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1.
Int. braz. j. urol ; 48(1): 54-66, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356296

ABSTRACT

ABSTRACT Introduction: The therapeutic role of pelvic lymph node dissection (PLND) in prostate cancer (PCa) is unknown due to absence of randomized trials. Objective: to present a critical review on the therapeutic benefits of PLND in high risk localized PCa patients. Materials and Methods: A search of the literature on PLND was performed using PubMed, Cochrane, and Medline database. Articles obtained regarding diagnostic imaging and sentinel lymph node dissection, PLND extension, impact of PLND on survival, PLND in node positive "only" disease and PLND surgical risks were critically reviewed. Results: High-risk PCa commonly develops metastases. In these patients, the possibility of presenting lymph node disease is high. Thus, extended PLND during radical prostatectomy may be recommended in selected patients with localized high-risk PCa for both accurate staging and therapeutic intent. Although recent advances in detecting patients with lymph node involvement (LNI) with novel imaging and sentinel node dissection, extended PLND continues to be the most accurate method to stage lymph node disease, which may be related to the number of nodes removed. However, extended PLND increases surgical time, with potential impact on perioperative complications, hospital length of stay, rehospitalization and healthcare costs. Controversy persists on its therapeutic benefit, particularly in patients with high node burden. Conclusion: The impact of PLND on biochemical recurrence and PCa survival is unclear yet. Selection of patients may benefit from extended PLND but the challenge remains to identify them accurately. Only prospective randomized study would answer the precise role of PLND in high-risk pelvis confined PCa patients.


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Lymph Node Excision , Pelvis , Prostatectomy , Prospective Studies , Lymph Nodes/surgery
2.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367125

ABSTRACT

Objetivo: Describir los tiempos de internación, cirugía y rehabilitación de una serie de pacientes con cadera flotante. El objetivo secundario fue comparar los resultados obtenidos en función de la reinserción laboral con los de pacientes que sufrieron fracturas de pelvis o acetábulo sin fractura femoral asociada. Materiales y Métodos: Estudio descriptivo, retrospectivo y multicéntrico de pacientes con trauma de pelvis y acetábulo de alta energía, divididos en dos grupos de estudio según la presencia de fractura de fémur asociada homolateral (cadera flotante) para su comparación, durante el período comprendido entre enero de 2014 y marzo de 2019. Resultados: Se incluyó a 102 pacientes con trauma de pelvis o acetábulo agrupados en 2 poblaciones según la presencia de cadera flotante (cadera flotante 23; pelvis/acetábulo 79). Las medianas de días de internación [cadera flotante 15,5 (rango 4-193); pelvis/acetábulo 7 (rango 3-31); p = 0,0001] y de la cantidad de cirugías por paciente [cadera flotante 5 (rango 3-8); pelvis/acetábulo 2 (rango 1-4); p = 0,0001] fueron mayores en los pacientes con cadera flotante. Además, la incapacidad laboral temporaria fue más alta (p = 0,00012), sin diferencias significativas en la tasa de recalificación laboral (p = 0,11). Conclusión: La asociación de la lesión cadera flotante aumentó significativamente el tiempo de internación, los procedimientos quirúrgicos necesarios y el tiempo de recuperación según la incapacidad laboral temporaria en pacientes con trauma de pelvis o acetábulo. Nivel de Evidencia: III


Objective: We aim to describe the lengths of hospitalization, surgery, and rehabilitation of a series of patients with floating hip. As a secondary objective, to compare the outcomes obtained in terms of return to work in patients who had suffered fractures of the pelvis or acetabulum without an associated femoral fracture. Materials and Methods: Descriptive, retrospective, and multicenter study of patients with high-energy trauma to the pelvis and acetabulum divided into two study populations according to the presence of associated ipsilateral femur fracture (floating hip) for comparison, during the period January 2014 - March 2019. Results: 102 patients with pelvis and/or acetabulum trauma were included, grouped into 2 populations according to the presence of a float-ing hip (Floating hip: 23 patients; Pelvis/acetabulum: 79 patients). The median days of hospitalization [floating hip: median = 15.5 (range = 4-193); pelvis/acetabulum: 7 (3-31); p = 0.0001] and the number of surgeries per patient [FH: median = 5 (range = 3-8); pelvis/acetabulum: 2 (1-4); p = 0.0001] were higher in patients with floating hip. Additionally, temporary work disability was higher (p = 0.00012), with no significant differences in the rate of job retraining (p = 0.11). Conclusion: Floating hip significantly increased the length of hospitalization, necessary surgical procedures, and recovery times according to temporary work disability in patients with trauma to the pelvis and/or acetabulum. Level of Evidence: III


Subject(s)
Adult , Pelvis/injuries , Treatment Outcome , Femur/injuries , Hip Fractures , Acetabulum/injuries
3.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367126

ABSTRACT

Introducción: Las fracturas de pelvis se asocian frecuentemente a un trauma de alta energía. La tasa de mortalidad varía del 5% al 46%. El objetivo de este estudio fue explorar si las variables analizadas se asociaron con el resultado final del tratamiento de las fracturas de pelvis APCII (AO/OTA: 61B2.3). materiales y métodos:Se evaluó a 23 de 79 pacientes luego de aplicarles los criterios de selección. Las fracturas fueron clasificadas, según Young y Burgess, en una radiografía panorámica de pelvis, de entrada y de salida, y tomografía computarizada. Se evaluó el resultado clínico según la escala funcional de Majeed. Las variables evaluadas fueron: tratamiento en la urgencia, lesiones asociadas, días de espera hasta la cirugía, fijación utilizada, reducción posquirúrgica inmediata, infección del sitio quirúrgico. Resultados: No se halló una diferencia estadísticamente significativa entre el tipo de tratamiento realizado en la urgencia, las lesiones asociadas, los días de espera hasta la cirugía y el tipo de fijación, con el resultado final a largo plazo. Los pacientes que tuvieron una reducción posoperatoria inmediata <1 cm y los que no sufrieron una infección del sitio quirúrgico obtuvieron mejores resultados funcionales, de manera estadísticamente significativa. Conclusión: Las variables calidad de la reducción posquirúrgica inmediata e infección del sitio quirúrgico en pacientes con fractura de pelvis APCII se asocian directamente con los resultados funcional y clínico a largo plazo. Nivel de Evidencia: IV


