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1.
J Oral Sci ; 62(3): 327-330, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32475865

RESUMO

This retrospective study aimed to investigate whether the corono-apical location of sinus tracts differs according to the presence/location of vertical root fracture (VRF) in microsurgically treated root-filled teeth. The cases included were (1) anterior and premolar teeth without a preoperative diagnosis of VRF, (2) those with a periodontal probing depth of ≤3 mm, and (3) those for which preoperative cone-beam computed tomography (CBCT) scans and intraoperative video records were available. VRF was diagnosed intraoperatively. The locations of buccal cortical bone defects and fracture lines were categorized on video images, and the corono-apical sinus tract locations were determined by superimposing video images onto volume-rendered CBCT images. Eleven of the 78 teeth investigated had VRF, and there was no significant difference in the incidence of sinus tracts between vertically fractured and non-fractured teeth (Mann-Whitney U-test, P > 0.05). The location of the sinus tract was significantly more coronal in vertically fractured than in non-fractured teeth (Mann-Whitney U-test, P < 0.0001). The location of sinus tracts was high correlated with cortical bone defects (Spearman's correlation, P < 0.0001). In microsurgically treated anterior and premolar teeth with a normal probing depth, sinus tracts were located more coronally in vertically fractured than in non-fractured teeth, and were highly correlated with the location of cortical bone defects.


Assuntos
Fraturas dos Dentes , Raiz Dentária , Tomografia Computadorizada de Feixe Cônico , Osso Cortical , Humanos , Microcirurgia , Estudos Retrospectivos
2.
PLoS One ; 15(3): e0229244, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32126093

RESUMO

The outer cortical table of the parietal bone has been commonly used as a calvarial bone graft site for the craniofacial reconstruction. However, little is known about how removing the outer table may affect the function and structure of the inner table, and how the knowledge of the biomechanics and material properties of cortical bones will help the calvarial graft to better integrate into the biological and mechanical functions of its surrounding native tissues. In this study, it was hypothesized that there were significant differences in both density and material properties between inner and outer cortical plates in cranial bones. Twelve cylindrical specimens, including inner-outer layers, of cortical parietal bone of a female baboon were collected. Cortical thicknesses and densities were measured, and elastic properties were assessed using an ultrasonic technique. Results demonstrated remarkable difference in both thickness (t = 8.248, p ≤0.05) and density (t = 4.926, p≤0.05) between inner and outer cortical paired samples. Orthotropic characteristics of the cortical plates were detected as well, these findings suggest that there are differences in biomechanical properties between two surfaces of cranial bones at both tissue and organ levels. How these differences are linked to the stress environments of the inner and outer cranial cortical layers awaits further studies. Further study will greatly enhance our ability to address questions derived from both morphological and craniofacial medicine fields about the development and biomechanics of craniofacial skeletons.


Assuntos
Osso Cortical/ultraestrutura , Papio/anatomia & histologia , Osso Parietal/ultraestrutura , Animais , Fenômenos Biomecânicos , Densidade Óssea , Osso Cortical/fisiologia , Elasticidade , Feminino , Especificidade de Órgãos , Osso Parietal/fisiologia , Transdutores , Ultrassom
3.
Zhonghua Yi Xue Za Zhi ; 100(9): 674-678, 2020 Mar 10.
Artigo em Chinês | MEDLINE | ID: mdl-32187910

