prosthesis

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Prosthetic arms

A prosthesis (from ancient Greek πρόσθεσις prósthesis , 'attachment', from πρός 'add , on top of that, also' and τίθημι 'put, put, put' ), also a body replacement piece , describes an artificially created, functionally similar product that replaces limbs , organs or parts of organs .

Types of prostheses

If the prosthesis is outside the body, as in the case of artificial limbs, it is called an exoprosthesis . Examples are leg, arm or hand prostheses. Otherwise it is an implant .

  • A closed implant, also known as an endoprosthesis , is completely surrounded by body tissue. A classic example is the artificial hip joint .
  • An open implant is anchored in the bone and at the same time protrudes from the body tissue. This type includes dental implants , but also implants for the attachment of leg prostheses or imitations of the nose, eyes and auricle ( epitheses ).

history

Egyptian prosthetic toe on display in the Egyptian Museum in Cairo .

The first simple prostheses for limbs existed as early as the 20th century BC. Chr. In Egypt ; a replica from around 600 BC A big toe prosthesis from the 4th century BC discovered in a mummy was experimentally found to be functional. According to other sources, this toe prosthesis was built around 950–710 BC. To date.

Herodotus (approx. 490–424 BC) tells of a seer ( Hegesistratos von Elis ) who severed his forefoot in order to escape captivity and execution, and who later had a wooden foot made. From the oldest leg prosthesis found, the stilted foot of Capua from around 300 BC. There is only one copy left - the original was destroyed in World War II. According to Pliny , who lived three centuries later, the Roman officer Marcus Sergius Silus is said to have worn an iron hand prosthesis around this time after he had lost his right hand in the Second Punic War .

In ancient China, foot or leg amputation was one of the “ five punishments ” since the second millennium BC and there are bronze figures with amputated lower legs from the time 900 BC. BC, but for a long time no reports or finds of prostheses. From the time 240–180 BC BC, about a century before the area was first conquered by the Chinese Empire , a tomb of the Gushi culture with a wooden leg found near Turpan in 2007 dates back to the year 2000.

The oldest fragmented foot prosthesis in Europe, dating from the 6th century, was found in 2013 in a grave on Hemmaberg in Carinthia . The left foot of the man of obviously high social standing was severed below the ankle and he wore the prosthesis, a padded wooden cup with an iron ring, for about two years.

In the late Middle Ages, passive, movable prostheses for the upper extremity appeared, the so-called iron hands , the most famous representative of which is the younger iron hand of the knight Götz von Berlichingen , which the surgeon Ferdinand Sauerbruch used in his research in the field of modern prosthetic surgery from 1915 onwards was made available to the von Berlichingen family. The construction principle lasted until the 18th century.

The French surgeon Ambroise Paré , who worked in the 16th century, is considered to be the founder of facial prosthetics .

The mechanic and inventor Johann Nepomuk Mälzel developed foot prostheses in Vienna in 1809 for the wounded in military conflicts during the Napoleonic campaigns .

“But how does Mr. Mälzel has not only earned applause, but also claims to public thanks, these are the artificial feet he invented. He knew, by means of an extremely simple, easy and permanent mechanism, to bring a life into the feet, which is admired by art experts and anatomists, and whereby these artificial feet are almost indistinguishable from natural ones. The sevenfold bend of the knee and threefold bend of the forefoot allow you to climb stairs and on horseback with ease. Mr. Mälzel has already delivered several such feet to the full satisfaction of his customers, and thereby, most worthy of him, refuted the accusation of certain journals which said that he used his talent only for pleasant things but not for useful things. "

The first arbitrarily movable arm prostheses, i.e. without the support of the healthy hand, developed the Berlin dentist and councilor Peter Baliff (also Ballif; 1775–1831) around 1812 and Margarethe Caroline Eichler in 1836 , who also worked as a surgical technician .

With the First World War , the need for prostheses for the upper and lower extremities in Europe increased significantly, and with it the new developments. Leading surgeons such as Ferdinand Sauerbruch or Konrad Biesalski invented prostheses such as the so-called Sauerbruch arm or the Fischer hand , which, however, were only available to a few people because of the cost.

The Tunisian-French scientist Jules Mardochée Amar (1879–1935), who was considered a pioneer in ergonomics and worked as a work physiologist from 1905, developed prostheses and training programs for the professional reintegration of war invalids. Among other things, he published La prothèse et le travail des mutilés (Paris 1916).

