الملخص
OBJECTIVE@#To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint.@*METHODS@#A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups ( P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05), and there was no significant difference in hospital stay between the two groups ( P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups ( P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation ( P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation ( P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group ( P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups ( P>0.05).@*CONCLUSION@#For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.
الموضوعات
Humans , Arthroplasty, Replacement, Hip/methods , Hip Dislocation/surgery , Spondylitis, Ankylosing/surgery , Retrospective Studies , Quality of Life , Treatment Outcome , Hip Joint/surgery , Hip Prosthesisالملخص
OBJECTIVE@#To explore the safety and effectiveness of one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation in the treatment of ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture.@*METHODS@#A clinical data of 20 patients with ankylosing spondylitis kyphosis combined with acute thoracolumbar spine fracture, who were treated with one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation between April 2016 and January 2022, was retrospectively analyzed. Among them, 16 cases were male and 4 cases were female; their ages ranged from 32 to 68 years, with an average of 45.9 years. The causes of injury included 10 cases of sprain, 8 cases of fall, and 2 cases of falling from height. The time from injury to operation ranged from 1 to 12 days, with an average of 7.1 days. The injured segment was T 11 in 2 cases, T 12 in 2 cases, L 1 in 6 cases, and L 2 in 10 cases. X-ray film and CT showed that the patients had characteristic imaging manifestations of ankylosing spondylitis, and the fracture lines were involved in the anterior, middle, and posterior columns and accompanied by different degrees of kyphosis and vertebral compression; and MRI showed that 12 patients had different degrees of nerve injuries. The operation time, intraoperative bleeding, intra- and post-operative complications were recorded. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the low back pain and quality of life, and the American spinal cord injury association (ASIA) classification was used to evaluate the neurological function. X-ray films were taken, and local Cobb angle (LCA) and sagittal vertical axis (SVA) were measured to evaluate the correction of the kyphosis.@*RESULTS@#All operations were successfully completed and the operation time ranged from 127 to 254 minutes (mean, 176.3 minutes). The amount of intraoperative bleeding ranged from 400 to 950 mL (mean, 722.5 mL). One case of dural sac tear occurred during operation, and no cerebrospinal fluid leakage occurred after repair, and the rest of the patients did not suffer from neurological and vascular injuries, cerebrospinal fluid leakage, and other related complications during operation. All incisions healed by first intention without infection or fat liquefaction. All patients were followed up 8-16 months (mean, 12.5 months). The VAS score, ODI, LCA, and SVA at 3 days after operation and last follow-up significantly improved when compared with those before operation ( P<0.05), and the difference between 3 days after operation and last follow-up was not significant ( P>0.05). The ASIA grading of neurological function at last follow-up also significantly improved when compared with that before operation ( P<0.05), including 17 cases of grade E and 3 cases of grade D. At last follow-up, all bone grafts achieved bone fusion, and no complications such as loosening, breaking of internal fixation, and pseudoarthrosis occurred.@*CONCLUSION@#One-stage posterior eggshell osteotomy and long-segment pedicle screw fixation is an effective surgical procedure for ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. It can significantly relieve patients' clinical symptoms and to some extent, alleviate the local kyphotic deformity.
