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1.
Zhonghua Wai Ke Za Zhi ; 58(6): 420-424, 2020 Jun 01.
Artículo en Chino | MEDLINE | ID: mdl-32498479

RESUMEN

High tibial osteotomy (HTO) is an effective treatment for knee osteoarthritis. With the application of bi-planer open wedge osteotomy high tibial osteotomy and new angular stable locking plates, HTO has become more accuracy, minimally invasive and standard, achieved satisfactory long-term treatment outcome. The indications of HTO are expanding. We need to comprehensively consider whether the patient has varus deformity, the location and severity of the deformity, the stage of osteoarthritis, age and the demand of activity, as well as individual factors such as weight, gender, bone condition and joint activity, and strive to give the best individualized treatment to osteoarthritis patients in different stages.


Asunto(s)
Aprendizaje Profundo , Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Tibia/cirugía , Humanos , Articulación de la Rodilla/cirugía
2.
Zhonghua Wai Ke Za Zhi ; 58(6): 425-429, 2020 Jun 01.
Artículo en Chino | MEDLINE | ID: mdl-32498480

RESUMEN

High tibial osteotomy(HTO) is an effective method for the treatment of knee osteoarthritis by transferring the weight bearing line to the lateral tibial plateau, which can significantly reduce the pressure and cartilage lesion of medial knee compartment.However, under- and over-correction of weight bearing line can lead to early postoperative failure.It is necessary to define the standard of axis correction, make correct preoperative plan, ensure the accuracy of operation and consider the risk factors of under- and over-correction of axis.With the advent of the era of intelligent medicine, the application of patient-specific instrumentation technology based on three dimention printing and navigation technology will help to achieve the precise control of axial alignment in high tibial osteotomy.


Asunto(s)
Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Osteotomía/tendencias , Tibia/cirugía , Desviación Ósea/etiología , Desviación Ósea/prevención & control , Humanos , Articulación de la Rodilla/cirugía , Extremidad Inferior/cirugía , Osteotomía/efectos adversos , Cirugía Asistida por Computador
3.
Zhonghua Wai Ke Za Zhi ; 58(6): 435-440, 2020 Jun 01.
Artículo en Chino | MEDLINE | ID: mdl-32498482

RESUMEN

Objective: To investigate the sagittal and torsional changes in the tibia after a medial open wedge high tibial osteotomy (OWHTO) and their correlation with the corrective angle of proximal tibial coronal plane. Methods: A prospective analysis was conducted on patients who underwent OWHTO at Department of Orthopaedic Surgery, Beijing Chaoyang Emergency Medical Center from March 2019 to July 2019.The operation were performed by the same surgeon. X-ray and CT were performed before and 3 days after the operation. The mechanical axis angle (mFTA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and tibial torsion angle (TTA) were measured and compared by paired t-test. Pearson correlation coefficient was used to analyze the correlation between the changes of PTS and TTA and the correction angle of MPTA. Results: A total of 13 patients (19 knees) were recruited. There were 9 males (13 knees) and 4 females (6 knees), aged (39.4±14.4) years (range:20 to 60 years). The mFTA improved from (8.1±2.8) degrees preoperatively to (-1.4±1.6) degrees postoperatively (t=14.819, P=0.000). The MPTA was changed from (81.1±2.4) degrees pre-operatively to (90.4±3.4) degrees postoperatively (t=-15.579, P=0.000). The PTS decreased from (79.6±3.2) degrees to (76.8±3.1) degrees (t=9.709, P=0.000). The differences of mFTA, MPTA and PTS were statistically significant. There was no significant difference in TTA between before and after operation ((28.2±1.5) ° vs. (27.3±6.3) °,t=1.925, P=0.070). There was no correlation between the correction angle of MPTA and the change of PTS and TTA (r=0.384, P=0.105; r=0.321, P=0.181). Conclusions: Even if the intra-operative measures were used to control tibial slope, the PTS still increased significantly after OWHTO, while the TTA has no significant change. No correlation was seen between the change of sagittal and torsional and the corrective angle of proximal tibial coronal plane.


