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1.
Bone Joint J ; 103-B(5): 976-983, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33934644

RESUMEN

AIMS: To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection. METHODS: In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae. RESULTS: Major and minor perioperative complications were observed in 122 (39.7%) and 84 (27.4%) patients respectively. The breakdown of complications was as follows: bleeding more than 2,000 ml in 60 (19.5%) patients, hardware failure in 82 (26.7%), neurological in 46 (15.0%), surgical site infection in 23 (7.5%), wound dehiscence in 16 (5.2%), cerebrospinal fluid leakage in 45 (14.7%), respiratory in 52 (16.9%), cardiovascular in 11 (3.6%), digestive in 19 (6.2%)/ The mortality within two months of surgery was four (1.3%). The total number of complications per operation were 1.01 (SD 1.0) in the single vertebral resection group and 1.56 (SD 1.2) in the group with more than two vertebral resections. Cardiovascular and respiratory complications, along with hardware failure were statistically higher in the group who had more than two vertebrae resected. Also, in this group the amount of bleeding in patients with a lumbar lesion or respiratory complication in patients with a thoracic lesion, were statistically higher. Multivariate analysis showed that using a combined anterior and posterior approach, when more than two vertebral resections were significant independent factors. CONCLUSION: The characteristics of perioperative complications after TES were different depending on the extent and level of the tumour resection. In addition to preoperative clinical and pathological factors, it is therefore important to consider these factors in patients who undergo en bloc resection for spinal tumours. Cite this article: Bone Joint J 2021;103-B(5):976-983.


Asunto(s)
Laminectomía/métodos , Osteotomía/métodos , Complicaciones Posoperatorias , Neoplasias de la Columna Vertebral/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Neoplasias de la Columna Vertebral/diagnóstico por imagen
2.
Bone Joint J ; 103-B(4): 665-671, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789486

RESUMEN

AIMS: We compared the clinical outcomes of curved intertrochanteric varus osteotomy (CVO) with bone impaction grafting (BIG) with CVO alone for the treatment of osteonecrosis of the femoral head (ONFH). METHODS: This retrospective comparative study included 81 patients with ONFH; 37 patients (40 hips) underwent CVO with BIG (BIG group) and 44 patients (47 hips) underwent CVO alone (CVO group). Patients in the BIG group were followed-up for a mean of 12.2 years (10.0 to 16.5). Patients in the CVO group were followed-up for a mean of 14.5 years (10.0 to 21.0). Assessment parameters included the Harris Hip Score (HHS), Oxford Hip Score (OHS), Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), complication rates, and survival rates, with conversion to total hip arthroplasty (THA) and radiological failure as the endpoints. RESULTS: There were no significant differences in preoperative and postoperative HHS or postoperative OHS and JHEQ between the BIG group and the CVO group. Complication rates were comparable between groups. Ten-year survival rates with conversion to THA and radiological failure as the endpoints were not significantly different between groups. Successful CVO (postoperative coverage ratio of more than one-third) exhibited better ten-year survival rates with radiological failure as the endpoint in the BIG group (91.4%) than in the CVO group (77.7%), but this difference was not significant (p = 0.079). CONCLUSION: Long-term outcomes of CVO with BIG were favourable when proper patient selection and accurate surgery are performed. However, this study did not show improvements in treatment results with the concomitant use of BIG. Cite this article: Bone Joint J 2021;103-B(4):665-671.


Asunto(s)
Trasplante Óseo/métodos , Necrosis de la Cabeza Femoral/cirugía , Osteotomía/métodos , Adolescente , Adulto , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos
3.
Medicine (Baltimore) ; 100(12): e24330, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761633

RESUMEN

ABSTRACT: This study aimed to investigate the therapeutic effects of osteotomy combined with lateral ligament reconstruction on the osteochondral lesion of patients with talar injuries and varus ankles.Seventy five patients with talar injuries and varus ankles who received osteotomy combined with lateral ligament reconstruction for the osteochondral lesions from June 2008 to December 2014 were retrospectively reviewed. Patients were followed up for 32.4 ±â€Š15.3 months after surgeries, and the AOFAS-AH score, VAS score and SF36 score were determined preoperatively and postoperatively. The iconographic data were compared preoperatively and postoperatively, including tibial anterior surface angle (TAS), TTS, TT, and tibial lateral surface angle (TLS) angles.After surgeries, the AOFAS-AF score increased from 43.2 ±â€Š8.1 to 82.1 ±â€Š5.6, the VAS score decreased from 6.9 ±â€Š2.3 to 1.8 ±â€Š1.5, and the SF36 score increased from 48.7 ±â€Š9.4 to 83.5 ±â€Š6.2. TAS increased from 83.3 ±â€Š5.1 to 90.3 ±â€Š6.1, TTS increased from 70.3 ±â€Š6.1 to 82.5 ±â€Š5.4, TT decreased from 12.9 ±â€Š6.1 to 6.9 ±â€Š5.7, and TLS increased from 76.5 ±â€Š4.1 to 81.2 ±â€Š3.3 (P < .05).Osteotomy combined with lateral ligament reconstruction is effective for the treatment of talar osteochondral lesion with varus ankle, which could relieve the arthritic symptoms induced by cartilage lesions. By correcting the force line on lower limbs and metapedes with osteotomy completely, the treatments on talar osteochondral lesion and lateral ligament reconstruction are the critical factors with better results.


