Előszó
Eredeti közlemények
Typical mechanisms and specific injuries of people involved in road traffic accidents are presented.
Injury patterns specific to occupants of vehicles with enclosed passenger compartment, as well as unprotected participants of traffic (pedestrians, bicyclists, motorcyclists, etc.) are grouped.
Injury severity classification, treatment planning and outcome prediction is usually done based on various scoring systems, both internationally and in Hungary. The enormous number of such scoring systems make a thorough survey difficult and conversion among these scores has limitations. However prehospital care providers and hospital emergency staff need a "common language", preferably a system that utilizes the advantages of scoring systems. There is no uniform practice of this communication and data transfer in Hungary now, that is why part of the important data from the incident scene might not get to the hospital together with the patient.
The documentation of prehospital care providers both in Hungary and abroad are discussed and analyzed. Score systems in prehospital and emergency medicine, as well as outcome prediction measures are covered. Data collection schemes especially the Utstein-Style for documenting major trauma and the German MIND2 (Minimale Notarztdatensatz, minimal prehospital care data set) are also presented.
A suggestion is introduced for the data content of prehospital documentation, so that it could further help hospital admission and care. The main aspects of the suggestion are road traffic accidents, because the creation of such a widely accepted and used document (a prehospital patient report form) requires a team of experts from various – mainly medical – specialties. Technical aspects, such as digital data collection are also covered. Future directions of development are named, too.
Aims: Even though several publications are available and experiments were done in the topic of the mechanical properties of vessels there is no data for special veins like coronary veins. Previously a few rectangular coronary vein parts had been examined and the results show that probably there is a difference between the transversal and longitudinal direction of coronary vein. The aim of this study is to investigating the differences in the mechanical properties of the two directions with in vitro tensile tests.
Method: Coronary veins from six pig hearts were tested within one hour after explantation. Five transversal and nine longitudinal coronary vein samples were prepared from these hearts and kept in physiologic solution until the tests. The samples were evaluated in 37 °C physiologic solution with tensile equipment and the force-displacement curves were recorded. Based on these curves and the tearing results the longitudinal and transversal tensile strengths, relative extensions and Young's modulus were calculated.
Results: The evaluation squarely proved the differences of mechanical properties between the longitudinal and transversal directions of coronary vein samples. Transversal direction had higher elongation properties (248±117% vs. 137±37%) but lower resistance to mechanical loading (0.99±0.16 MPa vs. 2.55 ± 0.46 MPa) than the longitudinal direction.
Conclusion: The experiments are successfully investigated the mechanical differences of coronary vein directions. These are important parameters, because in case of special application the maximal elongation capability and the maximal force that the vein can tolerate without injury had to be known. With the result of these experiments the maximal loading concerning to coronary veins can be modelled. However there are still question to answer for example the individual role of the different layers of coronary veins which is not known during the mechanical testing.
Further investigations are necessary to perform in order to have a complete analysis of mechanical properties of coronary veins.
The operation is unavoidable in a certain part of patients suffering from arthrosis. The contact surfaces of wide-spread applied human knee joint prostheses can be described with simple geometrical elements. The relative motion realized by knee joint and as its results the stability of the whole body is harmonic ensured by complicated condyle surfaces. For this reason the implanted prostheses comply with requirements limited and it causes additional load on the diseased bony tissue. According to observations at the fastening of the prostheses the bony tissues become inflamed which after some years need new operation.
At present it is a general aim in biomechanics to create a better mechanical model of human knee joint which can approach the natural motion and on its basis to make new prostheses. The motion of the human knee joint have been studying by many biomechanical research groups for decades. The problem is very complex and specific from technical point of view. The cause of complexity is partly the elaborateness of elements, partly the typical rheological properties of the components (bones, cartilages and other soft tissues).
Authors as members of the Szent István University Biomechanical Research Group in order to describe the motion of knee joint at first joined coordinate-systems on the basis of anatomical landmarks to the femur and tibia moreover joined a three-cylindrical mechanism as mechanical model to the axes of coordinate-systems.
The aim of the investigation is to determine the six independent kinematical parameters of tibia compared to the fixed femur during fl exion and extension. The experimental examinations were carried out on cadaver knees in cooperation with doctors of Szent János Hospital. The positioning was tracked by optical positioning appliance. Needed parameters can be obtained from the recorded data determined by the kinematical model.
