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1.
Orthop Surg ; 2019 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-31679187

RESUMO

OBJECTIVE: To determine whether lumbar anatomy parameters are in dynamic change and related factors. METHODS: This is a retrospective study. Participants who did lumbar computed tomography (CT) scanning in Shandong University Qilu Hospital from October 2017 to March 2019 were selected. The 476 participants were randomly selected as male or female, with the age ranging from 17 to 87 years (mean, 55.19; standard deviation, 14.28 years). All the measurements were taken based on the CT scanning image and the measurement of lumbar morphology was conducted using picture archiving and communication systems (PACS). The angle between the horizontal alignment and pedicle center on median sagittal view, the angle between upper endplate and lower endplate on median sagittal view as well as transverse section angle (TSA) using Magerl point in the axial view was determined by reconstructive CT analysis. RESULTS: In the overall participants, the angle between the horizontal alignment and pedicle center on median sagittal view of lumbar one to three was significantly decreased with aging, from 3.90° ± 2.81° to -4.18° ± 6.86° (P = 0.002), 5.60° ± 2.89° to -4.14° ± 5.90° (P = 0.030), and 4.75° ± 2.95° to -2.87° ± 4.68° (P < 0.001), respectively. Additionally, the angle between the horizontal alignment and pedicle center on median sagittal view in male participants of lumbar two was dramatically decreased, from 4.83° ± 2.79° to -4.45° ± 5.97° (P = 0.30). And that of lumbar three in female participants was significantly decreased, from 4.56° ± 2.52° to -2.88° ± 5.03° (P = 0.029). Furthermore, of the overall participants, the angle between upper endplate and lower endplate on median sagittal view of lumbar one to four was associated with aging (P < 0.001, P < 0.001, P = 0.015, P < 0.001, respectively). The angle of lumbar one, two and four in male participants and lumbar one to four in female participants were all significantly related to aging (all P < 0.05). Moreover, in the participants overall, the TSA of lumbar one to three was significantly associated with aging (P = 0.015, P = 0.006 and P = 0.007, respectively). In addition, this angle in lumbar one to lumbar four in male participants were all negatively associated with aging (P = 0.017, P = 0.001, P = 0.005 and P = 0.036, respectively). CONCLUSION: Lumbar anatomy parameters are in dynamic change in an age and gender dependent manner. During spine surgery in elderly patients, more attention should be paid to these anatomic changes.

2.
Chin Med J (Engl) ; 132(21): 2636-2637, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31651520
3.
Orthop Surg ; 11(5): 835-844, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31663282

RESUMO

OBJECTIVES: To evaluate the dynamic changes of key morphology indicators of the lower extremities in the coronal plane with progressing medial compartment knee osteoarthritis (KOA) with an emphasis on gender-dependent regional differences. METHODS: The radiographs of patients with non-traumatic knee pain and varying degrees of genu varus were reviewed. Radiographs were studied in 1538 lower limbs of 883 consecutive patients who visited our hospital from January to July 2017; all patients had long-standing anteroposterior image-splicing radiographs taken of their lower limbs. Morphological indicators of bones and joints that can change the alignment of lower limbs or reflect cartilage wear and soft-tissue relaxation were selected and measured with the help of picture archiving and communication systems. After comparing the data of different genders, the data of males and females was separated into three age groups, <40 years, 40-60 years, >60 years respectively, and then compared among age groups using the Kruskal-Wallis and Mann-Whitney U tests. Scatterplots of age and all the measurements were drawn to determine the strength of the relations. The Pearson correlation test was performed to reveal correlations of measurements and age. RESULTS: Femoral bowing angle (FBA) and joint line convergence angle (JLCA) have obvious differences between different genders (P = 0.001, 0.000, respectively). This suggests that females have greater femoral curvature and joint space angle than males. Significant differences were found in hip-knee-ankle angle (HKA), FBA, distal femoral valgus resection angle (DFVRA), medial proximal tibial angle (MPTA), JLCA, and minimum joint space width (min-JSW) by age groups in females (P = 0.000, 0.000, 0.000, 0.000, 0.003, 0.002, respectively). The difference of mechanical medial distal femoral angle (mMDFA) was significant with P values less than 0.05 deemed significant (P = 0.030). Significant correlations were found between age and all measurements (r = -0.166, 0.253, 0.270, -0.147, 0.089, -0.105, -0.076, respectively, P < 0.01). Whereas, the difference in min-JSW by age group was the only significant one in males (P = 0.001), and no significant correlation was found between age and measurements (r = -0.107, 0.041, 0.134, -0.067, 0.079, -0.134, -0.098, respectively, P > 0.01). CONCLUSIONS: As KOA progressed, both dynamic deformation of lower extremities and degeneration of articular cartilage could be found in females, while no obvious dynamic deformations were found in males. Dynamic deformation of lower extremities was the important feature and the major causative factor of KOA in females.

