9 research outputs found
Rekonstrukcija distalne ulne nakon resekcije gigantocelularnog tumora
Giant cell tumour (GCT) is a rare, benign tumour, but it has a locally aggressive nature and a high rate of recurrence. A wide en-bloc resection of the distal part of the ulna, with or without stabilisation of the ulnar stump, is the recommended treatment option. Functional results after that kind of surgery are mostly satisfying but, in some cases, it can result in wrist instability, causing pain and weakness of grip strength. That is why when it comes to young people, with high functional demands, we prefer reconstruction of distal ulna and distal radioulnar joint after an en-bloc resection of the distal ulna. The distal ulna is reconstructed with an autologous free fibular graft and the distal radioulnar joint is stabilised with an autologous palmaris longus tendon graft. We present our operative technique and good functional results of three young patients treated with this procedure. Our results confirm the hypothesis that the reconstruction of the distal ulna and the distal radioulnar joint leads to a satisfactory functional result in young and active patients with higher functional demands.Gigantocelularni tumour distalnog dijela ulne je izrazito rijedak, lokalno agresivan tumor sa velikom vjerojatnoÅ”Äu recidiva. Danas preporuÄena i najÄeÅ”Äe koriÅ”tena metoda lijeÄenja ovih bolesnika je Å”iroka resekcija ulne sa ili bez stabilizacije proksimalnog dijela ulne tetivom. Funkcionalni rezultati ovakvog naÄina lijeÄenja su uglavnom zadovoljavajuÄi, ali se neki sluÄajevi kompliciraju razvojem nestabilnosti ruÄnog zgloba i znaÄajnim smanjenjem snage Å”ake. Zato u mladih osoba sa visokim funkcionalnim zahtjevima preferiramo nakon resekcije tumora uÄiniti rekonstrukciju distalne ulne i distalnog radioulnarnog zgloba. Distalnu ulnu rekonstruiramo pomoÄu slobodnog koÅ”tanog presatka dijafize bolesnikove fibule, a distalni radioulnarni zglob stabiliziramo koristeÄi presadak bolesnikove tetive miÅ”iÄa palmaris longusa. Ovim radom prikazujemo naÅ”u operativnu tehniku i dobre funkcionalne rezultate troje mladih bolesnika operiranih na ovaj naÄin. NaÅ”i rezultati potvrÄuju pretpostavku kako rekonstrukcija distalne ulne i distalnog radioulnarnog zgloba dovode do zadovoljavajuÄeg funkcionalnog rezultata u mladih i aktivnih bolesnika sa veÄim funkcionalnim zahtjevima
HAND SURGERY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Reumatoidni artritis kroniÄna je, progresivna, sistemska upalna bolest koja u veÄine oboljelih dovodi do progresivnog razvoja deformiteta i gubitka funkcije Å”aka i ruÄnih zglobova praÄenih bolima te uzrokujuÄi teÅ”koÄe u svakodnevnom životu. KirurÅ”ko lijeÄenje ovih bolesnika ima ulogu u postizanju Å”to bolje funkcije Å”ake i ruÄnog zgloba, olakÅ”avanju boli, ali i postizanju boljeg estetskog rezultata. U ranim fazama bolesti izvode se preventivni zahvati, kojima usporavamo prirodni tijek bolesti uklanjajuÄi upaljeno i reaktivno tkivo. Oni popravljaju funkciju zgloba i snižavaju rizik od rupture tetiva i razvoja težih deformacija. U kasnijim fazama bolesti, kada su znatne promjene veÄ nastupile, rekonstruktivnim kirurÅ”kim zahvatima pokuÅ”avaju se poboljÅ”ati funkcija i smanjiti bol ili zbrinuti rupture tetiva. Pri odluci o obliku lijeÄenja u prvom su redu važni suradnja reumatologa i ortopeda te individualizirani pristup svakom bolesniku kako bi se odabrali najbolji oblik kirurÅ”kog zahvata, kao i najbolji trenutak za njegovo izvoÄenje.Rheumatoid arthritis is a chronic, progressive, systematic inflammatory disease which canoften cause progressive development of deformity and loss of function of the hand and the wrist, accompanied by pain and difficulties in everyday life. The goal of surgical treatment of these patients is regaining better function of the hand and the wrist, relief
of pain, and achieving a better esthetic result. Preventive procedures slow down the natural course of the disease by the removal of inflamed and reactive tissue. They enhance joint function and reduce the risk of tendon ruptures and development of more severe deformities. In the later course of the disease, with severe changes already present, reconstructive surgical treatments are performed with the goal to regain better function and reduce pain, or to treat ruptured tendons. Cooperation of rheumatologists and orthopedic surgeons is necessary in the treatment decision, with an individualized approach to each patient, to determine the best timeline and surgical procedure