Asunto(s)
Articulación del Tobillo/anomalías , Ligamentos Colaterales/cirugía , Osteotomía/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Astrágalo/lesiones , Articulación del Tobillo/cirugía , Cartílago Articular/lesiones , Cartílago Articular/cirugía , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Desbridamiento/efectos adversos , Desbridamiento/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/efectos adversos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Estudios Retrospectivos , Astrágalo/cirugía , Resultado del Tratamiento
4.
Rev. ADM ; 78(2): 95-99, mar.-abr. 2021. ilus
Artículo en Español | LILACS | ID: biblio-1247757

RESUMEN

Los dientes supernumerarios y la fusión dental son anomalías del desarrollo dental cuyas causas aún no se han dilucidado con certeza. El cuarto molar inferior, también denominado distomolar, es uno de los dientes supernumerarios con menor frecuencia de aparición clínica y su fusión con el tercer molar es una condición todavía menos común. A continuación, se reportan los casos clínicos de tres pacientes masculinos que presentaron fusión del tercer molar inferior derecho con un distomolar tratados mediante odontectomía (AU)


Supernumerary teeth and dental fusion are abnormalities of dental development whose causes have not yet been elucidated with certainty. The lower fourth molar, also called distomolar, is one of the supernumerary teeth with the least frequency of clinical appearance and its fusion with the third molar is an even less common condition. Next, the clinical cases of three male patients who presented fusion of the right lower third molar with a distomolar treated by odontectomy are reported (AU)


Asunto(s)
Humanos , Masculino , Adolescente , Adulto , Diente Supernumerario/epidemiología , Dientes Fusionados/epidemiología , Tercer Molar , Osteotomía/métodos , Dens in Dente/epidemiología , Dientes Fusionados/cirugía , Dientes Fusionados/diagnóstico por imagen , México
5.
Ann R Coll Surg Engl ; 103(4): 272-277, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682473

RESUMEN

INTRODUCTION: Aesthetic rhinoplasty remains a challenging procedure with high expectations and narrow tolerance for errors. Considerable training is required to achieve controlled and reliable results. Use of the Piezotome is gaining popularity for performing the nasal osteotomies, a key step in rhinoplasty, where it is reported to improve precision and predictability and to keep tissue damage to a minimum. We compare the outcomes of conventional osteotomy techniques to piezosurgery in human cadavers as undertaken by surgical trainees. MATERIALS AND METHODS: Seven human cadavers were used and a total of 14 osteotomies were performed. Conventional osteotomies and piezosurgery were carried out each on one side of the cadaver. A number of fragments and a blinded assessment of the accuracy of the osteotomy compared with the preprocedure skin markings were carried out by two experienced rhinoplasty surgeons. The Mann-Whitney test for statistical analysis was used. RESULTS: The mean number of fragments was 1.57 in the piezosurgery osteotomy and 2.14 using conventional osteotomies. Four of seven piezosurgery osteotomies achieved an accuracy within 1mm. The conventional osteotomies as performed by the trainees showed a significant mismatch of more than 3mm in three of seven of cases. Accuracy within 1mm was achieved in one of seven cases. DISCUSSION: Piezosurgery offers a safe, reliable and precise method of performing lateral nasal osteotomies. This human cadaver study shows a high accuracy of osteotomy and fewer comminuted fractures using this technique compared with conventional osteotomy techniques.


