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Biomedical subjects

V Bühren

Publications and source records attributed to V Bühren.

At least 19 recordsLinked to original sources
PubMed2002

[Retrograde intramedullary nailing of knee para-articular fractures in paraplegic patients].

INTRODUCTION: Patients with spinal cord lesions suffer injury even by marginal trauma, especially in the area of the knee joint. Because of lost sensitivity and proprioception, the treatment of the fracture has to be minimally invasive but stable enough for physiotherapy. METHODS: There were 18 patients with 20 fractures near the knee: 15 fractures of the supracondylar femur were treated with a retrograde intramedullary GSH nail and 5 fractures of the proximal tibia with a new retrograde nailing technique. RESULTS: At review all patients had a good motion range of the knee joint (> 100 degrees), and ankle joint motion was free. CONCLUSION: We saw in this study that the GSH nail is an excellent method for stabilizing supracondylar fractures of the femur in paraplegic patients because the treatment is minimally invasive and the fracture is stable enough for physiotherapy. The retrograde nailing of proximal fractures of the tibia is a good alternative method for treatment of patients with spinal cord lesions.

Adult↗
PubMed2002

[Development and clinical application of a thoracoscopy implantable plate frame for treatment of thoracolumbar fractures and instabilities].

The evolution of endoscopic spinal approaches and the associated possibilities for stabilization of the anterior column demands a new generation of spinal implants. Of particular interest is the possibility to implant using an endoscopic approach and the ability to achieve real angular stability so that for a suitable injury pattern an exclusively anterior procedure can be carried out. Since November 1999, a new type of anterior plate, MACS TL, developed to meet minimally invasive clinical requirements, has been used in the Berufsgenossenschaftliche Unfallklinik in Murnau, Germany for treating the mid and lower thoracic and lumbar region. The following reports on the results of the first 100 procedures carried out over a period of 15 months, of which 93% were performed endoscopically. The results convey a trend toward anterior endoscopic treatment of injuries of the anterior column using an implant with angular stability. The results now available on healing after fusion indicate the favorable influence of the stability provided by the implants on the bone-healing rate.

Adolescent↗
PubMed2001

[Surgical treatment of injuries of the thoracolumbar transition--3: Follow-up examination. Results of a prospective multi-center study by the "Spinal" Study Group of the German Society of Trauma Surgery].

OBJECTIVES: Prospective, multicenter study addressing late results after operative treatment of acute thoracolumbar spinal injuries. METHODS: 682 patients (T10-L2) were included and 372 (80%) were postoperatively followed for 2 1/4 years (4-61 months). RESULTS: Comparing the initially included patients (n = 682) with the study group (n = 372), no differences were observed and results were assumed to be representative. A C-type lesion or polytrauma significantly prolonged the hospital stay. The method of operative treatment did not affect the length of the rehabilitation period. Neurological improvement was observed in 3 out of 7 patients with complete, and in 44 out of 64 (69%) with incomplete lesion. The operative method did not affect the improvement rate. The physical capacity significantly decreased. After a mean of 1/2 year of disability only 71% returned to work. 48% returned to their preoperative physical level. The mean Hannover Spine Score was 68 points (preoperative 94, p < 0.001), indicating permanent impairment of function. The angle-stable internal fixator was superior in restoration of spinal alignment and best radiological results were noted after combined stabilization. Posterior stabilization lead to high re-kyphosing. No correlations between radiologic and clinical parameters were observed. CONCLUSIONS: All treatment methods under study were appropriate for achieving comparable clinical and functional outcome. The internal fixator is superior in restoration of the spinal alignment. Best radiological outcome is achieved by combined stabilization. Merely by direct reconstruction of the anterior column the postoperative re-kyphosing is prevented and a gain in segmental angle is achieved.

Adolescent↗
PubMed2001

The popliteal region: an anatomical study and a new approach to the tibial attachment of the posterior cruciate ligament.

