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1.
BMC Surg ; 20(1): 74, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295591

RESUMO

BACKGROUND: Percutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality. CASE PRESENTATION: We describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from L3-5 4 years prior and had an unremarkable postoperative course. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up. CONCLUSIONS: We present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition.


Assuntos
Cimentos para Ossos/efeitos adversos , Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas da Coluna Vertebral/cirurgia , Idoso de 80 Anos ou mais , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Acta Orthop ; 91(3): 293-298, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32237931

RESUMO

Background and purpose - The bone cement implantation syndrome characterized by hypotension and/or hypoxia is a well-known complication in cemented arthroplasty. We studied the incidence of hypotension and/or hypoxia in patients undergoing cemented or uncemented hemiarthroplasty for femoral neck fractures and evaluated whether bone cement was an independent risk factor for postoperative mortality.Patients and methods - In this retrospective cohort study, 1,095 patients from 2 hospitals undergoing hemiarthroplasty with (n = 986) and without (n = 109) bone cementation were included. Pre-, intra-, and postoperative data were obtained from electronic medical records. Each patient was classified for grade of hypotension and hypoxia during and after prosthesis insertion according to Donaldson's criteria (Grade 1, 2, 3). After adjustments for confounders, the hazard ratio (HR) for the use of bone cement on 1-year mortality was assessed.Results - The incidence of hypoxia and/or hypotension was higher in the cemented (28%) compared with the uncemented group (17%) (p = 0.003). The incidence of severe hypotension/hypoxia (grade 2 or 3) was 6.9% in the cemented, but not observed in the uncemented group. The use of bone cement was an independent risk factor for 1-year mortality (HR 1.9, 95% CI 1.3-2.7), when adjusted for confounders.Interpretation - The use of bone cement in hemiarthroplasty for femoral neck fractures increases the incidence of intraoperative hypoxia and/or hypotension and is an independent risk factor for postoperative 1-year mortality. Efforts should be made to identify patients at risk for BCIS and alternative strategies for the management of these patients should be considered.


Assuntos
Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos/efeitos adversos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Hipotensão/induzido quimicamente , Hipóxia/induzido quimicamente , Complicações Intraoperatórias/induzido quimicamente , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Artroplastia de Quadril/mortalidade , Cimentos para Ossos/uso terapêutico , Feminino , Fraturas do Colo Femoral/mortalidade , Hemiartroplastia/métodos , Hemiartroplastia/mortalidade , Humanos , Masculino , Estudos Retrospectivos
3.
J Vasc Interv Radiol ; 31(4): 649-658.e1, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32139256

RESUMO

PURPOSE: To assess early outcome, safety, and complications of an alternative to open surgical treatments of osteolytic lesions in periarticular load-bearing bones. MATERIALS AND METHODS: A single-center, prospective clinical cohort study of 26 lesions in 23 consecutive patients with painful osteolytic skeletal lesions was performed. Patients were followed for an average of 7 mo (1-18 mo). Lesions were targeted from the most intact bone via minimally invasive percutaneous approach for stable anchorage of internal fixation screws using fluoroscopic guidance. Cannulated screws served as universal portals for ablation, balloon osteoplasty, and delivery of bone cement in addition to internal fixation for cement anchoring and prophylactic stabilization of uninvolved bone. RESULTS: There were 19 osteolytic lesions in the pelvis, 4 in the proximal femur, 2 in the proximal tibia, and 1 in the calcaneus. All defects were associated with severe pain or fractures. There were no conversions to open surgery and no infection or bleeding requiring transfusion, embolization, or additional procedures. There was significant improvement in visual analogue scale (VAS) pain score from 8.32 ± 1.70 to 2.36 ± 2.23, combined pain and functional ambulation score from 4.48 ± 2.84 to 7.28 ± 2.76, and Musculoskeletal Tumor Society score from 45% to 68% (P < .05). CONCLUSIONS: Ablation, osteoplasty, reinforcement, and internal fixation is a safe and effective minimally invasive percutaneous image-guided treatment option for functional improvement or palliation of painful osteolytic lesions in the pelvis and periarticular loadbearing bones.