Introduction: Pelvic fractures are frequently associated with high-energy trauma. Mortality varies from 5%-46%. In these patients, the factors related to poor outcomes are still controversial. Purpose: To explore if the variables analyzed were related with the long term outcomes of the treatment of an anterior-posterior compression type II pelvic fracture (APCII; AO/OTA: 61B2.3). Materials and methods: 79 cases were analyzed and 23 patients remained for evaluation according to inclusion and exclusion criteria. Pelvic radiographs (anteroposterior, inlet and outlet) and CT-scans were evaluated. The Young & Burgess classification was used to define the fracture pattern and the Majeed Score for clinical outcomes. Variables analyzed: emergency treatment, associated injuries, delay for definitive fixation, method of fixation, quality of immediate postoperative reduction and surgical site infection. Results: We did not find any statistical relation between the type of emergency treatment, associated injuries, delay for definitive fixation, method of fixation, and the long-term clinical outcome. Patients who had an immediate postoperative reduction of less than 1 cm and those who did not have a surgical site infection obtained better functional outcomes (statistically significant). Conclusion: The quality variables of immediate postoperative reduction and surgical site infection in patients with APCII pelvic fracture had a direct relation with long-term functional and clinical outcomes. Level of Evidence: IV


Subject(s)
Adult , Middle Aged , Pelvis/injuries , Treatment Outcome , Fractures, Bone
4.
Article in Spanish | LILACS, BINACIS | ID: biblio-1378012

ABSTRACT

El tumor mesenquimático fosfatúrico es una entidad clinicopatológica sumamente infrecuente. Además de provocar dolor óseo insidioso y polimialgias, se acompaña de alteraciones del metabolismo fosfocálcico de difícil manejo clínico. El abordaje multidisciplinario resulta la clave del éxito en esta enfermedad. Presentamos una paciente de 52 años de edad con antecedente de tumor mesenquimático fosfatúrico en la hemipelvis derecha con extensión a la cadera homolateral de 10 años de evolución. Clínicamente presentaba osteomalacia oncogénica (hipofosfatemia e hiperfosfaturia) que no se corregía, pese a un agente de última generación, el burosumab, un inhibidor del factor de crecimiento fibroblástico 23, que aumenta la reabsorción tubular renal de fosfatos. En un comité multidisciplinario, se decidió la resección con márgenes oncológicos y se logró una mejoría clínica franca. Comunicamos este caso, debido a que es un cuadro infrecuente. Nivel de Evidencia: IV


Phosphaturic mesenchymal tumor (PMT) is an infrequent clinicopathological entity. It presents insidious bone pain and polymyalgia, accompanied by alterations in calcium and phosphorus metabolism that are difficult to resolve clinically. A multidisciplinary approach is a key to success in this pathology. We present the case of a 52-year-old female patient with a 10-year history of PMT in the right hemipelvis with ipsilateral hip extension. From the clinical point of view, she presented oncogenic osteomalacia (hypophosphatemia and hyperphosphaturia) that did not correct despite being administered the latest generation medication, burosumab, an FGF-23 inhibitor that increases renal tubular phosphate reabsorption. Resection with oncological margins was decided by a multidisciplinary committee resolving her clinical condition. Due to the rarity of this pathology, we decided to report the case. Level of Evidence: IV


Subject(s)
Middle Aged , Osteomalacia , Pelvis/surgery , Pelvis/pathology , Neoplasms, Bone Tissue , Mesenchymoma/surgery , Neoplasms, Connective Tissue
5.
Article in Chinese | WPRIM | ID: wpr-928873

ABSTRACT

CT image based organ segmentation is essential for radiotherapy treatment planning, and it is laborious and time consuming to outline the endangered organs and target areas before making radiation treatment plans. This study proposes a fully automated segmentation method based on fusion convolutional neural network to improve the efficiency of physicians in outlining the endangered organs and target areas. The CT images of 170 postoperative cervical cancer stage IB and IIA patients were selected for network training and automatic outlining of bladder, rectum, femoral head and CTV, and the neural network was used to localize easily distinguishable vessels around the target area to achieve more accurate outlining of CTV.


Subject(s)
Female , Humans , Image Processing, Computer-Assisted , Neural Networks, Computer , Organs at Risk , Pelvis , Tomography, X-Ray Computed , Uterine Cervical Neoplasms/surgery
6.
Article in Chinese | WPRIM | ID: wpr-928851

ABSTRACT

This study evaluates the static balance ability of human body based on lower limb rehabilitation robot.According to the balance parameters obtained from the movement trajectory of the center of human pelvis, SPSS statistical software was used to verify that there was significant difference between the two groups (P<0.01). Principal component analysis is used to allocate the weight of each parameter and establish the comprehensive evaluation value. The comprehensive evaluation value of the control group was 0.383±0.038, and the experimental group was 0.875±0.136. When the subject's comprehensive evaluation value is between 0.739 and 1.011, it indicates the presence of balance dysfunction, and when it is between 0.345~0.421, it indicates that the balance of the lower limbs of the subject is normal. Experimental results show that this evaluation method can objectively and quantitatively reflect the static equilibrium state of human body.