Asunto(s)
Hueso Nasal/cirugía , Osteotomía/métodos , Piezocirugía/métodos , Rinoplastia/métodos , Humanos , Osteotomía/efectos adversos , Osteotomía/instrumentación , Evaluación de Resultado en la Atención de Salud , Piezocirugía/efectos adversos , Piezocirugía/instrumentación , Rinoplastia/efectos adversos , Rinoplastia/instrumentación
6.
Acta Orthop Traumatol Turc ; 55(1): 28-32, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33650507

RESUMEN

OBJECTIVE: This study aimed to compare the clinical and radiological findings of radical reduction (open reduction and Salter innominate osteotomy combined with femoral osteotomy) for children of walking age, younger and older than 4 years in the treatment of with developmental dysplasia of the hip (DDH). METHODS: In this retrospective study, children of walking age with DDH who underwent radical reduction between 2008 and 2014 were identified. They were then divided into 2 groups according to the age at which the surgery was performed: before and after the age of 4 years. Improvement in the acetabular index was examined on follow-up radiographs. The presence of avascular necrosis (AVN) was determined and classified on the basis of the Kalamchi-MacEwen classification on final follow-up radiographs. Clinical assessment was performed with the modified McKay criteria at the final follow-up appointment. RESULTS: A total of 19 children (14 girls, 5 boys; mean age=37.5±21 months) (25 hips) were included. Their mean age was 27.9±4.9 and 63.3±19.7 months in children operated before and after the age of 4 years, respectively. The mean follow-up time was 29.9±19 and 19.6±5 months in children operated before and after the age of 4 years, respectively. No significant difference was observed in improvements in the acetabular index between children younger than 4 years (24±6.9°) and those older than 4 years (20.7±6.7°) (p=0.25). According to the modified McKay criteria, all the children younger than 4 years exhibited excellent or good clinical results compared with those operated after the age of 4 years (67%) (p=0.013). At the final follow-up, 64% of all patients demonstrated no radiographical sign of AVN. The rates of AVN were significantly higher in children operated after the age of 4 years (33%) than in those operated before the age of 4 years (19%) (p=0.049). CONCLUSION: Better clinical and radiographical results can be expected from radical reduction in children undergoing surgery before the age of 4 years. LEVEL OF EVIDENCE: level III, Therapeutic Study.


Asunto(s)
Acetábulo , Factores de Edad , Displasia del Desarrollo de la Cadera/cirugía , Fémur , Osteonecrosis , Osteotomía , Complicaciones Posoperatorias , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Preescolar , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Masculino , Osteonecrosis/diagnóstico , Osteonecrosis/etiología , Osteotomía/efectos adversos , Osteotomía/métodos , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Radiografía/métodos , Estudios Retrospectivos
7.
Int J Comput Assist Radiol Surg ; 16(3): 407-414, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33555563

RESUMEN

PURPOSE: This study presents a novel surgical navigation tool developed in mixed reality environment for orthopaedic surgery. Joint and skeletal deformities affect all age groups and greatly reduce the range of motion of the joints. These deformities are notoriously difficult to diagnose and to correct through surgery. METHOD: We have developed a surgical tool which integrates surgical instrument tracking and augmented reality through a head mounted display. This allows the surgeon to visualise bones with the illusion of possessing "X-ray" vision. The studies presented below aim to assess the accuracy of the surgical navigation tool in tracking a location at the tip of the surgical instrument in holographic space. RESULTS: Results show that the average accuracy provided by the navigation tool is around 8 mm, and qualitative assessment by the orthopaedic surgeons provided positive feedback in terms of the capabilities for diagnostic use. CONCLUSIONS: More improvements are necessary for the navigation tool to be accurate enough for surgical applications, however, this new tool has the potential to improve diagnostic accuracy and allow for safer and more precise surgeries, as well as provide for better learning conditions for orthopaedic surgeons in training.


Asunto(s)
Realidad Aumentada , Procedimientos Ortopédicos/métodos , Ortopedia/métodos , Cirugía Asistida por Computador/métodos , Algoritmos , Articulación de la Cadera/diagnóstico por imagen , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional/métodos , Imagen por Resonancia Magnética , Osteotomía/métodos , Pelvis/diagnóstico por imagen , Fantasmas de Imagen , Rango del Movimiento Articular , Reproducibilidad de los Resultados
8.
Int J Comput Assist Radiol Surg ; 16(3): 515-524, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33575933

