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1.
Medicine (Baltimore) ; 99(21): e20350, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481326

RESUMO

BACKGROUND: Previous studies have reported that extracorporeal shock wave (EPSW) combined spinal core decompression (SCD) has been used for the treatment of patients with femoral head necrosis (FHN) effectively. However, their results are still inconsistent. Therefore, this study will systematically assess the efficacy and safety of EPSW and SCD for the treatment of patients with FHN. METHODS: This study will systematically search the following databases from inception through March 1, 2020: MEDLINE, Web of Science, Scopus, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and China National Knowledge Infrastructure. All searches will be performed without language and publication date restrictions. This study will only include randomized controlled trials investigating the efficacy and safety of EPSW and SCD for the treatment of patients with FHN. Two authors will independently assess all literatures, extract data, and appraise risk of bias. Any confusion between 2 authors will be cleared up by a third author through discussion. RevMan 5.3 software will be utilized to analyze the data and to perform a meta-analysis if necessary. RESULTS: This study will summarize up-to-date evidence and provide a detailed summary related to the efficacy and safety of EPSW and SCD for the treatment of patients with FHN. CONCLUSION: This study may provide helpful evidence to determine whether or not EPSW combined SCD is effective and safety for the treatment of patients with FHN. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040092.


Assuntos
Descompressão Cirúrgica/normas , Tratamento por Ondas de Choque Extracorpóreas/normas , Necrose da Cabeça do Fêmur/cirurgia , Protocolos Clínicos , Descompressão Cirúrgica/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Cabeça do Fêmur/anormalidades , Cabeça do Fêmur/cirurgia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
2.
Medicine (Baltimore) ; 99(20): e20215, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443350

RESUMO

Hip preserving procedures are still a challenge in late-stage osteonecrosis of femoral head (ONFH) patients. We aimed to compare the clinical outcomes of surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy for treatment of ONFH in Association Research Circulation Osseous (ARCO) stage III patients.We retrospectively reviewed 30 ARCO stage III patients (33 hips) who had surgical dislocation and impaction bone graft or surgical dislocation and rotational osteotomy in our center from June 2012 to December 2017. Baseline characteristics, clinical evaluation using Harris score and radiologic evaluation up to 12 months after surgery were recorded and compared.Fifteen patients (17 hips) were in the surgical dislocation and impaction bone graft group and 15 patients (16 hips) were in the surgical dislocation and rotational osteotomy group. No significant differences in age, gender, etiology, ARCO stage, duration of illness, operation time, and length of hospitalization were observed between the 2 groups. Compared to preoperation Harris score, the Harris score of 6 months postoperation and 12 months postoperation significantly improved. At 12 months postoperation, the excellent and good rate was 76.5% in the impaction bone graft group and 87.5% in the rotational osteotomy group. No significant difference in Harris scores was detected in the 2 groups.Surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy had satisfactory 1-year efficacy for ARCO III ONFH patients. Surgical dislocation and rotational osteotomy had better short-term efficacy than surgical dislocation and impaction bone graft.


Assuntos
Necrose da Cabeça do Fêmur/cirurgia , Fratura-Luxação/cirurgia , Osteotomia/efeitos adversos , Adulto , Transplante Ósseo/métodos , Feminino , Cabeça do Fêmur/lesões , Cabeça do Fêmur/fisiopatologia , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Estudos Retrospectivos , Resultado do Tratamento
4.
Acta Chir Orthop Traumatol Cech ; 87(2): 82-89, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32396507

