Tibiotalocalcaneal arthrodesis for end-stage ankle and hindfoot arthropathy:Short-and mid-term clinical outcomes / 北京大学学报(医学版)

Objective:To analyze the clinical data of patients with end-stage ankle and hindfoot ar-thropathy who underwent tibiotalocalcaneal(TTC)arthrodesis by the same surgeon,explore the short-and mid-term clinical results,complications and functional improvement,and discuss the clinical progno-sis and precautions of TTC arthrodesis.Methods:Retrospective analysis was made on the clinical data of 40 patients who underwent TTC arthrodesis by the same surgeon from March 2011 to December 2020.In this study,23 males and 17 females were included,with an average age of(49.1±16.0)years.All the patients underwent unilateral surgery.The clinical characteristics,imaging manifestations,main diagno-sis and specific surgical techniques of the patients were recorded.The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and visual analogue scale(VAS)between pre-operation and at the last follow-up.The fusion healing time,symptom improvement(significant improvement,certain improvement,no improvement or deterioration)and postoperative complications were also recorded.Results:The median follow-up time was 38.0(26.3,58.8)months.The preoperative VAS score was 6.0(4.0,7.0),and the AOFAS score was 33.0(25.3,47.3).At the last follow-up,the median VAS score was 0(0,3.0),and the AOFAS score was 80.0(59.0,84.0).All the significantly improved compared with their preoperative corre-sponding values(P＜0.05).There was no wound necrosis or infection in the patients.One patient suf-fered from subtalar joint nonunion,which was syphilitic Charcot arthropathy.The median bony healing time of other patients was 15.0(12.0,20.0)weeks.Among the included patients,there were 25 cases with significant improvement in symptom compared with that preoperative,8 cases with certain improve-ment,4 cases with no improvement,and 3 cases with worse symptoms than that before operation.Con-clusion:TTC arthrodesis is a reliable method for the treatment of the end-stage ankle and hindfoot ar-thropathy.The function of most patients was improved postoperatively,with little impact on daily life.The causes of poor prognosis included toe stiffness,stress concentration in adjacent knee joints,nonunion and pain of unknown causes.

Cervical anterior arthrodesis: autologous or synthetic graft? / Artrodese cervical via anterior: enxerto autólogo ou sintético? / Artrodesis cervical anterior: ¿injerto autologo o sintético?

ABSTRACT: Objective: To compare patients who underwent anterior cervical arthrodesis with autologous iliac crest graft and those who used synthetic graft. Methods: Analysis of 38 patients aged between 18 and 100 years with anterior cervical spondylosis of 1 or 2 levels in a spine surgery service. Results: degenerative cervical spine changes associated with cervicalgia and cervicobrachialgia. Excluded: previous cervical spine surgeries, fractures, or surgery above two levels. Two groups were formed with 19 patients, one using autologous graft and the other using synthetic tricalcium phosphate - a questionnaire assessed satisfaction (Oswestry and VAS) pre- and postoperatively. Bone consolidation was evaluated by tomography at nine months. Results: Mean ODI (Group 1) was 68.5% ± 4.6% preoperatively and 27.2% ± 3.8% postoperatively, being statistically relevant (p<0.001). VAS performed to evaluate the cervical region, Group 1 pre and post-op was considered statistically relevant (p<0.001). No significant difference was observed when comparing the mean values found in the postoperative period between Group 1 and Group 2 (p=0.463). Only two patients complained of chronic pain, representing 10% of the total. In nine-month tomography, 100% of patients in Group 1 and 100% of Group 2 showed bone consolidation, with no statistically relevant difference (p=0.676) between the groups. Conclusion: Similar functional and osteointegration outcomes were observed in both types of grafts. Synthetic graft minimizes the risks and complications of using allografts. Level of Evidence III; Retrospective comparative study.

RESUMO: Objetivo: Comparar os pacientes que realizaram artrodese cervical anterior associada ao uso de enxerto autólogo de crista ilíaca e os que utilizaram enxerto sintético. Métodos: Análise de 38 pacientes entre 18 e 100 anos com espondilose cervical anterior de nível 1 ou 2 em um serviço de cirurgia da coluna. Inclusão: alterações degenerativas da coluna cervical, associado a cervicalgia e/ou cervicobraquialgia. Excluídos: cirurgias de coluna cervical prévia, fraturas ou cirurgia acima de 2 níveis. Foram formados 2 grupos com 19 pacientes cada, sendo num deles utilizado enxerto autólogo e, no outro, sintético fosfato tricálcico. Foi aplicado o questionário para avaliação de satisfação (Oswestry e EVA) pré e pós-operatória. Consolidação óssea foi avaliada por tomografia no nono mês. Resultados: O ODI médio do Grupo 1 apresentou 68,5% ± 4,6% na avaliação pré-operatória e 27,2%±3,8% no pós, sendo estatisticamente relevante (p<0,001). EVA realizada para avaliar a região cervical, o Grupo 1 no pré e pós foi considerada estatisticamente relevante (p<0,001). Não foi observada diferença relevante quando comparando os valores médios encontrados no pós-operatório entre o Grupo 1 e o Grupo 2 (p=0,463). Apenas 2 pacientes com queixa de dor crônica, representando 10% do total. Tomografia de 9 meses, 100% dos pacientes do Grupo 1 e 100% do Grupo 2 apresentaram consolidação óssea, não tendo diferença estatisticamente relevante (p=0,676) entre os grupos. Conclusão: Foram observados resultados funcionais e de osteointegração similares em ambos enxertos. O enxerto sintético minimiza riscos e complicações do uso de aloenxertos. Nível de Evidência III; Estudo Retrospectivo Comparativo

RESUMEN: Objetivo: Comparar los pacientes sometidos a artrodesis cervical anterior asociada al uso de un injerto autólogo de cresta ilíaca y los que utilizaron un injerto sintético. Métodos: Se analizaron 38 pacientes de entre 18 y 100 años con espondilosis cervical anterior de nivel 1 o 2 en un servicio de cirugía de la columna vertebral. Criterios de inclusión: cambios degenerativos en la columna cervical, asociados a cervicalgia y/o cervicobraquialgia. Excluidos: cirugía previa de la columna cervical, fracturas o cirugía por encima de 2 niveles. Se formaron dos grupos de 19 pacientes cada uno, en uno se utilizó un injerto autólogo y en el otro un injerto sintético de fosfato tricálcico. Se utilizó un cuestionario de satisfacción pre y postoperatorio (Oswestry y EVA). La consolidación ósea se evaluó mediante tomografía computarizada al noveno mes. Resultados: La media del ODI del Grupo 1 fue del 68,5% ± 4,6% en la valoración preoperatoria y del 27,2%±3,8% en la valoración postoperatoria, siendo estadísticamente relevante (p<0,001). La EVA realizada para valorar la región cervical en el Grupo 1 pre y post se consideró estadísticamente significativa (p<0,001). No se observaron diferencias relevantes al comparar los valores medios encontrados en el postoperatorio entre el Grupo 1 y el Grupo 2 (p=0,463). Sólo 2 pacientes se quejaron de dolor crónico, lo que representa el 10% del total. A los 9 meses, el 100% de los pacientes del Grupo 1 y el 100% del Grupo 2 presentaban cicatrización ósea, sin diferencias estadísticamente significativas (p=0,676) entre los grupos. Conclusión: Se observaron resultados funcionales y de osteointegración similares con ambos injertos. El injerto sintético minimiza los riesgos y complicaciones del uso de aloinjertos. Nivel de Evidencia III; Estudio Retrospectivo Comparativo.