Sindrom kubitalnog kanala
Sindrom kubitalnog kanala susreÄemo relativno Äesto te on predstavlja znaÄajan javnozdravstveni problem. SpecifiÄnost tijeka ulnarnog živca niz ruku, a napose anatomski meÄuodnosi s koÅ”tanim i mekotkivnim strukturama u podruÄju lakta Äine ga vrlo podložnim vanjskim utjecajima, ponajviÅ”e silama kompresije. Progresija parestezija na ulnarnoj strani Äetvrtog prsta i na Äitavom petom prstu zahvaÄene Å”ake uz pojavu motoriÄke slabosti i atrofije miÅ”iÄa Å”ake uvelike ograniÄava bolesnike, najÄeÅ”Äe one koji se bave aktivnostima koje zahtijevaju da im je lakat duže vremena u fleksiji, da neometano obavljaju svakodnevne aktivnosti. Stoga je iznimno važno pravovremeno dijagnosticiranje sindroma koje se zasniva na iscrpnoj anamnezi i detaljnom kliniÄkom pregledu uz pomoÄ niza specifiÄnih testova koji su detaljno opisani u radu. Elektromioneurografijom možemo utvrditi stupanj kompresije ulnarnog živca te pratiti uspjeÅ”nost daljnjeg lijeÄenja. Blaži oblici sindroma kubitalnog kanala uspjeÅ”no se lijeÄe konzervativnim naÄinom, dok teže oblike sindroma te one koji su neosjetljivi na provedeno konzervativno lijeÄenje treba lijeÄiti kirurÅ”ki. Metode kirurÅ”kog lijeÄenja sindroma možemo podijeliti na one koje ostavljaju živac u ležiÅ”tu u kubitalnom kanalu poput in situ dekompresije i medijalne epikondilektomije te na one tijekom kojih se živac premjeÅ”ta u novo ležiÅ”te ispred i iznad medijalnog epikondila, Å”to nazivamo antepozicijom ulnarnog živca. Sve opisane metode pokazale su se gotovo jednako uspjeÅ”nima, no usprkos tomu istraživanja pokazuju da se u danaÅ”nje vrijeme kao metoda izbora kirurÅ”kog lijeÄenja sindroma kubitalnog kanala najÄeÅ”Äe koristi in situ dekompresija
RARE LOCALIZATION OF OSTEOID OSTEOMA ā DISTAL PHALANX OF THE RING FINGER
Ovim kliniÄkim zapažanjem želimo upozoriti na osteoid osteom kao moguÄi uzrok tegoba u podruÄju distalne falange prstiju Å”ake. Ta iznimno rijetka lokalizacija osteoid osteoma predstavlja problem za prepoznavanje i zbog atipiÄne prezentacije. DvadesetogodiÅ”nji bolesnik se pet godina žalio na bol u podruÄju jagodice IV. prsta desne Å”ake koja je bila praÄena oteklinom i crvenilom jagodice prsta te deformacijom nokta. Na rendgenskim snimkama vidjela se osteoliza u podruÄju baze distalne falange. Magnetskom rezonancijom je postavljena sumnja na osteoid osteom, Å”to je potvrÄeno kompjuteriziranom tomografi jom. Nakon kirurÅ”kog lijeÄenja tijekom kojeg je osteoid osteom ekskohleiran, dolazi do potpunog nestanka tegoba. Potpuni oporavak bolesnika pokazuje i rezultat DASH upitnika, koji je veÄ tri mjeseca nakon zahvata pao sa 54,5 na 0 Å”to je prema tom upitniku uredan nalaz. Na osteoid osteom se uvijek mora posumnjati ako je oteklina distalne falange prsta s deformacijom nokta praÄena bolovima koji se smanjuju koriÅ”tenjem NSAIL. Metoda izbora u dijagnostici je kompjuterizirana tomografi ja koja mora biti naÄinjena tako da slojevi ne budu deblji od 1 do 2 mm. Zbog
blizine neurovaskularnih struktura i tetiva najboljim oblikom lijeÄenja osteoid osteoma u podruÄju distalne falange prstiju Å”ake smatra se kirurÅ”ka ekscizija ili ekskohleacija.With this clinical observation we would like to bring to mind osteoid osteoma as a possible cause of problems of distal phalanx of the fi ngers. Osteoid osteoma occurs rarely at this location and has atypical presentation. The main symptoms are swelling and redness of the fi ngertip with nail deformity, while typical night pain may not be present. Unusual clinical and x-ray presentation of tumor in this localization can make diagnosis of osteoid osteoma very difficult. A 20-year-old patient reported pain in the fi ngertip of his right ring finger persisting for fi ve years. Swelling and redness of the fi ngertip combined with nail deformity was also present. X-rays showed osteolysis in the base of distal phalanx. Magnetic resonance imaging showed suspicion of osteoid osteoma, which was confi rmed by computed tomography (CT). We performed surgical removal of osteoid osteoma in February 2014. The tumor was approached by longitudinal incision on the lateral side of the distal phalanx of the ring fi nger and the basal part of distal phalanx was cut with a small chisel to enable access to cystic change of the bone. Tumor removal with excochleation was performed and the material thus obtained was sent for histopathologic analysis. After surgery, the ring fi nger was immobilized in a plaster splint for a three-week period. After
