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1.
G Ital Cardiol (Rome) ; 21(5): 336-340, 2020 05.
Artículo en Italiano | MEDLINE | ID: mdl-32310918
2.
J Surg Oncol ; 121(7): 1104-1114, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32153042

RESUMEN

BACKGROUND AND OBJECTIVES: Acetabular reconstruction with a coned-stem prosthesis has been one of the reliable procedures following pelvic tumor resections but is associated with a risk of complications and postoperative morbidity. We investigated whether navigated reconstruction could decrease the complication rate and optimize outcomes. METHODS: A retrospective study was conducted on 33 patients who underwent acetabular resection and reconstruction with ice-cream cone prostheses; outcomes were compared between the navigated and nonnavigated groups. RESULTS: A clear margin was obtained in 91% and 82% of the navigated and nonnavigated groups, respectively. The local recurrence (LR) rate was 12%, and all LRs occurred in the nonnavigated group. The rate of major complications requiring surgical intervention was significantly lower in the navigated group (9%) than in the nonnavigated group (50%; P = .024). Two implant failures occurred in the nonnavigated group. Functional outcomes were significantly correlated with the occurrence of major complications (P = .010) and the use of navigation (P = .043); superior functional scores were observed in the navigated group (Musculoskeletal Tumor Society, 73% vs 55%; Toronto Extremity Salvage Score, 73% vs 56%). CONCLUSION: Ice-cream cone prosthesis is an acceptable reconstruction modality following periacetabular tumor resections, and computer navigation are useful to facilitate proper resection margins and implant position.


Asunto(s)
Acetábulo/cirugía , Neoplasias Óseas/cirugía , Prótesis de Cadera , Neoplasias Pélvicas/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias Pélvicas/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Procedimientos Quirúrgicos Reconstructivos/instrumentación , Estudios Retrospectivos , Cirugía Asistida por Computador/efectos adversos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X , Adulto Joven
4.
Int J Surg ; 76: 114-119, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32169570

RESUMEN

BACKGROUND: Prosthetic repair of inguinal hernias is one of the most performed surgical procedures. Nevertheless, high rates of complications affect the surgical treatment. Implant fixation, poor-quality tissue ingrowth and mesh shrinkage seem to be involved in postoperative complications, discomfort and chronic pain following inguinal hernia repair. To address these issues a multilamellar shaped 3D dynamic responsive prosthesis has been developed. This new implant, positioned fixation-free to obliterate the hernia opening, thanks its inherent dynamic compliance during inguinal movements, has demonstrated to induce an enhanced biological response. The ingrowth of newly formed muscle fibers, arteries and veins in a surrounding of viable connective tissue could be evidenced into the implant fabric. This appears to be quite different from the fibrotic plaque, typical biologic response of conventional meshes. In addition to myocytes and vessels, newly ingrown nerves have also been detected in the prosthetic structure. MATERIALS AND METHODS: The aim of this investigation was to determine by examining biopsy specimens excised from patients who underwent hernia repair with the 3D dynamic implant, quantity and quality of the neural ingrowth within the implant fabric in the short, medium, and long term post-implantation. RESULTS: Newly formed nervous structures were found in biopsy specimens, from multiple spots of nerve clusters evidenced in the short-term along the increased level of neural maturation in the midterm, until the nerves showed complete in all components in the long-term. CONCLUSION: The development of highly specialized nervous tissue in the 3D prosthesis seems to finalize the regenerative biologic response that is expected for the treatment of a degenerative disease, as, in fact, inguinal hernia is. Re-growth of the typical tissue components of the groin evidenced in the 3D dynamic prosthesis seems to effectively revert the degenerative source of inguinal hernia into regeneration of the vanished tissue components of the groin.


