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  • 1
    Electronic Resource
    Electronic Resource
    Gelenkbeteiligung bei entzündlichen Dermatosen (1999)
    Springer
    Der Hautarzt 50 (1999), S. 375-386 
    Details
    ISSN: 1432-1173
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050050927
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  • 2
    Electronic Resource
    Electronic Resource
    222. Indikation, Technik und Ergebnisse des alloplastischen Hüftgelenkersatzes bei per— und subtrochanteren Frakturen (1974)
    Springer
    Langenbeck's archives of surgery 337 (1974), S. 863-863 
    Details
    ISSN: 1435-2451
    Keywords: Alloarthroplasty ; Femoral Neck Fractures ; Total Hip Replacement ; Crutch Stick Prothesis ; Schenkelhalsfraktur ; Subtrochantere Oberschenkelfraktur ; Hüftalloarthroplastik ; Hüftspezialprothese
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Frakturen des coxalen Femurendes gefährden das Leben alter Menschen, wenn sie längere Bettlägerigkeit erzwingen. Nicht nur Schenkelhalsfrakturen, sondern auch per— und subtrochantere Frakturen stellen so eine vitale Indikation für die Alloarthroplastik dar. Von 32 per— und subtrochanteren Frakturen wurden 16 durch Hüftprothese mit überlangem Stiel, 16 weitere durch sog. Krückstockprothese versorgt. Indikationen, operatives Vorgehen, Ergebnisse und Komplikationen werden diskutiert.
    Notes: Summary Fractures of the proximal end of the femur can be fatal in old people if they lead to prolonged confinement to bed. Fractures of the femoral neck and also pertrochanteric and Subtrochanteric fractures are therefore a vital indication for alloarthroplasty. From July 1971 to July 1973, 32 cases of pertrochanterie and Subtrochanteric fractures were treated by total hip replacement. In 16 cases the Mathys and Milller crutch stick prosthesis was used. Indications, surgical technique, results, and complications are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01278854
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  • 3
    Electronic Resource
    Electronic Resource
    Biomechanical evaluation of a new modular rod-screw implant system for posterior instrumentation of the occipito-cervical spine: in-vitro comparison with two established implant systems (2000)
    Springer
    European spine journal 9 (2000), S. 417-425 
    Details
    ISSN: 1432-0932
    Keywords: Key words Posterior instrumentation ; Occipito-cervical spine ; Biomechanical testing, in vitro
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Posterior instrumentation of the occipito-cervical spine has become an established procedure in a variety of indications. The use of rod-screw systems improved posterior instrumentation as it allows optimal screw positioning adapted to the individual anatomic situation. However, there are still some drawbacks concerning the different implant designs. Therefore, a new modular rod-screw implant system has been developed to overcome some of the drawbacks of established systems. The aim of this study was to evaluate whether posterior internal fixation of the occipito-cervical spine with the new implant system improves primary biomechanical stability. Three different internal fixation systems were compared in this study: the CerviFix System, the Olerud Cervical Rod Spinal System and the newly developed Neon Occipito Cervical System. Eight human cervical spine C0/C5 specimens were instrumented from C0 to C4 with occipital fixation, transarticular screws in C1/C2 and lateral mass or pedicle screws in C3 and C4. The specimens were tested in flexion/extension, axial rotation, and lateral bending using pure moments of ± 2.5 Nm without axial preload. After testing the intact spine, the different instrumentations were tested after destabilising C0/C2 and C3/C4. Primary stability was significantly increased, in all load cases, with the new modular implant system compared to the other implant systems. Pedicle screw instrumentation tended to be more stable compared to lateral mass screws; nevertheless, significant differences were observed only for lateral bending. As the experimental design precluded any cyclic testing, the data represent only the primary stability of the implants. In summary, this study showed that posterior instrumentation of the cervical spine using the new Neon Occipito Cervical System improves primary biomechanical stability compared to the CerviFix System and the Olerud Cervical Rod Spinal System.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005860000173
