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Multipotent mesenchymal stromal cells in orthopedic: Potentiation of bone healing
Stehlík, David ; Trč, Tomáš (advisor) ; Janíček, Pavel (referee) ; Sedmera, David (referee)
The aim of the thesis was development of an innovative treatment of bone defects. Human multipotent mesenchymal stromal cells (MSC) play a crucial role in bone healing. Clinical applications of MSC require large amount of cells, which could be obtained by autologous expansion of MSC harvested from bone marrow. As a first step, the standard protocol of MSC expansion based on αMEM medium and fetal bovine serum (FBS) was used. Experiments replacing FBS by pooled human serum (HS) in the culture medium concluded in patenting of a new MSC cultivation protocol (EU 1999250, CR 301141). This one-step cultivation protocol and xenogeneic protein-free cultivation medium is based on CellGro® for Hematopoietic Cells' Medium, HS, human recombinant growth factors, dexamethasone, insulin and ascorbic acid. The preclinical in vitro and in vivo experiments with MSC from both expansion protocols were carried out. Fibrillar polylactic scaffolds were seeded with MSC, cultured, differentiated and implanted in immunodeficient mice (NOD/LtSz-Rag1-). Bone-like mineralized tissue containing vessels was observed. The MSC cultured according to patented method were classified as Advanced-therapy Medicinal Product and has to fulfil the European Medicines Agency regulations to enter the clinical trials. Nevertheless the use of MSC seems...
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Development of the surgical instrumentarium for the anterior cruciate ligament reconstruction by the hamstrings tendons
Hanus, Martin ; Trč, Tomáš (advisor) ; Podškubka, Aleš (referee) ; Douša, Pavel (referee)
The paper presents the development of instrumentaria designed to solve ACL lesions using hamstrings (tendons of semitendinosus and m. gracilis - ST / G). The work itself took place in two phases. Part of the first phase was the development of its own instrumentation, including the implant designed to fix hamstrings tendons. The inherent part of the development was the performance of both mechanical and functional tests. The most tested element of the instrumentation was the screw with eye. In the course of its development, mechanical tests of tensile strength were carried out on the individual variants of the solution, and then the rapture of the screw with the eye from animal bone - simulating the function of the product in a real environment. Part of this was the development of methodology and work with new instrumentation. Clinical testing was performed in the second stage and the results of the operations are part of the work. The self-developed ACL lesion reconstruction toolkit is designed to use a graft made up of four strands of the above tendons. In the experimental part of the instrumentation development, the suitability of the implant for clinical use has been demonstrated. The newly developed instrumentation for ACL reconstruction, using the test implant for fixation of the hamstrings...
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Monitoring of the development of the anatomical conditions in modern treatment of congenital foot deformities
Pellar, David ; Karpaš, Karel (advisor) ; Repko, Martin (referee) ; Trč, Tomáš (referee)
MONITORING OF THE DEVELOPMENT OF THE ANATOMICAL CONDITIONS IN MODERN TREATMENT OF CONGENITAL FOOT DEFORMITIES SUMMARY This dissertation discusses the questions related to the solution of residual defects after treatment of congenital clubfoot, mainly residual metatarsus adductus. The records of our patiens were divided into parts, namely historical and comparitive. In the historical part patients operated by basal osteotomy of I. - V. metatarsal (Berman - Gartland) and patients operated by transfer of anterior tibialis tendon were evaluated. The comparitive group comprised of patients operated by a double tarsal wedge osteotomy or a combination of medial cuneiform osteotomy along with basal osteotomy of II. - V. metatarsal. From 1996 - 2013, we operated a total of 58 children (39 boys, 19 girls) with residual deformity of the forefoot. A total of 66 feet were operated upon. The mean age at the time of surgery was 6.4 years (interval 3 - 20 years). In children older than 3 years with a flexible residual varus, transfer of tibialis anterior tendon to the outer aspect of foot was carried out. A total of 18 feet were operated upon by this technique. No postoperative complications were recorded. In two patients, for persistent postoperative residual deformity, basal osteotomy of I. - V. metatarsal (Berman -...
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Multipotent mesenchymal stromal cells in orthopedic: Potentiation of bone healing
Stehlík, David ; Trč, Tomáš (advisor) ; Janíček, Pavel (referee) ; Sedmera, David (referee)
The aim of the thesis was development of an innovative treatment of bone defects. Human multipotent mesenchymal stromal cells (MSC) play a crucial role in bone healing. Clinical applications of MSC require large amount of cells, which could be obtained by autologous expansion of MSC harvested from bone marrow. As a first step, the standard protocol of MSC expansion based on αMEM medium and fetal bovine serum (FBS) was used. Experiments replacing FBS by pooled human serum (HS) in the culture medium concluded in patenting of a new MSC cultivation protocol (EU 1999250, CR 301141). This one-step cultivation protocol and xenogeneic protein-free cultivation medium is based on CellGro® for Hematopoietic Cells' Medium, HS, human recombinant growth factors, dexamethasone, insulin and ascorbic acid. The preclinical in vitro and in vivo experiments with MSC from both expansion protocols were carried out. Fibrillar polylactic scaffolds were seeded with MSC, cultured, differentiated and implanted in immunodeficient mice (NOD/LtSz-Rag1-). Bone-like mineralized tissue containing vessels was observed. The MSC cultured according to patented method were classified as Advanced-therapy Medicinal Product and has to fulfil the European Medicines Agency regulations to enter the clinical trials. Nevertheless the use of MSC seems...