Asunto(s)
Hernia Inguinal , Herniorrafia , Impresión Tridimensional , Implantación de Prótesis , Miembros Artificiales , Ingle/cirugía , Hernia Inguinal/cirugía , Herniorrafia/métodos , Humanos , Complicaciones Posoperatorias/cirugía , Implantación de Prótesis/métodos , Investigación Cualitativa , Mallas Quirúrgicas
5.
J Laryngol Otol ; 134(3): 272-274, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32079553

RESUMEN

BACKGROUND: Implantation of bone-anchored hearing devices is performed to improve hearing in patients with chronic suppurative otitis media who cannot wear a conventional hearing aid. The surgical procedure can be safely performed in children aged over five years. CASE REPORT: A 15-year-old patient with bilateral chronic suppurative otitis media and conductive hearing loss underwent the procedure to implant a bone-anchored hearing device but was found to have skull thickness of less than 2.5 mm and the procedure was abandoned. A computed tomography scan of the skull was undertaken and a three-dimensional template was reconstructed to identify appropriate thickness of the skull to implant the abutment during a second procedure. CONCLUSION: Bone-anchored hearing devices can be implanted by prior imaging and using a template to identify the area of appropriate skull thickness to implant the abutment safely.


Asunto(s)
Audífonos , Pérdida Auditiva Conductiva/cirugía , Imagenología Tridimensional/métodos , Otitis Media Supurativa/cirugía , Implantación de Prótesis/métodos , Adolescente , Conducción Ósea , Pérdida Auditiva Conductiva/diagnóstico por imagen , Pérdida Auditiva Conductiva/etiología , Humanos , Masculino , Otitis Media Supurativa/complicaciones , Otitis Media Supurativa/diagnóstico por imagen , Cráneo/diagnóstico por imagen
6.
Medicine (Baltimore) ; 99(6): e19099, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028435

RESUMEN

We determined the clinical effectiveness and long-term outcomes in patients with distal biliary obstruction (DBO) secondary to pancreatic carcinoma (PC) who were treated by self-expanded metallic stent (SEMS) insertion with or without high-intensity focused ultrasound (HIFU) ablation.From January 2014 to December 2018, consecutive patients with DBO secondary to PC underwent SEMS insertion with or without HIFU ablation in our center. The long-term outcomes were compared between the 2 groups.During the included period, 75 patients underwent SEMS insertion with (n = 34) or without (n = 41) HIFU ablation in our center. SEMS insertion was successfully performed in all patients. Liver function was significantly improved after SEMS insertion in both groups. An average of 2.9 HIFU treatment sessions per patient were performed. Twenty patients (stent + HIFU group: 7; stent-only group: 13) experienced stent dysfunction (P = .278). The clinical response rate to HIFU ablation was 79.4%. The median stent patency was significantly longer in the stent with HIFU group than in the stent-only group (175 vs 118 days, P = .005). The median survival was significantly longer in the stent with HIFU group compared with the stent-only group (211 versus 136 days, P = .004). An Eastern Cooperative Oncology Group (ECOG) Performance Status of 3 (hazard ratio: 0.300; P = .002) and subsequent HIFU ablation (hazard ratio: 0.508; P = .005) were associated with prolonged survival.HIFU ablation following stent insertion can prolong the stent patency and survival for patients with DBO secondary to PC.


Asunto(s)
Colestasis/etiología , Ultrasonido Enfocado de Alta Intensidad de Ablación , Neoplasias Pancreáticas/complicaciones , Implantación de Prótesis , Stents , Anciano , Colestasis/cirugía , Femenino , Ultrasonido Enfocado de Alta Intensidad de Ablación/métodos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/mortalidad , Modelos de Riesgos Proporcionales , Implantación de Prótesis/métodos , Estudios Retrospectivos , Análisis de Supervivencia
7.
J Cardiothorac Surg ; 15(1): 20, 2020 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-31937330