Considering the irregular shapes of femur and tibia the anatomical coordinate systems can be joined with more or less position mistake. The aim of this paper is the determination of the effects of position mistakes on kinematical parameters.
Low back pain is one of the leading causes of disability, some patients don't respond to conservative therapy, and must undergo surgery. The aim of our study was to investigate the results of lumbar fusion operations, especially considering the changes in the sagittal range of motion (ROM) in the adjacent segments, thoracic, lumbar region and pain. 13 patients were involved, who had lumbar LIV/V rigid fusion (TLIF) operation, and still had low back pain symptoms. For the biomechanical measurement we used the Spinal Mouse, a computer associated device, based on electromagnetic impulses. For estimating the pain we used the 3D pain questionnaire (West-Haven-Yale Multidimensonal Pain Inventory [WHYMPI]).
In the outline analysis we found that the decrease in pain and improvement of symptoms after a lumbar fusion is definitely the result of increased thoracic segment hypermobility, decreased lumbar segment hypomobility, decreased proximal adjacent segment hypomobility and, increase of the distal adjacent segment hypomobility. The sagittal range of motion (ROM) of the whole spine, as the hypomobility is corrected towards the normal ROM resulted in decrease of pain. In conclusion we can notice when using semirigid systems for bridging adjacent segments, it is important to secure the hypermobility of the thoracic spine, and the mobility of the proximal segment.
Low back pain is one of the leading causes of disability. Exercise therapy is a management strategy that is widely used in low back pain. The aim of our study was to investigate the results of standard and enhanced exercise therapy. 15 patients who had low back pain were involved in the study, none of the patients had had spinal operations before. In the first group the patients did the exercises every day at home. The patients of the second group did the exercises 3 times a week. For the biomechanical measurement we used the Spinal Mouse, a computer associated device, based on electromagnetic impulses. For estimating pain we used the 3D pain questionnaire (West-Haven-Yale Multidimensional Pain Inventory [WHYMPI]).
Objective: To determine forces of hand and fingers in model situations.
Methods: Subjects were 16 university students (males). Dyna-8 force measuring system was used, which is equipped with transducers making the measurement of handgrip strength and forces of fingers possible. The maximum force value is displayed digitally and simultaneously, the complete force diagram is shown on the computer monitor.
Results: Right and left hand strengths and forces of all fingers were recorded, and descriptive statistics, correlation analysis, and t-test were executed. Forces of right and left hand strengths correlate, but differ significantly when their means are compared. Forces of the same fingers on the right and left hand correlate significantly with the exception of the middle and index fingers.
Objective: The physiological tremor which may extend up to 0.4–0.6 mm on the instrument tip in case of a well-skilled microsurgeon may cause difficulties in any field of microsurgery, in spite of using different armrests. The limit of correctness of medical robots is about 0.1 mm so far, but the application of these machines is expensive and not convenient for surgeons because the direct touch via microinstruments with living tissues is impossible.
Method: The effectiveness of the fingertip support technique has been proven by randomized analysis by exact measuring of the reduction of tremor.
Results: The 0.1 mm precision could be reached by fingertip support. This extra precise work has not been available by hand so far.
Conclusion: The significant effect of fingertip support technique in neurosurgery has been certified and published by exact measuring and clinical data.
Our hypothesis could be the indication for trials in any microsurgical work.
Célkitűzések: A várandósság hatással van a testtartásra és így a járásra, mint a dinamikus testtartás egy képviselőjére. Célunk volt bizonyítani ezen élettani változások hatásait a járásra.
Adatok és módszerek: Az utánkövetéses vizsgálatban, melyet a PTE ÁOK Szülészeti és Nőgyógyászati Klinikáján végeztünk 2008 májusától 2009 februárjáig, 42 nő vett részt: 21 várandós az I., a II. és a III. trimeszterben, és 21 nem terhes és még nem szült nő alkotta a kontrollcsoportot.
Eredmények: A stabilométeres mérések szerint a várandósok járása lassabb, mint a kontrollcsoporté (p=0,046), de a lépésciklus ideje a terhesség előrehaladtával csökken. A trimeszterekben mért lengőfázis ideje rövidebb a kontrollcsoporthoz képest. A kettőstámaszok aránya a teljes lépésciklushoz képest, a kontrollcsoporttal összehasonlítva trimeszterenként nőtt. A gördítés vizsgálatánál a kontrollcsoport és a kismamák I. trimeszterben mért adatai között szignifikáns különbséget találtunk (p=0,006). Az I. trimeszterben lévő kismamáknál mért lábszög nagyobb a kontrollcsoporténál (p=0,029). A kismamák I. trimeszterben mért lépésszélessége a kontrollcsoportéhoz képest kisebb (p=0,002). A várandós nők I. és III. trimeszterben mért lépésszélességét összehasonlítva szignifikáns növekedést tapasztaltunk (p=0,049).