RESUMEN

PURPOSE: Corrective osteotomy of a malunited distal radius conventionally relies on 2D imaging techniques for alignment planning and evaluation. However, this approach results in suboptimal bone repositioning, which is associated with poor patient outcomes. In this case series, we evaluate the use of novel patient-specific plates (PSPs), which feature navigation and fixation of bone segments as preoperatively planned in 3D. METHODS: Ten participants with distal radius malunion underwent CT scans for preoperative alignment planning. Patient-specific guides and plates were designed, 3D-printed, and sterilized for use in corrective surgery of the distal radius. Pre- and postoperative results were compared in regard to clinical, functional, and radiographic outcomes. RESULTS: The application of a PSP was successful in 7 of the 10 cases. After treatment, the residual alignment error was reduced by approximately 50% compared with conventional treatment. The use of PSPs reduced pain significantly. Pre- and postoperative results were pooled and demonstrated significant correlations between: (1) pain and malpositioning, (2) the range of pro- and supination motion, the MHOQ score, the EQ-5D-5L score and dorsovolar angulation, and (3) MHOQ score and proximodistal translation. CONCLUSION: The correlation between malalignment and MHOQ score, EQ-5D-5L score, pain, and range of motion shows that alignment should be restored as well as possible. Compared to the conventional approach, which relies on 2D imaging techniques, corrective osteotomy based on 3D preoperative planning and intraoperative fixation with a PSP has been shown to improve bone alignment and reduce pain. LEVEL OF EVIDENCE: IV.


Asunto(s)
Huesos/diagnóstico por imagen , Imagenología Tridimensional/métodos , Posicionamiento del Paciente/métodos , Radio (Anatomía)/cirugía , Cirugía Asistida por Computador/métodos , Adolescente , Adulto , Anciano , Huesos del Carpo , Femenino , Fracturas Mal Unidas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/métodos , Radiografía/métodos , Fracturas del Radio/cirugía , Rango del Movimiento Articular , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Articulación de la Muñeca/cirugía , Adulto Joven
9.
Int J Comput Assist Radiol Surg ; 16(3): 397-406, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33616839

RESUMEN

PURPOSE: 3D-printed patient-specific instruments have become a useful tool to improve accuracy in pelvic tumour resections. However, their correct placement can be challenging in some regions due to the morphology of the bone, so it is essential to be aware of the possible placement errors in each region. In this study, we characterize these errors in common pelvic osteotomies. METHODS: We conducted an experiment with 9 cadaveric specimens, for which we acquired a pre-operative computed tomography scan. Small PSIs were designed for each case following a realistic surgical approach for four regions of the pelvis: iliac crest (C), supra-acetabular (S), ischial (I), and pubic (P). Final surgical placement was based on a post-operative scan. The resulting positions were compared with pre-operative planning, obtaining translations, rotations, and maximum osteotomy deviations in a local reference frame defined based on the bone's morphology. RESULTS: Mean translations and rotations in the direction of the osteotomy plane were as follows: C = 5.3 mm, 6.7°; S = 1.8 mm, 5.1°; I = 1.5 mm, 3.4°; P = 1.8 mm, 3.5°. Mean translations in the remaining axes were below 2 mm. Maximum osteotomy deviations (75% of cases) were below 11.8 mm in C (7.8 mm for half-length), 7.8 mm in S (5.5 mm for half-length), 5.5 mm in I, and 3.7 mm in P. CONCLUSION: We have characterized placement errors for small PSIs in four regions of the pelvis. Our results show high errors in C and S PSIs in the direction of the resection plane's normal, and thus large osteotomy deviations. Deviations in short osteotomies in S, I and P and placement errors in the remaining directions were low. The PSIs used in this study are biocompatible and can be produced with a desktop 3D printer, thus minimizing manufacturing cost.


Asunto(s)
Acetábulo/cirugía , Imagenología Tridimensional/métodos , Osteotomía/métodos , Neoplasias Pélvicas/diagnóstico por imagen , Impresión Tridimensional , Cadáver , Humanos , Pelvis , Periodo Posoperatorio , Periodo Preoperatorio , Valores de Referencia , Reproducibilidad de los Resultados , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X
10.
Medicine (Baltimore) ; 100(3): e23978, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545983

RESUMEN

BACKGROUND AND PURPOSE: Medial compartment femoro-tibial osteoarthritis (OA) is a common disease and opening-wedge high tibial osteotomy (OWHTO) is the common surgical procedure carried out for these patients. While most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the pain control effect of femoral nerve block (FNB) for OWHTO patients. METHODS: In this prospective, single-center, randomized controlled trial (RCT) study, 41 patients were operated on by OWHTO for OA during 2017 to 2018. Twenty of them (group A) accepted epidural anesthesia with FNB and 21 patients (group B) only had their single epidural anesthesia. All blocks were successful and all the 41 patients recruited were included in the analysis and there was no loss to follow-up or withdrawal. Systematic records of visual analog scores (VAS), quadriceps strength, mean number of times of patient-controlled intravenous analgesia (PCIA), using of additional opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), and complications were done after hospitalization. The Student t test and Chi-Squared test was used and all P values ≤.05 were considered statistically significant. RESULTS: VAS scores at rest (3.48 ±â€Š1.0 vs 4.68 ±â€Š1.1) and on movemment (4.51 ±â€Š0.6 vs 4.97 ±â€Š0.8) decreased more in group A than group B with significance at follow-up of 12 hours. The quadriceps strength, consumption of additional opioids or NSAID injections and mean number of times that the patients pushed the PCIA button didnot differ significantly within each group. CONCLUSION: This RCT study shows that FNB in patients undergoing OWHTO for unicompartmental osteoarthritis of the knee could result in significant reduction in VAS scores at 12 hours postoperatively.Research registry, Researchregistry4792. Registered April 7, 2019 - Retrospectively registered, http://www.researchregistry.com.