RESUMEN

OBJECTIVE: The percutaneous closure of a single secundum atrial septal defect (ASD) under transesophageal echocardiography guidance as an accepted alternative to the transcatheter closure with fluoroscopy has been proven. However, the technique has not been routinely used. This study was to present and share our experience in comparing the clinical outcomes of the percutaneous and intra-operative device closure (IODC) of atrial septal defects without fluoroscopy. METHODS: From January 2013 to December 2016, 103 patients with maximum diameters of ASD of less than 30 mm were allocated to groups taking either the percutaneous closure of atrial septal defects approach (PASD group, n = 53) or the intra-operative device closure approach (IODC Group, n = 50). They were operated on using the minimally invasive Amplatzer duct occluder under the guidance of transesophageal echocardiography without cardiopulmonary bypass. Echocardiography was performed to obtain an en face view of the ASD and important surrounding structures before the operation. Patient characteristics, perioperative data, and follow-up data were retrospectively documented and analyzed. RESULTS: Patient characteristics were comparable between the two groups. These were no differences in the maximum diameters of defects and the size of the occluders in each group (16.4 ± 5.3 mm vs16.4 ± 5.2 mm, P = 0.98; 22.4 ± 5.8 mm vs 21.3 ± 6.6 mm, P = 0.38). Intracardiac manipulation time was 20.72 ± 7.70 min in the PASD group and 6.01 ± 1.03 min in the IODC group (P < 0.001). The procedure time was 28.70 ± 10.41 min in the PASD group and 39.13 ± 6.03 min in the IODC group (P < 0.001). The successful closure defect was 100% in both groups when the maximum diameter of defect less than 25 mm. Four patients the PASD groups with maximum diameters between 25 mm and 30 mm were transferred to the IOCD group after unsuccessful device implantations. The total occlusion rate was 82% immediately after deployment, 98% at 3 months, and 100% at 6 months. No cardiac-related complications occurred during the follow-up period of between 3 to 65 months (mean 21.4 ± 9.8 months). CONCLUSIONS: Percutaneous device closures of Secundum atrial septal defects showed safety and high efficiency in patients under guidance by transesophageal echocardiography when compared with intra-operative device closures and are especially suited for women and children.


Asunto(s)
Ecocardiografía Transesofágica , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/cirugía , Implantación de Prótesis/métodos , Dispositivo Oclusor Septal , Adolescente , Adulto , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
8.
J Cardiothorac Surg ; 15(1): 9, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31915066

RESUMEN

BACKGROUND: Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect (ASD). However, for young infants with ASD, device closure remains controversial, and such treatment features limited data. We compared the clinical data and follow-up results of percutaneous and intraoperative device closure for ASD to evaluate the feasibility, safety, and efficacy of both treatments in infants under 3 years of age. METHODS: From September 2010 to September 2018, 186 children under 3 years of age with significant secundum ASD were included in this study. A total of 88 and 98 patients were divided into groups A (transcatheter device closure) and B (intraoperative device closure), respectively. The clinical data and follow-up results of the two groups were analyzed retrospectively. RESULT: The mean age and weight of patients in group A were significantly higher than those in group B. The proportion of complex ASDs (multiples or rims deficiency) and the device/weight ratio in group B were significantly higher than those in group A. Successful closure was obtained in 86 (97.7%) and 96 (98.0%) infants in groups A and B, respectively, with two failed cases in each group (2.3% vs 2%). The rate of periprocedural complications reached 13.6 and 26.5% for groups A and B (P = 0.058), respectively. The durations of the procedure and postoperative hospital stay in group A were significantly shorter than those in group B (P < 0.05). Excellent follow-up results were observed in both groups. At present, no death nor major complications have occurred. Symptoms either resolved completely or improved significantly for all symptomatic infants. No residual shunts at the 6th month of follow-up evaluation were observed. Patients with failure to thrive gained weight appropriately for age, and the structure and hemodynamic parameters significantly improved during follow-up. CONCLUSION: Transcatheter and intraoperative device closure are feasible, effective, and safe methods for the treatment of ASDs in infants under 3 years of age. Considering improved cosmetic effect and the short duration of the procedure and postoperative hospital stay, transcatheter is preferred for patients with appropriate conditions. Intraoperative device closure can be performed as an alternative to percutaneous closure, particularly for infants with large, complex ASDs, young age, or low-body weight.


Asunto(s)
Defectos del Tabique Interatrial/cirugía , Implantación de Prótesis/métodos , Dispositivo Oclusor Septal , Cateterismo Cardíaco , Preescolar , Femenino , Estudios de Seguimiento , Defectos del Tabique Interatrial/fisiopatología , Humanos , Lactante , Complicaciones Intraoperatorias/etiología , Tiempo de Internación , Masculino , Tempo Operativo , Complicaciones Posoperatorias/etiología , Implantación de Prótesis/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento
9.
Bone Joint J ; 102-B(1): 117-124, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31888372