RESUMO

Objective: To explore and analyze the clinical efficacy of fixation bone fragments by screw though cortical bone tunnel combined with limited open reductionin treating 31A3 type irreducible femoral intertrochanteric fractures in elderly people. Methods: Clinical data of 18 elderly patients with 31A3 type irreducible femoral intertrochanteric fractures treated from July 2017 to June 2018 in Orthopedics Department of Jiangsu Province Hospital were collected and analyzed retrospectively. There were 8 males and 10 females, aged from 65 to 88 years (mean age,(76±4) years). When confirmed as irreducible femoral intertrochanteric fractures by C-arm machine during operation, limited open reduction and fixation bone fragments by screw though cortical bone tunnel and intramedullary nail fixation were conducted. General surgical data,the quality of fracture reduction and functional recovery scale (FRS) score were collected.Data before and after operation were compared with paired t-test. Results: All patients were followed up for a mean of 13.6 months (10 to 22 months). The surgical time was (55±13) min (42 to 95 min), the intraoperative blood loss was (223±26) ml (180 to 320 ml), the number of intraoperative fluoroscopy was 23±4 (18-32 times), and the fracture healing time was (4.8±0.7) months. The quality of fracture reduction was rated as grade Ⅰ in 15 cases andgrade Ⅱ in 3 cases, with an excellent to good rate of 100% according to Kim classification. FRS score was 84±10 at the last follow-up and it was comparable with that before injury (84±11) (t=0.144, P=0.887). Conclusion: For elderly patients with 31A3 type irreducible femoral intertrochanteric fractures, fixation bone fragments by screw though cortical bone tunnel combined with limited open reduction is an efficient treating method with advantages of high quality of fracture reduction and fixation without increasing of surgical time and blood loss.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Parafusos Ósseos , Osso Cortical , Feminino , Fêmur/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 162-167, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030945

RESUMO

Objective: CT three-dimensional reconstruction technology was used to simulate the placement of the lumbar cortical bone trajectory (CBT), to determine the starting point and direction of the screw trajectory. Methods: Between February 2017 and April 2018, 24 patients with lumbar CT were selected as the study object. There were 7 males and 17 females, with an average age of 50.4 years (range, 37-68 years). The CT DICOM data of patients were imported into Mimics 16.0 software, and the three-dimensional model of lumbar spine was established. A 5 mm diameter cylinder was set up to simulate the CBT by using Mimics 16.0 software. According to the different implant schemes, the study was divided into groups A, B, and C, the track of the screw respectively passed through the upper edge, the medial edge, and the lower edge of the isthmus of the pedicle. The intersection of simulated screw and lumbar spine was marked as region of interest (ROI) and a mask was generated. The average CT value [Hounsfield unit (HU)] and the screw length of ROI were automatically measured by Mimics 16.0 software. In addition, the head inclination angle and head camber angle of the screw were measured respectively. Point F was the intersection of the level of the lowest edge of the transverse process and the lumbar isthmus periphery. The horizontal and vertical distance between point F and the starting point were measured, and the relationship between the three schemes and the position of the zygapophysial joint and spinous process was observed. Results: Plan A has the highest ROI average HU, with the maximum value appearing in L 4; plan B has the longest screw length, with the maximum value appearing in L 5; plan C has the largest nail track head inclination angle, with the maximum value appearing in L 4; plan B has the largest nail track head camber angle, with the maximum value appearing in L 3. The screw length and head camber angle of the nail in group B were significantly greater than those in groups A and C ( P<0.05); the head inclination angle in groups A, B, and C was gradually increased, showing significant differences ( P<0.05); there was no significant difference in the average HU value of ROI between the 3 groups ( P>0.05). In plan A, 74.48% (143/192) screws had a horizontal distance of -2 to 4 mm from point F, a vertical distance of 6-14 mm from point F, a head inclination angle of (14.64±2.77)°, and a head camber angle of (6.55±2.09)°, respectively; in plan B, 84.58% (203/240) screws had a horizontal distance of 1-6 mm from point F, a vertical distance of 1-5 mm from point F, a head inclination angle of (26.93±2.21)°, and a head camber angle of (10.29±2.46)°, respectively; in plan C, 85.94% (165/192) screws had a horizontal distance of -2 to 3 mm from point F, a vertical distance of -2 to 4 mm from point F, a head inclination angle of (33.50±3.69)°, and a head camber angle of (6.47±2.48)°, respectively. Conclusion: Plan B should be selected as the starting point of the L 1-L 5 CBT implant. It is located at the intersection of the lowest horizontal line of the transverse process root and the lateral edge of the lumbar isthmus, which is 1-6 mm horizontally inward, 1-5 mm vertically upward, with a head inclination angle of (26.93±2.21)°, and a head camber angle of (10.29±2.46)°, respectively.