Access to the Lumbosacral Spine: A Current View / Acesso à coluna lombossacral: Visão atual

Abstract The surgical approach to the lumbosacral spine has been the subject of experimental and scientific anatomical studies since the Hippocratic era. However, it was in the 20th century that, with the evolution of asepsis and antibiotic therapy, spine surgery began to evolve at breakneck speed, and the various possibilities of access roads became objects of development and discussion. As a result, pathologies of the lumbosacral spine can be accessed in different ways and positions, from the traditional posterior approach in the prone position to the anterior, oblique, lateral, and endoscopic approaches. The current article brings state-of-the-art access routes to the lumbosacral spine. This article objective is to elucidate the possibilities of accesses the lumbar spine for any purposes, as decompression, fusion, tumour resections, reconstruction or deformity correction, despites type of implants or implants positioning.

Resumo A abordagem cirúrgica da coluna lombossacral tem sido objeto de estudos anatômicos experimentais e científicos desde a era hipocrática. Contudo, foi no século XX que, com a evolução da assepsia e da antibioticoterapia, a cirurgia da coluna começou a evoluir em velocidade vertiginosa e as diversas possibilidades de vias de acesso tornaram-se objetos de desenvolvimento e discussão. Desta forma, as doenças da coluna lombossacral podem ser acessadas de diferentes maneiras e posições, desde a abordagem posterior tradicional em decúbito ventral até as abordagens anterior, oblíqua, lateral e endoscópica. O presente artigo traz vias de acesso de última geração para a coluna lombossacral. O objetivo deste artigo é elucidar as possibilidades de acesso à coluna lombar para quaisquer finalidades, como descompressão, fusão, ressecções tumorais, reconstrução ou correção de deformidades, independentemente do tipo de implante ou seu posicionamento.

Minimally Invasive Tibiotalocalcaneal Arthrodesis with Blocked Retrograde Intramedullary Nail - Report of Three Cases / Artrodese tibiotalocalcaneana minimamente invasiva com haste intramedular retrógrada bloqueada - Relato de três casos

Abstract Ankle osteoarthritis (AOA) is associated with pain and variable functional limitation, demanding clinical treatment and possible surgical indication when conservative measures are ineffective - arthrodesis has been the procedure of choice, because it reduces pain, restores joint alignment and makes the segment stable, preserving gait. The present study reports 3 cases (3 ankles) of male patients between 49 and 63 years old, with secondary AOA, preoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS) of 27 to 39 points, treated by minimally invasive tibiotalocalcaneal arthrodesis using blocked retrograde intramedullary nail. Hospital stay was of 1 day, and the patients were authorized for immediate loading with removable ambulation orthotics, as tolerated. The physical therapy treatment, introduced since hospitalization, was maintained, prioritizing gait training, strength gain, and proprioception. Clinical and radiographic follow-up was performed at weeks 1, 2, 6, 12 and 24. After evidence of consolidation (between the 6th and 10th weeks), the orthotics were removed. One patient complained of pain in the immediate postoperative period and, at the end of the 1st year, only one patient presented pain during rehabilitation, which was completely resolved with analgesics. Currently, the patients do not present complaints, returning to activities without restrictions - one of them, to the practice of soccer and rappelling. The postoperative AOFAS AHS was from 68 to 86 points.

Resumo A osteoartrite do tornozelo (OAT) está associada a quadro álgico e limitação funcional variável, demandando tratamento clínico e eventual indicação cirúrgica quando as medidas conservadoras são inefetivas - a artrodese tem sido o procedimento de escolha, por reduzir a dor, restaurar o alinhamento articular e tornar o segmento estável, preservando a marcha. O presente estudo relata 3 casos (3 tornozelos) de pacientes do sexo masculino, com entre 49 e 63 anos de idade, portadores de OAT secundária, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS, na sigla em inglês) pré-operatória de 27 a 39 pontos, tratados mediante artrodese tibiotalocalcaneana minimamente invasiva utilizando haste intramedular retrógrada bloqueada. A permanência hospitalar foi de 1 dia, e os pacientes foram autorizados para carga imediata com órteses removíveis para deambulação, conforme tolerado. O tratamento fisioterápico, introduzido desde o internamento, foi mantido, priorizando-se treino de marcha, ganho de força e propriocepção. Foi realizado acompanhamento clínico e radiográfico nas semanas 1, 2, 6, 12 e 24. Após evidências de consolidação (entre a 6ª e a 10ª semanas), as órteses foram retiradas. Um paciente queixou-se de dor no pós-operatório imediato e, ao final do 1° ano, apenas 1 paciente apresentou dor durante a reabilitação, resolvida completamente com analgésicos. Atualmente, os pacientes não apresentam queixas, retornando às atividades sem restrições - um deles, à prática de futebol e rapel. A AOFAS AHS pós-operatória foi de 68 a 86 pontos.

Tratamiento quirúrgico del pie reumático mediante artrodesis de la primera articulación metatarsofalángica y panresección metatarsal

Introducción: La artritis reumatoide resulta una enfermedad autoinmune, inflamatoria, crónica y progresiva, que afecta al aparato locomotor. Puede provocar deformidad, dolor y disminución de la función del pie. Su tratamiento puede ser conservador o quirúrgico. Objetivo: Demostrar la eficacia de la artrodesis de la primera articulación metatarsofalángica con la panresección metatarsal en el tratamiento quirúrgico del pie reumático. Presentación del caso: Se presentaron diez casos de pacientes con factor reumatoideo positivo, intervenidos mediante artrodesis de la primera articulación metatarsofalángica y panresección metatarsal. Se valoró el seguimiento posquirúrgico inmediato y al año de evolución. Tras la intervención se consiguió una media de satisfacción de la escala Likert de 9,3 y una media de la escala visual analógica de dolor de 2,0. Asimismo, disminuyeron considerablemente los ángulos hallux abductus valgus e intermetatarsal I-II. Conclusiones: La combinación de artrodesis de la primera articulación metatarsofalángica con la panresección metatarsal se aplica en este tipo de pacientes, ya que favorece la funcionabilidad del pie y aminora significativamente la sintomatología dolorosa.

Introduction: Rheumatoid arthritis is an autoimmune, inflammatory, chronic and progressive disease that affects the locomotor system. It can cause deformity, pain, and decreased function of the foot. The treatment can be conservative or surgical. Objective: To demonstrate the efficacy of arthrodesis of the first metatarsophalangeal joint with metatarsal panresection in the surgical treatment of the rheumatoid foot. Methods: Ten cases of patients with positive rheumatoid factor who underwent arthrodesis of the first metatarsophalangeal joint and metatarsal panresection were reported. Immediate post-surgical follow-up and one year of evolution were assessed. Results: After the intervention, a mean Likert scale satisfaction of 9.3 was achieved and a visual analogue pain scale mean of 2.0. Likewise, the hallux abductus valgus and intermetatarsal I-II angles decreased considerably. Conclusions: The combination of arthrodesis of the first metatarsophalangeal joint with metatarsal panresection is used in this type of patients, since it favors the functionality of the foot and significantly reduces painful symptoms.

Total Wrist Arthrodesis: A Preoperative Test to Predict Functional Outcomes / Artrodese total do punho: Um teste pré-operatório para prever resultados funcionais

Abstract Objective The study aims to demonstrate an evaluation method to predict the functional success of total wrist arthrodesis (TWA) and assist its indication. Methods A prospective study including ten patients submitted to (TWA) posttraumatic arthritis. Exclusion criteria were patients who lost postoperative follow-up or incomplete information in the medical record. The objective functional assessment (handgrip strength, three-point pinch, lateral pinch and pulp-pulp pinch) and the subjective functional assessment (DASH, PRWE, EVA) were evaluated in 3 different periods: (1) Before surgery without articular anesthesia, (2) Before surgery under articular anesthesia and (3) 12 weeks after the surgical procedure. Results There was an increase in handgrip strength in all three pinches measurements after pain relief, both after joint anesthesia and after the consolidation of the arthrodesis (p < 0.05). In the comparisons between the subjective evaluations (DASH, PRWE and VAS), the patients had better scores in the postoperative evaluation after 12 weeks (p < 0.05). There was no statistical difference when comparing the mean strength values found after anesthesia and after 12 weeks of TWA. Conclusion the outcomes could propose an assessment protocol for patients with indication for TWA, in which patients with good response to intra-articular anesthetic infiltration would benefit from the effects of the surgical procedure.