Surgical treatment of posterior cruciate ligament injuries is gaining more and more importance. The central posterior approach according to Abbott (1945) has been considered a standard, with various complications involved owing to the local anatomic conditions. This study is intended to present a modified dorsomedial approach to the posterior capsule of the knee joint that is better adapted to the anatomic conditions. As a basis, the popliteal region was dissected in 150 knee joints, and the course of the popliteal artery with its branches as well as the bifurcation of the sciatic nerve were identified. The medial joint line served as a reference point. It has been shown that the knee joint arteries and the two sural arteries arose at relatively constant levels. At least one of the meniscofemoral ligaments was found in all of the knee joints examined; the anterior ligament was present in a slightly higher percentage than the posterior ligament. The modified dorsomedial approach to the posterior joint capsule was evaluated in 50 knee joints. Dissection was achieved by blunt division of the medial head of the gastrocnemius muscle, with careful preservation of the proximal vascular supply of that muscle. It was necessary to expose neither the popliteal artery and vein nor the tibial nerve. The tibial attachment of the posterior cruciate ligament could be exposed in every knee. The advantage of the new approach to the posterior cruciate ligament described in this study consists in the preservation of the central neurovascular bundle and the excellent exposure of the tibial attachment.

Aged↗
PubMed2000

[Intramedullary compression nailing of long tubular bones].

The biomechanical principle of intramedullary compression osteosynthesis is based on the implantation of a movable intramedullary nail that is statically interlocked in distal round holes and dynamically interlocked in a proximal slot. Distraction of the nail against the proximal interlocking screw by means of a compression screw leads to a relative movement of the proximal fragment directed distally against the nail. This results in direct contact of the main fragments under increasing compression. Simple fractures, pseudarthroses and osteotomies within the diaphyses of the long bones represent promising indications for the use of compression nailing. Furthermore, this method enables extraordinarily stable knee and ankle arthrodeses. Major positive aspects are controlled adaptation of fragments and a significantly increased stability of the fracture as compared to conventional intramedullary nailing techniques, especially as rotational forces are concerned. The biomechanical advantages result in earlier full weightbearing and an increased rate of fracture union in delayed healing. Given the use of optimized implants and instruments, compression intramedullary osteosynthesis offers a remarkable potential for further improvement in both the spectrum and success of intramedullary nailing.

Ankle Joint↗
PubMed2000

[Surgical treatment of injuries of the thoracolumbar transition. 2: Operation and roentgenologic findings].

