Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

{"title":"Quality of Life after Multisegmental Fusion Surgery for Degenerative Spine Diseases.","authors":"Frank Beyer, Johanna Schirmer, Tobias Prasse, Peer Eysel, Jan Bredow","doi":"10.1055/a-2546-7316","DOIUrl":"https://doi.org/10.1055/a-2546-7316","url":null,"abstract":"<p><p>Degenerative spinal diseases may lead to multisegmental instabilities and present as de novo scoliosis. Due to frequent primary and secondary complications, their treatment is controversial among spine surgeons. The aim of this systematic review is to investigate the postoperative quality of life after multilevel fusion surgery for de novo scoliosis. Furthermore, technical aspects and complications are examined in detail.A systematic literature search was conducted, excluding systematic reviews or meta-analyses. A follow-up period of at least 24 months was required. Standardised outcome instruments on quality of life, epidemiological data and information on surgical technique and any further follow-up examinations were extracted. Studies on adolescents or neuromuscular scoliosis were excluded, as were case reports and studies on short-span fusions.Twenty studies were included in the systematic review. The Oswestry Disability Index (ODI) was reported in 15 studies. All authors reported significant improvements. Inclusion of the L5/S1 segment showed no differences in quality of life, but better radiological correction, although the rate of adjacent segment degeneration and complications was higher. The data on general postoperative complications ranged from 10.5% to 71.5%.Quality of life after multilevel fusion for de novo scoliosis shows significant improvements. There is no general recommendation on the last instrumented vertebra or the caudal anchoring of the instrumentation. Treatment in specialised centres for spine surgery is strongly recommended, also due to the high postoperative complication rates.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813284","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":"Transient Hip Synovitis, 146 Cases, Origin and Duration.","authors":"Hartmut Gaulrapp, Philipp Schoof, Gregor Schönecker","doi":"10.1055/a-2533-4972","DOIUrl":"https://doi.org/10.1055/a-2533-4972","url":null,"abstract":"<p><p>Transient hip synovitis is one of the most common paediatric orthopaedic diseases. This non-controlled interventional study investigated the origin, clinical findings, imaging and the duration of symptoms. 146 affected patients out of the total of 27659 patients under 18 years result in an incidence of 0.53%. 76.7% boys outweighed 23.3% girls (1.8-12.9 years [Ø 6.3 y, boys Ø 6.5 y, girls Ø 6.2 y]). Diagnoses were defined by ultrasound and the absence of concurrent diseases. In 60.5% of patients, the right hip was affected, in 39.5% the left. A single patient had CF on both sides but not at the same time. No simultaneous incidence was recorded. There were two singular recurrences. Within the study period, we counted 11 cases of Perthes' disease, 2 juvenile hip arthritis and one septic hip. Patients' history showed 41.0% viral infections, 21.6% physical exertion and 15.1% singular trauma. In 22.3% no origin could be named. Clinical aspects included pain in inward rotation (51.5%), in hip flexion (49.3%) and limping (37.5%). Ultrasound depicted medium joint effusion in 53.4%, marked effusion in 46.6% and synovial thickening in 17.1% of patients. 119 patients could be followed up weekly. Joint effusion vanished after 3-36 days (Ø 13.3 d), clinical symptoms Ø 1.6 days earlier. Total duration in terms of sonographic appearance of effusion was 3 to 37 days (Ø 19.1 d).