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2.
Int J Mol Sci ; 22(14)2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34298988

RESUMO

This study evaluated the biocompatibility and biological performance of novel additive-manufactured bioabsorbable iron-based porous suture anchors (iron_SAs). Two types of bioabsorbable iron_SAs, with double- and triple-helical structures (iron_SA_2_helix and iron_SA_3_helix, respectively), were compared with the synthetic polymer-based bioabsorbable suture anchor (polymer_SAs). An in vitro mechanical test, MTT assay, and scanning electron microscope (SEM) analysis were performed. An in vivo animal study was also performed. The three types of suture anchors were randomly implanted in the outer cortex of the lateral femoral condyle. The ultimate in vitro pullout strength of the iron_SA_3_helix group was significantly higher than the iron_SA_2_helix and polymer_SA groups. The MTT assay findings demonstrated no significant cytotoxicity, and the SEM analysis showed cells attachment on implant surface. The ultimate failure load of the iron_SA_3_helix group was significantly higher than that of the polymer_SA group. The micro-CT analysis indicated the iron_SA_3_helix group showed a higher bone volume fraction (BV/TV) after surgery. Moreover, both iron SAs underwent degradation with time. Iron_SAs with triple-helical threads and a porous structure demonstrated better mechanical strength and high biocompatibility after short-term implantation. The combined advantages of the mechanical superiority of the iron metal and the possibility of absorption after implantation make the iron_SA a suitable candidate for further development.


Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis , Âncoras de Sutura , Alanina Transaminase/sangue , Animais , Materiais Biocompatíveis/química , Materiais Biocompatíveis/toxicidade , Fenômenos Biomecânicos , Nitrogênio da Ureia Sanguínea , Fosfatos de Cálcio/química , Fosfatos de Cálcio/toxicidade , Sulfato de Cálcio/administração & dosagem , Sulfato de Cálcio/química , Sulfato de Cálcio/toxicidade , Creatinina/sangue , Desenho de Equipamento , Fêmur/diagnóstico por imagem , Fêmur/ultraestrutura , Ferro , Lasers , Teste de Materiais , Microscopia Eletrônica de Varredura , Estrutura Molecular , Osseointegração , Polímeros/química , Polímeros/toxicidade , Porosidade , Coelhos , Distribuição Aleatória , Resistência à Tração , Vísceras , Microtomografia por Raio-X
4.
J Orthop Surg Res ; 15(1): 419, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938491

RESUMO

BACKGROUND: Distal radius fracture (DRF) is the most common upper extremity fracture that requires surgery. Operative treatment with a volar locking plate has proved to be the treatment of choice for unstable fractures. However, no consensus has been reached about the benefits of pronator quadratus (PQ) repair after volar plate fixation of DRF in terms of patient-reported outcome measures, pronation strength, and wrist mobility. METHODS: We searched the PubMed, Embase, Cochrane Central, and China National Knowledge Infrastructure (CNKI) databases up to March 13, 2020, and included randomized-controlled, non-randomized controlled, or case-control cohort studies that compared cases with and without PQ repair after volar plate fixation of DRF. We used a random-effects model to pool effect sizes, which were expressed as standardized mean differences (SMDs) and 95% confidence intervals. The primary outcomes included Disabilities of the Arm, Shoulder, and Hand scores and pronation strength. The secondary outcomes included the SMDs in pain scale score, wrist mobility, and grip strength. The outcomes measured were assessed for publication bias by using a funnel plot and the Egger regression test. RESULTS: Five randomized controlled studies and six retrospective case-control studies were included in the meta-analysis. We found no significant difference in primary and secondary outcomes at a minimum of 6-month follow-up. In a subgroup analysis, the pronation strength in the PQ repair group for AO type B DRFs (SMD = - 0.94; 95% CI, - 1.54 to - 0.34; p < 0.01) favored PQ repair, whereas that in the PQ repair group for non-AO type B DRFs (SMD = 0.39; 95% CI, 0.07-0.70; p = 0.02) favored no PQ repair. DISCUSSION: We found no functional benefit of PQ repair after volar plate fixation of DRF on the basis of the present evidence. However, PQ muscle repair showed different effects on pronation strength in different groups of DRFs. Future studies are needed to confirm the relationship between PQ repair and pronation strength among different patterns of DRF. REGISTRATION: This study was registered in the PROSPERO registry under registration ID No. CRD42020188343 . LEVEL OF EVIDENCE: Therapeutic III.