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  • 4
    Electronic Resource
    Electronic Resource
    Load-displacement properties of the normal and injured lower cervical spine in vitro (2000)
    Springer
    European spine journal 9 (2000), S. 104-108 
    Details
    ISSN: 1432-0932
    Keywords: Key words Cervical spine ; Biomechanical testing ; Discoligamentous structures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The objective of this study was to determine which discoligamentous structures of the lower cervical spine provide significant stability with regard to different loading conditions. Accordingly, the load-displacement properties of the normal and injured lower cervical spine were tested in vitro. Four artificially created stages of increasing discoligamentous instability of the segment C5/6 were compared to the normal C5/6 segment. Six fresh human cadaver spine segments C4-C7 were tested in flexion/extension, axial rotation, and lateral bending using pure moments of ± 2.5 Nm without axial preload. Five conditions were investigated consecutively: (1) the intact functional spinal unit (FSU) C5/6; (2) the FSU C5/6 with the anterior longitudinal ligament and the intertransverse ligaments sectioned; (3) the FSU C5/6 with an additional 10-mm-deep incision of the anterior half of the anulus fibrosus and the disc; (4) the FSU C5/6 with additionally sectioned ligamenta flava as well as interspinous and supraspinous ligaments; (5) the FSU C5/6 with additional capsulotomy of the facet joints. In flexion/extension, significant differences were observed concerning range of motion (ROM) and neutral zone (NZ) for all four stages of instability compared to the intact FSU. In axial rotation, only the stage 4 instability showed a significantly increased ROM and NZ compared to the intact FSU. For lateral bending, no significant differences were observed. Based on these data, we conclude that flexion/extension is the most sensitive load-direction for the tested discoligamentous instabilities.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005860050219
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  • 5
    Electronic Resource
    Electronic Resource
    Computer-assisted surgery in posterior instrumentation of the cervical spine: an in-vitro feasibility study (2000)
    Springer
    European spine journal 9 (2000), S. S065 
    Details
    ISSN: 1432-0932
    Keywords: Key words Computer-assisted ¶surgery ; Cervical spine ; Posterior instrumentation ; In vitro
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Transarticular C1/2 screws are widely used in posterior cervical spine instrumentation. The use of pedicle screws in the cervical spine remains uncommon. Due to superior biomechanical stability compared to lateral mass screws, pedicle screws can be used, especially for patients with poor bone quality or defects in the anterior column. Nevertheless there are potential risks of iatrogenic damage to the spinal cord, nerve roots or the vertebral artery associated with both posterior cervical spine instrumentation techniques. Therefore, the aim of this study was to evaluate whether C1/2 transarticular screws as well as transpedicular screws in C3 and C4 can be applied safely and with high accuracy using a computer-assisted surgery (CAS) system. We used 13 human cadaver C0-C5 spine segments. We installed 1.4-mm Kirschner wires transarticular in C1/2, using a specially designed guide, and drilled 2.5-mm pedicle holes in C3 and C4 with the assistance of the CAS system. Hole positions were evaluated by palpation, CT and dissection. Forty-eight (92%) of the 52 drilled pedicles were correctly positioned after palpation, imaging and dissection. The vertebral artery was not injured in any specimen. All of the 26 C1/2 Kirschner wires were placed properly after imaging and dissection evaluations. No injury to vascular or bony structures was observed. C1/2 transarticular screws as well as transpedicular screws in the cervical spine can be applied safely and with high accuracy using a CAS system in vitro. Therefore, this technique may be used in a clinical setting, as it offers improved accuracy and reduced radiation dose for the patient and the medical staff. Nevertheless, users should take note of known sources of possible faults causing inaccuracies in order to prevent iatrogenic damage. Small pedicles, with a diameter of less than 4.0 mm, may not be suitable for pedicle screws.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010024