Következtetések: Kimutattuk, hogy a járás kinematikája megváltozik a terhesség folyamán, illetve eltérést mutat a kontrollcsoporthoz képest.
The Dept. of Mechatronics, Optics and Information Engineering, within the project team, had built an electronic moire equipment to visualize and diagnose scoliosis. The device generates a computerized moire phenomenon, which can be viewed and save for later examination. The applicability of the system was teste with statistical method from the moire patterns, which was created by the prototype device. The results of the calculations – to determine the rate of scoliosis by moire patterns – are promising and comparable with X-ray examinations.
Large standard deviation can be observed during the analysis of the kinematical functions which describe the motion of the knee-joint. Screening the previous large number of published results concerning to the knee motion it seemed that they are scattered, therefore it can be regarded as unreliably. In our experiments anatomical coordinate system recommended by VAKHUM project was used in favor to reduce standard deviation. Setting up the anatomical coordinate system in its special anatomical points are very uncertain. A protocol was settled for the orientation of the anatomical points and for the anatomical coordinate system. Experiments were performed on five cadaver knees using the new protocol. The measurements were analyzed which has proved that the method offers a better accuracy.
A lumbális gerinc degenerációja nemcsak az életkor előrehaladásával léphet fel, hanem hirtelen mechanikai hatásokra is, például túlterhelésre vagy rossz mozdulatra is bekövetkezhet. 3D végeselemes szimuláció segítségével vizsgáljuk a centrikusan nyomott lumbálisgerinc-szegmentum túlterhelésből származó, hirtelen bekövetkező degenerációs folyamatait. Mivel hirtelen degeneráció bármely életkorban bekövetkezhet, figyelembe kell venni a gerinc aktuális életkori degenerációs állapotát is. Az életkori degenerációhoz hasonlóan a hirtelen degenerációt is a szegmentum anyagállandóival modelleztük. Figyelembe vettük a hirtelen lecsökkenő hidrosztatikus nyomást a nucleusban, az annulus felrepedését, szálszakadását, a véglemez és a szivacsos csigolyacsont károsodását. Megkülönböztettük a fiatal, életkorilag gyengén károsodott szegmentumok, és az idős, előrehaladott életkori degenerációval rendelkező szegmentumok hirtelen degenerációját. Az életkori degenerációval ellentétben, ahol a porckorong merevsége 5-6-szorosára is megnőhet a degenerációs folyamat végére, a hirtelen károsodásnál a merevség 60–80%-kal csökken, ami a szegmentum instabilitásához vezet, különösen fiatal korban, életkorilag gyengén károsodott szegmentumnál, mivel ott a hirtelen merevségcsökkenés a legalacsonyabb szintről indul. Fiatalabb korban a hirtelen degeneráció mintegy 2100 N/mm életkori merevségi szintről 75–80%-kal, mintegy 400–500 N/mm szintre csökken; míg idősebb korban mintegy 3600 N/mm életkori merevségről 60–65%-kal, mintegy 1300 N/mm merevségi szintre csökken. Következés képpen, az életkori károsodáshoz hasonlóan a hirtelen károsodás is a fiatal felnőtt korosztályt sújtja leginkább. Az életkori károsodással ellentétben, ahol a porckorong alakváltozási képessége, összenyomódása, kihasasodása a degenerációs folyamat végére mintegy 30–85%-kal csökken, a hirtelen károsodásnál ez szignifikánsan megnő mintegy 2-3-szorosára, amely a szegmentum instabilitásához és fájdalomhoz vezet, ugyancsak leginkább fiatal felnőtt korban.
