Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen:
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| Format: | Abschlussarbeit Buch |
| Sprache: | German |
| Veröffentlicht: |
2009
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| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | 143 S. Ill., graph. Darst. 21 cm |
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| adam_text | Titel: Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen
Autor: Oehm, Justus Jakob Wilhelm
Jahr: 2009
Inhaltsverzeichnis
1. Einleitung...................................................................................................8
1.1 Vorwort................................................................................................8
1.2 Fragestellung....................................................................................10
1.3 Funktionelle Anatomie.......................................................................11
1.4 Diagnostik der proximalen Humerusfraktur.......................................16
1.4.1 Standarddiagnostik....................................................................16
1.4.2 Zusätzliche Diagnostik...............................................................18
1.5 Frakturklassifikation..........................................................................19
1.5.1 Neer-Klassifikation.....................................................................19
1.5.2 AO-Klassifikation........................................................................21
1.6 Therapie............................................................................................23
1.6.1 Konservative Behandlung..........................................................23
1.6.2 Operative Versorgung................................................................24
1.6.2.1 Kirschnerdrahtosteosynthese..............................................25
1.6.2.2 Schraubenosteosynthese....................................................26
1.6.2.3 Zuggurtungsosteosynthese..................................................27
1.6.2.4 Intramedulläre Implantate....................................................27
1.6.2.5 Plattenosteosynthese..........................................................28
1.6.2.6 Humeruskopfprothese.........................................................29
1.6.2.7 Humeruskopfresektion.........................................................30
1.6.2.8 Schultergelenkarthrodese....................................................30
2. Patienten und Methoden.........................................................................31
2.1 Methodik...........................................................................................31
2.1.1 Indikation zu operativen Versorgung..........................................31
2.1.2 Implantatbeschreibung und Operationstechnik..........................31
2.1.3 Nachbehandlung........................................................................33
2.1.4 Schulterfunktionscores...............................................................34
2.1.4.1 Neer-Score..........................................................................35
2.1.4.2 Constant-Murley-Score........................................................36
2.1.4.3 UCLA-Score.........................................................................37
2.1.4.4 DASH-Score........................................................................38
2.1.4.5 Oxford-Shoulder-Score........................................................39
2.1.5 Gesundheitsfragebogen SF-36..................................................40
2.1.6 Schulterfunktionstests................................................................41
2.1.6.1 Painfularc............................................................................41
2.1.6.2 Impingement-Test nach Neer..............................................42
2.1.6.3 Horizontal-Adduktionstest....................................................42
2.1.6.4 Test nach Yergason.............................................................42
2.1.6.5 Palm-up-Test.......................................................................43
2.1.6.6 O-Abduktionstest.................................................................43
2.1.6.7 Supraspinatus Test nach Jobe............................................43
2.1.6.8 90-Außenrotationstest........................................................44
2.1.6.9 90-lnnenrotationstest..........................................................44
2.1.6.10 Load-and-Shift-Test nach Hawkins / Schubladentest nach
Gerber..................................................................................44
2.1.6.11 Vorderer Apprehensiontest..................................................45
2.1.6.12 Hinterer Apprehensiontest...................................................45
2.1.7 Sonographie...............................................................................45
2.1.8 Radiologische Auswertung........................................................46
2.1.9 Statistische Methode..................................................................48
2.2 Patienten und Nachuntersuchung.....................................................49
2.2.1 Patientenkollektiv.......................................................................49
2.2.2 Verfahren der Nachuntersuchung..............................................50
. Ergebnisse...............................................................................................53
3.1 Gesamtkollektiv.................................................................................53
3.1.1 Geschlechterverhältnis..............................................................53
3.1.2 Alter des Patienten zum Zeitpunkt des Unfalls...........................54
3.1.3 Berufs- und Wohnsituation.........................................................54
3.1.4 Unfallart.....................................................................................55
3.1.5 Frakturseite................................................................................56
3.1.6 Unfallmonat................................................................................56
3.1.7 Zusatzverletzungen....................................................................56
3.1.8 Vorerkrankungen.......................................................................57
3.1.9 ASA-Klassifikation......................................................................58
3.1.10 Tage zwischen Unfallzeitpunkt und Operation...........................59
3.1.11 Klinikaufenthalt...........................................................................59
3.1.12 Nachsorge..................................................................................60
3.1.13 Metallentfernung / Grund...........................................................61
3.1.14 Neer-Klassifikation.....................................................................61
3.1.15 AO-Klassifikation........................................................................62
3.2 Follow-up-Gruppe.............................................................................63
3.2.1 Geschlechterverhältnis..............................................................64
3.2.2 Alter des Patienten zum Zeitpunkt des Unfalls...........................64
3.2.3 Tage zwischen Unfallzeitpunkt und Operation...........................65
3.2.4 Follow-up-Zeitraum....................................................................65
3.2.5 Unfallart.....................................................................................65
3.2.6 Zusatzverletzungen....................................................................66
3.2.7 Vorerkrankungen.......................................................................67
3.2.8 ASA-Klassifikation......................................................................67
3.2.9 Klinikaufenthalt...........................................................................68
3.2.10 Nachsorge..................................................................................68
3.2.11 Metallentfernung / Grund...........................................................70
3.2.12 Postoperative Komplikationen....................................................71