Asunto(s)
Nervio Femoral/efectos de los fármacos , Bloqueo Nervioso/normas , Manejo del Dolor/normas , Tibia/cirugía , Femenino , Nervio Femoral/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Bloqueo Nervioso/estadística & datos numéricos , Osteotomía/efectos adversos , Osteotomía/métodos , Manejo del Dolor/métodos , Manejo del Dolor/estadística & datos numéricos , Estudios Prospectivos , Tibia/efectos de los fármacos
11.
Medicine (Baltimore) ; 100(7): e24693, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607809

RESUMEN

RATIONALE: Crouzon syndrome is a craniofacial malformation caused by premature fusion of fibrous sutures in infants. It is one of the most common craniosynostosis syndromes, and surgery is the only effective treatment for correcting it. Postoperative complications such as encephalocele, infections, hematoma have been reported. We herein report a case of a 62-month-old boy with Crouzon syndrome who underwent fronto-orbital advancing osteotomy, cranial vault remolding, and extensive osteotomy and subsequently developed left proptosis and severe chemosis, these complications are rare and we believe it will be of use to clinicians, physicians, and researchers alike. PATIENT CONCERNS: The patient's skull had been malformed since birth, and he had been experiencing paroxysmal headaches coupled with vomiting for 4 months. Having never received prior treatment, he underwent fronto-orbital advancement at our clinic; afterward, left proptosis and severe chemosis occurred. DIAGNOSIS: The patient was diagnosed with Crouzon syndrome, and the complications included left proptosis and severe chemosis, confirmed by the clinical manifestations, physical examination, and computed tomography (CT). INTERVENTION: We carried out cranial vault remodeling and fronto-orbital advancement. We applied ophthalmic chlortetracycline ointment on the conjunctivae, elevated the patient's head, evacuated the hematoma, and carried out a left blepharorrhaphy. OUTCOMES: The proptosis and chemosis resolved with no recurrence. No other complications occurred during the follow-up period (12 months), and CT scans revealed that the hematoma had disappeared. The calvarial vault reshaping was satisfactorily performed, and the patient's vision was not impaired. LESSONS: Severe proptosis and chemosis are rare complications that can occur after fronto-orbital advancement for Crouzon syndrome. A detailed preoperative examination (including magnetic resonance imaging and CT) is essential for diagnosis. Complete hemostasis, evacuation of hematoma, and placement of a periorbital drainage tube during surgery all contribute to an effective treatment plan. An ophthalmic ointment should be administered, and the patient's head should be elevated during the procedure. Evacuation of retrobulbar epidural hematoma and blepharorrhaphy could also help relieve proptosis and chemosis. Our report describes 2 rare complications associated with the treatment for Crouzon syndrome, and we believe it will be of use to clinicians, physicians, and researchers alike.


Asunto(s)
Disostosis Craneofacial/cirugía , Exoftalmia/etiología , Hueso Frontal/cirugía , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Órbita/cirugía , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Preescolar , Disostosis Craneofacial/diagnóstico , Disostosis Craneofacial/patología , Enfermedades de los Párpados/patología , Enfermedades de los Párpados/cirugía , Hueso Frontal/anomalías , Humanos , Masculino , Procedimientos Quirúrgicos Oftalmológicos/métodos , Órbita/anomalías , Osteotomía/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Hemorragia Retrobulbar/diagnóstico por imagen , Hemorragia Retrobulbar/cirugía , Cráneo/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Trastornos de la Visión/cirugía
12.
Spine (Phila Pa 1976) ; 46(6): E374-E383, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33620182

