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V Muzík

Publications and source records attributed to V Muzík.

9 recordsLinked to original sources
PubMed2005

[Arthroscopy of the hip joint].

PURPOSE OF THE STUDY: Arthroscopic examination of joints has recently gained wide application. Due to hip joint shape and a difficult approach to it, hip arthroscopy has long remained outside the attention and abilities of arthroscopists. The authors present their first experience with operative hip arthroscopy that offers new options for the treatment of intra-articular pathology of the hip joint. MATERIAL: In the years 2001-2003, 24 hip arthroscopies were performed. The following pathological conditions were diagnosed and treated: loose bodies, chondral lesions of the femoral head and acetabulum, ruptures of the labrum acetabuli and ligamentum teres, impingement syndrome of the labrum acetabuli, and coxitis. No post-operative neurologic symptoms or vascular complications were observed. METHODS: All procedures were carried out on patients in a supine position, with the treated joint in traction. A standard 30 degrees device and common instruments for arthroscopic surgery were used. The instruments were inserted in the articular fissure with the use of an X-ray intensifier. Movement in the hip joint during surgery is very limited due to traction, joint shape and the length of working canals. After traction is released, it is possible to examine also the intra-articular part of the femoral neck. RESULTS: The pre-operative complaints (clunking, painful joint) were relieved up to 4 to 6 weeks after surgery in 23 patients. In one patient primarily diagnosed with coxitis, infection was not eradicated after lavage and debridement and, because inflammation deeply affected the femoral head, the hip was eventually treated by Girdlestone arthroplasty. The results were evaluated clinically and on the basis of the Merle d'Aubigne and Postel questionnaire assessing pain and walking abilities by both the patients and the surgeon. All 24 patients reported poor or average conditions before surgery and, after surgery, 23 experienced improvement to a very good or average condition. One patient's state failed to improve and was evaluated as poor both before and after surgery. DISCUSSION: Hip arthroscopy is a minimal invasive technique which allows us to diagnose and, at the same time, treat intra-articular pathology in a gentle manner. In arthroscopic surgery, correct diagnosis (X-ray, CT and MRI), correct patient's position, their body mass (obesity), selection of appropriate approaches to the joint, surgeon's experience and potentials of arthroscopic instruments all play an important role. We assume that, with increasing experience, the number of patients as well as the scope of diagnosed and treated pathological conditions of the hip joint will grow. The outcomes of operative arthroscopy were very good (improvement in 23 of 24 patients) and it is probable that this technique can slow down or prevent early wear-and-tear hip arthritis. CONCLUSIONS: In our country, operative arthroscopy of the hip is only at its beginning. However, it can be assumed that, similarly to other large joints, it will soon become a widely used, indispensable diagnostic and therapeutic method.

Arthroscopy↗
PubMed2005

[Arthroscopic stabilization of the fractured intercondylar eminence].

