Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 16 de 16
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Biomed Mater ; 15(5): 055013, 2020 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-32252046

RESUMO

Osteoporotic bone defects are a major challenge in clinics for bone regeneration. With the condition of osteoporosis, excessive bone absorption and impaired osteogenesis result in unexpectedly long healing procedures for defects. In order to simultaneously enhance bone formation and reduce bone resorption, a polydopamine-coated porous titanium scaffold was designed, to be integrated with anti-catabolic drug zoledronic acid nanoparticles (ZOL loaded gelatin NPs), which was able to achieve a local sustained release of ZOL as expected. The in vitro study demonstrated that extracts of the composite scaffolds would stimulate osteoblast differentiation; they also inhibited osteoclastogenesis at a ZOL loading concentration of 50 µmol l-1. In the subsequent in vivo study, the composite scaffolds were implanted into ovariectomy-induced osteoporotic rabbits suffering from femoral condyles defects. The results indicated that the composite scaffolds without ZOL loaded gelatin NPs only induced callus formation, mainly at the interface margin between the implant and bone, whereas the composite scaffolds with ZOL loaded gelatin NPs were capable of further enhancing osteogenesis and bone growth into the scaffolds. Moreover, the research proved that the promoting effect was optimal at a ZOL loading concentration of 50 µmol l-1. In summary, the present research indicated that a new type of porous titanium scaffold integrated with ZOL loaded gelatin NPs inherited a superior biocompatibility and bone regeneration capability. It would be an optimal alternative for the reconstruction of osteoporosis-related defects compared to a traditional porous titanium implant; in other words, the new type of scaffold offers a new effective and practical procedure option for patients suffering from osteoporotic bone defects.

2.
Med Sci Monit ; 25: 7370-7375, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31571675

RESUMO

BACKGROUND Many clinical studies have assessed the association of laminoplasty opening size (LOS) with sagittal canal diameter (SCD) based on single-door cervical laminoplasty (SDCL). Nevertheless, the "worn-off" lamina extracted in SDCL was neglected in these reports. We aimed to develop a simple mathematical model to analyze the relationship between the effective LOS and SCD, taking into consideration the worn-off lamina. MATERIAL AND METHODS A total of 106 patients treated by SDCL at our hospital were included in this study. Pre-operative and post-operative SCDs were assessed using a picture archiving and communication system (PACS) based on computed tomography scans. Mini-plate sizes as well as drill bit diameters were recorded in detail in order to determine the effective LOS for each vertebral lamina involved. RESULTS SCD in all patients was increased significantly after SDCL (P<0.01). A linear correlation was found between effective LOS and the post-operative SCD increment from C3 to C7 (R²>0.933, P<0.001). The 12 mm mini-plate was most often used in SDCL, accounting for 64.45% of all cases, whereas 10 mm and 16 mm mini-plates were the least used, accounting for 3.85% and 3.00%, respectively. CONCLUSIONS There is a strong linear correlation between effective LOS and the post-operative SCD increment. The SCD was increased by about 0.5 mm per mm increase in effective LOS. Thus, post-operative SCD could be precisely calculated and predicted, enabling the selection of optimal mini-plate prior to SDCL.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Laminoplastia/métodos , Placas Ósseas , China , Humanos , Modelos Teóricos , Canal Vertebral/cirurgia , Estenose Espinal/cirurgia
3.
Eur Spine J ; 28(10): 2302-2310, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31053937