4.
Injury ; 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31445830

RESUMO

Currently, accurate diagnosis and successful treatment of infection after fracture fixation (IAFF) still impose great challenges. According to the onset of infection symptoms after implantation, IAFF is classified as early infection (<2 weeks), delayed infection (2∼10 weeks) and late infection (>10 weeks). Confirmation of IAFF should be supported by histopathological tests of intraoperative specimens which confirm infection, cultures from at least two suspected infection sites which reveal the same pathogen, a definite sinus or fistula which connects directly the bone or the implant, and purulent drainage from the wound or presence of pus during surgery. Diagnosis of IAFF is built on comprehensive assessment of medical history, clinical signs and symptoms of the patient, and imaging and laboratory tests. The gold standard of diagnosis is histopathological tests. Treatment of IAFF consists of radical debridement, adequate irrigation, implant handling, systematic and local antibiotics, reconstruction of osseous and/or soft tissue defects, and functional rehabilitation of an affected limb. Early accurate diagnosis and appropriate treatment of IAFF play a key role in increasing the cure rate, reducing infection recurrence and disability risk, restoring limb function and improving quality of life of the patient.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31448401

RESUMO

BACKGROUND: Through the anatomical study of relevant nerves and blood vessels of the anterior elbow, we aimed to provide reference for the study of associated surgical approaches of the elbow, thereby providing novel and simple surgical approaches for the clinical treatment of various fractures of the elbow. The aim of the study was to investigate the anatomy of the anterior nerve and artery of the elbow joint to provide reference on the relevant surgical approach of the elbow joint, and determine a simple better surgical approach on the treatment of part of the fractures of the elbow joint. MATERIALS AND METHODS: The upper extremities of 10 adult cadavers fixed by formaldehyde and affused latex from the artery were observed to investigate the anatomic structure of the anterior approach of the elbow joint. From the clearance of the brachioradialis and pronator teres muscle to the approach of the neurovascular interval, we observed the states of the median nerve, the brachial, radialand ulnar arteries, and its branches through anatomical layers and measurement methods. RESULTS: Through the anterior neurovascular interval approach of the elbow, nerve and artery can be protected, and can expose the anterior structures of the elbow, such as the ulna coronoid process, humeroulnar joint and trochlea of the humerus. CONCLUSIONS: This study demonstrates that the anterior anatomical structure of the elbow joint including the trochlea of the humerus, coronoid process of the ulna and the front capsule of the elbow can be exposed through the anterior neurovascular approach of the elbow.