removal of immobilization, the patient was referred to physical therapy consisting of individual exercises in order to obtain the full range of motion in all joints of the hands and strengthen hand and forearm muscles. After surgical removal of osteoid osteoma, all symptoms disappeared completely. Histopathologic findings confi rmed the diagnosis of osteoid osteoma. After physical therapy, he returned to daily activities without any problems. On regular follow ups at 3, 6 and 12 months after surgery, clinical fi ndings were normal and the patient had no pain or discomforts. Full recovery was shown by the result of the DASH questionnaire three months after the procedure. Preoperative DASH score 54.4 decreased to 0. Distal phalanx of the fi nger is a very rare localization of osteoid osteoma, and typical night pain may not be present. In addition, appearance on x-rays is not typical. Instead of central enlightenment surrounded with sclerosis, x-rays usually show a lytic lesion. For this reason, it may be diffi cult to make the diagnosis of osteoid osteoma. The main symptom is permanent pain, swelling
and redness of the fi nger, with nail deformity. The imaging method of choice is CT, which must be performed with thin layers of 1 to 2 mm. Furthermore, cooperation of surgeon and radiologist is extremely important to reach the accurate diagnosis. Many treatment options are described in the literature, such as CT-guided percutaneous thermocoagulation, destruction of lesions with alcohol, or CT-guided radiofrequency ablation. However, due to the proximity of neurovascular structures, tendons and joints, the best method for treatment osteoid osteoma in distal phalanx of the fi ngers is surgical excision or excochleation. Our conclusion is that one should always bear in mind that osteoid osteoma can be the cause of swelling of distal phalanx of the fi nger with nail deformity, and pain that alleviated with the use of non-steroidal anti-infl ammatory drugs. Surgical excision or excochleation is the best method for the treatment osteoid osteoma of distal phalanx of the finger
OPERATIVE TREATMENT OF THUMB CARPOMETACARPAL JOINT OSTEOARTRITIS WITH TRAPEZIECTOMY AND INTERPOSITION ARTHROPLASTY
CILJ
Kada se iscrpe sve moguÄnosti konzervativnog lijeÄenja bolesnika s rizartrozom, jedinu moguÄnost lijeÄenja predstavljaju operacijski zahvati. Ranije se u ovih bolesnika lijeÄenje svodilo na artrodezu prvog karpometakarpalnog zgloba Å”ake, Å”to je dovodilo do smanjenja bolova, ali je i znaÄajno limitiralo funkciju Å”ake, u prvom redu funkciju palca. Danas je cilj operacijskog lijeÄenja oÄuvati funkciju palca i u tu svrhu je razvijen cijeli spektar operacijskih zahvata. Cilj ovog rada je prikazati dugoroÄne rezultate trapeziektomije s interpozicijskom artroplastikom koriÅ”tenjem tetive miÅ”iÄa fleksor carpi radialisa (FCR), zahvata koji mi najÄeÅ”Äe koristimo
Reciprocal Alterations in Osteoprogenitor and Immune Cell Populations in Rheumatoid Synovia
Rheumatoid arthritis (RA) is chronic, autoimmune joint inflammation characterized by irreversible joint destruction. Besides increased resorption, destruction is a result of decreased bone formation, due to suppressed differentiation and function of the mesenchymal lineage-derived osteoblasts in inflammatory milieu. In this study, we analyzed the cellular composition of synovial tissue from 11 RA and 10 control patients harvested during planned surgeries in order to characterize resident synovial progenitor populations. Synovial cells were released by collagenase, and labeled for flow cytometry by two antibody panels: 1. CD3-FITC, CD14-PE, 7-AAD, CD11b-PECy7, CD235a-APC, CD19-APCeF780; and 2. 7-AAD, CD105-PECy7, CD45/CD31/CD235a-APC, and CD200-APCeF780. The proportions of lymphocytes (CD3+, CD19+) and myeloid (CD11b+, CD14+) cells were higher in synovial tissue from the patients with RA than in the controls. Among non-hematopoietic (CD45−CD31−CD235a−) cells, there was a decrease in the proportion of CD200+CD105− and increase in the proportion of CD200−CD105+ cells in synovial tissue from the patients with RA in comparison to the control patients. The proportions of both populations were associated with inflammatory activity and could discriminate between the RA and the controls