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Biomedical subjects

H J Hehne

Publications and source records attributed to H J Hehne.

At least 19 recordsLinked to original sources
PubMed1990

Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Report on 177 cases.

Despite conservative therapy in ankylosing spondylitis, kyphotic deformities are common. Mono-segmental lumbar osteotomy had a high complication rate. Therefore, a poly-segmental lordosis osteotomy of the lumbar spine was introduced in four to six segments using trans-pedicled screws and threaded rods in eight to ten segments (isolated correction is possible for each segment). Instead of dangerous short kinking, a poly-segmental lordosis osteotomy results in harmonious lordosis with a correction per segment of about 10 degrees, and complications are decreased. Of 177 patients undergoing the operation, there was a 2.3% mortality rate with cardiopulmonary problems, 2.3% with irreversible complications, and 18.1% with reversible complications, mostly small root lesions, of which 7% were reoperated. The 173 surviving patients had a correction of 43%, and improvement in body height of 9 cm, and improvement of flexion by 57%. Fifty-three patients have been followed for more tha 18 months. the visual axis in all cases was horizontal. No pseudoarthrosis occurred. After correction, the frequent spondylodiscitis healed. Ninety-two percent were pain free compared with 15% before the operation. Loss of correction of body height was 20%, of flexion 4%, and of the lordosis 7%, which was 18% in 37 patients after three years.

Adult↗
PubMed1990

Biomechanics of the patellofemoral joint and its clinical relevance.

An analysis of the patellofemoral joint based on experimental determinations of pressure distributions on the patellar cartilage and vectorial calculations is presented. The extension torque of all quadriceps muscles is similar. The force transmitted to the patella by the retinacula is small in all knee positions. Because the rigid patella has its own lever arms and tendon insertions at different heights, the forces on patellar and quadriceps tendons are unequal. The small patellar contact areas change according to flexion and are dependent on quadriceps force. Retropatellar pressure is thereby limited and becomes independent of flexion angle. By virtue of the direct force transmission of the quadriceps tendon to the femur, the increase in the retropatellar force is strongly limited beyond 70 degrees. The lateral-to-medial ratio of contact areas, pressing forces, cartilage areas, and bone mass is always 1.6:1, whereas the mean pressure is the same on both facets. The osseous form of the patella does not allow identification of dysplasia because cartilage compensates for apparent incongruence, especially about the medial ridge. This permits the rigid patella to adapt itself to very different abutments. Its individual form results from functional adaptation and does not explain chondromalacia. The ventralization of the tibial tuberosity does not alter retropatellar loading. The mediodistal transfer results in a high increase of pressure on both facets.

Biomechanical Phenomena↗
PubMed1989

[The importance of radiologic studies for the differentiated treatment of scoliosis].

Structural scoliosis is defined by curvature, fixation, rotation and torsion. Each case is different and must be assessed on the basis of etiology, flexibility, patient age, skeletal age, progression and degree, level, and the number of the deformities in order to decide whether conservative or operative treatment should be administered. The most important factor in the choice of therapy is radiographic evaluation to allow accurate measurement. This involves standing X-rays of the whole spine (plan d'éléction), checking with corset and cast, tomography, spot-film radiography, CT and MRI in congenital and neuromuscular deformities and neurofibromatosis, oblique projection after operations, and radiography of the left hand and the iliac crest to determine the bone age. The classification and terminology of scoliosis are presented, as are the interpretation and measurement of the radiographs and the treatment indications.

Humans↗
PubMed1989

[Correction of Bechterew kyphosis].

The derangement of posture in advanced flexion deformity due to ankylosing spondylitis, as well as operative correction procedures are analysed. The "Dorsal Lordosating Spondylodesis", DLS, according to Zielke is introduced. This method of polysegmental correction and transpedicular fixation via USIS implants allows the recreation of a balanced upright posture by restoration of smooth lumbar lordosis. We present results of 173 patients corrected by DLS. Since the total amount of correction is split into 5-7 osteotomy sites, complication rates are substantially lower than in the monosegmental methods. Besides the gain of body height and immediate pain relief, the restoration of a horizontal axis of vision could be achieved. The latter, for all patients the most important feature, was maintained as up to 5 years follow-up's show.

Adult↗
PubMed1984

[Therapy of gonarthrosis using chondroprotective substances. Prospective comparative study of glucosamine sulphate and glycosaminoglycan polysulphate].

68 patients with mild or moderate gonarthritis were treated with intra-articular injections of glucosamine sulphate or glycosaminoglycan polysulphate over a period of six weeks. The therapy was successful in two thirds of these patients. "Loading" pain was eliminated or improved in about 80%, "getting-going" pain in about 64%, and signs of synovialitis in about 66%. Gait function and mobility were improved. Glucosamine had a superior effect, in particular in mild arthritis, achieving an improvement of pain in 90%, while glycosaminoglycan polysulphate was successful in advanced cases. The tolerance of the two substances was 94%. The results and the underlying modes of action of the substances are discussed.

