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1.
Quintessence Int ; 51(5): 406-414, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32253392

RESUMEN

OBJECTIVE: The aim of this randomized controlled clinical study was to evaluate the efficacy of a new technique fully based on the use of a piezoelectric device for third molar root extraction versus the conventional technique based on the use of manual and rotary instruments. METHOD AND MATERIALS: Patients referred to the hospital of Bolzano for third molar extraction were randomly divided into two groups and treated by two experienced oral surgeons. In the test group all the procedures were performed using piezoelectric instruments and a specially designed piezoelectric lever, whereas in the control group conventional manual and rotary instruments were used. The main outcome measure was patient's pain perception, and the secondary outcome measures were complications, duration of the surgical treatment, and soft tissue healing. The study had a 1-week follow-up. RESULTS: Fifty patients (23 females and 27 males) out of 90 were included in the study, and 100 third molars (50 maxillary and 50 mandibular) were extracted. All patients completed the expected follow-up. No differences were found between the two groups regarding patient's pain perception, complications, and soft tissue healing. However, the new piezoelectric extraction technique took less than half the time when compared to the conventional technique (4.6 ± 4.5 minutes versus 10.2 ± 13.1 minutes; P = .049). CONCLUSIONS: The new piezoelectric third molar root extraction technique allowed third molar extraction in less than one half the surgical time required by the traditional technique. The advantages seem to be more pronounced in difficult cases. However, both surgeons who performed the procedures were very experienced and all the patients were young. Therefore, caution should be given to the generalization of the results. Multicenter studies with a larger variety of patients are needed to confirm the promising results of this study.


Asunto(s)
Tercer Molar , Piezocirugía , Diente Impactado , Femenino , Humanos , Masculino , Mandíbula , Osteotomía , Dolor Postoperatorio , Extracción Dental , Resultado del Tratamiento
2.
Zhongguo Gu Shang ; 33(3): 214-8, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32233246

RESUMEN

OBJECTIVE: To observe early clinical effect of high tibial osteotomy combined with arthroscopy for elderly patients with knee osteoarthritis of medial compartment. METHODS: Sixty-one elderly patients with medial compartment knee osteoarthritis were treated with high tibial osteotomy combined with arthroscopy from August 2017 to October 2018. Among them, including 17 males and 44 females, aged from 60 to 83 years old with an average of (67.87±6.45) years old. Weight bearing line (WBL) and femora-tibial angle (FTA) were analyzed to assess lower limb alignment before and 12 months after surgery. Visual analogue scale (VAS) score and Hospital for Special Surgery (HSS) score were used to evaluate knee pain and function before and 1, 3, 12 months after surgery. RESULTS: All patients were followed up from 12 to 19 months with an average of (14.27±4.69) months. WBL was improved from (14.79±5.61) % before operation to (59.33±7.82) % at 12 months after operation (t=2.294, P<0.05), FTA was improved from (182.14±2.19) ° before operation to (171.54±3.16) ° at 12 months after operation (t=1.827, P<0.05) . VAS score decreased from 6.14±2.21 before operation to 3.64±0.92, 2.02±0.63 and 0.93±0.61 at 1, 3 and 12 months after operation (F=458.24, P<0.001), HSS score increased from 49.66±13.79 to 58.39±9.26, 71.82±6.06 and 82.71±6.97 at 1, 3 and 12 months after operation (F=266.45, P<0.001) . Three patients had contralateral cortical fracture during surgery, whose osteotomy area healed well at 12 months after surgery. The incision healing of 4 cases was slow, while all healed at 3 to 4 weeks after surgery. CONCLUSION: High tibial osteotomy combined with arthroscopy could adjust lower limb alignment effectively, relieve knee pain and functional dysfunction, which indicated a significant short term efficacy on the elderly patients with knee osteoarthritis of medial compartment.


Asunto(s)
Osteoartritis de la Rodilla , Anciano , Anciano de 80 o más Años , Artroscopía , Femenino , Humanos , Articulación de la Rodilla , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Osteotomía , Tibia , Resultado del Tratamiento
3.
Zhongguo Gu Shang ; 33(3): 269-73, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32233258

