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1.
Medicine (Baltimore) ; 98(44): e17857, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689878

RESUMO

The aim of this study was to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) in Kambin triangle approach for the treatment of osteoporotic vertebral compression fractures (OVCFs).Between November 2017 and September 2018, 109 patients (144 vertebral bodies) with OVCFs, with a mean age of 76.7 ±â€Š9.9 years (55-96 years), underwent PVP in Kambin triangle approach. The time of operation, the volume of bone cement, the incidence of complication, the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score, the position of puncture needles, and the spread of polymethylmethacrylate (PMMA) in vertebral body (VB) were recorded.All patients had been completed the operation successfully and were followed up 9.1 ±â€Š2.9 months. The average operation time of each VB was 24.0 ±â€Š3.5 minutes. The average volume of cement was 4.8 ±â€Š0.6 ml. The mean VAS scores were 8.4 ±â€Š0.7 preoperatively, 1.6 ±â€Š0.6 at the first day postoperatively, and 1.2 ±â€Š0.6 at the last follow-up. The mean ODI scores were 70.97 ±â€Š7.73 preoperatively, 27.99 ±â€Š4.12 at the first day postoperatively, and 19.65 ±â€Š3.49 at the last follow-up. The position of puncture needles in the VB was: 119 vertebral puncture needles reached the midline, 15 were close to the midline, and 10 exceeded the midline. The spread of PMMA in the VB was: type 1 in 81 levels (56.3%), type 2 in 37 (25.7%), type 3 in 18 (12.5%), type 5 in 8 (5.5%), and no case in type 4. One case developed pneumothorax after operation. No other complications (hematoma, cement embolism, spinal cord, and nerve injury) occurred.Kambin triangle approach in PVP, which can deliver the puncture needle to the midline of VB easily and with excellent cement distribution, is a safe and effective method.


Assuntos
Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Polimetil Metacrilato , Complicações Pós-Operatórias , Estudos Retrospectivos , Vertebroplastia/efeitos adversos
2.
Bone Joint J ; 101-B(11): 1331-1347, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674244

RESUMO

AIMS: Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients. MATERIALS AND METHODS: Data from the National Joint Registry (NJR) of England and Wales were obtained for all primary cemented TKAs between March 2003 and July 2016. Patient, implant, and surgical variables were analyzed. Cox proportional hazards models were used to assess the influence of ALBC on risk of revision. Body mass index (BMI) data were available in a subset of patients. RESULTS: Of 731 214 TKAs, 15 295 (2.1%) were implanted with plain cement and 715 919 (97.9%) with ALBC. There were 13 391 revisions; 2391 were performed for infection. After adjusting for other variables, ALBC had a significantly lower risk of revision for any cause (hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77 to 0.93; p < 0.001). ALBC was associated with a lower risk of revision for all aseptic causes (HR 0.85, 95% CI 0.77 to 0.95; p < 0.001) and revisions for infection (HR 0.84, 95% CI 0.67 to 1.01; p = 0.06). The results were similar when BMI was added into the model, and in a subanalysis where surgeons using only ALBC over the entire study period were excluded. Prosthesis survival at ten years for TKAs implanted with ALBC was 96.3% (95% CI 96.3 to 96.4) compared with 95.5% (95% CI 95.0 to 95.9) in those implanted with plain cement. On a population level, where 100 000 TKAs are performed annually, this difference represents 870 fewer revisions at ten years in the ALBC group. CONCLUSION: After adjusting for a range of variables, ALBC was associated with a significantly lower risk of revision in this registry-based study of an entire nation of primary cemented knee arthroplasties. Using ALBC does not appear to increase midterm implant failure rates. Cite this article: Bone Joint J 2019;101-B:1331-1347.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia do Joelho/métodos , Cimentos para Ossos , Prótese do Joelho/efeitos adversos , Adulto , Idoso , Anticoagulantes/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Tromboembolia/prevenção & controle , Resultado do Tratamento
3.
Braz Oral Res ; 33: e092, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31576904

