Pacientų, patyrusių šlaunikaulio kaklo lūžius, gydymas – aktuali senstančios visuomenės problema, todėl literatūroje gausu publikacijų, analizuojančių įvairius šios patologijos gydymo aspektus. Analizuojant literatūros duomenis pastebima, kad nėra išskiriamas laikas nuo traumos iki patekimo į ligoninę, o laikas pradedamas skaičiuoti tik nuo tada, kada pacientas jau paguldytas į ligoninę. Šis veiksnys gali turėti reikšmingos įtakos galutiniams gydymo rezultatams, nes laikotarpio nuo traumos iki patekimo į ligoninę trukmė gali labai svyruoti tarp įvairių pacientų grupių. Todėl buvo tikslinga atlikti tyrimą, kuriame būtų įvertintas būtent šis laikotarpis ir nustatyta jo reikšmė pacientų mirštamumui ir funkciniams gydymo rezultatams. Savo darbe tyrėme veiksnius, įtakojančius šlaunikaulio kaklo lūžius patyrusių pacientų mirštamumą ir funkcinius gydymo rezultatus. / Treatment of patients with femoral neck fractures is an important issue in an ageing population; therefore, in the scientific literature, there are a lot of publications analysing various aspects of management of this pathology. However, while analysing the literature data, it was noted that the time from trauma to hospital admission is not taken into account, and the time is being counted just from that moment, when a patient is already hospitalised. This factor may have a great influence on treatment outcome because the time from trauma to hospital admission can vary significantly among different patient’s groups. Therefore, it was purposeful to carry out a study where exactly this period would be evaluated and its influence on patients’ mortality and functional outcome would be determined.

Most common joint degeneration disease is coxarthritis. This disease is diagnosed for 5 % of all adults, who are suffering from orthopedic illnesses. Coxarthritis and hip fractures are most often reasons to make joint replacement operations Hip joint endoprosthesis is most successful and economically efficacious of all surgical operations and interventions. About 1 million operations are produced all over the world per year. The hypothesis of this work was raised on considering the endoprosthesis operations situation, i.e. requirement and efficacious of operations, the treatment of the coxarthritis and hip fractures, the great signification of physical therapy on the postoperative stage. Muscle strength and joints mobility depends not only on the type of the hip fracture (traumatic or inflammatory) but also on the strength of hip muscles. The aim of this research was to establish the strength of hip muscles and mobility changes after physical therapy for patients after hip endoprosthesis and hip fractures. The research has been done at the rehabilitation centre UAB “Baldzio Silas” in 2005-2006. 60 patients were involved in this research. They were divided in two groups depending on a reason of the endoprosthesis. The patients were prescribed a complex of kinesitherapeutic means, i.e. curative gymnastic exercises performed for 30-45 minutes twice a day, 5-6 times per week. Measurements of the muscles were made 3 times: first time after operation, after arrival to the... [to full text]

