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Biomedical subjects

V Stĕdrý

Publications and source records attributed to V Stĕdrý.

At least 19 recordsLinked to original sources
PubMed2004

[Bilateral ankylosing paraarticular ossifications of the hip joint with involvement of the sciatic nerve].

In December 1997 a 48 year-old man was treated by resection of the bilateral paraarticular ankylosing ossifications that developed after 6 weeks of unconsciousness after necrotic pancreatitis. The ossifications on the posterior part of the hip joint involved a highly separated sciatic nerve. There was a bilateral osseous ankylosis of the hip joint and total denervation of sciatic nerve. In April 1999 the ossifications on the right side were removed. The splitted sciatic nerve was in two osseous channels. The head of the femur was vital and immediately following the operation, flexion of the hip joint was possible to 90 degrees. The same procedure was performed on the left hip joint in October 1999. In April 2000, a re-occurance of the paraarticular ossification on the ventral part of the right hip joint was removed from an ilioinquinal approach. In June 2002 the patient was able to stand and walk without crutches. ROM of the knee joints improved bilaterally to 120 degrees of flexion. The flexion of the right hip joint is 70 degrees and in the left hip is 80 degrees. 3 years after decompression of both sciatic nerves involved in heterotopic bone established significant reinervation. The motor function of the proximal femoral muscles and the function of the tibial nerve was renewed. Complete motor denervation syndrom persists in common peroneal nerve. Sensitive inervation was renewed as in n. tibialis as in common peroneal nerve except acral parts of the foot a toes. Concerning function of the sciatic nerves, the overall results can be assessed as partially succesfull because of partial denervation syndrome of sciatic nerves. In definite clinical improvement the recovery of the neurologic status is very important besides the mechanical improvement of range of motion of the hip joint.

Ankylosis↗
PubMed2003

[Initial experience with implantation of the cemented Beznoska/S.V.L. total knee joint endoprosthesis].

PURPOSE OF THE STUDY: The authors present the results of their first trial of a new, Beznoska/S. V. L. type, knee prosthesis in order to introduce it to a broad orthopedic public. MATERIAL: Clinical and radiological evaluation was carried out on 34 knee prostheses implanted in 31 patients between September 1997 and October 1999. The average patient age at the time of surgery was 71.3 years and the average interval between surgery and assessment was 22.4 months (range 6 to 31 months). All patients underwent implantation due to primary or secondary gonarthosis. A brief description of the implant and the instrumentation and used surgical technique is provided. METHODS: Clinical outcomes were evaluated according to the "Knee-Society Clinical Rating System" by John N. Insall. The system classifies both knee joint parameters and knee function. X-ray films were assessed on the basis of the "Knee-Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System" by Frederic C. Ewald. In standardized X-ray projections, this allowed us to evaluate the implant position as well as radiolucent lines. RESULTS: On stability evaluation, we found anteroposterior instability up to 5 mm in 85% of the implants and mediolateral instability up to 9 degrees in 97% of them. A maximum flexion of 90 degrees to 120 degrees was achieved in 91% of the implants. The final outcome in terms of knee score was on average 80.3 points (range, 40 to 97 points), which was a very good result. Evaluation by function score showed that only 17% of the patients were not able to walk farther than 500 meters. Although 82% of them had to hold on a railing when going upstairs, all were able of stair ascent and descent; 13% had to use a walking stick permanently. The average function score was 68.4 points (range, 30 to 100), which was a good outcome. Radiograms in anteroposterior projection, assessed according to Ewald, showed the average femoral flexion angle (alpha) to be 95.2 degrees, the average tibial angle (beta) to be 89 degrees and the total valgus angle (omega) to be 3.2 degrees. In lateral projection, the femoral flexion angle (gamma) was on average 2.5 degrees and the average tibial angle (delta) was 86.7 degrees. An optimal position of the patella was achieved in 27 implants. Five radiolucent lines, up to 1 mm, were found in zone 1 of the femoral component and further lines were observed in zones 1, 2 and 4 of the tibial component. DISCUSSION: When assessing the results by the knee and function scores, it had to be taken into consideration that the average age of the patients was 71.3 years. At this age, walking without a stick, or stair ascent or descent without the use of a railing can hardly be expected. The average result of 68.4 points achieved can, therefore, be considered a very satisfactory outcome. The values shown by X-ray examination were close to the normal condition. The patients were also asked for their subjective opinion of the effect of arthroplasty; 97% of them regarded the effect as good or very good, only one patient reported no benefit. CONCLUSIONS: The results of the first trial of the use of a cemented prosthesis, type Beznoska/S. V. L., in total knee arthroplasty are presented, together with practical recommendations. Although the patient sample was small and the follow-up period short, the results are promising and suggest excellent prospects for this implant.