Asunto(s)
Artropatías/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Osteotomía/métodos , Tibia/diagnóstico por imagen , Anomalía Torsional/diagnóstico por imagen , Adulto , Femenino , Humanos , Artropatías/cirugía , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteotomía/efectos adversos , Periodo Posoperatorio , Estudios Prospectivos , Tibia/cirugía , Anomalía Torsional/etiología , Adulto Joven
4.
Zhonghua Wai Ke Za Zhi ; 58(6): 447-451, 2020 Jun 01.
Artículo en Chino | MEDLINE | ID: mdl-32498484

RESUMEN

Objective: To analyze the incidence of recent complications in patients with osteoarthritis of the knee (OA) after medial opening wedge high tibial osteotomy(MOWHTO) and its influence on clinical effect. Methods: The clinical data of 131 patients with knee OA who received MOWHTO at Department of Sports Medicine and Arthroscopy,Tianjin Hospital from April 2017 to September 2018 were analyzed retrospectively. There were 75 males and 56 females, aged (62.8±5.1) years (range:48 to 70 years). Complications and clinical outcomes of patients were recorded and the proximal medial angle of tibia (MPTA), the International Knee Documentation Committee Subjective Knee Form (IKDC), the Western Ontario and McMaster Universities(WOMAC) Osteoarthritis Index and Knee Injury and Osteoarthritis Outcome score(KOOS) were collected before and 1 year after operation and compared between complication group and non-complication group. Data were analyzed by paired-samples t test, independent samples t test and χ(2) test. Results: The follow-up time was (18.5±3.4) months (range:13 to 22 months). Complications occurred in 22 patients(16.8%), including 8 cases(6.1%) of hematoma, 5 cases(3.8%) of neurosensory abnormality, 4 cases(3.1%) of intramuscular venous thrombosis, 2 cases(1.5%) of deep venous thrombosis, 3 cases(2.3%) of loss of correction angle, 3 cases(2.3%) of superficial infection, 2 cases(1.5%) of deep infection, 2 cases(1.5%) of delayed union of fracture, 1 case(0.8%) of postoperative stiffness, 1 case (0.8%) of hinge point cortex fracture. There were no significant difference in MPTA ((86.5±2.0)° vs. (86.7±2.1)°, t=-0.41, P=0.68) , IKDC ((86.4±4.8) vs.(85.5±6.9), t=0.74, P=0.50) , WOMAC ((87.7±6.5) vs. (86.1±5.8), t=1.16, P=0.25). There were no significant difference in knee scores except for the KOOS pain score ((79.4±4.4) vs. (87.2±5.9), t=-5.90, P<0.01) and sports and recreation score ((83.2±3.0) vs. (88.0±4.7), t=-6.14, P<0.01) . Conclusion: Short-term complications of MOWHTO can be managed appropriately through early diagnosis and individualized treatment and have no significant negative effect on knee function recovery of patients.


Asunto(s)
Osteoartritis de la Rodilla/cirugía , Osteotomía/efectos adversos , Tibia/cirugía , Anciano , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteotomía/métodos , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento
5.
Orthop Clin North Am ; 51(3): 345-360, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32498953

RESUMEN

Lower extremity deformities in children rely on osteotomies for correction. Percutaneous osteotomies offer a method for cutting bone that is advantageous for soft tissue healing. These low-energy osteotomies preserve the blood supply to bone, which maximizes the ability of bone to heal. Some of these techniques are technically demanding and should be performed first with an experienced operator. The key to maintaining safety in these osteotomies is to remain in a subperiosteal location. The categories of percutaneous osteotomy include multiple drill hole osteotomy, corticotomy, and Gigli saw osteotomy. This article discusses the advantages and indications for each type of osteotomy.