RESUMO

PURPOSE: To build a mathematical model which could calculate the desired laminoplasty opening size (LOS) based on the target sagittal canal diameter (SCD) before single-door cervical laminoplasty (SDCL) when taking the effects of surgery drill into consideration. METHODS: The model was based on geometric analysis on deformation of spinal canal; the formula was derived and characterized as: y (mm) = 2 [Formula: see text] × sin(ß/2) = c - d (y is the size of LOS, [Formula: see text] the size of transverse canal diameter, ß the size of laminoplasty opening size, c the size of mini-plate and d the diameter of the drill bit used during the surgery operation). The parameters of pre- and postoperative computed tomography scans of 20 patients who had undergone SDCL were measured by the picture archiving and communication system (PACS) software and a new instrument named as Lei's ruler, respectively. RESULTS: The effects of surgery SDCL were very significant; for each patient, the SCD was enlarged dramatically after the surgery (P < 0.01). The differences between the data obtained by PACS and Lei's ruler were no statistically significant (P > 0.05). According to the derived formula, the 95% confidence intervals of SCD after the surgery were within the range of 14 mm and 14.5 mm. CONCLUSION: Applying the mathematical model and derived formula, the desired LOS could be calculated according to the target SCD which could help the surgeon select an optimum mini-plate before SDCL. At the same time, a new measuring device named Lei's ruler is designed for the convenience of the derived formula. These slides can be retrieved under Electronic Supplementary Material.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Modelos Teóricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Med Sci Monit ; 24: 7438-7443, 2018 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-30334549

RESUMO

BACKGROUND The incidence of hip fracture is steadily increasing. We aimed to establish a creative approach to precisely estimate the risk of hip fracture by exploring the relationship between hip fracture and bone mineral density (BMD)/femur geometry. MATERIAL AND METHODS Sixteen samples of cadaveric female proximal femora were randomly selected. Experiments were performed experimental measurement of the femoral neck BMD and geometric parameters (including neck length, neck diameter, head diameter, and neck-shaft angle). In addition, the experimental measurements contain the failure load, which represents the mechanical strength of the femoral neck, and we calculated the correlation coefficient among BMD, geometric parameters, and failure load. RESULTS Significant correlations were discovered between femoral mechanical properties and femoral neck BMD (r=0.792, r²=0.628, P<0.001), trochanteric BMD (r=0.749, r²=0.560, P=0.001), and head diameter (r=0.706, r²=0.499, P=0.002). Multiple linear regression analyses indicated that the best predictor of hip fracture was the combination of femoral neck BMD, head diameter, and neck diameter (r²=0.844, P<0.001). CONCLUSIONS The results confirmed that, compared with BMD alone, the combination of BMD and geometric parameters of proximal femur is a better estimation of hip fracture. The geometry of the proximal femur played an important role in assessing the biomechanical strength of femur. This method greatly assists in predicting the risk of hip fracture in clinical trials and will assist studies on why the incidence of hip fracture varies among races.


Assuntos
Fêmur/anatomia & histologia , Fraturas do Quadril/etiologia , Fraturas do Quadril/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Densidade Óssea/fisiologia , Cadáver , China , Feminino , Fêmur/fisiologia , Colo do Fêmur/anatomia & histologia , Colo do Fêmur/fisiologia , Humanos , Masculino , Osteoporose Pós-Menopausa , Ossos Pélvicos , Fatores de Risco
5.
Medicine (Baltimore) ; 96(46): e8608, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29145279

RESUMO

RATIONALE: Osteosarcomas are the most common primary malignant bone tumors in children and young adults; these tumors often affect the metaphyses of long bones such as the proximal humerus, proximal tibia, and distal femur. In contrast, osteosarcoma of the coracoid process is extremely rare. PATIENT CONCERNS: Herein, we describe a case of osteosarcoma affecting the coracoid process in a 40-year-old woman. The patient presented with shoulder pain, weakness, and an inability to raise her left arm. She had no previous record of shoulder injury and no significant family history. DIAGNOSES: Her C-reactive protein levels were normal, whereas her erythrocyte sedimentation rate and alkaline phosphatase levels were elevated. Imaging studies led to the initial diagnosis of osteochondroma. INTERVENTION: The patient underwent surgical resection. However, the postoperative pathological results revealed an osteosarcoma. The patient transferred to another hospital for subsequent treatment, and her outcome is unknown. LESSONS: A misdiagnosis or inadequate and/or delayed treatment for a coracoid process osteosarcoma could have grave consequences. Computed tomography and magnetic resonance imaging are essential for a diagnosis, and a biopsy can effectively confirm the diagnosis. Our findings suggest that considering only a single factor, or using incomplete information, can lead to an arbitrary diagnosis.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Processo Coracoide , Imagem por Ressonância Magnética , Osteossarcoma/diagnóstico por imagem , Adulto , Biomarcadores Tumorais/análise , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Osteocondroma/diagnóstico por imagem , Osteossarcoma/cirurgia
6.
Mol Med Rep ; 14(3): 1957-62, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27430169