RESUMEN

AIMS: It is unknown whether kinematic alignment (KA) objectively improves knee balance in total knee arthroplasty (TKA), despite this being the biomechanical rationale for its use. This study aimed to determine whether restoring the constitutional alignment using a restrictive KA protocol resulted in better quantitative knee balance than mechanical alignment (MA). METHODS: We conducted a randomized superiority trial comparing patients undergoing TKA assigned to KA within a restrictive safe zone or MA. Optimal knee balance was defined as an intercompartmental pressure difference (ICPD) of 15 psi or less using a pressure sensor. The primary endpoint was the mean intraoperative ICPD at 10° of flexion prior to knee balancing. Secondary outcomes included balance at 45° and 90°, requirements for balancing procedures, and presence of tibiofemoral lift-off. RESULTS: A total of 63 patients (70 knees) were randomized to KA and 62 patients (68 knees) to MA. Mean ICPD at 10° flexion in the KA group was 11.7 psi (SD 13.1) compared with 32.0 psi in the MA group (SD 28.9), with a mean difference in ICPD between KA and MA of 20.3 psi (p < 0.001). Mean ICPD in the KA group was significantly lower than in the MA group at 45° and 90°, respectively (25.2 psi MA vs 14.8 psi KA, p = 0.004; 19.1 psi MA vs 11.7 psi KA, p < 0.002, respectively). Overall, participants in the KA group were more likely to achieve optimal knee balance (80% vs 35%; p < 0.001). Bone recuts to achieve knee balance were more likely to be required in the MA group (49% vs 9%; p < 0.001). More participants in the MA group had tibiofemoral lift-off (43% vs 13%; p < 0.001). CONCLUSION: This study provides persuasive evidence that restoring the constitutional alignment with KA in TKA results in a statistically significant improvement in quantitative knee balance, and further supports this technique as a viable alternative to MA. Cite this article: Bone Joint J. 2020;102-B(1):117-124.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Osteoartritis de la Rodilla/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Femenino , Humanos , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Osteoartritis de la Rodilla/fisiopatología , Planificación de Atención al Paciente , Cuidados Preoperatorios , Implantación de Prótesis/métodos , Rango del Movimiento Articular/fisiología , Resultado del Tratamiento
10.
Bone Joint J ; 102-B(1): 64-71, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31888359

RESUMEN

AIMS: The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma. METHODS: A total of 35 consecutive patients treated with extendable endoprosthetic replacement of the humerus in children were included. There were 17 boys and 18 girls in the series with a median age at the time of initial surgery of nine years (interquartile range (IQR) 7 to 11). RESULTS: The median follow-up time was 10.6 years (IQR 3.9 to 20.4). The overall implant survival at ten years was 75%. Complications occurred in 13 patients (37%). Subluxation at the proximal humerus occurred in 19 patients (54%) but only six (17%) were symptomatic. Subluxation was seen more commonly in children under the age of nine years (86%) than in those aged nine years or more (33%) (p = 0.002). Implant failure occurred in nine patients (26%): the most common cause was aseptic loosening (four patients, 11%). Lengthening of the implant was carried out in 23 patients (66%). At final follow up, three patients had a limb that was shortened by 5 cm or more. The mean Musculoskeletal Tumor Society (MSTS) functional score was 79% (73% to 90%). CONCLUSION: Extendable endoprosthetic replacement is a reliable method of reconstructing humerus after excision of a bone sarcoma. Children who are less than nine years old have a high risk of subluxation. Cite this article: Bone Joint J 2020;102-B(1):64-71.


Asunto(s)
Neoplasias Óseas/cirugía , Húmero/cirugía , Osteosarcoma/cirugía , Miembros Artificiales , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/mortalidad , Niño , Condrosarcoma/diagnóstico por imagen , Condrosarcoma/mortalidad , Condrosarcoma/cirugía , Femenino , Humanos , Húmero/diagnóstico por imagen , Masculino , Márgenes de Escisión , Metástasis de la Neoplasia , Osteosarcoma/diagnóstico por imagen , Osteosarcoma/mortalidad , Estudios Prospectivos , Prótesis e Implantes , Diseño de Prótesis , Falla de Prótesis , Implantación de Prótesis/métodos , Implantación de Prótesis/mortalidad , Rango del Movimiento Articular/fisiología , Sarcoma de Ewing/diagnóstico por imagen , Sarcoma de Ewing/mortalidad , Sarcoma de Ewing/cirugía , Resultado del Tratamiento
11.
Acta Orthop ; 91(2): 171-176, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31960731