الموضوعات
Humans , Male , Female , Animals , Adult , Middle Aged , Aged , Spinal Fractures/surgery , Pedicle Screws , Spondylitis, Ankylosing/surgery , Quality of Life , Retrospective Studies , Egg Shell/injuries , Thoracic Vertebrae/injuries , Lumbar Vertebrae/injuries , Kyphosis/surgery , Osteotomy , Fracture Fixation, Internal/methods , Fractures, Compression/surgery , Treatment Outcomeالملخص
Introducción: En pocas áreas de la cirugía ortopédica se han producido cambios técnicos tan importantes en las últimas décadas como en la cirugía correctora espinal. Los cambios fundamentales han sobrevenido con los nuevos sistemas de instrumentación espinal, que se han modificado y mejorado sustancialmente para facilitar la corrección tridimensional de la deformidad y aportar fijación segura de la columna, corrección y estabilidad. Objetivo: Evaluar los resultados alcanzados con los sistemas de instrumentación espinal utilizados en la corrección de la cifosis toracolumbar por espondilitis anquilopoyética. Método: Se realizó un estudio tipo descriptivo, retrospectivo y longitudinal a 16 pacientes con cifosis toracolumbar por espondilitis anquilopoyética intervenidos con la técnica de osteotomía de sustracción pedicular e instrumentados con sistemas pediculares y sublaminar tipo Luque, en el servicio de Ortopedia del Hospital Clínico Quirúrgico Hermanos Ameijeiras, durante el período comprendido entre marzo de 2001 y marzo de 2021. Resultados: La totalidad de los pacientes correspondieron al sexo masculino, color de la piel blanca y edad promedio de 39 años. Se logró más del 80 por ciento de corrección en el perfil sagital y un promedio de 34,3° por osteotomía, sin complicaciones neurológicas mayores. Se obtuvo un buen resultado funcional, con un alto grado de satisfacción de los pacientes y mejora de su calidad de vida. Conclusiones: La utilización de ambos sistemas instrumentación espinal es eficaz para mantener la corrección de la cifosis toracolumbar por espondilitis anquilopoyética(AU)
Introduction: Few areas of orthopedic surgery have had such important technical changes in recent decades as in corrective spinal surgery. Fundamental changes have come with the new spinal instrumentation systems, which have been substantially modified and improved to facilitate three-dimensional correction of the deformity and provide secure spinal fixation, correction and stability. Objective: To evaluate the results achieved with the spinal instrumentation systems used in the correction of thoracolumbar kyphosis due to ankylosing spondylitis. Methods: A descriptive, retrospective and longitudinal study was carried out on 16 patients with thoracolumbar kyphosis due to ankylosing spondylitis operated on with the pedicle subtraction osteotomy technique and instrumented with Luque-type pedicle and sublaminar systems, in the Orthopedics service at Hermanos Ameijeiras Surgical Clinical Hospital, from March 2001 to March 2021. Results: All the patients were male, white skin color and average age of 39 years. More than 80 percent correction was achieved in the sagittal profile and an average of 34.3° per osteotomy, without major neurological complications. Good functional results were obtained, with high degree of patient satisfaction and improvement in their quality of life. Conclusions: The use of both spinal instrumentation systems is effective in maintaining the correction of thoracolumbar kyphosis due to ankylosing spondylitis(AU)
الموضوعات
Humans , Adult , Middle Aged , Osteotomy/instrumentation , Spondylitis, Ankylosing/surgery , Kyphosis/surgery , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studiesالملخص