RESUMO

This study evaluated the effect of antimicrobial photodynamic therapy (aPDT) on the endodontic treatment of apical periodontitis (AP). AP was induced in 48 premolars of 6 dogs. After biomechanical preparation, the teeth were divided into 4 groups: Calcium-Hydroxide (CH)/120d and CH/180d: root canals filled with CH-based dressing for 15 days before obturation; aPDT/120d and aPDT/180d: conditioning with phenothiazine photosensitizer (10 mg/mL) for 1 minute and irradiation with diode laser in the same session as obturation. Root filling was performed with AH Plus sealer. After the experimental periods, animals were euthanized and teeth were submitted for histology. HE staining was performed for descriptive analysis of the periapical region, measurement of apical periodontitis and for inflammatory cells, and blood vessels count. Immunohistochemistry was performed for osteopontin (OPN) and alkaline phosphatase (ALP). Data were analyzed statistically by two-way ANOVA and chi-square test (α = 5%). Teeth in Group CH/120d presented only a slightly enlarged periodontal ligament (PL) with advanced repair. Group aPDT/120d presented the PL moderately enlarged, with moderate inflammatory infiltrate and few collagen fibers. The same pattern was observed at 180 days. AP lesions in CH-treated groups were smaller than those in aPDT-treated groups (p < 0.001) with more blood vessels (p < 0.0001), regardless of the evaluation period, without significant differences in the number of inflammatory cells (p > 0.05). CH-treated groups showed significantly more intense immunostaining for ALP and OPN (p < 0.001) in both periods. Although aPDT stimulated angiogenesis and expression of bone formation markers, the two-session endodontic treatment with CH-based dressing promoted better apical periodontitis repair.


Assuntos
Cimentos para Ossos/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Periodontite Periapical/tratamento farmacológico , Fotoquimioterapia/métodos , Tratamento do Canal Radicular/métodos , Animais , Vasos Sanguíneos/efeitos dos fármacos , Regeneração Óssea/efeitos dos fármacos , Imuno-Histoquímica , Neovascularização Fisiológica/efeitos dos fármacos , Periodontite Periapical/patologia , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(41): e17547, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593135

RESUMO

RATIONALE: Leakage of bone cement from femoral medullary cavity is a rare complication after hip arthroplasty, and there is no report on the leaked bone cement entering into iliac vessels. PATIENT CONCERNS: An 89-year-old woman presented with a fracture in the right femoral neck. She had well-fixed right femoral head replacement after careful preoperative examinations, and no adverse reactions appeared. She was able to get off bed to walk at the 2nd day after surgery. DIAGNOSES: Postoperative radiograph showed leakage of bone cement into the joint through femoral medullary cavity entering into iliac vessels, but the patient complained no discomforts. She received a treatment with low-molecular weight heparin and rivaroxaban. OUTCOMES: The patient was able to walk with normal gait, without swelling in both lower extremities and discomfort in the hip. There was no other complication concerning intravascular foreign bodies. LESSONS: This case calls into the phenomenon of leakage of injected bone cement in femoral head replacement regardless of complete and nonfractured femur, which may be into the lower limb and pelvic veins, given that, dangerous consequences will not occur.


Assuntos
Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos/efeitos adversos , Cabeça do Fêmur/cirurgia , Veia Ilíaca/patologia , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Veia Ilíaca/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiografia/métodos , Rivaroxabana/uso terapêutico , Resultado do Tratamento
5.
Bone Joint J ; 101-B(9): 1107-1114, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474140

RESUMO

AIMS: The aim of this study was to evaluate the differences in revision and complication rates, functional outcomes, and radiological outcomes between cemented and press-fit humeral stems in primary anatomical total shoulder arthroplasty (TSA). MATERIALS AND METHODS: A comprehensive systematic review and meta-analysis was conducted searching for studies that included patients who underwent primary anatomical TSA for primary osteoarthritis or rheumatoid arthritis. RESULTS: There was a total of 36 studies with 927 cemented humeral stems and 1555 press-fit stems. The revision rate was 5.4% (95% confidence interval (CI) 3.9 to 7.4) at a mean of 89 months for cemented stems, and 2.4% (95% CI 1.1 to 4.7) at a mean of 40 months for press-fit stems. A priori subgroup analysis to control for follow-up periods demonstrated similar revision rates: 2.3% (95% CI 1.1 to 4.7) for cemented stems versus 1.8% (95% CI 1.4 to 2.9) for press-fit stems. Exploratory meta-regression found that longer follow-up was a moderating variable for revision (p = 0.003). CONCLUSION: Cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up. Rotator cuff pathology was a prevalent complication in both groups but is likely not related to fixation type. Overall, with comparable revision rates, possible easier revision, and decreased operative time, humeral press-fit fixation may be an optimal choice for primary anatomical TSA in patients with sufficient bone stock. Cite this article: Bone Joint J 2019;101-B:1107-1114.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Úmero/cirurgia , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Prótese de Ombro/efeitos adversos , Cimentos para Ossos , Cimentação , Humanos , Complicações Pós-Operatórias , Falha de Prótese , Recuperação de Função Fisiológica , Reoperação , Resultado do Tratamento
6.
Bone Joint J ; 101-B(9): 1050-1057, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474145

RESUMO

AIMS: To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. PATIENTS AND METHODS: Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared. RESULTS: At all timepoints, group A hips had slightly better survivorship than those in group B without a statistically significant difference, except for the 24-year survival of acetabular components with revision for aseptic loosening as the endpoint, which was slightly worse. The survivorship was only significantly better in group A compared with group B when considering reoperation for any indication as the endpoint, 15 years postoperatively (74% vs 52%, p = 0.018). CONCLUSION: We concluded that there was not a substantial difference at almost any time in the outcome of cemented Charnley LFAs compared with hybrid THAs when treating patients with OA of the hip secondary to CHD. We believe, however, that after improvements in the design of components used in hybrid THA, this could be the method of choice, as it is technically easier with a shorter operating time. Cite this article: Bone Joint J 2019;101-B:1050-1057.