A numerikus szimuláció olyan jelenségek és folyamatok követésére is alkalmas, amelyek kísérleti úton nem vizsgálhatók. Ilyenek például a gerinc öregedéssel járó degenerációs folyamatai. A jelen dolgozatban az emberi lumbálisgerinc-szegmentumok nyomóteherből eredő, öregedéssel járó károsodási folyamatainak a végeselemes szimulációját mutatjuk be 3D végeselem-modellek alapján. A korral járó degenerációs folyamatot a szegmentumot alkotó egyes szervek anyagi tulajdonságainak változásával modellezzük. A kidolgozott végeselem-modelleket húzásra és nyomásra egyaránt úgy validáltuk, hogy a számítási eredményeinket összehasonlítottuk a saját és a szakirodalomból rendelkezésre álló kísérleti mérési adatokkal. Öt degenerációs fokozatot dolgoztunk ki a teljesen egészségestől a teljesen degeneráltig. A degenerációs folyamat két legfontosabb tényezőjének, a porckorong nucleusában lévő hidrosztatikus nyomásnak és a nucleus keményedésének a hatását külön-külön vizsgáltuk az öregedési folyamat során, és azt tapasztaltuk, hogy a degenerációs folyamat kezdeti szakaszában a hidrosztatikus nyomás megszűnésének van domináns hatása, míg a későbbiekben a nucleus keményedése a döntő. Ez azt mutatta, hogy a nyomómerevség az alig degenerált fiatal szegmentumnál a legkisebb, vagyis az instabilitás kockázata ekkor a legnagyobb, és a stabilitás esélye a további öregedéssel és degenerációval megnő. Kimutattuk, hogy a szegmentum merevségében a nucleusnak van domináns szerepe. Ahhoz, hogy a nucleus folyadékszerű, kezdeti egészséges állapotát pontosan modellezni tudjuk, a rugalmassági modulusát 1 MPa értéknél kisebbre, célszerűen 0,1 MPa értékre kell felvenni. A lumbális gerinc degenerációs folyamatainak végeselemes szimulációja segít megérteni e folyamatok kialakulását és lefutását, annak okait, de segít a lumbális porckorongproblémák konzervatív kezelési eljárásainak tökéletesítésben is.
A súlyfürdő a magyar reumatológia egyik legnagyobb gyakorlati jelentőségű felfedezése. Eredményeként az izmok ellazulnak, a gerinc megnyúlik, a porckorongsérv visszahúzódik, a fájdalom enyhül, a műtét megelőzhető. Ez a konzervatív kezelési mód hazánkban több mint fél évszázada széles körben elterjedt, sikeresen alkalmazzák, azonban külföldön nem ismerik, mivel korábban nem állt rendelkezésre a beavatkozás széles körű biomechanikai elemzése. A közelmúltban a kezelés biomechanikai hátterének elemzése és a keletkező megnyúlások in vivo kísérleti meghatározása, valamint a kezelés hatékonyságának klinikai kísérleti bizonyítása megtörtént. A jelen tanulmányban a kezelés numerikus szimulációjának eredményeit ismertetjük. 3D végeselemes numerikus szimulációval vizsgáljuk a kezelési folyamat mechanikai körülményeit és hatékonyságát. A súlyfürdőkezelés egy tipikus viszkoelasztikus folyamat. A jelen tanulmányban ennek a kezdeti rugalmas szakaszát vizsgáljuk. A számításainkat a lumbális L3–S1 gerincszakasz egy tipikus szegmentumának a végeselemes modellje alapján végezzük, amelynek húzási anyagállandóit a súlyfürdőben végzett in vivo kísérletek alapján állapítottuk meg, nyomási anyagállandóit a szakirodalomból vettük át. Számításaink alapján bebizonyítottuk, hogy a 40–45 év közötti korosztály lumbális szegmentumai a legsérülékenyebbek, a további idősödés során a szegmentális stabilitás erősödik. Megállapítottuk, hogy a súlyfürdőkezelés indirekt és direkt nyújtási szakaszból áll. A porckorong bilineárisan viselkedik: az indirekt szakaszban nagyobb a nyújtással szembeni ellenállása, mint a direkt szakaszban. Emiatt, annak ellenére, hogy a direkt nyújtóerő csak mintegy 6%-a az indirekt nyújtóerőnek, a direkt megnyúlások 20–80%-át teszik ki az indirekt megnyúlásoknak a szegmentum életkorától és degenerációs állapotától függően. Ugyanakkor a direkt szakaszban a porckorong feszültségi tehermentesülése csupán 2–8%-ot tesz ki. Következésképpen a többletsúlyokkal vezérelt direkt nyújtóerők elsősorban a porckorong megnyúlásaiért felelősek, előidézve az ideggyökök felszabadítását a kompressziós deformációk alól; ugyanakkor a felhajtóerő miatt lecsökkent testsúlyból és a függesztési testhelyzet miatt megszűnő izomerőkből eredő indirekt nyújtóerő a feszültségi tehermentesülésért felelős. A lumbális szegmentumok kezdeti rugalmas deformációi a súlyfürdőkezelés további viszkózus szakaszában a kúszási folyamat során mintegy megkettőződnek. A kezelés hatékonysága napi gyakoriságú többhetes kúra végére lesz optimális. Klinikai kísérletekkel azt bizonyították, hogy a súlyfürdő jótékony hatása három hónap elteltével is érzékelhető.