Subject(s)
Humans , Lower Extremity , Movement , Pelvis , Postural Balance
7.
Article in Chinese | WPRIM | ID: wpr-928320

ABSTRACT

OBJECTIVE@#To investigate whether the anteversion angle of acetabular prosthesis can be evaluated on the anteroposterior X-ray film of common double hip joint.@*METHODS@#Total 32 patients(41 hips) after total hip arthroplasty were selected, including 18 males and 14 females, aged(66.2±4.1) years. All patients completed the positive X-ray film of both hips and plain CT scan of pelvis after operation. Acetabular anteversion was measured by plain CT scan of pelvis, and measured by Saka and other measurement formulas on X-ray film.@*RESULTS@#The acetabular anteversion measured by X-ray film was(16.2±5.0)° and that measured by CT was (31.8±9.7)°(P=0.00). In addition, there was a significant linear correlation between X-ray film and CT(Pearson correlation coefficient (r=0.84, P=0.00).@*CONCLUSION@#CT can accurately measure the acetabular anteversion, but it has obvious disadvantages, such as large radiation, high cost, phantom CT artifact and so on. Although Saka measurement formula can not directly obtain the accurate acetabular anteversion as CT measurement, it has a high correlation with the acetabular anteversion measured by CT. Therefore, the method proposed in this study can also preliminarily evaluate the acetabular anteversion.


Subject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip/methods , Female , Hip Joint/surgery , Hip Prosthesis , Humans , Male , Pelvis
8.
Article in Chinese | WPRIM | ID: wpr-928212

ABSTRACT

The body weight support rehabilitation training system has now become an important treatment method for the rehabilitation of lower limb motor dysfunction. In this paper, a pelvic brace body weight support rehabilitation system is proposed, which follows the center of mass height (CoMH) of the human body. It aims to address the problems that the existing pelvic brace body weight support rehabilitation system with constant impedance provides a fixed motion trajectory for the pelvic mechanism during the rehabilitation training and that the patients have low participation in rehabilitation training. The system collectes human lower limb motion information through inertial measurement unit and predicts CoMH through artificial neural network to realize the tracking control of pelvic brace height. The proposed CoMH model was tested through rehabilitation training of hemiplegic patients. The results showed that the range of motion of the hip and knee joints on the affected side of the patient was improved by 25.0% and 31.4%, respectively, and the ratio of swing phase to support phase on the affected side was closer to that of the gait phase on the healthy side, as opposed to the traditional body weight support rehabilitation training model with fixed motion trajectory of pelvic brace. The motion trajectory of the pelvic brace in CoMH mode depends on the current state of the trainer so as to realize the walking training guided by active movement on the healthy side of hemiplegia patients. The strategy of dynamically adjustment of body weight support is more helpful to improve the efficiency of walking rehabilitation training.


Subject(s)
Biomechanical Phenomena , Gait , Hemiplegia , Humans , Pelvis , Range of Motion, Articular , Stroke Rehabilitation , Walking
10.
Rev. cuba. ortop. traumatol ; 35(1): e296, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289550

ABSTRACT

Introducción: El tratamiento del traumatismo pélvico es uno de los más complejos en la atención al trauma. La tasa de mortalidad es alta. Objetivo: Examinar los criterios actuales acerca de las lesiones traumáticas de pelvis y las posibles estrategias existentes para su tratamiento. Métodos: Se realizó una búsqueda de artículos publicados en la base de datos PubMed entre los años 2011-2020. Se excluyeron trabajos porque estaban duplicados o los datos de origen eran insuficientes. Resultados: Se analizaron los mecanismos de las lesiones, su fisiopatología, principios y pilares de la atención médica y recomendaciones para el uso de herramientas de diagnóstico en el trauma, entre otras. Las complicaciones se presentan en pacientes con trauma pélvico abierto que pueden tener secuelas crónicas como incontinencia fecal y urinaria, impotencia, dispareunia, discapacidad residual en las funciones físicas, absceso perineal y pélvico, dolor crónico y complicaciones vasculares como embolia o trombosis. La mayoría de las muertes (44,7 por ciento) ocurren el día del trauma. Un enfoque multidisciplinario en la atención a las lesiones traumáticas de pelvis, contribuye a una mejora en el rendimiento y en los resultados de los pacientes. Conclusiones: Las lesiones traumáticas del anillo pélvico son consecuencia de accidentes de alta energía y constituyen una de las lesiones de mayor gravedad a las que está expuesto el ser humano. La posibilidad de inestabilidad mecánica asociada a alteraciones hemodinámicas obliga a la adopción de protocolos de actuación inmediata, para evitar la elevada mortalidad que se asocia a estas lesiones(AU)


Introduction: The treatment of pelvic trauma is one of the most complex in trauma care. Mortality rate is high. Objective: To examine the current criteria about traumatic pelvic injuries and the possible existing strategies for their treatment. Methods: A search was carried out for articles published in PubMed database from 2011 to 2020. Works that were duplicated or had insufficient source data were excluded. Results: We analyzed injury mechanisms, pathophysiology, classifications, principles and pillars of medical care, and recommendations for the use of diagnostic tools in pelvic trauma, among others. Complications with functional limitations occur in patients with open pelvic trauma who may have chronic sequelae such as fecal and urinary incontinence, impotence, dyspareunia, residual disability in physical functions, perineal and pelvic abscess, chronic pain, and vascular complications such as embolism or thrombosis. Most deaths (44.7 percent) occur on the day of the trauma. A multidisciplinary approach to treating traumatic pelvic injuries contributes to improved performance and patient outcomes. Conclusions: Traumatic injuries to the pelvic ring are the consequence of high-energy accidents and constitute one of the most serious injuries to which humans are exposed. The possibility of mechanical instability associated with hemodynamic alterations requires the adoption of protocols for immediate action, to avoid the high mortality associated with these injuries(AU)