Resumo Objetivo O estudo tem como objetivo demonstrar um método de avaliação para predizer o sucesso funcional da artrodese total do punho (ATP) e auxiliar na sua indicação. Métodos Um estudo prospectivo incluindo dez pacientes submetidos a ATP por artrite pós-traumática. Os critérios de exclusão foram pacientes que perderam o acompanhamento pós-operatório ou informações incompletas no prontuário. A avaliação funcional objetiva (força de preensão manual, pinça de três pontos, pinça lateral e pinça polpa-a-polpa) e a avaliação funcional subjetiva (DASH, PRWE, EVA) foram avaliadas em 3 momentos diferentes: (1) Antes da cirurgia sem anestesia articular, (2) Antes da cirurgia sob anestesia articular e (3) 12 semanas após o procedimento cirúrgico. Resultados Houve aumento da força de preensão palmar nas três medidas de pinça após o alívio da dor, tanto após a anestesia articular quanto após a consolidação da artrodese (p < 0,05). Nas comparações entre as avaliações subjetivas (DASH, PRWE e VAS), os pacientes tiveram melhores escores na avaliação pós-operatória após 12 semanas (p < 0,05). Não houve diferença estatística ao comparar os valores médios de força encontrados após a anestesia e após 12 semanas de ATP.

Comparative Analysis Between Isolated Posterior and Anteroposterior Approaches for Severe Scoliosis Treatment / Análise comparativa entre as abordagens cirúrgicas por via posterior isolada e por via anteroposterior para tratamento de escoliose severa

Abstract Objective To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications

Resumo Objetivo Analisar comparativamente as abordagens cirúrgicas por via posterior isolada e dupla abordagem para tratamento da escoliose severa. Métodos Analisou-se retrospectivamente prontuários de 32 pacientes com escoliose de valor angular > 70° submetidos a tratamento cirúrgico em hospital terciário entre 2009 e 2019. Dividiu-se estes pacientes em dois grupos: Grupo VP com 17 pacientes submetidos a artrodese por via posterior isolada (VP) e Grupo VAP com 15 pacientes abordados por via anterior e posterior (VAP). O Grupo VP apresentou 16 pacientes do sexo feminino e 1 do masculino, com idade média de 16,86 anos. No grupo VAP, 10 pacientes do sexo feminino e 5 do masculino, com idade média de 17,71 anos. Os ângulos de Cobb foram mensurados por único cirurgião de coluna, manualmente, em radiografias panorâmicas, em ortostase no pré- e pós-operatório. Foram avaliados também peso, altura pré- e pós-operatória e duração do procedimento. Resultados No Grupo VP, o ângulo de Cobb pré-operatório e pós-operatório, verificados na curva principal, foram respectivamente 96,06° ± 8,45° e 52,27 ± 15,18°, apresentando taxa média de correção de 0,54 ± 0,16. No grupo VAP, esses valores foram de 83,12° ± 11,60° para o ângulo de Cobb pré-operatório, 48,53 ± 10,76, pós-operatório, com a taxa de correção da curva principal de 0,58 ± 0,11. Conclusão As duas formas de abordagem cirúrgica para tratamento de escoliose severa se equiparam quanto à taxa de correção da deformidade. Portanto, o acesso posterior isolado apresenta vantagem em relação a dupla via, baseado no menor tempo cirúrgico, menor tempo de internação e menos risco de complicações

Evaluación funcional y de calidad de vida en el seguimiento de pacientes con artropatía de Charcot tratados mediante artrodesis de tobillo con clavo centromedular retrógrado bloqueado / Functional evaluation and quality of life in the follow-up of patients with Charcot arthropathy treated by ankle arthrodesis with a locked retrograde nail

Resumen: Introducción: la artropatía de Charcot es una condición incapacitante, no infecciosa, progresiva, que se caracteriza por destrucción ósea y articular en pacientes con neuropatía sensorial. En casos avanzados, en los que se tiene deformidad severa e inestabilidad de tobillo, se requieren procedimientos más invasivos como la artrodesis de tobillo con clavo centromedular retrógrado bloqueado. Se desconoce si en estos pacientes las puntuaciones de la valoración funcional postquirúrgica con la escala de AOFAS (American Orthopaedic Foot and Ankle Society) correlaciona con las puntuaciones de la escala de calidad de vida medida con el test EuroQol-5D y las posibles complicaciones postquirúrgicas. Material y métodos: se trata de un ensayo autocontrolado de práctica clínica habitual, cuasiexperimental, longitudinal y prospectivo con recolección ambispectiva (retrospectiva y prospectiva) de datos para evaluar los resultados funcionales y de calidad de vida a un año de seguimiento de los pacientes con artropatía de Charcot tratados mediante artrodesis de tobillo con clavo centromedular retrógrado bloqueado del 1 de Enero de 2010 al 1 de Noviembre de 2018. Resultados: la consolidación se logró en nueve casos de un total de 11 pacientes para una tasa de éxitos de 81.8% y únicamente dos casos (18.2%) en los cuales no se observó consolidación. Las escalas de AOFAS y EuroQol-5D se correlacionaron positivamente de acuerdo con la correlación de Pearson. Conclusiones: las escalas de AOFAS y EuroQol-5D se correlacionan positivamente, obteniéndose 45 y 63% con resultados aceptables y satisfactorios respectivamente en ambas escalas.

Abstract: Introduction: Charcot's arthropathy is a disabling non-infectious, progressive condition characterized by bony and articular destruction in patients with sensory neuropathy. In advanced cases with deformities and ankle instability, it requires a more invasive treatment as an ankle fusion with a retrograde locked intramedullary nail. It is unknown if, in these patients, the functional results of AOFAS (American Orthopaedic Foot and Ankle Society) correlate with the quality of life ones from the EuroQol-5D test and the possible postoperative complications. Material and methods: the design is experimental, longitudinal prospective with ambispective data analysis (retrospective and prospective) to evaluate the functional results and life quality with a year of following patients with Charcot's arthropathy diagnosis treated with a retrograde locked nail from January 1, 2010, to November 1, 2018. Results: this study resulted in complete consolidation from nine out of 11 cases, with a success rate of 81.2%, and only two cases (18.2%) developed nonunion. AOFAS and EuroQol-5D tests correlate positively in agreement with the Pearson correlation. Conclusions: AOFAS and EuroQol-5D correlate positively, having a 45 and 63% of acceptable and satisfactory results, respectively, for both tests.