The biomechanical behaviour of a dental implant plays an important role in its functional longevity inside the bone. Occlusal forces affect the bone surrounding an oral implant. To avoid fracture and bone resorption – by achieving the most even stress distribution in the bone – implants should be applied that transfer occlusal forces to the bone within physiologic limits with geometry capable to enhance bone formation. The following study deals with the trabecular bone substance especially surrounding dental implants considering the microscopic conformation of the bone. The dental surgical use of a formerly developed stochastically generated frame model of the trabecular bone is introduced, which is created by interlinking a stochastically generated set of nodes in a certain domain, according to a previously defined linking-rule. The finite element model possesses the geometrical and mechanical microstructural properties – obtained from literature – of the trabecular bone substance of an average man from the edentulous mandibular region. The finite element beam model was submitted to compression, shear and torsion tests, and the macro-structural elastic properties were computed from the result data obtained by means of finite element analysis. The thus received frame model was combined with the finite element model of the cortical bone layer in the mandible (lower jaw bone) and a dental implant, where the incompleteness of the bone-implant interface was taken into account.
Purpose: The aim of study is to compare the kinematic parameters and activity pattern of muscles around the glenohumeral joint in multidirectional instability (MDI) treated by only physiotherapy and by capsular shift and physiotherapy, before and after treatment.
Material and method: The study was carried out on 32 patients with MDI treated with only physiotherapy (29 patients after 2 years, and 21 patients after 4 years), 19 patients with MDI treated by capsular shift and physiotherapy (19 patients after 2 and 4 years), and 50 healthy subjects as control group. The investigated kinematic parameters were the range of the humeral elevation (HE) in the scapular plane, the scapulothoracal and glenohumeral angle, the scapulothoracal (ST) and glenohumeral (GH) rhytms, and relative displacement between the rotation centers of the humerus and the scapula. The muscle activity was modeled by the on-off pattern of muscles around the shoulder.
Results: Before treatment the increased relative displacement between the rotation centers of the scapula and the humerus and different ST and GH rhythms were observed in MDI patients. The physiotherapy strengthened the rotator cuff, biceps brachii, triceps brachii, deltoid muscle, but ST and GH rhytms remained monolinear. Capsular shift and physiotherapy resulted bilinear ST and GH rhytms and normal relative displacement between the rotation center of scapula and humerus was restored. After surgery and physiotherapy the activity pattern of muscles around the shoulder was almost normal.
Conclusion: The significant alterations in kinematic parameters in MDI patients cannot be restored by physiotherapy only. After the capsular shift and postoperative physiotherapy the bilinear ST and GH rhytm (angulation at 60 degree), the normal relative displacement between the rotation centers of scapula and humerus and the normal muscular activity pattern can be restored.
Introduction: The therapeutic modalities available for the conservative management of chronic lumbar pain included infrared laser therapy and underwater traction, which usefulness is not universally acknowledged. This study was intended to ascertain any beneficial impact of infrared laser therapy and weightbath treatment on the clinical aprameters and quality of life of patients with lumbar discopathy.
Material and methods: The study population comprised 54 randomised subjects. I. group of 18 patents received only infrared laser therapy to lumbar region and painful Valley points. II. Group of 18 subjects each received underwater traction therapy of lumbar spine with add-on McKenzie exercise and iontophoresis. The remaining III. Group treated with exercise and iontophoresis, served as control. VAS, Oswestry index, SF36 scores, range of motion, neurological findings and thermography were monitored to appraise therapeutic afficacy in lumbar discopathy. A CT or MRI scan was done at baseline and after 3 months follow-up.