The authors report on a prospective multicenter study with regard to the operative treatment of acute fractures and dislocations of the thoracolumbar spine (T10-L2). The study should analyze the operative methods currently used and determine the results in a large representative collective. This investigation was realized by the working group "spine" of the German Trauma Society. Between September 1994 and December 1996, 682 patients treated in 18 different traumatology centers in Germany and Austria were included. Part 2 describes the details of the operative methods and measured data in standard radiographs and CT scans of the spine. Of the patients, 448 (65.7%) were treated with posterior, 197 (28.9%) with combined posterior-anterior, and 37 (5.4%) with anterior surgery alone. In 72% of the posterior operations, the instrumentation was combined with transpedicular bone grafting. The combined procedures were performed as one-stage operations in 38.1%. A significantly longer average operative time (4:14 h) was noted in combined cases compared to the posterior (P < 0.001) or anterior (P < 0.05) procedures. The average blood loss was comparable in both posterior and anterior groups. During combined surgery the blood loss was significantly higher (P < 0.001; P < 0.05). The longest intraoperative fluoroscopy time (average 4:08 min) was noticed in posterior surgery with a significant difference compared to the anterior group. In almost every case a "Fixateur interne" (eight different types of internal fixators) was used for posterior stabilization. For anterior instrumentation, fixed angle implants (plate or rod systems) were mainly preferred (n = 22) compared to non-fixed angle plate systems (n = 12). A decompression of the spinal canal (indirect by reduction or direct by surgical means) was performed in 70.8% of the neurologically intact patients (Frankel/ASIA E) and in 82.6% of those with neurologic deficit (Frankel/ASIA grade A-D). An intraoperative myelography was added in 22% of all patients. The authors found a significant correlation between the amount of canal compromise in preoperative CT scans and the neurologic deficit in Frankel/ASIA grades. The wedge angle and sagittal index measured on lateral radiographs improved from -17.0 degrees and 0.63 (preoperative) to -6.3 degrees and 0.86 (postoperative). A significantly (P < 0.01) stronger deformity was noted preoperatively in the combined group compared to the posterior one. The segmental kyphosis angle improved by 11.3 degrees (8.8 degrees with inclusion of the two adjacent intervertebral disc spaces). A significantly better operative correction of the kyphotic deformity was found in the combined group. In 101 (14.8%) patients, intra- or postoperative complications were noticed, 41 (6.0%) required reoperation. There was no significant difference between the three treatment groups. Of the 2264 pedicle screws, 139 (6.1%) were found to be misplaced. This number included all screws, which were judged to be not placed in an optimal direction or location. In seven (1.0%) patients the false placement of screws was judged as a complication, four (0.6%) of them required revision. The multicenter study determines the actual incidence of thoracolumbar fractures and dislocations with associated injuries and describes the current standard of operative treatment. The efforts and prospects of different surgical methods could be demonstrated considering certain related risks. The follow-up of the population is still in progress and the late results remain for future publication.

Adolescent↗
PubMed2000

Vascularised knee joint transplantation in man: the first two years experience.

OBJECTIVE: To describe our early experience with a new technique for restoring destroyed knee joints to give reasonable functional results. DESIGN: Observational clinical trial. SETTING: Level-1-Trauma centre, Germany. SUBJECTS: 5 patients with large bone defects of the knee and loss of the extensor apparatus caused either by serious injury alone, or infection after serious injury. INTERVENTIONS: Transplantation of fresh and perfused knee joints with a vascular pedicle from multiorgan donors under immunosuppression. MAIN OUTCOME AND MEASURES: Ability to walk, need to remove one transplanted joint. RESULTS: Four patients are able to walk, the range of movement being from 50 degrees-120 degrees. The first patient additionally had to be provided with a total knee joint arthroplasty. In the third patient the graft became infected and had to be removed. She finally had an arthrodesis and bone lengthening by the Ilizarov technique. CONCLUSIONS: Transplantation of the knee joint may be an alternative to bone lengthening or amputation for patients with total loss of the extensor apparatus.

Adult↗
PubMed1999

[Surgical management of tetraplegia].

The traumatic lesion of the cervical cord implies one of the most serious sequale after accident with severe consequences for lifetime. In patients with a relevant injury of the cervical spine in 28% neurological deficits are seen with an even higher incidence of 44% in the lower cervical spine. The risk of traumatic cervical cord injury further increases with progressing stenosis of the spinal canal and therefore a second peak of occurrence has to be observed in the elderly. In the preclinical phase even suspicion of a cervical cord lesion should lead to effective stabilization of the cervical spine and should be removed only after imaged proof of integrity. A high dosage therapy of methylprednisolon should be started as early as possible in every case of spinal cord injury. Diagnostic procedures are including x-rays of the whole spine, CT-scans for clearance of suspicious findings and pre-operative planning, image intensifiing under controlled stress for hidden instabilities and MRI for spinal cord injuries without abnormal radiological findings. Aims of operative treatment are consisting of decompression, reduction and stabilization with the aims of protection of the neurogenic structures and to secure intensive care treatment. These objectives can be met sufficiently by a single ventral approach in most instances. Dorsal approaches should be avoided whenever possible leaving the important innervation of the paracervical muscles intact. The postacute phase is marked by loss of systemic control mechanis as a consequence of the spinal shock. The consecutive deficits can be mastered only by treatment under intensive care standards. Respirator therapy is advisable especially for higher plegic lesions. Typical complications are frequent and should be watched for carefully because of the absence of pain sensation. Patients with cervical cord injuries should transferred to specialized paraplegic units for early rehabilitation as soon as possible since the rate of specific complications like decubital ulcera increases with the days of stay in non-specialized units.