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Development and evaluation of new cementless revision acetabular components for total hip arthroplasty / type TC /
Šťastný, Eduard ; Trč, Tomáš (advisor) ; Šponer, Pavel (referee) ; Pilný, Jaroslav (referee)
Development and evaluation of new cementless revision acetabular components for total hip arthroplasty / type TC / Objective: The aim of the clinical part of the study was to introduce a new revision oval cup type TC, and evaluate its reliability and utility in revision endoprosthesis. Due to the different structure of the implant, we aimed to objectively demonstrate the remodeling of bone tissue in its vicinity. In the experimental part of the work we verified the hypothesis that the use of locking screws has an effect on the bond strength of the implant with bone tissue, and therefore on the primary stability of the acetabular component. Method: We evaluated 31 patients that underwent revision hip surgery between 2004 and 2008. The mean follow-up was 7.1 years (range 5.3 to 9.3 years, minimum 5 years after surgery). Osteointegration of the implant and remodeling of bone tissue around the implant and its ribs were evaluated by digital radiography and computed tomography, and clinical results according to Harris. The experiment was based on the execution of pull-out tests after the implantation of TC cups in cadaveric bovine pelves. We evaluated the dependence of tensile forces in the axis of the implant on extraction of the metal cup from the bone bed. Four tests were conducted with the cup fixed...
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Fractures of the distal radius as serious geronto-traumatology problem and its possible solutions
Pacovský, Vladimír ; Topinková, Eva (advisor) ; Trč, Tomáš (referee) ; Pilný, Jaroslav (referee)
Fractures of the distal radius are the most common fractures treated at our clinics . It accounts for around 16 % of all fractures. Most often we meet them in two age groups - children and especially in postmenopausal women. In this group the fractures are frequently associated with osteoporosis. The most common cause of fracture is a fall on the outstretched extremity. Together with fractures of the proximal humerus, proximal femur and vertebral fractures they are the most common gerontotraumatologic fractures. The frequency of fractures of the distal radius gradually increasing. The reason is the increasing average age of the population and their active way of life. Our group consists of 5,359 patients treated for a fracture of the distal radius in 1998 and from 2001 to 2013 . During this time , the frequency of fractures increased by 19,7%. For women with distal radius fractures occur 3 times more frequently, the average age of treated was 59,1 years. About 80 % of distal radius fractures are treated conservatively. The surgical treatment of seniors decide not only the type and stability of the fracture, bone quality, but especially the overall condition of the patient and his claims to a final functional outcome. Long-term functional results after conservative treatment in the elderly are nearly the...
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Gait analysis in cerebral Palsy
Švehlík, Martin ; Trč, Tomáš (advisor) ; Smetana, Karel (referee) ; Chomiak, Jiří (referee)
lom><luclioo G>il :wd pos"'" disrurb= :n~ ~ of m. mosl common probl"", in childrm wilh CP. lk clinical studie; pr~ItN in tbi, tMsis" br~ ~ CUlImt mowlnlg~ 00 DlO\T'!IImI .bnorm>.liTi.. in childrm witb CP aru! a!low US to bffi..- und..-stand :md drscribr m. patbopby,i"logica! tlltClwli>mS "f~ dis...-dns .Um, Srudy I - To pro'" m., bypoIbrsis th:ot ~:nt)" kntt rrrurnTioo i, C:llIsN by . dynamic ~inus <lefumlity:md lal~ ~ =-:nion i, hnkN 10 m. fixrd ~inus <leťcrmity. Sttood . im " .." to analyz~ tbr rol~ ofbamstrings in tbt ""thobiomrcbani.. ofm. knt-r =",rum Srudy 1 - To ~"alU3t~ ~ fuoction of m. tr1cq>< S\lGI~ during wa1king ,,1Ien 6tbtr dynamic lricrps """" Tighmess or fixrd rquinus cootJacrur~ is """"'" in childr<n witb CP Srudy 3 - To perf<mll' cornprehensi,,, anaJys;s of m., >bort-leml dr""", of. stan<IardizN dosr ofBorubnnm 10xin A (BTX-A) aru! sniaI casting 00 spNic N[Uinn'. Srudy 4 - To compar. noodjoV'll,ional nonnaliz:ltioo of""'D' c.,.t of walling in childrm ,,~Ih CP to chnically UsN body mass oonnali..z.atioo "'~. Srudy 5 - To ~va!ll.1~ Ibr .".olutioo of diff..-mt gail p;uamrt..-s "'''' p..-lod ar niot months rollo"'1ng cOCf"",i,,, ""ft tis"", ru:g~'Y in cbild:ren ,,;Ih CP. ~Iotbod, Ccmp.iltriz.rd bn..-mtic :wd bnrTic thr..,-<liDV'Ilsional gail analysi' togrtb..- ,,;Ih...
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