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1.
Medicine (Baltimore) ; 99(16): e19791, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311991

RESUMO

RATIONALE: In the medical field, the use of 3-dimensional (3D) printing is increasing explosively and it is especially widespread in the clinical application of fabricating orthosis. Advantages of 3D-printed orthosis compared to conventional ones include its lower cost, easier modification, and faster fabrication. The 3D-printing technique makes it possible for physicians to easily create individual-tailored products. Recently, many kinds of orthosis through 3D printing have been studied and used. The knee orthosis, ankle-foot orthosis, wrist orthosis, hand orthosis, and foot orthotics are examples used in the rehabilitation fields of orthotics. We reported 3 cases of 3D-printed orthoses in patients with peripheral nerve injuries. PATIENTS CONCERNS: In spite of the rapid development of the clinical use of 3D printing, to our knowledge, its application to patients with peripheral nerve injuries has not yet been reported. Two patients suffered from upper limb problems and 1 patient had a foot drop associated with peripheral nerve injury. DIAGNOSIS: Three patients diagnosed with median neuropathy, ulnar neuropathy, and right lower lumbar radiculopathy, respectively, by electromyography. INTERVENTIONS: Herein we present 3 case reports of patients with peripheral nerve injuries whose orthotic needs were fulfilled with the application of 3D-printed wrist orthosis and ankle-foot orthosis. OUTCOMES: For hand function evaluation, we assessed the Jebsen-Taylor hand function test. Grasp and pinch powers were assessed by a hand dynamometer before and after orthosis application. For lower limb functional evaluation, we used a 6-minute walking test and modified Emory Functional Ambulation Profile for ambulatory function. LESSONS: The 3D-printed orthosis could help functional improvement in patients with peripheral nerve injuries.


Assuntos
Síndrome do Túnel Carpal/terapia , Aparelhos Ortopédicos , Impressão Tridimensional , Radiculopatia/terapia , Neuropatias Ulnares/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 99(14): e19586, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243378

RESUMO

To investigate the effects of body weight support (BWS) and gait velocity on cardiovascular responses during walking on an antigravity treadmill early after unilateral and bilateral total knee arthroplasty (TKA).This study was a cross-sectional study design. Fifty patients (7 males and 43 females; average age, 72.0 ±â€Š5.1 years) at 4 weeks after unilateral (n = 25) and bilateral (n = 25) primary TKA were enrolled in the study. Subjects walked on an antigravity treadmill at speeds of 2.5 km/hour and 3.5 km/hour with 3 levels (50%, 25%, and 0%) of BWS. Cardiovascular responses were monitored by measuring oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure (SBP/DBP), the respiratory exchange ratio (RER), and rate pressure product (RPP). Borg rating of perceived exertion (RPE) and a visual analog scale (VAS) of knee pain were recorded immediately after each trial.There were no significant differences in cardiovascular responses between the unilateral and bilateral TKA groups. In the repeated measures Analysis of Variance, VO2 levels, HR, RPP, RPE, RER, and VAS were significantly increased in proportion to 3 levels (50%, 25%, and 0%) of BWS for unilateral and bilateral TKA groups, respectively. Meanwhile, SBP and DBP were unaffected by differences in BWS. At 3.5 km/hour, VO2, RPE, and RER values were statistically greater than those at 2.5 km/hour under the same BWS conditions.We found that the reduction in the metabolic demand of activity, coupled with positive pressure on the lower extremities, reduced VO2 and HR values as BWS increased.Cardiovascular responses vary according to BWS and gait velocity during antigravity treadmill walking. BWS rather than gait velocity had the greatest effect on cardiovascular responses and knee pain.