Aged↗
PubMed1999

[Allogeneic vascularized transplantation in cases of bone and joint defects].

This paper presents preliminary results of allogeneic vascularized transplantations of three femoral diaphyses and four total human knee joints. Grafts were harvested from multi-organ-donors and immediately transplanted. Osteosyntheses were performed employing intramedullary nails. Vascular pedicles of the grafts were anastomosed in end-to-side technique. Immunosuppression mainly based on Cyclosporine and Azathioprine. Grafts' perfusion was demonstrated by DSA and Duplex-sonograms, bone metabolism by SPECT-scintigraphy. Five months following transplantation osteotomies demonstrated consolidation in conventional X-rays. Biopsies of the grafted bone revealed intact osteocytes and arthroscopy demonstrated intact synovial, chondral and ligamentous structures. From the technical aspect vascularized transplantation of the femoral diaphyses and total knee joints is feasible. The main problems are of immunologic nature. Transplantations were performed respecting the ABO-compatibility but with a large HLA-mismatch. Acute and chronic rejection crises may damage the grafts. At least in synovial joints live-long immunosuppression of the recipients seems to be unavoidable.

Adult↗
PubMed1999

[Surgical treatment of injuries of the thoracolumbar transition. 1: Epidemiology].

The authors report on a prospective multicenter study with regard to the operative treatment of fractures and dislocations of the thoracolumbar spine. 18 traumatologic centers in Germany and Austria, forming the working group "spine" of the German Society of Trauma Surgery, are participating in this continuing study. Between September 1994 and December 1996 682 patients (64% male) with an average age of 39 1/2 (7-83) years were entered. The entry criteria included all patients with acute and operatively treated (within 3 weeks after trauma) fractures and dislocations of the thoracolumbar spine (Th 10-L 2). Part 1 of this publication outlines the protocol and epidemiologic data. The incidence of fractures and dislocations of the thoracolumbar spine and associated injuries were recorded according to a standardized protocol, as well as the different operative methods and complications, duration of hospital stay, rehabilitation and incapacity. The analysis of the clinical social and radiological course was a second focus. The most frequent mechanism of injury was a fall (50%) or traffic accident (22%). Most of the fractures occurred at the L 1 level (49%). All injuries were classified according to the ASIF (AO) classification. 65% sustained an A-type fracture (compression fracture). Associated injuries were observed in 35% and 6% were polytraumatized. Extremities and thorax were most frequently affected. Younger age and traffic accidents lead more often to C-type fracture (fracture dislocation) and polytrauma. An increased number of multisegmental or multilevel lesions were observed in polytraumatized patients. There were 16% with incomplete paraplegia (Frankel/ASIA B-D) and 5% with complete paraplegia (Frankel/ASIA A). The rate of patients with initial neurologic deficits significantly increased with the severity of spinal injury according to the Magerl classification. Until discharge a neurologic improvement (at least 1 Frankel/ASIA grade) was observed in 32% of the partially paralyzed (Frankel/ASIA B-D) and in 12% of the patients with complete paraplegia (Frankel/ASIA A). A neurologic deterioration occurred in 3 patients (0.4%). As a base for further follow-up and late results the individual starting point was determined by collecting relevant data of the patients' history: 277 (40.6%) patients suffered from simultaneous diseases, one half was spine related. At the time of injury 559 (82.0%) patients were employed; 429 (62.9%) doing manual work. 369 (54.1%) patients stated sportive activities before the injury and 561 (82.3%) designated their "back function" as normal. For the time before injury the patients scored an average of 93.4 points in the Hannover Spine Score (0-100 points concerning complaints and function of the back/spine).