RESUMEN

OBJECTIVE: To explore clinical effects of fibular osteotomy and distal tibiofibular joint fusion for chronic valgus Pilon fracture malunion. METHODS: From January 2014 to January 2017, 8 patients with chronic valgus Pilon fracture malunion were treated, including 7 males and 1 female, aged from 20 to 47 years old, 6 patients on the left side and 2 patients on the right side; according to Rüedi-Allgöwer classification, 1 case was typeⅠ, 3 cases were typeⅡand 4 cases were type Ⅲ; the time from injury to admission ranged from 7 to 21 months. All deformities were evaluated individually based on pre-operatively weight bearing X-ray and 3D CT scan, and 3D printing model was also used for preliminary surgery. Weight-bearing X-ray showed posterior subluxation of ankle joint in 5 cases. There were 5 cases of fibular fracture at primary injury, and 2 cases of fibular fracture malunion. Fibular osteotomy and distal tibiofibular syndesmosis fusion strategy was performed to reduce articular surface congruency and correct lower limb alignment. Postoperative complication, fracture healing time and reduction were regularly recorded. Clinical function was evaluated according to American Orthopedic Foot and Ankle Society (AOFAS) at 1 year after operation. RESULTS: All patients were followed up from 12 to 30 months. All incisions were primarily healed. No infection, neurovascular injuries or implant failure, lost of reduction occurred. Fracture healing time ranged from 13 to 19 weeks with good lower limb alignment. AOFAS score at 1 year after operation was 63 to 90 points, 1 patient got excellent result, 4 good and 3 fair. Seven patients returned to work at 6 to 14 months after opertaion. CONCLUSION: For chronic valgus Pilon fractures malunion, fibular osteotomy and distal tibiofibular syndesmosis fusion could effectively restore congruency and alignment, correct lower limb alignment, improve ankle joint function, reduce occurrence of complication, and receive short term clinical effects.


Asunto(s)
Articulación del Tobillo , Fracturas Mal Unidas , Adulto , Femenino , Peroné , Fijación Interna de Fracturas , Fracturas Mal Unidas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteotomía , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
4.
Int. j. morphol ; 38(2): 309-315, abr. 2020. graf
Artículo en Inglés | LILACS | ID: biblio-1056440

RESUMEN

Stability is necessary to ensuring proper bone repair after osteotomies and fractures. The aim of this research was to analyze how the repair of pseudoarthrosis sites was affected by different conditions in related to soft tissue. An experimental study was designed with 18 New Zealand rabbits. Six study groups were formed. An osteotomy was performed on the mandibular body of each animal and muscle was installed at the osteotomy site to model pseudoarthrosis. Fixation by surgery was then carried out, using plates and screws. The animals were submitted to euthanasia after 21, 42 and 63 days to make a descriptive comparison of the histological results. No animal was lost during the experiment. In all the samples, bone formation was observed with different degrees of progress. Defects treated with or without removal of the tissue involved in pseudoarthrosis presented comparable bone repair, showing that stability of the bone segments allows the repair of adjacent tissue. In some samples cartilaginous tissue was associated with greater bone formation. Stabilization of the fracture is the key in bone repair; repair occurs whether or not the pseudoarthrosis tissue is removed.


La estabilidad de las osteotomías y de las fracturas son fundamentales para asegurar la adecuada reparación ósea; el objetivo de esta investigación fue analizar la reparación presente en sitios de pseudoartrosis realizando la limpieza de la zona previo a la fijación o manteniendo el tejido de la nounión en el mismo lugar durante la osteosíntesis. Se diseñó un estudio experimental incluyendo 18 conejos de raza Neozelandesa. Se formaron 6 grupos de estudios a quienes se relizó una osteotomía en el cuerpo mandibular y posterior instalación de músculo en el lugar de la osteotomía para fabricar un modelo de pseudoartrosis. En cirugía posterior se fijó con placa y tornillos. Se realizaron eutanasias a los 42 y 63 días para comparar los resultados de forma descriptiva mediante estudio histológico. No fue perdido ningún animal durante el experimento. En todas las muestras evaluadas se observó formación ósea en diferentes niveles de avance; defectos tratados con o sin el retiro del tejido involucrado en la pseudoartrosis presentaron una condición de reparación ósea comparables, determinando que la estabilidad de los segmentos óseos permite la reparación del tejido adyacente. El tejido cartilaginoso se presentó en algunas muestras asociadas a sectores con mayor presencia de formación ósea. La estabilización de la fractura es clave en la reparación ósea; la reparación se produce manteniendo o retirando el tejido presente en la pseudoartrosis.


Asunto(s)
Animales , Conejos , Curación de Fractura , Fracturas Mal Unidas/terapia , Fracturas Mandibulares/terapia , Osteotomía/efectos adversos , Fracturas Mandibulares/cirugía
5.
Compend Contin Educ Dent ; 41(4): 218-223, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32255653

RESUMEN

The management of an anterior open bite can be quite challenging and in some cases necessitate a multidisciplinary approach. In this case report, a patient presented with an anterior open bite with an ankylosed central incisor due to previous trauma. The open bite was corrected using conventional orthodontics, and the ankylosed incisor was repositioned in the correct tridimensional position using a segmental osteotomy. The repositioned bone block required 5 months of stabilization, and the prosthetic rehabilitation of the anterior maxilla was completed using lithium-disilicate crowns. At 24 months the outcome was stable with no relapse and had an excellent pink and white esthetic score.