PURPOSE OF THE STUDY: The authors present the results of arthroscopic reduction of a displaced fracture of the intercondylar eminence and stabilization of the fracture with a tension band wire and absorbable, double PDS sutures. MATERIAL: In the years 1998 to 2002, a fracture of the intercondylar eminence was arthroscopically diagnosed in 34 patients, 21 women and 13 men in the age range of 17 to 46 years. Five patients had type I fracture, 13 had type II fracture and 16 had type III fracture, as classified by the Meyers and McKeever system. Arthroscopic stabilization was used for all type II and type III fractures in a total of 29 patients. Double PDS sutures no. 1 were always applied. One double PDS loop was used in eight patients and, in the rest, two or three double PDS loops were employed. METHODS: PDS no. 1 sutures were inserted, by means of wire loops, through bone tunnels. These were drilled with 2-mm Kirschner's wires, using an anterior cruciate ligament (ACL) reamer, medial to the tibial tuberosity. Double PDS sutures were applied to the distal portion of the ACL, which permits good stabilization even in comminuted fractures of the eminence. The strength of a double PDS loop is sufficient and facilitates speedy recovery. Before terminating surgery it is necessary to check joint mobility and fixation stability. Only good stability allows for early mobilization of the joint. The postoperative treatment involved immobilization of the knee joint with a rigid brace in a semi-flexed position at 20 degrees for 6 weeks. However, from the second postoperative day, the brace was removed during targeted rehabilitation. Exercise on a continuous passive motion device, strengthening of the thigh muscles, patellar mobilization, walking with the use of crutches, while wearing the brace, with partial weight bearing until pain were practised. A treadmill without loading was used from the fifth postoperative week. RESULTS: Twenty-nine patients in whom stabilization with PDS sutures was used were evaluated. Of them 26 were completely free from any complaints and fully healed, always without findings of displacement on X-ray. In one patient, a fragment of the comminuted fracture was loosened and interfered with full extension. It was removed by arthroscopy and full recovery without consequences ensued. One patient underwent repeat surgery for hematoma in the wound; after wound healing and rehabilitation, he achieved a full range of motion. One patient showed signs of fibrosis of Hoffa's fat pad. All patients returned to the style of life as before injury. At follow-up of 1 to 4 years, Lysholm scores were excellent in 23 patients, very good in four patients, satisfactory in one patient (repeat surgery) and one patient was not examined. DISCUSSION: Fracture of the intercondylar eminence is caused by a mechanism similar to that causing rupture of the anterior cruciate ligament but, in addition, the margin of the intercondylar fossa is pressed against the eminence which breaks off. Displaced fractures (types II and III according to the Meyers and McKeever classification) are indicated for surgical stabilization. Fixation of the fractured eminence by means of absorbable material is sufficient, and insertion of metal material and its subsequent removal thus can be avoided. Arthroscopic inspection permits exact reduction; this procedure is minimally invasive. CONCLUSIONS: Arthroscopic stabilization of a fractured eminence by means of PDS sutures is a gentle surgical procedure that provides good mechanical support, facilitates early rehabilitation and achieves good outcomes. The use of absorbable sutures allows us to avoid further surgery in order to remove fixation material.

Adolescent↗
PubMed2004

[Isolated fractures of the atlas].

PURPOSE OF THE STUDY: To present the current tends in the diagnosis and management of isolated atlas fractures based on the retrospectively evaluated group of patients with this trauma. MATERIAL: In the period from 1995 to 2002, we treated 486 injuries to the cervical spine at our department. Out of these, 19 patients sustained an isolated fracture of the first cervical vertebra. This group consisted of 12 men and seven women; the average age was 46.6 years. Neurological findings in 18 patients were classified as Frankel E and, in one, as Frankel A. The causes of injury included a fall from height in five patient, a fall in the street in five pedestrians, a car accident in five patients, a dive into shallow water in three and a shooting injury in one patient. METHODS: We treated 16 patients conservatively, using a halo-vest in eight patients and a Philadelphia collar also in eight patients. In two patients with unstable atlas injury, we carried out C1-C2 transarticular stabilization according to Magerl. In the patient who had been shot, we removed the bullet transorally. RESULTS: All patients healed completely without signs of instability. One patient with postraumatic pentaplegia, who died within 24 h of surgery due to septic shock, had not been included in the follow-up. Two patients reported neck pain at rest, three after exercise and 13 were without any pain. The patient after C1-C2 transarticular stabilization had a significant restriction of the range of motion in the cervical spine; the rest of the patients were without limitation. None of the patients showed any deterioration of neurological findings during the treatment, nor was any post-traumatic atlantoaxial instability recorded after the therapy was completed. DISCUSSION: Isolated fractures of the atlas account for 1 to 2% of all spinal fractures. Many fractures may remain unnoticed and, therefore, it is important to X-ray patients with a symptomatic injury to the cervical spine in three standard projection planes (anteroposterior, lateral and transoral). When a fracture of the atlas is suspected, it is necessary to examine them by computed tomography to obtain a more accurate presentation of fracture lines. Views on the method of treating isolated fractures of the atlas, particularly unstable ones, are not consistent. CONCLUSIONS: Isolated fractures of the first cervical vertebra, in terms of therapy, are stable and unstable. Stable fractures heal within 8 to 12 weeks. A Philadelphia collar or halo-vest provide sufficient immobilization. Surgical stabilization or a halo-vest immobilization for a period of 12 weeks are recommended in unstable injuries that are characterized by the lateral mass displacement of more than 7 mm or extension of the space before the dens (predental space) by more than 3 mm, or in which magnetic resonance imaging demonstrated injury to the transverse ligament. After the halo-vest removal, it is necessary to perform functional examination of the cervical spine for detection of potential atlantoaxial instability.