Assuntos
Artroplastia do Joelho/reabilitação , Peso Corporal , Sistema Cardiovascular/fisiopatologia , Aparelhos Ortopédicos , Osteoartrite do Joelho/fisiopatologia , Velocidade de Caminhada , Idoso , Pressão Sanguínea , Estudos Transversais , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Hipogravidade , Masculino , Osteoartrite do Joelho/cirurgia , Período Pós-Operatório
3.
Zhongguo Gu Shang ; 33(3): 219-23, 2020 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-32233247

RESUMO

OBJECTIVE: To explore clinical efficacy of hand power device and Shujinxi (, SJX) external granule in treating collateral ligament contracture of metacarpophalangeal joint. METHODS: Fifty patients with collateral ligament contracture of metacarpophalangeal joint from June 2017 to January 2019 were divided into experimental and control group, 25 patients in each group. In experimental group, there were 17 males and 8 females aged from 19 to 63 years old with an average of (40.53±9.42) years old; 36 affected fingers; the courses of disease ranged from 23 to 82 days with an average of (52.37± 11.20) days; treated with hand power device and SJX external granule. In control group, there were 15 males and 10 females aged from 21 to 58 years old with an average of (42.11±8.36) years old; 32 affected fingers; the courses of diseases ranged from 18 to 71 days with an average of (48.24±12.50) days; treated with loose training of metacarpophalangeal joints. Symptoms of pain of affected finger, flexion and extension function were observed between two groups, VAS score was used to evaluate relieve degree of pain, grip size was used to evaluate recovery of grip, total active motion was applied to assess recovery of metacarpophalangeal joints, the second operation and occurrence of complications between two groups were compared. RESULTS: All patients were followed up about 8 weeks. VAS score, total active motion of metacarpophalangeal joints and grip of affected finger before and after treatment in experimental group were (4.22±1.09) point vs (1.98±1.01) point ,(17.40±6.31) ° vs (70.95±7.68) ° ,(4.83±3.09) kg vs (23.17±10.54) kg respectively, while in control group were (4.66±0.95) point vs (2.84± 1.06) point ,(16.25±5.66) ° vs (59.14±10.61) ° ,(5.06±4.05) kg vs (16.25±9.66) kg; there were statistical difference between two groups before and after treatment, and these items in experimental group after treatment were higher than that of control group (P<0.05) . There were no complicationsoccurred betweentwo groups. Onepatientinexperimentalgroup and 8 patients in controlgroupneededto bethesecondoperation, andhadsignificancedifference (P<0.05) . CONCLUSION: Handpowerdevice and SJXexternalgranulecouldobviouslyrelievesymptomsof pain of affected finger, improve recovery of grip strength, increase total active motion, and has good safety. It is an effective method for treating for the treatment of collateral ligament contracture of metacarpophalangeal joint.


Assuntos
Ligamentos Colaterais , Contratura , Adulto , Braquetes , Feminino , Humanos , Masculino , Articulação Metacarpofalângica , Pessoa de Meia-Idade , Aparelhos Ortopédicos , Amplitude de Movimento Articular , Adulto Jovem
4.
World Neurosurg ; 133: e342-e347, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562968

RESUMO

OBJECTIVE: This study was carried out to analyze the surgical effect of cervical spine sagittal alignment for patients with Hirayama disease (HD). METHODS: Forty-four subjects were retrospectively analyzed for the parameters of cervical spine sagittal alignment. The case group consisted of 23 patients with HD, whereas the control group consisted of 21 healthy adolescent subjects. Pre- and postoperative cervical spine sagittal parameters of the patients with HD were collected; the cervical sagittal parameters of the healthy adolescent subjects were also collected. Sagittal alignment parameters were compared between the patients with HD and the healthy adolescent subjects, and between the pre- and postoperative parameters for the patients with HD. RESULTS: Forty-four subjects completed the follow-up, with the average follow-up period being 18.0 months. No significant differences were detected between the HD and control groups for clinical parameters (P > 0.05). The preoperative HD group had smaller values compared with the control group in the sagittal parameters of C2-7 cervical lordosis (CL) angle, T1 slope, thoracic inlet angle (TIA), and cervical tilt angle (P < 0.05). For the patients with HD, the preoperative values were smaller compared with the postoperative HD values for the parameters of C2-7 CL angle, T1 slope, and cervical tilt angle (P < 0.05). We found no significant differences between the postoperative patients with HD and the healthy subjects, including C2-7 CL angle, C2-7 sagittal vertical axis, T1 slope, TIA, neck tilt angle, cervical tilt angle, and cranial tilt angle (P > 0.05). CONCLUSIONS: Patients with HD have sagittal imbalance of the cervical spine compared with age-matched healthy adolescent subjects, and surgical treatment could correct the sagittal imbalance.