RESUMO

PURPOSE OF THE STUDY The purpose of the study is to share the first experience of authors with the management of glenoid defects by a bone graft in reverse total shoulder arthroplasty. MATERIAL AND METHODS Evaluation of 7 patients was conducted, who underwent reverse total shoulder arthroplasty at the authors' department. Due to the presence of glenoid bone defect, augmentation was performed by bone graft, obtained either as an autograft harvested from the humeral head of the patient intraoperatively or as an allograft from the femoral head from the bone tissue bank. In all the implantations, a glenoid component with an extra-long "revision" peg was used. Postoperative fixation was secured only by a shoulder brace. Limited rehabilitation was commenced on the first postoperative day, full rehabilitation 5 weeks after the surgery. RESULTS The total ASES Shoulder Score increased from the mean 39.8 preoperatively to 75.2 postoperatively. Also, the overall range of motion improved, with the preoperative ventral flexion increasing from the mean 65.5° to 135.2°, abduction increasing from 63.9° preoperatively to 127.7° postoperatively, and external rotation increasing from 27.4° preoperatively to 45.1° postoperatively. In the evaluated group, 2 complications were observed, namely 1 case of bone graft breakage intraoperatively, necessitating the harvesting of a new bone graft, and 1 case of postoperative paresthesia of the fourth and the fifth finger, which completely disappeared within 4 months after the surgery. In the group of followed-up patients, no loosening of endoprosthetic components has so far been reported. DISCUSSION Glenoid defect constitutes one of the problems that need to be dealt with by the surgeon during the reverse total shoulder arthroplasty, most often it is accompanied by glenoid retroversion. The basic approach to defect management is to use the eccentric reaming technique which is, however, limited by the size of glenoid retroversion and can also worsen the already present glenoid medialization, with all the resulting consequences. Another option is to use solid bone grafts to correct glenoid version and simultaneously to lateralize the glenoid component. Yet another option is to use the prefabricated glenoid augments that are, however, not commonly available in the Czech market. CONCLUSIONS The short-term clinical outcomes of patients, in whom glenoid defect was during the reverse total shoulder arthroplasty managed by bone grafts, are very good. Radiological signs of bone-to-graph incorporation were present in all the patients of the followed-up group. Nonetheless, for the sake of evaluation of this method, more patients shall be included in the group and a longer follow-up is needed for their evaluation. Key words: reverse total shoulder arthroplasty, glenoid bone loss, glenoid retroversion, augmented implant.


Assuntos
Artroplastia do Ombro/métodos , Transplante Ósseo/métodos , Escápula/cirurgia , Articulação do Ombro/cirurgia , Cabeça do Fêmur/transplante , Humanos , Cabeça do Úmero/transplante , Amplitude de Movimento Articular , Estudos Retrospectivos , Transplante Autólogo , Transplante Homólogo , Resultado do Tratamento
5.
PLoS One ; 15(4): e0231001, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32251468

RESUMO

Whether borderline hip dysplasia is pathologic remains unclear. In order to evaluate the three-dimensional joint congruity, this study sought to answer the question: are borderline dysplastic hip curvature mismatch and eccentricity between the acetabulum and the femoral head different from dysplastic or control hips three-dimensionally? The 113 hips, categorized as: dysplastic (LCEA ≤ 20°), 47 hips; borderline (20° ≤ LCEA < 25°), 32 hips; and control (25° ≤ LCEA < 35°), 34 hips; were evaluated. Three-dimensional (3D) femoral and coxal bone models were reconstructed from CT images. Using a custom-written Visual C++ routine, the femoral head and acetabular radii of curvature, and the femoral head and the acetabular curvature center were calculated. Then the ratio of the acetabular radius to the femoral head radius (3D curvature mismatch ratio), and the distance between the acetabular curvature center and the femoral head center (3D center discrepancy distance) were calculated. These indices were compared statistically among the three groups using Tukey's post hoc test. The mean 3D curvature mismatch ratio in the borderline (1.13 ± 0.05) was smaller than in the dysplasia (1.23 ± 0.08, p < 0.001), and larger than in the control (1.07 ± 0.02, p < 0.001). The mean 3D center discrepancy distance in the borderline (3.2 ± 1.4 mm) was smaller than in the dysplasia (4.8 ± 2.3, p < 0.001) and larger than in the control (1.6 ± 0.7, p < 0.001). These results demonstrated that three-dimensional congruity of the borderline dysplastic hip is impaired, but its incongruity is not as severe as in dysplastic hips. The 3D curvature mismatch ratio and the 3D center discrepancy distance can be valuable signs of joint congruity in patients with borderline dysplasia. However, future studies are necessary to clarify any associations between curvature mismatch and pathogenesis of osteoarthritis in borderline dysplasia.


Assuntos
Acetábulo/patologia , Cabeça do Fêmur/patologia , Luxação do Quadril/patologia , Acetábulo/diagnóstico por imagem , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Tomografia Computadorizada por Raios X , Adulto Jovem
6.
Georgian Med News ; (298): 21-27, 2020 Jan.
Artigo em Russo | MEDLINE | ID: mdl-32141842

