Hungarian Society of Biomechanics: E-Journals / Magyar Biomechanikai Társaság
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Minimal invasive surgical techniques for the treatment of pathologic lesions, situated in the midline of the spinal canal
Get PDFObjective: Multilevel laminectomy for exposing the spinal canal to remove spinal cord lesions has been widely used in spine surgery. Destruction of the dorsal structures of the spinal column, detachment of the longitudinal musculature, resection of the vertebral arches, and injury of the joint capsules and ligaments are responsible most of short and late-time complications. Spinal deformities, instability, subluxation, invasion of haematoma and scar tissue into the spinal canal are the most often mentioned complications in the literature. The author main objective was to develop and summarize the novel minimally invasive techniques suitable for exploring and treating different pathologies, located in the midline of the spinal canal with preservation of the stability of the spine.Methods: 38 patients were operated on with intramedullary laesions located from CIII to LI level of the spine with the newly developed multilevel spinous process splitting and distracting laminotomy technique. The dorsal, paraspinal musculature was not detached from the vertebras. With splitting and distracting the spinous processes and the vertebral arches, the vertebral joints, the joint capsules and the ligaments were not injured, these structures remained mostly intact. To achieve a moderate enlargement and decompression of the spinal canal, complementary intervertebral spacer insertion was performed in some cases. The patients were followed with regular MRI, CT scans and neurological examinations.Results: Adequate surgery of the lesions located intramedullary was achieved in all patients using our new procedures. Moderate enlargement and permanent decompression of the spinal canal was achieved with the insertion of homologues tricortical iliac crest bone graft or heterologous PEEK spacer. The numbers of split laminae were 3 to 6. The split spinous processes were closed directly to each other in 24 patients. In 9 cases a tricortical bone graft and in 5 cases a heterologous PEEK spacer was inserted between the facing bony parts.The incidence of postoperative local pain was lower, within acceptable limits, and early mobilization was allowed. The average length of hospital stay was shorter too. The postoperative followup CT scans demonstrated bony healing, with the inserted graft or cage between the osteotomized faces. No compression or dislocation of the spacer was seen. Instability was not detected in any of the patients by fl exion or extension lateral radiographs. DOI: 10.17489/biohun/2010/1/2
The geometry of the proximal femur
Get PDFThe authors performed radiological and morphological examinations on 86 femurs from freshcadavers, and present their results to aid the planning of companies manufacturing hip endoprosthesis. DOI: 10.17489/biohun/2009/2/0
Scoliosis testing features on the basis of electronically generated moire patterns
Get PDFThe Dept. of Mechatronics, Optics and Information Engineering, within the project team, had built an electronic moire equipment to visualize and diagnose scoliosis. The device generates a computerized moire phenomenon, which can be viewed and save for later examination. The applicability of the system was teste with statistical method from the moire patterns, which was created by the prototype device. The results of the calculations – to determine the rate of scoliosis by moire patterns – are promising and comparable with X-ray examinations. DOI: 10.17489/biohun/2010/1/1
Retaining hand biomechanics in case of a hand tumor
Get PDFThe case of a patient with lung cancer is presented whose fi rst metastasis was detected in the 5th metacarpal head. Hand metastasis in lung cancer is a rarity in literature. After the detection of the hand tumor treatment was sidetracked by representatives of other medical specialities. The growing tumor destroyed the 3rd, 4th and 5th metacarpals, thus based on DSA, MRI, CT, PET-CT and X-ray results and thorough planning of the surgical procedures only opposition and grip of thumb and index fi nger was possible to form. During surgery unexpected diffi culties occured partly because of the condtion of tissues, partly because the tumor was infected. It was not possible to plan exactly before the procedure due to the nature of the tumor, and according to the hystological results, the metastasis was cleared only by 6 mm. It was possible to rescue the 2nd metacarpal with the atypical insertion of an AO-plate, so that the fi nal statics of the hand was secured. The postoperative period proved to be reassuring, however due to the quick progression of the underlying disease the patient was lost. DOI: 10.17489/biohun/2010/1/2
Intermediate biomechanical analysis of the effect of physiotherapy only compared to capsular shift and physiotherapy in multidirectional shoulder instability
Get PDFPurpose: The aim of study is to compare the kinematic parameters and activity pattern of muscles around the glenohumeral joint in multidirectional instability (MDI) treated by only physiotherapy and by capsular shift and physiotherapy, before and after treatment.Materilal and method: The study was carried out on 32 patients with MDI treated with only physiotherapy (29 patients after 2 years, and 21 patients after 4 years), 19 patients with MDI treated by capsular shift and physiotherapy (19 patients after 2 and 4 years), and 50 healthy subjects as control group. The investigated kinematic parameters were the range of the humeral elevation (HE) in the scapular plane, the scapulothoracal and glenohumeral angle, the scapulothoracal (ST) and glenohumeral (GH) rhytms, and relative displacement between the rotation centers of the humerus and the scapula. The muscle activity was modeled by the on-off pattern of muscles around the shoulder.Results: Before treatment the increased relative displacement between the rotation centers of the scapula and the humerus and different ST and GH rhythms were observed in MDI patients. The physiotherapy strengthened the rotator cuff, biceps brachii, triceps brachii, deltoid muscle, but ST and GH rhytms remained monolinear. Capsular shift and physiotherapy resulted bilinear ST and GH rhytms and normal relative displacement between the rotation center of scapula and humerus was restored. After surgery and physiotherapy the activity pattern of muscles around the shoulder was almost normal.Conclusion: The signifi cant alterations in kinematic parameters in MDI patients cannot be restored by physiotherapy only. After the capsular shift and postoperative physiotherapy the bilinearST and GH rhytm (angulation at 60 degree), the normal relative displacement between the rotation centers of scapula and humerus and the normal muscular activity pattern can be restored. DOI: 10.17489/biohun/2010/1/2