Assuntos
Vértebras Cervicais/patologia , Discotomia , Fusão Vertebral , Atrofias Musculares Espinais da Infância/cirurgia , Adolescente , Adulto , Antropometria , Placas Ósseas , Parafusos Ósseos , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Cifose/etiologia , Cifose/patologia , Lordose/diagnóstico por imagem , Lordose/etiologia , Lordose/patologia , Masculino , Aparelhos Ortopédicos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Atrofias Musculares Espinais da Infância/complicações , Adulto Jovem
5.
Oral Maxillofac Surg Clin North Am ; 32(1): 105-116, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31685348

RESUMO

Idiopathic condylar resorption (ICR), alternatively called progressive condylar resorption, is an uncommon aggressive form of degenerative disease of the temporomandibular joint seen mostly in adolescent and young women. ICR occurring before the completion of growth results in a shorter mandibular condyloid process, ramus and body, compensatory growth at the gonial angle and coronoid process, as well as an increase in anterior facial vertical dimension. Management options discussed include oral appliances, orthodontics, medical management, orthognathic surgery with and without disc repositioning, and alloplastic temporomandibular joint replacement.


Assuntos
Reabsorção Óssea , Côndilo Mandibular/cirurgia , Ortodontia Corretiva , Procedimentos Cirúrgicos Ortognáticos/métodos , Transtornos da Articulação Temporomandibular/cirurgia , Adolescente , Reabsorção Óssea/etiologia , Feminino , Humanos , Côndilo Mandibular/patologia , Aparelhos Ortopédicos , Articulação Temporomandibular
6.
Clin Podiatr Med Surg ; 37(1): 125-150, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735264

RESUMO

The article discusses the nuances required to effectively perform the biomechanical examination in children and assess the findings. The author covers several factors in children that make the examination different in certain respects than in that of adults, including growth, osseous maturation, gait development, and interpretation of symptoms as conveyed by the child. Further delineation is made for prewalkers, foot-flat to foot-flat walkers, and heel-to-toe walkers. Segmental review of the lower extremity is covered by age bracket, with clinical pearls inserted where relevant to assist the clinician. A brief discussion of shoe wear and orthoses is made as well.


Assuntos
Deformidades do Pé/terapia , Adolescente , Fatores Etários , Fenômenos Biomecânicos , Criança , Pré-Escolar , Deformidades do Pé/diagnóstico , Deformidades do Pé/fisiopatologia , Marcha , Humanos , Lactente , Aparelhos Ortopédicos , Seleção de Pacientes , Exame Físico , Sapatos
7.
Clin Podiatr Med Surg ; 37(1): 71-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735271

RESUMO

The adult acquired flatfoot deformity resulting from posterior tibial tendon dysfunction is the result of rupture of the posterior tibial tendon as well as key ligaments of the ankle and hindfoot. Kinematic studies have verified certain levels of deformity causing hindfoot eversion, lowering of the medial longitudinal arch and forefoot abduction. The condition is progressive and left untreated will cause significant disability. Bracing with ankle-foot orthoses has shown promising results in arresting progression of deformity and avoiding debilitating surgery. Various types of ankle-foot orthoses have been studied in terms of effects on gait as well as efficacy in treatment.