</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782324","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":"MRI-based L1 Vertebral Bone Quality Scores Predict Cage Subsidence Following Transforaminal Lumbar Interbody Fusion Similar to L1 CT Hounsfield Units.","authors":"Yongdi Wang, Qian Chen, Ce Zhu, Youwei Ai, Juehan Wang, Hong Ding, Dun Luo, Limin Liu","doi":"10.1055/a-2550-4502","DOIUrl":"https://doi.org/10.1055/a-2550-4502","url":null,"abstract":"<p><p>Cage subsidence is one of the most common complications after transforaminal lumbar interbody fusion (TLIF) and correlates with inferior bone quality. Studies have reported L1 vertebral bone quality score (VBQ) based on MRI to be a promising alternative to evaluating preoperative bone quality. However, to the knowledge of the authors, no study has examined the correlation between L1 VBQ scores and cage subsidence after TLIF.The purpose of the study was (1) to assess the interrelation between the L1 VBQ score and cage subsidence after TLIF; and (2) to compare L1 VBQ and L1 CT Hounsfield Unit (HU) values in predicting cage subsidence after TLIF.We reviewed patients who had undergone TLIF at one institution between 2012 to 2021. Cage subsidence was measured using postoperative lumbar CT based on cage protrusion through the endplates at more than 2 mm. The L1 VBQ score was calculated by dividing mean L1 signal intensity (SI) by mean SI of the cerebrospinal fluid (CSF) at L1. The L1 HU value representing bone mineral density (BMD) was measured using computed tomography. We then performed Student's <i>t</i>-test for independent samples and logistic regression analyses for statistical analysis. We also conducted receiver operating characteristic (ROC) analysis to assess the predictive ability of the L1 VBQ score and L1 CT HU.Of 233 participants, cage subsidence was observed in 41 patients (17.6%). Comparison between the characteristics of patients between the group with subsidence and the group without subsidence revealed significant differences in the age, VBQ score, and L1 CT HU. Multivariate logistic regression showed that higher L1 VBQ score (OR = 2.499, 95% CI: 1.205-5.180, p = 0.014) and lower L1 CT HU (OR = 0.960, 95% CI: 0.933-0.987, p = 0.005) were associated with an increased rate of cage subsidence. Area under the curve (AUC) analysis of the L1 VBQ score returned 0.735 (95% CI: 0.620-0.850) and the suitable threshold was 3.424 (sensitivity: 82.9%, specificity: 70.7%). The AUC of L1 CT HU was 0.747 (95% CI: 0.642-0.852) and the suitable threshold was 136.5 (sensitivity: 85.4%, specificity: 56.1%).The present study demonstrates that L1 VBQ score and L1 CT HU are reliable predictors with similar performance for cage subsidence after TLIF.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782323","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":"[Quadriceps Tendon and Patellar Tendon Rupture].","authors":"Christian Arras, Matthias Krause, Karl-Heinz Frosch","doi":"10.1055/a-2491-0972","DOIUrl":"https://doi.org/10.1055/a-2491-0972","url":null,"abstract":"<p><p>The vascularity of the quadriceps tendon influences the risk of tendon rupture. Quadriceps and patellar tendon ruptures are rare but serious injuries, with an incidence of 1.37/100000 and 0.68/100000, respectively. Risk factors include age, degeneration, and systemic diseases such as kidney disease and rheumatoid arthritis. While quadriceps tendon ruptures predominantly affect people over 50, patellar tendon ruptures are more common in younger, physically active people, often with pre-existing tendon pathologies. The most common mechanism of rupture of the quadriceps tendon is indirect trauma, typically caused by sudden eccentric loading or reflexive contraction, with degeneration of the tendon tissue being a predisposing factor. Diagnosis is primarily clinical, supported by imaging modalities such as ultrasound and MRI. Treatment options depend on the severity of the tear. Partial ruptures can often be managed conservatively, whereas complete ruptures require surgical repair, typically by transosseous suture or fixation with bone anchors or transosseous sutures. Early functional rehabilitation is essential for optimal recovery. The prognosis is generally favorable with early treatment, although complications such as quadriceps atrophy and flexion deficits may occur. Proper documentation of the mechanism of injury and histopathological evaluation of the tendon tissue are important to determine the underlying cause and ensure appropriate insurance coverage.