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1.
Bone Joint J ; 102-B(9): 1248-1255, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32862679

RESUMEN

AIMS: The treatment of tibial aplasia is controversial. Amputation represents the gold standard with good functional results, but is frequently refused by the families. In these patients, treatment with reconstructive limb salvage can be considered. Due to the complexity of the deformity, this remains challenging and should be staged. The present study evaluated the role of femoro-pedal distraction using a circular external fixator in reconstructive treatment of tibial aplasia. The purpose of femoro-pedal distraction is to realign the limb and achieve soft tissue lengthening to allow subsequent reconstructive surgery. METHODS: This was a retrospective study involving ten patients (12 limbs) with tibial aplasia, who underwent staged reconstruction. During the first operation a circular hexapod external fixator was applied and femoro-pedal distraction was undertaken over several months. Subsequent surgery included reconstruction of the knee joint and alignment of the foot. RESULTS: The mean follow-up was 7.1 years (2 to 10). The mean age of the patients at the time of the application of the fixator was 2.3 years (1.1 to 5.0). The mean time under distraction was 139.7 days (81.0 to 177.0). A mean fibular distalization of 38.7 mm (14.0 to 67.0) was achieved. Pin infections occurred in four limbs (33.3%) and osteitis in one. A femoral fracture occurred in one patient. Premature removal of the frame was not required in any patient. Sufficient realignment of the leg as well as soft tissue lengthening was achieved in all patients, allowing subsequent reconstruction. All patients were able to mobilize fully weight bearing after reconstruction. Functional outcome was limited in all limbs, and five patients (50.0%) required additional reconstructive operations. CONCLUSION: Regarding the functional results in the treatment of tibial aplasia, amputation remains superior to limb salvage. The latter procedure should only be performed in patients whose parents refuse amputation. Femoro-pedal distraction efficiently prepares the limb by realigning the leg and soft tissue lengthening. Minor complications are frequent, but usually do not hinder the continuation of distraction. Even though a fully weight-bearing limb is achieved, the functional outcome of reconstructive treatment remains limited. Recurrent deformities frequently occur and may require further operations. Cite this article: Bone Joint J 2020;102-B(9):1248-1255.


Asunto(s)
Fijadores Externos , Osteogénesis por Distracción/métodos , Tibia/anomalías , Tibia/cirugía , Preescolar , Femenino , Humanos , Lactante , Recuperación del Miembro , Masculino , Procedimientos Ortopédicos/instrumentación , Procedimientos Ortopédicos/métodos , Estudios Retrospectivos
2.
Int. j. morphol ; 38(4): 947-955, Aug. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1124881

RESUMEN

Trans-sutural distraction is a biological process that induces the formation of new bone and changes the position of bone by pulling on growing suture under the action of external forces. Currently, therapy to midfacial hypoplasia treated by trans-sutural distraction has been applied. In this study, Beagle dogs were selected as experimental animals, and a traction device designed by ourselves was applied to Beagle dogs to simulate the treatment process of trans-sutural distraction in human face, so as to provide a basis for the subsequent research on the related mechanism of trans-sutural distraction. The objective is that the animal model can provide the basis for the follow-up study of transsutural distraction. 45 month beagle dogs were randomly divided into two groups 3 in experiment group and 3 in control group. Implant nails were implanted as the bone marker in the bilateral zygomatic temporal suture, zygomandibular maxillary suture and palatine transverse suture in experimental group. The traction of the maxilla was carried out by the external cranial traction frame with canine fossa as bearing point, 800g force each side, elastic traction for 15 days. The control group only implanted the implant nail as the bone marker on both sides of the bone suture. The distance between two implant nails was measured by vernier calipers and X-ray examination, compared with preoperative and postoperative changes. X-ray and cephalometric measurements were used to measure change in the cranial basal angle. HE staining was used to observe the width of the bone seams, the morphology and structure of the cells and the tissue of the new bone under the phase contrast microscope. Then descriptive statistical analysis and t-test between two independent samples are carried out for the measurement data. The experimental group had a good retention of the beagle traction frame. In the experimental group, the maxillaries of dogs were protrudent in the process of traction gradually and the occlusal relationship changed to type II malocclusion. When the traction is 15 days, the coverage distance is about 8~9 mm. Before and after the traction, the distance between landmark points indicated that the spacing between the transverse palatine suture was the largest (experimental group: 5.52±0.19 mm control group 1.31±0.06 mm P<0.05), and zygomaticotemporal suture was the second (experimental group: 3.12±0.15 mm, control group 0.73±0.04 mm, P<0.05), and zygomaticomaxillary suture was less (experimental group: 2.60±0.34 mm, control group 0.53±0.05 mm, P<0.05). The cranial basal angle was no change before and after operation (controlgroup: 32.3±1.3°, experimental group: 33.2±1.1° P>0.05. Histology showed that the collagenous fibers in the suture of the control group were denser and the osteoblasts were visible on the edge of the suture, showing osteogenic activity. The experimental group significantly widened suture (experimental group: 1209.388±42.714 µm, control group 248.276±22.864 µm, P<0.05), the number of fibroblasts increased significantly with loose collagen fiber. The direction of cell and fiber arrangement were parallel to the traction force. There were many small blood vessels and marrow cavities, and the bone trabecula around the bone suture was thin (experimental group: 23.684±3.774 mm, control group: 86.810±9.219 mm, P < 0.05), showing active osteogenic activity. The growing beagle dog can be used to establish a suture traction animal model for experimental study. In the experiment, Kirschner wire was used to penetrate the bottom plane of the piriform hole of the maxilla (about the position of the canine fossa at the back) and the traction direction was basically the same as the growth direction, and the maxilla was basically parallel and moved forward.