RESUMO

Avascular necrosis of the femoral head is a multifactorial disease with progressive development of severe secondary coxarthrosis. There are two types of necroses - secondary and idiopathic. The pathogenesis of necrosis is associated with local blood circulation disorders, coagulopathies and violation of bone tissue regeneration. Usage of Steroids is one of the most often and important causes of non-traumatic osteonecrosis of the femoral head. Postulated pathogenetic mechanisms of steroid-induced osteonecrosis (ON) of the femoral head includes fat cell hypertrophy, fat emboli and intravascular coagulation. MRI stays the main diagnostic method for detection of osteonecrosis in the early stages. Preservation of the native hip is the goal of treatment in young and active patients. Early diagnosis and intervention prior to collapse of the femoral head is the key to a successful outcome of joint preserving procedures. There are no specific biomarkers for diagnostic of ON and NO "golden standard" for its treatment, and frequently a multidisciplinary approach becomes necessary. Joint replacement procedure remains as a main method of treatment after failure of joint preserving procedures and in cases of the late-stages of ON, involving collapse of the femoral head and degenerative changes of the acetabulum. More recent reports of hip replacement surgeries while osteonecrosis of the femoral head, have shown excellent results, but implant longevity and following revision surgeries, still remain an outstanding problem. In this article, there is described one of the latest clinical cases of the steroid induced avascular necroses of femoral head, which took place in our clinic. Positive clinical outcome, that means full physical and social rehabilitation of the patient, treated by total hip replacement confirms effectiveness of this method in treatment of above mentioned pathology.


Assuntos
Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Imagem por Ressonância Magnética , Esteroides/efeitos adversos , Artroplastia de Quadril , Cabeça do Fêmur , Necrose da Cabeça do Fêmur/cirurgia , Humanos , Osteoartrite , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Esteroides/uso terapêutico
7.
Klin Lab Diagn ; 65(3): 174-178, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32163692

RESUMO

The pathology of the hip joints in children is the object of increased attention of specialists both in our country and abroad. Despite the wide coverage of this problem, most studies are devoted to analysis of the advantages of various surgical intervention technologies. To determine the significance of differences in hemogram indices in children with different nosological forms of hip joint pathology and indicators of healthy children. Hemogram and leukoformula parameters were determined in 10 healthy children and 47 children with hip joint pathology. The significance of differences in indicators compared with the norm and between different nosological groups of patients was evaluated. The dynamics of hemogram changes was evaluated at a long time after surgery. The largest deviations from normal hemogram values were found in a group of children with hip dysplasia complicated by aseptic necrosis of the femoral head. Two months after surgery, the main hemogram parameters in all groups of patients are normalized. The reactions of lipid peroxidation are changing, as evidenced by a decrease in the number of peroxidation products, primarily diene conjugates. Along with this, the activity of individual antioxidant enzymes changes - the activity of catalase decreases and the activity of superoxide dismutase increases. The most extreme values were noted in the group of children with epiphyseal dysplasia. In children with hip dysplasia complicated by aseptic necrosis of the femoral head, prior to surgical treatment, a statistically significant increase in the number of leukocytes and platelets in the blood serum is observed. In patients with epiphyseal dysplasia, osteochondropathy, both in the early and late stages, changes in the hemogram indices relate to the indicators of red blood cells and hemoglobin. In children with aseptic necrosis of the femoral head, hemogram values did not have statistically significant differences from the norm. In all groups of patients, destabilization of the peroxidation and antioxidant defense systems was noted.


Assuntos
Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/cirurgia , Técnica de Ilizarov , Catalase/sangue , Criança , Cabeça do Fêmur/patologia , Luxação Congênita de Quadril/sangue , Articulação do Quadril/patologia , Humanos , Peroxidação de Lipídeos , Superóxido Dismutase/sangue
8.
Br J Radiol ; 93(1110): 20190039, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32142363

RESUMO

OBJECTIVE: Femoroacetabular impingement (FAI) and hip dysplasia are the most common causes of groin pain originating from the hip joint. To date, there is controversy over cut-off values for the evaluation of abnormal femoral head-neck anatomy with significant overlap between the normal and abnormal hips. Our aim was to perform three-dimensional CT analysis of femoral head and bump anatomy to quantify common hip pathologies (FAI and hip dysplasia) vs controls. METHODS: Consecutive patients who underwent three-dimensional CT imaging for hip dysplasia or CAM type FAI were compared to asymptomatic controls. α angles on radial CT and 3D volumetric femoral head and bump segmentations were performed by two readers. Inter- and intrapatient comparisons were performed including interreader and receiver operating characteristic analyses. RESULTS: 25 FAI patients, 16 hip dysplasia patients and 38 controls were included. FAI and dysplasia patients exhibited higher α angles and higher bump-head volume ratios than the controls (p < 0.05). Larger bump volumes were found among FAI than dysplasia patients and contralateral hips of FAI patients were also different than the controls. α angle at 2 o'clock and bump to head ratio showed the highest area under the curve for patients vs controls. The interreader reliability was better for volumetric segmentation (intraclass correlation coefficient = 0.35-0.84) as compared to the α angles (intraclass correlation coefficient = 0.11-0.44). CONCLUSION: Patients with FAI and dysplasia exhibit different femoral head anatomy than asymptomatic controls. Volumetric segmentation of femoral head and bump is more reliable and better demonstrates the bilateral femoral head anatomy differences in hip patients vs controls. ADVANCES IN KNOWLEDGE: Utilizing information from 3D volumetric bump assessment in patients with FAI and dysplasia, the physicians may be able to more objectively and reliably evaluate the altered anatomy for better pre-surgical evaluation.


