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Hat die Navigation in der Traumatologie noch einen Stellenwert?
No full textHintergrund
Navigationssysteme sollen die Präzision erhöhen und den Operateur bei der Durchführung bestimmter Eingriffe unterstützen. Unterschieden werden eine bildbasierte und eine bildfreie Navigation. Bildbasierte Verfahren beruhen auf 2‑D- bzw. heutzutage meist auf 3‑D-Systemen. Bei der bildfreien Navigation wird u. a. der 3‑D-Druck eingesetzt.
Indikationen
In der Literatur existieren zahlreiche Studien zu Navigationsverfahren in der Unfallchirurgie. Während sich die Navigation in der Extremitätenchirurgie nicht durchsetzen konnte, ist der Einsatz der 3‑D-Navigation in der Becken- und Wirbelsäulenchirurgie etabliert. Vor allem bei Frakturen des hinteren Beckenringes (SI-Verschraubung) und bei dorsalen Stabilisierungsoperationen der Halswirbelsäule wird die Navigation regelmäßig angewendet.
Voraussetzungen
Um die Navigation optimal einsetzen zu können, sollte die Lernkurve abgeschlossen sein und die Technik regelmäßig angewendet werden. Zudem sollte der Chirurg die Operationstechnik sicher in konventioneller Technik beherrschen, um potenzielle Fehler der Navigation zu erkennen.
Vor- und Nachteile
Vorteile sind neben der erhöhten Patientensicherheit, die reduzierte Strahlenbelastung sowie eine geringere Invasivität chirurgischer Eingriffe. Als Nachteile sind unter ökonomischen Gesichtspunkten u. a. die hohen Anschaffungskosten anzuführen.Background
Navigation systems are supposed to increase precision and support surgeons while they perform certain interventions. 2D, or nowadays 3D, systems are used in image-based approaches. Image-free navigation uses 3D printing.
Indications
There are several studies on navigation procedures in trauma surgery. In contrast to limb surgery, the use of 3D navigation in pelvic and spine surgery is already well established. Navigation is especially regularly used to treat fractures of the posterior pelvic ring and for posterior stabilization of the cervical spine.
Requirements
To be able to utilize navigation systems optimally, the learning curve should be completed, and the technique should be used regularly. In addition, the surgeon should know the surgical technique without navigation in order to recognize potential errors of the navigation.
Advantages and disadvantages
Advantages include increased patient safety, reduction in radiation exposure and less invasive surgical procedures. However, among other disadvantages, initial costs are high
Long-term Quality of Life after Fusion of the Ventral Thoracic and Lumbar Spine
No full textAbstract Background Cage implantations and autologous pelvic bone grafts are common surgical procedures to fuse the spine in cases of spinal disorders such as traumatic fractures or degenerative diseases. These surgical methods are designed to stably readjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. Benefits of these surgical interventions have been evaluated, but the long-term well-being of patients after the respective treatments has not yet been examined. This study was designed to evaluate the clinical outcome for patients who received iliac crest or cage implantations. Material and Methods Forty-six patients with traumatic fractures after they obtained an anterior fusion in the thoracic or lumbar spine (12 cages; mean age: 54.08 years; 34 pelvic bone grafts; mean age: 42.18 years) were asked to participate in the survey using a precast questionnaire according the Visual Analog Scale (VAS) Spine Score. Twenty-nine of them provided the data requested. Results Evaluation of the VAS scores of the patients, reporting at least 1 year after the surgery, revealed that cage implantations led to significantly better results with respect to all aspects of their daily life such as pain sensing, capability to undertake physical activities and exercise as compared with patients with autologous pelvic bone graft. Patients with autologous pelvic bone graft treatment reported a particularly poor overall satisfaction level concerning their long-term well-being. Conclusions Patients with cage implantation reported a higher degree of long-term well-being. The data provide evidence for a positive impact on the postsurgery quality of life after cage implantation.Abstract Background Cage implantations and autologous pelvic bone grafts are common surgical procedures to fuse the spine in cases of spinal disorders such as traumatic fractures or degenerative diseases. These surgical methods are designed to stably readjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. Benefits of these surgical interventions have been evaluated, but the long-term well-being of patients after the respective treatments has not yet been examined. This study was designed to evaluate the clinical outcome for patients who received iliac crest or cage