Result: infrared laser therapy and underwater traction for discopathy achieved significant improvement of all study parameters, which was evident 3 months later. Among the controls, significant improvement of only a single parameter was seen in patients with lumbar disco pathy.
Conclusions: infrared laser therapy and underwater traction treatment effectively mitigate pain, muscle spasms, enhance joint fl exibility, and improve the quality of life of patients with lumbar discopathy.
Background: There is a paucity in basic data concerning neck posture in childhood. Our aim was to gain preliminary data on the head/neck/shoulder posture, and to document their evolution with growth in schoolchildren.
Methods: For measuring posture digital photographs were taken of the children seated in a straight-high-backed chair. The camera (Agfa 5Ti, 5.2 megapixels) was located perpendicularly to each subject's height, positioned from the left side, the focus was on the tragus with a standard distance of 150 cm. The first photo was taken in the "neutral head posture" and a second photo in "resting" posture). The digital photos were then evaluated by a computer software program (distributed as Marker Angels). The angles analyzed were as follows: the craniovertebral angle (CVA), the head tilt angle (HTA), the shoulder angle (SHA). Subjects were hundred and fortyseven 9-year old, and hundred and fourtythree 16-year old schoolchildren, who were attending public school in different districts of Budapest.
Results: In the 16-year old's group the CVA values have been found reduced significantly (by an average of 8 degrees in neutral position and 6 degrees in resting position) compared to the 9 year olds. The HTA elevated by an average of 1.6 degrees (NS) in neutral position and reduced significantly (by 4.2 degrees) in resting position. The values of the SHA elevated significantly (by an average of 13.33 degrees in neutral position and 13.32 degrees in resting) between the 9–16 year olds, which referred to more protracted shoulder posture.
Discussion: The CVA characterizes the neck posture, the less it's value, the more the forward position. The neck posture is in strong correlation to the head and the shoulder positions. That means forward bent neck position is in correlation to the so called "rounded" shoulder or the shoulder protraction. Although the position of the was found not consequent in neutral position, however was in correlation in resting position.
Conclusion: Measuring head/neck/shoulder posture by means of digital photos and evaula ted by computer program proved easy, useful method. We obtained preliminary descriptive data on neck posture in degrees of two age groups of schoolchildren. The comparison of the results pro ved the tendency of progression in "poor posture" during 7 schoolyears, between in the age of 9–16.
Objective: Multilevel laminectomy for exposing the spinal canal to remove spinal cord lesions has been widely used in spine surgery. Destruction of the dorsal structures of the spinal column, detachment of the longitudinal musculature, resection of the vertebral arches, and injury of the joint capsules and ligaments are responsible most of short and late-time complications. Spinal deformities, instability, subluxation, invasion of haematoma and scar tissue into the spinal canal are the most often mentioned complications in the literature. The author main objective was to develop and summarize the novel minimally invasive techniques suitable for exploring and treating different pathologies, located in the midline of the spinal canal with preservation of the stability of the spine.
Methods: 38 patients were operated on with intramedullary laesions located from CIII to LI level of the spine with the newly developed multilevel spinous process splitting and distracting laminotomy technique. The dorsal, paraspinal musculature was not detached from the vertebras. With splitting and distracting the spinous processes and the vertebral arches, the vertebral joints, the joint capsules and the ligaments were not injured, these structures remained mostly intact. To achieve a moderate enlargement and decompression of the spinal canal, complementary intervertebral spacer insertion was performed in some cases. The patients were followed with regular MRI, CT scans and neurological examinations.
Results: Adequate surgery of the lesions located intramedullary was achieved in all patients using our new procedures. Moderate enlargement and permanent decompression of the spinal canal was achieved with the insertion of homologues tricortical iliac crest bone graft or heterologous PEEK spacer. The numbers of split laminae were 3 to 6. The split spinous processes were closed directly to each other in 24 patients. In 9 cases a tricortical bone graft and in 5 cases a heterologous PEEK spacer was inserted between the facing bony parts.
The incidence of postoperative local pain was lower, within acceptable limits, and early mobilization was allowed. The average length of hospital stay was shorter too. The postoperative followup CT scans demonstrated bony healing, with the inserted graft or cage between the osteotomized faces. No compression or dislocation of the spacer was seen. Instability was not detected in any of the patients by fl exion or extension lateral radiographs.
Status of a new project – focusing on technical aspects of fusion of live video and data from optical motion tracking – is summarized. Also, the significance of development in two areas is marked out: (1) in clinical field of endoscopic surgeries as demonstrating and training tool; (2) in biomechanical research for accurate detection of human motion curves.