Assuntos
Técnicas de Ablação , Cimentos para Ossos/uso terapêutico , Neoplasias Ósseas/cirurgia , Calcâneo/cirurgia , Cementoplastia , Fêmur/cirurgia , Fixação Interna de Fraturas , Osteólise/cirurgia , Ossos Pélvicos/cirurgia , Tíbia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos/efeitos adversos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/fisiopatologia , Remodelação Óssea , Parafusos Ósseos , Calcâneo/diagnóstico por imagem , Calcâneo/fisiopatologia , Cementoplastia/efeitos adversos , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/fisiopatologia , Neoplasias Femorais/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/fisiopatologia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Osteólise/diagnóstico por imagem , Osteólise/fisiopatologia , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Suporte de Carga
4.
Medicine (Baltimore) ; 99(11): e19354, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176057

RESUMO

RATIONALE: Leakage of bone cement is a common complication after percutaneous kyphoplasty. In rare cases, bone cement can leak into the venous system, which can be life threatening, especially when it causes an embolism in the heart. PATIENT CONCERNS: A 79-year-old female patient developed chest pain with chest tightness 3 weeks after the percutaneous kyphoplasty. DIAGNOSES: Initially, negative fluoroscopy results and elevated myocardial enzymes suggested that the patient's chest pain and chest tightness symptoms were manifestations of coronary heart disease. However, in the subsequent computed tomography (CT) examination, foreign bodies in the heart and pulmonary vessels were found. INTERVENTIONS: The patient underwent emergency surgery to remove the bone cement and repair the tricuspid valve. OUTCOMES: The postoperative course was uneventful and the patient was discharged on the 13th day after surgery. LESSONS: If a patient develops chest pain with chest tightness after percutaneous kyphoplasty, the clinicians must be vigilant and take into account the limited sensitivity of fluoroscopy and use chest computer tomography and echocardiogram as the first choice and thereby prevent serious consequences.


Assuntos
Cimentos para Ossos/efeitos adversos , Embolia/etiologia , Embolia/cirurgia , Corpos Estranhos/diagnóstico por imagem , Cifoplastia/efeitos adversos , Fraturas da Coluna Vertebral/cirurgia , Idoso , Cimentos para Ossos/uso terapêutico , Ecocardiografia/métodos , Embolia/diagnóstico por imagem , Feminino , Fluoroscopia/métodos , Seguimentos , Corpos Estranhos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Cifoplastia/métodos , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
5.
World Neurosurg ; 137: e286-e290, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32014549

RESUMO

BACKGROUND: Bone cement augmentation with polymethylmethacrylate is a reliable method for stabilizing osteoporotic compression fractures and improving fixation of pedicle screws. However, cement extrusion into the vertebral venous system can result in pulmonary cement embolism. The goal of this anatomic study was to identify the relationship between the internal/external vertebral plexus and neighboring abdominal caval system. METHODS: Thirty-two lumbar vertebral levels were used in this study. Anterior abdominal dissection was performed to access the lumbar vertebral bodies through the peritoneal cavity, and a 16-gauge needle was placed into the center of each lumbar vertebral body at its anterior aspect. Fluoroscopy was used to confirm if the needle was correctly placed. Next, latex and/or continuous air injections were performed into each lumbar vertebral level (L1-L5). Observations confirmed if the latex or air traveled into the inferior vena cava. In addition, the spinal canal was opened to see if any latex was found to enter inside the vertebral canal in cadavers injected with the latex. RESULTS: Latex or air was found to flow into the inferior vena cava at all the lumbar vertebral levels. The latex/air was not observed in the spinal canal in any specimen. CONCLUSIONS: An exact knowledge of the lumbar vertebral venous anatomy is essential when procedures that could affect the vertebral venous system are involved. Its complexity and anatomic variability necessitate such an understanding to better prevent/understand possible complications associated with polymethylmethacrylate extrusion.