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  • 6
    Electronic Resource
    Electronic Resource
    The importance of sonography in the diagnosis of septic complications following spinal surgery (1994)
    Springer
    European spine journal 3 (1994), S. 303-307 
    Details
    ISSN: 1432-0932
    Keywords: Sonography ; Spinal surgery ; Wound infection ; Hematoma ; Soft tissue
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The detection of infection after surgery on the thoracic and lumbar spine is difficult due to the anatomical circumstances. Clinical symptoms, laboratory findings, and most radiological techniques are of limited diagnostic value. Among other benefits, sonography offers the advantage of early postoperative examination, even with metal implants in the operated area. In a retrospective study, 27 patients with clinically suspicious wounds were evaluated by sonography in the postoperative follow-up; all cases were verified by puncture and/or operative revision. Eleven cases turned out to be hematomas, and 16 cases were found to be infections. Accumulations of fluid, however, could not be differentiated by the established sonomorphological criteria such as internal echo structures, septation, demarcation from the environment, and reaction of the surrounding tissue. Ultrasonically guided transcutaneous needle aspiration biopsy served to differentiate the local findings and to establish the diagnosis and therefore is required as an obligatory method of investigation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02200141
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  • 7
    Electronic Resource
    Electronic Resource
    Osteointegration of different bone substitute materials in an experimental model (1998)
    Springer
    Der Orthopäde 27 (1998), S. 105-117 
    Details
    ISSN: 1433-0431
    Keywords: Key words Bone transplantation • Bone substitute • Ceramics • Osteointegration • Allograft ; Schlüsselwörter Knochentransplantation • Knochenersatzstoffe • Keramiken • Osteointegration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Ziel der Untersuchung ist der Vergleich unterschiedlicher Knochenersatzstoffe hinsichtlich ihres Einwachsverhaltens im standardisierten Defektmodell des Kaninchenfemurkondylus. Bei 53 NZW-Kaninchen wurden insgesamt 105 zylindrische Bohrlöcher mit einem Durchmesser von 5,4 mm in jeweils beide Femurkondylen gesetzt und nach randomisierter Zuordnung mit kryokonservierter allogener Kaninchenspongiosa (n = 21), einer synthetisch hergestellten Hydroxylapatit (HA-)keramik (n = 21), korallinem HA-Granulat (n = 21) und oberflächenmodifiziertem Tricalciumphosphat (TCP) (n = 21) aufgefüllt. Bei der Kontrollgruppe (n = 21) verblieb der Substanzdefekt unaufgefüllt, um die spontane Knochenregeneration im gewählten Modell beurteilen zu können. Nach Tötung der Tiere erfolgte 2, 4, 6, 8, 12, 26 und 52 Wochen postoperativ die histomorphologische Untersuchung des Einwachsverhaltens sowie eine histomorphometrische Analyse an unentkalkten Methylmethacrylatdünnschnitten bzw. -schliffen. Die Ergebnisse zeigen in der Kontrollgruppe bei den meisten Tieren eine ausbleibende Knochenneubildung nach Leerlochbohrungen. Bei Applikation kryokonservierter Transplantate führt die initiale Anlagerung neugebildeten Knochens mit konsekutivem Umbau avitaler Bälkchen im Beobachtungszeitraum zu einem vollständigen Remodelling mit Wiederherstellung einer Spongiosaarchitektur, die dem unbehandelten Femurkondylus sehr ähnlich ist. Auch calciumphosphathaltige Knochenersatzstoffe und Implantate zeigen eine vollständige knöcherne Integration ohne Nebenwirkungen. Infolge der ausbleibenden Resorption kommt es jedoch im Verlauf der Untersuchung zu einer relativ hohen Volumendichte des Verbunds aus Prüfkörper und neugebildeter Spongiosa. Beim ausbleibenden Remodelling auch im ersatzstarken Lager des Kaninchens steht somit die langzeitstabile Keramik dem wünschenswerten Umbau zu einer trabekulären Spongiosaarchitektur, die auf modifizierte biomechanische Belastungen adäquat reagieren kann, im Weg.