Arthritis↗
PubMed1983

[Shoulder arthrography in rheumatoid arthritis].

Shoulder arthrography in a patient with rheumatoid arthritis is performed to differentiate between a rheumatoid flare and limitation of motion secondary to tear in the rotator cuff. Accurate diagnosis is important because of the therapeutic implications. The arthrographic findings characteristic of rheumatoid involvement of the shoulder joint are nodular filling defects of the joint, the subacromial and subdeltoideal bursa in case of rotator cuff tear, irregular capsular attachment, contracted joint space and visualized lymphatic drainage. A dilatation of the biceps tendon sheath has not been shown.

Arthritis, Rheumatoid↗
PubMed1981

[Measurements of tibio-femoral contact area after experimental partial and subtotal meniscectomie (author's transl)].

By means of section material, 24 partial and 58 subtotal meniscectomies were performed and the loss of tibio-femoral contact was evaluated by the Touchier-method planimetrically. In cases of partial resection this loss was 12% only, where as in subtotal resection 46%, where by the remaining contact zones lay in the central-, anyway meniscusfree area. The diagram of the chondral splitting lines showed a maximum of compression here, consecutively the remaining contact zone is reduced to the in earlier times most affected cartilage areas. The result correlates to the appearance of chondromalacies of the central tibial plateau in our own section cases and of postoperative osteoarthritis after subtotal meniscectomies in literature. Subtotal meniscectomies lead to incongruence and increased pressure. a pseudo-regeneration seems not to compensate the meniscus function sufficiently. A result for the clinic one should, when possible, resect menisci only partially.

Adolescent↗
PubMed1981

[Experimental patello-femoral contactprint measurements. 2. Report: sagittal osteotomy of the patella according to Morscher (author's transl)].

The recommended treatment method for chondropathy from Morscher 1978 using a sagittal patellaosteotomy was tested experimentally with contact area measurements with the erasing method on 11 corpse knees of the types II, II/III and III. Measurements were made in the bending region up to 90 degrees, and in isolated positions up to 140 degrees. The measurements showed a clear decrease in the contact area of the medial side of the lateral facet, and occassional displacement of contact whereby loses on the paramedial segment were compensated for by early loading on the border segment. Thus unphysiological loading of the medial facet occurred, from which chondromalasys could develop. Only three patellas had an increased contact area during inflexions up to 90 degrees, and then only because the central cartilage area, which usually undergoes the greatest loses, was already incongruent. Since during a complete knee bending the retropatella cartilage has almost 100% contact and that due to the medial cartilage ridge a considerably smaller incongruence is present as can be expected from the bone crosssection of the patella, we cannot expect any contact increase through an osteotomy.

Biomechanical Phenomena↗
PubMed1981

[Morphometric analysis of the proximal tibial cartilage tissue (author's transl)].

We analysed the tibial cartilage of 5 juvenile and 10 adult non-degenerative knees for morphometric criteria. Determination of cellular and nuclear total volume per unit cartilage volume,, number of cells and nuclei per unit cartilage volumen and cellular and nuclear single volumen of chondrocytes in the superficial and basal cartilage layer was done in relation to their being covered by meniscus. We found cells and nuclei and their total volumen in the superficial layer constantly smaller, number of chondrocytes and nuclei constantly higher than in the basal layer. This was clearly seen in the meniscus-covered part of cartilage, less marked in the central non-covered part. In adults the central cells are superficially hypertrophic and gain few individual and total volume in the basal layer. These superficial central cells are on a high level of metabolism, synthesising much intercellular substance, but they prostrate in basal direction. The aging chondrocyte is maximal adapted to the strain and uncapable to react to further load.

Adolescent↗
PubMed1981

[A new method for the determination of the weight-dependent course of pressure and contact in the articular surface].

A new method for measurements of pressure distributions and contact areas in joints. An innovative method is presented, allowing, for the first time, the exact determination of load-dependent pressure distributions and contact areas of joint surfaces in anatomical specimens. A thin flexible foil is inserted into the joint and adjust itself to curvatures. Upon loading, a monochromatic coloration occurs such that the optical density increases linearly with pressure. Using an electronic picture processor an analog representation of isobaric areas is obtained and evaluated, thereby integrating the areas of equal optical density. This procedure is considered to be superior to densitometric digital signal processing. For illustration, measurements of tibiofemoral-, patellafemoral- and ankle joints are shown, demonstrating the advantages and limitations of the new method.

Adult↗
PubMed1979

[Chondromalacia patellae--arthrographic observations on the genesis and diagnosis of cartilaginous damage (author's transl)].