6.
Am J Sports Med ; : 363546519849483, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31166113

RESUMO

BACKGROUND: Hamstring tendon autografts are commonly used for primary anterior cruciate ligament (ACL) reconstruction. Some patients have small hamstring tendons however, which may compromise the clinical outcome of the autograft. To solve this problem, many surgeons use hybrid grafting that involves augmentation of small hamstring autografts with allograft tissue. PURPOSE/HYPOTHESIS: The purpose was to compare the clinical outcomes between primary ACL reconstructions performed with hamstring autografts and those performed with hybrid grafts in terms of patient-reported evaluation, failure rate, and knee stability. The hypothesis was that primary ACL reconstruction performed with hamstring autograft alone will not differ significantly from that performed with a hybrid graft in terms of patient-reported evaluation, failure rate, or knee stability. STUDY DESIGN: Systematic review. METHODS: A systematic review was performed to identify prospective and retrospective comparative studies and cohort studies (evidence levels 1-3) comparing outcomes of primary ACL reconstructions performed with hamstring autografting alone and hybrid grafting. Outcomes included patient-reported evaluation, failure rate, and knee stability. RESULTS: Ten studies were included: 1 of level 2 and 9 of level 3. Collectively, they included 398 autografts and 341 hybrid grafts. Mean respective follow-up durations ranged from 24.0 to 69.6 months and from 24.0 to 70.8 months. Patient-reported evaluations, including Lysholm, Tegner, and subjective International Knee Documentation Committee scores, were reported in 8 of 10 studies. Failure rates were reported in all 10 studies. Results of knee stability examinations-including KT-1000 arthrometer measurements, the pivot-shift test, Lachman test, and overall International Knee Documentation Committee results-were reported in 4 of 10 studies. In this review, there were no statistically significant differences between autografts and hybrid grafts in terms of patient-reported evaluations, failure rates, or KT-1000 measurements. CONCLUSION: In this systematic review, there was no significant difference in patient-reported evaluation or failure rate between primary ACL reconstructions performed with autografts alone and those performed with hybrid grafts. Whether there is a substantial difference in knee stability examination results between autografts and hybrid grafts remains unknown, given a relative lack of reports on knee stability.

7.
Orthop Surg ; 11(3): 487-492, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31037844

RESUMO

OBJECTIVE: To investigate the microhardness distribution throughout the human hand phalanges using the Vickers method, which can be used to directly evaluate the bone mechanical properties at tissue level and provide an alternative means to investigate bone quality. METHODS: The phalanges bones involved in this study were collected from three healthy donors; fresh-frozen right limbs were used. The phalanges bones were dissected and cut into 3-mm thick slices perpendicular to the long axis in the phalanges base, the phalanges shaft, and the phalanges head with a low-speed saw and then the slices were polished with sandpaper. A microindenter fitted with a Vickers indenter point was used to measure the Vickers hardness in the plantar, dorsal, medial, and lateral sites of cortical bone in metatarsal shaft and trabecular bone in the metatarsal base and head. The indentation load and dwell time was set to 50 g and 12 s for both the cortical and cancellous tissues in this study. For each site or region, five valid values were recorded and averaged as the Vickers hardness for the site or region. RESULTS: In total, 96 bone slices were harvested from the base, shaft, and head of the 15 phalanges and 1920 indentations were performed. In general, the Vickers hardness in phalanges was 34.11 ± 7.95 HV. For the 5 phalanges, the 3rd phalanx showed the highest hardness (36.74 ± 7.10 HV), closely followed by the 1st (36.46 ± 5.96 HV) and 2nd (35.28 ± 6.52 HV) phalanx. The hardness in the 4th (31.90 ± 9.15 HV) and 5th (31.19 ± 8.22 HV) phalanx were significantly lower than in the other 3 phalanges. The hardness in the phalanx shaft (38.52 ± 6.67 HV) was significantly higher than that in both the base (30.73 ± 7.46 HV) and head (30.64 ± 6.81 HV) of the phalanx (F = 300.7, P = 0.000); no statistic difference existed between the base and head of the phalanx (P = 0.996). The Vickers hardness in the proximal, middle, and distal phalanx showed statistical difference in Vickers hardness (F = 19.278, P = 0.000). The proximal phalanx showed higher Vickers hardness than the middle phalanx in the 2nd to 5th phalanges (P = 0.002). CONCLUSION: This study reported on the Vickers hardness distribution of the human phalanges bone and provides the theoretical basis of differences in hardness, which will benefit the placement of plates and screws in orthopaedic surgery and contribute to the research on ideal artificial bones and 3D-printed orthopaedic implants with inner gradient distribution of hardness.