La distracción trans-sutural es un proceso biológico que induce la formación de hueso nuevo y cambia la posición del éste al tirar de la sutura en crecimiento bajo la acción de fuerzas externas. Actualmente, se ha aplicado la terapia para la hipoplasia de la cara media tratada por distracción trans-sutural. En este estudio, fueron seleccionados perros Beagle como animales experimentales, y un dispositivo de tracción fue instalado a los perros para simular el proceso de tratamiento de la distracción trans-sutural en el rostro humano. El objetivo fue proporcionar una base para la investigación posterior sobre mecanismos relacionados con la distracción trans-sutural. El modelo animal puede proporcionar la base para este tipo de estudio de seguimiento de la distracción trans-sutural. Perros Beagle de 45 meses de edad se dividieron aleatoriamente en dos grupos: 3 en el grupo experimental y 3 en el grupo control. Los clavos de implante se usaron como marcadores óseos en la sutura temporal cigomática bilateral, la sutura maxilar cigomandibular y en la sutura transversal palatina en el grupo experimental. La tracción del maxilar se realizó mediante el marco de tracción craneal externo con fosa canina como punto de apoyo, 800 g de fuerza a cada lado, tracción elástica durante 15 días. En el grupo control solo se implantó el clavo del implante como marcador óseo en ambos lados de la sutura. La distancia entre dos clavos de implante se midió mediante calibradores de vernier y examen de rayos X, en comparación con los cambios preoperatorios y postoperatorios. Se utilizaron mediciones cefalométricas y de rayos X para medir el cambio en el ángulo basal craneal. La tinción con HE se usó para observar el ancho de las suturas óseas, la morfología y la estructura de las células y el tejido del hueso nuevo bajo el microscopio de contraste de fase. Luego se realizó un análisis estadístico descriptivo y una prueba t entre dos muestras independientes para los datos de medición. El grupo experimental tuvo una buena retención del cuadro de tracción del Beagle. En el grupo experimental, los maxilares de los perros sobresalieron gradualmente en el proceso de tracción y la relación oclusal cambió a maloclusión tipo II. Cuando la tracción era de 15 días, la distancia de cobertura fue de aproximadamente 8 ~ 9 mm. Antes y después de la tracción, la distancia entre los puntos de referencia indicaba que el espacio entre la sutura palatina transversal era más grande (grupo experimental: 5,52 ± 0,19 mm, grupo de control 1,31 ± 0,06 mm, P <0,05), y la sutura cigomáticotemporal fue la segunda. (Grupo experimental: 3,12 ± 0,15 mm, grupo control 0,73 ± 0,04 mm, P <0,05), y la sutura cigomaticomaxilar fue menor (grupo experimental, 2,60 ± 0,34 mm, grupo control 0,53 ± 0,05 mm, P <0,05). El ángulo basal craneal no cambió antes ni después de la operación (grupo control 32,3 ± 1,3, grupo experimental, 33,2 ± 1,1 ° , P> 0,05). La histología mostró que las fibras colágenas en la sutura del grupo control eran más densas y los osteoblastos se observaron en el margen de la sutura, mostrando actividad osteogénica. En el grupo experimental se amplió significativamente la sutura (1209,388 ± 42,714 µm, grupo control 248,276 ± 22,864 µm, P <0,05), el número de fibroblastos aumentó significativamente con fibras colágenas dispersas. La dirección de la disposición de la celda y las fibras era paralela a la fuerza de tracción. Se observó gran cantidad de vasos sanguíneos pequeños, cavidades medulares, y trabéculas óseas alrededor de la sutura ósea (grupo experimental: 23,684 ± 3,774 mm, grupo control: 86,810 ± 9,219 mm, P <0,05), que mostró actividad osteogénica activa. El perro Beagle en crecimiento se puede utilizar para estudios experimentales y así establecer un modelo animal de tracción de sutura. En el proceso, se usó alambre de Kirschner para penetrar en el plano inferior del foramen piriforme del maxilar (aproximadamente en la posición de la fosa canina en la parte posterior) y la dirección de tracción fue básicamente la misma que en el crecimiento.


Asunto(s)
Animales , Perros , Anomalías Craneofaciales/cirugía , Osteogénesis por Distracción/métodos , Huesos Faciales/cirugía , Suturas , Tracción , Modelos Animales de Enfermedad , Maloclusión/cirugía
3.
Eur Spine J ; 29(10): 2409-2412, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32601848

RESUMEN

INTRODUCTION: At the time of writing, we are all coping with the global COVID-19 pandemic. Amongst other things, this has had a significant impact on postponing virtually all routine clinic visits and elective surgeries. Concurrently, the Magnetic Expansion Control (MAGEC) rod has been issued with a number of field safety notices and UK regulator medical device alerts. METHODS: This document serves to provide an overview of the current situation regarding the use of MAGEC rods, primarily in the UK, and the impact that the pandemic has had on the management of patients with these rods. RESULTS AND CONCLUSION: The care of each patient must of course be determined on an individual basis; however, the experience of the authors is that a short delay in scheduled distractions and clinic visits will not adversely impact patient treatment. The authors caution against a gap in distractions of longer than 6 months and emphasise the importance of continued remote patient monitoring to identify those who may need to be seen more urgently.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Imanes , Osteogénesis por Distracción/métodos , Pandemias/prevención & control , Seguridad del Paciente , Neumonía Viral/prevención & control , Prótesis e Implantes , Escoliosis/cirugía , Niño , Asignación de Recursos para la Atención de Salud/métodos , Asignación de Recursos para la Atención de Salud/normas , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Osteogénesis por Distracción/instrumentación , Osteogénesis por Distracción/normas , Seguridad del Paciente/normas , Guías de Práctica Clínica como Asunto , Telemedicina/métodos , Telemedicina/normas , Factores de Tiempo , Reino Unido
4.
Plast Reconstr Surg ; 146(4): 783-791, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32590521