Assuntos
Pé Chato/terapia , Disfunção do Tendão Tibial Posterior/complicações , Adulto , Idoso , Pé Chato/etiologia , Pé Chato/fisiopatologia , Humanos , Pessoa de Meia-Idade , Aparelhos Ortopédicos , Disfunção do Tendão Tibial Posterior/fisiopatologia
8.
Muscle Nerve ; 61(1): 52-57, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31588574

RESUMO

INTRODUCTION: Loss of ambulation in Duchenne muscular dystrophy presages scoliosis, respiratory failure, and death. Strategies to maintain ankle range of motion are employed, but little evidence exists to support these approaches and limited information is available concerning current practice. METHODS: In this study we assessed baseline bracing data from 187 boys participating in a multicenter, international clinical trial. RESULTS: Ankle-foot orthoses (AFOs) were recommended for 54% of the boys, with nighttime static AFOs and nighttime dynamic AFOs utilized in 94% and 6% of these boys, respectively. Daytime static AFOs were recommended for 3 boys. Compliance with bracing recommendations was 54% for nighttime static braces and 67% for nighttime dynamic braces. DISCUSSION: The basis for the variation in recommended AFO use is unknown and requires further study. Long-term follow-up of boys may permit assessment of the effects of AFO use.


Assuntos
Tornozelo , Braquetes , Distrofia Muscular de Duchenne/reabilitação , Distrofia Muscular de Duchenne/terapia , Articulação do Tornozelo , Criança , Pré-Escolar , Método Duplo-Cego , , Humanos , Masculino , Aparelhos Ortopédicos , Cooperação do Paciente , Modalidades de Fisioterapia , Amplitude de Movimento Articular , Resultado do Tratamento , Caminhada
9.
Spine (Phila Pa 1976) ; 44 Suppl 24: S1-S12, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31790063

RESUMO

STUDY DESIGN: A modified Delphi method was used to establish consensus. Subject matter experts were invited to participate as the expert panel. Best practice statements were distributed to the panel. Panel members were asked to mark "agree" or "disagree" after a series of statements during several rounds until either consensus could be obtained or the practice method was deemed unable to achieve consensus. OBJECTIVE: Lumbar total disc replacement (TDR) is acknowledged as an alternative to spinal fusion in appropriately selected patients. There is a lack of unanimity on the appropriate postoperative patient protocols and rehabilitation expectations for the procedure. The long-term viability of Lumbar TDR, further adoption in the community setting and specific patient outcomes are contingent on the existence of appropriate postoperative recovery programs. SUMMARY OF BACKGROUND DATA: Currently there are no established methods for postoperative care following lumbar TDR. Establishing a postoperative clinical pathway algorithm may improve patient outcomes with respect to lumbar TDR. METHOD: A lumbar TDR expert panel of 22 spine surgeons employed a modified Delphi method to drive consensus on postoperative care following single-level Lumbar TDR. The panel first reviewed literature and guidelines relevant to postoperative care following lumbar TDR. Panel members considered 21 survey questions intended to determine "standard-practice" postoperative care recommendations for patients who have undergone lumbar TDR for the initial recovery phase (0-4 wk) and rehabilitation (4-20 wk). Each panel member participated in a round of anonymous voting followed by a group discussion. Consensus was defined as 80% agreement or higher among the respondents. RESULTS: Consensus was achieved in 11 of the 21 survey questions. There was a high degree of consensus around the key goals for both the initial recovery and rehabilitation phases, ceased use of narcotics for pain management by 4 weeks postoperative, unrestricted walking immediately following surgery, timelines for physical therapy (within 2-4 wk) and return to work based on level of activity (as early as 1 wk postoperative). Lack of agreement included the use of back bracing and timing of postoperative visits. Generally, panel members felt that patient expectations regarding return to function were different following lumbar TDR versus fusion and warrant further study. CONCLUSION: Surgeon and patient alignment around postoperative expectations may significantly affect the long-term results of lumbar TDR. This surgeon consensus study found agreement for immediate postoperative ambulation, rapid reduction in opioids within the first month, and early return to work. When expectations are appropriately set with patients preoperatively, both provider and patient have shared goals in the return-to-function process. LEVEL OF EVIDENCE: 5.