Preliminary application of self-designed posterior reduction forceps for atlantoaxial dislocation in treatment of irreducible atlantoaxial dislocation / 中华创伤骨科杂志

Objective:To evaluate the preliminary clinical application of our self-designed posterior reduction forceps for atlantoaxial dislocation in the reduction and fixation of irreducible atlantoaxial dislocation with simple posterior screw-rod system.Methods:Our posterior reduction forceps was self-designed and developed to assist simple posterior screw-rod system in the treatment of irreducible atlantoaxial dislocation based on the posterior atlantoaxial screw-rod system. A retrospective study was conducted to analyze the clinical data of 5 patients with irreducible atlantoaxial dislocation who had been treated from January 2021 to October 2022 at Department of Spine Surgery, General Hospital of Southern Theatre Command of PLA with our self-designed posterior reduction forceps. There were 2 males and 3 females, aged 53, 62, 45, 32 and 48 years, respectively. Diagnosis: 1 case of free odontoid process combined with atlantoaxial dislocation, 2 cases of atlantoaxial dislocation, and 2 cases of old odontoid process fracture combined with atlantoaxial dislocation. Respectively, their preoperative Japanese Orthopaedic Association (JOA) scores were 9, 11, 12, 13 and 10 points and their atlanto-dental intervals (ADI) 9.8, 7.4, 6.6, 6.4 and 8.5 mm. Postoperatively, atlantoaxial reduction and spinal cord compression were evaluated by X-ray, CT, and MRI examinations, and internal fixation, atlanto-axial sequence, and bone graft fusion by X-ray and CT examinations. One week after surgery, the JOA scores were used to evaluate the patients' neurological function and the ADI was measured to evaluate the atlantoaxial reduction.Results:The surgery was successfully performed in the 5 patients, with no intraoperative complications like neurovascular injuries to the spinal cord. The postoperative atlantoaxial reduction was satisfactory, the position of internal fixation was good, the compression to the spinal cord was relieved, and the clinical symptoms were significantly improved. At 1 week after surgery, respectively, the JOA score: 13, 14, 14, 15 and 13; the ADI: 2.6, 2.1, 1.8, 1.5 and 2.2 mm; the follow-up time: 3, 6, 12, 9 and 6 months; the bone fusion time: 3, 3, 6, 6 and 3 months. Follow-ups revealed no loosening or fracture of internal fixation, good atlanto-axial sequence, and no recurrence of dislocation.Conclusion:Our self-designed posterior reduction forceps for atlantoaxial dislocation can assist the simple posterior screw-rod system to treat irreducible atlantoaxial dislocation, leading to good preliminary clinical outcomes.

Effectiveness comparison of supramalleolar osteotomy and ankle arthrodesis in treatment of inverted ankle osteoarthritis in Takakura 3A stage with talus tilt / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of supramalleolar osteotomy (SMOT) and ankle arthrodesis (AA) in the treatment of inverted ankle osteoarthritis (OA) in Takakura 3A stage with talus tilt.@*METHODS@#The clinical data of 41 patients with inverted ankle OA in Takakura 3A stage with talus tilt admitted between January 2016 to January 2020 and met the selection criteria were retrospectively analyzed, and they were divided into SMOT group (21 cases) and AA group (20 cases) according to the surgical method. There was no significant difference in baseline data such as gender, age, affected side, cause of injury, and preoperative talar tilt angle (TT), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, short-form 36 health survey scale (SF-36) score, and sagittal range of motion (ROM) between the two groups ( P>0.05). The operation time, intraoperative blood loss, partial weight-bearing time, and complications were recorded in the two groups. AOFAS ankle-hindfoot score, VAS score, SF-36 score, and sagittal ROM were used to evaluate the effectiveness. Bone healing was observed and the time of bony healing was recorded. In the SMOT group, the tibial lateral surface angle (TLS), TT, and the tibial articular surface angle (TAS) were measured on ankle joint weight-bearing anteroposterior and lateral X-ray films and compared with those before operation. And Takakura staging assessment was also performed.@*RESULTS@#The operation time and intraoperative blood loss in AA group were significantly less than those in SMOT group ( P<0.05). Patients in both groups were followed up 24-36 months, with an average of 28.9 months. Incision infection occurred in 2 patients in SMOT group and 1 patient in AA group, respectively, and no vascular or nerve injury occurred in both groups. The partial weight-bearing time of SMOT group was significantly less than that of AA group ( P<0.05), but there was no significant difference in bony healing time between the two groups ( P>0.05). At last follow-up, the difference of VAS score and SF-36 score before and after operation of AA group were less than those of SMOT group, and the difference of sagittal ROM before and after operation in SMOT group was less than that of AA group, with significant differences ( P<0.05). The difference of AOFAS ankle-hindfoot score before and after operation in AA group was slightly greater than that in SMOT group, but the difference was not significant ( P>0.05). The above scores in both groups significantly improved when compared with those before operation ( P<0.05). Sagittal ROM in AA group was significantly less than that before operation ( P<0.05), while there was no significant difference in SMOT group ( P>0.05). In the SMOT group, 17 patients (81.0%) showed improvement in imaging staging, 2 patients (9.5%) showed no improvement in staging, and 2 patients (9.5%) showed stage aggravation. TLS, TAS, and TT significantly improved when compared with those before operation ( P<0.05). At last follow-up, 2 patients in SMOT group received AA due to pain and stage aggravation, and 1 patient with bone nonunion underwent bone graft. Subtalar joint fusion was performed in 1 case of subtalar arthritis in AA group.@*CONCLUSION@#For inverted ankle OA in Takakura 3A stage with talus tilt, both SMOT and AA can significantly releave pain, improve foot function and quality of life, but AA has more definite effectiveness and better patient satisfaction.

Traitement chirurgical du Mal de Pott et de ses séquelles au Centre Hospitalier de l'Ordre de Malte Dakar / Surgical treatm ent of Pott's diseaseand its sequelae at the Hospital of the Order of Malta/Daka

Introduction. Evaluer les résultats du traitement chirurgical du Mal de Pott et de ses séquelles au Centre hospitalier de l'ordre de Malte de Dakar. Patients et méthodes. Nous présentons les résultats préliminaires d'une série consécutive de 23 patients (13 hommes et 10 femmes) d'âge moyen de 32,35 ans [6 ­70 ans] présentant des Maux de Pott ou de leurs séquelles nécessitant un traitement chirurgical. L'échelle d'incapacité d'Oswestry, l'échelle visuelle analogique et le score ASIA ont été utilisés pour l'évaluation clinique. Les radiographies pré opératoires, post opératoires et au recul ont été utilisés pour les résultats anatomiques. Tous ces patients ont été opérés selon trois stratégies opératoires sur une période de 67 mois (Avril 2014- Novembre 2019). Nous avons réalisé une laminectomie arthrodèse postérieure dans 52,2% ; une laminectomie plus OTP et arthrodèse postérieure dans 43,5% ; une discectomie et hémicorporectomie avec arthrodèse antérieure par plaque vissée de Roy Camille à l'étage cervical dans 4,3%. Résultats. La symptomatologie était dominée par la douleur rachidienne, la cyphose et les troubles neurologiques. La cyphose post opératoire était significativement améliorée (la moyenne passe de 48,52° en pré opératoire à 17,09° en post opératoire). On a obtenu 100% de fusion vertébrale. On note une nette amélioration de la douleur rachidienne (avec une baisse au recul de 55,44 points pour l'OID et de 5,66 pour l'EVA) ; 78,3% des patients étaient très satisfaits, 17,4% satisfaits et 4,3% mécontents. Conclusion. Le traitement chirurgical du Mal de Pott et de ses séquelles a fortement amélioré les rachis au Centre hospitalier de l'Ordre de Malte.

Introduction. To evaluate the results of the surgical treatment of Pott's disease and its sequelae at the Hospital Center of the Order of Malta in Dakar. Patients and methods. We present the preliminary results of a consecutive series of 23 patients (13 men and 10 women) with an average age of 32.35 years [6-70 years] presenting with Pott's disease or its sequelae requiring treatment. surgical treatment. Oswestry Disability Scale, Visual Analogue Scale and ASIA score were used for clinical assessment. Preoperative, postoperative and followup radiographs were used for anatomical results. All these patients were operated according to three operating strategies over a period of 67 months (April 2014- November 2019). We performed posterior laminectomy-arthrodesis in 52.2%; laminectomy plus OTP and posterior arthrodesis in 43.5%; discectomy and hemicorpectomy with anterior arthrodesis by Roy Camille screwed plate at the cervical level in 4.3%. Results. The symptomatology was dominated by spinal pain, kyphosis and neurological disorders. Postoperative kyphosis was significantly improved (the average goes from 48.52° preoperatively to 17.09° postoperatively). We got 100% spinal fusion. There is a clear improvement in spinal pain (with a drop at follow-up of 55.44 points for the OID and 5.66 for the EVA); 78.3% of patients were very satisfied, 17.4% satisfied and 4.3% dissatisfied. Conclusion. The surgical treatment of Pott's disease and its sequelae greatly improved the spines at the Hospital Center of the Order of Malta.

