Dynamische intraligamentäre Stabilisierung des vorderen Kreuzbandes

Die Unfallchirurgie - Goldstandard der operativen Therapie vorderer Kreuzbandrupturen ist die Rekonstruktion mittels Sehnentransplantat. Die dynamische intraligamentäre Stabilisierung des...     

Vollständiger plastischer Ersatz des vorderen Kreuzbandes und funktionell-anatomische Wiederherstellung desselben

Zusammenfassung Beschreibung eines vollst?ndigen plastischen Ersatzes des vorderen Kreuzbandes mit Hilfe eines durch ein Bohrloch der Tibia ins Kniegelenk geleiteten, in der H?he des Bohrloches gestielten Faszienlappens, der unter Spannung am hinteren Kreuzband in der N?he dessen femoralen Umsatzes befestigt wird. Vollkommene Wiederherstellung. Vorweisung in der Ges. der ?rzte in Wien am 26. 10. 28.     

Dynamische intraligamentäre Stabilisierung frischer Rupturen des vorderen Kreuzbandes (Ligamys)

Trauma und Berufskrankheit - Die Ersatzplastik des vorderen Kreuzbandes (VKB) mittels körpereigener Sehne hat sich als Standardverfahren in der Behandlung der VKB-Ruptur etabliert. Dennoch...     

Dynamische intraligamentäre Stabilisierung frischer Rupturen des vorderen Kreuzbandes (Ligamys)

Anterior cruciate ligament (ACL) reconstruction with the use of autologous tendon grafts is the gold standard in the treatment of ACL instability; however, many different techniques have been proposed to suture freshly ruptured ACLs. Unfortunately, the rate of recurrent instability is high. A new technique, dynamic intraligamentary stabilization (DIS), was developed to restore biomechanical stability after primary ACL repair and therefore to allow stable healing. In order to compensate for the anisometry of the ACL, in contrast to simple augmentation a spring mechanism is used in DIS that helps to maintain the tibia in a posterior drawer position during all degrees of flexion. Initial results of biomechanical and clinical studies are promising, indicating that reconstruction of knee joint kinematics after ACL repair with DIS is possible; however, further clinical studies are required to determine its usefulness in the clinical setting.     

Isolierter Bündelersatz bei Partialruptur des vorderen Kreuzbandes

Objective

Partial augmentation of isolated tears of the anteromedial and posterolateral bundle of the anterior cruciate ligament (ACL) with autologous hamstring tendons. The intact fibers of the ACL are preserved.

Indications

Symptomatic isolated tear of the anteromedial or posteromedial bundle of the ACL or rotational instability after ACL reconstruction with malplaced tunnels (e.g., high femoral position)

Contraindications

In revision cases: loss of motion due to malplaced ACL and excessive tunnel widening of the present tunnels with the risk of tunnel confluence.

Surgical technique

Examination of anterior–posterior translation and rotational instability under anesthesia. Diagnostic arthroscopy, repetition of the clinical examination under direct visualization of the ACL, meticulous probing of the functional bundles. Resection of ligament remnants, preparation/preservation of the femoral and tibial footprint. Harvesting one of the hamstring tendons, graft preparation. Positioning of a 2.4 mm K-wire in the anatomic center of the femoral anteromedial/posterolateral bundle insertion, cannulated drilling according to the graft diameter. Positioning of a 2.4 mm K-wire balanced according to the femoral tunnel at the tibia, cannulated drilling. Insertion of the graft and fixation.

Postoperative management

Analogous to that for ACL reconstruction.     

