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  1 / 2342 MEDLINE  
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PMID:28470463
Autor:Hoffmeister T; Schwarze F; Aschoff HH
Dirección:Sana Kliniken Lübeck GmbH, Kronsforder Allee 71/73, 23560, Lübeck, Deutschland.
Título:[The endo-exo prosthesis treatment concept : Improvement in quality of life after limb amputation].
Título:Das Endo-Exo-Prothesen-Versorgungskonzept : Verbesserung der Lebensqualität nach Extremitätenamputation..
Fuente:Unfallchirurg; 120(5):371-377, 2017 May.
ISSN:1433-044X
País de publicación:Germany
Idioma:ger
Resumen:Osseointegrated, percutaneous implants as the force bearer for exoprosthetics after limb amputation have been used in individual cases for clinical rehabilitation of amputees during the past years. Most experience in this field in Germany has been accumulated at the Sana Klinik in Lübeck with the so-called endo-exo prosthesis (EEP) system. The two-step implantation procedure can now be considered as reliable. Following a well-documented learning curve initial soft tissue problems concerning the cutaneous stoma can now be regarded as exceptions. The retrospective examination of the results concerning by now more than 100 patients provided with an endo-exo femoral prosthesis (EEFP) showed a very satisfying outcome concerning objective as well as subjective values, such as duration of daily use and wearing comfort of the exoprosthesis. Regaining the ability of osseoperception due to the intraosseous fixation is described by the patients as a great advantage. The step from a socket prosthesis to an EEP is felt to be a big increase in quality of life by nearly all patients included into the follow-up. Nearly all of the patients questioned would choose an endo-exo prosthesis again. Meanwhile, the success of the EEP resulted in the broadening of indications from above-knee amputations to transtibial as well as transhumeral amputations. The results are likewise encouraging. The use of EEP for the upper limbs leads to substantial improvement in the range of motion of the shoulder joint with the intramedullary anchored percutaneous implant. Furthermore, new pathbreaking possibilities in the fixation of myoelectrically controlled arm prostheses may arise from the EEP technique.
Tipo de publicación:JOURNAL ARTICLE; REVIEW


  2 / 2342 MEDLINE  
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PMID:28470462
Autor:Grundei H; Timmermann A
Dirección:Fa. Eska Orthopaedic Handels GmbH, Osterweide 2c, 23562, Lübeck, Deutschland. info@eskaorthopaedic.de.
Título:[Connecting adapter for coupling exoprostheses to endoshafts : Demands on orthopedic technicians with respect to planning and application].
Título:Anschlussadapter zur Ankopplung der Exoprothese an den Endostiel : Anforderungen an den Orthopädietechniker hinsichtlich Planung und Anwendung..
Fuente:Unfallchirurg; 120(5):378-384, 2017 May.
ISSN:1433-044X
País de publicación:Germany
Idioma:ger
Resumen:INTRODUCTION: Transcutaneous, bone anchored prostheses have proved to be an alternative for amputees. In addition to the safe osseointegration of the implant, the correct prosthetic alignment is also important. Therefore, the interaction between prosthesis components and the prosthesis wearer is significant and the role of the certified prosthetist should not be underestimated. AIM: The aim of treatment is the best possible compensation of disability after limb loss with increase of physical abilities and comfort of the prosthesis wearer by means of bone anchored prosthesis. METHOD: Endoprosthesis inserted by the surgeon carrying out both surgery with the implant and a double-cone and 6 weeks later the exoprosthesis is fitted by the certified prosthetist orthotist (CPO). Mounting the external adaptors, assembly of the prosthesis. RESULTS: The long-term results with cementless implants and more than 35 years experience are presented. Clinical experience with the endo-exo prosthesis since 1999. A total of 135 patients treated after transfemoral amputation, 8 of them bilateral, 8 out of 135 were transtibial amputees and 1 of them bilateral. A total of 85% were amputated as a consequence of trauma and 12 out of 135 had a full range of motion at the beginning of the prosthetic work following osseointegration. In other cases, a hip flexion contracture between 3 and 12 ° had to be considered by corresponding posterior displacement adaptors. CONCLUSION: Bone anchored prostheses influence the skeleton and joints in a more direct way. This fact requires specific prosthetic measures concerning the connection between the endo-implant and the exoprosthesis. Therefore, specially matched adaptors and the prosthetic alignment are the focus of interest. Prostheses connected to an osseointegrated implant have many biomechanical advantages compared to socket-guided prostheses. Because the quality of rehabilitation is clearly affected by the prosthetic alignment, it has to be carried out extremely carefully and precisely if the prosthesis is connected to an osseointegrated implant. According to the survey, none of the prosthesis wearers wanted to return to a socket-guided prosthesis.
Tipo de publicación:JOURNAL ARTICLE; REVIEW