Assuntos
Osso Cortical , Adulto , Idoso , Parafusos Ósseos , Osso Cortical/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Vértebras Lombares , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Fusão Vertebral
5.
Medicine (Baltimore) ; 99(7): e19046, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049803

RESUMO

INTRODUCTION: It is well known that the main segments of spinal fracture is thoracolumbar (T11-L11). Therefore, in addition to the lumbar, the lower thoracic vertebra (T9-T12) often has the clinical needs of implantation of cortical bone trajectory (CBT) screws. However, the anatomic parameters of the lower thoracic vertebrae are quite different from those of the lumbar vertebrae, which means that if CBT screws are to be implanted in the lower thoracic vertebrae, the selection of the screw entry point, the length, diameter, angle and path of the screws in each segment need to be redefined. Methods In this part, 3-dimensional finite element model was established to analyze the stress and fixation efficiency of CBT screws in thoracic vertebrae after 5000 times of fatigue loading of normal model and osteoporosis model. Discussion If the outcomes indicate the trial is feasible and there is evidence to provide some basic anatomical parameters for CBT screw implantation in the lower thoracic spine, so that the ideal insertion point, length, diameter, and angle of CBT screw in different segments of the lower thoracic spine were determined.Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026915.Registered on September 26, 2019.


Assuntos
Procedimentos Ortopédicos/instrumentação , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Fenômenos Biomecânicos , Parafusos Ósseos , Osso Cortical/anatomia & histologia , Osso Cortical/cirurgia , Estudos de Viabilidade , Feminino , Análise de Elementos Finitos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Vértebras Torácicas/anatomia & histologia , Adulto Jovem
6.
J Appl Oral Sci ; 28: e20190435, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049138

RESUMO

OBJECTIVE: To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. METHODOLOGY: For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the "distance" tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. RESULTS: The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. CONCLUSIONS: Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.


Assuntos
Transplante Ósseo/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Mandíbula/transplante , Crânio/transplante , Sítio Doador de Transplante , Adolescente , Adulto , Idoso , Pontos de Referência Anatômicos , Osso Cortical/diagnóstico por imagem , Osso Cortical/transplante , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Ilustração Médica , Pessoa de Meia-Idade , Estudos Retrospectivos , Crânio/diagnóstico por imagem , Sítio Doador de Transplante/diagnóstico por imagem , Adulto Jovem
7.
Am J Orthod Dentofacial Orthop ; 157(2): 178-185, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32005469

RESUMO

INTRODUCTION: Anchorage, which is defined as resistance against undesired tooth movements, is one of the most important factors in success of orthodontic treatment. In recent years, mini-implants have been used instead of uncomfortable headgears and Nance appliances. The pullout test is the most common method for measuring the anchorage capacity of mini-implants. The aim of this study was to investigate the effects of cortical bone thickness and cortical layer bone density on pullout strength of mini-implants. METHODS: Mini-implants were placed in polyurethane foam blocks representing 3 different cortical thicknesses (1 mm, 2 mm, and 3 mm) and 3 different cortical bone densities (grade 40, grade 45, and grade 50). Pullout tests were performed with 5 mm/min loading rate. Load vs displacement values were recorded during the tests. RESULTS: Comparing cortical thicknesses on the same bone densities, statistically significant differences were found between 1 mm, 2 mm, and 3 mm thicknesses. Likewise, comparing bone densities on the same cortical thicknesses, statistically significant differences were found among all groups. Spearman rank tests showed that both cortical thickness and cortical bone density are correlated with pullout strength (rs, 0.548; P <0.001 and rs, 0.691; P <0.001, respectively). CONCLUSIONS: Although both factors are positively correlated with pullout strength, the effect of cortical bone density was the dominant factor affecting primary stability.


Assuntos
Osso Cortical , Implantes Dentários , Procedimentos de Ancoragem Ortodôntica , Densidade Óssea , Osso e Ossos , Osso Cortical/anatomia & histologia , Humanos
8.
J Endod ; 46(2): 169-177.e1, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839413