Assuntos
Artroplastia de Quadril/métodos , Luxação Congênita de Quadril/cirurgia , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Adulto , Idoso , Cimentos para Ossos/uso terapêutico , Cimentação , Feminino , Luxação Congênita de Quadril/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(36): e17029, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490390

RESUMO

There is an increased enthusiasm in treating osteolytic metastatic acetabulum via injecting polymethyl-methacrylate (PMMA) as a bone filler to provide pain relief and potential structural support. The aim of this respective study is to determine the function and quality of life improvement after cement acetabuloplasty.Thirty two patients underwent acetabular cement augmentation between May 2014 and March 2018 were respectively reviewed. Isolated percutaneous acetabuloplasty (PA) was performed in 15 patients (group A) while radiofrequency ablation with PA (RFA-PA) in 12 patients (group B). Together with PA, open reconstructive surgery on ipsilateral femur was performed in another 5 cases (group C). Pre- and posttreatment functional evaluation and quality of life (QoL) assessment were carried out.The average followup duration was 11.5 (range, 3-36) months. None of major complications occurred. 81.2% (26/32) of patients achieved complete pain relief. Reduction of pain intensity and improvement of functional status achieved significantly differences after treatment (P = .00). Significant improvement (P = .00) was observed in scales of global QoL and pain-related restrictions in daily activities. Both isolated PA and RFA-PA procedures were equally effective towards the improvement of function and quality of life (P > .05). Regarding 5 patients in group C, pain intensity decreased when loading the affected limb and they could walk with crutches or cane.Bone cement acetabuloplasty is an adequate and effective mini-invasive procedure to relieve pain, restore function, and enhance the quality of life of patients for as long as possible in metastatic patients with short life expectancy. Ipsilateral surgery appears to be safe and well tolerated.


Assuntos
Acetabuloplastia/métodos , Acetábulo/cirurgia , Neoplasias Ósseas/cirurgia , Carcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Carcinoma/radioterapia , Carcinoma/secundário , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Ablação por Radiofrequência , Recuperação de Função Fisiológica , Estudos Retrospectivos
8.
Niger J Clin Pract ; 22(9): 1236-1240, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489860

RESUMO

Background: The aim of this study was to evaluate the effect of intracanal separated instruments with different lenghts on periapical pH levels using calcium hydroxide (CH) as an intracanal medicament. Materials and Methods: In total, 60 teeth were used. Following root canal preparation, teeth were divided into four groups (n = 15). In Group 1, 2 mm and in Group 2, 4 mm weakened from the tip of Revo-S NiTi SC2 (Micro-Mega, Besancon, France) instruments were separated in the apical portion of root canals. In Group 3, there was no separated instrument. CH paste was placed in the first three groups. In Group 4, there was no separated instrument or CH paste. Teeth were placed in containers with deionized distilled water. After 1 h and 1, 2, 7, 15, and 30 days, the pH of the solution was measured. Results: At 1 h, Group 3 showed a significantly higher pH than Groups 1 (2 mm) and 2 (4 mm; P < 0.05). At the same time point, Group 1 (2 mm) showed a higher pH than Group 2 (4 mm) without significance. At 1, 2, 7, 15, and 30 days, Group 2 (4 mm) showed a significantly lower pH than Groups 1 (2 mm) and 3 (P < 0.05). At the same time points, Group 1 (2 mm) showed a lower pH than Group 3 without significance. Conclusions: Separated instrument may affect the rise in periapical pH level when using CH as the intracanal dressing. Therefore, 4 mm of separated instrument in the apical third showed a significant effect.