Subject(s)
Humans , Pelvis/surgery , Pelvis/injuries , Therapeutics
11.
Rev. bras. ortop ; 56(2): 175-180, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1251344

ABSTRACT

Abstract Objective To evaluate knee alignment in the frontal plane and pelvic balance during the step-down test in female and male soccer players. Methods Cross-sectional study carried out with male and female soccer players from under-15 and under-17 teams of a professional club in Southern Brazil. The step-down test was performed, filmed with a video camera, and evaluated according to the angular measurements obtained during movement using the Kinovea software (open source), version 0.8.24. Results The sample consisted of 38 individuals, 19 males and 19 females. Female athletes had a greater varus angle (9.42º ± 1.65º) compared to male athletes (3.91º ± 2.0º; p = 0.04). There was no difference regarding the unilateral pelvic drop between the groups. In addition, the association between the hip-related pelvic drop and the projection angle on the frontal plane of the knee was weak in both genders. Conclusion Even though the pelvic drop was observed in both genders, young female athletes had greater varus knee angles on the step-down test, which require greater attention to minimize the risk of injury.


Resumo Objetivo Avaliar o alinhamento do joelho no plano frontal e o equilíbrio pélvico durante a descida de um degrau comparando atletas de futebol feminino e masculino. Métodos Estudo transversal, realizado com atletas de futebol das categorias sub-15 e sub-17, de ambos os sexos, de um clube profissional do Sul do Brasil. Foi realizado o teste de descida de um degrau, o qual foi filmado por uma câmera de vídeo, e, em sua avaliação, traçaram-se as medidas angulares durante o movimento por meio do software Kinovea (código aberto), versão 0.8.24. Resultados A amostra foi composta por 38 indivíduos, 19 do sexo masculino e 19 do sexo feminino. As atletas do sexo feminino apresentaram maior ângulo em varo (9,42º ± 1,65º) quando comparadas com os atletas masculinos (3,91º ± 2,0º; p = 0,04). Não houve diferença em relação à queda unilateral da pelve (drop pélvico) entre os grupos, e a associação entre o drop pélvico do quadril e o ângulo de projeção no plano frontal do joelho foi fraca em ambos os sexos. Conclusão Apesar de ambos os sexos terem apresentado queda pélvica, as atletas de base do sexo feminino apresentaram maior angulação do joelho em varo no teste de descida do degrau, e necessitam maior atenção para minimizar o risco de lesão.


Subject(s)
Humans , Male , Female , Pelvis , Soccer , Weights and Measures , Genu Varum , Athletes , Hip , Knee
12.
J. coloproctol. (Rio J., Impr.) ; 41(1): 47-51, Jan.-Mar. 2021.
Article in English | LILACS | ID: biblio-1286966

ABSTRACT

Abstract Objective The literature on the safety and long-term sequelae of transrectal and transvaginal drainage of pelvic abscesses is limited. We evaluated the outcomes and safety of pelvic abscess drainage by interventional radiology at our institution. Methods After obtaining institutional review board approval, we retrospectively evaluated the outcomes of transrectal and transvaginal pelvic abscesses drainage using computed tomography, endorectal ultrasound, and or fluoroscopy. Results The study included 26 patients, with an age range of 24 to 88 years old, out of whom 53.8% were men. A total of 46.1% of the participants were African Americans and 26.9% were Caucasians. The average body mass index was 28.4 (range: 15.6 to 41.9). The most common etiology was penetrating abdominal injury (27%), followed by appendectomy (23%), diverticular disease (11.5%), anastomotic leak (11.5%), and disorders of gynecological causes (11.5%). The mean abscess diameter was 6.3 cm (range: 3.3 to 10.0 cm). Transrectal drainage was performed in all except one patient who had a transvaginal drainage. Transrectal ultrasound was used for drainage in 92.3% cases, and fluoroscopy was used as an additional imaging modality in 75% of the cases. An 8- or 10-Fr pigtail catheter was used in>80% of the patients. Drains were removed between 2 and 7 days in 92.3% of the cases. The average follow-up was 30.4 months (range: 1 to 107 months), and no long-term complications were reported. Only one patient required subsequent operative intervention for an anastomotic leak. Conclusions Pelvic abscess drainage by transrectal route using radiological guidance is a safe and effective procedure.


Resumo Objetivo A literatura sobre a segurança e as sequelas no longo prazo da drenagem transretal e transvaginal do abscesso pélvico é limitada. Avaliamos os resultados e a segurança da drenagem do abscesso pélvico por radiologia intervencionista em nossa instituição. Métodos Após obter a aprovação do conselho de revisão institucional, avaliamos retrospectivamente os resultados da drenagem de abscessos pélvicos transretais e transvaginais por meio de tomografia computadorizada, ultrassom endorretal, e/ou fluoroscopia. Resultados Participaram do estudo 26 pacientes, com faixa etária de 24 a 88 anos, dos quais 53,8% eram homens. Um total de 46,1% eram afro-descendentes, e 26,9% eram brancos. O índice de massa corporal médio foi de 28,4 (gama: 15,6 a 41,9). A etiologia mais comum foi lesão abdominal penetrante (27%), seguida de apendicectomia (23%), doença diverticular (11,5%), fístula anastomótica (11,5%) e distúrbios de causas ginecológicas (11,5%). O diâmetro médio do abscesso foi de 6,3 cm(gama: 3,3 a 10,0 cm). A drenagem transretal foi realizada em todos os pacientes, com exceção de uma, que foi submetida a uma drenagem transvaginal. A ultrassonografia transretal foi utilizada para drenagem em 92,3% dos casos, e a fluoroscopia como modalidade adicional de imagem, em 75% dos casos. Um catéter duplo J de 8 ou 10 Fr foi usado em>80% dos pacientes. Os drenos foram retirados entre 2 e 7 dias em 92,3% dos casos. O acompanhamentomédio foi de 30,4meses (gama: 1 a 107 meses), e nenhuma complicação de longo prazo foi relatada. Apenas um paciente necessitou de intervenção cirúrgica subsequente para um vazamento anastomótico. Conclusão A drenagem do abscesso pélvico por via transretal com orientação radiológica é um procedimento seguro e eficaz.


