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Assesment of vitality of the vascularized fibular graft in intercalary defect reconstructions using Capanna technique
Lesenský, Jan ; Matějovský, Zdeněk (advisor) ; Trč, Tomáš (referee) ; Tomáš, Tomáš (referee)
INTRODUCTION: The reconstruction of the femoral diaphysis following bone tumor resection is challenging. While massive bone allografts are traditional, they carry risks due to avitality, leading to issues like infection and structural failure. Combining these with a vascularized fibula was proposed to solve these issues. However multiple complications including fibular graft necrosis exist. Currently, there's no reliable early postoperative technique to assess viability of the fibula, which is essential in management of complications. Also the superiority of this complex method compared to others is uncertain. STUDY OBJECTIVE: This study aims to introduce a noninvasive technique to determine fibula viability based on CT densitometry. Correlation of clinical outcomes with imaging studies is used to define predictive factors of fibular vitality. Results of combined grafts is tested against other reconstruction methods. MATERIAL AND METHODS: We prospectively collected data from 41 patients over ten years, all undergoing femoral diaphysis reconstruction post-tumor resection. Ten patients received a combined graft and underwent regular CT scans, which were then analyzed densitometrically to find objective signs of fibula vitality related to clinical outcomes. RESULTS: Our analysis confirmed that...
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Can the adverse complications of foot drop be prevented by endoprosthesis: design and development of a prototype device
El-Osta, Bassel ; Trč, Tomáš (advisor) ; Douša, Pavel (referee) ; Burget, Filip (referee)
Can the adverse complications of foot drop be prevented by an endoprosthesis: design and development of a prototype device Abstract Foot drop is a very old problem since Jacob from the bible was limping when he was wrestling with the angels. Foot drop occurs very often, and it is a very common condition in trauma, after surgery, and neurological diseases. The aim of this project is to identify an endo-prosthesis and test it bio-mechanically and bio- medically in order to resolve the problem. This endo-prosthesis must improve the quality of life for patients suffering from foot drop due to the injury to the common peroneal nerve. The device that must be created should be small and surgically will be attached to the muscle internally and work as if the muscles and nerve were intact. The device would be tested outside the human body. It is important to throw light on that the device should be made of a material that is accepted by the human body and should have a stiffness that is close to the weight of the foot to ensure a normal motion. The intent of this bio-mechanical device is to help patients suffering from foot drop to restore normal motion. An endo-prosthesis that is implanted in the foot might be the solution to foot drop disease. The endo-prosthesis has a major role to do the opposite movement and...
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Comparison of the long-term results of conservative and surgical therapies in children's hip pathology according to the type and degree of the disease
Stančák, Andrej ; Trč, Tomáš (advisor) ; Šponer, Pavel (referee) ; Kokavec, Milan (referee)
Legg-Calvé-Perthes (LCP) disease is associated with non-vascular necrosis of proximal epiphysis of the femur resulting in resorption of necrotic bone and subsequent remodelling of femoral head. The risk factors of the disease and factors affecting the treatment outcomes following conservative or surgical therapy are not completely understood. The first part of the thesis outlines the clinical and research problems pertaining to conservative and surgical treatment of LCP disease. The second, clinical part retrospectively analysed the predictors of treatment outcomes in patients treated conservatively or surgically, with emphasis on children younger than 6 years of age. The experimental part of the thesis analysed 3D kinematic data of the gait and hip range-of-motion data in patients treated conservatively or surgically. Age of the patient at the time of diagnosis and the shape of the lateral pillar of femur were significant predictors of treatment outcomes, and treatment outcomes after surgical treatment were comparable in children below and above the age of 6. Gait analysis showed a larger displacement of the pelvis in sagittal plane during the initial 25% of the standardised gait cycle and a larger extent of knee flexion during initial 13% of the gait in patients treated surgically compared to...
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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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Problems of the hip in patients with childhood cerebral palsy in childhood and adolescence. Experimentally influenced centering of the hip by a combination of operational tactics
Schejbalová, Alena ; Trč, Tomáš (advisor) ; Koudela, Karel (referee) ; Karpaš, Karel (referee) ; Kokavec, Milan (referee)
Cerebral palsy it must be nonprogressive brain lesion or lesions. The original lesion must occur prenatally, at birth, or early in the postnatal period. The primary disorder involves the musculoskeletal systém and lack of motor control, mental retardation or defects of hearing, language. Prevalence of cerebral palsy is different - between 0,6- 5,9 per 1000 births. In Western countries, the birth prevalence rate is about 2,0 per 1000. In children with cerebral palsy the hip joint appears to be relative nornmal at birth. There is abnormally increased femoral anteversion and neck-shaft angle. Increasing adduction-flexion contractures of the hip, acetabular dysplasia, subluxation eventual dislocation of the hip.Adduction deformity of the hip is caused by spasticity and contracture of the hip adductors and the medial hamstrings. Flexion deformity of the hip is primarily caused by spasticity and contracture of the iliopsoas and secondarily by rectus femoris muscles. When the rectus femoris is the cause, hip flexion deformity is increased with the knee in flexion and decreased with the knee in extension. When it is due to the iliopsoas muscle, the position of the knee has no effect on the degree of hip flexion contracture ( Thomas test). On passive flexion of the knee, if the test is positive, the pelvis will...
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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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Use of biochemical markers (Lipoprotein phospholipase A2 and hyaluronic acid) for laboratory diagnosis of metabolic and degenerative diseases of the musculoskeletal system
Kotaška, Jan ; Trč, Tomáš (advisor) ; Klapková, Eva (referee) ; Karpaš, Karel (referee)
Use of biochemical markers (Lipoprotein phospholipase A2 and hyaluronic acid) for laboratory diagnosis of metabolic and degenerative diseases of the musculoskeletal system Abstract Musculoskeketal disorders currently belong to the most common diseases. The presented work describes the use of biochemical markers (Lipoprotein phospholipase A2 and hyaluronic acid) for laboratory diagnosis of metabolic and degenerative diseases of the musculoskeletal system. Concentrations of LP-PLA2 were significantly elevated in the patients with bone resorption compared to the control group of healthy individuals. Serum levels of Lp-PLA2 also negatively correlated with decreased levels of serum osteocalcin in patients. HA concentrations in synovial fluid did not differ from published reference values in synovial fluid. Patients who underwent arthroscopy had significantly elevated synovial HA concentration than patients who underwent total knee endoprosthesis. HA positively correlates with osmotic pressure determined by examination of osmolality in synovial fluid. Lipoprotein phospholipase A2 concentrations are elevated in patients with bone density impairment. LpPLA2 concentrations correlate with the severity of bone density impairment expressed by the T score. Hyaluronic acid concentrations in patients with knee...
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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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