RESUMO

Aspirin is a commonly used medicine as an effective antipyretic, analgesic and anti-inflammatory drug. Previous studies have demonstrated its potential effects of anti-postmenopausal osteoporosis, while the molecular mechanisms remain unclear. The effects of aspirin on receptor­activator of nuclear factor κB (NF­κB) ligand (RANKL)­induced osteoclasts were investigated in RAW264.7 cells in the current study. Using tartrate­resistant acid phosphatase (TRAP) staining, it was observed that aspirin inhibited the differentiation of RANKL­induced RAW264.7 cells. The mRNA expression of osteoclastic marker genes, including cathepsin K, TRAP, matrix metalloproteinase 9 and calcitonin receptor, were suppressed by aspirin as identified using reverse transcription­quantitative polymerase chain reaction analysis. The immunofluorescence assay indicated that aspirin markedly inhibited NF­κB p65 translocation to the nucleus in RANKL­induced RAW264.7 cells. In addition, aspirin also suppressed the phosphorylation of mitogen­activated protein kinases (MAPKs), observed by western blot analysis. Taken together, these data identified that aspirin inhibits osteoclastogenesis by suppressing the activation of NF­κB and MAPKs in RANKL­induced RAW264.7 cells, implying that aspirin may possess therapeutic potential for use in the prevention and treatment of osteoporosis.


Assuntos
Aspirina/farmacologia , Proteínas Quinases Ativadas por Mitógeno/efeitos dos fármacos , Proteínas Quinases Ativadas por Mitógeno/metabolismo , NF-kappa B/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Ligante RANK , Transdução de Sinais , Animais , Catepsina K/genética , Diferenciação Celular , Regulação para Baixo , Metaloproteinase 9 da Matriz/genética , Camundongos , Osteoclastos/efeitos dos fármacos , Osteoclastos/metabolismo , Osteoclastos/fisiologia , Osteogênese/fisiologia , Fosforilação , Células RAW 264.7 , Receptores da Calcitonina/genética
7.
J Spinal Disord Tech ; 28(3): E166-72, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25353202

RESUMO

STUDY DESIGN: A novel total cervical prosthesis (TCP) for single-level cervical subtotal corpectomy was assessed in a caprine animal model. OBJECTIVES: To investigate the radiologic and histomorphometric characteristics of a novel TCP for single-level cervical subtotal corpectomy. SUMMARY OF BACKGROUND: Cervical disk replacement has emerged as a promising alternative to arthrodesis in the management of cervical disk herniation. However, they are designed for anterior cervical discectomy, and not suitable for cervical subtotal corpectomy. To solve this problem, our group has developed a novel TCP for single-level cervical subtotal corpectomy. MATERIALS AND METHODS: There were 12 adult Shannxi goats (2 y old) used in this study. The goats were divided into 2 groups based on postoperative survival periods of 3 (n=6) and 6 (n=6) months after surgery. Using an anterior surgical approach, a standard anterior C3 vertebra subtotal corpectomy and decompression of the spinal canal were performed, followed by implantation of the TCP device. Then all the goats were killed and underwent radiographic and histologic observations. RESULTS: The TCP implant procedures were successfully completed in all 12 goats without incidence of vascular or infectious complications. The range of motion of C2-C3 and C3-C4 segments were preserved in both of the groups. Three-dimensional images of specimens interface indicated confluent interdigitization of trabeculae at the prosthetic endplate-bone interface, without evidence of significant radiolucent lines or gaps. Histomorphometric analysis showed that there were a large number of fibrous tissue and a small amount of cartilage cells between the prostheses and bone in the 3 months' group. In the 6 months' group, part of fibrous tissue has changed into the cartilage tissue. CONCLUSIONS: Our data show that this prosthesis can maintain the stability of the cervical spine and retain the activity of the cervical spine in vivo. The findings in this study provide a foundation for ongoing clinical investigations using the TCP.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Disco Intervertebral/cirurgia , Implantação de Prótese , Animais , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Descompressão Cirúrgica , Cabras , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Modelos Animais , Radiografia , Amplitude de Movimento Articular
8.
Arch Orthop Trauma Surg ; 133(3): 295-301, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23274779