Asunto(s)
Mordida Abierta , Cefalometría , Estética Dental , Humanos , Maxilar , Osteotomía
6.
Zhongguo Gu Shang ; 33(1): 4-10, 2020 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-32115917

RESUMEN

OBJECTIVE: To compare the clinical effect of proximal fibular osteotomy (PFO) and single condyle replacement (UKA) in the treatment of knee osteoarthritis of different severity. METHODS: From June 2015 to September 2017, 53 patients with knee osteoarthritis were analyzed retrospectively. According to the operation mode, they were divided into PFO group (26 cases) and UKA group (27 cases) . According to Kellygren-Lawrence imaging classification standard:PFO group, 5 cases of gradeⅡ, 11 cases of grade Ⅲ, 10 cases of grade Ⅳ; UKA group, 7 cases of gradeⅡ, 9 cases of grade Ⅲ, 11 cases of grade Ⅳ. The amount of intraoperative bleeding, operation time and postoperative hospital stay were compared between the two groups. The patients were followed up regularly in the outpatient clinic before operation, 3 months after operation and 1 year after operation. The WOMAC score and the angle of tibiofemoral angle at each time point in the same group were compared, and the OMAC score and the angle of tibiofemoral angle at each time between the two groups were compared. RESULTS: Fifty-three patients were followed up for 12 to 24 (16.6±4.8) months. Compared with UKA group, PFO group had less intraoperative bleeding, shorter operative time and shorter postoperative hospital stay (P<0.05) . The scores of pain, stiffness and body function in UKA group were better than those in PFO group (P<0.05) . After 3 months and 1 year, the WOMAC index in PFO group was significantly improved (P<0.05) ; after 3 months and 1 year, the WOMAC index in UKA group was significantly better than that in PFO group (P<0.05) ; after 3 months, the WOMAC index in PFO group was significantly better than that in UKA group (P<0.05) . The tibiofemoral angle of gradeⅡand Ⅲ patients in both groups decreased gradually (P<0.05) ; the tibiofemoral angle of grade Ⅳ patients in UKA group was smaller than that of grade Ⅳ patients in PFO group (P<0.05) . CONCLUSION: Compared with UKA, PFO has the advantages of small trauma, fast recovery and low cost. The curative effect of PFO is equal to or more than UKA in the patients with gradeⅡand Ⅲ knee osteoarthritis. It is an alternative surgical method for the treatment of knee osteoarthritis.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Humanos , Articulación de la Rodilla , Osteoartritis de la Rodilla/cirugía , Osteotomía , Estudios Retrospectivos , Resultado del Tratamiento
7.
Zhonghua Yi Xue Za Zhi ; 100(9): 710-712, 2020 Mar 10.
Artículo en Chino | MEDLINE | ID: mdl-32187917

RESUMEN

Reports a case of diabetic foot patient with right toe pain, ulceration for 4 years and aggravation for 1 month. After rigorous medical treatment and related examinations, transeversal bone transfer of tibia was proposed. However, the skin condition on the inner side of the lower leg was not good before the operation, so the transversal bone removal of the fibula was performed. Two segments of the lateral fibula were osteotomized with miniature osteotomies. The two osteotomy lines were about 10 cm apart. The distal osteotomy line is about 10 cm from the tip of the lateral malleolus. On the 8th day after the surgery, the bone was moved every 6 hours and was extended inwards by 1 mm every day. After 14 days, the bone was moved back for another 14 days. Skin temperature from preoperative to postoperative, ankle brachial index, CT angiography, CT value, visual analogue scale (VAS) of pain and wound healing were evaluated by comparison. The wound was completely healed 28 days after the operation.


Asunto(s)
Pie Diabético , Huesos Tarsianos , Pie Diabético/cirugía , Peroné , Humanos , Osteotomía , Tibia
8.
Zhonghua Wai Ke Za Zhi ; 58(3): 203-208, 2020 Mar 01.
Artículo en Chino | MEDLINE | ID: mdl-32187923

