients with rheumatoid arthritis, all of whom have had one or two total hip replacements (THR) is presented. At the last follow-up examination it was found that these patients had undergone 5.6 orthopaedic operations on the average because of their rheumatoid arthritis. About 60% of the patients wore specially fitted shoes, and about 50% of the patients had received financial help to improve their homes or to find other accommodation more suited to their disability.

Adult↗
PubMed1979

Sexual difficulties and total hip replacement in rheumatoid arthritis.

Fifty-three patients with rheumatoid arthritis were interviewed by questionnaire. All the patients had undergone total hip replacement and were married at the time of operation. They were asked if they had had sexual difficulties because of hip pain or stiffness and if the hip operation had in any way alleviated these problems. Forty-four of the 53 patients answered the questionnaire. Twenty-eight patients had had sexual problems which they attributed to hip symptoms. Following total hip replacement the hips of 27 patients were no longer considered to be the cause of sexual difficulties, but in 10 of those patients other problems still rendered sexual life difficult.

Adult↗