Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.992
Filtrar
1.
Bone Joint J ; 103-B(4): 795-803, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789467

RESUMEN

AIMS: Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. METHODS: The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). RESULTS: The rates of major complications necessitating further surgery were 62%, 24%, 56%, and 17% for custom-made prostheses, ice-cream cone prostheses, irradiated autografts and nonskeletal reconstructions, respectively (p = 0.001). The ten-year cumulative incidence of failure of the reconstruction was 19%, 9%, 33%, and 0%, respectively. The major cause of failure was deep infection (11%), followed by local recurrence (6%). The mean functional Musculoskeletal Tumour Society (MSTS) scores were 59%, 74%, 64%, and 72%, respectively. The scores were significantly lower in patients with major complications than in those without complications (mean 52% (SD 20%) vs 74% (SD 19%); p < 0.001). For periacetabular resections involving the ilium, the mean score was the highest with custom-made prostheses (82% (SD 10%)) in patients without any major complication; however, nonskeletal reconstruction resulted in the highest mean scores (78% (SD 12%)) in patients who had major complications. For periacetabular resections not involving the ilium, significantly higher mean scores were obtained with ice-cream cone prostheses (79% (SD 17%); p = 0.031). CONCLUSION: Functional outcome following periacetabular reconstruction is closely associated with the occurrence of complications requiring further surgery. For tumours treated with periacetabular and iliac resection, skeletal reconstruction may result in the best outcomes in the absence of complications, whereas nonskeletal reconstruction is a reasonable option if the risk of complications is high. For tumours requiring periacetabular resection without the ilium, reconstruction using an ice-cream cone prosthesis supported by antibiotic-laden cement is a reliable option. Cite this article: Bone Joint J 2021;103-B(4):795-803.


Asunto(s)
Acetábulo/cirugía , Recuperación del Miembro/métodos , Osteosarcoma/cirugía , Huesos Pélvicos/cirugía , Acetábulo/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trasplante Óseo/métodos , Niño , Femenino , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Osteosarcoma/diagnóstico por imagen , Huesos Pélvicos/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.
Int J Mol Sci ; 22(6)2021 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-33801825

RESUMEN

The loss of bone following tooth extraction poses a significant clinical problem for maxillofacial esthetics, function, and future implant placement. In the present study, the efficacy of an erythropoietin-impregnated collagen scaffold as an alveolar ridge augmentation material versus a conventional collagen scaffold and a BioOss inorganic bovine bone xenograft was examined. The collagen/Erythropoietin (EPO) scaffold exhibited significantly more rapid and complete osseous regeneration of the alveolar defect when compared to bone xenograft and the collagen membrane alone. The new EPO induced extracellular matrix was rich in Collagen I, Collagen III, Fibronectin (Fn) and E-cadherin, and featured significantly increased levels of the osteogenic transcription factors Runt-related transcription factor 2 (Runx2) and Osterix (Osx). Histomorphometric evaluation revealed a significant two-fold increase in the number of capillaries between the EPO and the BioOss group. Moreover, there was a highly significant 3.5-fold higher level of vascular endothelial growth factor (VEGF) in the collagen/EPO-treated group compared to controls. The significant effect of EPO on VEGF, FN, and RUNX2 upregulation was confirmed in vitro, and VEGF pathway analysis using VEGF inhibitors confirmed that EPO modulated extracellular matrix protein expression through VEGF even in the absence of blood vessels. Together, these data demonstrate the effectiveness of an EPO-impregnated collagen scaffold for bone regeneration as it induces rapid matrix production and osseoinduction adjacent to new capillaries via VEGF.


