Biomedical subjects

J Heine

Publications and source records attributed to J Heine.

At least 145 records · Page 8Linked to original sources

PubMedDate not supplied

[Transpedicular lumbar spondylodesis in elderly patients].

70 patients older than 50 years (mean age: 60.2 years) underwent a CD-spondylodesis from 1987 to 1991 for degenerative changes of the lumbar spine, and were followed for 2 years. 88.2% improved, but only 47.1% showed a good-to-excellent result. Patients with fair and poor outcomes had had significantly more operations on the lumbar spine (p < 0.001), had a greater extent of preoperative lumbar kyphosis (p < 0.05), motor weakness (p < 0.05), had less vertebral slips (p < 0.01), had less posterior distraction postoperatively (p < 0.001), and had a greater extent of postoperative motor weakness compared to patients with good-to-excellent outcomes. Age, sex, duration of back/leg pain, taking of analgetic drugs, preoperative pain status, profession, range of walking, time of operation, number of fused segments, blood loss, blood transfusion, postoperative profile of the spine did not show any significant influence upon clinical results. Already at 6-months-follow-up there was significant difference of the clinical outcome (p < 0.001), making improvement of a then fair or poor result unlikely.

Aged↗

PubMedDate not supplied

[Significance of dorsal decompression and instrumentation in the treatment of spinal malignancies].

From 1986 to 1990 50 patients with increasing spinal instability due to pathologic fractures of one or more vertebrae were operated in the Orthopedic Department of Mainz University Hospital. In the course of 57 operations anterior decompression and stabilization were performed 3 times, whereas dorsal spondylodesis was done with Cotrel-Dubousset's instrumentation (CDI) 32 times, with Luque's 7 times and with Harrington's 1 time; a combination of CDI and Luque was chosen in 2 cases, a combination of Harrington and Luque in 1 case. 3 times a single-stage combination and 4 times a two-stage combination of ventral and dorsal stabilization was used. The application of the CDI required no postoperative external support. 35 patients suffered from major neurologic deficits preoperatively--among them 11 from a complete and 6 from an incomplete paraparesis--which made spinal cord decompression necessary in advance of the dorsal stabilization. Of these, 16 improved significantly; however, deterioration of the neurologic status occurred in 4 cases with a paraparesis in 3 of them. Survival time postoperatively was approximately 13 months in 27 patients. 9 of these died within half a year after the operative intervention. Failure of fixation as a result of tumor lesion was found in 2 cases of CDI procedure and in 1 case of the Harrington instrumentation. All required a revisional operation. 3 patients developed a radiologic lysis of methylmethacrylate implants fixed by an anterior procedure. Posterior decompression and stabilization render possible resolution of spine pain as well as restoration of mobility until a few days before exitus letalis without restricting adjuvant radio- or chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

[High-energy extracorporeal shock-wave therapy (ESWT) in the treatment of pseudarthrosis].

PROBLEM: The success rate of high-energy extracorporal shock wave therapy in the treatment of non-unions in comparison to the "golden standard" surgery is still unclear. METHOD: In a prospective study, 3000 impulses with an energy density of 0.6 mJ/mm2 were applied with an experimental device to the pseudarthrosis in 52 patients. RESULTS: The mean duration of pseudarthrosis was 13 months. A mean of 2.5 surgical interventions had already been performed. Bony union was achieved in 52% of our patients after an average of 3.3 months. Failures especially were found in the atrophic type of pseudarthrosis as well as in congenital bone disorders like fibrous dysplasia or osteogenesis imperfecta. No serious complications were observed. CONCLUSIONS: Even after numerous surgical interventions high-energy extracorporal shock wave therapy as a noninvasive method for the treatment of bony non-unions showed a fair success rate. A higher success rate can be expected by strict selection criteria.

Adolescent↗

PubMedDate not supplied

[The problem of comparability of results of the treatment of congenital hip dislocation--exemplified by the Severin scheme and the classification system of the Work Group Hip Dysplasia].