    Notes: Summary In order to avoid the potential risks of disease transmission in allograft surgery, numerous substitute materials have been described. As the biological response to implant materials is different, we undertook the following study to assess type and amount of bone ingrowth in CaP-ceramics. 105 cylindrical bone defects with a diameter of 5.4 mm were created surgically in the femoral condyles of 53 sceletal mature NZW rabbits. The defects were filled with crushed coralline hydroxyapatite (HA) implants (n = 21), synthetically produced hydroxyapatite (n = 21) and surface-modified alpha-Tricalciumphosphate (TCP) grains (n = 21). 21 defects were left empty and other drill holes were filled with rabbit cancellous bone cylinders (n = 21) after 3 months of cryopreservation at –78 °C without sterilization. Following observation periods of 2, 4, 6, 8, 12, 26 and 52 weeks the femoral condyles were harvested for histological evaluation and quantitative analysis of bone ingrowth. Woven bone formation at implant periphery can be observed in all substances as early as 2 weeks postoperatively. At 4-week-intervals cryopreserved allografts show new bone apposition on surfaces of necrotic trabeculae and graft-host junctions by a predominantly osteoblastic reaction at the periphery of all cylinders, while in HA- and TCP-grains early bone formation in the center of drill holes is detectable as well. There is a direct contact between HA-/TCP-particles and newly formed bone without fibrous tissue formation at the implant surfaces. Central new bone formation in rabbit allografts can be observed after 6 to 8 weeks together with a secondary osteoclastic resorption of necrotic transplant trabeculae. The result of this remodeling process is a complete degradation of transplant cylinders with reorganization of vital trabeculae oriented in a mature pattern after 12 to 26 weeks. In contrast the HA- and TCP-implants did not show any signs of resorption.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003476
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  • 8
    Electronic Resource
    Electronic Resource
    The treatment of spondylolistheses with segmental reduction and interbody fusion by means of an internal fixator (1997)
    Springer
    Der Orthopäde 26 (1997), S. 790-795 
    Details
    ISSN: 1433-0431
    Keywords: Key words Spondylolisthesis ; Instrumental reposition ; Intercorporal fusion ; PLIF-method ; Schlüsselwörter Spondylolisthese ; Instrumentelle Reposi-tion ; Interkorporelle Fusion ; PLIF-Technik
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei Spondylolisthesen mit einem Gleitweg von über 50 % wird bei gegebener Indikation zur Fusion allgemein wenigstens eine Teilreposition angestrebt, da bei einer Fusion in situ die Pseudarthroserate erhöht wäre und weil eine erhebliche Störung der Wirbelsäulengesamtstatik persistieren würde. Dafür muß bei fast allen Methoden eine gegenüber der Fusion in situ erheblich erhöhte operative Belastung und oft eine Ausdehnung der Fusionsstrecke in Kauf genommen werden. Bei geringeren Gleitwegen wird daher die Fusion in situ empfohlen, weil hier die Störung der Statik nicht so ausgeprägt ist, daß sie den bei solchen Methoden großen Aufwand der Reposition erzwingt. Wenn aber ein Operationsverfahren bei geringen Spondylolisthesen und Pseudospondylolisthesen die Reposition ohne nennenswerten Mehraufwand gestattet und wenn dabei das operative Risiko gegenüber der Fusion in situ nicht erhöht ist, dann ist es naheliegend, auch Olisthesen der Grade Meyerding I und II in der anatomischen Korrekturstellung zu fusionieren. Weil der von uns angewendete Wirbelsäulenfixateur diese Kriterien erfüllt, führen wir die Stellungskorrektur auch bei der Fusion geringgradiger Olisthesen durch. Das Auftreten neurologischer Komplikationen korreliert mit der Größe des Repositionsweges, und es kann durch präforaminale und durch extraforaminale Läsionen begründet sein, bei geringen Fehlstellungen spielen nur präforaminale Ursachen eine Rolle. Durch den beim Wirbelsäulenfixateur wegen des nach außen verlagerten Repositionsinstrumentars unbehinderten Zugang zum Segment und zu den präforaminalen neuralen Strukturen während des gesamten Repositionsvorganges können diese Schäden zuverlässig vermieden werden.