Asunto(s)
Proceso Alveolar/efectos de los fármacos , Regeneración Ósea/efectos de los fármacos , Capilares/efectos de los fármacos , Eritropoyetina/farmacología , Matriz Extracelular/efectos de los fármacos , Osteogénesis/efectos de los fármacos , Proceso Alveolar/fisiología , Aumento de la Cresta Alveolar/métodos , Animales , Trasplante Óseo/métodos , Capilares/fisiología , Bovinos , Células Cultivadas , Matriz Extracelular/metabolismo , Humanos , Minerales/farmacología , Ratas Sprague-Dawley , Trasplante Heterólogo , Factor A de Crecimiento Endotelial Vascular/metabolismo
4.
Bone Joint J ; 103-B(3): 492-499, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641418

RESUMEN

AIMS: Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. METHODS: In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. RESULTS: Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). CONCLUSION: Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492-499.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera , Trasplante Óseo/métodos , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Anciano , Anciano de 80 o más Años , Femenino , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , España
5.
Bone Joint J ; 103-B(3): 456-461, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641428

RESUMEN

AIMS: To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (ß-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. METHODS: A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using ß-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. RESULTS: There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. CONCLUSION: IMT using ß-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456-461.


Asunto(s)
Trasplante Óseo/métodos , Fosfatos de Calcio/farmacología , Fémur/cirugía , Ilion/trasplante , Procedimientos Quirúrgicos Reconstructivos/métodos , Tibia/cirugía , Adulto , Artrodesis , Desbridamiento , Femenino , Fémur/lesiones , Fémur/patología , Humanos , Japón , Masculino , Persona de Mediana Edad , Polimetil Metacrilato , Estudios Retrospectivos , Tibia/lesiones , Tibia/patología , Cicatrización de Heridas/efectos de los fármacos
6.
Medicine (Baltimore) ; 100(5): e22537, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592814

RESUMEN

RATIONALE: Gout can cause redness, swelling, local heat, severe pain, and limitation of function of the affected joints and surrounding tissues. Gouty tophi are commonly found in the auricle, joints, Achilles tendon and tarsal bursa. However, gouty tophi rarely affect the talus. PATIENT CONCERNS: We report a case of a 35-year-old man with a history of a sprained left ankle (six years before presentation), who presented with atraumatic and progressive pain, which the patient has been experiencing for a year. DIAGNOSIS: The patient was diagnosed with ankle pain with a gouty stone in the talus. INTERVENTIONS: The patient was treated with autologous osteochondral transplantation. OUTCOMES: During the two-year follow-up period, the patient's ankle joint underwent functional recovery and pain relief. Furthermore, the patient's Baird-Jackson ankle score improved from 80 to 95. LESSONS: The gold standard for the diagnosis of gouty tophus in the talus is intraoperative arthroscopy and pathology. The presented case achieved satisfactory clinical effects with autologous osteochondral transplantation as the treatment for gouty tophus in the talus, and obtained an ideal hyaline cartilage repair with restored ankle joint function.


Asunto(s)
Artritis Gotosa/cirugía , Trasplante Óseo/métodos , Astrágalo/cirugía , Adulto , Autoinjertos , Humanos , Masculino , Recuperación de la Función
7.
Medicine (Baltimore) ; 100(3): e24095, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546015

RESUMEN

RATIONALE: The treatment methods of pediatric scaphoid nonunion are still controversial. To our knowledge, arthroscopic-assisted treatments for pediatric scaphoid nonunion has not been reported in the English-language literature. Therefore, the purpose of this study is to report the use of arthroscopic-assisted bone grafting for scaphoid nonunion fracture in 3 patients and present a literature review. PATIENTS CONCERNS: Two 15-year-old patients developed carpal joint injuries over a year, prior to their hospital presentation, since they had not received adequate treatment. The third patient, 12 years of age, was diagnosed with scaphoid fracture after a traffic accident and underwent conservative treatment but presented to the hospital due to issues related with bone union. DIAGNOSIS: All 3 patients were diagnosed with scaphoid nonunion at our hospital, using plain wrist radiographs and computed tomography. INTERVENTIONS: All the patients underwent arthroscopic debridement; 2 patients received autogenous iliac cancellous bone graft, while the other patient received a bone substitute graft. The internal fixation of the scaphoid was performed with K-wires. OUTCOMES: Bone unions were achieved in all patients, and the final follow-up resulted in successful outcomes. LESSONS: Arthroscopic-assisted bone grafting and percutaneous K-wire fixation can be considered as a good method for the treatment of pediatric scaphoid nonunion fractures. Therefore, it is a primary treatment option for symptomatic scaphoid nonunion fracture and displaced fractures.