8.
Orthop Surg ; 11(2): 304-310, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30932355

RESUMO

OBJECTIVE: To investigate the incidence of low-energy upper extremity fractures and identify the associated risk factors in Chinese people aged 50 years or older. METHODS: This study was a part of the Chinese National Fracture Survey, which was performed between January and May 2015 and aimed to investigate the epidemiology of traumatic fractures in China in 2014. The China National Fracture Study (CNFS) was registered with the Chinese Clinical Trial Registry (number ChiCTR-EPR-15005878). A stratified multistage cluster randomized sampling method was used to recruit subjects and the survey was conducted through a questionnaire. The relevant results have been published elsewhere. In the current study, 154 099 Chinese men and women aged 50 years or older were included for data collection and analysis. Low-energy fractures were defined as fractures that were caused by simple falls from standing height. Individuals who had low-energy upper extremity fractures were included in the case group and the remainder were included in the control group. Univariate and multivariate logistics regression analysis models were constructed to investigate the independent risk factors, after adjustment for confounding variables. RESULTS: In total, 184 patients sustained low-energy upper extremity fractures in 2014, indicating that the overall incidence was 119.4/100 000 persons, with 57.4 and 180.9/100 000 person-years in men and women. Approximately 80% of fractures occurred at home and on the common road (other than high way). In men, alcohol consumption (OR, 2.12; 95%CI, 1.11-4.06), residence at ≥2nd floor without an elevator (OR, 2.86; 95%CI, 1.16-7.06), sleep duration<7 h/day (OR, 2.77; 95%CI, 1.42-5.37), and history of past fractures (OR, 3.10; 95%CI, 1.21-7.93) were identified as significant risk factors. In women, obesity (BMI ≥ 28.0) (OR, 1.86; 95%CI, 1.31-2.66), living in the central region in China (OR, 1.53; 95%CI, 1.01-2.31), living at a higher latitude (40°-49.9°N) (OR, 1.79; 95%CI, 1.02-3.14), alcohol consumption (OR, 2.40; 95%CI, 1.58-3.63), more births (OR, 1.45; 95%CI, 1.15-1.83), sleep duration <7 h/day (OR, 2.21; 95%CI, 1.53-3.20), and history of past fracture (OR, 2.70; 95%CI, 1.52-4.80) were identified as significant risk factors. CONCLUSION: Based on these results, health policies that focus on decreasing alcohol consumption and encouraging individuals to improve their quality and duration of sleep should be implemented in China. The significance of moving to a ground floor or to a building equipped with an elevator for men, and maintaining a healthy body weight for women should be emphasized to prevent upper extremity fractures.