RESUMO

INTRODUCTION: Limited field of view cone-beam computed tomography (LFOV CBCT) is the primary imaging modality recommended for treatment planning before endodontic microsurgery (EMS). Persistent apical periodontitis, often treated with EMS, results in changes in the buccal cortical plate that may detrimentally impact prognosis. The accuracy of a preoperative LFOV CBCT to predict intraoperative findings is unclear. METHODS: Electronic health records (EHRs) of EMS performed at 2 endodontic offices between 2016 and 2018 were reviewed retrospectively. EHR data extracted were documented for surgical findings of intact buccal cortical plate, fenestration, dehiscence, and height of remaining buccal collar of bone. Two calibrated, independent reviewers evaluated presurgical LFOV CBCTs in the multiplanar paraxial and parasagittal planes at 2 different reconstructed viewing plane thicknesses. Reviewer findings were compared with EHR documentation. Data were analyzed by using χ2, logistic regression, and multivariable analysis. Significance was set at P < .05. RESULTS: Within the 125 EMS cases included in the study, the EHR prevalence of intact buccal cortical plate was 49%, dehiscence 7%, and fenestration 44%. The imaging predictive value, whether it was negative (NPV) or positive (PPV), was higher when predicting presence of buccal bone (PPV of intact buccal cortical plate = 86.5%; NPV of dehiscence = 96%; NPV of fenestration = 89%). Sensitivity and specificity ranged from 80%-90%. Accuracy in prediction was high for all variables, exceeding 80%. Accuracy was not significantly influenced by reconstructed viewing slice thickness, viewing plane, or reviewer. CONCLUSION: Preoperative LFOV CBCT was highly discriminatory and accurately predicted intraoperative buccal cortical bone status, especially intact buccal cortical plate and fenestration.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Microcirurgia , Osso Cortical/diagnóstico por imagem , Humanos , Estudos Retrospectivos
9.
Dentomaxillofac Radiol ; 49(3): 20190210, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31714158

RESUMO

OBJECTIVES: The purpose of this study is to evaluate normal ranges of cortical bone Hounsfield units indices through cone beam CT images, and to investigate their relationships with age and sex. METHODS: 700 adult human cone beam CT images were evaluated retrospectively, and divided into 4 age groups. Six different cortical bone Hounsfield unit measurements were applied bilaterally, where gender and age were recorded. Collected data were subjected to statistical analysis and ANOVA tests were used for various comparisons. RESULTS: The cortical bone measurements between female and male patients were significantly different (p<0.05). Cortical bone thickness indices showed greater values in male patients compare to female patients (p<0.05). Quantitative mandibular indices were significantly lower in first age group (18-30 years) than other three older age groups (p<0.01). CONCLUSION: The results of this study seems to propose a persistent alteration in the mandibular cortical bone with age and that this influced by sex. Further studies with larger patient groups are needed to clarify and understand these mandibular indices.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Mandíbula , Adulto , Fatores Etários , Idoso , Osso Cortical , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/crescimento & desenvolvimento , Valores de Referência , Estudos Retrospectivos , Fatores Sexuais
10.
World Neurosurg ; 134: 14-24, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31639506

RESUMO

The use of cortical bone trajectory (CBT) pedicle screws for posterior fixation and fusion seems to constitute a viable alternative for spinal procedures, with the potential to mitigate risks, be minimally invasive, and cause less tissue damage than the traditional technique. This review analyzes the literature regarding CBT according to the rate of evidence of articles and their main focus. CBT has proved to be a safe and viable option for screw fixation in spine surgery. Given the denser bone interception, high-quality biomechanics studies show equal or even better properties compared with classic pedicle screw fixation, depending on several factors such as screw size and length. Through the years, surgical technique has improved to gain a longer and safer trajectory than first described. Level 2 and 3 clinical studies suggest equal clinical and radiologic outcomes compared with pedicle trajectory fixation, but high-quality, level 1, randomized controlled trials are needed to confirm these results.


Assuntos
Osso Cortical/cirurgia , Parafusos Pediculares , Fusão Vertebral/instrumentação , Coluna Vertebral/cirurgia , Fenômenos Biomecânicos , Parafusos Ósseos , Humanos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Fusão Vertebral/métodos
11.
Vet Radiol Ultrasound ; 61(1): 48-57, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31825150