Asunto(s)
Artroscopía/métodos , Trasplante Óseo/métodos , Fracturas no Consolidadas/cirugía , Hueso Escafoides/lesiones , Traumatismos de la Muñeca/cirugía , Adolescente , Niño , Humanos , Masculino
8.
Bone Joint J ; 103-B(2): 299-304, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517728

RESUMEN

AIMS: Various surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented acetabular component and autologous bone graft from the femoral neck. METHODS: A total of 22 patients with Crowe type III dislocated hips underwent 28 THAs using bone graft from the femoral neck between 1979 and 2000. A Charnley cemented acetabular component was placed at the level of the true acetabulum after preparation with bone grafting. All patients were female with a mean age at the time of surgery of 54 years (35 to 68). A total of 18 patients (21 THAs) were followed for a mean of 27.2 years (20 to 33) after the operation. RESULTS: Radiographs immediately after surgery showed a mean vertical distance from the centre of the hip to the teardrop line of 21.5 mm (SD 3.3; 14.5 to 30.7) and a mean cover of the acetabular component by bone graft of 46% (SD 6%; 32% to 60%). All bone grafts united without collapse, and only three acetabular components loosened. The rate of survival of the acetabular component with mechanical loosening or revision as the endpoint was 86.4% at 25 years after surgery. CONCLUSION: The technique of using autologous bone graft from the femoral neck and placing a cemented acetabular component in the true acetabulum can provide good long-term outcomes in patients with Crowe type III dislocated hips. Cite this article: Bone Joint J 2021;103-B(2):299-304.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Trasplante Óseo/métodos , Cuello Femoral/trasplante , Luxación Congénita de la Cadera/cirugía , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/instrumentación , Cementos para Huesos , Femenino , Estudios de Seguimiento , Prótesis de Cadera , Humanos , Persona de Mediana Edad , Trasplante Autólogo , Resultado del Tratamiento
9.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-33504535

RESUMEN

We report a case about a 69-year-old man, suffering from rheumatoid arthritis, diagnosed with a neglected Achilles tendon rupture. Considering the large Achilles tendon gap and the bad quality of the autologous tendons caused by rheumatoid disease, a reconstruction using an Achilles tendon with calcaneus bone block allograft was performed, with excellent clinical and functional outcomes.


Asunto(s)
Tendón Calcáneo/lesiones , Tendón Calcáneo/trasplante , Artritis Reumatoide/complicaciones , Trasplante Óseo/métodos , Calcáneo/trasplante , Rotura/cirugía , Anciano , Humanos , Masculino , Procedimientos Quirúrgicos Reconstructivos , Rotura/complicaciones , Trasplante Homólogo/métodos
10.
Int J Mol Sci ; 22(2)2021 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-33466904

RESUMEN

Reconstruction of segmental bone defects by autologous bone grafting is still the standard of care but presents challenges including anatomical availability and potential donor site morbidity. The process of 3D bioprinting, the application of 3D printing for direct fabrication of living tissue, opens new possibilities for highly personalized tissue implants, making it an appealing alternative to autologous bone grafts. One of the most crucial hurdles for the clinical application of 3D bioprinting is the choice of a suitable cell source, which should be minimally invasive, with high osteogenic potential, with fast, easy expansion. In this study, mesenchymal progenitor cells were isolated from clinically relevant human bone biopsy sites (explant cultures from alveolar bone, iliac crest and fibula; bone marrow aspirates; and periosteal bone shaving from the mastoid) and 3D bioprinted using projection-based stereolithography. Printed constructs were cultivated for 28 days and analyzed regarding their osteogenic potential by assessing viability, mineralization, and gene expression. While viability levels of all cell sources were comparable over the course of the cultivation, cells obtained by periosteal bone shaving showed higher mineralization of the print matrix, with gene expression data suggesting advanced osteogenic differentiation. These results indicate that periosteum-derived cells represent a highly promising cell source for translational bioprinting of bone tissue given their superior osteogenic potential as well as their minimally invasive obtainability.