RESUMO

PURPOSE: To evaluate effectiveness of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel in improving clinical outcomes after the first-time lumbar discectomy. METHOD: Ninety-three patients with herniated lumbar disc at L4-L5 or L5-S1 were enrolled and randomized into two groups: CMC/PEO gel treatment group and control group. All the patients underwent laminotomy and discectomy by posterior approach. The preoperative and postoperative Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores for lower-back pain and leg pain were analyzed and compared between two groups at 30- and 60-day time points. RESULTS: No patient presented with any clinically measurable adverse event during surgery. There were no significant differences between the treated group and the control group on the preoperative ODI and VAS scores. In general, the ODI and VAS scores decreased in both groups at all the time points. At the 30-day time point, the VAS scores for back pain and leg pain and the ODI scores in treatment group were lower by 9.9 % (P = 0.0302), 27.0 % (P = 0.0002) and 16.3 % (P = 0.0007) than those in control group. And at the 60-day time point, the ODI and VAS scores further decreased in both groups. The VAS scores for leg pain in treatment group were lower by 4.5 % than that in the control group (P = 0.0149). However, no significant difference was detected between two groups on the ODI and VAS scores for back pain. CONCLUSIONS: The results demonstrated that CMC/PEO gel is effective in reducing posterior dural adhesions in the spine with no apparent safety issues. It can improve patients' postoperative clinical outcome.


Assuntos
Anti-Inflamatórios/administração & dosagem , Carboximetilcelulose Sódica/administração & dosagem , Discotomia/efeitos adversos , Deslocamento do Disco Intervertebral/cirurgia , Polietilenoglicóis/administração & dosagem , Aderências Teciduais/prevenção & controle , Adulto , Espaço Epidural , Feminino , Géis/administração & dosagem , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Aderências Teciduais/etiologia
9.
J Surg Res ; 173(1): 91-8, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21067776

RESUMO

BACKGROUND: The incidence of screw loosening increases significantly in elderly patients with severe osteoporosis. Open vertebral cement augmentation of expandable pedicle screw fixation may improve fixation strength in the osteoporotic vertebrae. MATERIALS AND METHODS: Twenty cadaveric vertebrae (L1-L5) were harvested from six osteoporotic lumbar spines. Axial pullout tests were performed to compare the maximum pullout strength (Fmax) of four methods: 1. Conventional pedicle screws (CPS), 2. Expandable pedicle screws (EPS), 3. Cement augmentation of CPS (cemented-CPS), 4. Cement augmentation of EPS (cemented-EPS). Thirty-six consecutive patients with single-vertebral osteoporotic compressive fractures received posterior decompression and spinal fusion with cemented-CPS (16 cases) or cemented-EPS (20 cases). Plain film and/or CT scan were conducted to evaluate the spinal fusion and fixation effectiveness. RESULTS: The Fmax and energy absorption of cemented-EPS were significantly greater than three control groups. The mean BMD in the severe osteoporosis group was significantly lower than that in the osteoporosis group (t = 2.04, P = 0.036). In the osteoporosis group, cemented-EPS improved the Fmax by 43% and 21% over CPS and cemented-CPS group. In the severe osteoporosis group, cemented-EPS increased the Fmax by 59%, 22%, and 26% over CPS, EPS, and cemented-CPS, respectively. The clinical results showed that all patients suffered from severe osteoporosis. Six months after operation, the JOA and VAS scores in cemented-EPS group improved from 11.4 ± 2.6 and 7.0 ± 1.4 mm to 24.9 ± 1.6 and 2.1 ± 1.3 mm, respectively. No screw loosening occurred in the cemented-EPS group and spinal fusion was achieved. In the cemented-CPS group, four screws loosened (4.2%) according to the radiolucency. Six months after operation, the JOA and VAS scores improved from 13.1 ± 1.9 and 7.6 ± 1.5 mm to 22.8 ± 2.2 and 2.5 ± 1.6 mm, respectively. No cement leaked into the spinal canal in both groups. CONCLUSIONS: Cemented-EPS could increase fixation strength biomechanically. It could reduce the risks of screw loosening in patients with severe osteoporosis, requiring instrumented arthrodesis.