RESUMO

Magnetic resonance imaging and the correlation to histopathological findings of the equine palmar foot of lame horses have been described previously, using 0.27 and 1.5 T systems. Compared to these, 3 T systems provide superior spatial resolution and imaging contrast. The aim of our prospective anatomic study was to characterize the imaging anatomy of the navicular region on 3 T MRI in comparison to histopathological findings. We hypothesized that 3 T MRI allows a good visualization of the entire navicular apparatus and reliable measurements of navicular cartilage and cortical bone thickness. Twenty front feet of sound horses were examined using a 3 T MRI system. For histopathological examination, sagittal tissue sections of the navicular bones and adjacent ligaments were prepared. Alterations in magnetic resonance signal were graded for each region and compared to corresponding histological slices. Overall, there was good visualization of the anatomical detail and a very good agreement between MRI and histology for compact bone and spongiosa, good agreement for the fibrocartilage and the distal sesamoidean impar ligament, but only moderate agreement for the hyaline cartilage and the collateral sesamoidean ligament. A comparative measurement of cartilage and cortical bone thickness on magnetic resonance images and histological sections was performed. In MRI, the hyaline cartilage of the articular surface appeared significantly thinner and the fibrocartilage of the flexor surface appeared significantly thicker compared to histology. Findings indicated that MRI at a field strength of 3 T allows reliable depiction of anatomic details of the navicular apparatus.


Assuntos
Cavalos/anatomia & histologia , Imagem por Ressonância Magnética/veterinária , Ossos do Tarso/anatomia & histologia , Ossos do Tarso/diagnóstico por imagem , Animais , Osso Cortical/diagnóstico por imagem , Fibrocartilagem/diagnóstico por imagem , Cartilagem Hialina/diagnóstico por imagem , Estudos Prospectivos
12.
Acta Orthop ; 91(1): 1-75, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31801400

RESUMO

Background and purpose - Most guidelines use patient age as a primary decision factor when choosing between osteosynthesis or arthroplasty in displaced femoral neck fractures. We evaluate reoperation and death risk within 1 year after osteosynthesis, and estimate the influence of age, sex, degree of displacement, and bone quality.Patients and methods - All surgeries for femoral neck fractures with parallel implants (2 or 3 screws or pins) performed between December 2011 and November 2015 were collected from the Danish Fracture Database. Radiographs were analyzed for initial displacement, quality of reduction, protrusion, and angulation of implants. The bone quality was estimated using the cortical thickness index (CTI). Garden I and II type fractures with posterior tilt < 20° were excluded.Results - 654 patients with a mean age of 69 years were included. 59% were female. 54% were Garden II with posterior tilt > 20° or Garden III, and 46% were Garden IV. Only 38% were adequately reduced. 19% underwent reoperation and 18% died within 12 months. Female sex, surgical delay between 12 and 24 hours vs. < 12 hours, Garden IV type fracture, inadequate reduction, and protrusion of an implant were associated with statistically significant increased reoperation risk. No significant association between reoperation and age, CTI, or the initial angulation of implants was found. Notably, CTI was linked inversely with death risk.Interpretation - Reoperation risk is linked mainly to primary displacement and reduction of the fracture, with no apparent effect of age or bone quality. Bone quality may be linked with risk of death.


Assuntos
Osso Cortical/patologia , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/métodos , Fixação de Fratura/métodos , Mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Estudos de Coortes , Osso Cortical/diagnóstico por imagem , Dinamarca , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Risco , Fatores Sexuais , Tempo para o Tratamento , Adulto Jovem
13.
World Neurosurg ; 135: e333-e338, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31809891

RESUMO

OBJECTIVE: Various surgical techniques for treating spondylodiskitis have been proposed, but the most appropriate surgical treatment remains controversial. In this study, we propose a new hybrid approach combining the use of cortical bone trajectory screws and pedicle screws with the technique of transforaminal lumbar interbody debridement and fusion. With this method, we can shorten the length of the segment that needs to be fixed, minimize the extent of surgical dissection, and reduce the risk of adjacent level degeneration. METHODS: Patients with clinical and radiographic evidences of single-level lumbar spondylodiskitis seen between January and December of 2017 were included in the study. Demographic data, including age and sex, were recorded. The intraoperative details, results of culture, functional outcome, radiologic outcome, and length of hospital stay were recorded. RESULTS: The mean age of 15 patients was 62.8 years. The mean operative time was 135 minutes, and the mean blood loss was 260 mL. The culture rate was 80%. The mean Numeric Rating Scale score and Oswestry Disability Index score significantly improved from 6.60 to 2.47 and from 21.20 to 10.20, respectively. No major perioperative complications occurred. CONCLUSIONS: With the proposed hybrid approach using cortical bone trajectory and pedicle screws with the transforaminal lumbar interbody debridement and fusion technique, the damaged anterior column can be debrided and reconstructed, and spinal stabilization can also be achieved.