Assuntos
Impacto Femoroacetabular/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Colo do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Imageamento Tridimensional/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Curva ROC , Estudos Retrospectivos , Adulto Jovem
9.
West Afr J Med ; 37(2): 173-177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150636

RESUMO

BACKGROUND: Proximal femoral surgeries involving femoral head replacement are common procedures worldwide. In these patients, the femoral heads are replaced with femoral head prosthetic implants. Pre-operative planning to determine the likely size of the prosthetic implant is important. Estimation from radiographs is the commonest method being used but this is fraught with problems. This study, therefore, developed an alternative method that can be used to estimate the femoral head size prior to hemiarthroplasty. MATERIALS AND METHODS: This was a prospective descriptive study that involved measurements of parts of femoral bone. Forty-eight adult femoral bones were measured. Measurements taken were the femoral head size (FH), the femoral bone maximum length (ML), the trochanteric length of the femur (TL), and the distal femoral breadth (DFB) of the femur. All measurements obtained were recorded and were analyzed using STATA version 13 (StataCorp, Texas, USA). RESULTS: The maximum length of the femora ranged from 42.1 cm to 51.5 cm. The trochanteric length ranged from 39 cm to 48.3 cm. The distal femoral breadth ranged from 53.8 mm to 92.3 mm. The femoral head size ranged from 39 mm to 55 mm with a mean value of 46.6 ± 2.9 mm. An equation was generated using the trochanteric length. Femoral head size = 16 + 0.7(trochanteric length in centimeter) ± 5 mm. This will provide a range of possible femoral head prostheses that should be made available for the surgery. CONCLUSION: This study generated an alternate method to be used during the pre-operative planning of a femoral head replacement surgery. It provides the possible range of prosthetic implants sizes to be made available for such surgeries. The trochanteric length can be easily measured. The method described will be of great benefit in middle and low income countries where prosthetic implants are not usually stocked within the hospital.


Assuntos
Antropometria/métodos , Cabeça do Fêmur/anatomia & histologia , Adulto , Artroplastia de Quadril , Fraturas do Quadril/cirurgia , Prótese de Quadril , Humanos , Estudos Prospectivos
10.
Zhonghua Yi Xue Za Zhi ; 100(7): 546-551, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32164109

RESUMO

Objective: To analyze the wear debris characteristics ofcarbon-based nano- multilayer coatings on Ti(6)Al(4)V alloys and compared with the cobalt chromium molybdenum alloy (CoCrMo) femoral head to evaluate the friction and wear performance of the new coated femoral head. Methods: Three groups were set up in the wear simulation experiment according to the type of femoral head. Group A: imported Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo); group B: Titanium alloy femoral head (Ti(6)Al(4)V) with carbon-based nano-multilayer coatings; group C: domestic Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo). All heads were jointed with an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Serum samples were collected and stored in the hip joint simulator. After the sample has been digested and diluted, it was filtered through 5 µm, 1.2 µm and 0.4 µm filters, and the filter paper was collected for testing. Scanning electron microscope (SEM) was used to randomly select regions on the filter to obtain images of wear debris. Energy dispersive X-ray spectroscopy (EDS) was used to determine the elemental type of the particle and to eliminate possible contamination. The composition and structure of the abrasive chips were measured using Fourier transform infrared spectrometer (FTIR). The parameters related to the wear debris includingparticle size, shape, number and volume were calculated. The differences in correlation parameters between the groups were compared to evaluate the friction and wear properties of the new coated joints. Results: The main component of the wear debris produced was UHMWPE, and the particle size was mostly below 1 µm. The submicron particle ratio of group B was 49.4%, which was significantly lower than that of the group A and C (75% and 60%, respectively; χ(2)=66.032, 31.754, both P<0.017). The shape was mainly round, and there was no statistical difference between the groups (χ(2)=0.590, P=0.744). The number of particles in group B was significantly less than that of group C on all filters (t=9.960, 8.019, 5.790, all P<0.01), and less than group A on the 0.4 µm filter (t=7.810, P=0.000). Conclusion: The frictional wear performance of the new carbon-based nano-multilayer coatings femoral head is significantly better than that of the domestic femoral head, and even partially exceeds the imported femoral head level, which helps to reduce the production of particles and prevent osteolysis and aseptic loosening induced by UHMWPE particles.