Thoracolombar burst fractures: short fixation, without arthrodesis and without removal of the implant / Fratura toracolombar explosão: fixação curta, sem artrodese e sem a retirada do implante

ABSTRACT Objectives: To present the functional outcomes, through the first case series in our country, of patients with thoracolumbar burst fractures (A3,A4), submitted to short posterior fixation, without arthrodesis and without removal of the implants, until the end of the minimum follow-up of one year. Methods: Fifty five patients consecutively treated between January/2010 and January/2019 were evaluated through medical records and imaging exams. Radiographic analysis was performed by mea suring local and segmental kyphosis using the Cobb method. Functional assessment was analyzed using the non-specific SF-36 questionnaire and the 1983 Denis pain and work-specific questionnaire, applied after 12 months of follow-up. Results: With a loss of five patients (9%), 22 (44%) patients reported having minimal and occasional pain and 8 (16%) patients reported having no pain. Three (6%) patients responded that they were completely incapacitated. Patients had a mean score of 73.16 points in the SF-36 domains. There was a significant reduction in kyphosis in 12 months (9.1±5.2 [min-max 0-22]) compared to the preoperative period (14.9±7.8 [min-max 0-32]) ( p≤0.01). One patient required implant removal due to the symptomatic prominence of the implant. Conclusion: This case series suggests that the technique leads to satisfactory functional results, without implant failure or significant kyphosis after a minimum follow-up of 12 months of treatment. Evidence Level IV; Case series.

RESUMO Objetivo: Apresentar os desfechos funcionais, mediante primeira série de casos no nosso meio, de pacientes com fratura toracolombar do tipo explosão (A3, A4), submetidos a fixação posterior curta, sem artrodese e sem retirada dos implantes, até o final do acompanhamento mínimo de um ano. Métodos: Foram avaliados, por meio de prontuários e exames de imagem, 55 pacientes consecutivamente tratados entre Janeiro/2010 e Janeiro/2019. A análise radiográfica foi realizada medindo a cifose local e segmentar, pelo método de Cobb. A avaliação funcional analisada por meio do questionário inespecífico SF-36 e questionário específico de dor e trabalho de Denis de 1983, aplicados após os 12 meses de seguimento. Resultados: Com perda de cinco pacientes (9%), 22 (44%) pacientes relataram ter dor mínima e ocasional e 8 (16%) pacientes responderam não ter dor. Três (6%) pacientes responderam que estavam completamente incapacitados. Os pacientes tiveram uma pontuação média de 73,16 pontos nos domínios do SF-36. Houve redução significativa da cifose em 12 meses (9,1±5,2 [min-máx 0-22]) na comparação com o pré-operatório (14,9±7,8 [min-máx 0-32]) (p≤0,01). Um paciente necessitou de retirada do implante em razão da proeminência sintomática do implante. Conclusão: Esta série de casos sugere que a técnica leva a resultados funcionais satisfatórios, sem falha do implante ou cifose pós-traumática após acompanhamento mínimo de 12 meses de tratamento. Nível de Evidência IV; Série de casos.

Neurological recovery after surgical treatment in patients with thoracolumbar trm / Recuperação neurológica após tratamento cirúrgico em pacientes com trm toracolombar / Recuperación neurológica después de del tratamiento quirúrgico en pacientes con lme toracolumbar

ABSTRACT Objective: Evaluate the neurological recovery with a follow-up of 06 (six) months in victims of thoracic and lumbar fractures who underwent spinal decompression in less than 24 hours, between 24 and 48 hours, and more than 48 hours after the trauma. Methods: Data were collected on patients seen at a large public hospital in Belo Horizonte, between 2014 and 2018, who were victims of SCI who presented with neurological deficits at initial care, and the neurological recovery presented. Results: 41 SCI patients were evaluated, whose mean age was 34 years. There was a predominance of thoracic spine fractures (65.9% of the cases) and classified as AO Spine type C (75%). Regarding the time variable, about 68% of the patients were submitted to surgical treatment more than 48 hours after the trauma. It was observed that both the patients submitted to surgical decompression within less than 24 hours, and those operated on more than 48 hours after the trauma showed a slight neurological improvement at the 6-month follow-up. However, no statistical significance was found. It is worth noting that even when analyzing the 41 patients of the study, regardless of the surgical interval, it was impossible to observe a statistically significant neurological improvement at the 6-month follow-up. Conclusion: Our study could not demonstrate significant differences between those patients who operated early in less than 24 hours and those who operated after more than 48 hours. Level of Evidence III; Comparative retrospective study.

Resumo: Objetivo: Avaliar a recuperação neurológica com um acompanhamento de 06 (seis) meses em vítimas de fraturas torácicas e lombares submetidos a descompressão medular em menos de 24 horas, entre 24 e 48 horas e em mais de 48 horas do trauma. Métodos: Foram coletados dados relativos a pacientes atendidos em hospital público de grande porte de Belo Horizonte, no período de 2014 e 2018, vítimas de TRM que apresentavam déficits neurológicos no atendimento inicial, e a recuperação neurológica apresentada. Resultados: Foram avaliados 41 pacientes vítimas de TRM, cuja idade média foi de 34 anos. Observou-se predomínio de fraturas na coluna torácica (65.9% dos casos) e classificadas como AO Spine tipo C (75%). Em relação a variável tempo cerca de 68% dos pacientes foram submetidos a tratamento cirúrgico com mais de 48h decorridas do trauma. Observou-se que tanto nos pacientes submetidos a descompressão cirúrgica com menos de 24h quanto nos operados com mais de 48h após o trauma houve discreta melhora neurológica no follow-up de 6 meses. Não foi constatada, todavia, significância estatística. Cabe destacar ainda que mesmo analisando o conjunto dos 41 pacientes do estudo, independente do intervalo cirúrgico, não foi possível constatar melhora neurológica com significância estatística na reavaliação de 6 meses. Conclusão: Nosso trabalho não conseguiu demonstrar diferenças significativas entre aqueles pacientes operados precocemente em menos de 24 horas daqueles operados em mais de 48 horas. Nível de evidência III; Estudo retrospectivo comparativo.

Resumen: Objetivo: Evaluar la recuperación neurológica con un acompañamiento de 06 meses en víctimas de fracturas torácicas y lumbares sometidos a la descompresión medular en menos de 24 horas, entre 24 y 48 horas y en más de 48 horas del trauma. Métodos: Se recogieron datos de pacientes atendidos en un gran hospital público de Belo Horizonte, en el período de 2014 y 2018, víctimas de TRM que presentaban déficits neurológicos en el atendimiento inicial y la recuperación neurológica presentada. Resultados: Fueron evaluados 41 pacientes víctimas de TRM, cuya edad media fue de 34 años. Se ha observado una preponderancia de fracturas en la columna torácica (65.9% de los casos) y clasificadas como AO Spine tipo C (75%). En relación a la variable tiempo, un 68% de los pacientes fueron sometidos al tratamiento quirúrgico con más de 48h transcurridas del trauma. Se ha observado que tanto en los pacientes sometidos a la descompresión quirúrgica con menos de 24 horas cuanto en los operados con más de 48h tras el trauma hubo discreta mejora neurológica en "follow-up" de 6 meses. No fue averiguada, sin embargo, significancia estadística. Conviene resaltar todavía que, aunque analizando el conjunto de los 41 pacientes de estudio, independiente del intervalo quirúrgico, no fue posible observar mejora neurológica con significancia estadística en la revaluación de 6 meses. Conclusión: Nuestro trabajo no consiguió demostrar diferencias significativas entre aquellos pacientes operados tempranamente en menos de 24 horas de aquellos operados en más de 48 horas. Nivel de Evidencia III; Estudio retrospectivo comparativo.

