Orthopadie (Heidelberg, Germany)最新文献

{"title":"[Comparative evaluation of trabecular bone density in Hounsfield units in the lumbar native CT cross-section for osteoporosis diagnosis and fracture risk determination by different examiners].","authors":"Julian Ramin Andresen, Guido Schröder, Thomas Haider, Christoph Kopetsch, Claus Maximilian Kullen, Hans Christof Schober, Reimer Andresen","doi":"10.1007/s00132-024-04587-3","DOIUrl":"10.1007/s00132-024-04587-3","url":null,"abstract":"<p><strong>Background: </strong>An increasing loss of bone mineral density (BMD) in the axial skeleton leads to osteoporosis and fractures, with an increase found in the thoracic and thoracolumbar regions.</p><p><strong>Research question: </strong>The extent to which an examiner-independent assessment of the extent of osteoporosis and fracture risk determination is possible by determining the trabecular density in Hounsfield units (HU) in the spine should be examined. The next question was whether quantitative BMD values can be calculated from the HU values.</p><p><strong>Patients and methods: </strong>225 patients (pt.) with an average age of 64.9 ± 13.1 years and a body-mass-index (BMI) of 26.8 ± 6.8 kg/m², of which 37 were men and 188 were women, were examined to determine whether they had osteoporosis. The BMD was determined in mg/cm³ using quantitative computed tomography (QCT) in the lumbar region. After anonymization by three experienced radiologists, an additional measurement of the trabecular bone density in HU, was carried out in the same vertebral bodies (a total of 675 vertebral bodies), each using a region of interest (ROI) positioned in the midvertebral cancellous space in the sagittal reformed CT image. In additional lateral X‑rays of the thoracic and lumbar spine, vertebral fractures were detected and graded. Sacral insufficiency fractures that occurred at the same time were also recorded.</p><p><strong>Results: </strong>The median BMD was 73.2 (57.05-104.17) mg/cm³ and the median HU was 89.93 (67.90-126.95). With a correlation of 0.988 (p < 0.001), quantitative values in mg/cm³ can be calculated using the following formula: Xq = 12.1 + 0.68 × HU. With HU values less than 69.84 and a BMD of the lumbar spine below 59.54 mg/cm³, there was a significantly increased number of OVF. At least one OVF was found in 137/225 pt. In 17/137 pt., sacral fractures were also found; these patients showed the significantly lowest values with a median BMD of 41.81 (16.2-53.7) mg/cm³. Comparable HU values were determined independently of the examiners (p > 0.05).</p><p><strong>Discussion: </strong>The trabecular density measurements in HU values can be converted into quantitative BMD values in mg/cm³, which enables a good assessment of osteoporosis and fracture risk. Taking the results obtained into account, an opportunistic evaluation using HU values in native CT alone seems quite possible. Experienced examiners have arrived at comparable results.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"48-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Disc herniation (part 2)].","authors":"Dorothea Daentzer, Christoph J Siepe","doi":"10.1007/s00132-024-04583-7","DOIUrl":"https://doi.org/10.1007/s00132-024-04583-7","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":"54 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Elbow arthritis].","authors":"N Zumbansen, A Lenich","doi":"10.1007/s00132-024-04574-8","DOIUrl":"10.1007/s00132-024-04574-8","url":null,"abstract":"<p><p>Most patients with primary osteoarthritis of the elbow report a history of heavy lifting work with the affected upper limb. Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drug (NSAID) intake, and intra-articular injections can provide sufficient pain relief in the early stages when used in combination. If surgery is required, many patients experience significant pain relief from joint-preserving procedures despite existing cartilage damage. Although open debridement procedures are effective, arthroscopic osteocapsular arthroplasty has become established as the preferred surgical procedure. The ulnar nerve should be assessed during surgery and treated if necessary. Total elbow arthroplasty (TEP) is successful in terms of pain relief and function; however, it is recommended for older patients with advanced osteoarthritis or for whom joint-preserving procedures have failed.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"83-92"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Anaesthesiological concepts in knee joint arthroplasty and implementation of fast-track concepts in everyday clinical practice].","authors":"Christina Valle, Sandro Valle, Clemens Baier","doi":"10.1007/s00132-024-04592-6","DOIUrl":"10.1007/s00132-024-04592-6","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"78-82"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Discrepancy between the practitioner and the person signing the prescription: can panel doctors' associations reclaim fees? : Discussion of the judgement of the Social Court of Munich from November 13, 2023].","authors":"Christian Schüttler","doi":"10.1007/s00132-024-04596-2","DOIUrl":"10.1007/s00132-024-04596-2","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"71-73"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Insoles in the treatment of pes planovalgus : A prospective, randomised, double-blind, placebo-controlled comparative trial of sensomotoric and supportive insoles].","authors":"Alexander Pascal-Laurent Schmitt, Kira-Henriette Liebau, Alexander Hamm, Wolfram Mittelmeier, Christoph Schulze","doi":"10.1007/s00132-024-04589-1","DOIUrl":"10.1007/s00132-024-04589-1","url":null,"abstract":"<p><strong>Background: </strong>In adults, flexible symptomatic flat foot is treated conservatively with supportive foot orthoses. Sensorimotor foot orthoses, however, are controversial due to insufficient data.</p><p><strong>Purpose: </strong>Comparison of the effectiveness of sensorimotor and supportive foot orthoses in adults.</p><p><strong>Material and methods: </strong>In 73 patients, in addition to foot gymnastics, supportive, sensorimotor or placebo insoles were compared over 3 measurement points during 1 year as part of a double-blind, prospective, randomised placebo-controlled clinical trial using Numeric Rating-Scala, the Foot and Ankle Disability Index, as well as pedobarography and valgus index. The statistical analysis was performed using ANOVA with repeated measures.