    Notes: Summary In spondylolisthesis with an indication for fusion and with a slipping of more than 50 % at least a partial reposition should be reached in general because the incidence of pseudarthrosis would increase with a fusion in situ and a large disturbance of the spinal statics would persist. Hereby with almost all methods an enlarged operative morbidity and often a longer fusion range has to be taken in account compared to the fusion in situ. Therefore, in smaller slippages the fusion in situ will be favoured because the disturbance of the statics is not so important, that such an effort combined with such methods is necessary. If the operation method with small spondylolisthesis and pseudospondylolisthesis allows the reposition without much effort and if the operative morbidity in comparison with the fusion in situ is not higher, then it is reasonable to fuse the cases with a spondylolisthesis Meyerding grade 1 and 2 in the anatomic corrected position too. Because the spinal fixator we use fills out these criteria we combine the correction of the position with the fusion also in cases of small spondylolisthesis. The incidence of neurologic complications correlates with the amount of the reposition distance and can be caused by preforaminal or extraforaminal lesions. The reduction of small malpositions could only produce preforaminal lesions. Using the spine fixator with its reposition instruments linked outside the wound and with it's uninhibited access to the segment and to the preforaminal neural structures during the whole repositioning these lesions can be avoided.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003442
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  • 9
    Electronic Resource
    Electronic Resource
    Stimulation primärer Osteoblastenkulturen mit rh-TGF-ß, rh-bFGF, rh-BMP 2 und rx-BMP 4 in einem In-vitro-Modell (2000)
    Springer
    Der Orthopäde 29 (2000), S. 107-111 
    Details
    ISSN: 1433-0431
    Keywords: Schlüsselwörter Bone morphogenetic protein • Xenopus laevis • Osteoblastenproliferation • Osteoblastendifferenzierung ; Key words Bone morphogenetic protein • Xenopus laevis • Cell proliferation • Cell differentiation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Bone metabolism is influenced by systemic and local acting hormons. Bone morphogenetic proteins (BMPs) as representatives of the latter substances are known to have the ability for ectopic bone formation. Within this study, we investigated the influence of different growth factors on the proliferation- and differentiation rate of osteoblast-like cells. For that purpose, human osteoblast-like cells (HPOC) were incubated in the presence of either recombinant BMP-4 of the genome of xenopus laevis (rxBMP-4), recombinant human BMP 2 (rhBMP-2), transforming growth factor-ß (TGF-ß) or basic fibroblast growth factor (rh-bFGF) in two different concentrations each (10 ng/ml and 50 ng/ml). Cell proliferation was measured within a MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromid] assay, the amount of cell differentiation by the activity of alcaline phosphatase. Rx-BMP-4 induced a differentiation of HPOC to almost the same extent as rhBMP-2, whereas the addition of rh-bFGF, applied at the same concentration, failed to have any influence on cell differentiation. However, rh-bFGF provoked an increase in cell proliferation when compared with unstimulated HPOC, while rhBMP-2 and rxBMP-4 showed no effect on proliferation. TGF-ß influenced bone proliferation as well as differenciation significantly. The equipotent effect of recombinant human BMP-2 and recombinant BMP-4 obtained from Xenopus laevis with regard to differentiation and proliferation of human primary osteoblast-like cells originates either in the fact that target cells have receptors for BMP 2 as well as BMP 4, or that both BMP's link to the same receptor with almost the same affinity.