Assuntos
Cimentos para Ossos/farmacologia , Hidróxido de Cálcio/farmacologia , Instrumentos Odontológicos , Materiais Restauradores do Canal Radicular/farmacologia , Dente/efeitos dos fármacos , Bandagens , Humanos , Concentração de Íons de Hidrogênio , Irrigantes do Canal Radicular/administração & dosagem , Preparo de Canal Radicular/instrumentação , Preparo de Canal Radicular/métodos , Irrigação Terapêutica/instrumentação , Dente/fisiologia
9.
Braz Oral Res ; 33: e042, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31508725

RESUMO

This study evaluated the cytotoxicity and biocompatibility of a new bioceramic endodontic sealer (i.e., Sealer Plus BC) in comparison with those of MTA Fillapex and AH Plus. L929 fibroblasts were cultured and Alamar Blue was used to evaluate cell viability of diluted extracts (1:50, 1:100, and 1:200) from each sealer at 24 h. Polyethylene tubes that were filled with material or empty (as a control) were implanted in the subcutaneous tissue of rats. The rats were killed after 7 and 30 d (n = 8), and the tubes were removed for histological analysis. Parametric data was analyzed using a one-way ANOVA test, and nonparametric data was analyzed via the Kruskal-Wallis test followed by the Dunn test (p < 0.05). A reduction in cell viability was observed in the extracts that were more diluted for Sealer Plus BC when compared to that of Control and AH Plus (p < 0.05). However, the 1:50 dilution of the Sealer Plus BC was similar to that of the Control (p > 0.05). Conversely, more diluted extracts of MTA Fillapex (1:200) and AH Plus (1:100 and 1:200) were similar to the Control (p > 0.05). Histological analysis performed at 7 d did not indicate any significant difference between tissue response for all materials, and the fibrous capsule was thick (p > 0.05). At 30 d, Sealer Plus BC was similar to the Control (p > 0.05) and MTA Fillapex and AH Plus exhibited greater inflammation than the Control (p < 0.05). The fibrous capsule was thin for the Control and for most specimens of Sealer Plus BC and AH Plus. Thus, Sealer Plus BC is biocompatible when compared to MTA Fillapex and AH Plus, and it is less cytotoxic when less-diluted extracts are used.


Assuntos
Cimentos para Ossos/química , Hidróxido de Cálcio/química , Cerâmica/química , Materiais Restauradores do Canal Radicular/química , Compostos de Alumínio/química , Animais , Materiais Biocompatíveis , Cimentos para Ossos/farmacologia , Cimentos para Ossos/toxicidade , Compostos de Cálcio/química , Hidróxido de Cálcio/farmacologia , Hidróxido de Cálcio/toxicidade , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas/efeitos dos fármacos , Combinação de Medicamentos , Resinas Epóxi/química , Fibroblastos/efeitos dos fármacos , Técnicas In Vitro , Inflamação , Masculino , Teste de Materiais , Óxidos/química , Ratos Wistar , Materiais Restauradores do Canal Radicular/toxicidade , Silicatos/química , Tela Subcutânea/patologia
10.
Acta Cir Bras ; 34(6): e201900601, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31432992

RESUMO

PURPOSE: To evaluate PBS®MCIMMO cement in the filling of bone defects. METHODS: Thirty-six adult male Wistar rats were divided into three groups of twelve individuals each (group 1, group 2 and group 3). In all groups, a bone failure in the femur was induced, 2.0 mm wide and 7.0 mm deep. In group 1, the PBS®MCIMMO cement was applied to the bone defect produced and a titanium implant (CONNECTION®) 1.5 mm thick and 6 mm long was installed. In group 2, only the PBS® CIMMO cement was installed. In group 3, only bone failure was performed. Kruskal Wallis tests were performed to compare the mean area among the three groups. RESULTS: In all comparisons, significance was observed for group 2 (p = 0.0014-0.0026). CONCLUSION: The PBS®CIMMO cement induced bone neoformation, and integration between the newly formed bone, cement, and implant was observed.


Assuntos
Materiais Biocompatíveis/administração & dosagem , Cimentos para Ossos , Regeneração Óssea/fisiologia , Substitutos Ósseos/administração & dosagem , Cerâmica , Fêmur/cirurgia , Teste de Materiais , Animais , Estudos Longitudinais , Masculino , Modelos Animais , Estudos Prospectivos , Ratos , Ratos Wistar
11.
Zhongguo Gu Shang ; 32(7): 591-597, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31382714