Thoracic-lumbar arthrodesis via extreme lateral approach: a retrospective study / Artrodese com abordagem extremo lateral da coluna toracolombar: um estudo retrospectivo / Artrodesis por abordaje lateral extremo de la columna torácico-lumbar: un estudio retrospectivo

ABSTRACT: Objective: To evaluate the epidemiological, clinical, and radiological data of patients treated with XLIF, including the impact on quality of life, pain parameters, and improvement of lumbar lordosis. Methods: Retrospective longitudinal study, in which medical records of patients who underwent XLIF between 2017 and 2020 at Hospital do Trabalhador/UFPR were reviewed. Demographic characteristics and radiological aspects, such as the Cobb angle, were recorded. Clinical characteristics using parameters such as pain by VAS and the disability index by ODI were evaluated before surgery and 12 months after. Results: Female patients predominated (66.7%), with a mean age of 59.1 years (35-82 years). The length of stay, in the median, was three days, and the time to return to daily activities was three months. Only four patients (8.9%) had complications. The questionnaire analysis showed a significant difference between all scales' pre and postoperative scores. The ODI showed an average reduction of 39.2%, and the median score of VAS in the postoperative period was half the preoperative period (reduction of 50%; p <0.001). The lordosis angle increased by 26.3% in the postoperative period (p <0.001). Conclusion: XLIF presents low complication rates, improves lumbar lordosis, and allows recovery from daily activities in a short period, in addition to performing a statistically significant improvement in quality of life and pain according to the VAS and ODI scales, being, therefore, a viable and effective treatment technique. Level of Evidence II; Retrospective Study.

RESUMO: Objetivo: Avaliar o perfil epidemiológico dos pacientes tratados com a XLIF, dados clínicos e radiológicos, incluindo o impacto na qualidade de vida, parâmetros de dor e melhora da lordose lombar. Métodos: Estudo longitudinal retrospectivo, em que foram revisados prontuários de pacientes submetidos à XLIF entre 2017 e 2020 no Hospital do Trabalhador/UFPR. Foram registrados os aspectos demográficos, características clínicas através de parâmetros como dor pela EVA e o índice de incapacidade pelo ODI, aspectos radiológicos incluindo o ângulo de Cobb antes da cirurgia e 12 meses após. Resultados: Predominou o sexo feminino (66,7%), com média de idade de 59,1 anos (35-82 anos). O tempo de internação, em mediana, foi de 3 dias e o tempo de retorno às atividades diárias foi de 3 meses. Apenas quatro pacientes (8,9%) apresentaram complicações. A análise através de questionários demonstrou diferença significativa entre as pontuações pré e pós-operatórias em todas as escalas. No ODI, houve redução média na pontuação de 39,2% e na EVA, a pontuação mediana no pós operatório foi a metade da pontuação no pré-operatório (redução de 50%; p<0,001). O ângulo da lordose teve aumento de 26,3% no pós-operatório em relação ao valor basal (p<0,001). Conclusão: A XLIF apresenta baixos índices de complicação, melhora da lordose lombar e permite a recuperação às atividades diárias em curto período de tempo, além de desempenhar melhora estatisticamente significativa na qualidade de vida e no quadro álgico segundo as escalas EVA e ODI, sendo, portanto, uma técnica viável e eficaz de tratamento. Nível de Evidência II; Estudo Retrospectivo.

RESUMEN: Objetivo: Evaluar los datos epidemiológicos, clínicos y radiológicos de los pacientes tratados con XLIF, incluyendo el impacto en la calidad de vida, los parámetros de dolor y la mejoría de la lordosis lumbar. Métodos: Estudio longitudinal retrospectivo, revisando las historias clínicas de los pacientes que se sometieron a XLIF entre 2017 y 2020 en el Hospital do Trabalhador/UFPR. Se registraron características demográficas y radiológicas, como el ángulo de Cobb. Se evaluaron las características clínicas mediante parámetros como el dolor por EVA y el índice de discapacidad por ODI antes de la cirugía y 12 meses después. Resultados: Predominó el sexo femenino (66,7%), con una edad media de 59,1 años (35-82 años). La duración de la estancia, en promedio, fue de 3 días y el tiempo para volver a las actividades diarias fue de 3 meses. Solo cuatro pacientes (8,9%) presentaron complicaciones. Los cuestionarios mostraron una diferencia significativa entre las puntuaciones pre y postoperatorias. El ODI mostró una reducción media del 39,2% y la puntuación media de la EVA en el postoperatorio fue la mitad de la puntuación en el preoperatorio (p <0,001). El ángulo de lordosis aumentó un 26,3% en el postoperatorio (p <0,001). Conclusiones: XLIF presenta bajas tasas de complicaciones, mejora la lordosis lumbar y permite la recuperación de las actividades diarias en un corto período de tiempo, con una mejora estadísticamente significativa en la calidad de vida y el dolor según EVA y ODI, siendo una técnica de tratamiento viable y eficaz. Nivel de evidencia IV; Estudio Retrospectivo.

Anterior lumbar interbody fusion (alif): epidemiological and radiological profile / Artrodese lombar anterior: perfil epidemiológico, radiológico / Artrodesis lumbar anterior: perfil epidemiológico, radiológico

ABSTRACT: Objective: Evaluate the epidemiological and radiographic data of patients submitted to the Anterior Lumbar Interbody Fusion (ALIF) technique and the possible complications related to this procedure. Methods: A longitudinal and retrospective study was carried out to analyze electronic medical records and image files of patients who underwent spinal surgery using the ALIF technique between February 2019 and January 2021. Epidemiological data such as age, gender, and level of surgery were analyzed. Radiographic evaluations of lumbar lordosis from L1 to S1 were performed using the COBB technique and the anterior and posterior height of the disc space. The presence of intraoperative and postoperative complications in the patients was analyzed. Results: Initially, 70 patients were analyzed. The most prevalent operated level was L5-S1. The length of stay of the patients varied between 36 and 72 hours. Intraoperative bleeding ranged from 20mL to 400mL. Three patients had significant venous lesions. Differences between anterior and posterior lordosis and height measurements were significant (p < 0.001). Lordosis had a mean increase of 10.3°, anterior height had a mean increase of 7.9mm, and posterior height of 4.0mm. Six cases of intra and postoperative complications were observed. Conclusion: The patients showed improvement in the radiological parameters of the anterior and posterior height of the vertebral discs, with a significant increase in lumbar lordosis. Complication rates were 9.8%, and we had a short hospital stay. Level of Evidence II; Retrospective Longitudinal Study.

RESUMO: Objetivo: Avaliar os dados epidemiológicos e radiográficos de pacientes submetidos à técnica de Artrodese Lombar Anterior (ALIF) e avaliar as possíveis complicações relacionadas a este procedimento. Métodos: Realizou-se um estudo longitudinal e retrospectivo com análise dos prontuários eletrônicos e arquivos de imagem dos pacientes submetidos a cirurgia da coluna pela técnica de ALIF, no período entre fevereiro de 2019 e janeiro de 2021. Dados epidemiológicos como idade, sexo e nível de cirurgia foram analisados. Foram feitas avaliações radiográficas da lordose lombar de L1 a S1 através da técnica de COBB e da altura anterior e posterior do espaço discal. Foram analisados a presença de complicações intra e pós-operatórias dos pacientes. Resultados: Foram analisados inicialmente 70 pacientes. O nível operado mais prevalente foi L5-S1. O tempo de internamento dos pacientes variou entre 36 e 72 horas. O sangramento intraoperatório variou de 20mL a 400mL. Três pacientes apresentaram lesões venosas importantes. As diferenças entre as medidas de lordose e altura anterior e posterior foram significativas (p < 0,001). A lordose teve aumento médio de 10,3°, a altura anterior teve aumento médio de 7,9mm e a altura posterior de 4,0mm. Foram observados 06 casos de complicações intra e pós-operatórias. Conclusão: Os pacientes apresentaram melhora nos parâmetros radiológicos de altura anterior e posterior dos discos vertebrais, com um aumento da lordose lombar significativo. As taxas de complicações foram de 9,8 % e tivemos um curto período de internação hospitalar. Nível de Evidência II; Estudo Longitudinal e Retrospectivo.