Assuntos
Osso Cortical/cirurgia , Discite/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Parafusos Pediculares , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Parafusos Pediculares/efeitos adversos , Estudos Retrospectivos , Fusão Vertebral/métodos , Resultado do Tratamento
15.
Pediatr Blood Cancer ; 67(4): e28142, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31867838

RESUMO

BACKGROUND: The International Working Group on Staging Evaluation and Response Criteria Harmonization (SEARCH) seeks to provide a universally acceptable definition of cortical bone involvement in the staging of newly diagnosed pediatric Hodgkin lymphoma. PROCEDURE: A comprehensive literature search was performed using PubMed and Google Scholar with the search terms "Hodgkin lymphoma," "osseous lesions," "bony involvement," and "pediatric." Publications reviewed included case reports, retrospective analyses, and literature reviews. Each was evaluated for study design, number of participants, median age and age range at diagnosis, percentage of pediatric patients, criteria of interest definition, diagnostic tools, study objectives, and level of evidence. The final definition was based on the available data and consensus of the SEARCH working group. RESULTS: Twenty-five papers specifically addressing cortical bone involvement in Hodgkin lymphoma met the inclusion criteria. Eighteen papers were case reports with literature reviews; the remainder were observational cohort studies. Of these, 14 included pediatric patients (aged 0-21 years). The criteria for cortical bone involvement were not clearly defined in any paper, often varied within a study, and were inconsistent between publications. CONCLUSIONS: The SEARCH group for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (CAYAHL) proposes the following criteria as defining cortical bone involvement: any cortical bone biopsy-proven lesion; a positive bony window lesion on computer tomography (CT), with an FDG-PET positive correlate in a patient with biopsy-proven Hodgkin lymphoma, if there is no other typical skeletal pathology; auspicious skeletal lesions on FDG-PET or magnetic resonance imaging should be confirmed by CT or Tc-99m scan to distinguish cortical lesions from bone marrow involvement. Nodal masses that extend into bone with bony destruction are considered extranodal extension or "E" lesions and do not represent metastatic or stage IV disease.


Assuntos
Osso Cortical/patologia , Diagnóstico por Imagem/métodos , Doença de Hodgkin/classificação , Doença de Hodgkin/patologia , Criança , Osso Cortical/diagnóstico por imagem , Doença de Hodgkin/diagnóstico por imagem , Humanos , Estadiamento de Neoplasias , Critérios de Avaliação de Resposta em Tumores Sólidos
16.
Tech Hand Up Extrem Surg ; 23(4): 155-159, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31738737

RESUMO

Pedicled vascularized bone graft (VBG) is a useful method in treating the scaphoid fracture nonunion, especially when the avascular necrosis exists. Humpback deformity is an important issue that we have to correct it during the treatment. We describe a method by using combined wedge non-VBG to correct the nonunion deformity when treating scaphoid nonunion with pedicled VBG. The wedge bone graft was harvested just proximal to the 2,3 intercompartmental supraretinacular artery VBG and was used as an inlay at the volar site to correct the humpback deformity, whereas the VBG was set at the dorsal site for bone bridging and blood supply. We also present our results of 10 patients with scaphoid fracture nonunion and humpback deformity treated with this method. Bone healing was achieved and the lateral intrascaphoid angles could be improved in all the 10 patients. Functional outcomes, including the Visual Analog Pain Scale for pain during activity, grip strength, the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the modified Mayo Wrist Scores, were significantly improved.


Assuntos
Vasos Sanguíneos/transplante , Rádio (Anatomia)/transplante , Osso Escafoide/anormalidades , Osso Escafoide/cirurgia , Adolescente , Adulto , Transplante Ósseo/métodos , Osso Esponjoso/irrigação sanguínea , Osso Esponjoso/transplante , Osso Cortical/irrigação sanguínea , Osso Cortical/transplante , Feminino , Fraturas Ósseas/cirurgia , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/irrigação sanguínea , Osso Escafoide/lesões , Adulto Jovem
17.
Am J Physiol Endocrinol Metab ; 317(6): E1150-E1157, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638855