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 2","pages":"181-194"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712555","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":"Implantation of Reverse Shoulder Endoprothesis Using Navigation.","authors":"Olaf Rolf, Andreas Blana, Philipp Hagedorn","doi":"10.1055/a-2346-9916","DOIUrl":"10.1055/a-2346-9916","url":null,"abstract":"<p><p>Die Implantation einer inversen Schulterendoprothese (TEP) stellt eine bewährte Methode zur Schmerzlinderung und Schulterfunktionsverbesserung dar. Die Ergebnisse variieren je nach Patientenalter, Krankheitsgrad und Erfahrung des Operateurs. Indikationen für eine inverse TEP sind vielfältig, von der Defektarthropathie bis hin zu Frakturen. Aktuelle Studien zeigen verbesserte Überlebensraten und reduzierte Komplikationen nach primärer Implantation. Die präoperative Planung mittels 3-D-CT oder MRT gilt als Goldstandard. Patientenspezifische Instrumente (PSI) wurden eingeführt, sind jedoch mit Kosten und Wartezeit verbunden. Die Navigation mit \"Augmented Reality\" (AR) bietet eine effizientere Alternative. Die intraoperative Übertragung der Planung auf den Patienten erfolgt über AR-Brillen und ermöglicht Echtzeitinformationen, wodurch der Chirurg den Blick vom Situs nicht abwenden muss. Dies optimiert den Workflow und bietet potenziell präzisere Implantationsresultate. Zusammenfassend bietet die Kombination von 3-D-Planung, Navigation und AR eine vielversprechende Methode für präzise und effiziente Implantationen von inversen Schulterendoprothesen. Allerdings steht der Nachweis verbesserter Standzeiten und Funktionsscores noch aus.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"176-180"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305418","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":"Digitale Helfer: KI in der Unfallchirurgie im Einklang mit ethischen Standards.","authors":"Marie Samland","doi":"10.1055/a-2491-0794","DOIUrl":"https://doi.org/10.1055/a-2491-0794","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 2","pages":"122"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723026","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":"Cement Leakage after Augmentation of Osteoporotic Vertebral Bodies.","authors":"Mina Aziz, Inga Kniep, Benjamin Ondruschka, Klaus Püschel, Christian Hessler","doi":"10.1055/a-2343-4100","DOIUrl":"10.1055/a-2343-4100","url":null,"abstract":"<p><p>Der Zementaustritt ist die häufigste Komplikation bei der Zementaugmentation von Wirbelkörpern. In der vorliegenden Studie wurden die Zementaustrittsraten bei Zementaugmentationen an der Wirbelsäule untersucht und potenzielle Risikofaktoren für einen Zementaustritt identifiziert.Es wurden 140 Fälle von 131 Patienten und Patientinnen und 9 Verstorbenen ausgewertet. Insgesamt wurden 258 zementaugmentierte Wirbelkörper untersucht. Die Daten dafür stammen aus den Krankenhausdokumentationen von 131 Patienten und Patientinnen, die sich in 2 orthopädisch-unfallchirurgischen Kliniken in der BRD solchen Operationen unterzogen, sowie aus den Untersuchungen von 9 Sterbefällen im Institut für Rechtsmedizin der Universitätsklinikums Hamburg-Eppendorf.Zementaustritte wurden in 64 der 140 Fälle (45,7%) ermittelt. Lokale Zementaustritte waren mit 73,4% (n = 47) die häufigste Austrittsart. Venöse Austritte wurden in 15 Fällen (23,4%) und Lungenzementembolisationen in 2 Fällen (3,1%) evaluiert. Innerhalb des Kollektivs der retrospektiv untersuchten Fälle (n = 131) erlitt lediglich 1 Patient (0,8%) einen symptomatischen Zementaustritt. Als Risikofaktoren für Zementaustritte konnten Zementaugmentationen von Frakturen an Lendenwirbelkörpern sowie eine hohe applizierte Zementmenge identifiziert werden.Sowohl die Daten in der assoziierten Literatur als auch die Ergebnisse dieser Arbeit belegen eine hohe Inzidenz von Zementaustritten nach Wirbelkörperaugmentationen. Trotz des geringen prozentualen Anteils symptomatischer Fälle sollten bei der Planung und Durchführung von Zementaugmentationen an Wirbelkörpern die möglichen Einflussfaktoren für einen Zementaustritt berücksichtigt und in die OP-Planung einbezogen werden.