RESUMEN: Objetivo: Evaluar los datos epidemiológicos y radiográficos de pacientes sometidos a la técnica de Artrodesis Lumbar Anterior (ALIF) y evaluar las posibles complicaciones relacionadas con este procedimiento. Métodos: Se realizó un estudio longitudinal y retrospectivo con análisis de historias clínicas electrónicas y archivos de imágenes de pacientes intervenidos de columna vertebral mediante la técnica ALIF, en el período comprendido entre febrero de 2019 y enero de 2021. Datos epidemiológicos como edad, sexo y nivel quirúrgico fueron analizados. Las evaluaciones radiográficas de la lordosis lumbar de L1 a S1 se realizaron mediante la técnica COBB y la altura anterior y posterior del espacio discal. Se analizó la presencia de complicaciones. Resultados: Se analizaron 70 pacientes. El nivel operado más prevalente fue L5-S1. El tiempo de estancia de los pacientes varió entre 36 y 72 horas. El sangrado intraoperatorio osciló entre 20 ml y 400 ml. Tres pacientes tenían lesiones venosas importantes. Las diferencias entre la lordosis anterior y posterior y las medidas de altura fueron significativas (p < 0,001). La lordosis tuvo un aumento medio de 10,3°, la altura anterior tuvo un aumento medio de 7,9 mm y la altura posterior de 4,0 mm. Se observaron seis casos de complicaciones intra y postoperatorias. Conclusiones: Los pacientes mostraron mejoría en los parámetros radiológicos de altura anterior y posterior de los discos vertebrales, con aumento significativo de la lordosis lumbar. Las tasas de complicaciones fueron del 9,8% y hubo una corta estancia hospitalaria. Nivel de Evidencia II; Estudio Longitudinal y Retrospectivo.

Tibiocalcaneal arthrodesis: a comparison of anterior approach and transfibular approach / Artrodese tibiocalcaneana: comparação entre abordagem anterior e a abordagem transfibular

ABSTRACT Objective: The aim of this study was to evaluate the clinical and radiologic results and complications of patients who underwent ankle arthrodesis performed by the transfibular approach and anterior approach in end-stage ankle osteoarthritis. Methods: Between 2016 and 2022, 41 patients who satisfied the inclusion criteria for this retrospective comparative analysis were included. Of them, 19 patients are included in the anterior approach group and 22 patients are included in the transfibular approach group. The mean age of the participants is 58.9 years. Collected data included the BMI, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale, visual analogue scale (VAS) score, diabetes, smoking, time to fusion, nonunion, union rate, preoperative and postoperative coronal tibiotalar angle and complications. Result: The mean time to bone union was 14.3 weeks (range 11-17 weeks) in the anterior approach group, and 11.3 weeks in the transfibular approach group. Statistically significant difference was found between the two groups. Nonunion occurred in one case in the transfibular approach group and three cases in the anterior approach group. There was no significant difference in the nonunion rate between the both groups (p = 0.321). VAS score, and AOFAS score of the two groups were similar and no significant differences were found (p = 0.491, p = 0.448, p = 0.146, p = 0.073, p = 0.173, p = 0.506, respectively). Conclusions: A stable and firm ankle arthrodesis and plantigrade foot can be achieved with both transfibular approach and anterior approach technique. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Avaliar os resultados clínicos e radiológicos e as complicações de pacientes submetidos à artrodese de tornozelo realizada por abordagem transfibular e abordagem anterior em fase terminal de osteoartrite de tornozelo. Métodos: Foram incluídos 41 pacientes atendidos entre 2016 e 2022 que satisfizeram os critérios de inclusão para esta análise comparativa retrospectiva. Destes, 19 incluídos no grupo de abordagem anterior e 22 no grupo de abordagem transfibular. A média de idade foi de 58,9 anos. Os dados coletados incluíram o índice de massa corporal (IMC), a escala de retropé da American Orthopedic Foot and Ankle Society (AOFAS), o escore da escala visual analógica (EVA), assim como a presença de diabetes, tabagismo, tempo de fusão, não união, taxa de união, ângulo tibiotalar coronal pré e pós-operatório e complicações. Resultado: O tempo médio de consolidação óssea foi de 14,3 semanas (variação de 11 a 17 semanas) no grupo de abordagem anterior e 11,3 semanas no grupo de abordagem transfibular. Foi encontrada diferença estatisticamente significante entre os dois grupos. A consolidação não ocorreu em um caso no grupo de abordagem transfibular e em três casos no grupo de abordagem anterior. Não houve diferença significativa na taxa de não consolidação entre os dois grupos (p = 0,321). Os escores nas escalas EVA e AOFAS dos dois grupos foram semelhantes, não sendo encontradas diferenças significativas (p = 0,491, p = 0,448, p = 0,146, p = 0,073, p = 0,173, p = 0,506, respectivamente). Conclusões: Uma artrodese estável e firme do tornozelo e um pé plantígrado podem ser obtidos tanto com a abordagem transfibular quanto com a técnica de abordagem anterior. Nível de Evidência III, Estudo Comparativo Retrospectivo.

Anatomy of the great vessels by magnetic resonance in anterior lumbar interbody fusion / Anatomia dos grandes vasos por ressonância magnética na fusão intersomática lombar anterior / Anatomía de los grandes vasos por resonancia magnética en fusión intersomática lumbar anterior

ABSTRACT: Objective: To perform an analysis of the anatomy of the great vessels relevant to the access for anterior lumbar interbody fusion (ALIF), determining the level of their bifurcation, the distance between the iliac vessels at L5-S1, the morphological configuration of the left iliac vein and the presence of fatty tissue between the vessel and the disc. Methods: Two hundred magnetic resonance imaging (MRI) scans of the lumbar spine of patients (18-80 years old) were evaluated using axial, coronal, and sagittal cuts at levels L1-S1 in T2 weighting. The interiliac distance was defined as the measurement between the left iliac vein and the right iliac artery. The presence of fatty tissue was defined as the identification of space between the vessel and the disc. Vessel morphology was divided into oval and flat. Results: The population's average age was 49.6 years, with 52% being female. The average interiliac distance at L5-S1 was 27.48mm. The bifurcation of the aorta artery was identified at the level of L4 in 56.3%, as well as the confluence of the iliac veins (37.2%). The left iliac vein was identified as oval in 69% of patients and flat in 31% of patients. Fat tissue was evidenced in 60.5% of the exams. Conclusion: As a routine preoperative examination and surgical planning, lumbar MRI is fundamental in investigating the anatomy regarding anterior approach surgeries, allowing an effective assessment of the relationships between the great vessels and the lumbar spine. Level of Evidence IV; Retrospective Investigation.