Assuntos
Cabeça do Fêmur , Prótese de Quadril , Ligas , Carbono , Humanos , Teste de Materiais , Falha de Prótese , Titânio
11.
BMC Infect Dis ; 20(1): 202, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143583

RESUMO

BACKGROUND: Brucellosis is a zoonotic infection transmitted from infected animals to humans, osteonecrosis of the femoral head (ONFH) is a devastating disease that affects patients' life with pain, dysfunction of walking and always lead to total hip arthroplasty (THA). We presented a case of ONFH which was very likely due to the infection of Brucella spp. CASE PRESENTATION: The patient was a 49 years-old male who was a herder living in Inner Mongolia, the northern part of China. He first showed recurrent fever then presented bilateral hip pain, which was confirmed to be brucellosis and ONFH on the right side of the hip. He was admitted to our center showed bilateral ONFH with the restrictive movement of both hips. We performed THA after it was confirmed that the infection has been cured. The patient can walk with the help of the walker the second day after surgery. CONCLUSION: Brucellosis is still a common epidemic disease worldwide, which can lead to many complications, brucellosis arthritis is the most common complication of Brucellosis. Osteonecrosis of the femoral head can also present in the patients with brucellosis. All the patients presented with recurrent fever and hip pain, who is from the epidemic region, should be taken both septic arthritis and ONFH into consideration.


Assuntos
Brucelose/diagnóstico , Necrose da Cabeça do Fêmur/diagnóstico , Antibacterianos/uso terapêutico , Artroplastia de Quadril , Brucelose/complicações , Brucelose/tratamento farmacológico , China , Doxiciclina/uso terapêutico , Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rifampina/uso terapêutico
12.
Surg Technol Int ; 36: 347-350, 2020 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-32043532

RESUMO

INTRODUCTION: Transtrochanteric anterior rotational osteotomy (ARO) is an established joint-preserving surgery for collapsed osteonecrosis of the femoral head (ONFH) in which the collapsed necrotic lesion is rotated anteriorly. Recently, preoperative collapse of more than 2.98mm was reported to be the most influential factor for progressive collapse of the anteriorly transposed necrotic lesion after ARO, the main cause of secondary osteoarthritic changes and clinical failure. We attempted to prevent progressive collapse with re-sphericalization of the collapsed femoral head using calcium phosphate cement (CPC) filling in conjunction with ARO. MATERIALS AND METHODS: Between May 2015 and April 2018, five consecutive hips with ONFH, femoral head collapse of ³3mm, and one-third or more of the posterior region of the femoral head intact, were prospectively recruited for re-sphericalization with ARO. This report describes intraoperative surgical techniques focusing on re-sphericalization of the collapsed femoral head using CPC and short-term effects of this additional procedure on progressive collapse of the transposed necrotic lesion, defined as ³2mm progression on lateral radiographs. RESULTS: After anterior rotation of the proximal fragment, followed by fixation of the transtrochanteric osteotomy site, a 5mm fenestration was made in the collapsed region of the anterior femoral head cartilage, through which the collapsed surface was carefully lifted with an elevatrium. Subsequently, CPC paste was injected into the lifted subchondral space with a small needle. After CPC paste injection, the femoral head was maintained at 40°C for 10 minutes to promote solidification of the CPC paste. With the re-sphericalization method, the mean level of collapse decreased from 4.1mm before surgery to 2.0mm after surgery. Subsequently, progressive collapse of the transposed necrotic lesion was confirmed in two hips. One of these hips had a deep infection that required complete curettage of CPC three weeks after the initial surgery. All hip joints have been preserved without conversion to prosthesis during a mean follow up of 2.1 years. CONCLUSION: A joint-preserving procedure for ONFH with severe collapse remains a challenging problem for surgeons. When ARO is indicated based on one-third or more of the posterior region of the femoral head being intact, the current re-sphericalization method could be worth considering as an additional procedure in cases with severe collapse.