  • "Capua pedestal"

  • First hand from Florence (15th century)

  • Iron hand (16th or 17th century) from France or Germany, now in Cotehele House in Cornwall

  • Lower leg prosthesis according to Pieter Verduyn (1696)

  • Thigh prosthesis by Friedrich II. (Hessen-Homburg)

  • Arbitrarily movable arts according to Baliff (1812)

  • Leg prosthesis with mechanical knee joint according to Caroline Eichler (1834)

Modern prostheses

Readjusting a thigh prosthesis

While hardly any functions of the original organ or body part were adequately replaced with the first prostheses (think of glass eyes), today microprocessor-controlled arm or leg prostheses enable more complex movements and sporting activities. In the case of arm prostheses with gripping function (in contrast to passive jewelry prostheses, which only have a cosmetic effect), which are modeled on the human hand (in contrast to functional grippers or hook prostheses ), the outer skin of today's commercially available prostheses is made of PVC , which is more robust and resembles the skin more than other fabrics, such as wood or leather-steel prostheses. The disadvantage of PVC outer skins, so-called cosmetic gloves, is that they get dirty easily. The plastic will discolour and must be changed after about 3 to 4 months of wear. Cosmetic gloves made of silicone are an alternative . They are dirt-repellent, do not discolour, but tear easily. They are also highly abrasive and are significantly more expensive than PVC gloves. A more recent approach is to pull silicone gloves through with a reinforcing fabric made of nylon . Such gloves last about six months but cost twice as much as conventional ones made of PVC. In the case of prosthetic legs, cosmetics made of foam material ground into the shape of the body part with a cosmetic stocking put on is also often used.

Prostheses of the lower extremity can also be divided into foot prostheses for amputations and disarticulations below the ankle, lower leg prostheses for amputations below the knee and thigh prostheses for amputations above the knee and for disarticulations of the knee. Whole-leg prostheses are built for the prosthetic treatment of hip disarticulations or hemipelvectomies . The selection of the right prosthesis depends on the therapy goal and the patient's degree of mobility:

  • Mobility grade 0: unable to walk
  • Mobility grade 1: indoor walkers
  • Mobility grade 2: Restricted outdoor walker
  • Mobility grade 3: Unrestricted outdoor walker
  • Mobility grade 4: Unrestricted outdoor walker with particularly high demands

The knee joint-lower leg construction consists of a tubular skeleton in light prostheses . However, older techniques are still used, depending on the physical and psychological state of the patient. The patient's occupation must not be disregarded when selecting the supply, because occupational stresses can also affect the prosthesis. Prosthetic sockets for prostheses of the lower and upper extremities are always manufactured individually for the respective patient by the orthopedic technician or the prosthetist . In most cases, a plaster cast of the respective amputation stump serves as the basis for production .

Upper limb prostheses can be divided into upper arm and forearm prostheses, with further classification within their functionality being possible.

Prostheses also replace sensory organs as well as ossicles , joints , heart valves and even the entire heart . Research is currently being carried out into using tissue engineering to grow spare parts such as heart valves from our own tissue. These prostheses used as implants fall under the endoprosthesis category .

Epitheses are used to replace soft tissue (for example parts of the nose after tumor surgery).

Prosthetic eye

An eye prosthesis, generally also called a glass eye or an artificial eye, is an aid manufactured as a cosmetic eye replacement that is used exclusively for restoring facial aesthetics and for medical care of the enucleated eye socket .

Denture

Dental prosthesis for the upper jaw

A full denture (also: full denture) in dentistry means the replacement of all teeth in a jaw with removable dentures , which consist of a plastic base and the artificial teeth attached to it. A full denture not only replaces the teeth, but also the dismantled jaw.

Prostheses in sports

The South African sprinter Oscar Pistorius with prosthetic legs

In sports, prostheses have long been viewed as a disability. Due to the quality of modern prostheses, the question arose to what extent services such as those of Markus Rehm or Oscar Pistorius are even promoted by technology and prostheses become a competitive advantage. Unlike a muscle, carbon prostheses do not show signs of fatigue. However, research shows that even the best prostheses make it difficult to develop strength. The body's oxygen uptake is no different either.

Components

After the First World War, the German entrepreneur Otto Bock designed prostheses that could be industrially manufactured. He divided the wooden prostheses of that time into three assemblies, which were to be assembled by orthopedic mechanics in workshops and individually adapted to the patient.