Assuntos
Cimentos para Ossos , Vértebras Lombares/irrigação sanguínea , Polimetil Metacrilato , Cimentos para Ossos/efeitos adversos , Cadáver , Humanos , Cifoplastia/efeitos adversos , Parafusos Pediculares , Polimetil Metacrilato/efeitos adversos , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/etiologia , Veias , Vertebroplastia/efeitos adversos
6.
Medicine (Baltimore) ; 99(8): e19039, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080078

RESUMO

AIM: To compare the efficacy and safety of cemented and uncemented hemiarthroplasty in elderly patients with femoral neck fracture. MATERIALS AND METHODS: We searched PubMed, EMBASE, and Cochrane Library databases for published randomized clinical trials comparing cemented hemiarthroplasty with uncemented hemiarthroplasty in elderly patients with a femoral neck fracture. The search was not limited to language, time, or other factors. The quality of each study was assessed using the revised Jadad scale. Two researchers independently extracted data from all selected studies, including the following base line data: study period, fracture stage, number of patients, male female ratio, average age, and per-protocol (PP) or intent-to-treat (ITT), and the interest outcomes: the mortality at 12 months, operative time, hospital stay, common complications, prosthetic-related complications, blood loss and Harris Hip Score (HHS). Fixed-effects or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine heterogeneity of the included studies. RESULTS: A total of 8 studies involving 1577 hips (782 uncemented and 795 cemented) were included in this meta-analysis. The meta-analysis is indicated that the operation time of cemented hemiarthroplasty was longer than uncemented hemiarthroplasty and there was statistical significance between two groups (OR = -7.30, 95%CI, -13.13, -1.46; P = .01). However, there was no significant difference between the two methods of fixation in mortality at 12 months (OR = 1.22, 95%CI, 0.94-1.59; P = .14), hospital stay (OR = 0.26, 95%CI, -0.41, 0.93; P = .44), blood loss (OR = -17.94, 95%CI, -65.83, 29.95; P = .46), and HHS score. There were significant differences in the common complications of pulmonary embolism between the two groups, but there were no differences in the other five common complications. The results showed that uncemented hemiarthroplasty could reduce the incidence of pulmonary embolism after operation. Moreover, the outcomes of prosthetic-related complications showed that there were significant differences between the two groups in periprosthetic fracture (OR = 8.32, 95%CI, 3.85-17.98; P < .00001) and prosthetic subsidence and loosening (OR = 5.33, 95%CI, 2.18-13.00; P = .0002). CONCLUSIONS: Our study shows that uncemented prosthesis can shorten the operation time and reduce the incidence of pulmonary embolism, but it does not reduce mortality, blood loss, and hospital stay. Most importantly, the incidence of prosthetic-related complications was higher in uncemented patients.


Assuntos
Cimentos para Ossos/efeitos adversos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/tendências , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Feminino , Fraturas do Colo Femoral/mortalidade , Hemiartroplastia/métodos , Hemiartroplastia/mortalidade , Prótese de Quadril/efeitos adversos , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Embolia Pulmonar/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Int Orthop ; 44(2): 349-355, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31853584

RESUMO

PURPOSE: To evaluate the safety and efficacy of PKP under O-arm navigation system guidance for treating middle thoracic OVCF (T6~T9). METHODS: A retrospective study was conducted for 44 consecutive T6~T9 OVCF patients who received PKP assisted with O-arm navigation (n = 20) or fluoroscopy (n = 24) from January 2016 to December 2017. Demographic data, radiographic parameters, and clinical outcomes were collected and analyzed at pre-operative, post-operative, and final follow-up period. Complications including tissue lesion, needle malposition, and leakage of bone cement were also recorded amid operation. RESULTS: A total of 44 patients (4 males and 40 females, with mean age of 71.1 ± 8.7) were enrolled in this study, and the mean follow-up time was 14.4 months. In surgical details, navigation system could obtain more satisfactory volume of injected cement and less loss of blood, as well did not increase surgical time compared with fluoroscopy. Both radiological and clinical outcomes improved significantly at post-operative and final follow-up, while did not differed between two groups. For adverse events, the incidence of cement leakage was similar between two groups. However, O-arm navigation can achieve lower rate of complications than fluoroscopy. CONCLUSION: Our preliminary study demonstrated that PKP assisted with O-arm navigation is a safe and effective procedure that applied for middle thoracic OVCF (T6~T9), which can achieve favourable radiological and clinical outcomes, and low rate of complications.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Cimentos para Ossos/efeitos adversos , Feminino , Fluoroscopia , Fraturas por Compressão/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Técnicas Estereotáxicas , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Knee ; 27(1): 263-273, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31883856

