[Simple technique of percutaneous ligation of accessory veins for salvage of failing arteriovenous fistulae]. / Jednoduchá technika perkutánního podvazu akcesorních zil hemodialyzacních zkratu.

INTRODUCTION: Non-maturing arteriovenous fistula is a common problem in hemodialysis units. The main reasons for maturation failure include a poor venous system, vein stenosis, stenosis in an anastomosis, or the presence of collateral veins. Currently, the usual approach to eliminate collateral vein drainage consists in surgical ligation or coil embolization; however, these procedures are time-consuming, logistically demanding and expensive. Alternatively, various types of percutaneous ligation are done. Below follows the description of a technique of image-guided percutaneous ligation of collateral veins and an analysis of our cohort of patients. METHOD: A retrospective study of prospectively enrolled patients with non-maturing arteriovenous fistulae. The criterion of success was defined as successful hemodialysis within 4 weeks after percutaneous ligation. RESULTS: During a 2-year period (March 2015 - January 2017) 7 patients underwent 11 ligations of collateral veins. In all patients the arteriovenous shunts matured successfully for hemodialysis within 2 or 3 weeks following the ligation. CONCLUSION: The novel technique is fast, inexpensive and provides a good clinical and cosmetic outcome.Key words: arteriovenous fistula - collateral veins - percutaneus ligation.

[Fixation of acetabular fractures. a novel method of pre-operative Omega plate contouring]. / Osteosyntéza zlomeniny acetabula: nová metoda predoperacní modelace Omega dlahy.

PURPOSE OF THE STUDY: The aim of the study was to describe a novel Omega plate and the procedure for obtaining an accurate pelvic inlet view, the mode of pre-operative plate contouring, the surgical procedure used and the evaluation of results in the first 15 patients treated using this method. MATERIAL AND METHODS: In the period 2009-2011, a total of 232 patients underwent osteosynthesis for pelvic fractures. Out of them, 52 were treated by the modified Stoppa approach and 12 with the original Omega plate. Between July 2010 and January 2014, a novel 3.5-mm Omega plate was used in 12 men and 3 women. The average duration of follow-up was 8.5 months in 11 patients; four were shortly after surgery. The multi-functional Omega plate is described in detail. An exact pelvic inlet projection, named the "computer tomography-defined (CTD) view", was based on pre-operative CT examination. It facilitates pre-operative contouring of the plate according to a mirror image of the uninjured half of the pelvis. The surgical procedure enables us to apply the contoured plate to the correct position; the plate completes reduction, restores normal pelvic anatomy and makes operative time shorter. The radiographic evaluation of post-operative results was done using the Matta classification and functional outcome was assessed by the Harris Hip Score. RESULTS: Surgery using the isolated Stoppa approach was carried out in 11 patients and a procedure combining the Stoppa approach with another method was used in four patients. All operations were successfully completed, during two of them the external iliac vein was injured and treated by vascular suturing. No other vascular or nerve injury occurred. One deep wound infection successfully healed was recorded. The post-operative radiographic results were excellent or satisfactory in 12 and poor in three patients. At follow-ups of 6 to 12 months, no failure of fracture reduction or osteosynthesis was recorded in 11 patients. Neither avascular necrosis of the femoral head nor heterotopic ossification was found. One patient showed signs of post-injury arthritis at 6 months after surgery. The functional result assessed by the Harris Hip Score was excellent in seven patients, good in two (one of them with gonarthrosis), satisfactory in one patient with contralateral total hip replacement and ipsilateral gonarthrosis, and poor in one patient with hemiparesis after a stroke. DISCUSSION: Shape and size variability in CTD pelvic inlet views do not allow us to create a unified anatomically correct implant. Contouring during the operative procedure may not be accurate enough and significantly prolongs the time of surgery. Therefore, a custom-made plate for each patient seems to be an optimal method. It has been demonstrated on a group of 50 patients that CTD images of the right and left halves of the pelvis are identical in 68% and very similar (variation in length up to 5 mm and in curvature up to 3 mm) in 18%. At present plate contouring according to a mirror image of the acetabulum, which will be obtained by 3D printing, is prepared. CONCLUSIONS: Pre-operative contouring of an Omega plate based on a post-injury CT scan of the uninjured half of the pelvis is over 80% accurate or almost accurate. The multi-functional 3.5-mm pelvic plate Omega allows us to stabilise complicated fractures of the superior ramus of the pubic bone, anterior acetabular column or quadrilateral plate as well as fractures above the linea arcuata or uncomplicated fractures of the posterior column. The stabilisation of all fragments of the anterior column and quadrilateral plate is very firm and the Omega plate is resistant to fragment redisplacement. Also, it is its advantage that it can remain in situ if total hip arthroplasty is required later.

[Use of the Omega plate for stabilisation of acetabular fractures: first experience]. / Uzití Omega dlahy pri stabilizaci zlomenin acetabula--první zkusenosti.