RESUMEN

Background and purpose - Compressive osseointegration fixation is an alternative to intramedullary fixation for endoprosthetic reconstruction. Mechanical failure of compressive osseointegration presents differently on radiographs than stemmed implants, therefore we aimed to develop a reliable radiographic method to determine stable integration.Patients and methods - 8 reviewers evaluated 11 radiographic parameters from 29 patients twice, 2 months apart. Interclass correlation coefficients (ICCs) were used to assess test-retest and inter-rater reliability. We constructed a fast and frugal decision tree using radiographic parameters with substantial test-retest agreement, and then tested using radiographs from a new cohort of 49 patients. The model's predictions were compared with clinical outcomes and a confusion matrix was generated.Results - 6 of 8 reviewers had non-significant intra-rater ICCs for ≥ one parameter; all inter-rater ICCs were highly reliable (p < 0.001). Change in length between the top of the spindle sleeve and bottom of the anchor plug (ICC 0.98), bone cortex hypertrophy (ICC 0.86), and bone pin hypertrophy (ICC 0.81) were used to create the decision tree. The sensitivity and specificity of the training cohort were 100% (95% CI 52-100) and 87% (CI 74-94) respectively. The decision tree demonstrated 100% (CI 40-100) sensitivity and 89% (CI 75-96) specificity with the test cohort.Interpretation - A stable spindle length and at least 3 cortices with bone hypertrophy at the implant interface predicts stable osseointegration; failure is predicted in the absence of bone hypertrophy at the implant interface if the pin sites show hypertrophy. Thus, our decision tree can guide clinicians as they follow patients with compressive osseo-integration implants.


Asunto(s)
Interfase Hueso-Implante/diagnóstico por imagen , Árboles de Decisión , Extremidad Inferior/cirugía , Oseointegración , Falla de Prótesis/etiología , Estudios de Cohortes , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Hiperostosis , Extremidad Inferior/diagnóstico por imagen , Variaciones Dependientes del Observador , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Pronóstico , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Radiografía/métodos , Sensibilidad y Especificidad , Estrés Mecánico
12.
World Neurosurg ; 136: 101-109, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31931246

RESUMEN

OBJECTIVE: Interbody spacers have been successfully used in spinal fusion procedures with the aim to restore disc height, provide stability, and promote bone fusion. The authors evaluated the efficacy of structural body allograft versus polyetheretherketone (PEEK) implants in patients undergoing spinal fusion surgery. METHODS: A systematic review of electronic databases was conducted using different Medical Subject Headings terms from January 1970 to August 2019. Pooled and subgroup analyses were performed using random-effects and fixed-effects models based on I2 heterogeneity. RESULTS: The analysis included 6640 patients (structural allograft 64% and PEEK cage 36%) from 7 comparative studies. There were no statistically significant differences in age (P = 0.27), sex (P = 0.31), body mass index (P = 0.82), and smoking status (P = 0.27) between the 2 groups. Overall, the mean follow-up was 12.9 ± 1.5 months. Pooled meta-analysis revealed that patients with structural allograft had 2.59-fold higher likelihood of fusion compared with patients with PEEK cages (odds ratio [OR] 2.59, 95% confidence interval [CI] 1.02-6.57, P = 0.05) at last follow-up evaluation. Patients with structural allograft had 61% less likelihood of pseudarthrosis (OR 0.39, 95% CI 0.15-0.98, P = 0.05) and 74% lower incidence of reoperation compared with patients with PEEK implants (OR 0.26, 95% CI 0.09-0.79, P = 0.02). Our results suggest that patients with structural allografts had a higher subsidence rate compared with patients with PEEK implants, but this was statistically insignificant (OR 1.07, 95% CI 0.45-2.53, P = 0.89). CONCLUSIONS: Our results corroborate that structural allografts are highly effective in promoting bony fusion compared with PEEK implants in patients undergoing spinal fusion surgery.