implantations. Material and Methods Forty-six patients with traumatic fractures after they obtained an anterior fusion in the thoracic or lumbar spine (12 cages; mean age: 54.08 years; 34 pelvic bone grafts; mean age: 42.18 years) were asked to participate in the survey using a precast questionnaire according the Visual Analog Scale (VAS) Spine Score. Twenty-nine of them provided the data requested. Results Evaluation of the VAS scores of the patients, reporting at least 1 year after the surgery, revealed that cage implantations led to significantly better results with respect to all aspects of their daily life such as pain sensing, capability to undertake physical activities and exercise as compared with patients with autologous pelvic bone graft. Patients with autologous pelvic bone graft treatment reported a particularly poor overall satisfaction level concerning their long-term well-being. Conclusions Patients with cage implantation reported a higher degree of long-term well-being. The data provide evidence for a positive impact on the postsurgery quality of life after cage implantation
Efficiency of 48h vs. 24h Injection of Parathyroid Hormone for Amelioration of Osteopenic Spine Properties in Male Rats
No full textDaily application of parathyroid hormone (PTH 1-34) is used for treatment of osteoporosis. It was investigated whether orchiectomy-induced osteoporotic changes in spine can be ameliorated by every 48h administration of PTH in aged male rats. Eight-month-old male Sprague-Dawley rats were sham operated (n=24) or orchiectomized (Orx, n=36) and maintained untreated over 12 weeks. Thereafter, both tibia underwent transverse metaphyseal osteotomy (Komrakova et al. 2011, J Endocrinol; 209:9-19) and rats were divided into 5 groups treated s.c. as follows: 1) sham vehicle; 2) sham PTH every 24h (PTH/24h); 3) Orx vehicle; 4) Orx PTH/24h; 5) Orx PTH every 48h (PTH/48h). PTH dosage was 40 g/kg BW per injection. After 5 weeks, lumbar vertebral bodies were used in computed tomographical, biomechanical, histomorphological, ashing and gene expression analyses. Cortical and trabecular densities, biomechanical properties, serum osteocalcin level increased significantly after PTH treatments in all groups (yield load, sham: 232+17N, sham PTH/24h: 376+12N, Orx: 239+16N, Orx PTH/24h: 324+31N, Orx PTH/48h: 297+17N). Bone inorganic weight enhanced after daily PTH application in Orx rats. Bone gene expression did not differ (P>0.05) among the groups. Both PTH administration regimes (24h and 48h) improved impaired bone structure in osteopenic rats. Every 48h application was less effective, however, it improved bone properties to the level observed in healthy (sham) rats. Considering limitation of daily treatments known in humans, these results may be useful for further clinical studies
It is time for a change in the management of elderly severely injured patients! An analysis of 126,015 patients from the TraumaRegister DGU®
No full textThe Impact of Strontium Ranelate on Metaphyseal Bone Healing in Ovariectomized Rats
No full textThe following questions were addressed: whether therapy with strontium ranelate (SR) should be continued or interrupted if the fractures occur during SR treatment and whether SR could be applied directly after fracture to improve bone healing. Sprague-Dawley rats (3 month old) were ovariectomized (Ovx, n = 48) or left intact (n = 12). After 8 weeks, a bilateral transverse osteotomy of the tibia metaphysis was created in all rats. Ovx rats were divided into four groups: Ovx; SR applied directly after Ovx until osteotomy (prophylaxis, SR pr, 8 weeks); SR applied after osteotomy (therapy, SR th, 5 weeks); SR applied during the whole experiment (pr + th, 13 weeks). SR dosage was 625 mg/kg body weight/day, administered in the feed. Five weeks later, tibiae were analyzed by biomechanical, histological, micro-CT, and gene expression analyses. The SR pr + th treatment increased total bone mineral density (BMD), bone volume fraction, cortical BMD and volume, callus area and density, serum alkaline phosphatase, tartrate-resistant acid phosphatase mRNA, accelerated osteotomy bridging, and callus formation at weeks 2 and 3 of healing and decreased the osteoprotegerin/receptor activator of nuclear factor kB ligand mRNA ratio. SR th enlarged callus area and improved callus formation during the 5th week of healing. SR pr improved cortical BMD preserving bone after SR discontinuation (5-week rest); the bone healing was not affected. SR content in the tibia metaphysis was the highest in SR pr + th group and was not different between SR pr and SR th. SR has a positive effect on osteoporotic bone healing in rat and SR treatment can be continued after the fracture occurs or applied directly after the fracture.Elsbeth-Bonhoff Foundation [N 70