Assuntos
Vértebras Lombares/cirurgia , Planejamento de Assistência ao Paciente , Cuidados Pós-Operatórios , Substituição Total de Disco/reabilitação , Algoritmos , Analgésicos Opioides/uso terapêutico , Consenso , Procedimentos Clínicos , Técnica Delfos , Humanos , Aparelhos Ortopédicos , Modalidades de Fisioterapia , Retorno ao Trabalho , Caminhada
10.
NeuroRehabilitation ; 45(4): 519-524, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868690

RESUMO

BACKGROUND: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments. OBJECTIVE: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI. METHODS: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = 6) and who received inpatient rehabilitation without DBWS (SOC, n = 6). The primary outcome measure was the change in Functional Independence Measures (FIM) scores from admission to discharge. RESULTS: There was significant improvement in total FIM scores at discharge compared to admission for both the DBWS (p = 0.001) and SOC (p = 0.005) groups. Overall, the DBWS group had greater improvement in total FIM score and FIM subscales compared to the SOC group. CONCLUSIONS: Our results suggest DBWS has the potential to allow a greater intensity of therapy during inpatient rehabilitation and yield better outcomes compared to SOC in patients with TBI.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Vida Independente/normas , Reabilitação Neurológica/métodos , Aparelhos Ortopédicos , Adulto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Movimento , Reabilitação Neurológica/instrumentação , Alta do Paciente/estatística & dados numéricos , Recuperação de Função Fisiológica
12.
Zhonghua Shao Shang Za Zhi ; 35(11): 821-823, 2019 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-31775473

RESUMO

Scar contracture after burn on the back of hand can easily lead to the limitation of flexion function of fingers, which seriously affects daily life activities. Generally, comprehensive rehabilitation treatment is adopted for scar contracture on the back of hand, among which wearing braces is an effective treatment method. However, some braces will limit the normal finger joints or must wait until all the affected fingers heal before they can be worn, and the wearing operation is quite complicated. In order to solve these problems, the author designed and made a finger flexion band, which was used to stretch the patients with limited flexion of finger caused by scar contracture after burn on the back of hand, and achieved good therapeutic effect. According to the measured hand size, the finger flexion band is cut and spliced from the fabric commonly used in daily life. The finger flexion band is designed with finger sleeve, which will not limit the normal finger joints, can interfere with the healed finger in advance, fix the corresponding fingers better, and improve the treatment comfort, especially for children who do not cooperate with the braces wearing. This finger flexion band is simple to make, cheap, convenient to use, and suitable for clinical promotion.


Assuntos
Queimaduras/reabilitação , Cicatriz/reabilitação , Contratura/reabilitação , Traumatismos da Mão/reabilitação , Aparelhos Ortopédicos , Dedos , Humanos
13.
BMC Musculoskelet Disord ; 20(1): 437, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554516

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. CASE PRESENTATION: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.


Assuntos
Abscesso/terapia , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Fusão Vertebral/efeitos adversos , Abscesso/etiologia , Antibacterianos/uso terapêutico , Vértebras Cervicais/microbiologia , Desbridamento , Remoção de Dispositivo/efeitos adversos , Drenagem , Quimioterapia Combinada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Aparelhos Ortopédicos , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Fusão Vertebral/instrumentação , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo , Titânio/efeitos adversos , Resultado do Tratamento
14.
Turk J Pediatr ; 61(1): 79-84, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559725

RESUMO

Seyhan K, Kerem-Günel M. Does stable sitting influence upper limb function in children with cerebral palsy? Turk J Pediatr 2019; 61: 79-84. Bilateral spastic cerebral palsy (BSCP) patients frequently need to use various sitting devices for body control and function. The aim of this study was to investigate whether the use of a belt to position the pelvis in an adjustable chair would affect upper limb function in preschool children with BSCP. Fortyone children with BSCP [mean age 44 ±11, range 18-60 months] classified according to the Gross Motor Function Classification System (GMFCS), as level III (n=21) and level IV (n=20) were fitted with a hip-positioning belt. Upper limb functions were assessed by Quality of Upper Extremity Skills Test (QUEST). The median scores of the following upper extremity functions increased significantly by wearing the hip positioning belt: dissociated movements, grasping, weight bearing and protective extension. The total QUEST score increased from 56.7 (±46.3) to 66.1 (±39.2) (p < 0.001). The portable and adaptable hip-positioning belt may be used in daily life to improve upper limb activity in preschool children with moderate to severe BSCP.