The comparison of the results obtained by conservative or operative treatment of hip dysplasia shows that the consideration of absolute roentgenologic hip parameters is of little use. Classification principles for numerous hip parameters have been developed for this reason by Tönnis. In the Angloamerican and Scandinavian countries, on the other hand, it is predominantly the Severin classification that is employed for an evaluation of the methods of treatment. We examined in our study the differences in the evaluation of the results obtained in 117 hip joints treated by pelvic osteotomy according to Salter by application of the AKH and the Severin classification scheme. There were evident differences in all groups of these classifications. In the application of the Severin scheme the groups I, II and III contained 9.5% less, 24.8% more, and 18.8% less hip joints, respectively than in the respective groups of the Tönnis classification. In the groups IV, V and VI of the Severin classification there were altogether 3.5% less hip joints than in the respective groups of the Tönnis classification. Our study thus showed that a comparison of the operative results of hip dysplasia as presented in the Angloamerican and Scandinavian literature and those presented in the German literature is not possible. We conclude from this result that an evaluation according to a unified classification scheme would be most desirable.

Adolescent↗

PubMedDate not supplied

[The surgical treatment of scoliosis of various etiology. Results after 150 operations using CD-instrumentation with reference to the effects of the instrumentation on the sagittal spinal profile].

At the Orthopaedic University Hospital of Mainz more than 150 patients were treated surgically according to Cotrel and Dubousset procedure. By means of this operation average corrections of the curves of 54.8% to 64.6% could be achieved in the first 150 patients, depending of the localization of the curve. Operative procedure, duration of operation and blood loss are adequate to known procedures, the stability of the method is better than in other known methods. The change of the postoperative sagittal profile demonstrates the influence of the operation in cases of hypokyphosis in the thoracic and hypolordosis in the lumbar spine.

Adolescent↗

PubMedDate not supplied

[Diagnosis of transitory osteoporosis of the hip and its imaging in magnetic resonance tomography].

Magnetic resonance (MR) imaging may distinguish transient osteoporosis of the hip from more severe hip diseases. 12 patients with transient osteoporosis of the hip underwent MR imaging. The initial and follow-up studies included T1- and T2-weighted images in coronal, transverse or sagittal planes. There were revealed 3 stages: diffuse-, focal-, and residual stage. This syndrome is characterized by hip pain, limping, and osteoporosis of the femoral head with preservation of the joint space. The clinical symptoms and abnormalities on MR images disappeared completely within 6-10 months.

Adult↗

PubMedDate not supplied

[Use of the tumor prosthesis in secondary neoplastic destruction of the proximal end of the femur].

Total hip arthroplasty was performed with PMMA-augmented tumor prostheses in 42 individuals suffering from metastatic destruction of the proximal end of the femur at the Orthopedic University Hospital Mainz from 1980 to 1992. Neoplastic lesions had been triggered by carcinomas of the breast in 25 female patients. 24 of our patients presented with pathologic fractures. In all patients capable of walking preoperatively early mobilization could be attained by total hip arthroplasty. Pain relief was achieved in each patient. Resection of the major trochanter and, partially, of the pelvitrochanteric muscle sleeve entailed luxation of the prosthesis six times in 5 individuals during the first postoperative two months; closed reduction was practicable in all of them. Postoperative survival time amounted to an average of 10.5 months. Leg length and hip function were successfully re-established by implanting tumor prostheses after resection of the proximal part of the femur.

Adult↗

PubMedDate not supplied

[Indications and results of surgical treatment of neuromuscular scoliosis].

The results of the operative treatment of 44 patients suffering from a neuromuscular scoliosis are presented. Only multisegmental procedures - also in combination with anterior methods - should be used to avoid a postoperative care with cast or brace. By means of the operation an average correction of the curves of 50.7% was achieved. The preoperative mean angle was 75.1 degrees, postoperatively a mean angle of 37.0 degrees (mean correction of 38.1 degrees) was determined. The preoperative angle, the duration of the operations, the blood loss and the quantity of the complications are higher than in idiopathic scolioses. As a result of the known tendency of deterioration in neuromuscular scolioses, the members of the Arbeitskreis Skoliose of the German Orthopaedic Society (DGOT) recommend an early operation (in progressing curves over 20 degrees) in patients suffering from a muscular dystrophy Duchenne.