RESUMEN

BACKGROUND: The traditional method of distraction required a long period until the new bone was fully fused. This study aimed to evaluate the effect of cyclic and repetitive compressive force on new bone formation by applying a newly designed microactuator-generated distractor compared with the traditional distraction protocol. METHODS: The distraction devices were applied to the right and left mandibles of eight mature beagles, four of which were allocated to the experimental group and the other four to the control group. After a 5-day latency period, in the experimental group, 1.5-mm distraction and 0.5-mm compression were alternately applied every 12 hours; and in the control group, 0.5-mm distraction was repeated every 12 hours to perform a total of 7-mm mandibular lengthening. After an 8-week consolidation period, microstructure analysis using micro-computed tomography and histologic evaluations were performed. RESULTS: Bone volume fraction and trabecular number were significantly higher in the experimental group. Trabecular thickness did not show a significant difference, and trabecular separation was significantly higher in the control group. The measurement of new bone was significantly higher in the experimental group, but the difference in mineral apposition rate between the experimental and control groups was not statistically significant. CONCLUSIONS: This study has revealed that applying cyclic compressive and tensile forces during the distraction period induces better new bone formation than repetitive distraction alone. In addition, the new distraction device produced reliable distraction results during the experiment.


Asunto(s)
Mandíbula/cirugía , Osteogénesis por Distracción/instrumentación , Osteogénesis por Distracción/métodos , Osteogénesis , Animales , Perros , Masculino , Presión
5.
Clin Imaging ; 67: 15-29, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32502926

RESUMEN

Radiologists work in conjunction with orthopedic surgeons to evaluate the progression of bone healing and identify potential problems during bone reconstruction. Accurate evaluation and identification of healing progression or complications are critical to optimizing successful patient outcomes with either distraction osteogenesis or bone grafting. Therefore, radiologists must understand the fundamental concepts behind these surgical reconstructive techniques in order to provide accurate postoperative radiographic assessments. The cases and discussion within this review aim to provide this foundational knowledge.


Asunto(s)
Huesos/diagnóstico por imagen , Osteogénesis por Distracción/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Trasplante Óseo , Femenino , Humanos , Radiólogos
6.
Plast Reconstr Surg ; 145(6): 1073e-1088e, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32459782

RESUMEN

LEARNING OBJECTIVES: After studying this article and viewing the video, the participant should be able to: 1. Compare the relative stability and neurosensory changes following mandible distraction osteogenesis with those after traditional advancement and fixation. 2. Describe the condylar changes that can occur after mandible distraction osteogenesis and list three ways to mitigate these changes. 3. Propose clinical situations where segmental or rotational movements of the midface may allow improved outcomes compared to en bloc linear distraction advancement. 4. Summarize the advantages and risks associated with anterior and posterior cranial distraction osteogenesis compared to traditional one-stage expansion. SUMMARY: Over the past 30 years, distraction forces have been applied to the spectrum of craniofacial osteotomies. It is now time to assess critically the current understanding of distraction in craniofacial surgery, identifying both traditional procedures it has replaced and those it has not. This article provides a review of comparative studies and expert opinion on the current state of craniofacial distraction compared with traditional operations. Through this critical evaluation, the reader will be able to identify when distraction techniques are appropriate, when traditional techniques are more favorable, and what the future of distraction osteogenesis is.


Asunto(s)
Maloclusión de Angle Clase II/cirugía , Mandíbula/cirugía , Avance Mandibular/métodos , Osteogénesis por Distracción/métodos , Predicción , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Avance Mandibular/tendencias , Modelos Animales , Osteogénesis por Distracción/historia , Osteogénesis por Distracción/tendencias , Selección de Paciente
7.
J Craniofac Surg ; 31(5): 1301-1306, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32282486

RESUMEN

OBJECT: Distraction osteogenesis (DO) may allow for maximal volumetric expansion in the posterior vault (PV) by overcoming viscoelastic forces of overlying soft tissues. Little evidence exists regarding surgical planning and anticipated 3D volumetric changes pre- and post-operatively. We aim to study the volumetric changes occurring in PV distraction in lambdoid craniosynostosis. METHODS: From 2007 to 2019, a single institution retrospective review revealed 232 craniosynostosis patients. Fourteen demonstrated lambdoid synostosis (6%), and of those, 11 patients were included in the study due to treatment with PVDO or representative sample. Six patients had unilateral synostosis and 5 had bilateral synostosis. Imaging protocol for PVDO patients included preoperative head CT within 1 month of surgery and 8 weeks following distraction cessation with weekly skull plain films. 3D volumetric analyses were performed on pre and postoperative head CT using 3D Slicer software. RESULTS: Posterior fossa volume (PFV) increased by 38.7% and foramen magnum area increased by 26.9% postoperatively. Unilateral lambdoid craniosynostosis patients had greater increases in PFV versus bilateral lambdoid craniosynostosis patients (63.5% versus 8.9%, P = 0.007). Osteotomy to the asterion was more effective in increasing PFV versus osteotomy to foramen magnum (P = 0.050). Placement of distractor in the inferior third of the lambdoid suture is more effective in increasing PFV versus placement in the middle or top third of the suture (P = 0.041). CONCLUSIONS: Highest volumetric increases are seen in unilateral lambdoid synostosis. Extending osteotomy beyond the asterion is not necessary for maximal PV volumetric gain. Placement of distractor in the inferior third of the suture leads to maximal PV volumetric gains.


