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1.
Unfallchirurgie (Heidelb) ; 126(1): 67-71, 2023 Jan.
Article in German | MEDLINE | ID: mdl-35380265

ABSTRACT

The following case report shows a young male patient with a complex pelvic trauma due to a traffic accident. In addition to the pelvic ring fracture, he also suffered a severe accompanying injury to the efferent urinary tract in combination with extensive damage of the lumbosacral plexus. Multiple extensive operations were necessary to address the C3 fracture of the pelvic ring and the bladder injury. Due to an infection a wound healing disorder subsequently occurred, which necessitated a myocutaneous flap plasty. This case highlights the complexity of this injury and confirms the necessity for an interdisciplinary individualized treatment.


Subject(s)
Abdominal Injuries , Fractures, Bone , Pelvic Bones , Urinary Tract , Humans , Male , Fractures, Bone/complications , Pelvis/diagnostic imaging , Pelvic Bones/diagnostic imaging , Abdominal Injuries/complications
2.
Clin Neurol Neurosurg ; 213: 107125, 2022 02.
Article in English | MEDLINE | ID: mdl-35030419

ABSTRACT

OBJECTIVE: Decompression and cervical balance are major goals in the surgical treatment of cervical spondylotic myelopathy (CSM). Cervical balance is assumed to be a key factor for neurological recovery and pain reduction. Surgical reduction of C2-7 sagittal vertical axis (SVA) correlates with clinical improvement. However, it remains unclear, how much or even if correction is necessary for clinical improvement as long as surgery results in successful decompression. We aim to evaluate the role of radiological cervical balance parameter on the short-term course of CSM. METHODS: This is a retrospective study with prospectively collected data of 90 patients. The authors identified 45 patients suffering from CSM that underwent decompressive surgery and instrumentation and showed an increased C2-7 sagittal vertical axis (SVA) after surgery. 45 consecutive patients with a decreased C2-7 SVA were selected as a control group. RESULTS: Surgery improved the clinical outcome of both groups significantly. No differences could be seen comparing neck pain and neurological improvement between both groups. An increased C2-7 SVA did not correlate with an inferior clinical outcome. T1-slope correlated with the Cobb-angle. CONCLUSIONS: Decompression and stabilization appear to be key elements of surgical treatment of CSM. In short terms, clinical improvement does not appear to affect patients negatively who show a larger C2-7 SVA after surgery. Optimal C2-7 SVA and necessity for a specific C2-7 correction is unclear. The term "balance" remains a complex entity without clear definition.


Subject(s)
Lordosis , Spinal Cord Diseases , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Decompression , Humans , Lordosis/surgery , Neck Pain , Retrospective Studies , Spinal Cord Diseases/diagnostic imaging , Spinal Cord Diseases/surgery , Treatment Outcome
3.
Crit Care ; 23(1): 308, 2019 09 10.
Article in English | MEDLINE | ID: mdl-31506074

ABSTRACT

BACKGROUND: Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. METHODS: This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. RESULTS: One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). CONCLUSION: Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. TRIAL REGISTRATION: ISRCTN ISRCTN19392591 , registered 17 February 2011.


Subject(s)
Electric Stimulation Therapy/standards , Muscle Contraction , Adult , Aged , Berlin , Critical Illness/therapy , Electric Stimulation Therapy/methods , Electric Stimulation Therapy/statistics & numerical data , Female , Humans , Male , Middle Aged , Muscle Strength/physiology , Organ Dysfunction Scores , Prospective Studies
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