Assuntos
Necrose da Cabeça do Fêmur , Cabeça do Fêmur , Fosfatos de Cálcio , Seguimentos , Humanos , Osteotomia
13.
Unfallchirurg ; 123(5): 413-418, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32060596

RESUMO

A 50-year-old male suffered a crash landing while paragliding and sustained a posterior dislocation of the hip with a Pipkin fracture type 4 (fracture of the posterior acetabular wall and Pipkin fracture type 2) and a lesion of the sciatic nerve. After primary treatment in an external hospital, the patient was transferred to this hospital 4 days following the trauma. An operative stabilization of the acetabular fracture and the Pipkin fracture was performed using a trochanter flip osteotomy. Despite a large central defect of the femoral head it was decided to attempt a reconstruction. Following fixation of the Pipkin fragment an autologous bone graft harvested from the intertrochanteric region was used to fill the defect. Subsequently, a collagen matrix was applied onto the filled defect and a perineural adaptation of the sciatic nerve was performed.


Assuntos
Luxação do Quadril , Fraturas do Quadril , Acetábulo , Cabeça do Fêmur , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Isquiático , Resultado do Tratamento
14.
Instr Course Lect ; 69: 129-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017724

RESUMO

Osteonecrosis of the femoral head is characterized by reduced intraosseous blood flow to the subchondral bone. The management of early osteonecrosis usually involves joint preservation procedures to provide pain relief, prevent disease progression, and avoid joint replacement. A thorough clinical evaluation is crucial to identify at-risk patients and allow early intervention with joint preservation. The decision to use one joint preserving method over another is dependent on staging and patient characteristics. Surgeons should have a thorough understanding of the available joint preservation procedures to help determine the optimal treatment modality for their patients.


Assuntos
Necrose da Cabeça do Fêmur , Cabeça do Fêmur , Humanos , Osteonecrose
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 206-212, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030953

RESUMO

Objective: To explore the effect of icariin on early steroid-induced osteonecrosis of the femoral head in rabbits. Methods: Fifty mature New Zealand rabbits (weighing, 2.5-3.0 kg) were randomly divided into control group ( n=10), model group ( n=20), and experimental group ( n=20). The rabbits of model and experimental groups were injected with lipopolysaccharide and methylprednisolone to establish the animal model of early steroid-induced osteonecrosis of the femoral head. The rabbits of experimental group were feeded with icariin solution once a day for 6 weeks since the first injection of methylprednisolone, whereas the rabbits of control and model groups were given normal saline at the same time points. The left femoral heads were removed after 6 weeks and gross morphological features were evaluated. Micro-CT scan was performed to analyze the trabecular microstructure with the following parameters: trabecular bone volume to total volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Tn), and trabecular separation (Tb.Sp). The Micro-CT scan was also converted to three-dimensional reconstruction images for observation. HE staining was applied to observe the trabecular structure and morphological changes of osteocytes and marrow adipocytes. It was also used to determine whether the samples of femoral heads occurred osteonecrosis based on the criteria for pathological diagnosis, and calculate the rate of empty lacunae. Results: Seven rabbits died during the study, and 9, 16, and 18 rabbits in the control, model, and experimental groups, respectively, enrolled the final analysis. Compared with control group, the femoral head collapse and trabecular breaks were more obvious, and the trabeculae were sparse with irregular arrangement in the model group according to the results of gross observation, Micro-CT scan, and three-dimensional reconstruction images. But in the experimental group, the surface of femoral head was slight shrinking without obvious collapse, and the degeneration of trabecular structure was mild. According to bone microstructures analysis, the Tb.N, Tb.Tn, and BV/TV of femoral head in model and experimental groups were lower than those in control group, while the Tb.Sp in the model and experimental groups were significantly higher. The Tb.N, Tb.Tn, and BV/TV of femoral head in experimental group were higher than those in model group, while the Tb.Sp in the experimental group was significantly lower. The differences between groups were all significant ( P<0.05). In the model group, HE staining showed that the number of osteocytes reduced, the number of empty lacunae increased, and the marrow adipocytes piled up in the space between femoral trabeculae, some even mashed together like a cyst. In the experimental group, the trabecular structure was still relatively complete compared with model group, no obvious apoptosis of osteocytes was observed, the size and number of adipocytes were basically normal. None of the animals in control group occurred osteonecrosis of the femoral head based on the criteria for pathological diagnosis, and the incidence of osteonecrosis were 81.3% (13/16) in the model group and 66.7% (12/18) in the experimental group, and the difference was not significant ( P=0.448). The rate of empty lacunae of osteonecrotic femoral heads in the model group was 33.1%±1.4%, which was higher than that in experimental group (18.9%±0.8%) and in control group (12.7%±1.5%), and the differences between groups were significant ( P<0.05). Conclusion: The icariin has a protective effect on the early steroid-induced osteonecrosis of the femoral head in rabbits, which can decrease osteocytes apoptosis, improve the bone microstructure, and delay such disease processes.