Aged↗
PubMed2002

[Distal shortening osteotomy of the metatarsals using the Weil technique: surgical treatment of metatarsalgia and dislocation of the metatarsophalangeal joint].

PURPOSE: Weil technique of the distal shortening osteotomy of metatarsal is a relatively new method of the surgical treatment of metatarsalgia and dislocation of metatarsophalangeal (MTP) joints. A retrospective study evaluates the first experience in Weil osteotomy at the authors' department. MATERIAL: Between May 1999 and the end of 2000 twelve patients (14 feet) were operated on in which the Weil technique of the osteotomy was performed on 28 metatarsals. Indication for the surgery was chronic metatarsalgia with dislocation of the MTP joint, with excessive length of one or more lesser metatarsals, with insufficiency of the first ray after the surgery of hallux valgus and metatarsalgia after the resection of the head of II metatarsal. All patients were women, average age of 57 years (range, 50-68 years) at the time of operation. The average follow-up is 9 months (range, 6-24 months). Dislocated prior to operation were 9 MTP joints, in 2 cases a deformity of 2nd digit of the digitus supraductus type was operated on. METHODS: The patients evaluated subjectively the functional and cosmetic outcomes of the surgery. Clinical evaluation related to recurrence or transfer of difficulties to the head of the neighbouring metatarsal, range of motion of the MTP joint, function and grip of the digit. Radiograph was used for the evaluation of the metatarsal index, post-operative shortening of II metatarsal, reduction of dislocation in the MTP joint and healing of osteotomy. RESULTS: Satisfied with the functionla and cosmetic results of the operation were 83% patients (10 of 12). Recurrence of metatarsalgia was not found in any patient, transfermetatarsalgia in one patient. Reduction of the range of motion in the MTP joint (plantar flexion) by more than 50% was recorded in 43% operated on metatarsals and in all metatarsals after the reduction of the dislocation. Acceptable function and strength of the digit evaluated by the ability to press by the digit a sheet of paper against the floor was preserved in most of the operated on metatarsals--86% (24 of 28). Average shortening of II metatarsal was 5.6 mm. All dislocated MTP joints were reduced postoperatively. Dislocation recurred in 2 cases. Avascular necrosis of the head of II metatarsal after the reduction of the dislocation was encountered in one case. DISCUSSION: The small number of recurrences and transfermetatarsalgia proves that Weil osteotomy allowing a controlled shortening of metatarsal with a fixation is a reliable method in the solution of metatarsalgia. The operation directly on the joint allows reduction of the dislocation of the MTP joint. Shortening of metatarsal facilitates reduction and reduces axial pressure in the MTP joint. Recurrence of dislocation is reported between 15% and 22%. After a more difficult reduction and danger of redislocation some authors recommend a temporary transfixation of the MTP joint by K-wire. The disadvantage of the operation is a frequent temporary limitation of the range of motion in the MTP joint which is caused by the opening of the articular capsule and its subsequent contraction. No author reports any problems with the healing of the osteotomy. The results in our group of patients are comparable with the results published by other authors. CONCLUSION: Weil osteotomy allows a planned controlled shortening of metatarsal with a stable fixation. Osteotomy heals well. Osteotomy is intraarticular which on one side provides the possibility to correct dislocation in the MTP joint, however, on the other hand it poses a risk of the limitation of the range of motion of this joint. The main contribution the authors see in the new possibility of surgical treatment of more severe matatarsalgia and deformities of the forefoot with the preservation of joints.

Aged↗
PubMed2001

[Indications for the cementless Zweymuller Bicon cup in acetabular fractures].