RESUMEN

Objective: To explore the short-term effectiveness of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint. Methods: A retrospective study was performed on 17 patients with anterior cruciate ligament injury combined with varus deformity of knee joint who underwent arthroscopic combined with dual-plane high tibial osteotomy at Department of Bone and Joint, the Affiliated Hospital of Southwest Medical University from January 2017 to June 2018.There were 11 males (11 knees) and 6 females (6 knees), aged 41.3 years (range: 32 to 49 years) .During the surgery, the weight bearing line of lower extremity was set to 62.5% position of the tibial plateau on coronal plane. The tibial slope was adjusted to the normal range on sagittal plane, and anterior cruciate ligament was reconstructed to improve the stability of knee joint.At final follow up, full length weight bearing X ray was used to evaluate the position of weight bearing line, femoral tibial angle and tibial slope pre- and post-operatively.The Lysholm scores, Hospital for Special Surgery score, Tegner knee activity scores and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test, KT-1000 side-to-side difference and pivot-shift test were used to estimate the knee joint stability. Results: The patients were followed up for 1.8 years(range:1.2 to 2.5 years). No complication such as infection, deep vein thrombosis, graft failure, nonunion or delayed union was observed.The weight bearing line was corrected from (28.48±2.24)% preoperatively to (57.43±1.02)% postoperatively (t=46.80, P=0.00) .The femoral tibial angle was improved from (172.31±3.37) ° preoperatively to (178.91±1.34) ° postoperatively(t=10.46, P=0.00). The tibial slope was decreased from (14.29±1.26) ° preoperatively to (9.31±0.79) ° postoperatively (t=24.59, P=0.00) . The KT-1000 side-to-side difference decreased from (7.95±1.19) mm preoperatively to (1.79±0.49)mm postoperatively(t=18.34, P=0.00). At the last follow-up, Lysholm score, Hospital for Special Surgery score, Tegner score, and the IKDC knee evaluation score of patients showed significant improvement from preoperative(P<0.05). Conclusion: Arthroscopic combined with dual-plane high tibial osteotomy can get a good short term efficacy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint which can significantly improve the alignment of lower extremity and knee joint stability.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Artroscopía , Articulación de la Rodilla/cirugía , Osteotomía , Adulto , Femenino , Humanos , Articulación de la Rodilla/anomalías , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
9.
Zhonghua Wai Ke Za Zhi ; 58(3): 220-224, 2020 Mar 01.
Artículo en Chino | MEDLINE | ID: mdl-32187926

RESUMEN

Objective: To examine the clinical effect of autologous osteochondral transplantation via biplanar osteotomy for osteochondral lesions of the talus combined with subchondral cysts. Methods: A retrospective analysis of 25 patients who underwent autogenous osteochondral transplantation via biplanar osteotomy for treatment of talus osteochondral injury combined with subchondral cysts at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from December 2015 to December 2018 were conducted.There were 21 males and 4 females, aged 35.5 years(range: 21 to 47 years).The extent and depth of cartilage damage of patients were evaluated under arthroscopy.The Outerbridge classification of patients were stage Ⅱ-Ⅳ. Through the anterior and medial incision of the medial malleolus, bilateral osteotomy of the medial malleolus was performed. The osteotomy block was turned down to reveal the cartilage damage site. The abnormal cartilage was completely removed and the sclerotic wall of cyst was completely removed with a spatula.Then the healthy cartilage from the same knee joint was transplanted to the talus cartilage damage area. The preoperative and postoperative visual analogue scale(VAS), American Orthopedic Foot Andankle Society-Ankle Hindfoot Scale (AOFAS-AH) and Karlsson-Peterson score and Lysholm score of knee joint were recorded. Data were analyzed by paired-samples t-test. Results: All of patients were followed up for 25.6 months (range: 12 to 48 months) .The VAS decreased from 6.5±1.3 to 1.9±1.3 (t=8.13, P=0.00) .AOFAS-AH increased from 62.4±3.3 to 88.0±2.4 (t=-31.51, P=0.00) .Karlsson-Peterson scores increased from 59.8±2.7 to 85.2±3.5 (t=-25.50, P=0.00) . While there was no statistical different in Lysholm score of knee joint (92.5±1.3 vs. 92.0±1.3, t=1.93, P=0.065) . No complications like infection, translated cartilage necrosis, cycst residual, nonunion, persistent pain in donor site. Conclusion: Autologous osteochondral transplantation via biplanar osteotomy has satisfactory effect for patients with osteochondral lesions of the talus combined with subchondral cysts.


Asunto(s)
Quistes Óseos/cirugía , Trasplante Óseo , Cartílago Articular/trasplante , Osteotomía , Astrágalo/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trasplante Autólogo , Adulto Joven
10.
Zhongguo Gu Shang ; 33(2): 121-6, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32133809