Aneurismas são dilatações permanentes iguais ou superiores a 50% do diâmetro original de uma artéria ou do diâmetro proximal da mesma, de acordo com consenso publicado pela Sociedade de Cirurgia Vascular da América do Norte e Sociedade Internacional de Cirurgia Cardiovascular em 1991 (Vliet e Boll, 1997). Aneurisma de aorta é uma doença vascular que afeta mais de 5% da população masculina com mais de 55 anos de idade (How et al., 2005). Desde 1991 um novo método vem sendo utilizado como tratamento deste quadro clínico. Este novo método é considerado menos invasivo e com menor comorbidade, uma vez que se trata da instalação de uma endoprótese por meio de catéter através da artéria femoral. Neste trabalho, será verificado o escoamento através de três aneurismas de aorta abdominal (AAA) e das endopróteses indicadas para o tratamento de cada um dos aneurismas. Foram feitas simulações computacionais afim de se obter as pressões, as velocidades do escoamento sanguíneo e as tensões de cisalhamento na parede das geometrias, usando pulsos de pressão e velocidade fisiológico de um individuo adulto, normotenso, em repouso. No modelo de escoamento simulado, foi adotado o sangue como fluido Newtoniano, incompressível e homogêneo. Foi usado um modelo de turbulência K-, com interpolador upwind de 2ª ordem e tratamento de parede nas geometrias, para que se fosse possível obter resultados satisfatórios (das camadas próximas à parede, e de todos os vórtices). Os resultados obtidos no trabalho foram satisfatórios, uma vez que eles expressaram de forma realista o comportamento do escoamento sanguíneo pelos aneurismas e endopróteses. Foi possível justificar com esse trabalho a instalação de endopróteses em pacientes, quando necessário, com o objetivo de diminuir significativamente a degradação do vaso, causando a ruptura do aneurisma. / Aneurisms are permanently dilatation higher than 50% of the original diameter of an artery or of the proximal diameter of them, according to the published consensus of the Vascular Surgery Society of North America and International Society of Cardiovascular Surgery on 1991 (Vliet and Boll, 1997). Aortas Aneurism is a vascular disease that affects more than 5% of the male population, with more than 55 years old (How et al, 2005). Since 1991, a new method is used in the treatment of these diseases. This new method is less invasive and has less comorbidity. This method is provided by the installation of an endoprosthesis through the catheter through the femoral artery. In this work, the flow will be verified through three abdominal aortic aneurysms (AAA) and the endoprosthesis indicated for the treatment of each of the aneurysms. Computational simulations were made in order to obtain the pressures, velocities of the blood flow and the shear stresses on the wall of geometries, using a pulse pressure and velocity of an individual physiological adult normotensive at rest. For the fluid simulations, it was adopted the blood as Newtonian fluid, incompressible and homogeneous. In simulations, it was used a K- model of turbulence, with 2nd order upwind interpolator and wall geometry treatment in order to obtain satisfied results (on the layers near the walls, and all the vortices). The results obtained in this work were satisfied, once they expressed the realistic behavior of the blood flow through the aneurysm and the endoprosthesis. It was possible to justify with this work the installation of an endoprosthesis inside patients, when it is necessary, in order to decrease significantly the vessels degradation, causing the aneurysm rupture.

The presented work deals with the creation of computational model of total hip endoprosthesis and the subsequent stress-strain analysis. The models of geometry of the pelvis and femur were created on base of CT data. In this model were fitted components od endoprosthesis, i.e. femoral stem and acetabular cup (metal and polyethylene pad) and also cement. On this system was subsequently modelled the rals loads conditions. Just the real loading of the prosthesis leads to the wear. It has a great influence on the quality of bone tissue, what is deteriorated. The deteriorated tissue was simulated under the acetabular component. The behaviour of the whole system is assessed on base of stress-strain analysis. This problems is very topical these days.

No description available.

Objective: This study aims to evaluate the application of Pictorial Representation of Illness and Self-Measure (PRISM) in educating patients regarding oral health before endoprosthesis (EP). Methods: The study consisted of two parts: (I) a cross-sectional study, where patients received a PRISM interview, oral health briefing and oral examinations (treatment need, oral focus). (II) In an observational part, patients were randomly assigned to either PRISM task (Test) or flyer-based verbal briefing (Control). Before and after the interviews, patients answered a questionnaire regarding importance of oral health for EP. Results: (I) 122 patients were included. The distance between subject (“myself”) and objects (oral health issues or EP) in the PRISM task were mainly not associated with age, gender, and oral conditions. In part (II), 80 patients (PRISM: n = 40, Control: n = 40) were included. After the interview, the values for perceived relationship between EP and teeth (p < 0.01), EP and gums (p < 0.01), and EP and dental consultations (p < 0.01) significantly increased in both groups. Both groups perceived a high benefit of the interview and felt well educated. Conclusions: PRISM has comparable positive effects like a flyer-based verbal briefing. PRISM as a novel visual tool can support the patient education regarding oral health before EP