  3 / 2342 MEDLINE  
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PMID:28993523
Autor:Tropea P; Mazzoni A; Micera S; Corbo M
Dirección:From The BioRobotics Institute (P.T., A.M., S.M.), Scuola Superiore Sant'Anna, Pisa, Italy; Department of Neurorehabilitation Sciences (P.T., M.C.), Casa Cura Policlinico, Milan, Italy; and Translational Neural Engineering Laboratory, Center for Neuroprosthetics (S.M.), Swiss Federal Institute of Te
Título:Giuliano Vanghetti and the innovation of "cineplastic operations".
Fuente:Neurology; 89(15):1627-1632, 2017 Oct 10.
ISSN:1526-632X
País de publicación:United States
Idioma:eng
Resumen:OBJECTIVE: Developing functional artificial limbs for amputees has been a centuries-old challenge in medicine. We review the mechanical and neurologic principles of "cineplastic operations" and "plastic motors" used to restore movements in prostheses, with special attention to the work of Giuliano Vanghetti. METHODS: We evaluated original publications describing cineplastic operations, biographic information, writings, drawings, and unpublished letters from the Vanghetti library, preserved in Empoli, Italy, and performed a bibliographic search and comparison for similar procedures in the literature. RESULTS: Vanghetti's method for cineplastic operations differs from similar previous methods, being the first aimed at exploiting natural movements of the remnant muscles to activate the mechanical prosthesis, and the first to do so by directly connecting the prosthesis to the residual muscles and tendons. This represented a frame-changing innovation for that time and paved the way for current neuroprosthetic approaches. The first description of the method was published in 1898 and human studies started in 1900. The results of these studies were presented in 1905 and published in 1906 in . A German surgeon, Ferdinand Sauerbruch, often acknowledged as the inventor of the method, published his first results in 1915. CONCLUSIONS: Vanghetti was the first to accurately perform and describe cineplastic operations for patients following an upper arm amputation. He considered the neurologic implications of the problem and, perhaps in an effort to provide more appropriate proprioceptive feedback, he intuitively applied the prostheses so that they were functionally activated by the muscles of the proximal stump.
Tipo de publicación:HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW
Nombre personal como asunto:Vanghetti G


  4 / 2342 MEDLINE  
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PMID:28641140
Autor:Abdelhafez MM; Shaw J; Sutter D; Schnider J; Banz Y; Jenni H; Voegelin E; Constantinescu MA; Rieben R
Dirección:Department of Clinical Research, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland. Electronic address: mai.abdelhafez@dkf.unibe.ch.
Título:Effect of C1-INH on ischemia/reperfusion injury in a porcine limb ex vivo perfusion model.
Fuente:Mol Immunol; 88:116-124, 2017 Aug.
ISSN:1872-9142
País de publicación:England
Idioma:eng
Resumen:Revascularization of an amputated limb within 4-6h is essential to avoid extensive ischemia/reperfusion (I/R) injury leading to vascular leakage, edema and tissue necrosis. I/R injury is a pathological inflammatory condition that occurs during reperfusion of an organ or tissue after prolonged ischemia. It is characterized by a complex crosstalk between endothelial cell activation and the activation of plasma cascades. Vasculoprotective pharmacological intervention to prevent I/R injury might be an option to prolong the time window between limb amputation and successful replantation. We used C1-easterase inhibitor (C1-INH) in this study because of its known inhibitory effects on the activation of the complement, coagulation and kinin cascades. Forelimbs of 8 large white pigs were amputated, subjected to ischemia, and then reperfused with autologous whole blood. All limbs were exposed to 9h of cold ischemia at 4°C. After 2h of cold ischemia the limbs were either perfused with of C1-INH (1U/ml in hydroxyethyl starch, n=8) or hydroxyethyl starch alone (n=7). After completion of the 9-h ischemia period, all limbs were ex vivo perfused with heparinized autologous whole blood for 12h using a pediatric heart lung machine to simulate in vivo revascularization. Our results show that I/R injury in the control group led to a significant elevation of tissue deposition of IgG and IgM, complement C3b/c, C5b-9 and MBL. Also, activation of the kinin system was significantly increased, namely bradykinin in plasma, and expression of bradykinin receptors 1 and 2 in tissue. In addition, markers for endothelial integrity like expression of CD31, VE-cadherin and heparan sulfate proteoglycans were decreased in reperfused tissue. Limb I/R injury also led to activation of the coagulation cascade with a significant elevation of fibrin and thrombin deposition and increased fibrinogen-like protein-2 expression. C1-INH treated limbs showed much less activation of plasma cascades and better protection of endothelial integrity compared to the reperfused control limbs. In conclusion, the use of the cytoprotective drug C1-INH significantly reduced I/R injury by protecting the vascular endothelium as well as the muscle tissue from deposition of immunoglobulins, complement and fibrin.
Tipo de publicación:JOURNAL ARTICLE
Nombre de substancia:0 (Complement C1 Inhibitor Protein); 0 (Complement Membrane Attack Complex); 0 (Hydroxyethyl Starch Derivatives); 0 (Immunoglobulin G); 0 (Immunoglobulin M); 0 (Receptors, Bradykinin); 80295-43-8 (Complement C3b); 9001-31-4 (Fibrin); 9001-32-5 (Fibrinogen); EC 3.4.21.5 (Thrombin); S8TIM42R2W (Bradykinin)