</p><p><strong>Results: </strong>The valgus index increased significantly with supportive foot orthoses. In the follow-up, the foot contact area was only significantly reduced with sensorimotor foot orthoses in static and dynamic measurements. Supportive foot orthoses led to a faster reduction in pain, but without reducing the contact area of the foot. There were no relevant differences in functionality.</p><p><strong>Conclusions: </strong>The reduction of the contact surface in combination with sensorimotor foot orthoses shows the potential for muscular addressing of the flexible flat foot. There were no disadvantages compared to other treatments. Supportive foot orthoses led to a faster reduction in subjective complaints, but appear to weaken the muscles supporting the arch of the foot. In the longer term, consistent foot muscle training also appears to be effective, as wearing placebo foot orthoses also led to an improvement in subjective well-being without significant biomechanical changes.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"61-70"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Perioperative management and spinal anaesthesia in fast-track-Total Knee Arthroplasty].","authors":"Alexander H Andres, Roland E Willburger, Thomas Weber","doi":"10.1007/s00132-024-04591-7","DOIUrl":"10.1007/s00132-024-04591-7","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"74-77"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Lumbar disc herniation].","authors":"F C Heider, C J Siepe","doi":"10.1007/s00132-024-04586-4","DOIUrl":"10.1007/s00132-024-04586-4","url":null,"abstract":"<p><strong>Background: </strong>The most common cause of disc herniation is the degeneration of the intervertebral disc. Consequently, lumbar disc herniations are amongst the most common pathologies of the lumbar spine. Factors that can increase the risk of disc herniation include genetics, weight, occupational risk factors, smoking, as well as a predominantly sedentary profession.</p><p><strong>Clinical presentation and therapy: </strong>Pathognomonic symptoms of a herniated disc include sciatica, caused by the compression of one or more spinal nerve roots. The clinical sequelae of lumbar disc herniations range from mild low back and buttock pain to severe, immobilising cases of sciatica to cauda equina compression syndromes. In 1-1.5% of cases, a cauda equina syndrome may occur. This cauda equina syndrome may be considered an emergency situation that requires immediate attention and surgical decompression. The same applies to significant and rapidly deteriorating neurological deficits (< 24 h). In all other cases, which represents the majority of all patients, substantial pain relief can be achieved with nonsurgical measures. If an adequate and intolerable pain relief cannot be achieved despite intense conservative treatment measures after an extended period of 6-12 weeks, surgical removal of the disc herniation may be indicated.</p><p><strong>Surgical procedures: </strong>Lumbar disc herniations may be addressed surgically with minimally invasive techniques. The goal of the surgery is full and sufficient safe removal of the herniated disc fragments in order to decompress the spinal nerves as well as the cauda equina. The two most commonly used surgical techniques (endoscopic/microsurgical) entail five different approaches (endoscopic: interlaminar, transforaminal; microsurgical: interlaminar, translaminar, extraforaminal). Patients are generally fully mobilized within hours after the surgery without any further restrictions. Postoperative rehabilitation measures are often carried out, but have no scientifically proven influence on the outcome of the operation.</p><p><strong>Conclusion: </strong>This article sheds light on the diagnostic and therapeutic procedures, techniques and special features of this socio-medically very important clinical picture.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"3-17"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Persistent spinal pain syndrome : Consideration of psychosocial risk factors].","authors":"Friederike Schulz","doi":"10.1007/s00132-024-04584-6","DOIUrl":"10.1007/s00132-024-04584-6","url":null,"abstract":"<p><p>The introduction of the term persistent spinal pain syndrome (PSPS), replacing the term failed back surgery syndrome (FBSS) has significantly changed diagnostic and treatment approaches of PSPS. There are multiple risk factors that may contribute to the development of PSPS. Accurately identifying individual risk factors is, therefore, crucial for patient-centered treatment planning. This article mainly focuses on patient-related psychosocial risk factors. Possibilities of evaluating these risk factors prior to spinal surgery in order to prevent PSPS from developing, as well as treatment options for established PSPS will be discussed.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"40-47"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Thoracic disc herniation].","authors":"Stephan Dützmann, Daniel Rosenthal","doi":"10.1007/s00132-024-04585-5","DOIUrl":"10.1007/s00132-024-04585-5","url":null,"abstract":"<p><p>Contrary to traditional opinion thoracic herniation is more frequent than expected. The disease poses two main challenges: (1) surgical removal and (2) early and correct diagnosis. It is without a doubt that herniated thoracic discs can be difficult to remove. Often enough, it is equally challenging to attribute the correct symptoms to the disease to reach the diagnosis, because there is a great variability and supposedly low specificity of the clinical symptoms, especially concerning pain related symptoms, which are often attributed to muscular or joint related causes. However, radicular complaints and myelopathic deficits usually predominate, but also algetic symptoms exist in patients harboring this disease. The surgical approach should be a ventral one. The postoperative prognosis is mostly good after adequate decompression.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"18-25"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}