Assuntos
Cabeça do Fêmur , Animais , Modelos Animais de Doenças , Necrose da Cabeça do Fêmur , Flavonoides , Metilprednisolona , Coelhos
16.
J Pediatr Orthop ; 40(2): 86-92, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923168

RESUMO

BACKGROUND: Traumatic posterior hip dislocations in children and adolescents requires emergent closed reduction. Postreduction imaging is necessary to assess the concentricity of reduction and structural injuries to the hip. There is no a consensus for which imaging is a modality of choice in such condition. The purposes of this study are to describe magnetic resonance imaging (MRI) findings of traumatic posterior hip dislocations and to compare the effectiveness of MRI with computerized tomography (CT) in detecting structural abnormalities of the hip that impact patient management. METHODS: This study is a retrospective review of imaging in traumatically dislocated hips in patients who were treated at our institution. All CT and MRI imaging were reviewed and specific osseous and soft tissue injuries documented by consensus among 2 musculoskeletal pediatric radiologists who interpreted the MRI and CT scans of each patient in a blinded manner. RESULTS: In total, 27 patients (23 males, 4 females) with mean age of 12.5 years (range, 2 to 19 y) with postreduction MRI were evaluated. MRI findings revealed femoral head injuries in 17 (62.9%), posterior labral entrapments in 6 (22.2%), posterior labral tears in 17 (62.9%), posterior wall fractures in 15 (55.5%), fracture of the posterior unossified part of acetabulum in 4 (14.8%), and ligamentum teres injuries in 8 (29.6%). Of 16 patients who had postreduction CT scans, 6 (37.5%) had femoral head fractures, 9 (56.3%) had posterior wall fractures, and 8 (50%) had intra-articular osseous entrapments. All bony fractures and intra-articular entrapment could be seen on MRI imaging. In 16 patients with both CT and MRI, posterior acetabular injury was detected in 10/16 (62.5%) on MRI and 9/16 (56.3%) on CT. Three patients with entrapment of labrums identified on MRI could not be seen on CT scan. One patient with persistently unstable hip after reduction had an entrapped unossified portion of acetabular fracture which was seen on MRI but not on CT. CONCLUSIONS: MRI is superior to CT scan for detection of structural injuries in children and adolescents with traumatic hip dislocation. The unique structural injuries included entrapment of posterior labrum and posterior unossified acetabular fractures could be seen only at MRI. These findings will impact surgical decision making of these injuries. LEVEL OF EVIDENCE: Level IV.


Assuntos
Acetábulo/diagnóstico por imagem , Fraturas do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Acetábulo/lesões , Adolescente , Criança , Pré-Escolar , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/lesões , Luxação do Quadril/terapia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Ligamentos Redondos/lesões , Lesões dos Tecidos Moles/diagnóstico por imagem , Adulto Jovem
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 57-62, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939236

RESUMO

Objective: To observe the volume and distribution of necrotic tissue of femoral head in steroid-induced osteonecrosis of femoral head (SONFH) patients by three-dimensional reconstruction of CT. Methods: A clinical data of 25 patients with SONFH between September 2016 and December 2018 was analyzed. There were 22 males and 3 females, with an average age of 38.8 years (range, 20-63 years). The necrosis of the femoral head was in stage Ⅱ of Association Research Circulation Osseous (ARCO). The disease duration ranged from 3 to 18 months, with an average of 9.2 months. A three-dimensional reconstruction with CT data of SONFH patients were performed by Mimics Research 21.0 software and the femoral head was segmented into eight regions by 3-matic Research 13.0 software. The volume of necrotic tissue of the femoral head and the volume rate of necrotic tissue to femoral head were calculated and the distribution was also analyzed. Results: The three-dimensional digital model of the femoral head showed that the necrotic tissue of the femoral head was located above the anterior superior medial, and the area of the necrotic tissue was in a dome-like shape. The results showed that the necrotic tissue in the femoral head was mainly concentrated on the anterior superior internal area, the anterior superior outer area, and the posterior superior internal area. The volume of femoral head was (48 399.52±9 408.90) mm 3, and the volume of necrotic tissue was (20 917.08±6 566.94) mm 3, and the volume ratio of necrotic tissue to femoral head was 44.75%±15.72%. The proportion of necrotic volume in different regions was different, and the necrotic tissues were mainly distributed in the anterior superior internal area, the anterior superior outer area, and the posterior superior internal area. Conclusion: The volume and distribution of necrotic tissue in femoral head can be evaluated quickly and intuitively by three-dimensional reconstruction of CT in Mimics software.