New aspects in grouping typical injuries from road traffic accidents
Get PDFTypical mechanisms and specifi c injuries of people involved in road traffi c accidents are presented.Injury patterns specifi c to occupants of vehicles with enclosed passenger compartment, as well as unprotected participants of traffi c (pedestrians, bicyclists, motorcyclists, etc.) are grouped.Injury severity classifi cation, treatment planning and outcome prediction is usually done based on various scoring systems, both internationally and in Hungary. The enormous number of such scoring systems make a thorough survey diffi cult and conversion among these scores has limitations. However prehospital care providers and hospital emergency staff need a “common language”, preferably a system that utilizes the advantages of scoring systems. There is no uniform practice of this communication and data transfer in Hungary now, that is why part of the important data from the incident scene might not get to the hospital together with the patient.The documentation of prehospital care providers both in Hungary and abroad are discussed and analyzed. Score systems in prehospital and emergency medicine, as well as outcome prediction measures are covered. Data collection schemes especially the Utstein-Style for documenting major trauma and the German MIND2 (Minimale Notarztdatensatz, minimal prehospital care data set) are also presented.A suggestion is introduced for the data content of prehospital documentation, so that it could further help hospital admission and care. The main aspects of the suggestion are road traffi c accidents, because the creation of such a widely accepted and used document (a prehospital patient report form) requires a team of experts from various – mainly medical – specialties. Technical aspects, such as digital data collection are also covered. Future directions of development are named, too. DOI: 10.17489/biohun/2010/1/0
Specific biomechanical consideration in trauma cases involving forearm and hand
Get PDFThe rescue of a severed or amputated limb and restoration of the its biomechanical unity after serious hand or forearm injuries is analysed and discussed with two case presentations. Methods of anatomy and surgery in these cases are not part of the everyday practice, the need for improvization during surgery is essential. Ischaemia reperfusion time is also crucial when a limb has to be saved. The fi rst case reports on the subtotal amputation of a young man’s right hand and the successful revascularization and unorthodox restoration of the radiocarpal joint to full function. The second case is of a young woman with a conquassated left forearm. A special aspect in this case is the extremely long ischaemia-reperfusion time. Complete function was restored in this case too, however the patient’s refusal of spongiosa-plasty resulted in the fatigue break of the fi xation plate, that had to be replaced.In traumatology it happens quite often, that serious decisions have to made by the operating table without the chance of consultation with colleagues and literature. The two presented cases might help to decide on treatment for those who meet similar cases in their practice. DOI: 10.17489/biohun/2010/1/2
Survey among school-aged children with ultrasound-based motion analyzing system at two primary schools in szolnok
Get PDFAim: The use of ultrasound based motion analyzing systems is harmless and has no side effects. They are applicable among healthy people and children as well. Since 2007 we have been surveying children who suffer from spine and foot deformities and participate in adapted physical education. With three-year experience we decided to broaden the scope of the survey. In September last year we started a survey among primary school pupils aged 6-10 with the goal to follow up their state. At fi rst we examined the children’s initial state when their usual annual medical examination was made at school. The survey is planned to take at least three years. During the survey we pay special attention to reveal spine and foot vault deformities at an early stage, because these deformities are most common in the age group and after discovery conservative therapybased correction can be started without procrastination.Material and Method: After the orthopaedic examination, we performed a static posture examination and sole pressure distribution examination among 210 pupils from the two primary schools. By analysis with the Zebris CMS-HS ultrasound-based system and using Win Spine program we defi ned the degree of dorsal kyphosis and lumbar lordosis, the total trunk inclination in the sagittal and frontal planes and the degree of scoliosis.Results: Two children with innate locomotor disorders and a boy with neurological problems were excluded from the survey. Out of the remaining 207 children the orthopaedic examination found 75 healthy ones, 55 with bad back posture and 9 with flat back. 16 times the diagnosis was scoliosis, mostly functional but could be corrected properly. 53 children had no spine deformity but were positively fl at-footed. Following the recommendation of the GKE 2008 annual congress, we divided each group into subgroups according to the degree of curvatures in the sagittal plane. Dorsal kyphosis between 30 and 60 degrees and lumbar lordosis between 30 and 40 degrees were considered normal. Because of this consideration the healthy group was not homogeneous, either. 37.3% of them had fl at lumbar lordosis, 4% of them had fl at lumbar lordosis and thoracic kyphosis, too. Among children with bad back posture these ratios were 50.9% and 3%, respectively.Conclusion: Continuous control over different age groups makes it possible for us to search diagnosis- specifi csigns in the results of ultrasound-based motion analysis. The sign can be, for example, unbending of the curvature. The results of adapted physical education can be measured numerically. We can call the attention of teachers and parents for the need of posture correction built into physical education and everyday life. DOI: 10.17489/biohun/2010/1/3