Asunto(s)
Osteogénesis por Distracción , Tornillos Óseos , Niño , Suturas Craneales/cirugía , Craneosinostosis/cirugía , Femenino , Foramen Magno , Humanos , Imagenología Tridimensional , Osteogénesis por Distracción/métodos , Osteotomía/métodos , Periodo Posoperatorio , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
8.
Plast Reconstr Surg ; 145(4): 1025-1034, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32221227

RESUMEN

BACKGROUND: Monobloc advancement is a complex procedure used to treat patients with syndromic craniosynostosis. Studies directly addressing the long-term stability of monobloc advancement with distraction osteogenesis are underreported in the literature. The objectives of this study were to assess 5-year midface bone stability following monobloc advancement performed on patients with syndromic craniosynostosis, identify risk factors for relapse, and present strategies for prevention and management of complications. METHODS: An observational retrospective study was performed on consecutive patients with Apert, Crouzon, or Pfeiffer syndrome (n = 23) who underwent monobloc advancement using distraction osteogenesis between 1994 and 2013. A total of 130 lateral cephalograms were used to assess both long-term stability after monobloc advancement with distraction osteogenesis and risk factors for relapse. All serious complications were identified and recorded. The analysis of variance test was used to assess horizontal relapse of the midface and mandibular plane. RESULTS: Cephalometric analysis revealed long-term stability of frontofacial advancement using distraction osteogenesis, regardless of the presence of tested variables. Serious complications arising from monobloc advancement using distraction osteogenesis included cerebrospinal fluid leakage in six patients (26 percent), accompanying meningitis in two patients (8.7 percent), seizures in seven patients (30.4 percent), and impaired visual acuity in one eye of one patient (4.3 percent). CONCLUSION: Frontofacial monobloc advancement with distraction osteogenesis provides long-term midface bone stability. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Asunto(s)
Acrocefalosindactilia/cirugía , Craneosinostosis/cirugía , Huesos Faciales/fisiología , Osteogénesis por Distracción/métodos , Adolescente , Adulto , Transfusión Sanguínea/estadística & datos numéricos , Cefalometría , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Osteogénesis por Distracción/efectos adversos , Complicaciones Posoperatorias/etiología , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Síndrome , Resultado del Tratamiento , Adulto Joven
9.
Plast Reconstr Surg ; 145(4): 1071-1076, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32221236

RESUMEN

Osteocutaneous reconstruction can be challenging because of concomitant injuries and limited donor sites. There is a paucity of data on limb salvage outcomes following combined soft-tissue reconstruction and bone transport or Masquelet procedures. The authors reviewed a consecutive series of open tibia fracture patients undergoing soft-tissue reconstruction with either distraction osteogenesis or Masquelet technique. Endpoints were perioperative flap complications and bone union. Fourteen patients with Gustilo type IIIB open tibia fractures were included. Half of the group received muscle flaps and the remaining half received fasciocutaneous flaps. Ten patients (71.4 percent) underwent distraction osteogenesis and the remaining patients underwent Masquelet technique. Average bone gap length was 65.7 ± 31.3 mm (range, 20 to 120 mm). In the bone transport group, the average external fixation duration was 245 days (range, 47 to 686 days). In the Masquelet group, the average duration of the first stage of this two-stage procedure (i.e., time from cement spacer placement to bone grafting) was 95 days (range, 42 to 181 days). Bone union rate, as determined by radiographic evidence, was 85.7 percent. There was one complete flap failure (7.1 percent). One patient underwent below-knee amputation after failing bone transport and developing chronic osteomyelitis and subsequent infected nonunion. Our case series demonstrates that nonosteocutaneous flap methods of limb reconstruction are a viable option in patients with segmental long bone defects, with a bone union rate of 85 percent and a limb salvage rate over 90 percent in patients with Gustilo type IIIB fractures. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Asunto(s)
Fracturas Abiertas/cirugía , Colgajos Tisulares Libres , Recuperación del Miembro/métodos , Osteogénesis por Distracción/métodos , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Trasplante Óseo/métodos , Estudios de Factibilidad , Femenino , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
10.
Spine Deform ; 8(4): 763-770, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32170659

RESUMEN

STUDY DESIGN: Descriptive case series. OBJECTIVE: The aim of the study is to investigate the pain associated with magnetically controlled growing rod (MCGR) lengthening procedures. MCGRs have gained popularity because they offer non-surgical lengthening procedures in early-onset scoliosis (EOS) instead of semi-annual open surgery elongations with traditional growing rods. Many aspects of MCGR treatment have been investigated, but pain in conjunction with distraction is only sparsely described in the literature. METHODS: Pain intensity was assessed in 25 EOS patients before, during and after MCGR lengthening procedures in an outpatient setup. They underwent at least two (range 2-16) lengthening procedures prior to this study. The pain intensity was estimated using patient-reported Faces Pain Scale (FPS-R), caregiver-reported pain numeric rating scale (NRS), and NRS and revised Face, Legs, Activity, Cry, Consolability scale (r-FLACC) by two medically trained observers. The inter-rater reliability and correlation between instruments were analyzed. RESULTS: 23 of 25 EOS patients (8- to 16-year old) with mixed etiology were able to self-report pain. The average pain intensity was mild: median 1 (range 0-6) on all four instruments on a 0-to-10 scale. Afterward, 22/25 patients (88%) were completely pain free and the remaining 3 patients had a pain score of 1. MCGR stalling (i.e. clunking) was encountered in 14/25 (56%) of the patients without impact on the pain intensity. CONCLUSIONS: The average maximum pain intensities during the lengthening procedures were mild and pain ceased within few minutes. The inter-rater reliability was good to excellent for NRS and r-FLACC, and there were high correlations between all the four pain instruments, indicating high criterion validity. LEVEL OF EVIDENCE: Level IV, case series.


