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Clinical outcomes of first metatarsophalangeal joint prosthesis PH-Flex Medin and its effect on the biomechanics of the forefoot in the propulsion phase of the gait cycle
Popelka, Stanislav ; Hromádka, Rastislav (advisor) ; Krbec, Martin (referee) ; Holinka, Martin (referee)
The dissertation evaluates the results of a first metatarsophalangeal (MTP) joint replacement. The PH-Flex MTP joint replacement was developed at the 1st Department of Orthopaedics, the first faculty of medicine in conjunction with the Medin s.r.o. company. The clinical trials ran between 2007 and 2011. Between 2011 and 2016, the implant was used in clinical practice, where the indication criteria of its use were gradually adjusted. This work summarises publications originating in our department, evaluating the 5-year period during which the implant was used and the results of its use. In the first part of the dissertation, we present the retrospective study evaluating a group of 31 patients after the implantation of 35 MTP joint replacements was published in 2017. Bilateral surgery was performed on 4 patients. A minimum follow-up of 6 months was required for inclusion in the study. In 30 cases, the indication was 1st MTP joint arthritis of grades 3 and 4 according to the Coughlin classification. A conversion from hemiarthroplasty to total arthroplasty was performed in 4 patients, and in 1 case, the surgery was performed as a revision from a failed silastic 1st MTP joint replacement. The evaluation was performed not only radiographically but also according to the American Orthopaedic Foot and Ankle...
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Sources of error in interpretation of blood gas analysis: Current acid-base models of plasma
Krbec, Martin ; Duška, František (advisor) ; Jabor, Antonín (referee) ; Caironi, Pietro (referee)
Sources of error in interpretation of blood gas analysis: Current acid-base models of plasma Abstract of Doctoral thesis Martin Krbec Introduction. Evaluation of acid-base status is an essential tool used by clinicians to guide therapy in a wide range of conditions. Of all biological fluids, in which the acid-base equilibrium has been studied, isolated plasma is the best described one. For its evaluation, two main approaches have been developed: One is the traditional bicarbonate-centered school based the work of Henderson, Hasselbalch, van Slyke, and Siggaard-Andersen. The other is the quantitative physicochemical approach invented by Stewart and further developed by Staempfli and Constable or Figge and Fencl. Each of the mentioned models uses a set of constants for characterizing the behavior of non-carbonic buffers (proteins and phosphates) in plasma, the value of which is crucial for precise calculation of derived parameters. The values of the constants used by the Stewart model, i.e., the total weak nonvolatile acid concentration (Atot) and its dissociation constant (pKa), have only been experimentally determined once in a group of 8 healthy volunteers. Our aim was to experimentally determine the value of these constants in healthy volunteers and, for the first time ever, in two populations of...
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Lumbar spinal stenosis: changes in the fibrous structures of the posterior spinal column and the rule of the ligamentum flavum
Ježek, Jakub ; Krbec, Martin (advisor) ; Chaloupka, Richard (referee) ; Matějka, Jiří (referee)
The dissertation is focused on lumbar spinal stenosis (LSS), because it is a serious desease, that primary affects elderly patients and which often leads to disability. Because the pathophysiology or feasible prophylaxy is not yet fully understood, the first part of the thesis is devoted to the ligamentum flavum (LF), whose changes (hypertrophy and degeneration) are one of the main factors leading to LSS. We focused in this experimental part on changes in the LF properties that could cause its degeneration and hypertrophy - changes in vascularization (investigated as vascular density - Lv), the presence of inflammatory changes and the occurrence of chondroid metaplasia, and then to clarify changes in the LF mechanical properties (stiffness). Vascular density analysis of degenerated and healthy human LF combined with measurement of micromechanical properties was performed. It was found that Lv changes were not dependent on the degree of LSS but were age dependent, that is, LF vascular density declines up until 50 years of age and thereafter changes very little. A significant increased incidence of chondroid metaplasia and clear signs of inflammation in LSS patients were found out. LF samples from LSS patients showed significantly lower stiffness in comparison to samples of healthy patients. The...
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Morphology of ankle fractures - its impact on the type of fracture and the outcomes of treatment
Marvan, Jiří ; Krbec, Martin (advisor) ; Čapek, Lukáš (referee) ; Pilný, Jaroslav (referee)
Ankle fractures can be serious and complex injuries with variable prognoses. In our department, ankle fractures are the third most common fracture behind fractures of the distal radius and the proximal femur. Ankle fractures present with considerable variability with regard to the extent of injury to bones and ligaments, with each injured structure requiring appropriate treatment. We analyzed a group of patients that were surgically treated, in the Orthopedics and Traumatology Clinic, 3rd Medical Faculty of Charles University, for ankle fractures, with a particular focus on the epidemiological, clinical, and morphological parameters of the fractures. Our objective was to supplement existing information regarding the morphology of ankle fractures. Furthermore, we wanted to experimentally verify certain aspects related to ankle fractures. Our first step was to focused on the structure of cortical and cancellous bone in the fibula by carrying out a biomechanical study of the distal fibula after treatment with various types of fixation. The structure of fibular cortical bone was analyzed, using superficial sections, from dry preparations of a human fibula. By rubbing Indian ink into polished sections of cortical bone, we were able to visualize both the direction and organization of the central vascular...