Asunto(s)
Trasplante Óseo/métodos , Cetonas , Polietilenglicoles , Implantación de Prótesis/métodos , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Aloinjertos , Humanos , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Osificación del Ligamento Longitudinal Posterior/cirugía , Medición de Resultados Informados por el Paciente , Complicaciones Posoperatorias/epidemiología , Seudoartrosis/epidemiología , Traumatismos Vertebrales/cirugía , Resultado del Tratamiento
13.
World Neurosurg ; 136: 117-121, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31954887

RESUMEN

OBJECTIVE: We sought to evaluate the feasibility for awake, endoscopic treatment of lumbar pseudarthrosis after a transforaminal lumbar interbody fusion (TLIF). METHODS: A 71-year-old male with severe cardiac disease, determined to be high risk for general anesthesia, presented with mechanical back pain and a L3-4 pseudarthrosis and L3 pedicle screw loosening after a L3-5 TLIF. An awake, transforaminal endoscopic redo diskectomy and TLIF procedure were performed by removing residual disk material adjacent to the previous "PEEK" (polyetheretherketone) interbody spacer and placing allograft, bone morphogenetic protein, and an expandable titanium interbody device adjacent to the PEEK cage. RESULTS: At 1-year follow-up, preoperative visual analog scale for back pain and Oswestry disability index improved from 7 and 38% to 1 and 2%. The 1-year follow-up radiograph showed stable interbody placement and no further screw loosening. CONCLUSIONS: A minimally invasive, awake procedure is presented for the treatment of pseudarthrosis after TLIF.


Asunto(s)
Vértebras Lumbares/cirugía , Neuroendoscopía/métodos , Complicaciones Posoperatorias/cirugía , Seudoartrosis/cirugía , Fusión Vertebral/métodos , Anciano , Trasplante Óseo/métodos , Discectomía/métodos , Falla de Equipo , Humanos , Masculino , Tornillos Pediculares , Complicaciones Posoperatorias/diagnóstico por imagen , Implantación de Prótesis/métodos , Seudoartrosis/diagnóstico por imagen , Reoperación/métodos , Vigilia
15.
Spine (Phila Pa 1976) ; 45(2): E111-E119, 2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-31404053

RESUMEN

STUDY DESIGN: A meta-analysis. OBJECTIVE: To investigate whether robot-assisted techniques are superior to conventional techniques in terms of the accuracy of pedicle screw placement and clinical indexes. SUMMARY OF BACKGROUND DATA: Robot-assisted techniques are increasingly applied to spine surgery to reduce the rate of screw misplacement. However, controversy about the superiority of robot-assisted techniques over conventional freehand techniques remains. METHODS: We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library for potentially eligible articles. The outcomes were evaluated in terms of risk ratio (RR) or standardized mean difference and the associated 95% confidence intervals (CIs). Meta-analysis was performed using the RevMan 5.3 software and subgroup analyses were performed based on the robot type for the accuracy of pedicle screw placement. RESULTS: Nine randomized controlled trials with 696 patients were included in this meta-analysis. The results demonstrated that the robot-assisted technique was more accurate in pedicle screw placement than the freehand technique. Subgroup analyses showed that the TINAVI robot-assisted technique was more accurate in screw positions Grade A (RR, 1.10; 95% CI, 1.06-1.14), Grade B (RR, 0.46; 95% CI, 0.28-0.75), and Grades C + D + E (RR, 0.21; 95% CI, 0.09-0.45) than the freehand technique, whereas the Renaissance robot-assisted technique showed the same accuracy as the freehand technique in screw positions Grade A, Grade B, and Grades C + D + E. Furthermore, the robot-assisted techniques showed equivalent postoperative stay, visual analogue scale scores, and Oswestry disability index scores to those of the freehand technique and shorter intraoperative radiation exposure time, fewer radiation dose and proximal facet violations but longer surgical time than the freehand technique. CONCLUSION: The robot-assisted technique is more accurate in pedicle screw placement than the freehand technique. And TINAVI robot-assisted pedicle screw placement is a more accurate alternative to conventional techniques and the Renaissance robot-assisted procedure. LEVEL OF EVIDENCE: 1.