Assuntos
Placas Ósseas , Antebraço , Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Músculo Esquelético/cirurgia , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Músculo Esquelético/fisiopatologia , Avaliação de Resultados da Assistência ao Paciente , Pronação , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
J Orthop Surg (Hong Kong) ; 28(2): 2309499020935994, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730729

RESUMO

Reconstruction of an infected knee joint with a large defect and extensor mechanism deficiency is challenging. In this study, we aim to describe a one-stage reconstruction surgery and provide its surgical outcome. Two patients had patellar open fracture and subsequent septic arthritis; in addition, a large soft tissue defect, loss of patella, and shortening of the patellar tendon were observed. The semitendinosus-gracilis tendon formed a loop to stabilize the patella. A free or supercharged reverse pedicle myocutaneous anterolateral thigh flap with fascial extension is designed to fill the defect and eradicate the infection. Mean clinical follow-up was 18 months. Although some limitation in the knee range of motion was observed, the dynamometer showed only partial loss in peak concentric power and eccentric power. We developed an innovative surgical procedure to alleviate infection and reconstruct a complex knee defect with extensor mechanism deficiency; this procedure resulted in favorable clinical outcomes.


Assuntos
Tendões dos Músculos Isquiotibiais/transplante , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamento Patelar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Transplante Autólogo
6.
Clin Rehabil ; 34(9): 1217-1229, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32539454

RESUMO

OBJECTIVE: To compare the efficacy of various strategies in the treatment of trigger finger. DATA SOURCES: A systematic literature search for randomized controlled trials to compare treatments for trigger finger was conducted through three online databases, Pubmed, Embase and Cochrane Library, from their inception dates to 22 May 2020. METHODS: Relative risk (RR) with 95% confidence interval (CI) was used to evaluate the effect sizes in success rate for included articles. RESULTS: Sixteen articles (n = 1185) were included in our meta-analysis. The results showed that the efficacy of steroid injection was significantly better than the placebo group at short-term follow-ups (RR = 19.00, 95% CI = 1.17-309.77 for one-week; RR = 3.70, 95% CI = 3.70, 95% CI = 1.61-8.53 for one-month), and then became non-significant at four months (RR = 3.21, 95% CI = 0.88-11.79). There was no significant difference in success rate between steroid injection and nonsteroidal anti-inflammatory drug injection, and between open surgery and percutaneous release at all the follow-ups. Only surgical treatment had significantly better efficacy in success rate than steroid injection at all follow-ups (RR = 0.48, 95% CI = 0.34-0.66 for one-month; RR = 0.87, 95% CI = 0.80-0.96 for three-month; RR = 0.58, 95% CI = 0.48-0.68 for six-month; RR = 0.38, 95% CI = 0.20-0.72 for 12-month). CONCLUSION: There were no differences in efficacy between steroid injection and shockwave or nonsteroidal anti-inflammatory drug injection. The surgical treatments had the best efficacy among these treatments.


Assuntos
Dedo em Gatilho/terapia , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-32326323

RESUMO

The SARC-F questionnaire has been suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) as a first-step screening tool for sarcopenia. However, the sensitivity to SARC-F is low among community-dwelling older adults. Therefore, this study aimed to develop a new prediction model for sarcopenia screening in the community setting. We conducted a cross-sectional analysis of data from the Taiwan Integration of Health and Welfare (TIHW) study. Covariates including comorbidities, socioeconomic status, social support, health behaviors, body composition, and serum biomarkers were collected for analysis. Sarcopenia was defined using handgrip strength and gait speed cut-off values suggested by the Asian Working Group for Sarcopenia. Risk scores for sarcopenia were estimated by stepwise logistic regression. Among 1025 participants (mean age, 71.95 ± 6.89 years), 179 (17.5%) had sarcopenia. Seven items, including age, female sex, receiving social assistance pension, absence of exercise, being underweight, abnormal fasting glucose levels, and abnormal creatinine levels were selected for the Taiwan Risk Scores for Sarcopenia (TRSS) with a cutoff value of 76 (sensitivity, 71.8%; specificity, 71.1%) and area under the curve (AUC) of 0.757. Our results suggested that the TRSS model could be applied cost-effectively in the community for early detection of sarcopenia.