Subject(s)
Humans , Male , Female , Pelvis/physiopathology , Rectum/diagnostic imaging , Vagina/diagnostic imaging , Drainage/methods , Pelvic Infection/etiology , Abscess/diagnostic imaging
13.
Rev. medica electron ; 43(1): 2873-2886, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156781

ABSTRACT

RESUMEN Introducción: las lesiones traumáticas del anillo pélvico constituyen un desafío para los cirujanos ortopedistas por su alta morbimortalidad y las consecuencias que de ellas derivan. Objetivo: describir el comportamiento de variables demográficas y clínicas en los pacientes atendidos por lesiones traumáticas del anillo pélvico en el Hospital Universitario "Comandante Faustino Pérez Hernández" de Matanzas Materiales y Métodos: se realizó un estudio longitudinal prospectivo descriptivo de los pacientes ingresados en el servicio de ortopedia y traumatología por presentar lesiones traumáticas del anillo pélvico en dicho centro en el período comprendido de enero del 2009 a enero del 2019. Se seleccionaron variables demográficas y clínicas Resultados: el estudio incluyó a 48 pacientes. Predominó el sexo masculino 29 pacientes para un 60,4%, la edad de mayor frecuencia estuvo entre 31 a 50 años. Predominaron las fracturas tipo B con 24 pacientes para 50% y el tratamiento quirúrgico con 27 pacientes para 56,2%, dentro de las complicaciones inmediatas predominó el shock hipovolémico en 14 pacientes para 29.1%, en las tardías la sepsis superficial con 6 pacientes, 12.5%. Conclusiones: las lesiones traumáticas del anillo pélvico siempre deben ser tratadas como lesiones graves, por lo que deben ser valoradas de forma multidisciplinaria y apegados a protocolos de actuación, y con especialistas de alta experiencia profesional (AU).


SUMMARY Introduction: pelvic ring traumatic lesions are a challenge for orthopedic surgeons due to their high morbi-mortality and the consequences derived from them. Objective: to describe the behavior of clinical and demographic variables in patients cared due to pelvic ring traumatic lesions in the University Hospital "Comandante Faustino Perez Hernandez" of Matanzas. Method: a descriptive, prospective, longitudinal research was carried out in patients admitted to the Orthopedics and Traumatology Service of the before-named hospital for presenting pelvic ring traumatic lesions in the period from January 2009 until January 2019. Clinical and demographic variables were chosen. Results: the study included 48 patients. Male sex predominated, 29 patients, 60.4 %; the most frequent age ranged between 31 and 50 years. Type B fractures predominated with 24 patients and 50 %; surgical treatment also predominated with 27 patients and 56.2 %; among the immediate complications, hypovolemic shock predominated in 14 patients for 29.1 %; among the late ones, surface sepsis predominated with 6 patients, 12.5 %. Conclusions: pelvic ring traumatic lesions should be always treated like serious lesions; therefore they should be evaluated in a multidiscipline way, adhered to the intervention protocols, and by highly experienced professionals (AU).


Subject(s)
Humans , Pelvis/injuries , Shock/etiology , Wounds and Injuries/epidemiology , Sepsis/etiology , Pelvis/surgery , Wounds and Injuries/mortality , Indicators of Morbidity and Mortality , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
14.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(4) (Nro Esp - ACARO Asociación Argentina para el Estudio de la Cadera y Rodilla): 463-474, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353947

ABSTRACT

Introducción: Las enfermedades degenerativas de la cadera y la columna vertebral son causas comunes de discapacidad y dolor y los síntomas suelen superponerse. Cuando algún parámetro se altera, otro debe modificarse para evitar el choque femoroacetabular y una posible luxación. Se piensa que la fijación lumbar afectaría la adaptación de la unidad espino-pélvica en las diferentes posturas. El objetivo de este estudio fue analizar el comportamiento espino-pélvico en pacientes con artroplastia total de cadera y artrodesis lumbar. Materiales y Métodos: Se realizó un estudio no aleatorizado, retrospectivo, de casos y controles en pacientes con artroplastia total de cadera evaluados con radiografía lumbopélvica de frente y de perfil en posición erecta y en sedestación, divididos en dos grupos: con artrodesis lumbar o sin ella. Se midieron parámetros espino-pélvicos y femoroacetabulares. Resultados: La muestra tenía 50 pacientes: 25 en cada grupo. Quince tenían artroplastia total de cadera bilateral y el nivel de fijación lumbar más frecuente era L5-S1. No hubo diferencia estadísticamente significativa en la edad y el sexo entre ambos grupos. Los pacientes con artrodesis lumbar necesitaron más flexión de cadera para sentarse, sin un aumento significativo asociado en la tasa de luxación. Conclusiones: La composición ideal de los componentes aún es difícil de alcanzar. La reconsideración de las "zonas seguras" de los componentes ha comenzado a alejarse de los valores del plano coronal de Lewinnek. Se ha propuesto un nuevo enfoque en las zonas seguras del plano sagital más apropiadas y precisas en pacientes seleccionados con enfermedad espino-pélvica grave. Nivel de Evidencia: III