Assuntos
Cimentos para Ossos , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas por Compressão/cirurgia , Vértebras Lombares/lesões , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Cadáver , Falha de Equipamento , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fraturas por Compressão/diagnóstico por imagem , Humanos , Fixadores Internos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Polimetil Metacrilato , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
10.
Arch Orthop Trauma Surg ; 132(4): 471-6, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22146812

RESUMO

INTRODUCTION: The aim of this study is to compare the rate of screw loosening and clinical outcomes of expandable pedicle screws (EPS) with those of conventional pedicle screws (CPS) in patients treated for spinal stenosis (SS) combined with osteoporosis. METHODS: One hundred and fifty-seven consecutive patients with SS received either EPS fixation (n = 80) or CPS fixation (n = 77) to obtain lumbosacral stabilization. Patients were observed for a minimum of 24 months. Outcome measures included screw loosening, fusion rate, Japanese Orthopaedic Association (JOA) scores and Oswestry disability index (ODI) scoring system, and complications. RESULTS: In the EPS group, 20 screws became loose (4.1%) in 6 patients (7.5%), and two screws (0.4%) had broken. In the CPS group, 48 screws became loose (12.9%) in 15 patients (19.5%), but no screws were broken. The fusion rate in the EPS group (92.5%) was significantly higher than that of the CPS group (80.5%). The rate of screw loosening in the EPS group (4.1%) was significantly lower than that of the CPS group (12.9%). Six EPS (1.8%) screws were removed. In the EPS group, two screws had broken but without neural complications. Twelve months after surgeries, JOA and ODI scores in the EPS group were significantly improved. There were four cases of dural tears, which healed after corresponding treatment. CONCLUSIONS: EPS can decrease the risk of screw loosening and achieve better fixation strength and clinical results in osteoporotic lumbar spine fusion.


Assuntos
Parafusos Ósseos , Vértebras Lombares/cirurgia , Osteoporose/complicações , Falha de Prótese , Fusão Vertebral/instrumentação , Estenose Espinal/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estenose Espinal/complicações , Resultado do Tratamento
11.
Zhonghua Yi Xue Za Zhi ; 91(13): 925-9, 2011 Apr 05.
Artigo em Chinês | MEDLINE | ID: mdl-21600123

