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Acta Biomed ; 78(1): 60-70, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17687819


Hip problems are frequent and can represent a therapeutic challenge for the orthopaedic surgeon. In the wide spectrum of hip pathologies, coxarthrosis still remains the most common cause of hip disability. The treatment of hip disorders in adult patients has rapidly evolved during the past decades because of the enhanced understanding of osteoarthritis (OA) aetiology combined with improved imaging, better patient selection and refinements in surgical procedures. Despite great strides that have been made in the field of total hip arthroplasty (THA), femoral and pelvic osteotomy still play a successful role in the prevention and treatment of OA. Primary OA is rare, or may not exist at all, and the majority of cases that are considered as primary are secondary to a pre-existing anatomical deformity. If an identifiable anatomic and biomechanical hip abnormality is diagnosed, its surgical correction may prevent or lessen OA and postpone THA for many years or even indefinitely in certain cases. The success of such surgery depends on the correct indication, time of surgery, completeness with which osteotomies normalize the environment of the hip, and the grade of OA present when procedure is performed.

Fêmur/cirurgia , Osteoartrite do Quadril/cirurgia , Osteotomia/métodos , Ossos Pélvicos/cirurgia , Humanos , Seleção de Pacientes
Acta Orthop ; 76(1): 67-74, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15788310


BACKGROUND: When surgical treatment of dysplastic hip osteoarthrosis is necessary, osteotomy is preferable to fusion or THR. We evaluated periacetabular osteotomy as a method of choice. PATIENTS AND METHODS: We treated 36 symptomatic dysplastic hip joints (32 patients) with the Bernese periacetabular osteotomy (PAO) between 1994 and 2001. We used the ilio-inguinal (I-I) approach in 32 hips and a modified Smith-Petersen (S-P) approach in 4. The patients were followed for mean 4 (1.5-8) years. In 1 patient with coxa valga, a varus femoral osteotomy was performed 1 year after PAO. 2 hips, in which we used the modified S-P approach, necessitated a capsulotomy. RESULTS: The median Merle d'Aubignè score increased from 13 points preoperatively to 16 points postoperatively. This improvement in terms of pain, motion and ambulation was accompanied by spatial reorientation and correction. The lateral center edge angle of Wiberg (CE) improved from an average of 7 degrees to 28 degrees. The anterior center edge angle of Lequesne (FP) improved from an average of 18 degrees to 28 degrees. The acetabular index angle (AC) improved from an average of 22 degrees to 10 degrees. Major complications included 1 partial lesion of the sciatic nerve, 1 malunion and 1 combined nonunion of the pubic and ischiatic osteotomy. 2 patients underwent subsequent total hip replacement (THR) for progressive osteoarthrosis with pain. INTERPRETATION: We found good radiographic correction of deformities, improvement of hip function and pain relief with an acceptable complication rate. With appropriate patient selection, this procedure is the most physiological treatment of symptomatic hip dysplasia in young adults. In addition to relieving symptoms, it may prevent and postpone the development of secondary osteoarthrosis.

Acetábulo/cirurgia , Luxação do Quadril/cirurgia , Osteoartrite do Quadril/cirurgia , Osteotomia/métodos , Adulto , Seguimentos , Luxação do Quadril/complicações , Luxação do Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Osteoartrite do Quadril/etiologia , Osteotomia/efeitos adversos , Radiografia , Recuperação de Função Fisiológica , Rotação
Thromb Haemost ; 94(6): 1177-80, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16411390


The administration of recombinant activated factor VII (rFVIIa) by continuous infusion has provided a safe and convenient alternative to bolus injections in haemophiliacs with inhibitors, but it has only been reported in a single case with congenital factor VII (FVII) deficiency. The results of 12 consecutive surgical procedures in 7 patients with congenital FVII deficiency are reported here. rFVIIa was always given in continuous infusion,aiming at plasma FVII activity of 0.5 IU/mL. Treatment was given for 2 to 7 days with a mean total dose of 7.8 mg rFVIIa. Blood loss was as expected from the different types of procedures and the only thromboembolic complication was a superficial thrombophlebitis at the infusion site. This mode of substitution was therefore safe, effective and well tolerated.

Deficiência do Fator VII/tratamento farmacológico , Fator VIIa/administração & dosagem , Hemostasia Cirúrgica , Hemostáticos/administração & dosagem , Proteínas Recombinantes/administração & dosagem , Adolescente , Adulto , Criança , Pré-Escolar , Deficiência do Fator VII/sangue , Fator VIIa/farmacocinética , Feminino , Hemostáticos/farmacocinética , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/farmacocinética , Procedimentos Cirúrgicos Operatórios
Acta Biomed ; 74(1): 38-46, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12817791


Developmental hip dysplasia (DDH) is characterized by an anomalous growth of the hipjoint. Without adequate treatment, the natural history of DDH is development of secondary osteoarthritis in adulthood. The correction of the deformities modifies the biomechanics of the hip, which is important in order to slow down the progression of osteoarthritis and maybe to prevent and postpone this development. The Bernese periacetabular osteotomy is a procedure which reorientates the acetabular articular surface. Several surgical approaches have been used to achieve the same effective osteotomy. No surgical approach represents "the optimum", with selection of appropriate exposure representing a balance of advantages and disadvantages. We used the ilioinguinal approach in 32 periacetabular osteotomies for acetabular dysplasia performed between 1996 and 2002. The operation was successful in 30 patients with acceptable operation time and blood loss and few complications. The advantages and disadvantages with the ilioinguinal approach as compared to other possibile incisions are discussed.

Luxação Congênita de Quadril/cirurgia , Luxação do Quadril/cirurgia , Osteotomia/métodos , Acetábulo , Adolescente , Adulto , Fenômenos Biomecânicos , Perda Sanguínea Cirúrgica , Parafusos Ósseos , Nervo Femoral/lesões , Seguimentos , Luxação do Quadril/complicações , Luxação do Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/complicações , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Ílio , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Complicações Pós-Operatórias , Osso Púbico/cirurgia , Radiografia , Reoperação , Decúbito Dorsal , Resultado do Tratamento