Introduction: Degenerative diseases of the hip and spine are common causes of disability and pain, and the symptoms usually overlap. When a parameter is altered, another one should be modified to avoid femoroacetabular impingement and a potential dislocation. It is believed that lumbar fixation would affect the adaptation of the spinopelvic unit in different postures. This article aims to analyze the spinopelvic behavior in patients with Total Hip Arthroplasty (THA) and lumbar arthrodesis. Materials and Methods: A non-randomized retrospective study of cases and controls was carried out in patients with THA, who were assessed using anterior and lateral X-ray views in functional sitting and standing postures, divided into two groups depending on the presence or absence of lumbar arthrodesis. Spinopelvic parameters as well as femoroacetabular parameters were measured. Results: A sample of 50 patients was selected, 25 in each group. In total, 15 patients had bilateral THA, and the most common level of lumbar fixation was L5-S1. There was no statistically significant difference in gender and age between both groups. Lumbar arthrodesis patients required more hip flexion to sit, without being associated with a significant increase in the rate of dislocation. Conclusion: The ideal composition of the components is still difficult to achieve. The review of the "safe zones" of the components has started to depart from the values of the body plane proposed by Lewinnek. A new approach has been proposed to the safe zones of the sagittal plane, which are more appropriate and accurate in selected patients with severe spinopelvic pathology. Level of Evidence: IIII


Subject(s)
Aged , Pelvis , Spinal Fusion , Range of Motion, Articular , Arthroplasty, Replacement, Hip , Joint Dislocations
15.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353985

ABSTRACT

Introducción: La articulación sacroilíaca es el origen del dolor en el 10-25% de los pacientes con lumbalgia mecánica. Si no hay traumatismos, tumores, enfermedades metabólicas ni colagenopatías, su papel en la fisiopatología del dolor lumbar aún no está completamente dilucidado. El objetivo fue estudiar la anatomía sagital de la pelvis a través de la medición de la incidencia pélvica en pacientes con dolor sacroilíaco en el ámbito laboral frente a personas asintomáticas. Materiales y métodos: Estudio analítico, observacional, retrospectivo de pacientes con dolor sacroilíaco diagnosticados mediante un bloqueo guiado por tomografía computarizada en un centro de patología laboral, entre enero de 2015 y diciembre de 2018. El grupo de comparación fue una muestra aleatoria de personas sin enfermedad de la pelvis o lumbosacra estudiados con tomografía computarizada de pelvis y columna durante el mismo período. Resultados: La incidencia pélvica media en pacientes con dolor sacroilíaco fue de 52,57 (DE 9) y 46,52 (DE 9) en el grupo de personas sanas. La diferencia fue estadísticamente significativa con valores mayores de incidencia pélvica en pacientes con dolor sacroilíaco (p 0,042). Conclusión: Los pacientes con dolor sacroilíaco presentaron una mayor incidencia pélvica que las personas sanas, con una diferencia estadísticamente significativa en nuestro estudio. Nivel de Evidencia: IV


Introduction: The sacroiliac joint causes pain in 10 to 25% of patients with mechanical low back pain or symptoms radiating to the lower limbs. In the absence of trauma, metabolic disease, and collagen disease, its role in the pathophysiology of low back pain is not yet fully understood. The objective is to study the sagittal pelvic anatomy through the measurement of pelvic incidence (PI) in patients with sacroiliac pain in the workplace compared to asymptomatic patients. Materials and methods: A retrospective observational analytical study of adult patients with sacroiliac pain diagnosed with CT-guided block in an occupational pathology center during January 2015 and December 2018. The comparison group was a random sample of patients without pelvic or lumbosacral pathology studied with CT of the pelvis and spine during the same period. Results: The mean PI in patients with sacroiliac pain was 52.57 (SD 9) and 46.52 (SD 9) in the group of healthy patients. The difference was statistically significant with the higher PI values in patients with sacroiliac pain (p 0.042). Conclusion: Patients with sacroiliac pain had a higher pelvic incidence than healthy patients, with a statistically significant difference in our study. Level of Evidence: IV


Subject(s)
Adult , Pain , Pelvis/pathology , Sacroiliac Joint , Occupational Diseases
16.
Rev. colomb. ortop. traumatol ; 35(1): 53-51, 2021. ilus.
Article in Spanish | LILACS, COLNAL | ID: biblio-1378506

ABSTRACT

Introducción No hay consenso sobre el paradigma de tratamiento óptimo para pacientes que se presentan con fractura de pelvis inestable y más si se asocia a inestabilidad hemodinámica. El estudio se realizó para determinar la experiencia en el manejo de pacientes con una fractura inestable de la pelvis, con o sin inestabilidad hemodinámica, en un centro de referencia de trauma de Medellín, Colombia, como un paso inicial para avanzar protocolos adaptados a las necesidades particulares de nuestra población. Materiales & Métodos Se realizó un estudio retrospectivo, observacional que incluyó pacientes con fractura pélvica por traumatismo. Se recogieron datos demográficos, signos vitales de admisión, presencia de shock al ingreso (según escala ATLS), método de control de hemorragias, requerimiento de transfusión y mortalidad global. Se realizó análisis de un subgrupo de pacientes que se presentaron con signos de Shock hemodinámica grave asociado, definido como ATLS III- IV al ingreso y requerimiento de hemoderivados de más de 8UI en las primeras 48 horas. Resultados Un total de 567 pacientes con fractura pélvica de cualquier tipo, entre enero de 2011 y diciembre de 2018, identificados en las bases de datos de la institución, de los cuales 149 pacientes presentaron un patrón de fractura inestable de la pelvis (FIP). El 68.1% de los pacientes eran varones, con una edad media de 34 RIQ; 30 años y una puntuación de gravedad de la lesión (ISS) de 34 RIQ: 20. La mortalidad hospitalaria fue del 13.3%. La angioembolización y la colocación de fijadores externos fueron el método más común de control de hemorragias utilizado. Un total de 37 pacientes (27%) se sometieron intervención para el control de la hemorragia en las primeras 48 horas. Hubo 37 pacientes con fractura pélvica admitidos en estado de shock grave o requerimiento de más de 8U hemoderivados, 17 pacientes requirieron intervención en la pelvis, únicas o combinadas. La mortalidad calculada para estos pacientes fué de 32%. Discusión Los pacientes con FPI admitidos en nuestra institución tienen una alta mortalidad y es aún mayor en los pacientes quienes se presentan con Shock grave. Se utilizaron varios métodos para el control de la hemorragia de forma semejante a las indicadas en la literatura actual. Requerimos un esfuerzo institucional sostenido para tratar las fracturas pélvicas y disminuir la mortalidad de nuestros pacientes y conocer nuestra población nos permite orientar las estrategias de manejo.