Assuntos
Avaliação Geriátrica , Sarcopenia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Força da Mão , Humanos , Vida Independente , Masculino , Medição de Risco , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Taiwan
8.
J Shoulder Elbow Surg ; 28(12): 2364-2370, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31371161

RESUMO

BACKGROUND: Recalcitrant clavicular nonunion is a rare but complicated problem of clavicular fracture fixation. Nonunion is most often treated with clavicular shortening or in extreme cases vascularized bone grafting. Herein we describe our experience using the vascularized medial femoral condyle (MFC) free flap for the reconstruction of segmental defects in cases of recalcitrant clavicular nonunion. METHODS: A retrospective chart review was conducted of patients with symptomatic recalcitrant nonunion of the clavicle who underwent reconstruction with the vascularized MFC free flap from June 2003 to January 2018. Patients' demographics, time to union, and postoperative complications were collected. RESULTS: A total of 7 patients (6 women; 39.8 ± 9.01 years old) underwent clavicular reconstruction after an average of 3.7 ± 1.3 previous surgical procedures. Average preoperative visual analog scale score for pain was 4.1. The graft size ranged from 2 to 5 cm in length with approximately 1 cm in width and depth. The average time of total nonunion was 66 ± 48.2 months before surgery. All flaps survived and all clavicles healed with an average time to radiographic union of 15 ± 6.7 months. Patients regained full shoulder motion, and average postoperative visual analog scale score was 1.6 ± 1.8. All patients returned to their preoperative employment status. Donor site morbidity from the knee was minimal. CONCLUSION: The MFC free flap is a good option for recalcitrant bone nonunion of the clavicle where larger vascularized flaps are not warranted. It is effective and offers minimal donor site morbidity.


Assuntos
Transplante Ósseo/métodos , Clavícula/cirurgia , Fêmur/transplante , Fraturas não Consolidadas/cirurgia , Retalhos de Tecido Biológico/transplante , Adulto , Clavícula/lesões , Epífises/transplante , Feminino , Fixação Interna de Fraturas , Fraturas não Consolidadas/complicações , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Medição da Dor , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos
10.
Biomaterials ; 192: 189-198, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30453215

RESUMO

Reducing rotator cuff failure after repair remains a challenge due to suboptimal tendon-to-bone healing. In this study we report a novel biomaterial with engineered tendon-fibrocartilage-bone composite (TFBC) and bone marrow-derived mesenchymal stem cell sheet (BMSCS); this construct was tested for augmentation of rotator cuff repair using a canine non-weight-bearing (NWB) model. A total of 42 mixed-breed dogs were randomly allocated to 3 groups (n = 14 each). Unilateral infraspinatus tendon underwent suture repair only (control); augmentation with engineered TFBC alone (TFBC), or augmentation with engineered TFBC and BMSCS (TFBC + BMSCS). Histomorphometric analysis and biomechanical testing were performed at 6 weeks after surgery. The TFBC + BMSCS augmented repairs demonstrated superior histological scores, greater new fibrocartilage formation and collagen fiber organization at the tendon-bone interface compared with the controls. The ultimate failure load and ultimate stress were 286.80 ± 45.02 N and 4.50 ± 1.11 MPa for TFBC + BMSCS group, 163.20 ± 61.21 N and 2.60 ± 0.97 MPa for control group (TFBC + BMSCS vs control, P = 1.12E-04 and 0.003, respectively), 206.10 ± 60.99 N and 3.20 ± 1.31 MPa for TFBC group (TFBC + BMSCS vs TFBC, P = 0.009 and 0.045, respectively). In conclusion, application of an engineered TFBC and BMSCS can enhance rotator cuff healing in terms of anatomic structure, collagen organization and biomechanical strength in a canine NWB model. Combined TFBC and BMSCS augmentation is a promising strategy for rotator cuff tears and has a high potential impact on clinical practice.