Möglichkeiten und Grenzen des „tissue engineering“ des vorderen Kreuzbandes

Although current concepts of cruciate ligament reconstruction using tendon transplants provide midterm knee joint stabilization, a single-bundle or double-bundle tendon cannot adequately restore the complex three-dimensional structure of the anterior cruciate ligament. Therefore, researchers are attempting to develop alternatives using tissue engineering technology. The basic principle includes seeding of suitable cells on a resorbable carrier construct, in vitro biological and mechanical stimulation to generate a ligament-like extracellular matrix, and subsequent implantation as a cruciate ligament bioprosthesis. Several natural and synthetic materials have proven to be suitable as cell carriers; however, most of these exhibit inadequate tensile strength as well as minor fatigue properties, making an additional load carrier necessary. In principle, research has shown that tissue engineering technology is capable of generating a construct with a ligament-like extracellular matrix. However, the step from basic research to clinical application has not yet been taken.     

Die räumlich homogene Tiefendosierung mit Hilfe des Felderwählers

Ohne Zusammenfassung Demonstrationsvortrag am 31. VII. 1920. Mittelrheinische Chirurgentagung, Freiburg i. B.     

Intraoperative Diagnostik bei der operativen Behandlung von Herzfehlern mittels eines neuen elektromanometrischen Druckmeßgerätes

Ohne Zusammenfassung a. E.     

Analyse der Aufmerksamkeitsverteilung des Anästhesisten mit Hilfe der Blickbewegungsmessung Pilotstudie zur Methodenevaluation unter den Bedingungen eines modernen Operationsbetriebes

INTRODUCTION: With the inclusion of new monitoring devices over the last two decades, the distribution of the anesthesiologists vigilance has changed which might influence the ergonomic profile of an optimal anesthesia workstation. The aim of this pilot study was the evaluation of an eyetracking device to analyze the vigilance distribution of an anesthesiologist during routine cases in an operating theatre of the 21st century. MATERIAL AND METHODS: Five anesthesiologist with different levels of training were followed during different types of surgery using a video camera-based eye-tracking system. The films were analyzed by an independent observer and rated according to defined regions of interest (ROI). Then typical scan-paths were identified and quantitatively analyzed. RESULTS: The eye-tracking studies proved to be technically of high quality but were time-consuming. Only few disturbances to the operating room (OR) personnel were recorded according to their subjective impressions but bias of behaviour due to the measurement procedure itself cannot be completely excluded. The vigilance of the anesthesiologist towards different factors was dependent on the level of professional training, the type of anesthesia and the type of surgery. Certain factors such as documentation (10-15%) or external disturbances (approximately 20%) proved to be relatively constant. Typical scan-paths could also be identified. CONCLUSION: Eye-tracking studies proved to be a suitable way to analyze the distribution of vigilance of anesthesiologists in a modern operating theatre. For further studies examining the influence of detailed modifications of the OR environment, a standardized study design with the same level of education, the same anesthesia technique and the same surgical procedure needs to be chosen.     

Die präoperative Behandlung des blutenden Gastroduodenalulcus mit Hilfe der lokalen Hypothermie des Magens

Ohne ZusammenfassungMit 3 AbbildungenVortragender:S. Dressler-Berlin.     

Vollständige Wiederherstellung des Schlüsselbeins mit Hilfe der freien Knochenplastik

Ohne Zusammenfassung (Mit 5 Abbildungen.)     

Arthroskopische Auff��llung von fehlplatzierten und erweiterten Bohrkan?len mit Beckenkammspongiosa bei Rezidivinstabilit?t nach Ersatzplastik des vorderen Kreuzbandes

Objective

Arhroscopically performed autologous bone grafting of the femoral or tibial tunnel after anterior cruciate ligament (ACL) reconstruction in symptomatic anterior knee instability.

Indications

Subjective and objective instability in cases with recurrent instability following ACL reconstruction with tibial or femoral tunnel malplacement and tunnel widening.

Contraindications

Open growth plates, severe osteoarthritic changes.

Surgical technique

Arthroscopic ACL graft resection and implant removal followed by debridement of the tunnel and the sclerotic tunnel walls. Cortical bone cylinders and cancellous bone grafts are harvested from the iliac crest and transplanted into the enlarged and malplaced tunnels. The harvest site may be filled with bone substitutes.