  5 / 2342 MEDLINE  
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PMID:28339333
Autor:Batsford S; Ryan CG; Martin DJ
Dirección:a School of Health and Social Care , Teesside University , Middlesbrough , UK.
Título:Non-pharmacological conservative therapy for phantom limb pain: A systematic review of randomized controlled trials.
Fuente:Physiother Theory Pract; 33(3):173-183, 2017 Mar.
ISSN:1532-5040
País de publicación:England
Idioma:eng
Resumen:The aim of this manuscript was to investigate the effectiveness of conservative therapy for phantom limb pain (PLP). In this systematic review, CINAHL, AMED, the Cochrane database of systematic reviews, PEDro, psychology and behavioral sciences collection, and MEDLINE were systematically searched for appropriate randomized controlled trials (RCTs). Selected papers were assessed for risk of bias, and evidence was graded using the GRADE approach. Twelve RCTs met initial inclusion/exclusion criteria, of which five were of sufficient quality for final inclusion. There is conflicting evidence from two RCTs for the effectiveness of electromagnetic shielding limb liners on pain in the short term. There is limited evidence supporting the effectiveness of both hypnosis in the short term and graded motor imagery (GMI) in the short-to-medium term. Additionally, there is limited evidence that a single session of mirror therapy has no immediate effect on PLP. Limb liner discomfort was the only adverse effect identified. This review identifies a range of conservative therapies, many of which demonstrate preliminary evidence of potential with respect to clinically worthwhile effects above control interventions and few, if any, adverse effects. However, there is a paucity of high-quality evidence upon which to make any firm clinical conclusions.
Tipo de publicación:JOURNAL ARTICLE; REVIEW