9.
Orthop Surg ; 11(2): 204-211, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30955245

RESUMO

OBJECTIVES: To reveal the anatomical adaptation of the fibula and its relations to age and settlement of the medial tibial plateau, and to explore the mechanism of proximal partial fibulectomy in treating medial compartment knee osteoarthritis (OA). METHODS: A retrospective study was performed in the Third Hospital of Hebei Medical University. Weight-bearing full-leg anteroposterior (AP) radiographs of 280 adults (560 knees) obtained from 1 January 2018 to 31 October 2018 were enrolled according to our inclusion and exclusion criteria, including 157 men and 123 women, with an average age of 50.3 ± 14.8 years (range, 19-80 years). Radiographic severity of knee OA was assessed using Kellgren and Lawrence (K-L) grading. The settlement of the medial tibial plateau was evaluated using the medial proximal tibial angle (MPTA). Curvatures of the tibia and the fibula were measured as proximal tibial curvature (PTC), distal tibial curvature (DTC), proximal fibular curvature (PFC), and distal fibular curvature (DFC). Two orthopaedic surgeons performed all the radiological measurements for 30 randomly selected patients, and repeated the measurements 1 week later. Based on the satisfactory intra-observer and inter-observer reliabilities (ICC > 0.9), each parameter was analyzed in this study. Multivariable linear regression models were used to examine relations between radiological measurements and age. RESULTS: The mean MPTA, PTC, DTC, PFC, and DFC were 85.4° ± 2.8°, 176.2° ± 1.9°, 176.8° ± 1.8°, 176.8° ± 1.9°, and 177.0° ± 2.0°, respectively. Ninety-three knees of K-L grade I were categorized as non-knee OA, and 467 knees of K-L grades II-IV were categorized as knee OA. The MPTA, PTC, and PFC of the knee OA group were significantly smaller than those of non-knee OA group (P < 0.05). The K-L grade of knee OA significantly increased with age (χ 2 = 182.169, P < 0.01). The multivariate linear regression analysis indicated that the MPTA and fibular curvatures were negatively correlated with age (the regression equation is age = 561.165-0.945 MPTA-0.937 PFC-0.959 DFC, P < 0.05), and the MPTA was negatively correlated with PFC (the regression equation is MPTA = 7.827 + 0.099 DFC, P < 0.05). CONCLUSIONS: The proximal curve of the fibula increased in patients with medial compartment knee OA, and this change was positively correlated with age and settlement of the medial tibial plateau. This anatomical adaptation of the fibula was associated with greater fibular axial load and the pulling from the peroneus longus. The proximal partial fibulectomy procedure effected a receptive foot pronation to reduce KAM and rebalance the biceps-proximal fibula-peroneus longus complex, consequently achieving medial compartment unloading.

10.
Rev Assoc Med Bras (1992) ; 65(3): 355-360, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30994833

RESUMO

OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.


Assuntos
Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Úmero/lesões , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Feminino , Seguimentos , Humanos , Fraturas do Úmero/fisiopatologia , Úmero/fisiopatologia , Ilustração Médica , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
11.
Orthop Surg ; 11(2): 195-203, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30895703

RESUMO

OBJECTIVE: To compare the biomechanical stability and compatibility of two iliosacral screws (ISS), a tension band plate (TBP), and a minimally invasive adjustable plate (MIAP) for treating Tile C pelvic fractures. METHODS: Three groups of finite element models of the intact pelvis, including the main ligament and the proximal one-third of both femurs, were developed to simulate vertical sacral fractures and treated with the three abovementioned internal fixation techniques. A 500 N vertical load, a 500 N vertical load plus a 10 Nm moment of forward sagittal direction, and 500 N vertical load plus a 10 Nm moment of right lateral direction were applied to the sacrum to simulate standing status, bending status, and flexion status, respectively. The maximum displacement value, the stress value, and the stress value of the fracture interface were compared among the three internal fixation techniques. RESULTS: The results showed that all three internal fixation techniques effectively restored the biomechanical transmission of the injured pelvis. The stress on the implants in the TBP model was 167.47% and 53.41% higher than that in the ISS model and the MIAP model, respectively, and the stress shielding phenomenon of the TBP model was more obvious than in the other two models. Meanwhile, the stress between the fracture interfaces in the TBP fixation models was apparently higher than that in the other two models. However, the vertical displacement of the MIAP model was not significantly different from that in the ISS and TBP model; therefore, strong fixation could be obtained in all three models. CONCLUSION: Based on our results, we believe that the stability of Tile C pelvic fracture fixed with MIAP was similar to that of fractures fixed with ISS and TBP, but the stress shielding phenomenon and safety of implants in the TBP models were inferior to those in the MIAP and ISS fixation models. Meanwhile, MIAP and ISS fixation were more helpful to the healing processing than was TBP fixation, especially at the fracture interface of the second and third vertebral body levels.