Provision of an Explanation for the Inefficacy of Immunotherapy in Sporadic Inclusion Body Myositis Quantitative Assessment of Inflammation and beta-Amyloid in the Muscle
No full textObjective. In sporadic inclusion body myositis (IBM), inflammation and accumulation of beta-amyloid-associated molecules cause muscle fiber damage. We undertook this study to determine why intravenous immunoglobulin (IVIG) and prednisone are not effective in sporadic IBM despite their effectiveness in other inflammatory myopathies. Methods. Relevant inflammatory and degeneration-associated markers were assessed by quantitative polymerase chain reaction and immunohistochemistry in repeated muscle biopsy specimens from patients with sporadic IBM treated in a controlled study with IVIG and prednisone (n = 5) or with prednisone alone (n = 5). Functional effects were assessed in a muscle cell culture model. Results. In muscle biopsy specimens, messenger RNA (mRNA) expression of the proinflammatory chemokines CXCL9, CCL3, and CCL4 and of the cytokines interferon-gamma (IFN gamma), transforming growth factor beta, interleukin-10 (IL-10), and IL-1 beta was significantly reduced after treatment in both groups. No consistent changes were observed for tumor necrosis factor alpha, IL-6, inducible costimulator (ICOS), its ligand ICOSL, and perforin. Messenger RNA expression of the degeneration-associated molecule ubiquitin and the heat-shock protein alpha B-crystallin was also reduced, but no changes were noted for amyloid precursor protein (APP) or desmin. By immunohistochemistry, a significant down-modulation of chemokines was observed, but not of inducible nitric oxide (NO) synthase, nitrotyrosine, IL-1 beta, APP, and ubiquitin; beta-amyloid was reduced in 6 of 10 patients. Pronounced staining of IgG was observed in the muscle after treatment with IVIG, indicating penetration of infused IgG into the muscle and a possible local effect. In muscle cells exposed to IFN gamma plus IL-1 beta, IgG and/or prednisone downregulated mRNA expression of IL-1 beta 2.5-fold. Accumulation of beta-amyloid, overexpression of alpha B-crystallin, and cell death were prevented. In contrast, NO-associated cell stress remained unchanged. Conclusion. IVIG and prednisone reduce some inflammatory and degenerative molecules in muscle of patients with sporadic IBM and in vitro, but do not sufficiently suppress myotoxic and cell stress mediators such as NO. The data provide an explanation for the resistance of sporadic IBM to immunotherapy and identify markers that may help to design novel treatment strategies
Ostarine and Ligandrol Improve Muscle Tissue in an Ovariectomized Rat Model
No full textIn postmenopausal women, hormonal decline changes muscle function and structure. The non-steroidal selective androgen receptor modulators (SARMs) Ostarine (OS) and Ligandrol (LG) have been shown to increase muscle mass and physical function while showing a relative low risk profile. Information about their effects on muscle structure and metabolism is lacking. To analyze this, two experiments were performed using ovariectomized rats as a standard model for postmenopausal conditions. In each experiment, 3-month old Sprague-Dawley rats were divided into five groups (n = 12 to 15). One group remained intact (Non-OVX), the other four groups were ovariectomized (OVX) and remained untreated for eight (OS Experiment) or nine (LG Experiment) weeks. Thereafter, rats of three of the four OVX groups were treated with OS or LG (with doses of 0.04, 0.4, or 4 mg/kg body weight/day) for 5 weeks. Then, uterus, gastrocnemius, and soleus muscles were weighed, fiber size, capillary density, and enzyme activity (lactate dehydrogenase [LDH], citrate synthase [CS], and complex I) were analyzed. In the LG experiment, intramuscular fat content was determined in the quadriceps femoris muscle. All OS treatments resulted in a higher capillary density in the gastrocnemius and longissimus muscles compared with the Non-OVX and the OVX rats, whereas all LG treatments showed a higher capillary density compared with the Non-OVX group. Muscle fiber size and distribution patterns were not changed under either SARM. The CS activity was higher in the longissimus muscle under OS treatment. LG resulted in a higher activity of CS in the gastrocnemius and of LDH in the longissimus muscle. Both SARMs showed an uterotrophic effect, OS at 4 and 0,4 mg dosages, LG at 4 mg dosage. In sum, beneficial effect on muscle vascularization was observed for both SARMs with a stronger impact for OS. LG showed more effect on muscle metabolism. However, a higher muscle weight and intramuscular fat content observed after LG treatment (4 mg) as well as an uterotrophic effect of both SARMs at higher dosages could be considered as an unfavorable side effects and might be a limitation for their application at these dosages.Open-Access-Publikationsfonds 202
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