  6 / 2342 MEDLINE  
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PMID:28280002
Autor:Zayed MA; Wei X; Park KM; Belaygorod L; Naim U; Harvey J; Yin L; Blumer K; Semenkovich CF
Dirección:Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; zayedm@wustl.edu.
Título:-Acetylcysteine accelerates amputation stump healing in the setting of diabetes.
Fuente:FASEB J; 31(6):2686-2695, 2017 Jun.
ISSN:1530-6860
País de publicación:United States
Idioma:eng
Resumen:Over 60% of lower extremity amputations are performed in patients with diabetes and peripheral arterial disease, and at least 25% require subsequent reamputation due to poor surgical site healing. The mechanisms underlying poor amputation stump healing in the setting of diabetes are not understood. -acetylcysteine (NAC) is known to promote endothelial cell function and angiogenesis and may have therapeutic benefits in the setting of diabetes. We tested the hypothesis that NAC alters the vascular milieu to improve healing of amputation stumps in diabetes using a novel murine hindlimb ischemia-amputation model. Amputation stump tissue perfusion and healing were evaluated in C57BL/6J adult mice with streptozotocin-induced diabetes. Compared with controls, mice treated with daily NAC demonstrated improved postamputation stump healing, perfusion, adductor muscle neovascularization, and decreased muscle fiber damage. Additionally, NAC stimulated HUVEC migration and proliferation in a phospholipase C ß-dependent fashion and decreased Gαq palmitoylation. Similarly, NAC treatment also decreased Gαq palmitoylation in ischemic and nonischemic hindlimbs In summary, we demonstrate that NAC accelerates healing of amputation stumps in the setting of diabetes and ischemia. The underlying mechanism appears to involve a previously unrecognized effect of NAC on Gαq palmitoylation and phospholipase C ß-mediated signaling in endothelial cells.-Zayed, M. A., Wei, X., Park, K., Belaygorod, L., Naim, U., Harvey, J., Yin, L., Blumer, K., Semenkovich, C. F. -acetylcysteine accelerates amputation stump healing in the setting of diabetes.
Tipo de publicación:JOURNAL ARTICLE
Nombre de substancia:0 (Reactive Oxygen Species); WYQ7N0BPYC (Acetylcysteine)


  7 / 2342 MEDLINE  
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PMID:28275847
Autor:McGough RL; Goodman MA; Randall RL; Forsberg JA; Potter BK; Lindsey B
Dirección:The University of Pittsburgh Medical Center, 5200 Centre Avenue, 15232, Suite 415 Pittsburgh, PA, USA. mcgoughrl@upmc.edu.
Título:The Compress® transcutaneous implant for rehabilitation following limb amputation.
Título:Transkutanes Compress®-Implantat zur Rehabilitation nach Extremitätenamputation..
Fuente:Unfallchirurg; 120(4):300-305, 2017 Apr.
ISSN:1433-044X
País de publicación:Germany
Idioma:eng
Resumen:Amputation is an unfortunate outcome of a variety of orthopedic conditions. Many amputees can be functionally fitted with conventional suspension sockets. A substantial subset, however, fails this conventional treatment and is unable to function. In Europe, an alternative to socket-based prostheses has been available for 25 years. Patients there who are unable to functionally use socket-based prostheses have been offered the possibility for transcutaneous osseointegration. With this technology, the prosthetic limb can be rigidly attached to the residual bone, and the socket is eliminated, in many cases enabling improved function and patient satisfaction. In the United States, regulatory barriers have greatly limited the adoption and acceptance of transdermal osseointegration. The Compress® device was developed as an alternate means of fixation for massive endoprostheses, such as distal femoral replacements. A uniquely designed prosthesis is rigidly anchored to the end of the cortical bone and is then subjected to a large axial stress. The bone then grows avidly into the device, providing permanent osseointegration. We have recently adopted this device for transcutaneous use. These procedures have been performed in the United States on a custom regulatory basis. Results of this have been encouraging, and we are planning to begin a regulatory trial in the near future.
Tipo de publicación:CASE REPORTS; JOURNAL ARTICLE; REVIEW


  8 / 2342 MEDLINE  
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PMID:28249981
Autor:Chimutengwende-Gordon M; Pendegrass C; Blunn G
Dirección:Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
Título:The effect of a porous titanium alloy flange with hydroxyapatite, silver and fibronectin coatings on soft-tissue integration of intraosseous transcutaneous amputation prostheses.
Fuente:Bone Joint J; 99-B(3):393-400, 2017 Mar.
ISSN:2049-4408
País de publicación:England
Idioma:eng
Resumen:AIMS: The Intraosseous Transcutaneous Amputation Prosthesis (ITAP) may improve quality of life for amputees by avoiding soft-tissue complications associated with socket prostheses and by improving sensory feedback and function. It relies on the formation of a seal between the soft tissues and the implant and currently has a flange with drilled holes to promote dermal attachment. Despite this, infection remains a significant risk. This study explored alternative strategies to enhance soft-tissue integration. MATERIALS AND METHODS: The effect of ITAP pins with a fully porous titanium alloy flange with interconnected pores on soft-tissue integration was investigated. The flanges were coated with fibronectin-functionalised hydroxyapatite and silver coatings, which have been shown to have an antibacterial effect, while also promoting viable fibroblast growth The ITAP pins were implanted along the length of ovine tibias, and histological assessment was undertaken four weeks post-operatively. RESULTS: The porous titanium alloy flange reduced epithelial downgrowth and increased soft-tissue integration compared with the current drilled flange. The addition of coatings did not enhance these effects. CONCLUSION: These results indicate that a fully porous titanium alloy flange has the potential to increase the soft-tissue seal around ITAP and reduce susceptibility to infection compared with the current design. Cite this article: 2017;99-B:393-400.
Tipo de publicación:JOURNAL ARTICLE
Nombre de substancia:0 (Alloys); 0 (Coated Materials, Biocompatible); 0 (Fibronectins); 3M4G523W1G (Silver); 91D9GV0Z28 (Durapatite); D1JT611TNE (Titanium)