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"146-152"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972518","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":"GeriNOT in the Surgical Inpatient Setting.","authors":"Birgit Feindt, Andreas Roth, Christoph-Eckhard Heyde, Johann Behrens, Beate Feist, Lysann Kasprick, Ralf Sultzer, Christoph Baerwald","doi":"10.1055/a-2343-4014","DOIUrl":"10.1055/a-2343-4014","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Die Richtlinie des Gemeinsamen Bundesausschusses (G-BA) über Maßnahmen zur Qualitätssicherung zur Versorgung von Patient*innen mit hüftgelenknaher Femurfraktur verpflichtet Krankenhäuser zum Einsatz eines validierten geriatrischen Screeninginstruments. Die systematische Anwendung des GeriNOT mit prozessproduzierter Datenerhebung im Akutaufnahmeprozess durch Integration in das Krankenhausinformationssystem (KIS) ermöglicht die Identifikation von Risikopotenzialen auch in anderen geriatrischen Diagnosegruppen.Mit Einbindung des GeriNOT in den Akutaufnahmeprozess wurde geprüft, ob auch andere vulnerable geriatrische Diagnosegruppen von einer frühzeitig eingeleiteten Risikoidentifikation profitieren können.Datengrundlage dieser Untersuchung bildete eine retrospektive bizentrische Erhebung elektronischer Fallakten (Mai 2014 bis April 2015, n = 3443). Aus diesem Primärdatensatz wurde die Subgruppe stationärer Akutaufnahmen (n = 821) der Orthopädie/Unfallchirurgie eines Zentrums in Bezug auf die Endpunkte \"Inanspruchnahme bedarfsgerechter poststationärer Pflegeleistungen\" und \"Neueinzug in stationäre Dauer-/Kurzzeitpflege\" analysiert. Es wurden Prädiktionskraft und Klassifikationsgenauigkeit von GeriNOT dieser ab 70-jährigen Personen in Diagnosegruppen für die definierten Endpunkte beurteilt: Akutaufnahmen insgesamt, Frakturen insgesamt, hüftgelenknahe Femurfraktur und Wirbelsäulenerkrankungen inklusive Wirbelsäulenfrakturen.Im Untersuchungszeitraum wurden 821 Personen akutstationär aufgenommen. Das mittlere Alter betrug 81,4 ± 6,8 Jahre (n = 821; 68,1% Frauen, 31,9% Männer). Folgende Diagnosegruppen wurden gebildet und analysiert: Frakturen insgesamt (n = 490), Wirbelsäulenerkrankungen (n = 265), davon Wirbelsäulenfrakturen (n = 174), hüftgelenknahe Femurfraktur (n = 108). In der Gesamtgruppe (n = 821; MW = 4,279; SD = 2,180) und in den Diagnosegruppen lag der Mittelwert des GeriNOT-Scores über dem Schwellenwert ≥ 4. In der Gruppe der hüftgelenknahen Femurfraktur wurde der höchste Wert ermittelt (MW = 4,852; SD = 2,022), der niedrigste in der Gruppe der Wirbelsäulenfrakturen (MW = 4,177; SD = 2,171). In der Aufnahmesituation bez. behandlungsbedürftiger Diagnosen, Polypharmazie und bereits in Anspruch genommener Pflegeleistungen unterschieden sich die Diagnosegruppen nur geringfügig. Einweisungen aus stationärer Kurz- und Dauerpflege erfolgten in der Gesamtgruppe (n = 821) in 16,44% der Fälle, am häufigsten mit 31,48% in der Gruppe der hüftgelenknahen Femurfraktur, hingegen am seltensten in der Diagnosegruppe der Wirbelsäulenerkrankungen mit 6,79%. GeriNOT detektierte für diese Gruppe ein erhöhtes Risiko in Bezug auf die definierten Endpunkte. Nur 4,26% aller Patient*innen mit identifiziertem geriatrischen Risikopotenzial wurden akutgeriatrisch weiterversorgt.Die Ergebnisse zeigten ein erhöhtes geriatrisches Risiko in allen analysierten Diagnosegruppen, am stärksten innerhalb der Gruppe der Wirbelsäulenerkrankungen. Der KIS-gestützte Einsatz des G","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"137-145"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402615","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":"Erstes gemeinsames fächerübergreifendes Konsensuspapier: „Operative Tätigkeiten in Schwangerschaft und Stillzeit“.","authors":"Lisa Rosch, Golnessa Rommelfanger","doi":"10.1055/a-2466-8226","DOIUrl":"https://doi.org/10.1055/a-2466-8226","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 2","pages":"123-124"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723067","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":"Konsequenzen der Umstellung auf Hybrid-DRG – Sicht der Kliniken und Sicht der Praxen.","authors":"Guntram Fischer","doi":"10.1055/a-2530-3607","DOIUrl":"https://doi.org/10.1055/a-2530-3607","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 2","pages":"113-115"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723069","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}