Asunto(s)
Cara/fisiología , Fijadores Internos/efectos adversos , Osteogénesis por Distracción/efectos adversos , Osteogénesis por Distracción/métodos , Dimensión del Dolor/métodos , Dolor/etiología , Escoliosis/cirugía , Adolescente , Edad de Inicio , Niño , Preescolar , Femenino , Humanos , Masculino , Dolor/prevención & control
11.
Spine Deform ; 8(2): 303-309, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32026442

RESUMEN

STUDY DESIGN: Retrospective, comparative, multicenter. OBJECTIVES: To determine if the choice of proximal anchor affects thoracic sagittal spine length (SSL) for children with idiopathic early-onset scoliosis (EOS). Debate exists as to whether spine growth is maintained during treatment for EOS. As rib- (RB) and spine-based (SB) distraction procedures may be kyphogenic, the traditional measurement of spine growth on coronal radiographs may not identify out-of-plane increase in spine length. A measure of SSL, along the spine's sagittal arc of curvature, has been validated to reliably assess the length of the thoracic spine. METHODS: Patients with idiopathic EOS treated with distraction-based systems (minimum 5-year follow-up, five lengthening surgeries) with radiographic analysis preoperatively, postimplant (L1), and during lengthening periods (L2-L5, L6-L10) were evaluated with primary outcome of T1-T12 SSL. RESULTS: We identified 34 patients (14 RB, 20 SB) with preoperative age 4.9 years (4.2 RB vs. 5.4 SB), scoliosis 72° (60° RB vs. 77° SB; p < 0.05), kyphosis 39° (50° RB vs. 34° SB; p < 0.05), and SSL 17.8 cm (15.5 RB vs. 18.5 SB; p < 0.05). After initial scoliosis correction from implantation, scoliosis remained constant over time. RB patients had greater kyphosis than SB patients: L1, 46° RB vs. 19° SB (p < 0.05); L2-L5, 50° RB vs. 27° SB (p < 0.05); L6-L10, 56° RB vs. 26° SB (p < 0.05). SSL increased for both groups from preoperative to the tenth lengthening (p < 0.05). As compared with RB patients, SB patients had higher SSL preoperatively and maintained this difference to the tenth lengthening (p < 0.05). After ten lengthening surgeries, when normalized to preoperative SSL, relative thoracic growth was greater for RB (27%) than for SB patients (19%) (p < 0.05). CONCLUSION: Regardless of proximal anchor choice, thoracic length continued to increase during the distraction phase of treatment for idiopathic EOS. LEVEL OF EVIDENCE: Level III.


Asunto(s)
Osteogénesis por Distracción/métodos , Escoliosis/cirugía , Vértebras Torácicas/crecimiento & desarrollo , Vértebras Torácicas/cirugía , Edad de Inicio , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , Escoliosis/patología , Escoliosis/fisiopatología , Vértebras Torácicas/patología
12.
J Craniofac Surg ; 31(4): e319-e321, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32028363

RESUMEN

Mandibular distraction osteogenesis (MDO) is a fairly common procedure in specialized craniofacial surgery centers. The MDO is a minimally invasive technique that is able to generate new bone in patients with a severe hypoplastic ascending ramus, while also expanding the overlying soft tissues; therefore, it has become the treatment of choice for the surgical correction of mandibular hypoplasias. One of the most common postoperative complications involves misplacement of the distractor and/or corticotomy, which can result in the creation of an erroneous distraction vector. The introduction of 3-dimensional (3D) printing has revolutionized preoperative planning in several surgical fields; however, cost can hinder its application in developing nations, specially in public institutions. The aim of this work is present our experience using low-cost 3D-printed anatomic models for preoperative planning and surgical simulation in patients requiring MDO.


Asunto(s)
Enfermedades Mandibulares/diagnóstico por imagen , Osteogénesis por Distracción/métodos , Niño , Femenino , Humanos , Masculino , Enfermedades Mandibulares/cirugía , Modelos Anatómicos , Impresión Tridimensional
13.
PLoS One ; 15(1): e0227975, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31968005

RESUMEN

OBJECTIVES: Knee joint distraction (KJD) has been evaluated as a joint-preserving treatment to postpone total knee arthroplasty in knee osteoarthritis patients in three clinical trials. Since 2014 the treatment is used in regular care in some hospitals, which might lead to a deviation from the original indication and decreased treatment outcome. In this study, baseline characteristics, complications and clinical benefit are compared between patients treated in regular care and in clinical trials. METHODS: In our hospital, 84 patients were treated in regular care for 6 weeks with KJD. Surgical details, complications, and range of motion were assessed from patient hospital charts. Patient-reported outcome measures were evaluated in regular care before and one year after treatment. Trial patients (n = 62) were treated and followed as described in literature. RESULTS: Patient characteristics were not significantly different between groups, except for distraction duration (regular care 45.3±4.3; clinical trials 48.1±8.1 days; p = 0.019). Pin tract infections were the most occurring complication (70% regular care; 66% clinical trials), but there was no significant difference in treatment complications between groups (p>0.1). The range of motion was recovered within a year after treatment for both groups. WOMAC questionnaires showed statistically and clinically significant improvement for both groups (both p<0.001 and >15 points in all subscales) and no significant differences between groups (all differences p>0.05). After one year, 70% of patients were responders (regular care 61%, trial 75%; p = 0.120). Neither regular care compared to clinical trial, nor any other characteristic could predict clinical response. CONCLUSIONS: KJD as joint-preserving treatment in clinical practice, to postpone arthroplasty for end-stage knee osteoarthritis patient below the age of 65, results in an outcome similar to that thus far demonstrated in clinical trials. Longer follow-up in regular care is needed to test whether also long-term results remain beneficial and comparable to trial data.