PURPOSE OF THE STUDY: The aim of the study is an assessment of short-term results after the implantation of cementless Zweymüller Bicon cup in patients with a complicated anatomy after acetabular fractures. MATERIAL: The group of 10 patients indicated for Zweymüller cementless THR in post-traumatic osteoarthritis after acetabular fracture was selected of the total number of 703 primary implantations performed in 1998 and 1999 at the authors' Orthopaedic Department. The group includes patients treated conservatively as well as by means of open reduction and fixation. METHODS: For the evaluation we used Harris Hip Score and radiographic assessment based on radiographs in two projections on which signs of implant loosening and incidence of particular ossifications were monitored. RESULTS: Harris Hip Score was in 6 cases higher than 90 points, in 2 cases its value was 80 points. The low score in another 2 patients related to the limitation of the function resulting from the trauma and in one case from the injury of sciatic nerve during open reduction and fixation with a subsequent common peroneal nerve palsy. Radiographic check did not reveal any signs of loosening of the implant. Within the evaluation of particular ossifications the finding was 3 times classified in Group 1 and twice in Group 2. DISCUSSION: The number of patients of the authors' group corresponds with the numbers of patients presented in literature, however, due to a short time of the follow-up both clinical and radiographic results in our group are better. In all cases a good primary stability and position of the acetabular cup in the complicated anatomical conditions was obtained. Structural bone grafting was not necessary in any of the cases. Peroperative complications were not encountered. CONCLUSION: Short-term results of our small group of patients are very good. Both in the clinical and radiographic evaluation they correspond with the results of Zweymüller THR performed in patients with dysplastic acetabulum.

Acetabulum↗
PubMed2001

[The Zweymuller endoprosthesis in hip joint revision surgery].

PURPOSE OF THE STUDY: The aim of the study is the verification of the applicability of the Zweymüller system of total hip replacement in dependence on the size of defects of acetabulum and femur and evaluation of early results in patients operated on in 1998 and 1999. MATERIAL: In 1998 and 1999 we reimplanted 125 total hip replacements. In 60 revision surgeries we used at least one component of Zweymüller Bicon Plus system. We prospectively followed defects of acetabulum and femur in DGOT classification. The size of the stem was planned, final indication of the cup was determined peroperatively. METHODS: During the implantation of the cup we tried to achieve primary stability of the implant. The cup was implanted in uni- and bisegmental defects. In total we implanted 50 Bicon cups, in 24 hip joints we applied morselized allograft in the defect. In tri-segmental defects we used twice the Burch Schneider cage and in 4 hip joints a bone allo-graft with a cemented cup in combination with SL-Plus stem. In one female patients after the implantation of Bicon cup in type 7 defect there occurred an early failure. When removing bone cement we preferred fenestration of the cortical bone of the femoral shaft. In 30 hips SL-Plus stem was used and in 13 hip joints SLR-Plus was applied. We checked 50 hip joints operated on by the method after Harris and by radiographs in two projections. RESULTS: Fifteen patients are without pain, 14 patients take analgesics. The final result is excellent in 24% of patients, good result in 32%, satisfactory in 24% and poor in 20% of patients followed up. By comparison with HHS value prior to the surgery HHS got worse in two patients who are not satisfied with the result of the operation. Average score prior to surgery was 47.4 points (range, 23-82.6). Five times we encountered a radioluscent line of acetabular component in zone III. Radiograph signs of loosening of the cup or stem were not found in any of the hip joints. CONCLUSION: Zweymüller system is applicable in revision surgeries of both cemented and cementless hip joint replacements. The cup may be applied in uni-segmental and bi-segmental acetabular defects under the condition of achievement of primary stability. Applied morselized bone allografts have a good potential for osteointegration and remodeling. The rectangular stem is suitable for the treatment of defects extending as far as 5 cm below the level of lesser trochanter. Bone cement was extracted from fenestration, transfemoral approach was not required in any of the patients. Even with the use of SLR (revision) stem we did not transfer fixation of the femoral component to the lower half of femur.

Acetabulum↗
PubMed2001

[Revision of total hip replacement operations at the Orthopedic Clinic IPVZ in Prague, 1999].