RESUMO

OBJECTIVE: To explore the therapeutic efficacy of manual reduction combined with percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures(OVCFs) with intravertebral clefts. METHODS: The clinical data of 94 patients with osteoporotic vertebral compression fractures with intravertebral clefts treated from January 2014 to January 2017 were retrospectively analyzed. The patients were divided into group A and group B according to different operative methods. In group A, 45 patients were treated with unilateral approach PVP, including 17 males and 28 females, aged (75.35±11.82) years old, with a bone density T-value of (-4.28±0.65) g/cm³; in group B, 49 patients treated with manual reduction combined with unilateral approach PVP, including 19 males and 30 females, aged (76.79±9.64) years old, with a bone density T-value of (-4.33±0.72) g/cm³. The operation time, bone cement injection volume and postoperative complications of two groups were recorded. The VAS and ODI scores of two groups were analyzed respectively at 1, 12, 18 months after operation. Vertebral height and kyphosis Cobb angle of two groups were compared immediately after surgery and 12, 18 months after operation. The distribution of bone cement in the vertebral body was observed and its distribution excellent rate was calculated. RESULTS: There was no significant difference in operation time between two groups. The amount of bone cement injection was(8.42±1.24) ml in group A and(9.19±1.09) ml in group B, and the difference between two groups was statistically significant(P<0.05). No spinal nerve root injury during operation and no complications including pulmonary embolism, bone cement toxicity and infection were found in two groups. There were 5 cases of bone cement leakage in group A and 4 cases in group B, which did not cause corresponding clinical symptoms and were not treated additionally. The distribution of bone cement in group A was excellent in 25 cases, good in 19 cases, poor in 1 case and in group B was excellent in 45 cases, good in 4 cases. The distribution excellent rate of bone cement was higher in group B than in group A (P<0.05). The VAS and ODI scores before operation and 1, 12, 18 months after operation were 8.29±0.74, 2.59±0.14, 3.75±0.38, 3.84±0.88 and 40.04±3.16, 9.24±2.82, 12.27±2.64, 15.83±2.58 in group A, 8.22±0.82, 2.54±0.19, 2.81±0.23, 2.82±0.45 and 39.98±2.05, 9.16±2.10, 9.46±2.41, 9.76±2.46 in group B. There was no significant difference in VAS and ODI scores at 1 month after operation between two groups (P>0.05), but group A was higher than group B at 12 and 18 months after operation (P<0.05). The vertebral height and Cobb angle before surgery, immediately after surgery, and 12, 18 months after surgery in group A were(59.17±1.42)%, (85.95±2.19)%, (75.27±3.45)%, (68.34±2.24)% and(23.83±3.37)°, (15.26±2.61)°, (17.63±2.16)°, (19.46±2.54)°, and in group B were(59.31±1.87)%, (89.19±2.53)%, (88.62±2.51)%, (88.59±2.62)% and(24.72±3.78)°, (14.91±2.28)°, (15.48±2.55)°, (15.86±2.81)°. Vertebral height Immediately after surgery was greater in group B than in group A and Cobb angle in group B was smaller than in group A (P<0.05). During follow-up, there was no significant change in vertebral height in group B, while vertebral body recollapse in group A(P<0.05). CONCLUSIONS: In the treatment of osteoporotic vertebral compression fractures with intravertebral clefts, the manual reduction combined with PVP is more effective than single PVP, which can effectively prevent vertebral body recollapse and improve the long-term efficacy of patients.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
Zhongguo Gu Shang ; 32(7): 609-613, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31382717

RESUMO

OBJECTIVE: To explore the application effect of operation bed and C-arm digital metrology adjustment in percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures. METHODS: Ninty-four patients with osteoporotic thoracolumbar vertebral fractures admitted to our hospital from February 2015 to February 2017 were divided into control group and observation group according to random number table method, with 47 cases in each group. Control group adjusted C-arm and operating bed based on experience. For observation group surgical bed and C arm were measured and adjusted digitally and metrologically during percutaneous vertebroplasty. The operation time, times of fluoroscopy, hidden blood loss and bone cement volume were recorded in two groups. The clinical efficacy of two groups was observed by visual analogue score (VAS) and Oswestry Disability Index(ODI). Cobb angle and height of injured vertebrae before and after surgery were analyzed by imaging data. RESULTS: The operation time, times of fluoroscopy, and hidden blood loss were significantly lower in observation group than in control group (P<0.05), but there was no significant difference in bone cement volume between two groups (P>0.05); VAS and ODI of observation group were significantly lower than that of the control group(P<0.05); there was no significant difference in Cobb angle and height of injured vertebrae before and after operation between two groups. There were 3 cases of cement leakage, 1 case of urinary tract infection, 1 case of pulmonary infection, 2 cases of bedsore in observation group with complication rate was 14.89%(7/47); there were 8 cases of cement leakage, 2 cases of spinal nerve injury, 1 case of urinary tract infection, 3 cases of pulmonary infection, 2 cases of bedsore in control group with complication rate was 34.04% (16/47). The incidence of complications in observation group was significantly lower than that of control group (P<0.05). CONCLUSIONS: Operation bed and C-arm digital metrology adjustment can improve the surgical effect in percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures and promote rapid recovery.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos para Ossos , Humanos , Estudos Retrospectivos , Resultado do Tratamento
13.
Zhongguo Gu Shang ; 32(7): 614-619, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31382718