Asunto(s)
Huesos/anomalías , Huesos/cirugía , Anomalías Musculoesqueléticas/cirugía , Osteotomía/métodos , Niño , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos
6.
Orthop Clin North Am ; 51(3): 403-422, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32498959

RESUMEN

This article presents the indications, contraindications, preoperative surgical planning, surgical technique, and postoperative management of some of the most common percutaneous procedures in orthopedic foot and ankle surgery. The background of each procedure also is presented, supported by the latest in published literature to educate surgeons. Such topics include percutaneous bunionectomy, lesser toe deformity and bunionette correction, calcaneal osteotomy, cheilectomy, and first metatarsophalangeal joint arthrodesis.


Asunto(s)
Huesos del Pie/cirugía , Procedimientos Ortopédicos/métodos , Tobillo/diagnóstico por imagen , Tobillo/cirugía , Artrodesis/efectos adversos , Artrodesis/métodos , Pie/diagnóstico por imagen , Pie/cirugía , Huesos del Pie/diagnóstico por imagen , Hallux Valgus/diagnóstico por imagen , Hallux Valgus/cirugía , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Ortopédicos/efectos adversos , Osteotomía/efectos adversos , Osteotomía/métodos , Falanges de los Dedos del Pie/diagnóstico por imagen , Falanges de los Dedos del Pie/cirugía
7.
Medicine (Baltimore) ; 99(20): e20215, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32443350

RESUMEN

Hip preserving procedures are still a challenge in late-stage osteonecrosis of femoral head (ONFH) patients. We aimed to compare the clinical outcomes of surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy for treatment of ONFH in Association Research Circulation Osseous (ARCO) stage III patients.We retrospectively reviewed 30 ARCO stage III patients (33 hips) who had surgical dislocation and impaction bone graft or surgical dislocation and rotational osteotomy in our center from June 2012 to December 2017. Baseline characteristics, clinical evaluation using Harris score and radiologic evaluation up to 12 months after surgery were recorded and compared.Fifteen patients (17 hips) were in the surgical dislocation and impaction bone graft group and 15 patients (16 hips) were in the surgical dislocation and rotational osteotomy group. No significant differences in age, gender, etiology, ARCO stage, duration of illness, operation time, and length of hospitalization were observed between the 2 groups. Compared to preoperation Harris score, the Harris score of 6 months postoperation and 12 months postoperation significantly improved. At 12 months postoperation, the excellent and good rate was 76.5% in the impaction bone graft group and 87.5% in the rotational osteotomy group. No significant difference in Harris scores was detected in the 2 groups.Surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy had satisfactory 1-year efficacy for ARCO III ONFH patients. Surgical dislocation and rotational osteotomy had better short-term efficacy than surgical dislocation and impaction bone graft.


Asunto(s)
Necrosis de la Cabeza Femoral/cirugía , Fractura-Luxación/cirugía , Osteotomía/efectos adversos , Adulto , Trasplante Óseo/métodos , Femenino , Cabeza Femoral/lesiones , Cabeza Femoral/fisiopatología , Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/métodos , Estudios Retrospectivos , Resultado del Tratamiento
8.
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
9.
Medicine (Baltimore) ; 99(7): e19041, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049801