Results

Arthroscopic filling of malplaced or enlarged bone tunnels was performed in 42?patients (14?men, 28?women, age range 18?C37?years) with recurrent instability after ACL reconstruction. All patients presented with tunnel malplacement, while 38?patients also had tunnel widening. In 39?cases, a tibial bone graft was necessary; in 12?cases the femoral defect was filled with autologous bone. No complications, such as hematomas of infections, were observed. CT scans showed complete integration of the osseous grafts after 3?C6?months.     

Dorso-ventrale Dauerspülung mit Hilfe des Incise Pouch

Zusammenfassung Ein Therapiekonzept der Behandlung schwerster Formen der Peritonitis bei Ein- oder Multiorganversagen ist das offene Abdomen kombiniert mit dorsoventraler Dauerspülung. Besonders bei der Dauerspulung treten gehäuft technische, intensiv-medizinische und pflegerische Probleme auf. Mit Hilfe des Incise Pouch und der von uns beschriebenen Technik ist es jedoch gelungen, folgende Probleme zu beherrschen: (1) Die exakte Bilanzierung größerer Spülmengen durch Sammeln der Spülflüssigkeit im Incise Pouch und Absaugen derselben mittels darin plazierter Saugdrainagen. (2) Die Möglichkeit der absolut trockenen Lagerung des Patienten. (3) Die Ausschaltung der Gefahr des Auftretens von Darmfisteln oder Arrosionsblutungen durch in traabdominell liegende Saugdrainagen. Operative Revisionen (on demand oder geplant) können problemlos durchgeführt werden, ebenso wird das frühzeitige Erkennen und Therapieren von postoperativen Komplikationen durch diese Technik ermöglicht.

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The Incise Pouch: a helpful device in continuous postoperative dorso-ventral lavage procedures

Dorso-ventral lavage procedures in the treatment of abdominal sepsis are often complicated by technical and nursing problems. With the help of the Incise Pouch, which consists of an adhesive foil with a plastic bag around it, we have succeeded in solving the main problems of the torso-ventral lavage procedure. (1) All the lavage solution is collected in the bag and drawn into a vacuum pump. The suction drains are placed directly in the bag. This enables us to measure the lavage solution exactly. (2) There is no leakage of liquid into the bed, so that the patient remains dry. (3) The danger of intestinal fistulas or intraabdominal bleeding caused by suction drains is eliminated (by putting them into the bag of the Incise Pouch). If reexploration of the abdominal cavity (on demand or planned) is done, the Incise Pouch remains in position. This method makes early diagnosis and treatment of postoperative complications possible.

     

Frühdiagnose post-operativer Komplikationen mit Hilfe des C-reaktiven Proteins

Zusammenfassung Das C-reaktive Protein (CRP), ein bei allen infektiösen Erkrankungen im Blutserum auftretender pathologischer Eiweißkörper, wurde bei 33 frischoperierten neurochirurgischen und allgemeinchirurgischen Patienten in regelmäßigen Abständen bestimmt. Eine Frühdiagnose post-operativer Komplikationen war in den ersten Tagen nicht möglich, da nach jedem operativen Eingriff das CRP konstant im Serum auftrat. Erst nach Absinken der Titerwerte einige Tage später konnte der CRP-Test Hinweise für beginnende Komplikationen geben. Diese Präcipitationsbestimmung war somit post-operativ nur bedingt zu verwerten. Sie erwies sich dagegen von großem Wert für die frühzeitige Erkennung auftretender infektiöser Komplikationen bei bewußtlosen Patienten nach gedeckten Schädel-Hirntraumen. Der CRP-Test war vom ersten Tage nach dem Trauma zu verwerten, erlaubte zentrale Temperatursteigerungen von infektiös bedingten zu unterscheiden und ermöglichte somit rechtzeitig eine gezielte antibiotische Therapie einzuleiten, bevor richtungsweisende klinische Zeichen aufgetreten waren.