PURPOSE OF THE STUDY: The aim of the work is to evaluate the results of revision surgeries of total hip replacements at the Orthopaedic Department IPVZ in 1999. MATERIAL: Revision surgery of 61 THR was performed at the Orthopaedic Department IPVZ in 1999. Most of them (54) were reoperated for aseptic loosening of the cup or both components, 4 patients for aseptic loosening of the stem, 1 patient was reoperated for recurring dislocation of THR and 2 patients for septic loosening. Eleven loosened 44/32 Poldi cups were reoperated on average after 160 months, twelv 49/32 Poldi cups on average after 143 months and seven 54/32 Poldi cups on average after 111 months. Sixteen loosened Walter Motorlet cups were reoperated on average after 111 months, 16 loosened Walter-Motorlet cups were revised on average after 83 months, 3 Martin cups on average after 112 months. Another 4 cementless cups of different provenance were reoperated in the interval of 9-54 months after the primary operation. METHODS: For the revision surgery we used 28 times Zweymüller Bicon cementless cup and in 26 hip joints Poldi cemented cup, in 6 patients we applied structural bone allografts, in 31 patients morselized allografts prepared on a bone mill. For the revision surgery of loosened stems we used in 18 patients Zweymüller SL Plus stem and in 7 patients Zweymüller SLR stem. DISCUSSION: From the viewpoint of long-term results THR implanted in patients with a secondary postdysplastic osteoarthritis is more risky than in the patients with a primary degenerative affection of the joint. It has been proved that also a cemented total hip replacement may bring good long-term results comparable with the results of some cementless implants. CONCLUSION: In most of the patients the primary diagnosis was postdysplastic osteoarthritis of the hip joint. Recently the need has started to grow for revision surgery in patients with loosened modern cementless implants. In revision surgeries the system of cementless THR of Zweymüller type proved suitable. The need for the application of bone allografts was quite frequent.

Aged↗
PubMed1993

Participation of complement in nasal polyposis.

No changes in immunoglobulin (IgG, IgM and IgA) and complement components C3 and C4 levels could be observed in patients suffering from both recurrent and acute nasal polyposis. However, in both groups of patients a significant decrease of the alternative pathway of complement activation (up to 80%) was found. In addition, patients suffering from the acute disease showed even decreased classical complement pathway (up to 20%). Examination of complement activation pathways was shown to be advantageous for the follow-up of the course of this disease.

Acute Disease↗
PubMed1993

[Noncemented revision of femoral hip joint prostheses with severe bone defects (preliminary report)].

The authors present an account of their initial experience with Wagner's non-cemented femoral revision prosthesis of the hip joint. After a brief technical description of the implant the mention the indications and contraindications of they revision shaft. They emphasize the necessity of peroperative planning and describe the surgical technique. Since 1992 they used a revision shaft in five patients (three times in aseptic loosening of a TEP of the hip joint, once during septic loosening and once when treating a periprosthetic fracture with extensive bone destruction). Long-term experience will be the subject of a subsequent paper.

Cementation↗
PubMed1993

[Experience with non-cemented stems in Schenker hip prosthesis].

In 1986-1988 at the Orthopaedic clinic of the Institute for Postgraduate Medical Training 56 stems on non-cemented total endoprostheses of the hip joint type Schenker were implanted. The non-cemented stem was combined in all patients with a cemented socket Poldi. The endoprosthesis was indicated in particular in young patients in 59% in hip joints affected with secondary postdysplastic arthritis of the hip joint. The group was checked by Harris' method, the mean follow-up period in 1992 was 58 months. Of 36 followed up patients 21 operated patients reported pain in the area of the hip joint, 10 patients used analgetics. In nine patients reimplantation of the non-cemented Schenker stem was performed on account of aseptic loosening, in 11 patients the X-ray check revealed obvious signs of aspectic loosening associated with subjective complaints. The dependence of aseptic loosening on the quality of primary implantation is marked. In patients with perfect cortical contact of the stem aseptic loosening developed in 27% of the patients, in patients with inadequate cortical contact aseptic loosening was recorded in 80% of the operated patients. The general evaluation according to Harris comprised 42% excellent results, 30% good results, 14% satisfactory results and 14% poor results. This evaluation does not include patients who on account of pain and loosening of the femoral Schenker component were already re-operated. Because of the considerable number of complications implantation of this type of prosthesis was discontinued at the authors' department.