Assuntos
Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/reabilitação , Aparelhos Ortopédicos , Postura Sentada , Extremidade Superior/fisiopatologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino
15.
World Neurosurg ; 132: 63-66, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479787

RESUMO

BACKGROUND: Symptomatic calcification of the ligamentum flavum (CLF) is common in the cervical spine but rare in the thoracic spine. Rapidly progressing CLF in the thoracic spine has not been reported in the literature. CASE DESCRIPTION: A 76-year-old Asian male experienced back pain after a fall and was diagnosed with osteoporotic vertebral fractures at T11 and L1. He was treated conservatively because of the lack of neurologic deficits. Nine months after the initial visit, he complained of progressive incomplete paraplegia. Magnetic resonance imaging and computed tomography of the thoracic spine showed CLF at T11-T12 severely compressing the spinal cord. This finding had not been seen on imaging studies at the initial visit. The patient underwent surgical resection of CLF and posterior instrumented spine fusion. Symptoms of muscle weakness recovered postoperatively. CONCLUSIONS: In this case, sequential imaging studies with a 9-month interval showed evidence of rapidly progressing thoracic CLF. The preceding osteoporotic vertebral fracture may have triggered the development of CLF.


Assuntos
Calcinose/cirurgia , Ligamento Amarelo/cirurgia , Vértebras Lombares/cirurgia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/cirurgia , Idoso , Calcinose/complicações , Calcinose/diagnóstico por imagem , Tratamento Conservador , Progressão da Doença , Humanos , Ligamento Amarelo/diagnóstico por imagem , Masculino , Aparelhos Ortopédicos , Fraturas por Osteoporose/complicações , Paraplegia/etiologia , Fraturas da Coluna Vertebral/complicações , Fusão Vertebral , Vértebras Torácicas/lesões , Vertebroplastia
16.
BMC Musculoskelet Disord ; 20(1): 401, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481055

RESUMO

BACKGROUND: Stress fracture of the lateral tubercle of the posterior talar process in runners is extremely rare. Here, we describe a case of a female long-distance runner who sustained a stress fracture of the lateral tubercle of the posterior talar process. Osteosynthesis with screw fixation via two-portal hindfoot endoscopy achieved a good surgical outcome with a less invasive procedure. CASE PRESENTATION: An 18-year-old female long-distance runner who belonged to her university's road running club presented to our institution with a half-year history of persistent left hindfoot pain when running. Radiographs revealed a stress fracture of the lateral tubercle of the posterior talar process. Because the fracture showed no signs of healing 3 months after starting conservative therapy, osteosynthesis with screw fixation was performed via two-portal hindfoot endoscopy. Non-contrast computed tomography at 10 weeks postoperatively revealed consolidation of the stress fracture. At 15 weeks postoperatively, the patient was permitted to jog and return to athletic activity while wearing an orthosis. As of this writing 2 years postoperatively, she remains an active competitive runner. CONCLUSIONS: Osteosynthesis with screw fixation via two-portal hindfoot endoscopy was a less invasive procedure that successfully treated stress fracture of the lateral tubercle of the posterior talar process in this female long-distance runner.


Assuntos
Atletas , Endoscopia/métodos , Fixação Interna de Fraturas/métodos , Fraturas de Estresse/cirurgia , Tálus/lesões , Adolescente , Parafusos Ósseos , Endoscopia/instrumentação , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Aparelhos Ortopédicos , Radiografia , Corrida , Tálus/cirurgia , Resultado do Tratamento
17.
Orthopade ; 48(10): 879-896, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31511916

RESUMO

Atraumatic fractures of the spine are a common orthopedic disease condition that can be asymptomatic or associated with complaints of varying intensity and quality. The risk factors for such fracture forms are often metabolic and genetic diseases, which have a direct or indirect effect on bone metabolism and therefore secondarily affect the stability of the spinal vertebrae. Furthermore, benign and malignant tumors as well as infectious diseases can also be causative for atraumatic spinal fractures; however, those factors that are attributable to lifestyle habits should also not be underestimated. The treatment of affected patients is complex and nearly always interdisciplinary. In addition to purely symptom-oriented treatment concepts, orthoses in particular and when indicated surgical treatment procedures can be implemented. This article summarizes the important clinical, diagnostic and therapeutic aspects of atraumatic spinal fractures.