RESUMEN

OBJECTIVE: To investigate the surgical choice of posterior osteotomy way by the observation of clinical outcome of Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column re-section (VCR) for senile osteoporotic thoracolumbar fracture with kyphosis. METHODS: From June 2015 to August 2017, an amount of 8 elderly patients with thoracolumbar kyphosis caused by osteoporotic vertebral fracture underwent osteotomy approach for posterior osteotomy. All patients were old osteoporotic vertebral fracture more than 6 months and received invalid conservative treatment for 3 months including nonsteroidal anti-inflammatory and analgesic drugs, anti-osteoporosis drugs and acupuncture, etc. There were 3 males and 5 females, with an average age of 73.4 years (66 to 83 years), with an average course of the disease of 34.6 months (8 to 60 months). Eight patients had a total of 8 vertebral fractures, and fracture segment was in T10 of 1 case, T11 of 1 case, T12 of 3 cases, L1 of 2 cases, L2 of 1 case. Eight patients showed kyphosis caused by wedge deformation of single segmental vertebral fractures. The thoracolumbar kyphosis and symptoms were progressively developing into central sagittal imbalance. SPO osteotomy was performed in 3 cases, PSO osteotomy in 3 cases, and VCR osteotomy in 2 cases. Orthopaedic effects were analyzed by imaging measurements, including pre- and post-operative kyphosis Cobb angle, localized kyphosis (LK), thoracic kyphosis (TK), lumbar lordosis (LL), sacral tilt angle (ST) and sagittal vertical axis (SVA). Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the pain and lumbar function. RESULTS: All the eight patients were followed up from 8 to 24 months with an average of 13.5 months and all the symptoms of low back pain have significantly reduced or disappeared. The VAS score decreased from 5-8 points (mean 6.5 points) before surgery to 1-4 points (mean 1.88 points) at the final follow-up, and the score was significantly improved. The ODI score decreased from 36-78 points (mean 60.25 points) before surgery to 10-32 points (mean 20.38 points) at the final follow-up, and the functional score improved significantly. During the follow-up period, X-ray examination showed that some patients had a slight decrease in the height of the intervertebral fusion, and the bone graft was healed. There was no obvious corrected degree loss and internal fixation loosening, and the thoracolumbar kyphosis was significantly improved. The mean Cobb angle of T10-L2 was reduced from 25.3° to 2.8° with corrected rate of 89.3% ; LK was reduced from 43.4° to 7.1° with corrected rate of 86.2% ; TK was reduced from 49.9° to 30.6°, LL was reduced from 43.6° to 30.8°, and ST was changed from 24.0° to 32.1°, SVA was changed from 6.23 cm to 2.40 cm. CONCLUSION: For the different pathological features and deformities of senile osteoporotic thoracolumbar fracture combined with kyphosis, SPO, PSO or VCR can achieve good orthopedic effect and clinical efficacy.


Asunto(s)
Cifosis , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Vértebras Lumbares , Masculino , Fracturas Osteoporóticas/cirugía , Osteotomía , Estudios Retrospectivos , Vértebras Torácicas , Resultado del Tratamiento
11.
Zhongguo Gu Shang ; 33(2): 126-30, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32133810

RESUMEN

OBJECTIVE: To investigate the influence of posterior osteotomy on spinopelvic parameters in lumbar degenerative kyphosis (LDK) patients. METHODS: The clinical data of 21 patients with lumbar degenerative kyphosis who underwent osteotomy from January 2012 to December 2015 were retrospectively analyzed. There were 5 males and 16 females, aged from 55 to 76 years with an average of (66.24±5.13) years. All patients had taken preoperative and postoperative full length spinal X-ray, analyzing the spinopelvic parameters as thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). RESULTS: All operations were successful, the average operative time was 190 min (160 to 220 min) and intraoperative blood loss was 1 000 ml (800 to 1900 ml). Parameters of the patients between preoperative and period 1-year follow-up were as follows : preoperative TK increased from (31.67±21.13) ° to (34.67±11.60) °, LL corrected from (4.76±3.17) ° to (37.41±6.28) °, PT reduced from (33.94±5.01) ° to (20.12±5.36) °, and SS improved from (18.47±2.60) ° to (31.71±4.30) °, SVA restored from (13.24±3.60) cm to (2.82±1.33) cm. There were significant differences of spinopelvic parameters between preoperation and postoperation (P<0.05). CONCLUSION: Posterior osteotomy can effectively reconstruct the sagittal balance of spinopelvis in patients with lumbar degenerative kyphosis. The recovery of lumbar lordosis and sacral slope is closely related to the reconstruction of sagittal balance.