Adolescent↗

PubMedDate not supplied

[Recommendations for participation in sports by patients with idiopathic scoliosis].

Presented is the recommendation of the "Arbeitskreis Skoliose" of the DGOT concerning the sporting activities for juvenile patients suffering from an idiopathic scoliosis. The main points of this concept are the desirable active participation in school sport activities and the ascertainment that restrictions are not necessary in scolioses up to 21 degrees. A special recommendation for operated patients predicates the begin of sport activities after ohne year postoperatively. The kind of sport must be recommended by the surgeon, high-performance sports cannot be tolerated in those patients. Precondition for these recommendations are regularly physical examinations by the orthopedic physician and standardized x-rays in standing position.

Adolescent↗

PubMedDate not supplied

[Xanthomas of the Achilles tendon. Long-term results following total and partial resection].

In a 32-year-old man with Frederiksen's Type II beta-hyperlipoproteinemia, a total and a subtotal resection of the Achilles tendons were performed. The follow-up examination six years later confirmed the very good prospects of success of total resection and reconstruction of the Achilles tendon; this is the only long term result reported in the literature. Following subtotal resection residual complaints are likely to occur.

Achilles Tendon↗

PubMedDate not supplied

[New classification of recommendations for forensic assessment of patients with scoliosis].

In 1977, for the first time, a recommendation for the expert evaluation of scoliosis-sufferers was given out. On the basis of this a new classification followed, which takes into consideration modern orthetics and new operative procedures. Unchanged are the classifications of incapacity to work with regard to decreasing lung capacity. The levels of vital capacity are still the main factor for determining lung capacity.

Disability Evaluation↗

PubMedDate not supplied

[Initial results of the surgical treatment of scoliosis with the Cotrel and Dubousset CD instruments].

At the Orthopaedic University Hospital Muenster 50 patients were surgically treated according to the Cotrel and Dubousset technique from June 1985 to October 1986. An outstanding characteristic of this method is the three-dimensional correction of the curve without exclusive application of distraction or transverse forces, bringing about excellent stability. By means of this operation an average preoperative angle of 63.4 degrees could be diminished to 33.9 degrees, meaning a gain of correction of 46.5%. Complications occurred essentially due to insufficient experience with this technique in the first patients operated on. After sufficient training this procedure is as practicable as the Harrington technique.

Adolescent↗

PubMedDate not supplied

[Results of operative treatment of Scheuermann disease].

Only rarely is a surgical intervention necessary for increased kyphosis in Scheuermann's disease. However, effective erection of fixed kyphoses is only possible with an incision of the anterior spinal ligament, removal of the discs at the vertex of the curvature, resection of the vertebral arch joints, narrowing of the considerably widened vertebral arches and stabilizing with Harrington's instrumentation. The present authors have treated 11 patients in this way. With this procedure it proved possible to erect the kyphosis on average by 53.4%. In the first postoperative year there was an average loss of correction of 1.7 degrees, though subsequent deterioration was only 0.7 degrees up to the time of the last follow-up examination. The residual correction gain was 50.4 per cent. The results in 4 other patients, in whom Schöllner's erector rods were implanted, were less favorable. The permanent correction was only 50.4 in these cases. The best postoperative results are likely to be obtained by a unilateral ventral and dorsal procedure.

Adolescent↗

PubMedDate not supplied

[Results of the treatment of congenital hip dislocation using Salter's open repositioning and pelvic osteotomy].