The movement of pneumatic artificial muscle (PAM) is soft that similar to the human muscle therefore it can be used as the actuator for rehabilitation devices and prostheses. In this paper a Fluid Muscle manufactured by Festo is tested, and some experimental results, rehabilitation devices and prostheses are shown. Our goal is to construct an intelligent prosthetic arm using PAMs.
Our goal was to compare the direct plate known as the "gold standard" technology in case of a pelvis fracture with the H-plate technology reinforced with iliolumbar fusion and the pelvis screwing technology reinforced with iliolumbar fusion, especially focusing on the matter of stability.
In our work we studied and examined the securing possibilities and stability of the transforaminal pelvis fracture using the finite element analysis. My colleauges and I created the anatomically correct model (including the 4th and 5th lumbars and cartilages under the lumbars). To create the model we used a previous geometric model used for older preceding analyses. During the modeling we perfected the geometry; we separated the different bone regions and paid close attention to create the scale model of the implements. The placements of the implements are appropriate and in accordance with real surgery procedures. We examined three different cases: standing on the healthy leg, standing on both legs and standing on the injured leg. The boundary conditions for the finite element analysis: the femur is fixed and in case of standing on one leg the opposing side of the hip bone is fixed on both the X and Z axes directions. Furthermore both hip bones are fixed on the Y axis direction, and this applies when standing on both legs as well. We added the load to the 4th lumbar on the model. The value of the load is 500 N and the direction is –Z. We defined surface to surface connection between the femur and acetabulum and also between the side of the symphysis pubica and the fracture ends. We defined bonded connection between all the other components. In our analyses and evaluation we examined the arising stress values and also the displacements in the cortical and spongiosa regions and in the implements. We examined the elongation of the ligaments in the pelvis and measured the maximal distance between the fracture ends under load.
Considering the results of the stress states, the iliolumbar fusion technologies provide more stability. Therefore it is recommended to use these technologies, not mentioning the fact that the dorsal exposure puts the patient through considerably less trauma.
Considering the results of the fracture ends displacements it can be declared that the reason for the existence of the H-plate technology reinforced with iliolumbar fusion cannot be questioned. Therefore continuing the research can be justified by further analyzing and examining dynamic loads on models extracted from CT images.
Az aktív, gyógyszer-hatóanyagot kibocsátó sztentek folyamatosan bővülő családjának fejlődése jellemzi az elmúlt évek orvoslását. Az orvoslás eredményei igazolták az aktív és passzív sztentek használatának létjogosultságát. Egy jelenleg már használt passzív sztentnek, a gyártóval együttműködve, aktív bevonattal való ellátása a kitűzött célunk. A bevonatnak kétféle célja is van, egyrészt a sztent biokompatibilitását fokozza, másrészt mint aktív bevonat, a sztent felhasználásának körét bővítse.
Kísérleteink során a megfelelően előkészített, sztentek felületével megegyező felületű lapkákra felvitt PUR bevonatok (Carbothane®, Tecothane®, ChronoFlex®) gyógyszermegkötő és időben elhúzódó -leadási képességeit vizsgáltuk.
A PUR bevonatok jól használhatóak a sztentek bevonására, és gyógyszert is képesek tárolni. A PUR bevonatok alaptulajdonságaik szerint – mint hidrofil vagy hidrofób – több vagy kevesebb hatóanyagot tudtak megkötni a felületükön és a mélyebb rétegeikben. A több rétegben felvitt bevonatok nagyobb mennyiségű hatóanyagot tudtak megkötni, mint az egyrétegű bevonatok. A leadási görbék alapján értelmezhető egy, a PUR bevonatok felületről és az anyag belsejéből leadott hatóanyag mennyiség, ez a PUR alaptulajdonságától függően változó az idő függvényében. A legtöbb hatóanyagot a hidrofil tulajdonságú ChronoFlex® bevonat tudta felvenni, míg a legkevesebbet a hidrofób Tecothane®.