RESUMEN

In this retrospective observational study, I aimed to report long-term follow-up results of femoral varus osteotomy in the treatment of Perthes disease patients who were between 6 and 8 years old at the onset of the disease with Herring B and C hip involvement. I also aimed to compare 2 different osteotomy techniques: open-wedge and closed-wedge femoral varus osteotomies.Patients with Perthes disease treated with femoral varus osteotomies were invited for final examination. Twenty two hips of 19 patients were evaluated. Mean follow-up period was 15.2 years. Patients were divided into 2 homogenous groups according to femoral osteotomy technique. In Group A (12 hips) open-wedge osteotomy, and in Group B (10 hips) closed-wedge osteotomy was performed.There were 15 male (78.9%) and 4 female (21.1%) patients. The median age at the onset of the disease was 7 years in Group A and B. The mean follow-up period was 16.2 years in Group A, and 11.4 years in Group B. According to Stulberg classification 5 hips (22.7%) were healed as Class I, 4 hips (18.2%) were healed as Class II, 12 hips (55.5%) were healed as Class III, and 1 hip (4.6%) was healed as Class IV. Also in Group A 4 hips (33.3%) were healed as Class I or II, 7 hips (58.3%) were healed as Class III, and 1 hip (8.3%) was healed as Class IV; in Group B 5 hips (50.0%) were healed as Class I or II, and 5 hips were healed as Class III (50.0%). There was no significant difference between the groups. According to Iowa scale, mean values were 92.6 in Group A and 92.4 in Group B. There was no significant difference between the groups. At the final follow-up mean center-edge angles of Group A and B were 16 and 22, the difference was significant.Long-term follow-up results showed that femoral varus osteotomy was an effective treatment method in Perthes disease patients who were between 6 and 8 years old with Herring B and C hip involvement at the onset of the disease. Hip joint congruency was obtained with femoral varus osteotomies, and closed-wedge osteotomy served more favorable center-edge angle results.


Asunto(s)
Enfermedad de Legg-Calve-Perthes/cirugía , Osteotomía/métodos , Niño , Femenino , Humanos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
10.
Int J Nanomedicine ; 15: 913-925, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32103946

RESUMEN

Introduction: Masquelet proposed a new solution for the healing of segmental bone defects, thus minimizing the disadvantages associated with traditional bone grafting. However, a major factor leading to the failure of this technique pertains to be the residual infection. Accordingly, we developed an antibiotic- and osteo-inductive agent-loaded composite scaffold to solve this problem. Methods: A mesh-like polycaprolactone scaffold was prepared using a lab-exploited solution-type three-dimensional printer, and hybrid sheath-core structured poly(lactic-co-glycolic-acid) nanofibers were fabricated using co-axial electrospinning technology. Vancomycin, ceftazidime, and bone morphological protein (BMP)-2 were employed. The in vitro and in vivo (rabbit fracture model) release patterns of applied agents from the composite scaffold were investigated. Results: The results revealed that the drug-eluting composite scaffold enabled the sustainable release of the medications for at least 30 days in vitro. Animal tests demonstrated that a high concentration of medications was maintained. Abundant growth factors were induced within the bioactive membrane stimulated by the applied scaffold. Finally, satisfactory bone healing potential was observed on radiological examination and biomechanical evaluation. Discussion: The developed composite scaffold may facilitate bone healing by inducing bioactive membrane formation and yielding high concentrations of antibiotics and BMP-2 during the Masquelet procedure.


Asunto(s)
Antibacterianos/administración & dosificación , Regeneración Ósea/fisiología , Fémur/cirugía , Nanofibras/química , Procedimientos Quirúrgicos Reconstructivos/métodos , Animales , Antibacterianos/farmacocinética , Antibacterianos/uso terapéutico , Ceftazidima/química , Ceftazidima/farmacología , Nanofibras/administración & dosificación , Nanofibras/uso terapéutico , Osteotomía/métodos , Poliésteres/química , Copolímero de Ácido Poliláctico-Ácido Poliglicólico , Impresión Tridimensional , Conejos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Infección de la Herida Quirúrgica/prevención & control , Andamios del Tejido , Vancomicina/química , Vancomicina/farmacología
11.
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
12.
World Neurosurg ; 136: 6, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31901500