RESUMO

OBJECTIVE: To evaluate the effect of different bone cement injection methods during percutaneous vertebroplasty(PVP) on vertebral morphology and cement diffusion. METHODS: The clinical data of 52 patients with single-segment osteoporotic vertebral compression fracture treated from January 2016 to December 2017 were retrospectively analyzed. The patients were divided into hydraumatic group (28 cases) and pusher group (24 cases) according to bone cement injection method during PVP. By comparing visual analogue scale(VAS), height of anterior vertebral body, compression ratio, kyphosis angle before and after operation and analyzing filling ratio of bone cement in the first 1/3, median line and back 1/3 of the vertebral body in lateral X-rays and the conditions of bone cement diffusion in AP X-rays were to evaluate the effect of different bone cement injection methods on vertebral morphology and cement diffusion. RESULTS: Postoperative VAS was obviously improved in all patients and hydraumatic group was better than pusher group(P<0.05). Postoperative height of anterior vertebral body, compression ratio and kyphosis angle obviously restored in all patients while there was no significant difference between two groups(P>0.05). There was no significant difference in filling ratio of bone cement in the first 1/3 and median line of the vertebral body by lateral X-ray films between two groups(P>0.05), but in the back 1/3 of the vertebral body filling ratio of bone cement in hydraumatic group was better than in pusher group(P<0.05). The distribution of bone cement from AP X-ray films were more significant in hydraumatic group(P<0.05). CONCLUSIONS: Hydraulic delivery vertebroplasty (HDVP) has better clinical efficacy and it can guarantee sufficient distribution of bone cement into the fractured vertebra and preferably restore the morphology of vertebral body, which is worthy of clinical application.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos para Ossos , Humanos , Estudos Retrospectivos , Resultado do Tratamento
14.
Zhongguo Gu Shang ; 32(7): 620-623, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31382719

RESUMO

OBJECTIVE: To observe the effect of temperature contrast injection procedure on prevention and reduction of bone cement leakage in vertebroplasty (PVP). METHODS: The clinical data of 42 patients(48 vertebral bodies) with osteoporotic vertebral compression fractures(OVCFs) treated from July 2014 to July 2018 were retrospectively analyzed. There were 19 males and 23 females, aged from 62 to 80 years old with an average of 72 years. The vertebral fracture segment was T8-L5, including 30 lumbar vertebrae and 18 thoracic vertebrae. The course of the disease ranged from 3 d to 2 months. Twenty cases (20 vertebral bodies) were treated by single vertebroplasty (group A) and 22 cases (28 vertebral bodies) were treated by temperature contrast injection procedure(group B). The operative time, amount of bone cement injection, VAS score at 3 days after surgery, leakage rate and refracture rate were compared between two groups. RESULTS: The operative time, amount of bone cement injection and VAS score at 3 days after surgery in group B were (40.05±7.78) min, (3.93±0.19) ml, (3.55±0.74) points, respectively, and in group A were(38.90±6.81) min, (4.03±0.24) ml, (4.05±1.00) points, there was no significant difference between two groups(P>0.05). The leakage rate in group B was lower than that in group A (9.1% vs 40.0%, P<0.05). The refracture rate in group B was 9.1%(2/22), in group A was 15.0%(3/20), there was no significant difference between two groups (P>0.05). CONCLUSIONS: Temperature contrast injection procedure is an effective method to reduce the bone cement leakage in vertebroplasty.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Temperatura Ambiente , Resultado do Tratamento
15.
Zhongguo Gu Shang ; 32(7): 624-629, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31382720

RESUMO

OBJECTIVE: To evaluate the therapeutic effects and bone cement distribution of unilateral percutaneous kyphoplasty (PKP) with oriented bone cement injector for thoracolumbar osteoporotic vertebral compression fractures (OVCFs). METHODS: The clinical data of 211 patients (211 vertebrae) with thoracolumbar osteoporotic compression fractures underwent PKP between July 2016 to July 2018 were retrospectively analyzed. All punctures were performed unilaterally:102 patients in observation group used oriented bone cement injector including 30 males and 72 females with an average age of (68.4±8.9)years old; 109 patients in regular group used traditional bone cement injector including 32 males and 77 females with an average age of (70.4±9.2) years old. The two groups were compared in terms of duration of operation, cement volume, visual analogue scale(VAS), Oswestry Disability Index(ODI), distribution of bone cement, bone cement leakage and Cobb angle modified rate. RESULTS: There were no significant difference in gender, age and fracture vertebra between the two groups(P>0.05). No significant difference was found between two groups in duration of operation, cement volume, VAS, ODI and Cobb angle(P>0.05). In observation group, 10 cases occurred cement leakages, with leakage rate of 9.80%; and in regular group, 11 cases occurred cement leakage, with leakage rate of 10.09%. There was no significant difference in the cement leakage rate between two groups(P>0.05). In observation group, proportion rate of I-IV degree in cement distribution was 60.78%, 19.61%, 9.80%, 9.80%, respectively; while 39.45%, 22.93%, 22.93%, 14.68% in regular group. The I degree of cement cross-filling rate was better in observation group than in regular group(P<0.05). There was no significant difference between two groups in II degree distribution rate of bone cement(P>0.05). From T10 to L5, I degree bone cement distribution rate of both groups showed decline trend. The I degree cement cross-filling rate in L1-L5 was 50% in observation group and 30.23% in regular group(P<0.05). CONCLUSIONS: Oriented bone cement injector can control the direction of bone cement dispersion and achieve effective distribution of bilateral bone cement using unilateral puncture and satisfactory surgical results. It is feasible and effective for unilateral PKP treatment of OVCFs.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Cimentos para Ossos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
16.
Zhongguo Gu Shang ; 32(7): 635-640, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31382722