In this paper the results of Salter's innominate osteotomy combined with an open reduction are shown on the basis of radiographic and clinical investigations. From 1969-1976 43 hips up to the age of 3.11 years had been treated after Salter's method. At the follow-up 65.6% of the hips were found to have normal or slightly pathological AC angles. 63.4% of the hips show good and fair results concerning the ACM angle. The results of the CE angle and the 'hip value' are disappointing: only just 34.1% of the hips can be considered good or fair. This is a consequence of the high rate of preoperative avascular necrosis on the one hand, on the other hand it is based on the fact that most of the cases had had a previous non-operative or operative treatment.

Child↗

PubMedDate not supplied

[Long-term results of the conservative treatment of scoliosis using the Chêneau brace].

At present, we survey 52 patients who had been fitted with Chêneau braces in the years 1978 to 1980. The average primary correction of the single curved thoracic, single curved lumbar, and double curved scolioses amounted to 41%. The best late results are to be expected in the single curved thoracic and single curved lumbar scolioses that presented corrections of 14.2% and 9.2%. In the double curved scoliosis we found a correction of 5.5% of the thoracic and 5.6% of the lumbar curves. The Chêneau orthosis was well accepted by the patients. A final valuation, however, will not be possible till some years have passed.

Adolescent↗

PubMedDate not supplied

[Final results of the conservative treatment of scoliosis using the Milwaukee brace].

At present, we survey the final results of 62 patients having been treated by a Milwaukee brace. The average curve amounted initially to 35 degrees. There succeeded a primary correction to 32 degrees. At start of weaning the initial angle of 35 degrees was reached again. During the weaning period an evident deterioration of 39 degrees occurred, and at the follow-up control 6 years after the end of weaning the curve was 42 degrees on the average. Thus, our own results are somewhat more unfavourable than those of Mellenkamp et al. In 1977, they reported the results of 47 patients who could be submitted to a follow-up control. The mean scoliotic curve of these 47 patients amounted to 44 degrees at start of treatment, at the last control, on the average 5 years after weaning from the Milwaukee brace, the mean angle was about 40 degrees. Essentially, we could prevent the progression of the curvature, too. If there occurred deteriorations in comparison with the initial angle, they were usually caused by a few patients who developed a drastic deterioration of their scoliosis.

Adolescent↗

PubMedDate not supplied

[Experiences with lateral electric surface stimulation in the treatment of progressive idiopathic scoliosis].

Up to now, 106 patients were treated by the muscle stimulation method for scoliosis after Axelgaard at the Orthopaedic University Hospital. We introduced this procedure in 1979. 43 curves could be improved whereas 19 deteriorated also under this treatment. 44 curves did not show any change. At the start of treatment, the average age was 11.3 years, the average angle 21 degrees. It appeared that thoracolumbar curves were best to be influenced. Furthermore, there were better results in angles below 30 degrees than above 30 degrees, and in patients below 13 years than above 13 years. Accordingly, the muscle stimulation therapy is indicated as an early treatment in mild scolioses.

Adolescent↗

PubMedDate not supplied

[Follow-up of collagen and bone metabolism in patients with cement-free total hip endoprosthesis].

INTRODUCTION: This study investigated the influence of concentration and activity of several markers of the collagen and bone metabolism and their impact on ingrowth of non-cemented total hip arthroplasty. METHODS: 40 patients underwent an implantation of a ABG-prosthesis. Before surgery and 1, 2, 12 and 24 weeks after it serum concentrations of PICP, ICTP, IGF-1, ON, b-AP, Calcium, Phosphate, GPT and Creatinin were measured and a collagen ratio (CQ) was calculated. RESULTS: PICP decreased until 1st week, increased at 2nd week and decreased again after that time. ICTP increased significantly in 1st week, reached a maximum in 2nd week and decreased after that. b-AP decreased in 1st week but increased after that time. IGF-1 and ON decreased significantly after surgery but increased later. Calcium and Phosphate always showed normal values. CQ decreased in 1st week in males (45%) and females (60%), but increased later on. CONCLUSION: These markers investigated made it possible to estimate the osteointegration of non-cemented total hip arthroplasty and confirm radiologic and histomorphometric results of the literature.

Adult↗