RESUMEN

A previously healthy 44-year-old woman presented with a first-time seizure. Magnetic resonance imaging (MRI) revealed a right frontal intraaxial mass extending from the orbitofrontal gyri and gyrus rectus to the head of the caudate (Video 1). The mass demonstrated heterogeneous signal intensity on precontrast T1-weighted MRI, minimal contrast enhancement, and mixed intensity on gradient echo MRI sequence consistent with a likely cavernous malformation. Given the location above the orbital roof with cranial-caudal extension to the level of the caudate, a transblepharo-preseptal modified orbitozygomatic craniotomy was recommended. With the assistance of plastic surgery, the lesion was approached through an eyelid incision that extended laterally to expose the keyhole. A McCarty burr hole was made, followed by a tailored orbitozygomatic craniotomy with osteotomies extending through the superolateral orbit and greater sphenoid wing to expose the proximal sylvian fissure. Dura was opened in a C-shaped fashion over the periorbital fat to allow for mild downward retraction of the globe, exposing the subfrontal trajectory. The opticocarotid cistern was opened to allow for cerebrospinal fluid egress and relaxation, and the lesion was readily identified through the use of stereotactic neuronavigation and presence of a faint hemosiderin blush within the underlying parenchyma. The standard microsurgical technique was used to perform a gross total resection of the pathologically confirmed cavernous malformation. The orbitozygomatic bone flap was replaced and plated, and the wound was closed in multiple layers. The patient was seen at a 3-month follow-up without further seizures.


Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Neuronavegación/métodos , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Osteotomía/métodos
13.
Clin Oral Investig ; 24(3): 1073-1089, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31927693

RESUMEN

OBJECTIVES: The aim of this systematic review was to investigate the predictability of the sandwich osteotomy technique to provide sufficient alveolar bone height for dental implant therapy in vertically atrophic jaws. MATERIAL AND METHODS: A MEDLINE (Pubmed), EMBASE and Cochrane Library electronic search and a manual search were performed until July 2018. Any clinical study published in English, reporting data on at least 10 patients rehabilitated with implant-supported dental prostheses after vertical ridge augmentation by means of the sandwich osteotomy technique and followed for at least 12 months after loading, was included. Data on study and patients' characteristics, interventions provided, implant and prostheses survival rates and complications were extracted from the included studies. Each study design was evaluated using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS: Initially, 415 records were identified, from which 10 full-text articles could be included in the final qualitative analysis. Implant survival rate after a mean follow-up of 3.7 years (median: 3 years; range: 1-7 years) was 94% (median: 93%; range: 91-100%). Peri-implant mean marginal bone resorption was 1.6 mm (median: 1.4 mm; range: 0.6-4.7 mm). The calculated mean alveolar bone height available at the time of implant placement was 11.3 mm (median: 11.5 mm; range: 7.8-16 mm). A temporary sensory disturbance of the inferior alveolar nerve was the most commonly reported complication following the sandwich osteotomy. CONCLUSIONS: The present systematic review documents that implant survival rate after mandibular vertical ridge augmentation using the sandwich osteotomy technique is high after up to 5 years of loading. The complication rate can be considered moderate and has predominantly a transient nature. Data on the long-term behavior of the augmented bone and inserted implants are missing. CLINICAL RELEVANCE: The present technique can be considered a reliable treatment option in cases of moderate vertical bone deficiency of the posterior mandible to provide suitable conditions for later implant placement. Intra- and post-operative complications do not seem to jeopardize the final outcome.


Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Implantes Dentales , Osteotomía/métodos , Trasplante Óseo , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Humanos , Resultado del Tratamiento
14.
Plast Reconstr Surg ; 145(2): 403-406, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985631

RESUMEN

Humpectomy is one of the most common steps in reduction rhinoplasty among Caucasian patients. The most widespread procedures to address hump removal are both the "en bloc humpectomy" (with reconstruction of the middle third with spreader grafts) and the "split hump technique" (with confection of spreader flaps). The spare roof technique, for rhinoplasty reduction, has been developed over the past 4 years. In this technique, the upper lateral cartilages are completely preserved-even the hidden part under the caudal aspect of the nasal bones. It consists of five main steps: step 1, the upper lateral cartilages are released from the dorsal aspect of the nasal septum; step 2, a 1-mm strip of the dorsal septum is taken in each movement as required; step 3, ostectomy of the caudal aspect of nasal bones, keeping the upper lateral cartilages intact and releasing the "lateral" (left and right) pyriform aperture ligament; step 4, classic medial and lateral osteotomies (closing the open bony roof); and step 5, suturing the upper lateral cartilages to the dorsal septum and thus avoiding the natural spring effect. The outcomes of the first 100 patients have been validated by a prospective, interventional, and longitudinal study performed on patients undergoing primary rhinoplasty by means of the spare roof technique. This study confirms that the spare roof technique significantly improved patient quality of life regarding nose function and appearance. It is a reliable technique that can help deliver consistently good results in Caucasian and Mediterranean patients with a dorsal hump seeking rhinoplasty.