Asunto(s)
Células de la Médula Ósea/metabolismo , Trasplante Óseo/métodos , Huesos/metabolismo , Células Madre Mesenquimatosas/metabolismo , Biosíntesis de Proteínas , Ingeniería de Tejidos/métodos , Adulto , Bioimpresión/métodos , Células de la Médula Ósea/citología , Huesos/citología , Diferenciación Celular/genética , Células Cultivadas , Humanos , Células Madre Mesenquimatosas/citología , Osteogénesis/genética , Impresión Tridimensional , Andamios del Tejido , Trasplante Autólogo
11.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33509868

RESUMEN

We present a case of a postoperative cartilage defect in a patient with polydactyly who was treated with a costal osteochondral graft. Excision of the radial digit and ligamentous periosteal flap with longitudinal osteotomy were performed when the patient was 1 year old. The alignment of the interphalangeal joint was straight after surgery, but the deviation gradually developed. A revision surgery using a costal osteochondral graft was performed when the patient was 3 years old. A satisfactory outcome was obtained at the 3-year follow-up. The authors suggest that a costal osteochondral graft may be a reasonable option for revision surgery for a postoperative cartilage defect.


Asunto(s)
Trasplante Óseo/métodos , Cartílago/trasplante , Articulaciones de los Dedos/cirugía , Polidactilia/cirugía , Complicaciones Posoperatorias/cirugía , Costillas/trasplante , Pulgar/cirugía , Preescolar , Humanos , Lactante , Masculino , Reoperación , Pulgar/anomalías
12.
Medicine (Baltimore) ; 100(2): e24261, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466211

RESUMEN

BACKGROUND: Calcaneal fractures are a prevalent form of injury caused by high-energy trauma. This study aimed at investigating whether bone graft and non-bone graft are essential for the internal fixation of calcaneal fractures. A meta-analysis of relevant clinical studies evaluated radiographic parameters, functional outcomes, and complications that offer practical recommendations on the suitability of bone grafts for the management of Calcaneal fractures. METHODS AND ANALYSIS: This study performed a comprehensive search on PubMed, EMBASE, and Cochrane electronic to retrieve related clinical studies. The studies incorporated in our meta-analysis were identified after doing a preliminarily screening, reading of the full-text articles, and eliminating repeated studies. After quality assessment and data extraction, the standardized mean difference and risk ratio were selected as effect sizes. The data on Böhler angle, Gissane angle, calcaneal height, American Orthopaedic Foot and Ankle Society hindfoot scores, Maryland Foot Evaluation, and rate of wound infection were analyzed using Revman 5.3 software (Cochrane Collaboration). RESULTS AND CONCLUSIONS: This study did not reveal any significant differences (P < .05) in both Böhler and Gissane angles, calcaneal height, American Orthopaedic Foot and Ankle Society hindfoot scores, Maryland foot evaluation, and rate of wound infection between the 2 groups. Due to the lack of a large sample of comparative studies, the use of bone grafting for the management of calcaneal fractures requires additional substantiation.


Asunto(s)
Trasplante Óseo/métodos , Calcáneo/lesiones , Traumatismos de los Pies/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Calcáneo/diagnóstico por imagen , Calcáneo/cirugía , Estudios de Cohortes , Investigación sobre la Eficacia Comparativa , Femenino , Traumatismos de los Pies/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Resultado del Tratamiento
13.
J Pediatr Orthop ; 41(1): e60-e66, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32960831