Asunto(s)
Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Osteogénesis por Distracción/métodos , Osteogénesis por Distracción/normas , Adulto , Antibacterianos/administración & dosificación , Artroplastia de Reemplazo de Rodilla , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/fisiopatología , Cartílago Articular/cirugía , Ensayos Clínicos como Asunto/normas , Fijadores Externos , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/normas , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/epidemiología , Osteoartritis de la Rodilla/fisiopatología , Rango del Movimiento Articular/fisiología , Resultado del Tratamiento
14.
Orthop Surg ; 12(1): 184-193, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31943836

RESUMEN

OBJECTIVE: The aim of this study is to assess the clinical results of bifocal or trifocal bone transport using unilateral rail system in the treatment of large tibial defects caused by infection. METHODS: There were a total of 37 eligible patients with an average age of 40.11 ± 10.32 years (range, 18-57 years; 28 males and nine females) with large tibial defects due to infection who were admitted to our hospital from June 2006 to June 2016. Among the patients, 21 underwent bifocal bone transport (BF group), and the remaining 16 were treated with trifocal bone transport (TF group). The demographic data (age, sex, interval duration before bone transport, previous operation time), intraoperative outcomes (size and location of the defect, size of soft tissue defect), postoperative variables (lengthening speed, external fixation index, duration of regenerate consolidation and docking union), postoperative bone and functional outcomes evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated by Paley classification (muscle contraction, axial deviation, delayed consolidation, pin problems, repeated fracture, joint stiffness and others) of the two groups were recorded and compared at a minimum follow-up of 24 months. RESULTS: The mean duration of follow-up after removal of fixator was 29.49 ± 4.34 months (range, 24-38 months). There was no statistically significant difference in the demographic data, intraoperative outcomes including size and location of the defect, size of soft tissue defect, as well as postoperative complications. However, postoperative functional result in the TF group were superior to those in the BF group at a minimum follow-up of 24 months, and lengthening speed, external fixation index (EFI), duration of regenerate consolidation and docking union were significantly reduced in the TF group when compared with the BF group. CONCLUSIONS: Treatment of large tibial defects caused by infection with trifocal bone transport using unilateral rail system could significantly improve postoperative functional recovery and reduce duration of regenerate consolidation and docking union. The present study provides novel insight for the treatment of large tibial defects caused by infection.


Asunto(s)
Técnica de Ilizarov , Osteogénesis por Distracción/métodos , Osteomielitis/cirugía , Tibia/microbiología , Tibia/cirugía , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
15.
J Craniofac Surg ; 31(3): 648-652, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31895846

RESUMEN

BACKGROUND: The purpose of this study is to review 10 years of surgical experience in the management of Apert syndrome, focusing on an updated algorithm which includes hand reconstruction and posterior vault distraction osteogenesis (PVDO). Additionally, the authors compare PVDO, which is currently used, with fronto-orbital advancement (FOA), which was utilized in a previous algorithm. METHODS: An observational retrospective study was performed on consecutive patients with Apert syndrome who underwent upper and lower limb reconstruction and craniofacial surgery between 2007 and 2017. A modified Clavien-Dindo surgical complication scale was used to stratify complications between PVDO and FOA. Demographic, surgical, and outcome data was also recorded. The blood transfusion rate between PVDO and FOA was also assessed and compared utilizing the Student t test. RESULTS: The present study included 69 patients with Apert syndrome (34 males and 35 females). Craniofacial surgeries were performed on a total of 38 patients. A total of 210 operations were performed on the respective upper and lower limbs of patients included in this study. A total of 18 patients underwent PVDO (n = 9) and FOA (n = 9). Posterior vault distraction osteogenesis required significantly less transfused blood volume than FOA (P < 0.05). Complication rate and length of hospital stay were similar for each procedure. CONCLUSION: An updated algorithm to treat Apert patients was implemented. Posterior vault distraction osteogenesis incorporated into an updated algorithm results in a lower blood transfusion rate.


Asunto(s)
Acrocefalosindactilia/cirugía , Adolescente , Algoritmos , Niño , Preescolar , Femenino , Humanos , Tiempo de Internación , Masculino , Osteogénesis por Distracción/métodos , Procedimientos Quirúrgicos Reconstructivos , Estudios Retrospectivos
16.
Clin Orthop Relat Res ; 478(4): 836-851, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31794478