Adult↗
PubMed1993

[Causes of corrosive mechanical defects in isoelastic endoprostheses].

Within the framework of evaluation of endoprostheses of the hip joint reoperated at the orthopaedic clinic of the Institute for Postgraduate Medical Training, Faculty Hospital Na Bulovce in Prague in the course of six years the authors made a more detailed analysis of the group of isoelastic POLDI endoprostheses which displayed obvious signs of corrosion. The specimens from this group were subjected to evaluation focused on corrosion, metallographic and fractographic evaluation. In impaired wires of isoelastic endoprostheses the fracture surfaces have a fatigue character where a corrosion fatigue mechanism may be assumed as well fracture with a dominant mechanical component of stress. From the analysis of corrosion ensues that the connections of the wire shank with the head of the endoprosthesis are affected by crevice corrosion, the revealed fractures and cracks are most probably associated with corrosion fatigue. The construction of isoelastic prostheses of this type is the cause of corrosion processes which lead to mechanical failure. This should be the reason to refuse them for patients of any age group.

Corrosion↗
PubMed1993

[Technical problems in reoperation of hip joint prostheses].

At the Orthopaedic Clinic of the Institute for Postgraduate Medical Training in the course of 10 years (1979-1989) 2340 primary implantations of total endoprostheses of the hip joint were performed. During the same period 168 total endoprostheses of the hip joint and 20 cervico-occipital prostheses were reoperated. The most frequent reason for reoperation was aseptic loosening of the acetabular component. The mean period between operation and reoperation in these patients was 98 months. In the group with loosening of the socket associated with mechanical destruction of the component the mean period which had elapsed since the primary operation was 43 months. In 87% small size sockets were involved. The most serious problem of reoperation of total endoprostheses of the hip joint is replacement of bone defects. During reoperation of acetabular components an isolated defect on the floor of the acetabulum was found in 26%, a defect of the margins in 38% and a combined defect of the margins in 26% of the patients. For treatment of the defects the authors used bone grafts in the majority allogenic grafts were involved which were used to reconstruct the margins and floor of the acetabulum. Metal implants should hold the bone grafts in the desired position and should not serve as a skeleton. Reoperation of the acetabular part of total endoprostheses of the hip joint is easier from the technical aspect; in defects of the upper portion of the femur it is essential to use a very careful procedure and to preserve the skeleton to a maximal extent.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1991

HLA and venous thrombosis: a prospective study.

The frequency of venous thrombosis diagnosed by the fibrinogen uptake test and ultrasound in relation to HLA typing was examined in a prospective study of 154 patients undergoing total hip replacement. The results demonstrate an association between venous thrombosis and the presence of HLA Cw4 and B35 (being in a linkage disequilibrium with Cw4) (Cw4 34.4% and B35 27.3%, relative risk 2.531 and 1.935 respectively). These results suggest that the presence of HLA Cw4 can be regarded as one of laboratory risk factors of venous thrombosis.

Adult↗
PubMed1990

[Traumatic indications for total hip joint prosthesis].

In the years 1978-1986 the authors implanted 207 total prostheses in patients with the fracture of the femoral neck or after the fractures in the area of the hip joint. 50 patients were operated on for an acute fracture of the neck. The surgical technique in these indications does not differ on principle from the surgical technique of coxarthrosis. They point out a higher number of some peroperative complications. They checked 141 patients with and average follow-up of 47 months. In 4.2 per cent of late complications they reported roentgenological symptoms of loosening. Reoperation because of the loosening of the acetabular component was inevitable in 2.9 per cent of patients. All these cases fall into the group of patients in which the total hip arthroplasty was performed after the fractures of the acetabulum. In no patient it was necessary to reoperate the femoral component. Within the check up the patients underwent roentgenological examination and the result was assessed by the method according to Harris. In total, excellent result was reported in 43.2 per cent of patients, good result in 29.8 per cent, fair result in 14.2 per cent and poor result in 12.8 per cent of patients. With regard to a low number of complications and very good results of the evaluation according to Harris the authors consider total hip arthroplasty in the treatment of post-traumatic conditions for fully indicated. Total hip arthroplasty is indicated also in acute fractures of the femoral neck in which it brings in a short time interval good functional results with minimum complications. A group at risk is represented by patients operated on after the fractures of acetabulum.