Adolescent↗
PubMed2004

[Traumatic atlanto-occipital dislocation].

The authors present two cases of survival after atlanto-occipital dislocation (AOD). Atlanto-occipital dislocation is in majority of cases lethal and only rarely compatible with life. AOD is often missed mainly in polytrauma in unconscious patients when the life endangering injury detracts attention from the examination of the upper cervical spine. The authors point out to the fact that with the improvement of the work of the rescue service and a fast transport of the patient to the hospital the number of these injuries may be expected to grow.

Adult↗
PubMed2004

[Injuries to the lower cervical spine].

PURPOSE OF THE STUDY: The authors present a retrospective evaluation of a group of patients with injury to the lower cervical spine. The aim of the study is to show current trends in the diagnosis and treatment of this trauma. MATERIAL: Between 1995 and 2003, 363 patients with trauma to the lower cervical spine were treated in our clinic. They included 63 women and 300 men, who fell into age categories as follows:14-19 years, 52 patients; 20-29, 108 patients; 30-39, 76 patients; 40-49, 57 patients; 50-59, 40 patients; 60-69, 22 patients; over 70, 8 patients. Neurological findings were classified as Frankel A in 109 patients, Frankel B in 24 patients, Frankel C in 19 patients, Frankel D in 12 patients and Frankel E in 199 patients. The trauma was due to a car or motorcycle accident in 183 patients, a fall from a height in 67 patients, a dive in water in 57 patients, a fall of the pedestrian in 47 patients and other causes in 9 patients. According to the level of the vertebra injured, fractures of the fifth cervical vertebra and the C6/7 segment were most frequent; fractures of the C7/T1 segment were least frequent. The AO classification showed type A injury in 22 %, type B in 23 % and type C in 55 % of the patients. METHODS: Conservative treatment was carried out in 100 patients, of whom 56 had a halo vest and 44 received a Philadelphia collar. Surgery was performed in 463 patients, most of whom, i. e., 246 patients, were treated from the anterior approach. Monocortical stabilization was used in 228 patients, bicortical fixation in 18 patients. Fifteen patients were treated from the posterior approach and two patients underwent a combined two-stage treatment. RESULTS: In the group of 263 patients treated surgically, there were several complications. Injury to the recurrent laryngeal nerve were recorded in nine patients, an abscess in the operative wound following the anterior approach developed in one patient and a hematoma of the anterior operation wound requiring revision surgery occurred in two patients. Complications involving implants were the following: fracture of the anterior plate in one patient, failure of anterior plate fusion in two patients, failure of posterior plate fusion in one patient and loosening of two anterior, bicortically inserted screws in one patient. Pseudoarthrosis was recorded in one patient with a fracture of the cervical spine locking plate. In the remaining patients (99.8 %) bony union was achieved by 6 months. Of the 363 patients, 164 had a medullary lesion; of these 17 died. Sixteen were classified as having Frankel A lesions and one having a Frankel B lesion. The cause of death was unrelated to the operation. Six patients with neurological deficit were transferred abroad. A patient diagnosed by the neurologist as Frankel A remained included in this group, although an improvement in his neurological status suggested an incomplete medullary lesion. Of the 141 patients with neurological deficit who were followed up for more than one year, 60 showed an improvement in neurological findings. DISCUSSION: The treatment of fractures of the lower cervical spine aims a decompression of the affected nerve structures and at restoration of the correct position and stability of the cervical spine. It is predominantly performed from the anterior approach; the posterior approach is used less frequently, only when indicated. CONCLUSIONS: The diagnosis of injuries to the lower cervical spine is based on the medical history, X-ray images in three basic projections and a CT scan. The necessity of a pre-operative MRI examination has recently been discussed. The use of the anterior approach in treatment of the injured lower spine is safe and effective. It allows us to carry out decompression as well as insertion of a graft and plate under direct visual control. It is associated with a minimum of complications and a high probability of bony fusion. Only immediate decompression will facilitate the regeneration of an injured spinal cord. Key words: cervical spine, spinal injury, anterior fixation.