Assuntos
Aparelhos Ortopédicos , Fraturas da Coluna Vertebral/diagnóstico , Coluna Vertebral , Discite/complicações , Humanos , Vértebras Lombares , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia
18.
Fisioter. Pesqui. (Online) ; 26(3): 247-257, jul.-set. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1039888

RESUMO

ABSTRACT The purpose of this study is to analyze the effects of using customized insoles and leg and foot exercises on the feet of patients with neuropathy caused by leprosy. Thirty volunteers diagnosed with leprosy were assigned to one of three groups: (1) Exercise group (n=10): performed exercises for the intrinsic muscles of the foot; (2) Insole group (n=10): used insoles to correct foot positioning; (3) Insole and Exercise group (n=10): used insoles and performed an exercise routine. The results of the treatments were analyzed with photogrammetry using the Alcimagem® and AutoCAD® programs. Left hindfoot posture changed after treatment in the Exercise and Insole groups (hindfoot, pre versus post <0.001). We also found that combining exercise and insoles did not alter the alignment of the feet during the study's evaluation period (customized insoles and exercises, pre versus post <0.05), which suggests that follow-up for more than four months may be needed. The left hindfoot's alignment can be changed with supervised exercises and the use of insoles.


RESUMO O objetivo deste estudo é analisar a influência do uso de palmilhas personalizadas e exercícios para perna e pés nos ângulos do antepé, retropé e arco plantar de pacientes com neuropatia causada por hanseníase. Trinta voluntários diagnosticados com hanseníase foram designados para um dos três grupos: (1) grupo exercício (n=10): realização de exercícios para pernas e pés; (2) grupo palmilha (n=10): utilização de palmilhas para corrigir o posicionamento do pé; (3) grupo palmilha e exercícios (n=10): uso de palmilhas associado a uma rotina de exercícios. O resultado dos tratamentos foi analisado por meio de fotogrametria, com os softwares Alcimagem e AutoCAD. A postura do retropé esquerdo foi modificada após o tratamento no "grupo exercício" e "grupo palmilha" (retropé, pré versus pós<0,001). Também foi observado que a combinação entre exercícios e palmilhas não alterou o alinhamento dos pés durante o período de avaliação do estudo (palmilha e exercícios, pré versus pós>0,05), o que sugere que o acompanhamento por mais de quatro meses pode ser necessário. Assim, o uso isolado de exercícios supervisionados ou de palmilhas altera o alinhamento do retropé, como aferido por fotogrametria.


RESUMEN El presente estudio tiene como objetivo analizar la influencia del uso de plantillas personalizadas y la práctica ejercicios de piernas y pies en los ángulos del antepié, del retropié y del arco plantar de pacientes con neuropatía debido a lepra. Treinta voluntarios diagnosticados con lepra fueron asignados a uno de estos tres grupos: (1) grupo de ejercicios (n=10): hacer ejercicios de piernas y pies; (2) grupo de plantillas (n=10): utilizar plantillas para corregir la posición del pie; (3) grupo de plantillas y ejercicios (n=10): utilizar plantillas asociadas con una rutina de ejercicios. Los resultados de los tratamientos se analizaron mediante fotogrametría, con los softwares Alcimagem y AutoCAD. La postura del retropié izquierdo se modificó tras el tratamiento en el "grupo de ejercicios" y en el "grupo de plantillas" (retropié, pre versus pos <0,001). También se observó que la combinación de ejercicios y plantillas no alteró la alineación del pie durante el período de evaluación del estudio (plantilla y ejercicios, pre versus pos >0,05), lo que sugiere que puede requerirse seguimiento durante más de cuatro meses. Por lo tanto, la práctica aislada de ejercicios supervisados o el uso de plantillas altera la alineación del retropié, medido por fotogrametría.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Aparelhos Ortopédicos , Doenças do Sistema Nervoso Periférico/reabilitação , Terapia por Exercício , Fotogrametria , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Pé/etiologia , Doenças do Pé/reabilitação , Hanseníase/complicações
19.
World Neurosurg ; 132: e878-e884, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31382064