RESUMEN

BACKGROUND: The management of severe and recalcitrant diabetic foot ulcers is challenging. Distraction osteogenesis is accompanied by vascularization and regeneration of the surrounding tissues. Longitudinal distraction of the proximal tibia stimulates increased and prolonged blood flow to the distal tibia. However, the effects of transverse distraction of the proximal tibia cortex on severe and recalcitrant diabetic foot ulcers are largely unknown. QUESTIONS/PURPOSES: (1) Does tibial cortex transverse distraction increase healing and decrease major amputation and recurrence of severe and recalcitrant diabetic foot ulcers compared with routine management (which generally included débridement, revascularization, negative pressure wound therapy, local or free flaps, or skin grafts as indicated)? (2) Does neovascularization and perfusion increase at the foot after the procedure? (3) What are the complications of tibial cortex transverse distraction in patients with severe and recalcitrant diabetic foot ulcers? METHODS: Between July 2014 and March 2017, we treated 136 patients with diabetes mellitus and University of Texas Grade 2B to 3D ulcers (wound penetrating to the tendon, capsule, bone, or joint with infection and/or ischemia). The patients had failed to respond to treatment for at least 6 months, and their ulcers had a mean ± SD area of 44 cm ± 10 cm. All 136 patients underwent tibial cortex transverse distraction (partial corticotomy of the upper tibia, which was in normal condition, followed by 4 weeks of transverse distraction medially then laterally). We compared these patients with the last 137 consecutive patients we treated with standard surgical treatment, consisting of débridement, revascularization, local or free flap or skin equivalent, or graft reconstruction along with negative-pressure wound therapy between May 2011 and June 2013; there was a 1-year period during which both treatments were in use, and we did not include patients whose procedures were performed during this time in either group. Patients in both groups received standard off-loading and wound care. The patients lost to follow-up by 2 years (0.7% of the treatment group [one of 137] and 1.4% of the control group [two of 139]; p = 0.57) were excluded. The patients in the treatment and control groups had a mean age of 61 years and 60 years, respectively, and they were predominantly men in both groups (70% [95 of 136] versus 64% [88 of 137]; p = 0.32). There were no differences with respect to parameters associated with the likelihood of ulcer healing, such as diabetes and ulcer duration, ulcer grades and area, smoking, and arterial status. We compared the groups with respect to ulcer healing (complete epithelialization without discharge, maintained for at least 2 weeks, which was determined by an assessor not involved with clinical care) in a 2-year follow-up, the proportion of ulcers that healed by 6 months, major amputation, recurrence, and complications in the 2-year follow-up. Foot arterial status and perfusion were assessed in the tibial cortex transverse distraction group using CT angiography and perfusion imaging. RESULTS: The tibial cortex transverse distraction group had a higher proportion of ulcers that healed in the 2-year follow-up than the control group (96% [131 of 136] versus 68% [98 of 137]; odds ratio 10.40 [95% confidence interval 3.96 to 27.43]; p < 0.001). By 6 months, a higher proportion of ulcers healed in the tibia cortex transverse distraction group than the control group (93% [126 of 136] versus 41% [56 of 137]; OR 18.2 [95% CI 8.80 to 37.76]; p < 0.001). Lower proportions of patients in the tibia cortex transverse distraction group underwent major amputation (2.9% [four of 136] versus 23% [31 of 137], OR 0.10 [95% CI 0.04 to 0.30]; p < 0.001) or had recurrences 2.9% (4 of 136) versus 17% (23 of 137), OR 0.20 [95% CI 0.05 to 0.45]; p < 0.001) than the control group in 2-year follow-up. In the feet of the patients in the tibial cortex transverse distraction group, there was a higher density of small vessels (19 ± 2.1/mm versus 9 ± 1.9/mm; mean difference 10/mm; p = 0.010), higher blood flow (24 ± 5 mL/100 g/min versus 8 ± 2.4 mL/100 g/min, mean difference 16 mL/100 g/min; p = 0.004) and blood volume (2.5 ± 0.29 mL/100 g versus 1.3 ± 0.33 mL/100 g, mean difference 1.2 mL/100 g; p = 0.03) 12 weeks postoperatively than preoperatively. Complications included closed fractures at the corticotomy site (in 1.5% of patients; two of 136), which were treated with closed reduction and healed, as well as pin-site infections (in 2.2% of patients; three of 136), which were treated with dressing changes and they resolved without osteomyelitis. CONCLUSIONS: Proximal tibial cortex transverse distraction substantially facilitated healing and limb salvage and decreased the recurrence of severe and recalcitrant diabetic foot ulcers. The surgical techniques were relatively straightforward although the treatment was unorthodox, and the complications were few and minor. These findings suggest that tibial cortex transverse distraction is an effective procedure to treat severe and recalcitrant diabetic foot ulcers compared with standard surgical therapy. Randomized controlled trials are required to confirm these findings. LEVEL OF EVIDENCE: Level II, therapeutic study.


Asunto(s)
Pie Diabético/cirugía , Recuperación del Miembro , Osteogénesis por Distracción/métodos , Tibia/cirugía , Amputación , Desbridamiento , Femenino , Pie/irrigación sanguínea , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos , Recurrencia , Índice de Severidad de la Enfermedad , Colgajos Quirúrgicos , Cicatrización de Heridas
17.
J Orthop Res ; 38(5): 961-971, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31777101

RESUMEN

Distraction osteogenesis (DO) is an ideal model to study bone regeneration. The major limitation is the relatively long period required for new bone consolidation. Here, we investigated whether the application of polycaprolactone (PCL) and hydroxyapatite (HA) composite microspheres could enhance bone formation in DO. Pure PCL microspheres and composite PCL and 10% HA microspheres were synthesized. Bone mesenchymal stem cells isolated from green fluorescent protein rats (GFP-rBMSCs) were cultured with microspheres in a rotary bioreactor system. Scanning electron microscopy was used to examine the microstructures. Osteogenic differentiation of rBMSCs was confirmed. Moreover, PCL/HA (20 mg) and PCL (20 mg) were locally administered into the distraction gap in the rat DO model toward the end of the distraction period. Imaging detection, mechanical and histological examinations were performed to assess the quality of the 4-week regenerates. Results showed that the microspheres were of uniform size and monodisperse. After incubation with rBMSCs in culture, PCL/HA microspheres showed a better ability for cell adhesion and osteogenic differentiation compared with PCL microspheres. In vivo, bone volume/total tissue volume, bone mineral density, and mechanical properties of the new callus were significantly higher in the PCL/HA group compared with the PCL group. Histological analyses confirmed improved bone formation and vascularization in PCL/HA group. We presented an effective protocol for the generation of functionalized microspheres and demonstrated implantation of PCL/HA microspheres into the distraction regenerate could significantly enhance bone consolidation. Thus, the application of PCL/HA composite microspheres may be a novel approach for promoting bone regeneration. This article is protected by copyright. All rights reserved © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:961-971, 2020.