12.
Orthop Surg ; 11(2): 270-276, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30908880

RESUMO

OBJECTIVE: To investigate the bone hardness of different anatomical regions of the human radius and its impact on the pullout strength of screws. METHODS: Fresh radius bones were obtained from three donated cadavers. They were divided into three parts: proximal metaphysis, shaft, and distal metaphysis. The proximal metaphysis contains the head, neck, and radial tuberosity. The distal metaphysis includes the palmaris radius and the styloid process. The shaft of the radius was divided into nine segments of equal length. The bone hardness of three radiuses, one from each cadaver, was measured by Vickers microindentation hardness tests, and the screw pullout strength was examined in the other three radiuses using a materials testing machine. The trend between radius hardness and pullout strength was analyzed by using an analysis of variance randomized block design. Pearson correlation analysis was performed to evaluate the linear correlation between the bone hardness and the pullout strength of the human radius. RESULTS: The mean hardness ranged from 33.30 HV (the head) to 43.82 HV (the diaphysis). The hardest part of the radius was the shaft, with a value of 42.54 ± 5.59 HV. The proximal metaphysis had a hardness value of 34.15 ± 6.48 HV, and the distal metaphysis hardness value was 35.24 ± 5.17 HV. The shaft was 23.5% harder than the proximal metaphysis and 20% harder than the distal metaphysis. The microhardness test demonstrated that the bone hardness value of the diaphysis was significantly higher than those of both the proximal and distal metaphysis of the radius (both P < 0.05). The mean pullout strength values ranged from 552 N (the distal metaphysis) to 2296 N (the diaphysis). The greatest pullout strength of the radius was observed for the shaft, with a pullout strength of 1727.96 ± 111.44 N. The pullout strength of the proximal metaphysis was 726.33 ± 236.39 N, and the pullout strength of the distal metaphysis was 590.67 ± 36.30 N. The pullout strength of the shaft was 138% greater than that of the proximal metaphysis and 190% greater than that of the distal metaphysis. The pullout strength was also higher in the diaphysis than at both ends of the radius (both P < 0.05). A positive correlation was found between bone hardness and pullout strength (R = 0.927, P < 0.001). CONCLUSIONS: Bone hardness and screw pullout strength are higher in the diaphysis of the radius than at either end. The pullout strength is positively related to bone hardness in the human radius.

13.
Rev. Assoc. Med. Bras. (1992) ; 65(3): 355-360, Mar. 2019. graf
Artigo em Inglês | LILACS-Express | ID: biblio-1003039

RESUMO

SUMMARY OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.


RESUMO OBJETIVO: Explorar o efeito do tratamento com uma abordagem anterior do intervalo neurovascular médio para fraturas de cisalhamento coronal da porção distal do úmero. METODOLOGIA: Este estudo prospectivo incluiu duas pacientes do sexo feminino de 30-64 anos de idade, com idade média de 47 anos. As fraturas foram causadas por quedas de bicicleta. O tempo entre a lesão e a operação foi de 1-2 dias, com um intervalo de tempo médio de 1,5 dias. Duas pacientes com cisalhamento coronal da porção distal do úmero foram tratadas com redução aberta e fixação interna utilizando a abordagem anterior do intervalo neurovascular. RESULTADOS: Não houve complicações neurológicas e vasculares intra e pós-operatórias, nem complicações ou infecções, e a fratura foi unida. Após 12 meses da cirurgia, as pacientes retornaram ao trabalho sem dor e com uma amplitude normal de movimento de rotação do antebraço e cotovelo. Os raios-X revelaram excelente união das fraturas, sem sinais de ossificação heterotópica e sem artrite traumática. De acordo com as diretrizes da clínica Mayo para avaliação da função do cotovelo, uma pontuação de 100 é considerada excelente. CONCLUSÃO: A aplicação da abordagem anterior do intervalo neurovascular do cotovelo no tratamento de uma fratura de cisalhamento da superfície articular da porção distal do úmero, especificamente da tróclea do úmero, pode reduzir o desgaste do tecido mole.