Background There is no consensus about treatment for patients with an unstable pelvic fracture and even less when hemodynamic instability is associated with. Study was conducted to determine the outcome in the management of patients with an unstable fracture of the pelvis, with or without hemodynamic instability, in a trauma referral center in Medellín, Colombia. Methods A retrospective, longitudinal cohort study was conducted including patients with pelvic fracture due to trauma. Demographic data, vital signs on admission, presence of hemodynamic shock on admission (according to the ATLS scale), method of bleeding control, transfusion requirement and overall mortality rate were collected. An analysis was performed on a subgroup of patients who presented with signs of associated severe hemodynamic shock, defined as ATLS III-IV upon admission and a requirement for blood products of more than 8IU in the first 48hours. Results A total of 567 patients with any type of pelvic fracture, between January 2011 and December 2018, identified in the institution's databases, of which 149 patients presented an unstable pelvic fracture pattern (FIP). 68.1% of the patients were male, with a mean age of 34 IQR; 30 years and an Injury Severity Score (ISS) of 34 IQR: 20. Hospital mortality was 13.3%. Angioembolization and external fixator placement were the most used method of bleeding control. A total of 37 patients (27%) underwent intervention to control bleeding in the first 48hours. There were 37 patients with pelvic fracture admitted in a state of severe shock or requiring more than 8U of blood products, 17 patients required intervention in the pelvis, using single or combined ways. The mortality calculated for these patients was 32%. Discussion Patients with unstable pelvis fractures admitted to our institution have a high mortality rate and it is even higher in patients who present with severe shock. Various methods were used to control bleeding similar to those indicated in the current literature. We require a sustained institutional effort to treat pelvic fractures and reduce the mortality of our patients, and knowing our population characteristcs allows us to guide management strategies.


Subject(s)
Humans , Pelvis , Wounds and Injuries , Risk Factors , Mortality , Fractures, Bone
17.
Rev. colomb. ortop. traumatol ; 35(1): 89-94, 2021. ilus.
Article in Spanish | LILACS, COLNAL | ID: biblio-1378581

ABSTRACT

Se trata de un paciente masculino de 31 años con diagnóstico de fibroma condromixoide del ilíaco derecho manejado en el Hospital Universitario San Ignacio en febrero del 2018. El paciente fue llevado inicialmente a biopsia abierta para confirmación histológica, posteriormente fue llevado a embolización preoperatoria, manejo intralesional con curetaje, fresado extendido, manejo adyuvante local y aplicación de cemento óseo. Se realiza seguimiento postoperatorio por 18 meses sin evidencia clínica ni radiográfica de recidiva tumoral. El objetivo de este trabajo es hacer una revisión de la literatura sobre el fibroma condromixoide con énfasis en su localización pélvica y su tratamiento.


We report a case of a 31-year-old male patient with diagnosis of chondromyxoid fibroma (CMF) of the iliac bone diagnosed at Hospital Universitario San Ignacio in february 2018; an open biopsy allowed recognizement and description of cytologic features, forward diagnosis and treatment with combination of pre-operative embolization, local and extended curettage, local adyuvance and bone cement as described. At 18 months follow-up have found the patient remains without clinical or radiologic recurrence of CMF. We made a review of literature on chondromixoid fibroma emphasizing on pelvic bones compromise regarding diagnosis and management options.


Subject(s)
Humans , Fibroma , Pelvis , Ilium
18.
Acta Medica Philippina ; : 294-301, 2021.
Article in English | WPRIM | ID: wpr-886402

ABSTRACT

@#BACKGROUND AND OBJECTIVE: Limb deformity in terms of length discrepancy, angular and rotational deformities are amenable to correction using the Ilizarov method. The corrections can be achieved using the Ortho SUV Frame (OSF), a computer assisted six axes external fixator. Previous studies have reported easier and more accurate deformity correction. In this study, we report on our initial experience and treatment outcomes in using this system. MATERIALS AND METHODS: This study is a case series of patients where the Ilizarov circular frame was applied and which the deformity correction was carried out using the OSF. Success and accuracy in correction, length of time to correct, number of revisions needed and complications were gathered from a review of medical records. RESULTS: Thirty limbs in twenty nine cases were included in this report. Seventy seven percent (23/30) of the deformities were due to previous trauma. The rest were due to Blounts, infection and tumor. Correction in eighty seven percent (26/30) were achieved using the turning schedule provided by the Ortho SUV application software. Three cases required surgical removal of soft tissue interposition before further correction using the software was achieved. One case with posterior translation underwent closed manipulation. In the end all planned deformity corrections were achieved. Complications included pin tract swelling and erythema in 13% and all resolved either with oral antibiotics alone or combined with surgical release of pin sites under local anesthesia. CONCLUSION: The Ortho SUV is an effective tool to carry out deformity corrections using the Ilizarov method.