A PUR bevonatok megfelelő kiválasztásával a felhasználási területük bővíthető, kombinálásukkal szélesíthető az indikációs területük. Az eredmények alapján a többrétegű bevonatok előnyösebb gyógyszermegkötő képessége látszik az egyrétegűvel szemben, és ezzel bizonyítható a híg oldatok használatának javaslatát a bevonási eljárásban a töménnyel szemben. A kapott eredmények alapján tervezhető a bevonatok gyógyszermegkötő kapacitása, és a bevonatok szendvicsszerkezetű elrendezésével az időbeli leadás szabályozható lehet. A hidrofil PUR bevonatok nagyobb hatóanyag-felvétele az anyag duzzadásával magyarázható, és ez alapján tervezhető a bevonat által bejuttatható hatóanyag mennyisége.
The case of a patient with lung cancer is presented whose first metastasis was detected in the 5th metacarpal head. Hand metastasis in lung cancer is a rarity in literature. After the detection of the hand tumor treatment was sidetracked by representatives of other medical specialities. The growing tumor destroyed the 3rd, 4th and 5th metacarpals, thus based on DSA, MRI, CT, PET-CT and X-ray results and thorough planning of the surgical procedures only opposition and grip of thumb and index finger was possible to form. During surgery unexpected difficulties occured partly because of the condtion of tissues, partly because the tumor was infected. It was not possible to plan exactly before the procedure due to the nature of the tumor, and according to the hystological results, the metastasis was cleared only by 6 mm. It was possible to rescue the 2nd metacarpal with the atypical insertion of an AO-plate, so that the final statics of the hand was secured. The postoperative period proved to be reassuring, however due to the quick progression of the underlying disease the patient was lost.
The rescue of a severed or amputated limb and restoration of the its biomechanical unity after serious hand or forearm injuries is analysed and discussed with two case presentations. Methods of anatomy and surgery in these cases are not part of the everyday practice, the need for improvization during surgery is essential. Ischaemia reperfusion time is also crucial when a limb has to be saved. The first case reports on the subtotal amputation of a young man's right hand and the successful revascularization and unorthodox restoration of the radiocarpal joint to full function. The second case is of a young woman with a conquassated left forearm. A special aspect in this case is the extremely long ischaemia-reperfusion time. Complete function was restored in this case too, however the patient's refusal of spongiosa-plasty resulted in the fatigue break of the fixation plate, that had to be replaced.
In traumatology it happens quite often, that serious decisions have to made by the operating table without the chance of consultation with colleagues and literature. The two presented cases might help to decide on treatment for those who meet similar cases in their practice.
Aim: The use of ultrasound based motion analyzing systems is harmless and has no side effects. They are applicable among healthy people and children as well. Since 2007 we have been surveying children who suffer from spine and foot deformities and participate in adapted physical education. With three-year experience we decided to broaden the scope of the survey. In September last year we started a survey among primary school pupils aged 6-10 with the goal to follow up their state. At first we examined the children's initial state when their usual annual medical examination was made at school. The survey is planned to take at least three years. During the survey we pay special attention to reveal spine and foot vault deformities at an early stage, because these deformities are most common in the age group and after discovery conservative therapybased correction can be started without procrastination.
Material and Method: After the orthopaedic examination, we performed a static posture examination and sole pressure distribution examination among 210 pupils from the two primary schools. By analysis with the Zebris CMS-HS ultrasound-based system and using Win Spine program we defined the degree of dorsal kyphosis and lumbar lordosis, the total trunk inclination in the sagittal and frontal planes and the degree of scoliosis.
Results: Two children with innate locomotor disorders and a boy with neurological problems were excluded from the survey. Out of the remaining 207 children the orthopaedic examination found 75 healthy ones, 55 with bad back posture and 9 with flat back. 16 times the diagnosis was scoliosis, mostly functional but could be corrected properly. 53 children had no spine deformity but were positively fl at-footed. Following the recommendation of the GKE 2008 annual congress, we divided each group into subgroups according to the degree of curvatures in the sagittal plane. Dorsal kyphosis between 30 and 60 degrees and lumbar lordosis between 30 and 40 degrees were considered normal. Because of this consideration the healthy group was not homogeneous, either. 37.3% of them had fl at lumbar lordosis, 4% of them had fl at lumbar lordosis and thoracic kyphosis, too. Among children with bad back posture these ratios were 50.9% and 3%, respectively.
Conclusion: Continuous control over different age groups makes it possible for us to search diagnosis- specificsigns in the results of ultrasound-based motion analysis. The sign can be, for example, unbending of the curvature. The results of adapted physical education can be measured numerically. We can call the attention of teachers and parents for the need of posture correction built into physical education and everyday life.
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