OBJECTIVE@#To explore the effect of robot-assisted internal fixation in lateral decubitus position for the treatment of ankylosing spondylitis (AS) complicated with thoracolumbar fractures.@*METHODS@#The clinical data of 26 patients with ankylosing spondylitis complicated with thoracolumbar fractures treated from January 2018 to June 2020 was retrospectively analyzed. According to different surgical methods, these patients were divided into observation group and control group. There were 8 patients in observation group, which were treated with robot-assisted percutaneous screw fixation in lateral decubitus position, including 4 males and 4 females, aged form 55 to 85 years old with an mean of (66.25±9.42) years, the course of disease was (4.00±0.76) days on average, 2 cases were T11 fracture, 2 cases were T12, 3 cases were L1 and 1 case was L2. And there were 18 patients in control group, which were treated with conventional percutaneous screw fixation in prone position, including 6 males and 12 females, aged from 48 to 81 years old with a mean of (61.22±9.53) years, the course of disease was (4.11±0.83) days on average, 2 cases were T10 injury, 3 cases were T11, 4 cases were T12, 7 cases were L1, and 2 cases were L2. The intraoperative blood loss, operation time, position time and postoperative neurological complications were compared between two groups. Postoperative visual analogue scale (VAS) at 1d and 3 months, and Oswestry Disability Index (ODI) before and 3 months after operation were observed. According to Gertzbein-Robbins standard to evaluate the accuracy of pedicle screw placement.@*RESULTS@#There was no nerve injury due to pedicle screw placement in both groups. The intraoperative blood loss in observation group and control group was (34.13±4.61) ml and (78.17±22.02) ml, operation time was(92.13±9.82) min and (106.22±11.55) min, position time was(10.00±2.14) min and (15.17±2.66) min, the differences was statistically significant(P<0.05);VAS of the two groups were (2.38±0.52) points and (4.56±0.98) points one day after surgery, respectively, with statistically significant differences (P<0.05), while VAS and ODI three months after surgery showed no statistically significant differences (P>0.05). The screw accuracy was 96.88%(62/64) in observation group and 81.48%(88/108) in control group, the difference was statistically significant(P<0.05).@*CONCLUSION@#Robot-assisted internal fixation in lateral decubitus position for the treatment of ankylosing spondylitis complicated with thoracolumbar fractures can shorten the position time and operation time, significantly improve the accuracy of internal fixation screw placement, relieve the early postoperative pain, reduce intraoperative blood loss and postoperative complications, and facilitate the fast track rehabilitation of patients.
الموضوعات
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Fracture Fixation, Internal , Lumbar Vertebrae/surgery , Pedicle Screws , Retrospective Studies , Robotics , Spinal Fractures/surgery , Spondylitis, Ankylosing/surgery , Thoracic Vertebrae/surgery , Treatment Outcomeالملخص
SUMMARY INTRODUCTION: Ankylosing spondylitis (AS) is an idiopathic seronegative spondyloartropathy that involves mainly the axial skeleton and the sacroiliac joints. AS promotes biomechanical changes in the spine that predispose to fractures, spinal deformity and spondylodiscitis. The aim of this article is to report the clinical and laboratorial characteristics of patients with AS who underwent spinal surgery at our Institution. METHODS: Retrospective review of medical charts of patients who had AS and underwent spinal interventions. RESULTS: Nine patients were found and eight were included in the present study. There were three men and six women and the patients' mean age was 57 years old. All patients had pain at the involved spinal level and one patient had tetraparesis due to cervical myelopathy. Acute-phase proteins were positive in six patients (75%), and HLA-B27 was found in two patients (25%). Four patients had the radiological diagnosis of spondylodiscitis (50%) and underwent a spinal disc biopsy. They were all characterized as having aseptic spondylodiscitis. Three patients were free of pain with analgesics in their last follow-up and one patient had only partial solution of his pain. Three additional patients had spinal fractures surgically treated (37.5%) and one patient was operated because of a cervical kyphotic deformity (12.5%). There were no deaths or surgical complications in this series. CONCLUSIONS: the majority of our clinical and laboratories findings were discrepant with the medical literature. These differences may be secondary to regional characteristics or by the fact that our population included only those patients who underwent spinal surgery.