RESUMO

OBJECTIVE: To explore the therapeutic effects of aspirin on postmenopausal osteoporosis and understand its action mechanism. METHODS: Forty three-month-old female SD rats were randomly divided into 5 groups (n = 8 each): sham group, OVX group and aspirin groups (A1, A2 & A3). The OVX and aspirin groups were ovariectomized (OVX). All rats underwent BMD (bone mineral density) scan at the time of OVX and 3 months after OVX. After the animal model of osteoporosis was established, aspirin groups were intragastrically administered at a dose of 8.93 mg×kg(-1)×d(-1) (A1), 26.79 mg×kg(-1)×d(-1) (A2) and 80.36 mg×kg(-1)×d(-1) (A3) daily in OVX rats. Three months later, the BMD and micro-architecture of vertebrae were measured by dual-energy X-ray absorptiometry and microtomography. Alkaline phosphatase and osteocalcin were measured in peripheral blood. The trabecular architecture changes were observed by histomorphology. Axial compression tests were used to evaluate the mechanical properties of vertebral specimens and three-point bending tests used for femur shaft. RESULTS: Three months after ovariectomy, BMD was significantly lower than preoperative. BMD in aspirin treated groups was significantly higher than that in OVX group. Alkaline phosphatase in peripheral blood decreased significantly in aspirin groups than those in OVX, but osteocalcin had no significant difference between aspirin and OVX groups. The microtomography reconstruction analysis also showed that the trabecular thickness, trabecular number and BMD increased significantly in aspirin groups than those in OVX. And there was no significant difference between A3 and sham groups. The results of biomechanical test showed that the maximum compression load of lumbar spine and three-point bending load of femur shaft were significantly higher in aspirin groups than those in OVX group. CONCLUSION: Aspirin can promote trabecular bone remodeling, improve three-dimensional structure of trabecular bone and increase bone density of cancellous in osteoporotic rats by stimulating bone formation. It may become a new drug for the treatment of osteoporosis.


Assuntos
Aspirina/uso terapêutico , Osteoporose/tratamento farmacológico , Animais , Modelos Animais de Doenças , Feminino , Ovariectomia , Ratos , Ratos Sprague-Dawley
12.
J Spinal Disord Tech ; 24(7): 444-50, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21150659

RESUMO

STUDY DESIGN: The application of rapid prototyping (RP) technique for improving accuracy of pedicle screw placement in congenital scoliosis is described in this study. OBJECTIVE: To compare the accuracy and safety of pedicle screw placement in congenital scoliosis using the RP technique versus the conventional fluoroscopy. SUMMARY OF BACKGROUND DATA: Maldeveloped vertebral components in congenital scoliosis leads to prolonged operation time and higher rate of screw misplacement. RP technique can enhance preoperative and perioperative planning. No data are available on the accuracy of pedicle screw fixation using the RP technique. METHODS: Sixty-two consecutive patients with hemivertebra had undergone posterior-only hemivertebra resection. Pedicle screws were implanted either by the conventional intraoperative fluoroscopy technique (C-arm group; n=28) or the RP technique (RP group; n=34). Accuracy of pedicle screw placement was compared by postoperative computed tomographic scan. RESULTS: Seventy of 677 inserted screws were found to be misplaced, showing an overall accuracy of 89.7% (90.8% in the thoracic spine and 87.4% in the lumbar spine). In the C-arm group, 86.1% (167 of 194) and 82.0% (82 of 100) of screws were accurately placed in the thoracic and lumbar spine, respectively. While in the RP group, the respective screw placement accuracies were 94.4% (238 of 252) and 91.6% (120 of 131). In the C-arm and the RP groups, 94.8% (279 of 294) and 97.9% (375 of 383) of the screws were within the safety zone, respectively. Compared with the fluoroscopy method, the RP-assisted technique showed a shorter operation time and higher scoliosis correction rate. No neurovascular-related complication was observed with this technique during the study. CONCLUSION: The application of RP technique in congenital scoliosis can reduce the operation time, the risk of screw misplacement and its consequent complications. The use of RP technique in congenital scoliosis is safe and efficacious.


Assuntos
Parafusos Ósseos/normas , Cuidados Pré-Operatórios/normas , Escoliose/cirurgia , Índice de Gravidade de Doença , Fusão Vertebral/normas , Adolescente , Criança , Pré-Escolar , Seguimentos , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Escoliose/congênito , Escoliose/diagnóstico por imagem , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
Clin Invest Med ; 33(6): E368-74, 2010 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-21134338