RESUMEN

BACKGROUND: Treatments for unicameral bone cysts (UBCs) have high documented failure rates (27% to 63%) because of recurrence or persistence of the cyst, similar to nonoperative management. Recent evidence suggests that filling of the defect with a synthetic bone graft substitute (SBGS) supports the weakened cortex and promotes new bone growth. A calcium sulfate, brushite, calcium phosphate, composite graft material (PRODENSE, Wright Medical, Memphis, TN) has been evaluated as a substitute for autogenous or allogenous graft in animal and human studies. The purpose of this study was to compare the rates of revision surgery in patients treated for UBCs with an SBGS compared with historical treatments with allograft or autologous bone marrow aspirate. METHODS: The authors reviewed 27 of 33 patients (age, 6 months to 21 years) an average of 121 months (range, 32 to 228) after filling of a UBC with an injection of SBGS (n=18) versus allograft or autologous bone marrow aspirate (n=9) between June 2008 and December 2017. Six patients with no follow-up were excluded. Groups did not differ in age at surgery, sex (19/27 male), history of pathologic fracture (22/27), or previous treatments (11/27). The primary outcome was the rate of revision surgery. Secondary outcomes included revision surgery-free survival as evaluated by the log-rank test, rate of postoperative fracture, persistent cysts, continued pain, and/or growth disturbance at the final follow-up. RESULTS: Seven of 9 patients treated with allograft or autograft underwent revision surgery for postoperative pathologic fracture (n=2) or resorption of the graft (n=5) compared with 2 of 18 patients injected with the SBGS, both treated for graft resorption. The use of SBGS was associated with a decreased need for revision surgery over all time periods (hazard ratio, 0.14; 95% confidence interval, 0.03-0.05). There was no significant difference between postoperative fracture (2/18 vs. 2/9), persistent cyst (7/18 vs. 5/9), pain (0/18 vs. 2/9), or growth disturbance (1/18 vs. 3/9). CONCLUSIONS: Treatment of UBCs with SBGS may decrease reoperation rates. Initial radiographic appearance after SBGS treatment shows solid structural support, followed by new bone formation. This appearance may lead to a less aggressive approach in considering revision surgery. LEVEL OF EVIDENCE: Level III-retrospective comparative study investigating the results of treatment.


Asunto(s)
Quistes Óseos , Sustitutos de Huesos/farmacología , Trasplante Óseo , Fracturas Espontáneas , Complicaciones Posoperatorias , Reoperación/estadística & datos numéricos , Trasplante Homólogo , Aloinjertos , Quistes Óseos/complicaciones , Quistes Óseos/cirugía , Trasplante Óseo/efectos adversos , Trasplante Óseo/instrumentación , Trasplante Óseo/métodos , Niño , Femenino , Fracturas Espontáneas/etiología , Fracturas Espontáneas/prevención & control , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Prevención Secundaria/métodos , Trasplante Homólogo/efectos adversos , Trasplante Homólogo/métodos
14.
Spine (Phila Pa 1976) ; 46(1): 41-47, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-32947500

RESUMEN

STUDY DESIGN: Report of surgical technique and long-term outcome; review of prospectively gathered data and follow-up survey of patient cohort. OBJECTIVE: The aim of this study was to review surgical technique for a trephine graft harvest technique and assess perioperative complications/pain, long-term outcome, and patient satisfaction after anterior iliac crest bone graft (ICBG) harvest for anterior cervical fusion. SUMMARY OF BACKGROUND DATA: Rates of complications and residual pain after ICBG harvest have reduced its utility as a source of autograft for spinal fusion. Less invasive options reduce morbidity, and trephine harvest is a simple technique, with low morbidity and perioperative and long-term pain. It has not been presented in the peer-reviewed spine literature, and the long-term experience has not been previously reported. METHODS: Sixty-eight patients undergoing anterior cervical discectomy and fusion (ACDF), using allograft spacers, underwent ICBG harvest using a 3.5 mm trephine by a minimally invasive approach. Perioperative complications, pain incidence and Visual Analog Scale (VAS) were analyzed. Thirty consecutive patients were subsequently surveyed for long-term follow-up regarding pain, function, and satisfaction. RESULTS: No perioperative (0-6 weeks) graft-site complications (infection, hematoma, fracture, wound dehiscence) occurred. There were no reoperations, and no treatment required for graft-site complaints. No patient reported clinically significant perioperative pain (>3/10). At long-term follow-up (mean 45 months) no patients reported pain >3/10 at their graft-site, and the mean VAS was 0.20/10. No patient was impaired by graft-site symptoms, and all were satisfied with their graft harvest. CONCLUSION: Trephine graft harvest minimizes soft tissue dissection, periosteal elevation, and cortical disruption. Outcome using this technique eliminated perioperative complications in this study group, and reduced pain in both perioperative and long-term assessments. Compared to historical outcomes, trephine harvest provides sufficient graft with comparable or improved results relative to other minimally invasive approaches, and significantly improved relative to traditional open techniques. LEVEL OF EVIDENCE: 4.