RESUMO INTRODUÇÃO: A espondilite anquilosante (EA) é uma espondiloartropatia soronegativa, caracterizada principalmente pelo envolvimento do esqueleto axial e das articulações sacroilíacas. A EA promove alterações biomecânicas que predispõem a coluna a fraturas, deformidades e à espondilodiscite. O objetivo do presente estudo é reportar as características clínicas e laboratoriais dos pacientes com EA que foram submetidos a procedimentos cirúrgicos na coluna vertebral em nossa instituição. MÉTODOS: Estudo retrospectivo com revisão de dados médicos dos pacientes com EA que foram submetidos a intervenções na coluna vertebral. RESULTADOS: Nove pacientes foram encontrados e oito incluídos no presente estudo. Três pacientes eram homens e seis mulheres, com média de 57 anos de idade. Todos os pacientes apresentavam dor no segmento da coluna acometido pela doença e um paciente tinha tetraparesia por mielopatia cervical. Seis pacientes (75%) apresentaram proteínas de fase aguda com níveis séricos elevados e dois eram HLA-B27 positivos. Em quatro pacientes houve o diagnóstico radiológico presumido de espondilodiscite e estes foram submetidos à biópsia de disco (três por via percutânea e um com biópsia aberta) - em nenhum deles houve identificação de agente infeccioso. Desses, três pacientes tiveram melhora total da dor durante o seguimento, enquanto um deles mantinha dores leves. Houve três casos de fraturas tratadas cirurgicamente (37,5%) e um caso de deformidade cervical cifótica grave (12,5%). Não houve mortes ou complicações relacionadas às cirurgias nessa série. CONCLUSÕES: A maioria dos dados clínicos e laboratoriais de nosso estudo divergiu da literatura. Essas diferenças podem ser atribuídas às características regionais de nossa população ou pelo fato de incluirmos apenas pacientes que foram submetidos à intervenção cirúrgica.
الموضوعات
Humans , Male , Female , Adult , Aged , Spine/surgery , Spondylitis, Ankylosing/surgery , Spine/diagnostic imaging , Spondylitis, Ankylosing/diagnostic imaging , Magnetic Resonance Imaging , Retrospective Studies , Spinal Fractures/surgery , Spinal Fractures/diagnostic imaging , Treatment Outcome , Back Pain/surgery , Hospitals, University , Middle Agedالملخص
BACKGROUND: Patients with ankylosing spondylitis (AS) achieve early bone union compared to those with other spinal diseases. This study compared the time to bone union after surgery between AS patients and degenerative spinal disease patients. METHODS: Patients with degenerative spinal diseases (control group) and AS (experimental group) underwent pedicle subtraction osteotomy followed by posterolateral fusion, and decompression and posterolateral fusion, respectively. There were 10 patients in the experimental group. The control group included 26 patients who were less than 50 years of age and underwent two-level autogenous grafting after decompression and spinal fusion. Autogenous grafts and a range of bone substitutes were used in the experimental group, whereas only autogenous grafts were used in the control group. Bone union was determined on the radiographs and 3-dimensional CT scan images. The level of union was assessed using the Lenke's and Christensen's classification systems. RESULTS: In the experimental group, the mean age was 41.3 years (range, 30 to 67 years), the mean follow-up period was 21.7 months (range, 12 to 43 months), and bone union was confirmed at an average of 3.5 months (range, 3 to 5 months) after surgery. In the control group, the mean age was 43.1 years (range, 35 to 50 years), the mean follow-up period was 21.8 months (range, 12 to 74 months), and bone union was observed at an average of 5.6 months (range, 4 to 12 months) after surgery. The difference in the time to bone union between the two groups was significant (p = 0.023). CONCLUSIONS: The union of grafted bone was obtained earlier in patients with AS than in those with degenerative spinal diseases. Therefore, future studies should examine the factors affecting the early union in AS patients.