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Summary The C-reactive Protein (CRP), one of the pathological proteins which develops in the serum in all infectious processes, was estimated in 33 recently operated neurosurgical and general surgical patients at routine intervals. An early diagnosis of postoperative complications was not possible in the first days, because after every operative manoeuvre the CRP constant in the serum increased. Only, after the fall in the titre a few days later can the CRP Test give an indication of commencing complications. Therefore, only postoperative precipitation values were allowed to be utilised. They showed themselves on the other hand of the greatest value for the earliest recognition of oncoming infectious complications in unconscious patients after severe skull and brain trauma. The CRP Test was of value in the first days after the injury, it made it possible to distinguish between rises in temperature of central or of infectious origin and thus promptly to begin antibiotic therapy, before recognisable clinical signs had developed.

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Resumen La proteina reactiva C (C. R. P.) es una de las proteinas patológicas que aparecen en el suero de todos los procesos infecciosos. Fué determinada en 33 casos recientemente operados en enfermos neuroquirúrgicos y en enfermos de cirugia general observados a ciertos intervalos. Un diagnóstico precoz de las complicaciones postoperatorias no fué posible durante los primeros dias, porque después de las intervenciones quirúrgicas la C. R. P. del suero aumenta. Solamente la precipitación de los valores post-operatorios pudo ser utilizada. Por otro lado el estudio de la C. R. P. tiene gran valor para el reconocimiento precoz de complicaciones infecciosas en los enfermos inconscientes después de lesiones traumáticas y cerebrales. La prueba C. R. P. tiene valor en los primeras dias después del traumatismo para distinguir los aumentos de temperatura de origen central o infeccioso y consecuentemente comenzar la terapéutica con antibióticos antes de que comiencen los sintomas clinicos.

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Résumé Le CRP, corps albuminoïde que l'on retrouve dans le sérum sanguin au cours de toutes les maladies infectieuses a été régulièrement étudié chez 33 opérés précoces de Neurochirurgie et de chirurgie générale. Un diagnostic précoce des complications post-opératoires n'a pas été possible dans les premiers jours parce que le CRP augmente toujours dans le sérum après l'agression opératoire. Ce n'est que quelques jours plus tard après la chute du taux du CRP que ce test donnait des renseignements sur les complications. Il s'est avéré très utile pour reconnaitre le début de complication infectieuse chez des traumatisés crâniens fermés. Le test permet le premier jour après le traumatisme de différencier les ascensions thermiques d'origine centrales ou infectieuses et de commencer une thérapeutique antibiotique avant l'apparition des signes cliniques.

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Riassunto La proteina reattiva C. (PRC), una albumina, che compare nel siero di sangue in tutte le malattie infettive, venne ricercata in 33 pazienti operati di recenti per malattie neurochirurgiche o chirurgiche. La diagnosi precoce di una complicazione postoperatoria non fu possibile nei primi giorni, in quanto la detta proteina compare nel siero costantemente dopo un intervento chirurgico. Soltanto dopo alcuni giorni il testo PRC può dare segni di una complicazione postoperatoria. Esso va quindi preso con cautela per quanto riguarda le complicazioni postoperative. Ha invece un grande valore per riconoscere complicazioni infettive in pazienti incoscenti dopo un trauma cranico coperto. Il PRC test si può utilizzare fin dai primi giorni dopo il trauma, e consente di differenziare gli aumenti di temperatura di origine centrale da quelli di origine infettiva, e quindi di stabilire una adatta terapia antibiotica, prima delle comparsa di sintomi clinici.

     

Bestimmung kleiner Sauerstoffverbrauchswerte des hypothermen Hundeherzens mit Hilfe einer fortlaufenden Messung des Sauerstoffdruckes in einem hämoglobinfreien Coronarperfusat

Ohne ZusammenfassungMit 5 AbbildungenMit Unterstützung der Deutschen Forschungsgemeinschaft.Vortragender:K. Bonhoeffer-Köln.     

Erworbene Zwerchfellshernien Bearbeitet und mit neuen Fällen vermehrt

Ohne Zusammenfassung