RESUMO

Insulin-like growth factor-I (IGF-I) is anabolic for cartilage and important for cartilage integrity, which might suggest a connection between IGF-I and osteoarthritis (OA) development. However, the results of studies performed so far are conflicting, and we aimed to clarify the role of endocrine IGF-I in rodent OA. Male mice with inducible inactivation of circulating, liver-derived IGF-I (LI-IGF-I-/- mice, serum IGF-I reduced by ~80%) were used. Experimental OA was induced in young adult LI-IGF-I-/- and control mice by destabilization of the medial meniscus (DMM); age-related OA was also evaluated in 1-yr-old mice. DMM-operated LI-IGF-I-/- mice had thinner lateral subchondral bone plate in tibia compared with control mice, whereas osteophyte volume and articular cartilage damage were unaffected at the medial side of the DMM knee. However, the control mice but not the LI-IGF-I-/- mice also developed mild OA on the lateral side of the DMM knee compared with the unoperated knee. One-year-old LI-IGF-I-/- mice had lower mid-diaphyseal cortical bone area than the 1-yr-old control mice, whereas analyses of joint tissues displayed smaller osteophyte volume and thicker calcified cartilage than the control mice. There was no difference in OA severity in the articular cartilage between old LI-IGF-I-/- and control mice. Our study is the first to investigate whether there is an association between circulating IGF-I and OA in mice. We conclude that, although there is an ~80% reduction of circulating IGF-I and a decrease in cortical bone in male LI-IGF-I-/- mice, cartilage damage is clearly not intensified and may instead be slightly reduced.


Assuntos
Cartilagem Articular/patologia , Osso Cortical/patologia , Fator de Crescimento Insulin-Like I/genética , Fígado/metabolismo , Osteoartrite/genética , Osteófito/patologia , Joelho de Quadrúpedes/patologia , Tíbia/patologia , Animais , Técnicas de Silenciamento de Genes , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Camundongos , Osteoartrite/metabolismo , Osteoartrite/patologia , Joelho de Quadrúpedes/metabolismo , Tíbia/metabolismo , Lesões do Menisco Tibial
18.
Nutrients ; 11(10)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31574967

RESUMO

Bone mineral density (BMD) and microstructure depend on estrogens and diet. We assessed the impact of natural mineral-rich water ingestion on distal femur of fructose-fed estrogen-deficient female Sprague Dawley rats. Ovariectomized rats drank tap or mineral-rich waters, with or without 10%-fructose, for 10 weeks. A sham-operated group drinking tap water was included (n = 6/group). Cancellous and cortical bone compartments were analyzed by microcomputed tomography. Circulating bone metabolism markers were measured by enzyme immunoassay/enzyme-linked immunosorbent assay or multiplex bead assay. Ovariectomy significantly worsened cancellous but not cortical bone, significantly increased circulating degradation products from C-terminal telopeptides of type I collagen and receptor activator of nuclear factor-kappaB ligand (RANKL), and significantly decreased circulating osteoprotegerin and osteoprotegerin/RANKL ratio. In ovariectomized rats, in cancellous bone, significant water effect was observed for all microstructural properties, except for the degree of anisotropy, and BMD (neither a significant fructose effect nor a significant interaction between water and fructose ingestion effects were observed). In cortical bone, it was observed a significant (a) water effect for medullary volume and cortical endosteal perimeter; (b) fructose effect for cortical thickness, medullary volume, cross-sectional thickness and cortical endosteal and periosteal perimeters; and (c) interaction effect for mean eccentricity. In blood, significant fructose and interaction effects were found for osteoprotegerin (no significant water effect was seen). For the first time in ovariectomized rats, the positive modulation of cortical but not of cancellous bone by fructose ingestion and of both bone locations by natural mineral-rich water ingestion is described.