Asunto(s)
Trasplante Óseo/efectos adversos , Trasplante Óseo/métodos , Discectomía/efectos adversos , Ilion/cirugía , Adulto , Anciano , Fracturas Óseas/cirugía , Humanos , Persona de Mediana Edad , Morbilidad , Dimensión del Dolor , Dolor Postoperatorio/etiología , Satisfacción del Paciente , Complicaciones Posoperatorias , Enfermedades de la Columna Vertebral/epidemiología , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral , Columna Vertebral/cirugía , Encuestas y Cuestionarios , Trasplante Autólogo , Resultado del Tratamiento
15.
Methods Mol Biol ; 2230: 75-89, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33197009

RESUMEN

The shortcomings of autografts and allografts in bone defect healing have prompted researchers to develop suitable alternatives. Numerous biomaterials have been developed as bone graft substitutes each with their own advantages and disadvantages. However, in order to test if these biomaterials provide an adequate replacement of the clinical standard, a clinically representative animal model is needed to test their efficacy. In this chapter, we describe a mouse model that establishes a critical sized defect in the mid-diaphysis of the femur to evaluate the performance of bone graft substitutes. This is achieved by performing a femoral ostectomy and stabilization utilizing a femoral plate and titanium screws. The resulting defect enables the bone regenerative potential of bone graft substitutes to be investigated. Lastly, we provide instruction on assessing the torsional strength of the healed femurs to quantitatively evaluate the degree of healing as a primary outcome measure.


Asunto(s)
Materiales Biocompatibles/farmacología , Regeneración Ósea/efectos de los fármacos , Trasplante Óseo/métodos , Diáfisis/efectos de los fármacos , Fémur/cirugía , Animales , Autoinjertos/trasplante , Tornillos Óseos , Sustitutos de Huesos/farmacología , Diáfisis/crecimiento & desarrollo , Modelos Animales de Enfermedad , Fémur/crecimiento & desarrollo , Fémur/fisiopatología , Curación de Fractura/efectos de los fármacos , Humanos , Ratones
16.
Methods Mol Biol ; 2230: 397-413, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33197028

RESUMEN

This chapter describes the methods of isolation of mouse periosteal progenitor cells. There are three basic methods utilized. The bone grafting method was developed utilizing the fracture healing process to expand the progenitor populations. Bone capping methods requires enzymatic digestion and purification of cells from the native periosteum, while the Egression/Explant method requires the least manipulation with placement of cortical bone fragments with attached periosteum in a culture dish. Various cell surface antibodies have been employed over the years to characterize periosteum derived progenitor cells, but the most consistent minimal criteria was recommended by the International Society for Cellular Therapy. Confirmation of the multipotent status of these isolated cells can be achieved by differentiation into the three basic mesodermal lineages in vitro.


Asunto(s)
Trasplante Óseo/métodos , Técnicas de Cultivo de Célula/métodos , Periostio/crecimiento & desarrollo , Células Madre/citología , Animales , Diferenciación Celular/genética , Proliferación Celular/genética , Células Madre Mesenquimatosas/citología , Ratones , Osteogénesis/genética , Periostio/citología
17.
J Orthop Surg Res ; 15(1): 601, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33308245