Asunto(s)
Tabique Nasal/cirugía , Rinoplastia/métodos , Humanos , Hueso Nasal/cirugía , Osteotomía/métodos , Cuidados Posoperatorios/métodos , Colgajos Quirúrgicos
15.
BMC Oral Health ; 20(1): 22, 2020 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-31992277

RESUMEN

BACKGROUND: Periodontally accelerated osteogenic orthodontics (PAOO) is a treatment for bone defects associated with a lack of bone graft stability, especially in coronal locations. This study aimed to compare a modified technique of membrane fixation that utilizes periosteal sutures (using a pouch design) with the traditional approach, which does not use membrane fixation. METHODS: Twenty-eight patients with a total of 168 teeth treated were divided into two groups: 1-A, in which patients were treated using the modified technique (with membrane fixation), and group 2-B, in which patients were treated using the traditional technique (without membrane fixation). The postoperative bone thickness was evaluated via radiographic examination. RESULTS: Postoperative improvements in bone augmentation were detected in both groups. At 12 months, the values of the CHBT (measured from the midpoint of the coronal third to the labial cortical surface, 0.84 ± 0.33 mm) and the values of VBL (measured from the alveolar crest to the cemento-enamel junction, - 2.35 ± 0.80 mm)were significantly greater in the modified technique group than those in the traditional technique group (CHBT:0.12 ± 0.21 mm and VBL:-1.39 ± 0.99 mm; P = 0.00 and P = 0.01). CONCLUSIONS: This study shows that compared to the traditional technique, the modified PAOO technique with membrane fixation using periosteal sutures provides improved graft stabilization, superior coronal augmentation and satisfactory vertical volume.


Asunto(s)
Proceso Alveolar/cirugía , Trasplante Óseo/métodos , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteogénesis/fisiología , Osteotomía/métodos , Aumento de la Cresta Alveolar/métodos , Humanos , Ortodoncia Correctiva/instrumentación , Técnicas de Movimiento Dental/métodos , Resultado del Tratamiento
16.
Medicine (Baltimore) ; 99(4): e18636, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977853

RESUMEN

RATIONALE: Knee osteoarthritis (KOA) is a common disease. It has long been believed that the main causes of KOA are knee degenerative diseases, trauma, overwork, and labor habits. However, long-term deformity leads to uneven stress on the surface of the knee joint, and the cause of lower limb force line damage has not been taken seriously. Comprehensive application of high tibial osteotomy (HTO), chronic distraction tissue regeneration, and computer-assisted external fixation for the treatment of severe KOA has many advantages over total knee arthroplasty, such as lasting and thorough orthopedic effects, a lower cost, and a faster recovery. PATIENT CONCERNS: The patient was a 48-year-old male with KOA caused by long-term genu varus, resulting in pain in both knees, especially in the right knee. The right knee pain had been aggravated for 2 years, and he was admitted to the hospital for left knee pain for 1 month. DIAGNOSES: X-ray: The patient has right KOA and varus deformity INTERVENTIONS: Comprehensive application of HTO, chronic distraction tissue regeneration technology, and computer-assisted external fixation technology has a good therapeutic effect for patients with KOA and varus. OUTCOMES: The patient's severe genu varus was corrected, the bone and soft tissue regeneration was good, the lower limb force line was improved, lower limb function was restored well, and the treatment was satisfactory. CONCLUSION: For the treatment of KOA patients with genu varus, the combination of HTO, chronic distraction tissue regeneration, and computer-assisted adjustment of external fixation technology have a good effect on the correction of genu varus deformity and the recovery of the lower limb force line. This treatment method is also conducive to preventing postoperative infection and avoiding secondary trauma caused by the removal of internal fixation plates.


