RESUMO
The authors report their experience of treating complex elbow fracture-dislocations in elderly people, using a minimally-invasive approach with a new articulated external fixator that is associated with minimal internal fixation. The clinical results for 19 patients are presented according to outcome factors, such as range of motion, pain and function, rate and type of complications, and reoperation rate. The results indicate that this treatment strategy should be considered as a good alternative to other treatment options reported in the literature, including conservative treatment, ORIF with angular stable plates and total elbow arthroplasty.
Assuntos
Articulação do Cotovelo/cirurgia , Fixadores Externos , Fixação de Fratura , Fraturas Ósseas/cirurgia , Luxações Articulares/cirurgia , Osteoporose/cirurgia , Idoso , Avaliação da Deficiência , Feminino , Seguimentos , Fixação de Fratura/instrumentação , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/reabilitação , Humanos , Luxações Articulares/fisiopatologia , Luxações Articulares/reabilitação , Masculino , Osteoporose/complicações , Osteoporose/fisiopatologia , Estudos Prospectivos , Qualidade de Vida , Amplitude de Movimento Articular , Resultado do Tratamento , Lesões no CotoveloRESUMO
AIMS: To find a means of achieving operability very quickly without the additional discomfort of prolonging systemic chemotherapy. To improve the patient's quality of life by obtaining quick tumor reduction and decreasing systemic toxicity. MATERIALS AND METHODS: From January 1991 to January 1995, 13 patients with locally advanced breast cancer (LABC) and 8 patients with recurrent breast cancer (RBC), were treated by transfemoral Seldinger technique, with the catheter tip placed into the subclavian artery at the basis of the internal mammary artery. The patients received 5-fluorouracil (5FU) 1000 mg, epirubicin (EPI) 30 mg/m2, mitomycin (MMC) 7 mg/m2 over an infusion for 30 minutes. The cycle was repeated every two weeks for three times. RESULTS: The overall response rate was 62%. Stage IIIb and RBC patients had a response rate of 100% and 25% respectively. In respondent patients a measurable response was seen after the first cycle. Ten patients were radically operated. After a media follow-up of 21 months, the overall survival is 52% at 48 months (68% at 48 months and 65% at 34 months for stage IIIb and RBC patients respectively). CONCLUSIONS: PIAC is feasible and effective. In LABC patients it reaches 100% of response rate. Systemic toxicity was absent and the local one was mild. The interval between the starting of PIAC and operation is short. There was an optimal compliance of the patients.