RESUMEN

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to make a thorough comparison of clinical and radiographic outcomes between ankylosing spondylitis (AS) patients with severe kyphosis who underwent one- or two-level pedicle subtraction osteotomy (PSO) and to determine the indications of one-level PSO. SUMMARY OF BACKGROUND DATA: Traditionally, one-level PSO was considered being able to obtain 35° to 40° correction. However, in our practice, one-level PSO might achieve satisfied clinical and radiographic outcomes in AS patients with severe thoracolumbar kyphosis defined as global kyphosis (GK) ≥80°. METHODS: Fifty-five AS-related severe thoracolumbar kyphosis patients undergoing one- or two-level PSO from January 2007 to November 2016 were reviewed. The radiographic parameters included thoracic kyphosis (TK), lumbar lordosis (LL), GK, pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), sagittal vertical axis (SVA), and femoral obliquity angle (FOA). Clinical outcomes were evaluated by Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). RESULTS: The mean follow-up period was 39.7 ±â€Š20.2 months (range, 24-120 months). Patients who underwent one-level PSO have significantly smaller preoperative GK, SVA, FOA, and larger preoperative LL and SS compared to those who underwent two-level PSO (P < 0.05). The optimal cutoff points of preoperative radiographic parameters for selecting one-level PSO were: GK <94°, SVA <18.0 cm, and LL <18°. No significant difference was observed between the two groups with regard to preoperative ODI and VAS (P > 0.05), and the improvement of ODI and VAS (P > 0.05). Significantly more operative time, blood loss, and fusion levels were found in two-level PSO group (P < 0.05). CONCLUSION: One-level PSO might be appropriate for selected severe AS-related kyphosis patients with GK <94°, SVA <18.0 cm, and LL <18°. This finding might be beneficial for surgical decision-making in performing one-level PSO, a relatively less risky procedure, to reconstruct the ideal sagittal alignment in AS patients with severe thoracolumbar kyphosis.Level of Evidence: 2.


Asunto(s)
Cifosis/cirugía , Vértebras Lumbares/cirugía , Osteotomía/métodos , Satisfacción del Paciente , Espondilitis Anquilosante/cirugía , Vértebras Torácicas/cirugía , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Cifosis/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Espondilitis Anquilosante/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen , Resultado del Tratamiento , Adulto Joven
13.
J Clin Neurosci ; 85: 64-66, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33581792

RESUMEN

The surgical management of sacro-iliac chondrosarcomas is challenging given their intimate relationship to the nerves and vessels of the pelvis. Osteotomies for en bloc excision can be challenging because of lack of visualization and high risk of injury to pelvic structures. The use of three-dimensional (3D) printed models helps conceptualize the tumor relative to the patient's anatomy. Coupled with stereotactic navigation, safe osteotomy planning and execution can be performed with avoidance of vital nerves and vessels. Very few cases have been reported demonstrating the successful use of these 2 modern technologies for en bloc excision of difficult tumors. We present our technique of using a 3D printed model and navigation for en bloc excision of a large sacro-iliac chondrosarcoma, supplemented with an intraoperative video.


Asunto(s)
Neoplasias Óseas/cirugía , Condrosarcoma/cirugía , Imagenología Tridimensional/métodos , Neuronavegación/métodos , Osteotomía/métodos , Impresión Tridimensional , Humanos , Rayos Láser , Masculino , Persona de Mediana Edad , Articulación Sacroiliaca/patología , Articulación Sacroiliaca/cirugía , Resultado del Tratamiento
14.
Neurosurgery ; 88(4): 864-883, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33548924

RESUMEN

Adult cervical deformity management is complex and is a growing field with many recent advancements. The cervical spine functions to maintain the position of the head and plays a pivotal role in influencing subjacent global spinal alignment and pelvic tilt as compensatory changes occur to maintain horizontal gaze. There are various types of cervical deformity and a variety of surgical options available. The major advancements in the management of cervical deformity have only been around for a few years and continue to evolve. Therefore, the goal of this article is to provide a comprehensive review of cervical alignment parameters, deformity classification, clinical evaluation, and surgical treatment of adult cervical deformity. The information presented here may be used as a guide for proper preoperative evaluation and surgical treatment in the adult cervical deformity patient.


Asunto(s)
Vértebras Cervicales/cirugía , Fijación Ocular/fisiología , Cifosis/cirugía , Lordosis/cirugía , Postura/fisiología , Vértebras Cervicales/diagnóstico por imagen , Femenino , Humanos , Cifosis/clasificación , Cifosis/diagnóstico por imagen , Lordosis/clasificación , Lordosis/diagnóstico por imagen , Masculino , Osteotomía/métodos , Fusión Vertebral/métodos , Resultado del Tratamiento
15.
Med Sci Monit ; 27: e929149, 2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33608494