RESUMEN

OBJECTIVE: Extensive bone defects remain a therapeutic challenge necessitating alternative surgical approaches with better outcomes. Can increase the effectiveness of PRP or EGF treatment in surgical treatment of large bone defects with Masquelet technique? Aim of this study examined potential therapeutic benefits of the Masquelet technique with induced membranes in combination with platelet-rich plasma (PRP) or epidermal growth factor (EGF) in a rat model of segmental femur defect. METHODS: Three groups each consisting of 20 Sprague-Dawley rats were defined as follows: EGF group, PRP group, and control group. A femoral bone defect was created and filled with antibiotic embedded polymethyl methacrylate. Half of the animals in each group were sacrificed at week 6 and the pseudo-membranes formed were analyzed. In the remaining half, the cement was removed and the space was filled with autograft. After another 6 weeks, the structures formed were examined radiologically, histologically, and biochemically. RESULTS: At week 6, both PRP and EGF groups had significantly higher membrane CD31, TGF-beta, and VEGF levels than controls. At week 12, when compared to controls, PRP and EGF groups had significantly higher membrane CD31 levels and the PRP group had significantly higher membrane TGF levels. Regarding bone tissue levels, PRP and EGF groups had significantly higher VEGF levels and the EGF group had significantly higher BMP levels. In addition, PRP and EGF groups had higher radiological scores than controls. However, the two experimental groups did not differ with respect to any parameter tested in this study. CONCLUSION: Both PRP and EGF seem to be associated with histological, biochemical, and radiological improvements in experimental rat model of Masquelet technique, warranting in further clinical studies. LEVEL OF EVIDENCE: Level 5.


Asunto(s)
Enfermedades Óseas/cirugía , Trasplante Óseo/métodos , Factor de Crecimiento Epidérmico/administración & dosificación , Fémur/cirugía , Membrana Interósea/metabolismo , Plasma Rico en Plaquetas , Animales , Enfermedades Óseas/metabolismo , Enfermedades Óseas/fisiopatología , Regeneración Ósea , Modelos Animales de Enfermedad , Fémur/metabolismo , Fémur/fisiología , Membrana Interósea/fisiología , Masculino , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/metabolismo , Polimetil Metacrilato , Ratas Sprague-Dawley , Factor de Crecimiento Transformador beta/metabolismo , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/metabolismo
19.
Rev. cuba. ortop. traumatol ; 34(2): e295, jul.-dic. 2020. tab, ilus
Artículo en Español | LILACS, CUMED | ID: biblio-1156591

RESUMEN

RESUMEN Introducción: Las pseudoartrosis diafisarias de cúbito y radio constituyen un desafío terapéutico para el cirujano ortopédico, a causa de la dificultad para lograr y mantener la reducción de dos huesos paralelos en presencia de músculos pronadores y supinadores que ejercen influencias angulares y rotacionales. Objetivo: Evaluar la eficacia de la aplicación del minifijador externo combinado con el injerto óseo homólogo en esta afección. Métodos: Se realizó un estudio longitudinal, retrospectivo de corte transversal en 74 pacientes operados de pseudoartrosis diafisaria de cúbito y radio desde enero de 2000 hasta diciembre de 2014, en el Complejo Científico Ortopédico Internacional Frank País, en los que se utilizó el modelo de minifijación externa RALCA® e injerto óseo homólogo del Banco de Tejidos ORTOP. Resultados: La pseudoartrosis fue más frecuente en hombres (73 por ciento) y en las edades comprendidas entre 30 y 39 años. La localización más frecuente fue en el cúbito, en su tercio superior (52 por ciento). La mayoría de los pacientes presentaron una pseudoartrosis no viable (56 por ciento). Se consolidó en 66 por ciento de los pacientes antes de las 18 semanas y en solo uno no se obtuvo la consolidación. El hueso que menos tiempo requirió para consolidar fue el radio. En la evaluación de la eficacia de la técnica quirúrgica se obtuvo 62 por ciento de resultados buenos, 33 por ciento regulares y 5 por ciento malos. Conclusiones: La asociación de la minifijación externa modelo RALCA® e injerto óseo homólogo de banco mostró buenos resultados en el tratamiento de la pseudoartrosis de cúbito y radio(AU)