Assuntos
Necrose da Cabeça do Fêmur , Cabeça do Fêmur , Adulto , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
Acta Orthop ; 91(2): 197-202, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31711345

RESUMO

Background and purpose - There are few studies on overgrowth of the affected limb after treatment of developmental dysplasia of the hip (DDH). We investigated the incidence of overgrowth and its risk factors in DDH patients.Patients and methods - 101 patients were included in this study. Overgrowth was defined by 2 criteria: when the height of the femoral head of the affected side was higher than that of the contralateral side by more than 10 mm, or by more than 15 mm. The potential risk factors of distinct overgrowth were retrospectively examined using multivariable analysis.Results - When overgrowth was defined as femoral head height difference (FHHD) > 10 mm, its incidence was 44%, and only femoral osteotomy was identified as a significant risk factor with a relative risk (RR) of 1.6 (95% confidence interval [CI] 1.0-2.5). When overgrowth was defined as FHHD > 15 mm, its incidence was 23%, and femoral osteotomy was identified as the only significant risk factor with an RR of 2.3 (CI 1.2-4.5). Overgrowth developed more frequently in patients who underwent femoral osteotomy at the age of 2 to 4 years (87%) than in the others (46%) (p = 0.04).Interpretation - Overgrowth of the affected limb is common in DDH patients. Patients who underwent femoral osteotomy, especially at the age of 2 to 4 years, may require careful follow-up because of the substantial risk for overgrowth.


Assuntos
Cabeça do Fêmur/patologia , Luxação Congênita de Quadril/cirurgia , Desigualdade de Membros Inferiores/etiologia , Osteotomia/efeitos adversos , Pré-Escolar , Feminino , Fêmur/cirurgia , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/crescimento & desenvolvimento , Seguimentos , Humanos , Incidência , Lactente , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/patologia , Masculino , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Fatores de Risco
19.
Arch Orthop Trauma Surg ; 140(1): 129-137, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31696320

RESUMO

INTRODUCTION: While numerous classifications of hip arthritis have been proposed, none considered the magnitude and direction of femoral head translation relative to the native acetabulum. A more precise classification of architectural hip deformities is necessary to improve preoperative templating and anticipate surgical challenges of total hip arthroplasty (THA). The purpose of the present study was to introduce a classification system to distinguish different types of architectural hip deformities, based on femoral head translation patterns, and to evaluate its repeatability using plain radiographs (qualitative) and Computed Tomography (CT) measurements (quantitative). MATERIALS AND METHODS: We studied pre-operative frontal and lateral hip radiographs and CT scans of 191 hips (184 patients) that received primary THA. The distance between the femoral head center (FC) and the acetabular center (AC) was measured, as well as femoral offset, acetabular offset, head center height, acetabular floor distance and femoral neck angle. The hips were classified qualitatively using frontal plain radiographs, and then quantitatively using CT scans (with an arbitrary threshold of 3 mm as Centered, Medialized, Lateralized, Proximalized or Proximo-lateralized. The agreement between qualitative and quantitative classification methods was compared for applying the same classification. RESULTS: Qualitative classification identified 120 centered (63%), 8 medialized (4%), 49 lateralized (26%), 3 proximalized (2%), and 11 proximo-lateralized (6%) hips, while quantitative classification identified 116 centered (61%), 8 medialized (4%), 51 lateralized (27%), 5 proximalized (3%), and 11 proximo-lateralized (6%) hips. The agreement between the two methods was excellent (0.94; CI 0.90-0.98). Medialization reached 9.7 mm, while lateralization reached 10.9 mm, and proximalization reached 8.5 mm. Proximalized and proximo-lateralized hips had more valgus necks, while medialized hips had more varus necks (p = 0.003). CONCLUSIONS: The classification system enabled repeatable distinction of 5 types of architectural hip deformities. The excellent agreement between quantitative and qualitative methods suggests that plain radiographs are sufficient to classify architectural hip deformities.


Assuntos
Acetábulo , Artroplastia de Quadril/métodos , Cabeça do Fêmur , Articulação do Quadril , Artropatias , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Estudos de Coortes , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Artropatias/classificação , Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Cuidados Pré-Operatórios , Radiografia , Tomografia Computadorizada por Raios X
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