RESUMO

PURPOSE: To investigate the clinical abstract and radiographic outcome of multi-axial expandable pedicle screws (MEPS) in patients with osteoporosis. METHODS: One hundred and twenty-five consecutive patients received MEPS from the UPASS spinal fixation system to obtain thoracolumbar or lumbosacral stabilization. All patients underwent bone mineral density (BMD) scans. The indications for use of the MEPS were spinal diseases with severe osteoporosis (degenerative diseases 46 cases, compression fractures 28 cases, lumbar tuberculosis 27 cases and revision spine surgery 24 cases). The pre-operative and three months post-operative functional evaluations were graded with JOA and VAS scoring system. One week, six months and 12 months after surgery, plain film and three-dimensional CT scans were obtained to evaluate the spinal fusion and fixation effectiveness of MEPS. RESULTS: The mean follow-up period was 18 months (ranged from 6 to 33 months). All patients suffered from severely osteoporosis with a decrease of 25.3% in BMD. The pre-operative JOA and VAS scores were 11.3±3.0 and 6.7±1.8 mm, respectively. Three months after operation, the JOA and VAS scores were 25.2±2.0 and 2.3±1.7 mm. The recovery rate was 78.1±11.5% and the clinical results were satisfying. There were no instances of screw loosening or pullout of the MEPS and the screw-bone interface was excellent. The radiographic results showed that bone healing, both around the screws and inter-vertebral, was achieved. CONCLUSION: In osteoporosis spine surgery, excellent bone-screw interface and fixation strength can be achieved by using MEPS. MEPS are a novel approach to increase the pedicle screw fixation in osteoporotic and revision spine surgeries.


Assuntos
Parafusos Ósseos , Osteoporose/diagnóstico por imagem , Osteoporose/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Adulto , Idoso , Densidade Óssea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/metabolismo , Radiografia , Coluna Vertebral/metabolismo , Resultado do Tratamento
14.
J Surg Res ; 164(2): e253-6, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20934724

RESUMO

BACKGROUND: Epidural leaks or canal intrusion are often found in vertebroplasty, which can lead to several complications. To the best of our knowledge, this is the first report on using two-stage injection procedure in vertebroplasty to reduce cement leakage rate. MATERIALS AND METHODS: Fifty cadaveric vertebrae (L1-L5) were harvested from 10 osteoporotic lumbar spines. The age of the female donors ranged from 60 to 72 y; the bone mineral density (BMD) of the vertebrae ranged from 0.226 to 0.631 g/cm(2). Polymethylmethacrylate (PMMA) was injected into vertebral bodies by either novel two-stage injection (1 mL cement was injected at first stage and another 4 mL cement was injected at second stage after the cement solidified) or standard conventional injection procedure. After injection, all vertebral bodies (VBs) were checked for cement leakage into spinal canal by vision and fluoroscopy. Cement leakage rates were recorded. RESULTS: The two-stage injection procedure resulted in a significant decrease in the epidural or canal leakage rate (P = 0.032). In addition, the paravertebral leakage rate was significantly higher in two-stage injection procedure group (48%) than in conventional injection procedure group (16%). However, no significant difference was found for the total cement leakage rate between the two groups. CONCLUSION: Compared with conventional procedure, the two-stage injection procedure in vertebroplasty decreased incidence of epidural and canal leaks. The first-stage injecting PMMA can be a barrier to the epidural extravasation of cement during vertebroplasty. Further in vivo and clinical researches are needed to evaluate the new procedure.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Vértebras Lombares/cirurgia , Osteoporose/cirurgia , Vertebroplastia/métodos , Idoso , Fístula Anastomótica/epidemiologia , Cadáver , Feminino , Humanos , Injeções/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/patologia , Radiografia , Vertebroplastia/efeitos adversos
15.
Orthop Surg ; 2(1): 19-26, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22009903