RESUMEN

BACKGROUND This retrospective study aimed to identify the factors associated with successful surgical correction of thoracic kyphosis (TK) in 43 patients with adolescent idiopathic scoliosis (AIS) with Lenke type 1 curvature, in which the major curve with the largest Cobb angle was mainly in the thoracic region. MATERIAL AND METHODS We collected data from patients with Lenke 1 AIS. The following parameters were measured: Cobb angle, side-bending Cobb angle, cervical lordosis (CL), TK, lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), the sagittal vertical axis (SVA), the center of a C7 plumb line to the center sacral vertical line (C7-CSVL), correction rate, Ponte osteotomy, flexibility, and screw density. Univariate analysis and multivariate logistic regression analyses were performed. RESULTS Among the 43 cases analyzed, the mean postoperative Cobb angle at the last follow-up, C7-CSVL, SVA, CL, TK, LL, PI, SS, and PT were respectively 21.33±9.47°, 10.41±8.45 mm, 19.68±14.33 mm, 16.19±7.45°, 23.12±7.45°, 50.33±11.37°, 49.70±9.83°, 39.42±8.11°, and 10.16±6.63°. Univariate analysis suggested that preoperative TK, preoperative LL, and Ponte osteotomy were statistically significant (P<0.05), and multivariate analysis suggested that preoperative LL and Ponte osteotomy were statistically significant (P<0.05). CONCLUSIONS The results of this study demonstrated that preoperative TK, preoperative LL, and Ponte osteotomy were related factors for maintaining normal TK. Multivariate analysis suggested that preoperative LL and the use of Ponte osteotomy with full-thickness segmental resection of the spinal posterior column resulted in the successful surgical correction of TK in patients with AIS with Lenke type 1 curvature.


Asunto(s)
Enfermedad de Scheuermann/cirugía , Enfermedad de Scheuermann/terapia , Escoliosis/cirugía , Adolescente , Vértebras Cervicales/cirugía , Niño , Femenino , Humanos , Cifosis/cirugía , Vértebras Lumbares/cirugía , Masculino , Osteotomía/métodos , Periodo Posoperatorio , Equilibrio Postural/fisiología , Postura/fisiología , Estudios Retrospectivos , Enfermedad de Scheuermann/rehabilitación , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía
16.
Biomed Res Int ; 2021: 6357109, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33604377

RESUMEN

The present study is aimed at assessing the changes in tibial rotation at the osteotomy site after an open-wedge, high-tibial osteotomy (OWHTO) and analysing the factors that affect rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the same site. This study involved 53 patients (60 knees; 16 males and 37 females) with medial osteoarthritis (OA) who underwent OWHTO and preoperative and 3-month postoperative computed tomography (CT) scans. Rotational angles of the distal tibia were measured using Stryker OrthoMap 3D by comparing preoperative and postoperative CTs. The mean rotational angle yielded an external rotation of 2.9° ± 4.8°. There were 17 knees with internal rotations, 37 knees with external rotations, and one knee with no rotation. The rotational angle significantly correlated with the resultant change in the femorotibial angle (correction angle) and the angle between the ascending and transverse osteotomy lines on the anterior osteotomised surface on which a flange was formed with the distal tibial osteotomised surface (flange angle). The flange angle affected the rotation, but it may have been affected by our surgical technique. The rotational angle did not significantly correlate with the change in the angle of the posterior tibial slope or body mass index. There were significant correlations between the rotational angle and correction angle (r = 0.42, p < 0.05). Additionally, the rotational angle correlated with the flange angle (r = -0.41, p < 0.05).


Asunto(s)
Osteotomía , Rango del Movimiento Articular/fisiología , Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/cirugía , Osteotomía/efectos adversos , Osteotomía/métodos , Tibia/diagnóstico por imagen , Tibia/fisiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
17.
Int J Comput Assist Radiol Surg ; 16(3): 505-513, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33475897

RESUMEN

PURPOSE: In corrective osteotomy of the distal radius, patient-specific 3D printed surgical guides or optical navigation systems are often used to navigate the surgical saw. The purpose of this cadaver study is to present and evaluate a novel cast-based guiding system to transfer the virtually planned corrective osteotomy of the distal radius. METHODS: We developed a cast-based guiding system composed of a cast featuring two drilling slots as well as an external cutting guide that was used to orient the surgical saw for osteotomy in the preoperatively planned position. The device was tested on five cadaver specimens with different body fat percentages. A repositioning experiment was performed to assess the precision of replacing an arm in the cast. Accuracy and precision of drilling and cutting using the proposed cast-based guiding system were evaluated using the same five cadaver arms. CT imaging was used to quantify the positioning errors in 3D. RESULTS: For normal-weight cadavers, the resulting total translation and rotation repositioning errors were ± 2 mm and ± 2°. Across the five performed surgeries, the median accuracy and Inter Quartile Ranges (IQR) of pre-operatively planned drilling trajectories were 4.3° (IQR = 2.4°) and 3.1 mm (IQR = 4.9 mm). Median rotational and translational errors in transferring the pre-operatively planned osteotomy plane were and 3.9° (IQR = 4.5°) and 2.6 mm (IQR = 4.2 mm), respectively. CONCLUSION: For normal weight arm specimens, navigation of corrective osteotomy via a cast-based guide resulted in transfer errors comparable to those using invasive surgical guides. The promising positioning capabilities justify further investigating whether the method could ultimately be used in a clinical setting, which could especially be of interest when used with less invasive osteosynthesis material.