Asunto(s)
Cifosis , Lordosis , Escoliosis , Anciano , Femenino , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Osteotomía , Estudios Retrospectivos
12.
Zhongguo Gu Shang ; 33(2): 131-5, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32133811

RESUMEN

OBJECTIVE: To analyze the effectiveness and safety of one stage three column osteotomy in treatment of scoliosis with split spinal cord malformation. METHODS: The clinical data of 41 patients with scoliosis and split spinal cord malformation underwent one-stage three-column osteotomy from January 2015 to December 2017 were retrospectively analyzed. There were 17 males and 24 females with average age of (25.14±4.51) years old and the average weight of (65.14±9.11) kg. According to the classification of longitudinal spina bifida, 15 cases of Pang typeⅠwere group A and 26 cases of Pang typeⅡwere group B. The general situations of two groups were recorded ; preoperative and postoperative Cobb angle were observed and the correction rate of Cobb angle of coronal plane was calculated ; the coronal and sagittal torso offset distances were compared between two groups and the trunk balance was evaluated ; the complication of two groups was recorded. RESULTS: All 41 patients were followed up for more than 12 months. The operation time, intraoperative blood loss, and perioperative blood transfusion volume in group A were (610.14±115.02) min, (4 001.12±1 014.33) ml, (3 951.14±1 021.55) ml, respectively, and group B were (520.12±101.14) min, (2 701.57±1 021.45) ml, (2 565.77±880.47) ml, the difference between the two groups was statistically significant (P<0.05). The postoperative hospital stays in the group A and B were (9.45±4.21) days and (9.14±3.01) days, respectively, and there was no significant difference (P>0.05). There was no significant difference in postoperative coronary Cobb angle and correction rate between two groups (P>0.05). Immediately after surgery and 12 months after surgery, there was no significant difference in the trunk displacement distance of coronal view and sagittal view between two groups (P>0.05). Six patients in group A had complications, which was higher than that in group B of 1 case (χ2=4.885, P< 0.05). CONCLUSION: One-stage three-column osteotomy in treatment of scoliosis with split spinal cord malformation has high correction rate and good balance of the trunk. However, for patients with typeⅠsplit spinal cord malformation, they will face longer operation time, more intraoperative bleeding volume, large amount of perioperative blood transfusion and higher risk of complications, and the safety is not as good as that of typeⅡpatients. Therefore, in the actual treatment of scoliosis, especially for those with typeⅠsplit spinal cord malformation, a more reasonable surgical plan should be developed in combination with the actual situations of the patients, so as to improve the safety of the operation.


Asunto(s)
Escoliosis , Fusión Vertebral , Adulto , Femenino , Humanos , Masculino , Osteotomía , Estudios Retrospectivos , Escoliosis/cirugía , Médula Espinal , Resultado del Tratamiento , Adulto Joven
13.
Zhongguo Gu Shang ; 33(2): 144-8, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32133814

RESUMEN

OBJECTIVE: To explore the safety and effectivity of ultrasonic bone knife in osteotomy of degenerative kyphosis. METHODS: The clinical data of 32 patients with degenerative kyphosis treated from February 2014 to May 2016 were retrospectively analyzed. There were 12 males and 20 females, aged 50 to 71 years with an average of (62.1±12.3) years. Preoperative Cobb angle was 25.3° to 36.7° with an average of (28.6±10.2) °. All patients underwent multi-segment Ponte osteotomy combined with posterior long segmental internal fixation. According to different osteotomy tools, the patients were divided into traditional tool group (group A, 18 cases) and ultrasonic bone knife group (group B, 14 cases). The operation time, laminectomy time, number of osteotomy segments, intraoperative blood loss, postoperative drainage, hospitalization time and postoperative complications were recorded.Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate clinical outcomes before and 1 month after surgery. RESULTS: All the patients were followed up from 8 to 24 months with an average of 16.4 months. There were no significant differences in operative time and hospitalization time between two groups (P>0.05). Intraoperative single laminectomy time of group A was more than that of group B (P<0.05). The number of osteotomy segments in group A was less than that in group B (P<0.05). Intraoperative blood loss and postoperative drainage in group A were more than that in group B (P<0.05). There were no significant differences in VAS and ODI between two groups (P>0.05). There were no dural, nerve and spinal cord injuries in both groups, and there were no complications such as improper operation of the instrument and nonunion of the osteotomy. CONCLUSION: The use of ultrasonic bone knife for Ponte osteotomy is safe and effective. It can effectively save the time of single laminectomy while reducing the amount of intraoperative blood loss and postoperative drainage. The safety and clinical efficacy of ultrasonic bone knife are no less than traditional tools.


Asunto(s)
Cifosis , Ultrasonido , Anciano , Femenino , Humanos , Cifosis/diagnóstico por imagen , Cifosis/cirugía , Laminectomía , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Osteotomía , Estudios Retrospectivos , Vértebras Torácicas , Resultado del Tratamiento
14.
Orthop Clin North Am ; 51(2): 227-233, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138860

RESUMEN

Ulnar abutment (ulnocarpal impaction) syndrome may be a source of ulnar-sided wrist pain in the athlete. This condition results from excessive load transfer across the triangular fibrocartilage complex and ulnocarpal joints with characteristic degenerative changes. It frequently occurs in patients with either static or dynamic ulnar positive variance. Treatment is tailored to the athlete and their sporting demands. Surgical treatment focuses on addressing ulnar variance to unload the ulnocarpal joint, with multiple surgical options, including the metaphyseal closing wedge osteotomy achieving this goal. This review focuses on the presentation, biomechanics, and treatment options for ulnar abutment syndrome in the athlete.