ABSTRACT Introduction: Diaphyseal pseudoarthroses of the ulna and radius constitute a therapeutic challenge for the orthopedic surgeon, due to the difficulty to achieve and maintain the reduction of two parallel bones in the presence of pronator and supinator muscles that exert angular and rotational influences. Objective: To evaluate the effectiveness of using external minifixator combined with homologous bone graft in the treatment of this condition. Method: A longitudinal, retrospective and cross-sectional study was carried out with 74 patients operated on, from January 2000 to December 2014, for diaphyseal pseudoarthrosis of the ulna or radius at Frank País International Orthopedic Scientific Complex, cases in which RALCA® external minifixation and homologous bone graft from the ORTOP Tissue Bank were used. Results: Pseudoarthrosis was more frequent in men (73 percent) and at ages 30-39 years. The most frequent location was the ulna, in its upper third (52 percent). Most of the patients had nonviable pseudoarthrosis (56 percent). The condition was consolidated in 66 percent of the patients within 18 weeks, and only one did not achieve consolidation. The bone that took the least time to heal was the radius. In the evaluation of the effectiveness of the surgical technique, 62% obtained good outcomes; 33 percent fair outcomes; and 5 percent, poor outcomes. Conclusions: The association of the RALCA® model miniexternal fixation and homologous bone graft from the Bank showed good outcomes in the treatment of ulna and radius pseudoarthrosis(AU)


Asunto(s)
Humanos , Masculino , Femenino , Seudoartrosis/cirugía , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Trasplante Óseo/métodos , Aloinjertos/trasplante , Estudios Transversales , Estudios Retrospectivos , Estudios Longitudinales
20.
Int. j. odontostomatol. (Print) ; 14(4): 678-684, dic. 2020. graf
Artículo en Inglés | LILACS | ID: biblio-1134557

RESUMEN

ABSTRACT: The present study aims to describe, through a case report, the functioning of bone grafts, where they are obtained including bone banks and the different dental areas in which it is used. A 50-year.old female patient HMR, sought the postgraduate college of dentistry CECAPE for oral rehabilitation. The initial clinical examination revealed the absence of several dental elements in both the maxilla and mandi ble, bone resorption in the entire maxillary extension where there was an absence of elements in the anterior region and the presence of a torus in the palatal region. Initial tomographic examinations of the maxilla and mandible were performed, looking for the best conduct regarding the diagnosis and planning of the case. After the clinical and radiographic examinations was performed, and the diagnosis was reached, it was determined as a treatment for oral rehabilitation of the maxilla, bone grafting and an Implant-supported Removable Partial Prosthesis and for the mandible a Dento-muco-supported Removable Partial Prosthesis. Dental treatments and oral rehabilitation from the use of bone tissues and bone grafting have become commonly used. Procedures that would normally lead to failure started to increase the percentage of successes due to the use of these biomaterials. The use of bone grafts in dentistry has been shown to be a very effective and useful resource, considering its great applicability in bone reconstructions in different areas of dentistry.


RESUMEN: El presente estudio tiene como objetivo describir a través de un informe de caso, el funcionamiento de los injertos óseos, donde se obtienen, incluidos los bancos de huesos y las diferentes áreas dentales en las que se emplea. Una paciente HMR, de 50 años de edad, asistió el centro universitario de posgrado CECAPE para rehabilitación oral. El examen clínico inicial reveló la ausencia de varios dientes tanto en el maxilar como en la mandíbula, la resorción ósea en toda la extensión maxilar donde había ausencia de dientes en la región anterior y la presencia de un torus en la región palatina. Se realizaron exámenes tomográficos iniciales del maxilar y mandíbula, buscando la mejor conducta con respecto al diagnóstico y la planificación del caso. Después de los exámenes clínicos y radiográficos realizados y el diagnóstico listo, se determinó como un tratamiento para la rehabilitación oral del maxilar, el injerto óseo y una prótesis removible implantosoportada y para la mandíbula una prótesis parcial removible dento-muco-soportada. Los tratamientos dentales y la rehabilitación oral a partir del uso de tejidos óseos y el injerto óseo se han utilizado comúnmente. Los procedimientos que normalmente conducirían al fracaso comenzaron a aumentar el porcentaje de éxitos debido al uso de estos biomateriales. Se ha demostrado que el uso de injertos óseos en odontología es un recurso muy eficaz y útil, considerando su gran aplicabilidad en las reconstrucciones óseas en diferentes áreas de la odontología.


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Trasplante Óseo/métodos , Implantación Dental Endoósea/métodos , Interfase Hueso-Implante/anatomía & histología , Tomografía Computarizada por Rayos X , Técnicas de Laboratorio Clínico , Mandíbula/diagnóstico por imagen , Rehabilitación Bucal
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...