Asunto(s)
Huesos del Carpo/diagnóstico por imagen , Osteotomía/métodos , Impresión Tridimensional , Procedimientos Quirúrgicos Reconstructivos/métodos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Cadáver , Diseño Asistido por Computadora , Elasticidad , Humanos , Radio (Anatomía) , Reproducibilidad de los Resultados , Rotación
18.
Arch Orthop Trauma Surg ; 141(4): 645-653, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33417031

RESUMEN

INTRODUCTION: Preoperative supine joint line convergence angle (JLCA) correlates with postoperative standing JLCA. Here, we compared the radiographic and clinical outcomes of knees with preoperative JLCAs of ≥ 4° and < 4° in open-wedge high tibial osteotomy (OWHTO). We hypothesized that the postoperative coronal alignment in both groups would not be affected by a change in JLCA if this change could predict before surgery. MATERIALS AND METHODS: Eighty-four patients with medial knee osteoarthritis who underwent OWHTO were enrolled retrospectively. A weight-bearing line (WBL) ratio of 62% and a JCLA equivalent to the preoperative supine JLCA were anticipated in preoperative planning. These were intraoperatively set using an alignment rod and a radiolucent protractor under fluoroscopy. Soft tissue correction was defined as correction angle minus bone correction. The participants with preoperative JLCAs of < 4° (low-JLCA group) and ≥ 4° (high-JLCA group) were compared. RESULTS: No significant difference in the coronal alignment was found between the groups after OWHTO. No significant differences in correction angle or bone correction were found between the groups, but the soft tissue correction in the high-JLCA group was higher than that in the low-JLCA group after OWHTO (p = 0.013). CONCLUSIONS: When we controlled intraoperative JLCA, the postoperative coronal alignment was not affected by the change in JLCA and the differences in soft tissue correction between the low-JLCA and high-JLCA groups. However, overcorrection compared with the target coronal alignment remained in both groups. LEVEL OF EVIDENCE: Level III, retrospective comparative study.


Asunto(s)
Articulación de la Rodilla , Osteotomía/métodos , Tibia , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/cirugía , Radiografía , Estudios Retrospectivos , Tibia/diagnóstico por imagen , Tibia/cirugía , Resultado del Tratamiento
19.
Orthopade ; 50(1): 75-85, 2021 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-33415427

RESUMEN

The cavovarus foot (CF) is a complex three-dimensional foot deformity. In addition to primary forms, secondary forms can be distinguished. The diagnosis of CF is made clinically; however, anamnestic information, a targeted examination including neurological status and at least radiological imaging using the hindfoot-centered imaging technique are required to determine the treatment. Conservative treatment for CF consists of the provision of insoles up to the adaptation of an orthopedic custom-made shoe, depending on the severity of the deformity. The indications for a surgical procedure are present in the case of increasing complaints, although the timing should be extensively discussed with the patient in order to be able to achieve the best functional results. Surgical treatment is generally complex but a combination of soft tissue interventions and osteotomy/arthrodesis can usually be used to achieve a plantigrade foot position and thereby enable the patient to walk with a functionally improved gait.


Asunto(s)
Artrodesis/métodos , Deformidades del Pie/cirugía , Osteotomía/métodos , Pie Cavo/cirugía , Pie , Deformidades del Pie/diagnóstico por imagen , Humanos , Pie Cavo/diagnóstico por imagen
20.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33495186

RESUMEN

Comminuted zygomatic arch fractures are a challenge to manage without complete exposure owing to their instability. The presence of facial nerve branches near the bone often means that these fractures are often treated by closed methods or left untreated. The disadvantages of such comminuted fracture left untreated cannot be overemphasised. Hence, there is a need of a surgical approach for exposure and fixation of such fractures without limitation of facial nerve injury. We propose and report a case of malunited comminuted fracture of zygomatic arch using facelift approach.


Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas Mal Unidas/cirugía , Fracturas Mandibulares/cirugía , Osteotomía/métodos , Ritidoplastia/métodos , Fracturas Cigomáticas/cirugía , Humanos , Masculino , Fracturas Mandibulares/complicaciones , Persona de Mediana Edad , Cigoma , Fracturas Cigomáticas/complicaciones
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