الموضوعات
Adult , Aged , Female , Humans , Male , Middle Aged , Bone Substitutes , Bone Transplantation , Orthopedic Procedures , Osseointegration , Spinal Diseases/surgery , Spine/surgery , Spondylitis, Ankylosing/surgery , Transplantation, Autologousالملخص
JUSTIFICATIVA E OBJETIVOS: A espondilite anquilosante (EA) é uma doença inflamatória crônica das articulações, incluída no grupo das espondiloartropatias soronegativas. A característica principal dessa doença é a fusão óssea da coluna vertebral que leva à perda permanente da flexibilidade do dorso e do pescoço. Outras grandes articulações e tecidos conectivos poderão estar afetados pelo processo inflamatório. A EA acomete principalmente homens entre 20 e 40 anos; é rara após os 50 anos. As mulheres correspondem somente à minoria de pacientes. Há pouca informação sobre a EA na literatura anestésica. O objetivo deste artigo foi revisar aspectos da EA de interesse para o anestesiologista, permitindo um adequado manuseio perioperatório. CONTEUDO: Estão definidas as características da espondilite anquilosante quanto à clínica e a conduta anestésica. CONCLUSÕES: Os pacientes com doenças crônicas da coluna vertebral apresentam desafios específicos para o anestesiologista. O manuseio da via aérea e o acesso ao neuroeixo poderão ser difíceis. Preferência tem sido dada à anestesia geral, mesmo com via aérea difícil reconhecida, evitando-se a anestesia no neuroeixo. O grau de envolvimento da coluna cervical determinará o quanto poderá ser difícil a intubação traqueal. Cuidado especial deve ser tomado para evitar a manipulação excessiva da coluna cervical, que poderia levar ao trauma da medula espinhal.
BACKGROUND AND OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the joints, included in the group of seronegative spondyloarthropathies. Its main characteristic is the fusion of the bones in the spine, which causes loss of flexibility of the back and neck. Other large articulations and connective tissues can be affected by the inflammatory process. It affects mainly men between the ages of 20 and 40; it is rare after the age of 50. Women represent a minority of patients. There is little information about AS in the anesthetic literature. The objective of this article was to review the characteristics of AS pertaining anesthesiology for an adequate perioperative handling. CONTENTS: The clinical characteristics of ankylosing spondylitis pertaining to the anesthetic conduct are reviewed. CONCLUSIONS: Patients with chronic diseases of the spine represent specific challenges to the anesthesiologist. Handling of the airways and the access to the neuroaxis can be difficult. Most anesthesiologists prefer to use general anesthesia, avoiding the neuroaxis, in those patients, despite the presence of difficult airways. The degree of spine involvement will determine how difficult the tracheal intubation might be. Special care should be taken to avoid excessive manipulation of the neck, which could cause trauma to the spinal cord.
JUSTIFICATIVA Y OBJETIVOS: La espondilitis anquilosante (EA) es una enfermedad inflamatoria crónica de las articulaciones, incluida en el grupo de las espondiloartropatías soronegativas. La característica principal de esa enfermedad es la fusión ósea de la columna vertebral que conlleva a la pérdida permanente de la flexibilidad del dorso y del cuello. Otras grandes articulaciones y tejidos conectivos podrán estar afectados por el proceso inflamatorio. La EA acomete principalmente a hombres entre los 20 y 40 años; es rara después de los 50 años. Las mujeres corresponden solamente a la minoría de pacientes. Existe poca información sobre la EA en la literatura anestésica. El objetivo de este artículo fue revisar aspectos de la EA de interés para el anestesiólogo, permitiendo un adecuado manoseo perioperatorio. CONTENIDO: Están definidas las características de la espondilitis anquilosante en cuanto a la clínica y la conducta anestésica. CONCLUSIONES: Los pacientes con enfermedades crónicas de la columna vertebral presentan desafíos específicos para el anestesiólogo. El manoseo de la vía aérea y el acceso al neuro-eje podrán ser difíciles. La preferencia ha sido dada a la anestesia general, incluso con la vía aérea de difícil acceso, evitando la anestesia en el neuro-eje. El grado de involucración de la columna cervical determinará cuanto podrá ser difícil la intubación traqueal. Un cuidado especial debe tenerse para evitar la manipulación excesiva de la columna cervical, lo que podría conllevar al trauma de la médula espinal.
الموضوعات
Humans , Spondylitis, Ankylosing/surgery , Intubation, Intratracheal/adverse effects , Anesthesia, General/methods , Physical Therapy Modalities , Cyclooxygenase 2 Inhibitors/therapeutic useالملخص
A case of severe ankylosing spondylitis involving the entire spine was to be operated for lumbar osteotomy. She had fixed rigidity of the cervical spine with minimal rotational movement, inability to lie down supine and severe restrictive lung disease with hypoxemia (pO2 = 65 mmHg). An awake intubation was performed and the patient was operated under general anaesthesia in the prone position. Intraoperative "wake-up" test was performed to judge whether extent of straightening was excessive. Postoperatively, she was electively ventilated and extubated uneventfully after 24 hours.