Asunto(s)
Durapatita/administración & dosificación , Osteogénesis por Distracción/métodos , Osteogénesis/efectos de los fármacos , Poliésteres/administración & dosificación , Animales , Fenómenos Biomecánicos , Células de la Médula Ósea/fisiología , Huesos/anatomía & histología , Huesos/diagnóstico por imagen , Adhesión Celular , Diferenciación Celular , Masculino , Células Madre Mesenquimatosas/fisiología , Microesferas , Ratas Sprague-Dawley , Microtomografía por Rayos X
18.
Int J Comput Assist Radiol Surg ; 15(2): 351-367, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31673962

RESUMEN

PURPOSE: Predicting changes in face shape from corrective surgery is challenging in growing children with syndromic craniosynostosis. A prediction tool mimicking composite bone and skin movement during facial distraction would be useful for surgical audit and planning. To model surgery, we used a radial basis function (RBF) that is smooth and continuous throughout space whilst corresponding to measured distraction at landmarks. Our aim is to showcase the pipeline for a novel landmark-based, RBF-driven simulation for facial distraction surgery in children. METHODS: An individual's dataset comprised of manually placed skin and bone landmarks on operated and unoperated regions. Surgical warps were produced for 'older' monobloc, 'older' bipartition and 'younger' bipartition groups by applying a weighted least-squares RBF fitted to the average landmarks and change vectors. A 'normalisation' warp, from fitting an RBF to craniometric landmark differences from the average, was applied to each dataset before the surgical warp. The normalisation was finally reversed to obtain the individual prediction. Predictions were compared to actual post-operative outcomes. RESULTS: The averaged change vectors for all groups showed skin and bone movements characteristic of the operations. Normalisation for shape-size removed individual asymmetry, size and proportion differences but retained typical pre-operative shape features. The surgical warps removed the average syndromic features. Reversing the normalisation reintroduced the individual's variation into the prediction. The mid-facial regions were well predicted for all groups. Forehead and brow regions were less well predicted. CONCLUSIONS: Our novel, landmark-based, weighted RBF can predict the outcome for facial distraction in younger and older children with a variety of head and face shapes. It can replicate the surgical reality of composite bone and skin movement jointly in one model. The potential applications include audit of existing patient outcomes, and predicting outcome for new patients to aid surgical planning.


Asunto(s)
Disostosis Craneofacial/cirugía , Craneosinostosis/cirugía , Cara/cirugía , Osteogénesis por Distracción/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Cefalometría , Niño , Femenino , Humanos , Masculino , Periodo Posoperatorio
19.
Oral Maxillofac Surg Clin North Am ; 32(1): 83-88, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31685346

RESUMEN

Patients and orthodontists seek to reduce treatment time in braces. Rapid canine retraction through dentoalveolar distraction osteogenesis is one of several treatment approaches to reduce treatment in braces. This article provides an overview of technique of dentoalveolar distraction osteogenesis to accomplish rapid canine retraction and associated outcomes. When this treatment protocol is implemented well, rapid canine retraction is achieved predictably with minimal side effects. Although current evidence suggests that adverse sequelae, such as root resorptions and pulp devitalization, are rare, prospective clinical studies that are adequately powered and documenting long-term follow-up of these outcomes are lacking.


Asunto(s)
Procedimientos Quirúrgicos Orales/métodos , Métodos de Anclaje en Ortodoncia , Diseño de Aparato Ortodóncico , Osteogénesis por Distracción/métodos , Osteotomía/métodos , Técnicas de Movimiento Dental/métodos , Humanos , Maxilar , Métodos de Anclaje en Ortodoncia/efectos adversos , Métodos de Anclaje en Ortodoncia/instrumentación , Aparatos Ortodóncicos , Procedimientos Quirúrgicos Ortognáticos , Estudios Prospectivos , Resultado del Tratamiento
20.
J Plast Reconstr Aesthet Surg ; 73(2): 351-356, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31473118

RESUMEN

Midface advancement with distraction osteogenesis is more routinely used for faciocraniosynostosis. Distraction devices are generally classified into external and internal types. Compared with external distractors, internal distractors are smaller and better tolerated, but their removal is complicated. Here, we introduce a refined internal distraction device and describe its applicability. Unlike the previous anterior fixation plate that utilises screws, the refined internal distraction (type Z'gok) has 3 claws. This anterior point of the distractor is positioned behind the malar eminence, or the lateral orbital wall. Eight patients with syndromic craniosynostosis underwent midface distraction osteogenesis using the type Z'gok between 2016 and 2017 (Z'gok group). Twelve patients were treated using conventional internal distractors (control group). Patient age ranged from 6 to 21 years. Among them, 4 patients underwent Le Fort III distraction osteogenesis, while the others underwent Le Fort IV distraction osteogenesis. The operative time to remove the distractors in the Z'gok group was 65 ± 18 min, shorter than 89 ± 12 min in the control group. The blood loss per kilogram of body weight in the Z'gok and control groups was 3.6 ±â€¯3.3 mL/kg and 4.7 ±â€¯1.7 mL/kg, respectively. In conclusion, the type Z'gok is a reliable and effective internal distractor for midface distraction osteogenesis.


Asunto(s)
Disostosis Craneofacial/cirugía , Huesos Faciales/cirugía , Osteogénesis por Distracción/instrumentación , Adolescente , Niño , Diseño de Equipo , Femenino , Humanos , Osteogénesis por Distracción/métodos , Osteotomía Le Fort , Estudios Retrospectivos , Adulto Joven
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