Asunto(s)
Artralgia/terapia , Traumatismos en Atletas/terapia , Desviación Ósea/terapia , Cúbito/lesiones , Traumatismos de la Muñeca/terapia , Artralgia/complicaciones , Artralgia/cirugía , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/cirugía , Desviación Ósea/complicaciones , Desviación Ósea/cirugía , Humanos , Osteotomía , Cúbito/cirugía , Traumatismos de la Muñeca/complicaciones , Traumatismos de la Muñeca/cirugía
15.
Zhongguo Gu Shang ; 33(2): 97-8, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32133804
16.
Instr Course Lect ; 69: 15-24, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017715

RESUMEN

Although total hip arthroplasty (THA) surgery is one of the most successful procedures in orthopaedics, the number of revision procedures is predicted to increase by 137% over the next two decades.1 Implant failure modes such as instability, infection, loosening, and wear are becoming more prevalent.2 Instability, infection, extensive bony defects, and soft-tissue damage are the most important concerns and complications associated with revision surgery. More than 50% of revisions involve the acetabular implant.2 Paprosky et al described a classification of acetabular defects that occur in cases of implant failure.3 Treating type 2 and 3 uncontained defects can be technically challenging because the surgeon has to use extensive reconstruction techniques to adequately restore the biomechanics of the hip, structural stability, and leg length. Furthermore, neurovascular structures can be in jeopardy when complex pelvic reconstructive procedures are being conducted. In an attempt to optimize the access to the pelvic bone, to minimize soft-tissue damage and to protect the pelvic neurovascular structures, we use an extensile anterior approach to the acetabulum. This approach has been described by Ganz et al to conduct periacetabular osteotomies (PAO).4,5 This approach uses the Smith Petersen interval and exposes the anterior column and the acetabulum along with its defects. To our knowledge, the approach has not been used or described yet to conduct complex reconstructive surgeries for extensive acetabular defects in THA. The following is a description of a modified extensile surgical technique for challenging acetabular defects that may be encountered in certain revision THA reconstructions, as well as certain primary THA. This is an enhanced technical description of a technique presented by these authors in a previously described series of 48 patients who underwent revision using these techniques.6.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Acetábulo , Humanos , Osteotomía , Reoperación , Resultado del Tratamiento
17.
Instr Course Lect ; 69: 363-370, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017738

RESUMEN

The management of bunion deformities in adolescent patients is often a source of consternation for orthopaedic surgeons. Reports of recurrence and surgical failure along with a multitude of procedures to choose from create a wariness to manage the problem surgically. The biggest challenge in managing this problem is a lack of understanding by orthopaedic surgeons that adolescent bunions and adult bunions frequently arise from two distinct etiologies. The main difference between the two is that unlike adult bunion deformities, the hallux metatarsophalangeal joint in the adolescent bunion is congruent as the deformity is caused by a dysplasia of the metatarsal head. This dysplasia results in a valgus orientation of the first metatarsal articular surface (ie, elevated DMAA [distal metatarsal articular angle]). The recognition of this difference has implications for the evaluation and treatment of these deformities in adolescents.


Asunto(s)
Juanete , Hallux Valgus , Huesos Metatarsianos , Articulación Metatarsofalángica , Adolescente , Humanos , Osteotomía
18.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 173-178, 2020 Feb 15.
Artículo en Chino | MEDLINE | ID: mdl-32030947

RESUMEN

Objective: To investigate the effectiveness of the Evans lateral lengthening calcaneal osteotomy (E-LLCOT) in treatment of talocalcaneal coalition (TCC) with hindfoot valgus deformity. Methods: Between January 2014 and October 2017, 10 patients (13 feet) of TCC with hindfoot valgus deformities underwent E-LLCOTs. There were 6 males (8 feet) and 4 females (5 feet) with an age of 13-18 years (mean, 15.8 years). The disease duration was 10-14 months (mean, 11.5 months). The foot deformity was characterized by hindfoot valgus, forefoot abduction, and collapse of the medial arch. Pain site was the tarsal sinus in 4 feet, TCC in 5 feet, and ankle joint in 4 feet. There were tightness of the gastrocnemius in 3 cases (4 feet) and Achilles tendon in 7 cases (9 feet) on Silverskiold test. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 46.54±9.08 and visual analogue scale (VAS) score was 6.54±0.88 after walking 1 kilometer. The AOFAS ankle-hindfoot score and VAS score were adopted to evaluate the postoperative function of the foot. The talar-first metatarsal angle (T1MT), talonavicular coverage angle (TCA), talar-horizontal angle (TH), calcaneal pitch angle (CP), and heel valgus angle (HV) were measured after operation. Results: All incisions healed by first intention. All patients were followed up 12-30 months (mean, 18 months). At last follow-up, the AOFAS ankle-hindfoot score and VAS score were 90.70±6.75 and 1.85±0.90, respectively, showing significant differences when compared with preoperative scores ( t=-23.380, P=0.000; t=35.218, P=0.000). X-ray films showed that the osteotomy healed at 2-4 months (mean, 3 months) after operation. At last follow-up, the T1MT, TCA, TH, and HV were significantly lower than preoperative ones ( P<0.05), and the CP was significantly higher than preoperative one ( P<0.05). During the follow-up, the pain did not relieve obviously in 1 patient (1 foot), and the cutaneous branch of the sural nerve injured in 1 patient (1 foot). Conclusion: For TCC with severe hindfoot valgus deformity, E-LLCOT can effectively correct deformity and relieve pain.