14.
Orthop Surg ; 11(1): 97-101, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30734492

RESUMO

OBJECTIVE: The purpose of this retrospective study was to determine the incidence of fibular fractures as an associated injury in tibial plateau fractures according to CT scan. We also attempt to introduce a new morphological sub-classification on this associated injury and to analyze the correlation between this classification and tibial plateau fractures. METHODS: We selected cases with fibular fractures from all the tibial plateau fracture patients. The cases were further divided into 2 groups: unicondylar group and bicondylar group. On the basis of our new classification system of fibular fracture, all the included cases were divided into 5 subgroups. RESULTS: Finally, a total of 150 cases associated with fibular fractures in 502 tibial plateau fracture cases were identified from our institution database. The incidence of fibular head fracture in tibial plateau fractures was 29.88% (150/502). Seventy-one cases (47.3%) were involved one condyle, and 79 cases (52.7%) involved both. It shows significant difference in the subgroup of avulsion fracture with horizontal fracture line (Type A) which is ratio of 16.9% in unicondylar group and 1.27% in bicondylar group. CONCLUSION: A new classification of this associated injury describing the morphology of the fracture fragments may improve operative planning.


Assuntos
Fíbula/lesões , Fraturas Múltiplas/classificação , Fraturas da Tíbia/classificação , Adolescente , Adulto , Idoso , Feminino , Fíbula/diagnóstico por imagem , Fraturas Múltiplas/diagnóstico por imagem , Humanos , Fraturas Intra-Articulares/classificação , Fraturas Intra-Articulares/diagnóstico por imagem , Traumatismos do Joelho/classificação , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Technol Health Care ; 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30507595

RESUMO

BACKGROUND: Although there are several different kinds of fixation techniques for the sacroiliac fracture-dislocation, the treatment remains a challenge for orthopedic surgeons. OBJECTIVE: The purpose of this study was to compare the stability of sacroiliac fracture-dislocation fixed with two iliosacral (IS) screws, tension band plate (TBP), and minimally invasive adjustable plate (MIAP). METHODS: Five human cadavers (L4-pelvic-femora) were used to compare biomechanical stability. The pubic symphysis separation and left sacroiliac dislocation were created. The symphysis pubis was stabilized with a five-hole plate. The sacroiliac joint dislocation fracture was fixed with three kinds of internal fixation in a randomized design. The specimens were fastened in a biomechanical machine with a cycle vertical load. Displacements of the whole specimen and shifts in the fracture gap were recorded. RESULTS: Under different vertical loads, the shifts in the fracture gap and the displacements of the pelvis fixed with MIAP were similar to those in fractures fixed with two IS screws. However, the shifts in the fracture gap and the displacements of the pelvis fixed with MIAP were significantly smaller than those fixed with TBP. CONCLUSIONS: The stability of the sacroiliac joint dislocation fixed with MIAP was similar to that of dislocation fixed with two IS screws, and MIAP performed better than the TBP under vertical load.

17.
Chin Med J (Engl) ; 131(21): 2524-2530, 2018 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-30381585

RESUMO

Background: Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods: We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters (neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]) were recorded. Student's t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results: Statistically significant differences in NSA (137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P < 0.001), CEA (37.62 ± 6.77° vs. 43.11 ± 7.09°, t = 5.597, P < 0.001), FND (35.21 ± 3.25 mm vs. 34.09 ± 3.82 mm, t = 2.233, P = 0.027), and FNAL (99.30 ± 7.91 mm vs. 103.58 ± 8.39 mm, t = 3.715, P < 0.001) were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes (all P < 0.001). The greater NSA was the risk factor for femoral neck fractures (odds ratio [OR]: 0.70, P < 0.001), greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures (OR: 1.15, 1.17, all P < 0.001), and greater FND was a protective factor for femoral intertrochanteric fractures (OR: 0.74, P < 0.001). Conclusions: We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should be considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.