RESUMO: Objetivo: Realizar uma análise da anatomia dos grandes vasos relevantes ao acesso para fusão intersomática lombar anterior (ALIF), determinando o nível de sua bifurcação, a distância entre os vasos ilíacos em L5-S1, a configuração morfológica da veia ilíaca esquerda e a presença de tecido gorduroso entre o vaso e o disco. Métodos: duzentos exames de ressonância magnética (RM) da coluna lombar de pacientes (18-80 anos) foram avaliados, utilizando cortes axiais, coronais e sagitais nos níveis L1-S1, na ponderação T2. A distância interilíaca foi definida como a medida entre a veia ilíaca esquerda e artéria ilíaca direita. A presença de tecido gorduroso foi definida como identificação de espaço entre o vaso e o disco. A morfologia do vaso foi dividida em oval e plana. Resultados: A idade média da população foi de 49,6 anos, sendo 52% mulheres. A distância média interilíacas em L5-S1 foi 27,48 mm. A bifurcação da artéria aorta foi identificada ao nível de L4 em 56,3%. A confluência das veias ilíacas também foi mais frequente ao nível de L4, representando 37,2%. A veia ilíaca esquerda foi identificada com o formato oval em 69% e plana em 31% dos pacientes. Tecido gorduroso foi evidenciado em 60,5% dos exames. Conclusão: Como rotina no exame pré-operatório e no planejamento cirúrgico, a RM lombar tem fundamental importância na investigação da anatomia visando cirurgias de abordagem anterior, pois permite uma avaliação eficaz das relações entre os grandes vasos e a coluna lombar. Nível de Evidência IV; Investigação Retrospectiva.

RESUMEN: Objetivo: Realizar un análisis de la anatomía de los grandes vasos relevantes para el acceso en artrodesis intersomática lumbar anterior (ALIF), determinando el nivel de su bifurcación, la distancia entre los vasos ilíacos en L5-S1, la configuración morfológica de la vena ilíaca izquierda y la presencia de tejido graso entre el vaso y el disco. Métodos: Se evaluaron 200 imágenes de resonancia magnética (RM) de la columna lumbar de pacientes (18-80 años) mediante cortes axiales, coronales y sagitales en los niveles L1-S1, en ponderación T2. La distancia interilíaca se definió como la medida entre la vena ilíaca izquierda y la arteria ilíaca derecha. La presencia de tejido graso se definió como la identificación de espacio entre el vaso y el disco. La morfología de los vasos se dividió en ovalados y planos. Resultados: La edad media de la población fue de 49,6 años, de los cuales 52% eran mujeres. La distancia interilíaca media en L5-S1 fue de 27,48 mm. La bifurcación de la arteria aorta se identificó a nivel de L4 en 56,3%, así como la confluencia de las venas ilíacas (37,2%). La vena ilíaca izquierda se identificó como ovalada en 69% y plana en 31%. Se evidenció tejido graso en 60,5% de los exámenes. Conclusión: Como rutina en examen preoperatorio, la RM lumbar es fundamental en la investigación de anatomía de cirugías de abordaje anterior, permitiendo una evaluación eficaz de las relaciones entre los grandes vasos y la columna lumbar. Nivel de Evidencia IV; Investigación Retrospectiva.

Tratamiento reconstructivo de bajo costo tras resección de tumor de células gigantes de radio distal / Low-cost reconstructive treatment after resection of distal radius giant cell tumor

Resumen: Introducción: El tumor de células gigantes (TCG) es un tumor óseo intramedular benigno que surge con frecuencia en los extremos de los huesos largos. Después del fémur distal y la tibia proximal, el radio distal es el tercer sitio más afectado con tumores, particularmente agresivos. Nuestro objetivo es la presentación del caso clínico de una paciente con diagnóstico de TCG de radio distal clasificada en grado III de Campanacci que recibió un tratamiento ajustado a sus posibilidades económicas. Reporte de caso: Paciente femenino de 47 años, sin solvencia económica y sin ningún servicio médico. El tratamiento incluyó resección en bloque, reconstrucción con autoinjerto de peroné distal y artrodesis radiocarpiana con placa de compresión bloqueada. Dieciocho meses después, la paciente presentaba una buena fuerza de prensión (80% respecto al lado sano) y tenía una función motora fina en la mano. La muñeca presentó estabilidad con pronación de 85o, supinación de 80o, flexión-extensión de 0o y una puntuación de 6.7 en el cuestionario de evaluación de resultados funcionales DASH. Su evolución radiológica a cinco años después de su cirugía continuó sin datos de recidiva local y afectación pulmonar. Conclusión: El resultado en esta paciente, junto con los datos publicados, indican que la técnica de resección tumoral en bloque, más el autoinjerto de peroné distal y la artrodesis con placa de compresión bloqueada proporcionan un resultado óptimo de funcionalidad para el tumor radial distal grado III a bajo costo.

Abstract: Introduction: Giant cell tumor (GCT) is a benign intramedullary bone tumor that frequently arises at the ends of long bones. After the distal femur and proximal tibia, the distal radius is the third most affected site with particularly aggressive tumors. Our objective is the presentation of the clinical case of a patient diagnosed with distal radius GCT classified in grade III of Campanacci who received a treatment adjusted to her economic possibilities. Case report: A 47-year-old female, without economic solvency and with some medical service. Treatment included block resection, reconstruction with distal fibula autograft, and radiocarpal fusion with blocked compression plate. Eighteen months later, the patient had good grip strength (80% on the healthy side) and had fine motor function in the hand. The wrist presented stability with pronation of 85o, supination of 80o, flexion-extension of 0o and a score of 6.7 in the DASH functional outcomes assessment questionnaire. His radiological evaluation five years after his surgery continued with no evidence of local recurrence and pulmonary involvement. Conclusion: The result in this patient, together with the published data, indicate that the block tumor resection technique, plus distal fibula autograft and arthrodesis with blocked compression plate provide an optimal result of functionality for the grade III distal radial tumor at low cost.

Tumor de células gigantes en el extremo distal del radio / Giant Cell Tumor Of The Distal Radius

Introducción: El tumor de células gigantes de hueso es uno de los tumores menos frecuentes y su comportamiento local es agresivo. Objetivo: Presentar un caso afectado por un tumor de células gigantes tratado con resección en bloque y artrodesis de la articulación de la muñeca. Presentación del caso: Paciente masculino de 29 años de edad, con antecedentes relativos de salud, que presentaba desde hacía 5 meses aumento de volumen e impotencia funcional al realizar flexo extensión activa de la muñeca izquierda, con empeoramiento progresivo. Se diagnosticó tumor óseo de células gigantes con marcada actividad proliferativa estromal en el extremo distal del radio, se realizó resección en bloque y artrodesis del extremo distal del radio con márgenes oncológicos y transferencia del flexor radial corto al extensor común y del palmar menor al extensor y abductor del pulgar. Conclusiones: La resección en bloque y artrodesis es una de las opciones a tener en cuenta en la cirugía reconstructiva de la extremidad superior con un resultado satisfactorio(AU)

Introduction: Giant cell tumor of bone is one of the least frequent tumors and the local behavior is aggressive. Objective: To report a case with giant cell tumor treated with en bloc resection and arthrodesis of the wrist joint. Case report: A relative healthy 29-year-old male patient had had increased volume and functional impotence when performing active flexor extension of the left wrist for 5 months, with progressive worsening. A giant cell bone tumor with marked stromal proliferative activity was diagnosed in the distal end of the radius. En bloc resection and arthrodesis of the distal end of the radius were performed with oncological margins and the transfer of the flexor radialis brevis to the common extensor and the palmaris minor to the extensor and abductor pollicis. Conclusions: En bloc resection and arthrodesis is one of the options to consider in reconstructive surgery of the upper extremity with a satisfactory result(AU)

TOTAL HIP REPLACEMENT USING ACETABULAR METAL AUGMENT AND BONE GRAFT IN PAPROSKY TYPE 3B ACETABULAR DEFECT: A CASE REPORT

Old unreduced and untreated fracture of the acetabulum is seen more commonly in developing countries and can be due to various reasons. Various methods can be used in the management of such cases which in general includes arthrodesis in young and total hip replacement in elderly patients. Acetabular fractures associated with acetabular defect pose challenge to the treating surgeon and the management of such defects plays an important role in the ?nal outcome of the surgery. We are here reporting a case of a 36 years old male patient who presented with 1 year 6 months old fracture of posterior wall of the acetabulum who is treated with THR with acetabular reconstruction using bone graft and acetabular augment. The patient was under regular follow up and now after 6 months of surgery patient is having good functional improvements with painless range of motions at index hip