Asunto(s)
Tornillos Pediculares , Implantación de Prótesis/métodos , Procedimientos Quirúrgicos Robotizados , Columna Vertebral/cirugía , Humanos , Tiempo de Internación , Oportunidad Relativa , Tempo Operativo , Dolor Postoperatorio/etiología , Implantación de Prótesis/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Procedimientos Quirúrgicos Robotizados/efectos adversos
16.
Eur J Ophthalmol ; 30(1): 212-216, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30832506

RESUMEN

A new technique of correcting tube-corneal touch is described in a case of Ahmed glaucoma valve implantation. This technique repositions the intracameral tube without externalization unlike the standard procedures which aim to correct tube-corneal touch. The technique makes use of a transscleral supracapsular anchor suture to facilitate repositioning of the tube within the ciliary sulcus. Feasible only in pseudophakic and aphakic patients, either a preexisting iridectomy or intraoperative iridectomy is an essential prerequisite to perform this procedure. The final positioning of the tube within the sulcus potentially prevents chronic rubbing of the iris by polypropylene suture as opposed to a transcameral suture.


Asunto(s)
Epitelio Posterior/patología , Implantes de Drenaje de Glaucoma , Glaucoma/cirugía , Falla de Prótesis/etiología , Implantación de Prótesis/métodos , Tacto , Afaquia Poscatarata/etiología , Afaquia Poscatarata/cirugía , Preescolar , Glaucoma/etiología , Humanos , Presión Intraocular , Masculino , Reoperación , Colgajos Quirúrgicos , Técnicas de Sutura
17.
World Neurosurg ; 134: 272-279, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31669245

RESUMEN

BACKGROUND: Cervical spine degenerative disease is one of the main causes of myelopathy. Anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure used to treat cervical myelopathy. Therefore, it is important to study pseudarthrosis rates after ACDF and correlate them with the graft used. METHODS: We performed a systematic review to evaluate the relationship between pseudarthrosis after ACDF and the interbody graft used. RESULTS: A total of 3732 patients were evaluated in 46 studies. The mean age of the included patients was 51.5 ± 4.18 years (range, 42-59.6 years). ACDF is most often perforemd as single-level surgery and the level most impaired is C5-C6. The use of titanium cages, zero profile, recombinant human bone morphogenetic protein 2, and carbon cages was seen as a protective factor for pseudarthrosis compared with the autograft group (control group); with an odds ratio of 0.29, 0.51, 0.03, and 0.3, respectively; the results were statistically relevant. The use of polyetheretherketone, poly(methyl methacrylate), and trabecular metal was a risk factor for development of pseudarthrosis compared with the control group, with an odds ratio of 1.7, 8.7, and 6.8, respectively; the results were statistically relevant. Radiologic follow-up was an important factor for the pseudarthrosis rate; paradoxically, a short follow-up (<1 year) had lower rates of pseudarthrosis and follow-up >2 years increased the chance of finding pseudarthrosis. CONCLUSIONS: Different types of grafts lead to a significant difference in pseudarthrosis rates. Follow-up time is also an important factor that affects the rate of pseudarthrosis after ACDF.


Asunto(s)
Trasplante Óseo/métodos , Vértebras Cervicales/cirugía , Discectomía/métodos , Complicaciones Posoperatorias/epidemiología , Implantación de Prótesis/métodos , Seudoartrosis/epidemiología , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Proteína Morfogenética Ósea 2/uso terapéutico , Carbono , Humanos , Cetonas , Oportunidad Relativa , Polietilenglicoles , Polimetil Metacrilato , Diseño de Prótesis , Proteínas Recombinantes/uso terapéutico , Factores de Riesgo , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Columna Vertebral/complicaciones , Titanio , Factor de Crecimiento Transformador beta/uso terapéutico , Trasplante Autólogo
18.
Ann Thorac Surg ; 109(1): e59-e62, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31521594

RESUMEN

Utilization of the Gelweave Valsalva graft (Terumo Vascutek, Tokyo, Japan) for David-type valve-sparing aortic root replacement was still controversial because this prosthesis did not completely reproduce the native sinus of Valsalva. We focused on the morphology of pseudo-Valsalva sinus after the reimplantation procedure and evaluated our novel crimp plication stitch from the viewpoint of morphology of Valsalva sinus at midterm follow-up periods.