PURPOSE OF THE STUDY: The aim of our study is to solve the problem of insufficient fixation of comminuted fractures of the quadrilateral plane and the iliopectineal line. These fixation problems occur while using the standard narrow 3.5 mm fixation plate applied from a modified Stoppa approach. A new plate developed by the authors--the Omega plate--fulfils the requirements. MATERIAL AND METHODS: In the period 2010-2012, we performed 156 stabilisations of pelvic ring fractures and acetabular fractures. We used the modified Stoppa approach applying the standard fixation plate in 24 patients and the Omega plate in 15 patients. The patient group with the Omega plate included 10 male and five female patients with the average age of 61 years (range, 30-72). Only 11 patients were followed up, with an average period of 13.3 months, because one patient was lost to followup and three patients were shortly after surgery. The surgical technique of Omega plate application is described in detail. The clinical evaluation of post-operative results was based on the Harris Hip Score; the graphical results were rated using the Matta and Pohlemann criteria. RESULTS: The Stoppa approach alone was used in four patients, combination of two approaches (Stoppa and Kocher-Langenbeck approach) was used in six cases and three approaches were employed in five patients. No adverse intra- or post-operative events were recorded. Excellent or satisfactory graphical results were obtained in 12 patients and an unsatisfactory graphical outcome was recorded in three cases. In the follow-up period ranging from 8 to 22 months, 11 patients healed. Late complications included avascular femoral head necrosis in two and severe post-traumatic coxarthrosis in three patients. Due to these complications, all five patients underwent total hip arthroplasty without previous Omega plate removal at an average interval of 15 months from the primary pelvic surgery. They were not included in the follow-up evaluation. The remaining six patients had an average Harris Hip Score of 88 points (range, 81-98). DISCUSSION: The novel plate, shaped as a reverse omega letter, enables fixation of the quadrilateral area of the acetabulum through pressure of the arc of the plate against this area. Hitches, with holes for screw insertion, attached to the Omega plate in its middle part allow for fixation of fragments above the linea arcuata simply by pressure. Hitches in the ventral part provide for plate fixation to the ventral acetabular column and the superior pubic ramus. Hitches in the posterior segment of the plate facilitate insertion of a long screw in the posterior acetabular column from an additional iliac approach for stabilisation of simple acetabular fractures. The Omega plates are manufactured in several modifications. CONCLUSIONS: The Omega plate enables us to fix fractures of the superior pubic ramus, fractures of the anterior acetabular column, fractures of the quadrilateral acetabular plate, fractures in the iliopectineal line and simple fractures of the posterior column. A CT-defined projection of the pelvic inlet based on pre-operative CT scans allows us to choose the appropriate plate size and to shape the plate pre-operatively. After a technically well performed Stoppa approach and good fragment reduction, the application of an Omega plate is easy if our recommendations are followed. Fixation of all fragments of the anterior column and the quadrilateral plate is very stable and the Omega plate is highly resistant to secondary loss of reduction. A potential total hip arthroplasty does not require Omega plate removal.

[Percutaneous CT-guided radiofrequency ablation in spinal osteoid osteoma treatment]. / Perkutánní CT-navigovaná radiofrekvencní ablace v terapii spinálních osteoidních osteomu

PURPOSE OF THE STUDY: Radiofrequency ablation is a minimally invasive method indicated in the treatment of bone tumors. Its effectiveness and safety have been reported in a number of studies concerned with the therapy of osteoid osteoma of extremities. However, only scarce information is available on effectiveness of ablation in osteoid osteoma of the spine. The aim of the study was to verify the efficacy of percutaneous CT-guided radiofrequency ablation on this indication. MATERIAL AND METHODS: This prospective study included four patients, three women and one man, with osteoid osteoma of the lumbar or sacral spine who were treated by percutaneous CT-guided radiofrequency ablation in the period from February 2002 to March 2005. Two tumors were found in the third lumbar vertebra, one in the fourth lumbar and one in the first sacral verstebra. The pre-operative pain values assessed on the visual analogue scale (VAS), and function restriction rated by the Oswestry Disability Index (ODI) were compared with the post-operative values at 2 years after surgery. Patients' satisfaction with surgical outcome was evaluated according to Odom's criteria. RESULTS: All four procedures were accomplished successfully in technical terms and the patients completed the two-year followup. All patients reported significant relief of pain immediately after surgery and this held even after 2 years. The average pre-operative VAS value of 8.3 was reduced to 2.45 at the final examination, and the pre-operative ODI of 70/100 improved to 95/100 post-operatively. The outcome of treatment rated by Odom's criteria was regarded as excellent. CONCLUSIONS: Percutaneous CT-guided radiofrequency ablation is an effective and safe method for treatment of spinal osteoid osteoma. It has advantages that could make it preferable to surgical excision of tumors. Key words: osteoid osteoma, computed tomography, radiofrequency ablation.

[Classification-based surgical approach in surgical management of thoracolumbar fractures of the spine]. / Klasifikací rízená volba operacního prístupu pri operacním lécení zlomenin torakolumbární pátere.

INTRODUCTION: The decision on the surgical approach in the operative treatment of the fractures of thoracolumbar spine is possible only by following a detailed classification. However, the application of the classification systems is not reliable without a complex imagination of the bony and fibrous structures involved into the fracture. Pre-op investigation should include x-rays, CT-scans and MRI. MATERIAL AND METHODS: Patient series consists of 21 females and 43 males treated surgically for the unstable thoracolumbar fracture during 2001. The average age was 43 years. Patients suffering form osteoporosis, fresh spinal cord injury and multiple spine fractures were excluded. All fractures were examined by plain x-rays, CT-scans and MRI and classified according the AO-ASIF classification system. In patients with A-type fractures the single anterior approach was used. Patients with B- or C-type of fracture were operated by the posterior approach. These fractures were complementary classified according to the Load-sharing classification and those with 6 or more points were additionally operated also from the front. Patients were divided into the three groups: the anterior approach (22 pts), the combined procedure (22 pts) and the posterior approach (20 pts). In the third group, the hardware was removed after 15 months on average. No posterolateral fusion was carried out. Minimum follow-up was 22 months. RESULTS: No implant failure was found in any patient. No significant loss of correction was found in the first and the second group. The loss of correction in the third group was 3.1 degree on average. CONCLUSION: Overall graphical imagination of the thoracolumbar fractures (including MRI) is essential for their classification. The classification helps to choose the optimum surgical approach. The approach related to the fracture classification prevents the treatment failure.