    Notes: Zusammenfassung Der Knochenstoffwechsel wird auf vielfältige Weise von Hormonen und lokal sezernierten Wachstumsfaktoren beeinflusst. Die „bone morphogenetic proteins“ (BMP), als Vertreter der letzteren Gruppe zeichnen sich gegenüber anderen Wachstumsfaktoren durch ihre Fähigkeit zur ektopen Knochenneubildung aus. Ziel unserer Untersuchung war die Überprüfung des Proliferations- und Differenzierungsverhaltens osteoblastenähnlicher Zellen nach Stimulation mit unterschiedlichen Wachstumsfaktoren, die einen Einfluss auf den Knochenstoffwechsel haben. Zu diesem Zweck wurden humane primäre Osteoblastenkulturen mit rekombinant hergestelltem rx-BMP 4 des Frosches (Xenopus laevis), rekombinant hergestelltem humanem rh-BMP 2, transforming growth factor-ß (TGF-ß) und Fibroblastenwachstumsfaktor (b-FGF) jeweils in zwei unterschiedlichen Dosierungen (10 und 50 ng/ml) inkubiert. Die Zellproliferationsrate wurde anhand eines kolorimetrischen MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromid] Assay bestimmt, das Ausmaß der Zelldifferenzierung wurde anhand der Enzymaktivität der Alkalischen Phosphatase gemessen. Rx-BMP-4 induzierte die Zelldifferenzierung humaner Osteoblasten in gleichem Maße wie rh-BMP 2, wohingegen die Zugabe von rh-b-FGF in gleicher Konzentration keine Wirkung auf die Zelldifferenzierung zeigte. Rh-b-FGF führte jedoch, verglichen mit nichtstimulierten Zellen, zu einer signifikanten Zunahme der Zellproliferation. Weder rx-BMP 4 noch rh-BMP 2 hatten einen proliferationssteigernden Effekt auf primäre humane Osteoblasten. TGF-ß beeinflusste signifikant günstig die Zellproliferation und noch deutlicher die Zelldifferenzierung. Die equipotente Wirkung des rekombinant hergestellten humanen BMP 2 und des rekombinanten BMP 4 des Xenopus laevis auf die Zelldifferenzierung und -proliferation primärer humaner Osteoblastenkulturen legt den Schluss nahe, dass entweder die Zielzellen Rezeptoren für BMP 2 und BMP 4 besitzen oder aber, dass beide BMP mit annähernd der gleichen Affinität an den selben Rezeptor binden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003703
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  • 10
    Electronic Resource
    Electronic Resource
    The development of juxta-articular osteoporosis after synovectomy of the knee (1993)
    Springer
    International orthopaedics 17 (1993), S. 188-192 
    Details
    ISSN: 1432-5195
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Dans une étude prospective on a effectué chez 9 malades atteints d'arthrite rhumatoïde une double photo-absorptiométrie avant une synovectomie du genou, ainsi que 3, 6, 12 et 24 mois après l'opération. Cet examen a permis d'évaluer quantitativement le degré d'ostéoporose juxta-articulaire. La densité osseuse a ensuite été comparée à un groupe de contrôle sans lésions du genou. Les mesures faites après synovectomie montrent une augmentation de la minéralisation osseuse à partir du sixième mois post-opératoire. Ceci prouve que la densitométrie de l'os constitue un indicateur objectif de l'évolution de l'ostéoporose juxta-articulaire dans les rhumatismes inflammatoires.
    Notes: Summary In a prospective study 9 patients, who were going to have a synovectomy for rheumatoid arthritis of the knee, underwent dual photon absorptiometry before, and at intervals after, operation. This determined the degree of juxta-articular osteoporosis quantitatively. The density was compared to a control group with normal knees. The follow up measurements showed an improvement in the juxta-articular bone mineral content after the 6th month. This demonstrates that bone densitometry is an objective indicator of the development of juxta-articular osteoporosis in inflammatory joint disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00186384
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