Adult↗
PubMed2003

[Traumatic spondylolisthesis of the axis].

PURPOSE OF THE STUDY: The study presents a group of patients with traumatic spondylolisthesis of the axis. Views on the treatment of different types of spondylolisthesis vary. The aim of this study was to carry out a retrospective evaluation of the group of patients with this traumatic condition. MATERIAL: In the period from 1995 to 2002, 26 patients with traumatic spondylolisthesis of the axis were treated. They accounted for 5% of all patients admitted to our department for cervical spine injuries. Three types of traumatic spondylolisthesis were distinguished according to the Effendi classification. Type I was diagnosed in seven, type II in 18 patients and type III in one patients. METHODS: Type I traumatic spondylolisthesis was, as a rule, treated conservatively. A halo vest was used in four and a Philadelphia collar in three patients. Patients diagnosed with type II spondylolisthesis were treated surgically from the anterior approach (16 patients) or with a halo vest (two patients). The only patient with a type III fracture was operated on from the anterior approach. RESULTS: Osseous healing was achieved in all patients. No pseudoarthrosis developed and no repeat surgery for infection or osteosynthesis failure was needed. No deterioration of neurological findings was recorded. The range of motion in the cervical spine after healing was not affected. DISCUSSION: Views on the classification and therapy of traumatic spondylolisthesis of the axis are diverse. The greatest diversity is associated with making a decision on whether the injury is unstable and requires surgical treatment or not. Further arguments are related to the use of the most suitable approach. Treatment from the anterior approach is prevailing. Type III fractures are rare and must always be treated surgically. CONCLUSIONS: Methods for treatment of traumatic spondylolisthesis of the axis are currently a topic of dispute. The decisive factor for therapy is whether the injury is stable or unstable. When instability is present, anterior C2-3 spondylodesis completed with plate osteosynthesis is the method of choice. Stable injuries are treated by the application of a halo vest or Philadelphia collar.

Adolescent↗
PubMed2002

[A less invasive retropleural-retroperitoneal approach to the thoraco-lumbar spine].

UNLABELLED: Authors describe the technique of anterior less invasive approach to the treatment of thoracolumbar spine. The advantage of the mentioned approach is the treatment of the anterior spinal column without opening the thoracic cavity. MATERIAL: In the period between 1996-2000 the described method was used in 46 patients. The average age of patients was 49 years (range, 22 to 67 years). There were 30 men and 16 women. Most frequently affected was L1-fractures in 29 patients, Th12 was handled in 16 patients and Th11 only in one case. METHOD: The surgical technique is based on the anterior approach to thoracolumbar spine without opening of the pleural cavity. RESULTS: The evaluation included 46 patients. The surgical time ranged between 100 minutes and 180 minutes. Blood losses ranged between 300 and 2000 ml. Pleural cavity was opened in three cases. Thoracic drainage was not applied in any patient from the followed-up group. Neither preoperative nor postoperative complications were recorded. In all cases allograft was used without complications. DISCUSSION: The described method is one of the possibilities of treating the anterior spinal column in the region of thoracolumbar spine in addition to the classic Hodgson approach or thoracoscopic treatment. CONCLUSION: In the given group of patients the authors' department introduced the treatment of the anterior column of thoracolumbar spine without opening pleural cavity and without the necessity of draining the thoracic cavity. It is a less invasive method as compared to the classic Hodgson approach. The alternative to the treatment of the anterior spinal column in the thoracolumbar region is the thoracoscopic method.

Adult↗