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Development of the first metatarsophalangeal joint replacement
Barták, Vladislav ; Popelka, Stanislav (advisor) ; Stehlík, Jiří (referee) ; Krbec, Martin (referee)
The work provides a comprehensive overview of the issues hallux rigidus with a focus on the first metatarsophalangeal joint replacement and development of our own implant. The development was built to perform anatomical studies, the results were the basis for the construction of hemiarthroplasty and total arthroplasty. It was necessary to measure the marrow cavities of the distal part of first metatarsal and proximal half of proximal phalanx. We measured the size of the metatarsal head in two planes, and its tendency to diaphysis on the dry preparations. Through these studies we obtained valid data for the construction all components of both hemiarthroplasty and total arthroplasty of specifying the size spectrum. We have verified and then corrected the shape of implant treatment during post-mortem tests on the models. The result is a new type of arthroplasty with their own design to guarantee restoration of joint function and coated with a high osteointegral potential. In clinical studies, we performed 22 implantations of hemiarthroplasty and one implantation of total arthroplasty. Clinical results suggest the fact that the implant will be successful. However the ultimate answer to this question will provide long-term study. The other results presented with a detailed anatomical description show to...
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Morphology of ankle fractures - its impact on the type of fracture and the outcomes of treatment
Marvan, Jiří ; Krbec, Martin (advisor) ; Čapek, Lukáš (referee) ; Pilný, Jaroslav (referee)
Ankle fractures can be serious and complex injuries with variable prognoses. In our department, ankle fractures are the third most common fracture behind fractures of the distal radius and the proximal femur. Ankle fractures present with considerable variability with regard to the extent of injury to bones and ligaments, with each injured structure requiring appropriate treatment. We analyzed a group of patients that were surgically treated, in the Orthopedics and Traumatology Clinic, 3rd Medical Faculty of Charles University, for ankle fractures, with a particular focus on the epidemiological, clinical, and morphological parameters of the fractures. Our objective was to supplement existing information regarding the morphology of ankle fractures. Furthermore, we wanted to experimentally verify certain aspects related to ankle fractures. Our first step was to focused on the structure of cortical and cancellous bone in the fibula by carrying out a biomechanical study of the distal fibula after treatment with various types of fixation. The structure of fibular cortical bone was analyzed, using superficial sections, from dry preparations of a human fibula. By rubbing Indian ink into polished sections of cortical bone, we were able to visualize both the direction and organization of the central vascular...
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Development of the first metatarsophalangeal joint replacement
Barták, Vladislav ; Popelka, Stanislav (advisor) ; Stehlík, Jiří (referee) ; Krbec, Martin (referee)
The work provides a comprehensive overview of the issues hallux rigidus with a focus on the first metatarsophalangeal joint replacement and development of our own implant. The development was built to perform anatomical studies, the results were the basis for the construction of hemiarthroplasty and total arthroplasty. It was necessary to measure the marrow cavities of the distal part of first metatarsal and proximal half of proximal phalanx. We measured the size of the metatarsal head in two planes, and its tendency to diaphysis on the dry preparations. Through these studies we obtained valid data for the construction all components of both hemiarthroplasty and total arthroplasty of specifying the size spectrum. We have verified and then corrected the shape of implant treatment during post-mortem tests on the models. The result is a new type of arthroplasty with their own design to guarantee restoration of joint function and coated with a high osteointegral potential. In clinical studies, we performed 22 implantations of hemiarthroplasty and one implantation of total arthroplasty. Clinical results suggest the fact that the implant will be successful. However the ultimate answer to this question will provide long-term study. The other results presented with a detailed anatomical description show to...
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Injury to the distal tibiofibular junction in the growing skeleton
Pešl, Tomáš ; Bartoníček, Jan (advisor) ; Koudela, Karel (referee) ; Krbec, Martin (referee)
In adults the complex fractures of the ankle joint have been thoroughly discussed and there are several therapeutic schedules proposed. Weber distinguished three types of ankle joint fractures according to the type of fibular fractures. In agreement with this classification we are certain that fibula is an important element of the immature ankle joint. We concentrated on the anatomy of immature ankle joint, especially on the mutual position of the distal fibular physis and the plane of the tibiotalar joint. The results are summarized as follows: 9.1. AUTOPSY At first we performed autopsy of six ankle joints in stillborns in which there were no orthopaedic and/or neurological lesions. We paid attention to anatomy of the distal tibiofibular junction. Two adult ankles were anatomised for correlation the findings. We ascertained, that in all preparations there was articulation between tibia and fibula, as it is formerly described in the literature. In all six stillborn joints we found well formed ligaments of the distal tibiofibular junction: anterior, posterior and interosseal tibiofibular ligaments. The anterior and posterior tibiofibular ligaments begin at the anterior, respectively posterior surface of the distal tibial epiphysis and terminate at the anterior, respectively posterior surface of the distal...
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