RESUMO

BACKGROUND: Isolated unilateral alar ligament injury (ALI) is a very rarely diagnosed condition, with only 9 cases reported in the literature. The purpose of this study is to determine clinical, diagnostic, and biomechanical features of unilateral ALI. METHODS: A total of 6 patients diagnosed with ALI were included in this series. The hospital records and radiologic imaging of admission and follow-ups were investigated retrospectively. RESULTS: Rotation of the neck and/or hyperflexion was always present as a mechanism of injury. The patients were neurologically intact. All patients presented with mild neck pain aggravated by head rotation. On computed tomography (CT) scans, the dens was observed to be displaced to the opposite side. Magnetic resonance imaging (MRI) showed a widened lateral dens-atlas space with high signal intensity. All patients underwent lateral flexion-extension CTs for the confirmation of craniovertebral junction (CVJ) stability. The patients were treated with hard collars. The follow-up MRI of 3 patients obtained at the third month showed normal lateral dens-atlas interval and recovered ligaments. All patients were pain free after 6 months. CONCLUSIONS: Unilateral ALI appears to be more common but misdiagnosed than previously thought. Trauma mechanism consists of hyperflexion and contralateral rotation. Neck pain aggravated with rotation is the most significant clinical finding. Dens lateralization is the most important finding in CT scans. An MRI focusing on the CVJ is essential for the diagnosis. The stability of CVJ must be checked with a flexion-extension CT scan. Unilateral ALI is a stable condition and responds to conservative treatment.


Assuntos
Imobilização , Ligamentos/lesões , Lesões do Pescoço/terapia , Osso Occipital , Processo Odontoide , Aparelhos Ortopédicos , Adolescente , Adulto , Idoso de 80 Anos ou mais , Vértebra Cervical Áxis , Atlas Cervical , Criança , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Eur J Paediatr Neurol ; 23(5): 723-732, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31420131

RESUMO

OBJECTIVE: To evaluate the effect of 15° forward (FW) seat inclination and foot-support in children with cerebral palsy (CP) on postural adjustments during reaching. DESIGN: Observational study repeated-measures design; step two of two-step-project. SETTING: Laboratory unit within University Hospital and two special education schools. PARTICIPANTS: 19 children (ten unilateral spastic CP (US-CP); nine bilateral spastic CP (BS-CP); Gross Motor Function Classification System levels I-III; 6-12 years old). Participants were able to take part for one one-hour session. INTERVENTION: Reaching while sitting in four seating conditions (FW or horizontal seat; with or without foot-support) applied in randomized order. OUTCOME MEASURES: Simultaneously, surface electromyography (EMG) of neck, trunk and arm muscles and kinematics of head and reaching arm (step one of two-step-project) were recorded. Primary outcome parameters were the ability to modulate EMG-amplitudes at baseline and during reaching (phasic muscle activity). Other EMG-parameters were direction-specificity (1st control level), and 2nd level of control parameters: recruitment order, and anticipatory postural activity. Motor behaviour measures: ability to modulate EMG-amplitudes to kinematic characteristics of reaching and head stability. RESULTS: Only foot-support was associated with increased tonic background EMG-amplitudes and decreased phasic EMG-amplitudes of the trunk extensors in children with US-CP and BS-CP (mixed-models analyses; p-values <0.01). The foot-support effect was also associated with better kinematics of reaching (Spearman's Rho; p-values <0.01). CONCLUSION: In terms of postural adjustments during forward reaching, foot-support enhanced the children's capacity to modulate trunk extensor activity, which was associated with improved reaching quality. FW-tilting did not affect postural muscle activity.


Assuntos
Paralisia Cerebral/fisiopatologia , Aparelhos Ortopédicos , Postura/fisiologia , Desempenho Psicomotor/fisiologia , Fenômenos Biomecânicos , Paralisia Cerebral/reabilitação , Criança , Eletromiografia , Feminino , Humanos , Masculino
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