Aged↗
PubMed1990

[Manifestations of epidermolysis bullosa in the deglutition tract].

An account of a rare mucosal form of epidermolysis bullosa dystrophica in a 26-year-old female patient. The mucosal manifestations involved severe stenosis of the oral portion of the oesophagus. After exhausting all conservative therapeutic procedures (corticoids, transfer factor, dilatation), the stenosis of the oesophagus was successfully operated by resection of the stenotic portion and a plastic operation.

Adult↗
PubMed1990

[Electromyographic findings in the gluteal muscles in the Watson-Jones and the Bauer surgical approaches to the hip joint].

The authors have made electromyographic examination of m. tensor fasciae latae and m. glutaeus medius and sometimes also minimus in patients after the implantation of total endoprosthesis of the hip joint by anterolateral Watson - Jones approach and transgluteal Bauer approach with the aim to find out if there occurs the anticipated transection of n. glutaeus usp. and dennervation of m. tensor fasciae latae and compare from this viewpoint both approaches. The examination was performed in 18 patients after the implantation of 20 total endoprostheses of the hip joint (out of which 10 hip joints were operated on by Watson - Jones approach and 10 by Bauer approach) in the period of 6-20 weeks after operation. In the examination concentric needle electrodes and NEUROMATIC 2000 C device (produced by DANTEC Co.) were applied. It was found out that the transection of n. glutaeus sup. is inevitable in neither approach. In patients operated on by Watson-Jones approach there occurred only twice complete transection of the nerve with the dennervation of m. tensor fasciae latae, six time incomplete interruption of the nerve and twice the finding in m. tensor fasciae latae was normal. In patients operated on by Bauer approach complete transection of n. glutaeus sup. was found out six times and incomplete interruption of this nerve four times. Thus from this viewpoint Watson-Jones approach is more considerate. Moreover, in Bauer approach eight times there occurred partial interruption of the innervation of the ventral portion of m. glutaeus medius. Consequently, the study has not proved the assumption that both approaches must necessarily result in complete transection of n. glutaeus sup.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Comparison of treatment of juvenile bone cysts using local administration of corticoids and surgical therapy].

The authors describe the results of the juvenile bone cyst in the group of 41 patients by the method of the application of corticoids and compare them with the results of the therapy by means of excochleation and filling the cavity of the cyst with bone grafts. In the therapy by corticoids restitutio ad integrum was achieved in 37.8 per cent and in 43.2 per cent of patients the healing was incomplete. In 5.5 per cent of cases there occurred recurrence after the cyst was healed, in 13.5 per cent there was no response to the application of corticoids. In the groups of surgically treated patients the cyst was healed in 68.8 per cent, out of which 48 per cent was restitutio ad integrum. The number of recurrence was relatively high--31.2 per cent. Both methods have their place in the therapy of bone cysts. The surgical approach makes it possible to achieve more quickly restitutio ad integrum in extensive bone cysts located at lower extremities. For the cysts affecting the humerus the method of choice is the local application of corticoids. In the therapy by steroids the authors the necessity of regular control and in case of the survival of the cyst the necessity of repeating the instillation of the steroid.

Adolescent↗
PubMed1987

[Diagnostic contributions to the tympanometric study of malignant nasopharyngeal processes].

Extensive studies in areas of high prevalence of nasopharyngeal carcinoma have demonstrated that the most frequent site of origin is Rosenmuller's fossa. Even a small tumour may cause changes in the lumen of the orifice of the Eustachian tube either because of compression or because of a growth of the tumour directly into the lumen of the tube. This causes various wellknown disorders which are frequent initial signs and symptoms of the disease. Initially, subjective symptoms and signs are not accompanied by objective pathological findings except for a pathological tympanogram. The present method of tympanometric examination offers the possibility of detection of several initial stages of nasopharyngeal carcinoma, and combined with nasopharyngoscopy proves to be a very useful complementary examination to serology, biopsy and molecular-biological methods.

Acoustic Impedance Tests↗