Assuntos
Remodelação Óssea , Osso Esponjoso/fisiopatologia , Osso Cortical/fisiopatologia , Açúcares da Dieta/administração & dosagem , Água Potável/administração & dosagem , Fêmur/fisiopatologia , Frutose/administração & dosagem , Águas Minerais/administração & dosagem , Osteoporose Pós-Menopausa/prevenção & controle , Ovariectomia , Animais , Biomarcadores/sangue , Densidade Óssea , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/metabolismo , Colágeno Tipo I/sangue , Osso Cortical/diagnóstico por imagem , Osso Cortical/metabolismo , Modelos Animais de Doenças , Ingestão de Líquidos , Feminino , Fêmur/diagnóstico por imagem , Fêmur/metabolismo , Humanos , Osteoporose Pós-Menopausa/sangue , Osteoporose Pós-Menopausa/diagnóstico por imagem , Osteoporose Pós-Menopausa/fisiopatologia , Osteoprotegerina/sangue , Peptídeos/sangue , Ligante RANK/sangue , Ratos Sprague-Dawley , Microtomografia por Raio-X
19.
J Orthop Sci ; 24(6): 974-978, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31526648

RESUMO

BACKGROUND: Cortical bone trajectory (CBT) screws are popular for spinal fixation, but their ideal diameter has not been determined. Studies using postoperative computed tomography (CT) have revealed ample bone marrow space around 5.5-mm screws, which are commonly used. However, evidence indicates that a larger screw diameter provides a greater fixation strength. This study aimed to develop a generalizable formula for computing the diameter of CBT screws that could be inserted safely for fixation of the lower lumbar spine. METHODS: Records of 44 consecutive patients who had undergone posterior fusion with CBT screws for single-level degenerative lumbar spondylolisthesis were retrospectively reviewed. We estimated the maximum diameter for conventional pedicle screws by the minimum diameter of the pedicle using preoperative CT (PSD). We measured the minimum endosteal diameter of the pedicle on the reconstructed plane of the postoperative CT which passed through the cannula used for the screw and estimated the maximum diameter for the CBT screws that could be inserted within the bone marrow space of the pedicle (CBTD). RESULTS: Among the 176 pedicles measured, there were 151 (85.8%) with a PSD of 8.5 mm and 13, 7.5 mm. Because of a slight pedicle wall breach, 13 screws were excluded from the sample. There were 64 (39.3%) screws with a CBTD of 8.5 mm; 45, 7.5 mm; and 40, 6.5 mm. Of 163 screws, 156 (95.7%) had PSD minus CBTD ≤2 mm for each pedicle. PSD minus the minimum outer cortical diameter was ≤1 mm for each pedicle in 155 (95.1%) screws. CONCLUSION: Our results show that CBT screws with a diameter 1 mm smaller than the endosteal diameter of the pedicle were inserted safely. STUDY: Design: Clinical study.


Assuntos
Parafusos Ósseos , Osso Cortical/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Idoso , Idoso de 80 Anos ou mais , Osso Cortical/diagnóstico por imagem , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Tomografia Computadorizada por Raios X
20.
Forensic Sci Int ; 303: 109950, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31542400

RESUMO

Histological methods can be used forensically to estimate age-at-death based on patterns of change in osteon shape, size, and population density, all of which result from the continuous process of bone remodelling. The present study examines the applicability of three existing histological age-at-death estimation methods as applied to an Australian population of known age and sex. Microradiographs from 50 mid-shaft femora thin sections, equally divided by sex, were obtained from the Melbourne Femur Reference Collection (MFRC); stated chronological age-at-death is 18 to 88 years. Osteon shape metrics are measured using ImageJ and the age-at-death prediction formulae of i) Singh and Gunberg, ii) Keough et al., and iii) Goliath et al. are applied. The relationship between estimated and actual age-at-death is then statistically quantified. All three formulae demonstrate pooled and sex-specific SEE values in excess of 20 years: i) pooled ±22.92 (♂±20.91, ♀±25.20); ii) ±20.79 (♂±20.96, ♀±21.05); and iii) ±35.43 (♂±32.68, ♀±38.66). When individuals under 40 years of age were excluded from the analysis, only two of the methods demonstrated increased accuracy: i) pooled ±20.87 (♂ ±17.47, ♀ ±23.70); ii) pooled ±18.21 (♂±16.51, ♀±19.90); and iii) pooled ±41.18 (♂ ±40.12, ♀ 43.05). The present study represents a preliminary investigation of the accuracy of existing histological age-at-death standards applied in an Australian population of known age.


Assuntos
Determinação da Idade pelo Esqueleto/métodos , Osso Cortical/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Osteon/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Antropologia Forense , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Microrradiografia , Pessoa de Meia-Idade , Modelos Estatísticos , Adulto Jovem
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