الموضوعات
Adult , Anesthesia, General/methods , Female , Humans , Intubation, Intratracheal/methods , Osteotomy , Spondylitis, Ankylosing/surgeryالملخص
El reemplazo total de cadera proporcional alivio espectacular y rápida recuperación funcional, sin embargo en casos de afección bilateral la cirugía en dos tiempos prolonga el periodo de recuperación y eleva sustancialmente el costo de la atención. Se presenta una serie de casos con patología bilateral, operados en un tiempo quirúrgico, evaluando el proceso de selección, evento quirúrgico y evolución postoperatoria inmediata, estableciendo las ventajas y desventajas del procedimiento. Se evaluaron 10 pacientes (20 caderas) con diagnóstico con diagnóstico de espondilitis anquilosante (3), artritis reumática (3), coxartrosis (3) y necrosis capital (1). Se efectuaron evaluación preoperatoria con exámenes de laboratorio completos incluyendo determinación de albúmina sérica. Se efectuó primero el lado con mayor dolor del paciente. Se colocó drenaje a succión midiéndose la pérdida hemática trans y postoperatoria. A todos se les administró antibiótico profiláctico. La edad fue de 29 a 55 años. Ocho pacientes fueron masculinos y 2 femeninos, el tiempo quirúrgico varió de 150 a 255 minutos. La vía de acceso fue lateral transglútea, la pérdida hemática total tiene una media de 1,894 ml. La estancia hospitalaria fue una media de 8 días. Se presentaron 2 complicaciones técnicas (fisura femoral) y una médica (síndrome ictérico). Deben ser pacientes seleccionados y tratados en centros hospitalarios con recursos suficientes de equipamiento, personal médico y paramédico. En pacientes seleccionados es un procedimiento seguro con tasa de complicaciones similar a la técnica habitual. Acelera la rehabilitación del paciente, es altamente satisfactorio para el usuario y disminuye en forma importante los costos de atención
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Arthritis, Rheumatoid/surgery , Arthroplasty , Spondylitis, Ankylosing/surgery , Time Factors , Hip Prosthesisالملخص
La Espondilitis Aquilosante con severa deformidad cérvico-espinal representa un escollo en la práctica anestesiológica por la dificultad en el manejo de la vía aérea. Describimos las técnicas elegidas para tratar a un paciente con Espondiloartrosis Anquilopoyética que requirió dos intervenciones quirúrgicas
الموضوعات
Humans , Male , Aged , Anesthesia, General , Bronchoscopy , Intubation, Intratracheal , Spondylitis, Ankylosing/surgery , Cervical Vertebrae/pathology , Cervical Vertebraeالملخص
In 13 hips of 13 patients, the acetabulum was reconstructed using morselised femoral head allografts during revision of total hip arthroplasty. Average age at the time of revision was 62.2 years. Average follow up was 11 months. The average modified harris hip score before surgery was 33.8 points and at the end of follow up 80.6. Allografts appeared to be incorporated securely to the acetabulum, as determined by radiographic examination There was no radiographic evidence of resorption or collapse of allograft. Morselised femoral head allografts appear to provide a useful techique for the reconstruction of a severely deficient acetabulum during revision total hip arthroplasty
الموضوعات
Humans , Arthroplasty , Spondylitis, Ankylosing/surgeryالملخص