RESUMO

OBJECTIVE: To explore the application of three-dimensional CT and image classification in the treatment of osteoporotic vertebral compression fracture(OVCFs) by percutaneous vertebroplasty(PVP). METHODS: A total of 90 patients with OVCFs who were treated with PVP in Linqu People's Hospital of Shandong Province from April 2016 to March 2018 were selected as subjects. There were 31 males and 59 females, aged from 63 to 84 years old. Bone mineral density measurements were performed in all patients to confirm the presence of osteoporosis and imaging examinations were performed to confirm the presence of vertebral fractures. The fracture area was determined by MRI fat surpressed image before operation and three-dimensional modeling was performed to calculate the volume of fracture area. Three dimensional CT imaging of bone cement in fracture area was performed after PVP and the volume ratio of bone cement in fracture area was calculated by computer aided design software, by which patients were divided into groups for study. Forty-one patients whose volume ratio of bone cement in fracture area less than 50% are control group and the rest of 90 patients are observation group. Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were collected in two groups before operation and 1 day, 3 months after operation. The amount of bone cement was recorded after operation. RESULTS: All operations were successful. There were 3 cases of cement leakage in control group and 4 cases in observation group. All patients had no obvious clinical symptoms. After continuous observation and follow-up for 3 months, no complications such as adjacent vertebral fracture, infection, bone cement displacement were found. There was no significant difference in bone cement doses and bone cement leakage between two groups(P>0.05). There was no significant difference in preoperative VAS and ODI between two groups(P>0.05). All VAS and ODI obviously decreased(P<0.05) at 1 day after operation and in observation group the decrease was more significant (P<0.05). At 3 months after operation there was no significant difference between two groups. This may have been due to basically healing of vertebral fractures at 3 months after surgery and the pain was no longer significantly related. CONCLUSIONS: PVP can significantly improve clinical symptoms of OVCFs and bone cement filling in fracture area is the key to the short-term effect of PVP.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
J Surg Oncol ; 120(6): 1008-1015, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31432531

RESUMO

BACKGROUND AND OBJECTIVES: Patients undergoing cement fixation for hip arthroplasty are at increased risk of developing bone cement implantation syndrome (BCIS). We sought to determine: what is the occurrence of BCIS in patients with cancer after hip arthroplasty? What are the risk factors in patients with cancer for the development of this syndrome? What is the outcome for patients with cancer having BCIS? METHODS: We identified 374 patients with cancer who underwent cemented hip arthroplasty between 2010 and 2014. Patient characteristics, operative variables, and outcomes were collected. RESULTS: BCIS occurred in 279 (75%) patients. A total of 353 (94%) patients had bone metastases and 179 (48%) patients had lung metastases at the time of surgery. Age greater than 60 (hazard ratio [HR] 2.09, P = .02) and the presence of lung metastases (HR 1.77, P = .019) were associated with increased risk of BCIS. Increased perioperative use of vasopressors (HR 1.72, P = .023) and increased hospital stay beyond 10 days (HR 2.67, P = .003) was associated with BCIS. CONCLUSIONS: BCIS is a frequent clinical event in patients with cancer undergoing femoral cemented arthroplasty with increased risk for patients over age 60 and those with compromised lung function due to lung metastases and lung cancer. Patients who develop BCIS are more likely to require longer postoperative hospitalization. Careful preoperative assessment and intraoperative communication are crucial steps to reduce the consequences of BCIS.


Assuntos
Artroplastia de Quadril/mortalidade , Cimentos para Ossos/uso terapêutico , Fraturas do Colo Femoral/mortalidade , Neoplasias/fisiopatologia , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Síndrome , Adulto Jovem
18.
J Laryngol Otol ; 133(8): 658-661, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31270001

RESUMO

OBJECTIVE: This study aimed to evaluate the long-term results of ossiculoplasty using bone cement. METHOD: Forty patients (24 females and 16 males; mean age: 34.1 ± 11.8 years; range, 9-54 years) with chronic otitis media with perforation but without cholesteatoma who had undergone incudostapedial rebridging ossiculoplasty using bone cement were evaluated retrospectively. Pre-operative and post-operative audiograms were evaluated. Bone conduction, air conduction and air-bone gaps were calculated according to international guidelines. RESULTS: There was a mean reduction in pre-operative and post-operative air conduction (12.30 ± 11.98 dB), and this result was significant (p = 0.0001). There was a mean reduction in pre-operative and post-operative bone conduction (4.30 ± 6.69 dB), and this result was significant (p < 0.0001). The pre-operative air-bone gap was 27.65 dB and decreased to 19.65 dB during follow-up (p = 0.0001). No adverse reactions or complications were observed. CONCLUSION: Bone cement is reliable for the repair of incudostapedial-joint defects.