Assuntos
Fibrocartilagem/química , Células-Tronco Mesenquimais/citologia , Manguito Rotador/fisiologia , Tendões/química , Tecidos Suporte/química , Cicatrização , Animais , Materiais Biocompatíveis/química , Osso e Ossos/química , Cães , Transplante de Células-Tronco Mesenquimais , Manguito Rotador/citologia , Engenharia Tecidual
12.
Case Rep Oncol Med ; 2018: 4078672, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29808140

RESUMO

Compartment syndrome may be acute or chronic based on the clinical course and etiology. Here, we report the first known case to be diagnosed with skeletal muscle-derived B-cell lymphoma presenting with chronic compartment syndrome after trauma. A 62-year-old woman sought medical attention due to a one-month history of painful left lower leg swelling and paresthesia of the medial side of the foot after falling over. The patient underwent fasciotomy and debridement under the preoperative diagnosis of fasciitis and myositis with associated compressive neuropathy. Preoperative laboratory tests were within normal limits. Postoperative pathologic examination and bone marrow aspiration revealed B-cell lymphoma with bone marrow involvement postoperatively. Tumor lysis syndrome took place, presenting with drowsiness, poor appetite, and oliguria, after the operation along with multiple organ failure. Awareness of the differential diagnoses of compartment syndrome in such clinical situation is crucial because it may lead to different examination and treatment plan preoperatively.

13.
Kaohsiung J Med Sci ; 32(12): 624-629, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27914614

RESUMO

Percutaneous release (PR) of the A1 pulley is a quick, safe, and minimally invasive procedure for treating trigger fingers. The purpose of this study is to identify if PR with additional steroid injections can shorten the recovery to reach unlimited range of motion. Between January 2013 and December 2013, we included 432 trigger fingers with actively correctable triggering or severer symptoms without previous surgical release or steroid injections from two hand clinic offices (A and B). The same experienced surgeon performed PR at the office. Patients from Clinic A received PR with steroid injections and those from Clinic B received PR without steroid injections. Patients returned for follow-up 1 week, 6 weeks, and 12 weeks after the procedure. Between the steroid group and the nonsteroid group, there is no significant difference in the mean time for patients to return to normal work and the rate of residual extensor lag. Middle fingers showed a 5.09-fold chance of having a residual extensor lag over that of the other fingers. High grade trigger fingers recovered more slowly than low grade ones. The success rate of a 12-week follow-up was 98.4%. There was no significant difference between the steroid group (97.5%) and the nonsteroid group (99.1%). PR can treat trigger fingers effectively, but additional steroid injection does not provide more benefit. Some fingers showed temporary extensor lag, especially in middle fingers and high grade trigger fingers, but 85% of those will eventually reach full recovery after self-rehabilitation without another surgical release.


Assuntos
Injeções , Procedimentos Ortopédicos , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Dedo em Gatilho/tratamento farmacológico , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
14.
Kaohsiung J Med Sci ; 30(9): 471-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25224771

RESUMO

This study aims to describe the clinical results of isolated talonavicular arthrodesis in rare Müller-Weiss disease, spontaneous osteonecrosis of the navicular in adults. From June 2001 to April 2010, we performed isolated talonavicular arthrodesis on 13 feet of 13 patients (mean age: 55.6 years) with Müller-Weiss disease. The feet were staged by the preoperative radiographs according to the Maceira classification. The average modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score improved from 48.5 points preoperatively to 87.2 points at final follow-up (mean 51 months, range 10-114 months). Union was achieved in 10 cases (76.9%). If the subtalar and calcaneocuboid joints are relatively healthy, isolated talonavicular arthrodesis may be an effective and reliable surgical option for treatment of Müller-Weiss disease that is resistant to conservative treatment.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese , Deformidades do Pé/cirurgia , Adulto , Idoso , Articulação do Tornozelo/diagnóstico por imagem , Parafusos Ósseos , Feminino , Deformidades do Pé/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Radiografia
15.
Artigo em Inglês | MEDLINE | ID: mdl-27252953

RESUMO

The purpose of this study is to demonstrate an occulting metastatic lung cancer diagnosed by a painful mass at right hand. Under early diagnosis and meticulous treatment, this patient has been painless without local recurrence and had full hand function for 3 years.

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