Foram operados 12 pacientes com artrite reumatóide e um com espondilite anquilosante que necessitaram de artroplastia múltipla de quadris e joelhos; destes, três receberam três e os restantes precisaram de quatro artroplastias para sua recuperaçäo. Os resultados foram bons na quase totalidade dos casos, havendo apenas cinco resultados maus e regulares, num total de 49 operaçöes. Levando em consideraçäo as dificuldades para a recuperaçäo, o número de internaçöes e de anestesias, bem como as doses de medicamentos necessárias em cada intervençäo, propusemo-nos a operar dois quadris ou dois joelhos numa só sessäo operatória, em dois casos selecionados, a realizar três e quatro intervençöes (um quadril e dois joelhos) de uma só vez. Tal procedimento teve a justifica-lo o fato de serem pacientes altamente incapacitados, guardando o leito, sem condiçöes para deambulaçäo, cuja recuperaçäo teria sido muito mais difícil se operássemos uma articulaçäo de cada vez. Teve ainda a vantagem de demonstrar que é possível assim proceder, desde que os pacientes sejam bem selecionados, motivados e preparados clinicamente para o ato cirúrgico. Todos os pacientes receberam corticóides durante a operaçäo e nos primeiros três dias de pós-operatório, permanecendo na terapia intensiva por 24 horas, a fim de prevenir possível choque por falência adrenal
الموضوعات
Adult , Middle Aged , Humans , Male , Female , Arthritis, Rheumatoid/surgery , Hip/surgery , Knee/surgery , Spondylitis, Ankylosing/surgery , Arthroplasty , Postoperative Careالملخص
Os autores analisam 14 casos de "pacientes altamente incapacitados" pela artrite reumatóide e pela espondilite anquilosante que receberam tratamento cirrurgico-reumatológico de 1962 a 1977. Esses pacientes recuperaram, total ou parcialmente, a capacidade de execuçäo dos atos da vida diária, depois de serem submetidos a no mínimo quatro e no máximo 18 operaçöes ortopédicas. O tempo de evoluçäo foi de 10 a 21 anos e os resultados perduraram até hoje; houve um óbito por pneumonia intercorrente e, dos 13 casos remanescentes, apenas quatro vieram a necessitar de novo tratamento cirúrgico, na maioria por artroplastias totais. Concluem pela validade da conduta que permitiu transformar pacientes altamente incapacitados ou totalmente dependentes em indivíduos relativamente incapacitados e parcialmente dependentes
الموضوعات
Child , Adolescent , Adult , Humans , Male , Female , Arthritis, Juvenile/surgery , Arthritis, Rheumatoid/surgery , Disabled Persons , Spondylitis, Ankylosing/surgery , Activities of Daily Living , Quality of Life , Retrospective Studiesالملخص
Foram operados 12 pacientes com AR e um com EA, que necessitaram de artroplastia múltipla de quadris e joelhos; destes, três receberam três e os restantes precisaram de quatro artroplastias para sua recuperaçäo. Os resultados foram bons na quase totalidade dos casos, havendo apenas cinco resultados maus e regulares, num total de 49 operaçöes. Levando em consideraçäo as dificuldades para a recuperaçäo, o número de internaçöes e de anestesias, bem como as doses de medicamentos necessárias em cada intervençäo, propusemo-nos a operar dois quadris ou dois joelhos numa só sessäo operatória, chegando, em dois casos selecionados, a realizar três e quatro intervençöes (um quadril e dois joelhos e dois quadris e dois joelhos) de uma só vez. Tal procedimento teve a justificá-lo o fato de serem pacientes altamente incapacitados, guardando o leito, sem condiçöes para deambulaçäo, cuja recuperaçäo teria sido muito mais difícil se operássemos uma articulaçäo de cada vez. Teve ainda a vantagem de demonstrar que é possível assim proceder, desde que os pacientes sejam bem selecionados, motivados e preparados clinicamente para o ato cirúrgico. Todos os pacientes receberam corticóides durante a operaçäo e nos primeiros três dias de pós-operatório, permanecendo na terapia intensiva por 24 horas, a fim de prevenir possível choque por falência adrenal