Asunto(s)
Enfermedades de la Aorta/cirugía , Prótesis Vascular , Seno Aórtico/anatomía & histología , Adulto , Válvula Aórtica , Femenino , Humanos , Tratamientos Conservadores del Órgano/métodos , Diseño de Prótesis , Implantación de Prótesis/métodos , Técnicas de Sutura , Procedimientos Quirúrgicos Vasculares/métodos
19.
World Neurosurg ; 134: e1008-e1014, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31756502

RESUMEN

BACKGROUND: Deep brain stimulation (DBS) is considered standard of care for the treatment of medically refractory Parkinson disease (PD). The placement of brain electrodes is performed using contrast imaging to enhance blood vessel identification during stereotactic planning. We present our experience with a series of patients implanted using noncontrast imaging. METHODS: All cases of DBS surgery for PD performed between 2012 and 2018 with noncontrast imaging were retrospectively reviewed. Clinical features, postoperative imaging, and complications were analyzed. RESULTS: A total of 287 deep-seated electrodes were implanted in 152 patients. Leads were placed at the subthalamic nucleus and globus pallidus internus in 258 and 29 hemispheres, respectively. We identified 2 cases of intracranial hemorrhage (0.7%). CONCLUSIONS: DBS lead placement can be performed without the use of intravenous contrast with a postoperative intracranial hemorrhage rate comparable with other reported series.


Asunto(s)
Neuroestimuladores Implantables , Hemorragias Intracraneales/epidemiología , Imagen por Resonancia Magnética/métodos , Procedimientos Neuroquirúrgicos/métodos , Enfermedad de Parkinson/terapia , Hemorragia Posoperatoria/epidemiología , Implantación de Prótesis/métodos , Cirugía Asistida por Computador/métodos , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste , Estimulación Encefálica Profunda/métodos , Femenino , Globo Pálido/cirugía , Humanos , Masculino , Persona de Mediana Edad , Núcleo Subtalámico/cirugía
20.
Ann Otol Rhinol Laryngol ; 129(4): 380-387, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31771342

RESUMEN

PURPOSE: To compare intra- and postoperative outcomes between the standard linear incision with tissue preservation and the Minimally Invasive Ponto Surgery (MIPS). STUDY DESIGN: A non-randomized retrospective cohort series. METHODS: Medical files were reviewed of adult and pediatric bone anchored hearing implant recipients. Extracted outcomes included patient characteristics, implant survival, operative time, anesthesia use, intra and postoperative complications, soft tissue tolerability assessed by the Holger's classification, and implant stability assessed by the Resonance Frequency Analysis (RFA). Outcomes were compared between two surgeries. RESULTS: A total of 59 implants were placed (21 MIPS; 38 linear). Conductive hearing loss was the most common etiology for implantation. Surgery was conducted under local anesthesia in 67% of MIPS patients and 16% of linear patients. No intraoperative complications were reported for both surgical approaches and no implants were lost. Patients undergoing implantation via the MIPS approach displayed less skin reaction postoperatively, however this was not significant (P = .2848). The most common Holgers score for both groups was grade 1. The median and mean surgical duration for the MIPS group was statistically lower than the linear group (P = .0001). Implant stability measured by the RFA implant stability quotient was greater in the MIPS cohort. CONCLUSION: The MIPS approach seems either similar or superior to the linear approach in all perioperative outcomes evaluated. Outcomes such as surgical duration, anesthesia choice and implant stability measurements support implantation through the MIPS approach for patients meeting eligibility criteria.


Asunto(s)
Prótesis Anclada al Hueso , Pérdida Auditiva , Complicaciones Posoperatorias , Implantación de Prótesis , Adulto , Anestesia/métodos , Anestesia/estadística & datos numéricos , Canadá/epidemiología , Niño , Femenino , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/etiología , Pérdida Auditiva/cirugía , Pruebas Auditivas/métodos , Pruebas Auditivas/estadística & datos numéricos , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Tempo Operativo , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Falla de Prótesis , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Retención de la Prótesis/métodos , Retención de la Prótesis/estadística & datos numéricos , Estudios Retrospectivos
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