  9 / 2342 MEDLINE  
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PMID:28235982
Autor:Aschoff HH
Dirección:Sektion Endo-Exo-Prothetik, Unfallchirurgische Klinik der MHH, Carl-Neuberg-Str-1, 30625, Hannover, Deutschland. aschoff.horst@mh-hannover.de.
Título:[Transcutaneous osseointegration after limb amputation : A review over 27 years].
Título:Transkutane Osseointegration nach Gliedmaßenamputation : Ein Überblick über 27 Jahre..
Fuente:Unfallchirurg; 120(4):278-284, 2017 Apr.
ISSN:1433-044X
País de publicación:Germany
Idioma:ger
Resumen:Intramedullary, bone-anchored (osseointegrated), transcutaneous docking of artificial limbs has been in clinical use for more than 25 years. This system of prosthetic limb attachment is a valuable treatment option in the rehabilitation of patients after limb amputation. Only a few centers are systematically investigating this topic worldwide so that current knowledge on this special treatment option is still limited; however, mainstream medical opinion still regards percutaneous skeletal prosthetic docking with some skepticism. Concerns remain about possible ascending infections along the skin perforating device and this has indeed been a limiting factor in the widespread implementation of this technology and has also been rejected by many orthopedic surgeons. There are also reservations among institutions responsible for exoprosthetic treatment. Ultimately, the advantages and disadvantages of this treatment procedure must be explained in detail to the patients themselves in order to reduce fears and concerns and to be able to bring the overstretched expectations back to reality.
Tipo de publicación:JOURNAL ARTICLE; REVIEW


  10 / 2342 MEDLINE  
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PMID:28232236
Autor:Xu H; Greenland K; Bloswick D; Zhao J; Merryweather A
Dirección:School of Medical Imaging, Xuzhou Medical University, Xuzhou, China; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA. Electronic address: h_xu@xzmc.edu.cn.
Título:Vacuum level effects on gait characteristics for unilateral transtibial amputees with elevated vacuum suspension.
Fuente:Clin Biomech (Bristol, Avon); 43:95-101, 2017 Mar.
ISSN:1879-1271
País de publicación:England
Idioma:eng
Resumen:BACKGROUND: The elevated vacuum suspension system has demonstrated unique health benefits for amputees, but the effect of vacuum pressure values on gait characteristics is still unclear. The purpose of this study was to investigate the effects of elevated vacuum levels on temporal parameters, kinematics and kinetics for unilateral transtibial amputees. METHODS: Three-dimensional gait analysis was conducted in 9 unilateral transtibial amputees walking at a controlled speed with five vacuum levels ranging from 0 to 20inHg, and also in 9 able-bodied subjects walking at self-preferred speed. Repeated ANOVA and Dunnett's t-test were performed to determine the effect of vacuum level and limb for within subject and between groups. FINDINGS: The effect of vacuum level significantly affected peak hip external rotation and external knee adduction moment. Maximum braking and propulsive ground reaction forces generally increased for the residual limb and decreased for the intact limb with increasing vacuum. Additionally, the intact limb experienced an increased loading due to gait asymmetry for several variables. INTERPRETATION: There was no systematic vacuum level effect on gait. Higher vacuum levels, such as 15 and 20inHg, were more comfortable and provided some relief to the intact limb, but may also increase the risk of osteoarthritis of the residual limb due to the increased peak external hip and knee adduction moments. Very low vacuum should be avoided because of the negative effects on gait symmetry. A moderate vacuum level at 15inHg is suggested for unilateral transtibial amputees with elevated vacuum suspension.
Tipo de publicación:JOURNAL ARTICLE



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