Objectives: This cross-sectional survey aimed to evaluate the oral health behaviour of patients prior to endoprosthesis (EP), as well as the handling of oral health topics by German orthopaedic surgeons. Materials and methods: Consecutive patients prior to EP answered a questionnaire regarding oral health behaviour, oral hygiene, oral complaints and information on the relationship between EP and oral health. Another questionnaire was digitally mailed to orthopaedic centres throughout Germany. This questionnaire included the importance of oral health for EP and issues on dental referrals/consultations prior to EP. Results: A total of 172 patients were included in the study, of whom 35.5% of patients reported that they were informed about oral health and EP. Half of the individuals reported regular professional tooth cleaning, and less than one-third (29.1%) reported of the performance of interdental cleaning. Information on oral health and EP was associated with regular professional tooth cleaning (yes: 59.8% vs. no: 35.6%, p = 0.01). A total of 221 orthopaedic clinics were included in the study, of which only a few had dental contact (14%), although the majority (92.8%) of the clinics were familiar with causal relationships between oral health and EP infections. Less than half of the centres reported of either verbal (48%) or written (43.9%) referrals for their patients to the dentist. University Medical Centres reported of more frequent dental contacts (p < 0.01). Conclusion: Prior to EP, patients exhibited deficits in oral health behaviour, and orthopaedic clinics exhibited a lack of dental collaboration. Improvements in interdisciplinary care, especially regarding practical concepts for patient referral and education on oral health, appear to be necessary.

Cette étude à pour but de développer un concept de stent atraumatique pour le remplacement percutanée de la valve aortique. Le stent est obtenu à partir de brins de Nitinol tressés, ce qui lui permet, de part sa géométrie et sa structure, d'être compressible, auto-expansible, et atraumatique. Le principe de fabrication des prototypes et les contraintes qui lui est associé sont présentées. Les performances de ces prototypes, en terme d'ancrage, de régurgitation statique et de régurgitation dynamique sont ensuite évaluées par des essais in vitro, pour lesquel le banc de test en flux pulsé a été optimisé afin de prendre en considération la compliance de la racine aortique. Les résultats obtenus permettent de mettre en évidence les différents paramètres de fabrication stent, tant au niveau dimensionnel (hauteur du cylindre, angle du cône...) qu'au niveau structurel (rigidité), qui ont une influence significative sur le comportement de l'endoprothèse. / The goal of this work is to develop an atraumatic stent concept for percutaneous aortic valve replacement. Shape setted braided nitinol wires, thanks to their specific geometry and elasticity, allows stent's compressibility, self deployment and aortic root preservation. Prototypes manufacturing technique and relatives constraints are presented. Performance of the obtained prototypes are evaluated in vitro, in terms of sealing, static and dynamic regurgitation. More specifically, the pulsatile bench testing has been optimized to take in account the compliant constraint of the aortic valve environment. The results bring to the fore which are the dimensions (head height, cone angle...) and the structures features that do influence the endoprosthesis behavior significantly.

L’objectif de ce travail était d’élaborer un copolymère biodégradable dans le but de développer une endoprothèse biorésorbable. Ainsi, des copolymères de lactide et de glycolide ont été synthétisés par copolymérisation par ouverture de cycle, dans des conditions permettant le contrôle de leurs paramètres macromoléculaires. Après plastification et mise en forme des copolymères par extrusion, l’étude des propriétés mécaniques, à l’état sec et après immersion en milieu aqueux, a été réalisée. Les essais de traction ont permis de vérifier l’importance de la vitesse de sollicitation et d’accéder à certaines grandeurs caractéristiques du matériau. L’étude de la dégradation des copolymères, sous forme de jonc, a mis en évidence un mécanisme de dégradation hétérogène sur une durée en accord avec l’application visée. La plastification par des molécules acides a permis d’accélérer la vitesse d’hydrolyse des copolymères. En conclusion, les propriétés mécaniques et de dégradation des copolymères PDLGA synthétisés sont donc en adéquation avec le cahier des charges de l’application biomédicale. / This work describes the synthesis of biodegradable copolymer to design a bioabsorbable endoprosthesis. Lactide and glycolide-based copolymers were synthesized by ring opening polymerization. Experimental conditions were chosen to produce controlled structures. The study of mechanical properties was performed in dry and wet states. During the tensile experiments, the effect of strain rate was noticed and some characteristics parameters were determined. Hydrolytic degradation of materials was fast and revealed a heterogeneous mechanism. Addition of acidic molecules for plasticizing increased the degradation rate of the copolymers.Mechanical properties and degradation of the PDLGA copolymers are indeed in good agreement with the specifications of this biomedical application.

This diploma thesis is concerned with the stress analysis of the total hip joint endoprosthesis ceramic head under oblique loading. Load was obtain from experimental in vivo measurement on three patients, whereas two of them was the same weight. As input variables were use contact forces, especially knee bend and standing on one leg. Furthermore they will be considered shape deflections from ideal cone, especially circle deviation, cone deviation and cone plus circle deviation together.