Asunto(s)
Calcáneo , Deformidades del Pie , Huesos Metatarsianos , Adolescente , Tobillo , Calcáneo/cirugía , Femenino , Humanos , Masculino , Osteotomía , Resultado del Tratamiento
19.
Medicine (Baltimore) ; 99(3): e18425, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011435

RESUMEN

RATIONALE: Hypophosphatemic rickets (HR) is a rare hereditary disease characterized by hypophosphatemia, defects in bone mineralization, and rickets, and surgical intervention is warranted for the patient of severe skeletal deformity. PATIENT CONCERNS: Here we report a case of an 11-year-old boy who presented with severe varus deformities of the bilateral lower extremities and was associated with uncoordinated gait with multiple unintentional falls onto ground resulting in fractures of lower extremities. DIAGNOSES: He was diagnosed as HR caused by genetic mutations in the phosphate-regulating endopeptidase homologue. Based on his family history and laboratory tests, including high serum alkaline phosphatase, high urinary phosphorus, hypophosphatemia, and normal serum calcium level, the patient was diagnosed with this disorder. INTERVENTIONS: Rotational and translational osteotomy was performed to redress the severe varus deformity and readjust the malalignment of the lower extremity. OUTCOMES: Right after the surgery, the alignment in the left lower extremity was readjusted, and his appearance seemed normal. Combined with rehabilitation and pharmacological intervention, including oral intake of phosphate and alphacalcidol, the bone healed uneventfully. After the second surgery of a similar procedure on the right femur, the patient was able to walk almost like a normal teenager. LESSONS: This case proposed a novel technique to treat severe varus or valgus deformity of the lower extremity. HR is a rare disease, and it is important to stress its recognition to avoid delay of diagnosis and surgical intervention if necessary.


Asunto(s)
Raquitismo Hipofosfatémico Familiar/diagnóstico , Raquitismo Hipofosfatémico Familiar/terapia , Niño , Fémur/cirugía , Humanos , Hidroxicolecalciferoles/administración & dosificación , Masculino , Osteotomía/métodos , Fosfatos/administración & dosificación
20.
Medicine (Baltimore) ; 99(7): e18826, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049784

RESUMEN

To analyze the efficacy of arthrodesis combined with osteotomy applied to subtalar, calcaneocuboid, and talonavicular joints for the treatment of adult rigid flatfoot.This retrospective study included 29 adult patients with rigid flatfoot who underwent triple arthrodesis combined with osteotomy from January 2015 to December 2017. All patients suffered from stage III of adult acquired flatfoot. Patients returned for a clinical and radiologic follow-up evaluation at an average of 19.5 (range, 15-27) months postoperatively. Outcomes were assessed by comparing pre- and postoperative AOFAS scores, VAS pain scores, and Karlsson scores, and the radiographic assessment including Meary, Pitch, and Kite angles.Twenty six patients returned for final evaluation. Twenty four patients had an excellent or good outcome on patient subjective self-assessment. All the VAS scores, AOFAS scores, and Karlsson scores at final follow-up showed different extents of improvement. The mean Meary angle significantly decreased from 25.8 ±â€Š5.4 degrees preoperatively to 6.9 ±â€Š7.7 degrees at final follow-up, and the mean Pitch angle improved markedly from 12.5 ±â€Š3.7 points preoperatively to 23.2 ±â€Š4.1 points at final follow-up (P < .001).Arthrodesis combined with osteotomy can effectively correct calcaneal valgus deformity, restore arch structure, and relieve foot pain in adult rigid flatfoot.


Asunto(s)
Artrodesis/métodos , Pie Plano/cirugía , Osteotomía/métodos , Adulto , Terapia Combinada , Femenino , Pie Plano/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
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