18.
Arthroscopy ; 34(10): 2936-2938, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30286890

RESUMO

Hybrid grafting (augmentation of small hamstring autografts with allograft tissue) is preferred by many surgeons for anterior cruciate ligament (ACL) reconstruction. Although a recent, well-conducted, systematic review reported no significant differences in failure risk between hybrid graft and autograft ACL reconstruction, a trend toward a greater failure risk using the hybrid graft existed in many of the included studies. Three potential causes of hybrid graft ACL reconstruction failure that are absent in autograft ACL reconstruction are different levels of graft revascularization and ligamentization, differences in the tendon-bone healing capacity between the allograft and autograft portions in the bone tunnel, and processing of the graft. Research advances in these areas will further reduce the failure risk of hybrid graft ACL reconstruction.

19.
J Orthop Surg Res ; 13(1): 231, 2018 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-30208920

RESUMO

BACKGROUND: This meta-analysis was performed to compare the clinical outcomes of primary anterior cruciate ligament (ACL) reconstruction using the ACL remnant preservation technique versus the standard technique. METHODS: PubMed, Embase, and the Cochrane Library were searched through December 24, 2017, to identify randomized controlled studies that compared the use of the ACL remnant preservation technique versus the standard technique for primary ACL reconstruction. Statistical heterogeneity among the trials was evaluated with chi-square and I-square tests. A sensitivity analysis was conducted to explore sources of heterogeneity. Subgroup analysis was performed to identify potential differences according to type of ACL remnant tissue (remnant bundle or remnant fibers). RESULTS: Seven studies with a combined 412 patients (208 in the remnant preservation technique group and 204 in the standard technique group) were included in the meta-analysis. There was a significant difference between the groups in Lysholm score (mean difference (MD), 2.20; 95% confidence interval (CI), 0.95-3.45; P = 0.0006) and side-to-side difference (MD, - 0.71; 95% CI, - 0.87 to - 0.55; P < 0.01). There was no significant difference between the groups in subjective International Knee Documentation Committee (IKDC) score, complications, pivot shift test, Lachman test, or overall IKDC score. Subgroup analysis demonstrated that for primary ACL reconstruction with preservation of remnant fibers, the remnant preservation technique was superior to the standard technique based on Lysholm scores (P < 0.01) and side-to-side difference (P < 0.01). CONCLUSIONS: Based on the current literature, using the remnant preservation technique showed a better clinical outcome than using the standard technique for patients undergoing primary ACL reconstruction with respect to Lysholm score and side-to-side difference. However, it remains unclear that there is a definite advantage to use the remnant preservation technique compared with the standard technique.

20.
Cancer Cell Int ; 18: 115, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30123093

RESUMO

Background: Increasing data has indicated an association between increased soluble B7-H3 (sB7-H3) levels and unfavorable prognosis in patients with malignancies. However, the level of sB7-H3 and its clinical significance in osteosarcoma (OS) are not well known. In this present study, we investigated whether sB7-H3 levels in serum could be as a tool for differential diagnosis of OS patients. Methods: Peripheral blood samples from healthy controls, benign bone tumors, and OS patients were collected. Levels of sB7-H3 in serum samples were measured by enzyme-linked immunosorbent assays. The correlation between OS-derived sB7-H3 and clinical features was analyzed, and prognostic significance of the sB7-H3 concentrations and tumor expressions of the biomarkers was then evaluated. Results: sB7-H3 concentrations were significantly increased in patients with OS than in osteochondroma patients, bone fibrous dysplasia patients and healthy people (p < 0.05, respectively). Using 60.94 ng/mL as a cutoff value, the sensitivity and specificity of sB7-H3 was to differentiate between OS patients and other bone benign tumor patients were 75.7% and 83.8%, respectively. In addition, upregulated serum sB7-H3 in patients with OS associated with tumor differentiation, tumor stage, and metastasis status (p < 0.05, respectively). The area under the curve value for sB7-H3 (0.868) was markedly higher than those for ALP (0.713) and CA125 (0.789) for differentiating between OS patients and other begin bone tumor patients. Conclusions: We demonstrated that enhanced sB7-H3 levels correlated with the clinical characteristics of OS patients, and B7-H3 might be a potential biomarker and associated with the pathogenesis of OS.

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