Asunto(s)
Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Fijadores Externos , Regeneración Tisular Dirigida/métodos , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Tibia/cirugía
17.
Medicine (Baltimore) ; 99(4): e18910, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977905

RESUMEN

BACKGROUND: Knee osteoarthritis (KOA) is a common disease in the elderly, which seriously reduces the quality of life of patients and increases the social burden. proximal fibula osteotomy (PFO) and high tibial osteotomy (HTO) are effective methods to treat KOA. However, it is not entirely clear which method has the advantage. Therefore, we evaluated the efficacy and safety of HTO and PFO in the treatment of KOA. METHODS: Randomized controlled trials from online databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Data and Chinese Biomedical Literature Database that compared the efficacy of HTO and PFO in the treatment of KOA were retrieved. The main outcomes included hospital for special surgery (HSS) knee scores, knee society knee scoring system (KSS) score, visual analog scale (VAS) knee pain scores, western ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, complications. The Cochrane risk of bias tool was used to assess methodological quality. RESULTS: The literature will provide a high-quality analysis of the current evidence supporting HTO for KOA based on various comprehensive assessments including HSS scores, KSS score, VAS scores, western Ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, and complications. CONCLUSION: This proposed systematic review will provide up-to-date evidence to assess the effect of HTO in the treatment for patients with KOA.


Asunto(s)
Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Peroné/cirugía , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como Asunto , Tibia/cirugía
18.
PLoS One ; 15(1): e0227596, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31923920

RESUMEN

High tibial osteotomy (HTO) is a well-established treatment for medial compartmental knee osteoarthritis. Several microRNAs (miRNAs) are involved in osteoarthritis progression and are useful as osteoarthritis-related biomarkers. In this prospective study, we investigated differentially expressed microRNAs in the synovial fluid (SF) before and after HTO in patients with medial compartmental knee osteoarthritis to identify microRNAs that can be used as prognostic biomarkers. We used miRNA-PCR arrays to screen for miRNAs in SF samples obtained preoperatively and 6 months postoperatively from 6 patients with medial compartmental knee osteoarthritis who were treated with medial open wedge HTO. Differentially expressed miRNAs identified in the profiling stage were validated by real-time quantitative PCR in 22 other patients who had also been treated with HTO. All patients radiographically corresponded to Kellgren-Lawrence grade II or III with medial compartmental osteoarthritis. These patients were clinically assessed using a visual analogue scale and Western Ontario McMaster Universities scores. Mechanical axis changes were measured on standing anteroposterior radiographs of the lower limbs assessed preoperatively and at 6 months postoperatively. Among 84 miRNAs known to be involved in the inflammatory process, 14 were expressed in all SF specimens and 3 (miR-30a-5p, miR-29a-3p, and miR-30c-5p) were differentially expressed in the profiling stage. These 3 miRNAs, as well as 4 other miRNAs (miR-378a-5p, miR-140-3p, miR-23a-3p, miR-27b-3p), are related to osteoarthritis progression. These results were validated in the SF from 22 patients. Clinical and radiological outcomes improved after HTO in all patients, and only 2 miRNAs (miR-30c-5p and miR-23a-3p) were significantly differentially expressed between preoperative and postoperative 6-month SF samples (p = 0.006 and 0.007, respectively). Of these two miRNAs, miR-30c-5p correlated with postoperative pain relief. This study provides potential prognostic miRNAs after HTO and further investigations should be considered to determine clinical implications of these miRNAs.