Assuntos
Perda Auditiva Condutiva/cirurgia , Substituição Ossicular/instrumentação , Otite Média/cirurgia , Cirurgia do Estribo/instrumentação , Adolescente , Adulto , Audiometria , Cimentos para Ossos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/complicações , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Acta Chir Orthop Traumatol Cech ; 86(3): 188-192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31333182

RESUMO

PURPOSE OF THE STUDY With the ageing of population the vertebral insufficiency fractures are increasing in number and occur ever more frequently. Symptomatic relief is often difficult to achieve by non-operative treatment. The aim of this study was to determine the level of pain relief and functional outcomes in patients who failed initial non-operative treatment and, because of persisting or growing symptoms, underwent kyphoplasty. MATERIAL AND METHODS Total number of 303 patients who underwent balloon kyphoplasty between January 2011 and December 2016 were included in our study. These 303 patients had 357 surgeries. This is a retrospective review of a prospectively updated database maintained by our spinal surgery department. In total, 575 levels were augmented. The patients were mostly females (246). The age of the patients ranged from 30 years to 98 years, with the mean age being 72.6 years. The average follow-up for our series was 17.2 months (2-63 months). Pain relief was assessed using the Visual Analogue Scale (VAS) and functional outcome using the Oswestry Disability Index (ODI). RESULTS The average pre-operative VAS was 6.34 (p = 0.00003). At 6 weeks postoperatively the average VAS decreased to 3.80 (p = 0.00000). In our series, the VAS scores showed a progressive decline progressing from the mean value of 3.18 (p = 0.15890) at 1 year to the mean value of 2.85 (p = 0.00205) at 2 years. The average pre-operative ODI was 25.65 (p = 0.03604). At 6 weeks, the value improved to 17.69 (p = 0,00120) and further improvements were seen at 1 year (ODI 14.13) and at 2 years (ODI 12.08). In our series no clinically significant complications were reported. The social drift was observed in 17 patients in our study. DISCUSSION The pain relief and the improvement of functional outcomes were maintained even at a two-year follow-up. No clinically significant complications were reported that would require further surgical intervention and that would affect the good clinical results of our study. CONCLUSIONS Balloon kyphoplasty proved to be a safe surgical technique and should be considered in patients with an ongoing pain following vertebral insufficiency fractures that do not improve with the initial non-operative treatment. Cement augmentation significantly improves pain levels and as well functional status in elderly patients. Key words:cement augmentation, osteoporotic fracture, kyphoplasty, vertebroplasty, osteoporotic spine fracture.


Assuntos
Cifoplastia/métodos , Vértebras Lombares/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Cimentação , Feminino , Fraturas por Compressão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
Knee ; 26(4): 933-940, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262634

RESUMO

BACKGROUND: Increasing numbers of Total Knee Arthroplasty (TKA) operations are carried out worldwide each year. This brings with it an ever-increasing revision burden and it is therefore important to appreciate both the functional outcome and survivorship of established arthroplasties when considering new designs. We aim to evaluate the long-term survivorship of a fully cemented mobile bearing Total Knee Arthroplasty. METHODS: This study prospectively analyses the 20-year survivorship of a cohort of 487 consecutive patients who underwent cemented TKA under the care of a single surgeon using the Low Contact Stress (LCS) rotating platform (RP) implant. These patients were followed up prospectively with patient reported and functional outcomes recorded at regular intervals postoperatively. RESULTS: Five hundred and forty-two consecutive primary TKAs were carried out in 487 patients. A total of 139 knees (25.6%) were reviewed at 20 years post-operation. Overall cumulative survivorship, using revision for any reason as primary endpoint, was 98.0%. Mean Knee Society Scores for the patient cohort were 87.3 (Clinical score) and 52.5 (Functional score). Eleven (2.0%) were revised within 20 years - two for aseptic loosening, two for unexplained pain, five secondary patellar resurfacings for anterior knee pain, one for late infection and one liner exchange following spin-out. CONCLUSION: This series demonstrates excellent survivorship and satisfactory outcome of a cemented mobile bearing TKA at 20 years.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Reoperação/estatística & dados numéricos
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