Thanks to recent advances in arthrography, diagnosis of cartilaginous lesions has increasingly become a task of the radiologist. An accurate assessment of the cartilage of the femoropatellar joint can be established via double-contrast technique and so-called "défilé" projections, whereas the axial projection of the patella without contrast medium shows only secondary arthrotic changes of bone and is unsuitable for demonstrating early cartilaginous damage. The classification of dysplastic patellae into different types according to Wiberg and Baumgartl yields a statistical correlation with the frequency of chondromalacia, but does not give any conclusive evidence in individual cases. A special influence on joint mechanics and the development of chondromalacia patellae is exercised by a cartilaginous ridge of the medial patellar facette.

Adolescent↗
PubMed1979

[Dwyer's calcaneal osteotomy for varus deformity of the foot. (A follow-up study including gait analysis) (author's transl)].

A follow-up study on 20 patients one to 9 years after lateral wedge resection of the calcaneus according to Dwyer is reported. In 18 feet with neurogenic varus deformity of the hind foot, the angle between the axis of the lower leg and the heel was altered from 11.4 degrees +/- 1.4 degrees SD varus to a normal value of 5.9 degrees +/- 0.9 degrees SD valgus. The position of the calcaneal tuberosity was changed from 6.7 degrees +/- 1.1 degree SD varus to 0.1 degree +/- SD varus in 7 congenital club feet. The osteotomy reduced accompanying deformities of pes cavus and pes adductus in the operated children.

Adolescent↗
PubMed1979

[Double-contrast arthrography in chondropathia patellae--clinical and experimental study on pathogenesis and diagnosis (author's transl)].

This study is based on the evaluation of 250 arthrographies of the patellofemoral joint ("défilé" arthrographs in Ficat's terminology) which were performed because of clinical suspicion of chondropathia patellae and which could be controlled intraoperatively in 30 cases, as well as on examinations employing an etching paste as used in metallurgy and performed on 20 knee-joints of corpses. 46% of the arthrographies showed a ridge-shaped cartilaginous thickening which was not pre-modelled in the osseous structure and which separated the medial facette into a paramedian and a marginal segment and correlated with chondromalacia to a greater degree than patellar dysplasias or secondary osseous changes. This variant, which could not be detected by plain roentgenography, must be considered as a pre-arthrotic deformity on account of the high point-shaped pressure load on the ridge. The findings were fully confirmed by macroscopic examination of the postmortem material.

Adolescent↗
PubMed1979

[Neurovascular compression syndroms of the shoulder girdle (author's transl)].

Shoulder girdle compression syndroms appear intermittently and according to body carriage. Very seldom they are caused by neck ribs, mostly by a costoclavicular narrowness. Important for the symptoms is the nerval plexus compression, for diagnostic reasons the blood vessel compression. Essential are provocating tests, subclavia phonogramms and in doubtful cases, angiography. Oszillo- and sonography often fail, EMG and nerval conductive measurement are only of differential diagnostik importance. In all together 120 healthy persons compression was shown phonographically, phlebographically and manometrically in 58--88%. Only the symptomatic and distinct compression are abnormal. Physiotherapy should be applied, only operative decompression is a causal treatment. The transaxilar resection of the first rib with scalenotomy and eventually also resection of a neck rib is by fat better than any other method. This is a report of 112 operated patients.

Angiography↗
PubMed1977

[Resection arthroplasty of the metatarsophalangeal joints after Clayton (10 years of clinical experience) (author's transl)].

57 resection arthroplasties of the metatarsophalangeal joints using the method of Clayton were performed in arthritic and arthrotic deformities of the forefoot. 43 feet were controlled after an average of 5 years postoperatively. The good postoperative position of the toes changes into a progressive shortening, dorsal transposition and frequently valgus direction of the toes during the first year after operation. The deformity is much less than preoperatively. Passive mobility is good, but there is little active motion. The splay foot deformity is reduced in 50% of the cases. No arthritic recurrences were observed, callosities, clavi and mild pain were rarely found. Foot movements, walking ability was improved in all patients and 50% were wearing standard shoes. The results are influenced negatively by errors in resection technique, particularly lack of plantar rounding, exaggerated resection and unfavourable differencies in length of the metatarsal bones, and occasionally by secondary ossifications.

Arthritis, Rheumatoid↗
PubMed1976

[Freshly frozen preserved plasma for the treatment of intravascular coagulation in polytraumatized patients].

Coagulation disorders in hemorrhagic shock need not represent an isolated intravascular coagulation. They may also occur as a complex of local disseminated intravascular consumption, extravascular consumption, dilution, and reduced synthesis of coagulation factors. In the severely bleeding patient with hemorrhagic diathesis heparin is contraindicated because it does not normalize coagulability. Therefore, it fails to stop hemorrhage and shock remains untreatable. Fresh frozen plasma, however, has proved to be suitable as simultaneous substitution therapy of coagulopathy and of hypovolemic shock. 11 patients suffering from traumatic-hemorrhagic shock associated with intravascular coagulation and hemorrhagic diathesis were successfully treated with fresh frozen plasma, after conventional shock therapy had failed over a period of hours.

Blood Preservation↗