3.2.13 Klinische Untersuchung.............................................................71
3.2.14 Schulterscores...........................................................................72
3.2.14.1 Neer-Klassifikation...............................................................72
3.2.14.2 AO-Klassifikation.................................................................73
3.2.14.3 Constant-Murley-Score........................................................74
3.2.14.4 Neer-Score..........................................................................75
3.2.14.5 DASH-Score........................................................................76
3.2.14.6 UCLA-Score.........................................................................79
3.2.14.7 Oxford-Shoulder-Score........................................................80
3.2.15 SF-36.........................................................................................81
3.2.15.1 Körperliche (physische) Funktionsfähigkeit..........................82
3.2.15.2 Rollenverhalten wegen körperlicher
Funktionsbeeinträchtigung...................................................82
3.2.15.3 Schmerzen...........................................................................82
3.2.15.4 allgemeiner Gesundheitszustand.........................................83
3.2.15.5 Vitalität und körperliche Energie..........................................83
3.2.15.6 Soziale Funktionsfähigkeit...................................................83
3.2.15.7 Rollenverhalten wegen seelischer
Funktionsbeeinträchtigung...................................................84
3.2.15.8 Seelische (psychische) Funktionsfähigkeit..........................84
3.2.16 Sonographie...............................................................................86
3.2.17 Kraftmessung.............................................................................86
3.2.18 Radiologische Auswertung........................................................87
3.2.18.1 Osteoporose........................................................................87
3.2.18.2 Humeruskopfwinkel.............................................................88
3.2.18.3 Tuberculumstand.................................................................89
3.2.18.4 Deformität............................................................................89
3.2.18.5 Humeruskopfnekrose...........................................................90
3.2.18.6 Implantat..............................................................................90
3.2.18.7 Omarthrose..........................................................................91
3.2.18.8 Verzögerte Heilung..............................................................91
3.2.18.9 Frakturreposition / sekundäre Dislokation............................91
4. Statistik....................................................................................................92
4.1 Univariate Analyse............................................................................92
4.1.1 Gesamtkollektiv..........................................................................92
4.1.1.1 Unfallalter - Unfallart............................................................92
4.1.1.2 Unfallalter - Geschlecht.......................................................92
4.1.1.3 Geschlecht - Unfallart..........................................................93
4.1.2 Follow-up-Gruppe......................................................................93
4.1.2.1 Unfallalter - Unfallart............................................................93
4.1.2.2 Unfallalter - Geschlecht.......................................................94
4.1.2.3 Geschlecht - Unfallart..........................................................94
4.1.2.4 Constant-Murley-Score........................................................94
4.1.2.5 Neer-Score..........................................................................95
4.1.2.6 UCLA-Score.........................................................................96
4.1.2.7 DASH-Score........................................................................96
4.1.2.8 Oxford-Shoulder-Score........................................................97
4.1.2.9 SF-36...................................................................................97
4.1.2.9.1 Körperliche (physische) Funktionsfähigkeit......................97
4.1.2.9.2 Rollenverhalten wegen körperlicher
Funktionsbeeinträchtigung................................................98
4.1.2.9.3 Schmerzen.......................................................................98
4.1.2.9.4 Allgemeiner Gesundheitszustand.....................................98
4.1.2.9.5 Vitalität und körperliche Energie.......................................98
4.1.2.9.6 Soziale Funktionsfähigkeit................................................99
4.1.2.9.7 Rollenverhalten wegen seelischer
Funktionsbeeinträchtigung................................................99
4.1.2.9.8 Seelische (psychische) Funktionsfähigkeit.......................99
4.2 Muttivariate Aratyse..........................................................................99
4.2.1 Consfarrt-Muriey-Scote............................................................100
4.2.2 Meer-Score...............................................................................100
4.2.3 UCLA-Score.............................................................................101
4.2.4 DASH-Score............................................................................101
4.2.5 Onfofä-Shoulder-Score............................................................101
5. Diskussion.............................................................................................102
6. Zusammenfassung................................................................................110
7. Literatur..................................................................................................112
8. Anhang...................................................................................................128
8.1 Exemplarische Fälle........................................................................128
8.2 NachuntersuohviTigsDogen..............................................................130
8.3 SpezifischerScore.........,.....,..........................................................140
9. Danksagung...........................................................................................142
10. Lebenslauf.............................................................................................143
|
| any_adam_object | 1 |
| author | Oehm, Justus Jakob Wilhelm 1980- |
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| dewey-ones | 617 - Surgery & related medical specialties |
| dewey-raw | 617.1 |
| dewey-search | 617.1 |
| dewey-sort | 3617.1 |
| dewey-tens | 610 - Medicine and health |
| discipline | Medizin |
| format | Thesis Book |
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| spelling | Oehm, Justus Jakob Wilhelm 1980- Verfasser (DE-588)139783148 aut Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen vorgelegt von Justus Jakob Wilhelm Oehm 2009 143 S. Ill., graph. Darst. 21 cm txt rdacontent n rdamedia nc rdacarrier Tübingen, Univ., Diss., 2009 (DE-588)4113937-9 Hochschulschrift gnd-content HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=020573610&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title | Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen |
| title_auth | Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen |
| title_exact_search | Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen |
| title_full | Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen vorgelegt von Justus Jakob Wilhelm Oehm |
| title_fullStr | Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen vorgelegt von Justus Jakob Wilhelm Oehm |
| title_full_unstemmed | Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen vorgelegt von Justus Jakob Wilhelm Oehm |
| title_short | Klinisch-radiologische Evaluation proximaler Humerusfrakturen in der BGU-Tübingen |
| title_sort | klinisch radiologische evaluation proximaler humerusfrakturen in der bgu tubingen |
| topic_facet | Hochschulschrift |
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