Adolescent↗
PubMed1999

[Thoracoscopy-guided management of the "anterior column". Methods and results].

Anterior thoracoscopic interbody stabilization and fusion was performed in 163 patients. Lesions treated were located between T4 and L3, most frequently occurring at T12/ L2. Operative time decreased dramatically as experience was gained with the procedure. 2 patients early in the series successfully were converted to an open procedure. One positioning related pressure harm on the thoracodorsal nerve and one irritation of the L1 root at the entrance site were both transitory. Postoperative control by X-ray and CTscan showed correct positioning of the bone graft, as well as the fixation device in all patients. Our experience with this minimally invasive procedure demonstrated the feasibility of the method. Major advantages compared to the open procedure are reduced morbidity of the approach, postoperative pain reduction, early recovery of function and shortened hospital stay.

Diaphragm↗
PubMed1999

[Therapeutic concept for injuries of the lower cervical spine].

Over a period of two and half years, the Spinal Surgery Working Group of the Deutsche Gesellschaft für Unfallchirurgie (German Association for Trauma Surgery) DGU has carried out a prospective study of relevant injuries of the cervical vertebral column in 544 patients. The lower section C3 to Th1 of the cervical vertebral column was affected in 308 cases (56 per cent). The injuries of the cervical vertebral column were caused primarily by accidents in road traffic and in the pursuit of recreational activities. More than half of the patients had multiple injuries. The share of degenerative concomitant changes as a cause for relevant injuries increased with age considerably. In case of a qualified trauma with the suspicion of an injury, the immobilisation of the cervical vertebral column has to be retained until the X-ray diagnosis inclusive of a computer tomography has been completed as this is obligatory for the clarification of suspected findings or for pre-operative planning, respectively. The diagnostic range is complemented by guided function imaging to reveal instabilities, and magnetic resonance imaging, which has to be carried out in case any X-ray pathology is absent and neurological functional deficit exists. Patients with neurological deficits, which were found in 43 per cent of the cases suffering from injuries of the lower cervical vertebral column, should be treated as quickly as possible with a high dose of methyl prednisolone. A recovery of the neurological abolition by at least one ASIA level was observed in 10 per cent of the patients concerned. A conservative therapy with a cervical collar was pursued in 24 per cent of the cases with stable injuries. An operative treatment indication, which was diagnosed in 76 per cent of the cases, aims at the early recovery of the anatomy with decompression of the spinal cord, reposition, and stabilisation of segments concerned. The point of the operation was determined by the neurological status, the existing dislocation, and the increasing instability as well as the concomitant injuries. Positioning necessary for intensive medical interventions required an early stabilisation of the spinal column. The front access with plate spondylodesis as a standard procedure with various special implants has proved to be safe and reliable in the healing result. Dorsal accesses shall remain reserved for definable individual indications and should be prevented in case of injuries of the cervical medulla, if possible, to spare the cervical muscles.

Accidents, Traffic↗
PubMed1998

[Endoscopically controlled division of the diaphragm. A minimally invasive approach to ventral management of thoracolumbar fractures of the spine].

On 90 patients with 93 unstable fractures of the thoracic spine and the thoracolumbar junction we treated by a minimal invasive procedure between may 1996 and april 1998, in 46 patients an endoscopic splitting of the diaphragm was performed. The diaphragma was dissected at its attachment at the spine and the adjoining costal base. After partial corporectomy and discectomy, a tricortical bone graft has been inserted. An additional stabilization was done by using a plate and screw system. The incision of the diaphragm was closed by suturing or using an universal endostapler. Controlling the postoperative results a complete closure of the incision was documented by X-ray and CT-scan. There was no conversion to the open procedure or postoperative infection. Splitting the diaphragma opens also the thoracolumbar junction to a minimal invasive treatment and stabilization of fractures.

Adult↗