The assemblies were:

  • shaft
  • Knee / calf component
  • foot

This classification still applies, even if the manufacture of prostheses has meanwhile revolutionized into tubular skeleton technology .

Tubular skeletal prostheses are divided into shaft, tube and foot. In the case of thigh prostheses, the knee joint is an additional component.

See also

literature

Web links

Commons : Prosthetics  - collection of images, videos and audio files
Wiktionary: prosthesis  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ^ Wilhelm Pape : Greek-German concise dictionary. Edited by Max Sengebusch., 3rd edition, 6th reprint. Vieweg & Sohn, Braunschweig 1914, p. 765 sv πρόσθεσις .
  2. ↑ Truig's dictionary of origin: prosthesis .
  3. ↑ Jacqueline Finch: The ancient origins of prosthetic medicine. In: The Lancet . Volume 377, No. 9765, 2011, pp. 548-549, doi: 10.1016 / S0140-6736 (11) 60190-6 full text
  4. ↑ Mummies' false toes helped ancient Egyptians walk on eurekalert.org
  5. ↑ a b c Xiao Li, Mayke Wagner, Xiaohong Wu, Pavel Tarasov, Yongbin Zhang, Arno Schmidt, Julia Gresky: Fully functional leg prosthesis from a third / second century BC grave in Turfan, China . In: Bridging Eurasia . September 2014 ( online at bridging-eurasia.org [accessed January 14, 2016]). Online at bridging-eurasia.org ( Memento of the original from January 14, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / bridging-eurasia.org
  6. ↑ Herodotus 9:37 : “ σταθμησάμενος γὰρ ὅκως ἐξελεύσεταί οἱ τὸ λοιπὸν τοῦ ποδός, ἀπέταμε τὸν ταρσὸν ἑωυτοῦ. ”( Digitized version )
  7. ^ Walter von Brunn : The stilted foot of Capua and the ancient prostheses. In: Archives for the History of Medicine . Vol. 18, No. 4 (November 1, 1926). Steiner, Stuttgart 1926, pp. 351-360.
  8. ↑ C. Pliny Secundus: Naturalis Historia. 7.105: “ dextram sibi ferream fecit […] ” ( digitized version ).
  9. ↑ The oldest prosthetic foot in Europe found. In: kaernten.orf.at. January 13, 2016, accessed January 14, 2016 .
  10. ↑ M. Binder, J. Eitler, J. Deutschmann, S. Ladstätter, F. Glaser, D. Fiedler: Prosthetics in antiquity — An early medieval wearer of a foot prosthesis (6th century AD) from Hemmaberg / Austria . In: International Journal of Paleopathology . tape March 12 , 2016, p. 29–40 , doi : 10.1016 / j.ijpp.2015.11.003 (English, published online on December 8, 2015).
  11. ^ Ferdinand Sauerbruch, Hans Rudolf Berndorff : That was my life. Kindler & Schiermeyer, Bad Wörishofen 1951; cited: Licensed edition for Bertelsmann Lesering, Gütersloh 1956, pp. 184–193.
  12. ↑ Liebhard Löffler: The substitute for the upper extremity: the development from the first evidence to today. Enke, Stuttgart 1984, ISBN 3-432-94591-4 .
  13. ^ Alfred Renk: Ambroise Paré. Founder of facial prosthetics. In: Advances in Medicine. Volume 112, 1994, No. 29, pp. 415-418.
  14. ^ Cf. Augsburgische Ordinari Postzeitung. Nro. 273, Wednesday, Nov. 15, 1809, pp. 1f.
  15. ↑ See Bayerische Nationalzeitung , Oct. 11, 1809, pp. 992f.
  16. ^ Ferdinand Sauerbruch, Hans Rudolf Berndorff: That was my life. Kindler & Schiermeyer, Bad Wörishofen 1951; cited: Licensed edition for Bertelsmann Lesering, Gütersloh 1956, p. 185 f.
  17. ↑ Liebhard Löffler: The substitute for the upper extremity: the development from the first evidence to today. Enke, Stuttgart 1984, ISBN 3-432-94591-4 , p. 89 ff.
  18. ↑ Christoph Auf der Horst: Amar, Jules Mardochée. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin 2005, ISBN 3-11-015714-4 , p. 50.
  19. ↑ How and where does the amputee get his prosthesis.
  20. ↑ Springy progress , Tagesspiegel of August 8, 2014