RESUMO

OBJECTIVE: To evaluate functional outcomes and complications of reconstruction of the proximal humerus after intra-articular tumor resection. METHODS: Twenty-five patients who underwent Malawer I type resection and reconstruction of the proximal humerus for treatment of malignant or invasive benign tumors from August 1999 to August 2005 were evaluated. A variety of reconstructive procedures, including modular tumor prosthesis, osteoarticular allograft, and allograft-prosthetic composite (APC), were performed after resection of tumor. Oncological and radiographic parameters were evaluated. The modified Musculoskeletal Tumor Society (MSTS) evaluation system was used to assess limb functional outcome. RESULTS: The study group consisted of 10 male and 15 female patients, among which there were 20 malignant and 5 benign tumors. Restoration of shoulder function was achieved with a prosthesis in 6 patients, osteoarticular allograft in 12, and allograft-prosthesis composite in 7. At a mean of 48 months follow-up, 2 patients had died of disease. Two patients had local recurrence and 2 had metastatic disease. On the basis of the modified MSTS functional evaluation, the mean scores were 22.50 in the modular prosthesis group, 24.58 in the osteoarticular allograft group, and 27.00 in APC group, respectively. Joint instability and subluxation were serious complications affecting shoulder function in 10 patients. CONCLUSION: Reconstruction of the proximal humerus is an option that provides good relief of pain and preserves manual dexterity. Functional outcomes are better for APC and allograft than for modular prosthesis, due to retention of the rotation cuff. Complications in the APC group were less than in the allograft one.


Assuntos
Artroplastia de Substituição/métodos , Neoplasias Ósseas/cirurgia , Úmero/cirurgia , Neoplasias de Tecido Conjuntivo/cirurgia , Articulação do Ombro/cirurgia , Adolescente , Adulto , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Criança , Feminino , Humanos , Úmero/patologia , Linfoma/mortalidade , Linfoma/patologia , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Neoplasias de Tecido Conjuntivo/mortalidade , Neoplasias de Tecido Conjuntivo/patologia , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Articulação do Ombro/patologia , Resultado do Tratamento , Adulto Jovem
16.
Med Eng Phys ; 30(9): 1112-8, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18595763

RESUMO

Osteoporotic/osteopenia fractures occur most frequently in trabeculae-rich skeletal sites. The purpose of this study was to use a high-resolution micro-computed tomography (micro-CT) and dual energy X-ray absorptionmeter (DEXA) to investigate the changes in micro-architecture and bone mineral density (BMD) in a sheep model resulted from ovariectomy (OVX). Biomechanical tests were performed to evaluate the strength of the trabecular bone. Twenty adult sheeps were randomly divided into three groups: sham group (n=8), group 1 (n=4) and group 2 (n=8). In groups 1 and 2, all sheep were ovariectomized (OVX); in the sham group, the ovaries were located and the oviducts were ligated. In all animals, BMD for lumbar spine was obtained during the surgical procedure. BMD at the spine, femoral neck and femoral condyle was determined 6 months (group 1) and 12 months (group 2) post-OVX. Lumbar spines and femora were obtained and underwent BMD scan, micro-CT analysis. Compressive mechanical properties were determined from biopsies of vertebral bodies and femoral condyles. BMD, micro-architectural parameters and mechanical properties of cancellous bone did not decrease significantly at 6 months post-OVX. Twelve months after OVX, BMD, micro-architectural parameters and mechanical properties decreased significantly. The results of linear regression analyses showed that trabecular thickness (Tb.Th) (r=0.945, R2=0.886) and bone volume fraction (BV/TV) (r=0.783, R2=0.586) had strong (R2>0.5) correlation to compression stress. In OVX sheep, changes in the structural parameters of trabecular bone are comparable to the human situation during osteoporosis was induced. The sheep model presented seems to meet the criteria for an osteopenia model for fracture treatment with respect to morphometric and mechanical properties. But the duration of OVX must be longer than 12 months to ensure the animal model can be established successfully.


Assuntos
Densidade Óssea , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/fisiopatologia , Modelos Animais de Doenças , Osteoporose/diagnóstico por imagem , Osteoporose/fisiopatologia , Ovariectomia , Animais , Fenômenos Biomecânicos , Força Compressiva , Módulo de Elasticidade , Feminino , Humanos , Radiografia , Ovinos , Estresse Mecânico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...