Subject(s)
Ilizarov Technique , External Fixators , Upper Extremity , Pelvis
19.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1566-1570, July-Aug. 2020. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1131516

ABSTRACT

No Brasil, Mangalarga Marchador é a raça com o maior número de equinos registrados, um total de 600.000 animais. Devido à falta de estudos termográficos, este estudo buscou avaliar alterações superficiais de temperatura corporal de membros torácicos e pélvicos após o esforço de marcha, usando uma câmera termográfica com infravermelho. O estudo avaliou 25 equinos, com peso médio de 414,9±34,5kg e idade média de 6,5±3 anos. As imagens foram obtidas a cinco metros de distância perpendicular à superfície lateral e caudal do corpo, em uma sala apropriada. Os animais foram submetidos ao exercício de marcha na velocidade de 15km.h-1 por 20 minutos. As imagens foram capturadas imediatamente antes e após o esforço, e repetidas após 30 minutos de repouso. As frequências cardíaca e respiratória aumentaram significativamente (P<0,001), comparando-se antes e após o esforço. Embora tenha sido notado também aumento significativo da temperatura retal (P<0,001), as alterações de temperatura superficial dos membros torácicos e pélvicos entre os termogramas obtidos antes e após o exercício não foram significativas (P>0,05). Dessa forma, mais estudos se fazem necessários para avaliar a relação da duração desse esforço e elevação da temperatura corporal.(AU)


Subject(s)
Animals , Pelvis , Physical Conditioning, Animal/physiology , Thorax , Body Temperature , Body Temperature Regulation/physiology , Horses/physiology , Thermography/veterinary
20.
Coluna/Columna ; 19(3): 184-188, July-Sept. 2020. tab, graf
Article in English | LILACS | ID: biblio-1133577

ABSTRACT

ABSTRACT Objectives The hip-spine syndrome (HSS) is defined as the simultaneous degeneration of the hip and lumbar spine. The objective of this study is to quantify the sagittal balance values in the population with HSS and to compare them with the normal sagittal balance parameters. Methods A retrospective study was conducted in which 30 patients with HSS who were waiting for total hip arthroplasty (THA) were evaluated. The lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and spinopelvic harmony (SH) angles and the BMI of these patients were measured. Results Seventeen women and 13 men participated in the study, with a mean LL of 39.55°, a mean SS of 36.92°, a mean PT of 25.77°, a mean PI of 62.72°, a mean SH of 23.17° and a mean BMI of 25.55. Only the SS did not present a changed value when compared to the normal values of the population. Conclusions HSS is increasingly present in our environment due to the aging population. Sagittal balance is gaining more and more attention in studies related to spinal pathologies. All the parameters measured in this study, except for SS, presented altered values when compared to the populational means. Evidence Level II. Observational and retrospective study.


RESUMO Objetivos A síndrome quadril-coluna (SQC) é definida como a degeneração simultânea do quadril e da coluna lombar. O objetivo do presente estudo consiste em quantificar os valores do equilíbrio sagital na população com SQC e compará-los com os parâmetros normais do equilíbrio sagital. Métodos Foi realizado um estudo retrospectivo em que foram avaliados 30 pacientes com SQC aguardando cirurgia de artroplastia total de quadril (ATQ). Foram aferidos os ângulos de lordose lombar (LL), declive sacral (DS), versão pélvica (VP), incidência pélvica (IP), harmonia espinopélvica (HP) e o IMC dos pacientes no estudo. Resultados Participaram do estudo 17 mulheres e 13 homens, sendo que a LL média foi de 39,55°, DS 36,92°, VP 25,77°, IP 62,72°, HP 23,17° e IMC 25,55. Apenas o DS não apresentou valor alterado quando comparado aos valores normais da população. Conclusão A SQC está cada vez mais presente em nosso meio devido ao envelhecimento populacional. O equilíbrio sagital ganha cada vez mais espaço nos estudos relacionados às patologias da coluna vertebral. Com exceção do DS, os demais parâmetros medidos nesse estudo apresentaram valores alterados quando comparados à média populacional. Nível de Evidência II. Estudo observacional e retrospectivo.


RESUMEN Objetivos El Síndrome de Columna-Cadera (SCC) se define como la degeneración simultánea de la columna lumbar y la cadera. El objetivo del presente estudio consiste en cuantificar los valores del equilibrio sagital en la población con SCC y compararlos con los parámetros normales del equilibrio sagital. Métodos Se realizó un estudio retrospectivo en el que se evaluaron 30 pacientes con SCC que esperaban cirugía para artroplastia total de cadera (ATC). Fueron medidos los ángulos de lordosis lumbar (LL), pendiente sacra (PS), versión pélvica (VP), incidencia pélvica (IP), armonía espinopélvica (AP) y el IMC de los pacientes en el estudio. Resultados Participaron en el estudio 17 mujeres y 13 hombres, siendo que la LL promedio fue de 39,55 °, PS 36,92°, VP 25,77°, IP 62,72°, AP 23,17° e IMC 25,55. Sólo la PS no presentó un valor alterado, cuando comparado a los valores normales de la población. Conclusión El SCC está cada vez más presente en nuestro medio debido al envejecimiento poblacional. El equilibrio sagital está ganando cada vez más espacio en los estudios relacionados a las patologías de la columna vertebral. Con excepción de la PS, los demás parámetros medidos en este estudio presentaron valores alterados cuando comparados al promedio poblacional. Nivel de Evidencia II. Estudio observacional y retrospectivo.


Subject(s)
Humans , Osteoarthritis, Spine , Pelvis , Radiography , Osteoarthritis, Hip , Low Back Pain , Arthroplasty, Replacement, Hip , Postural Balance
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