Asunto(s)
MicroARNs/genética , Osteoartritis de la Rodilla/genética , Anciano , Biomarcadores , Femenino , Perfilación de la Expresión Génica/métodos , Regulación de la Expresión Génica/genética , Humanos , Articulación de la Rodilla/cirugía , MicroARNs/metabolismo , Persona de Mediana Edad , Osteoartritis de la Rodilla/metabolismo , Osteotomía/métodos , Pronóstico , Estudios Prospectivos , Líquido Sinovial/metabolismo , Tibia/metabolismo
19.
Acta Orthop ; 91(2): 177-183, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928105

RESUMEN

Background and purpose - Both medial unicompartmental knee arthroplasties (UKA) and high tibial osteotomies (HTO) are reliable treatments for isolated medial knee osteoarthritis. However, both may with time need conversion to a total knee arthroplasty (TKA). We conducted the largest nationwide registry comparison of the survival of TKA following UKA with TKA following HTO.Patients and methods - From the Danish Knee Arthroplasty Registry, aseptic conversions to TKA from UKA and TKA converted from HTO within the period of 1997-2018 were retrieved. The Kaplan-Meier method and the Cox proportional hazards regression were used to estimate the survival and hazard ratio (HR) for revision, considering confounding by indication utilizing propensity-score based inverse probability of treatment weighting (PS-IPTW).Results - PS-IPTW yielded a well-balanced pseudo-cohort (standard mean difference (SMD) < 0.1 for all covariates, except implant supplementation) of 963.8 TKAs following UKA and 1139.1 TKAs following HTO. The survival of TKA following UKA was significantly less than that of TKA following HTO with a 5-year estimated survival of 0.88 (95% confidence interval (CI) 0.85-0.90) and 0.94 (CI 0.93-0.96), respectively. The differences in survival corresponded to an implant-supplementation adjusted HR of 2.7 (CI 2.4-3.1) for TKA following UKA compared with TKA following HTO.Interpretation - Previous UKA more than doubled the revision risk of a subsequent TKA compared with previous HTO. This potential risk should be considered in the shared treatment decision of patients who are candidates for both UKA and HTO.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Falla de Prótesis/etiología , Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Estudios de Cohortes , Dinamarca , Femenino , Humanos , Estimación de Kaplan-Meier , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Osteotomía/efectos adversos , Puntaje de Propensión , Sistema de Registros , Reoperación/estadística & datos numéricos , Medición de Riesgo/métodos
20.
Acta Orthop ; 91(2): 197-202, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31711345

RESUMEN

Background and purpose - There are few studies on overgrowth of the affected limb after treatment of developmental dysplasia of the hip (DDH). We investigated the incidence of overgrowth and its risk factors in DDH patients.Patients and methods - 101 patients were included in this study. Overgrowth was defined by 2 criteria: when the height of the femoral head of the affected side was higher than that of the contralateral side by more than 10 mm, or by more than 15 mm. The potential risk factors of distinct overgrowth were retrospectively examined using multivariable analysis.Results - When overgrowth was defined as femoral head height difference (FHHD) > 10 mm, its incidence was 44%, and only femoral osteotomy was identified as a significant risk factor with a relative risk (RR) of 1.6 (95% confidence interval [CI] 1.0-2.5). When overgrowth was defined as FHHD > 15 mm, its incidence was 23%, and femoral osteotomy was identified as the only significant risk factor with an RR of 2.3 (CI 1.2-4.5). Overgrowth developed more frequently in patients who underwent femoral osteotomy at the age of 2 to 4 years (87%) than in the others (46%) (p = 0.04).Interpretation - Overgrowth of the affected limb is common in DDH patients. Patients who underwent femoral osteotomy, especially at the age of 2 to 4 years, may require careful follow-up because of the substantial risk for overgrowth.


Asunto(s)
Cabeza Femoral/patología , Luxación Congénita de la Cadera/cirugía , Diferencia de Longitud de las Piernas/etiología , Osteotomía/efectos adversos , Preescolar , Femenino , Fémur/cirugía , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/crecimiento & desarrollo , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Diferencia de Longitud de las Piernas/patología , Masculino , Osteotomía/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Factores de Riesgo
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