RESUMO

Iliotibial band (ITB) friction syndrome is known to be one of the main causes of lateral knee pain related to an overuse injury. In the field of knee arthroplasty, ITB traction syndrome has been reported following guided motion total knee arthroplasty, due to posterior femoral translation and internal tibial rotation during knee flexion. However, ITB friction syndrome following conventional knee arthroplasty has not been reported. This paper reports four cases of this syndrome following conventional knee arthroplasty, mainly caused by an obstruction just under the ITB. Cases 1 and 2 presented extruded cement at the femoral component's lateral side after total knee arthroplasty. Case 3 presented a highly sharp-edged bearing at the lateral compartment after bicompartmental knee arthroplasty. Case 4 presented an osteophyte at the femoral component's lateral side after total knee arthroplasty. Although none of the cases responded well to conservative treatment, ITB friction syndrome was completely relieved just after excising the obstruction. Excision of an obstruction should be considered for ITB friction syndrome caused by obstruction just under the ITB following knee arthroplasty.


Assuntos
Artroplastia do Joelho/efeitos adversos , Cimentos para Ossos/efeitos adversos , Síndrome da Banda Iliotibial/etiologia , Prótese do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Osteófito/complicações , Idoso , Artralgia/etiologia , Artralgia/cirurgia , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Cimentação/efeitos adversos , Feminino , Humanos , Síndrome da Banda Iliotibial/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/cirurgia , Reoperação , Sinovite/etiologia , Sinovite/cirurgia
9.
J Orthop Surg Res ; 14(1): 452, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852483

RESUMO

BACKGROUND: The purpose of this study is to explore the therapeutic effect of percutaneous kyphoplasty (PKP) combined with anti-osteoporosis drug, zoledronic acid, on postmenopausal women with osteoporotic vertebral compression fracture (OVCF) and to perform an analysis of postoperative bone cement leakage risk factors. METHODS: A total of 112 OVCF patients, according to therapeutic regimens, were divided into control group (n = 52, treated with PKP) and observation group (n = 60, treated with PKP and zoledronic acid injection). RESULTS: Postoperative tumor necrosis factor-α and interleukin-6 levels were significantly decreased in the two groups, compared with those before treatment (both P < 0.05); bone mineral density (BMD), serum bone gla protein (BGP), and vertebral height ratio of injured vertebrae were significantly increased, and procollagen type I N-terminal propeptide (PINP), Cobb angle, visual analogue scale/score (VAS), and Oswestry disability index (ODI) were significantly decreased compared with those before treatment (all P < 0.05). There were significantly higher changes in difference value of BMD, PINP, BGP, vertebral height ratio of injured vertebrae, Cobb angle, VAS, and ODI levels and significantly better therapeutic effect in the observation group than those in the control group (all P < 0.05). Multivariate logistic regression analysis showed that the use of zoledronic acid, vertebral height ratio of injured vertebrae, and ODI were independent factors affecting the therapeutic effect, and that the dosage of bone cement, and peripheral vertebrae wall damage were independent risk factors causing postoperative bone cement leakage. There were no significant differences in postoperative bone cement leakage rate between the two groups. CONCLUSIONS: Peripheral vertebrae wall damage and the dosage of bone cement are independent risk factors causing bone cement leakage in OVCF patients treated with PKP. PKP combined with zoledronic acid has an improvement effect on the condition of postmenopausal women with OVCF and reduces the inflammation and pain in patients, which is beneficial to clinical treatment.


Assuntos
Cimentos para Ossos/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fraturas da Coluna Vertebral/cirurgia , Ácido Zoledrônico/uso terapêutico , Estudos de Coortes , Terapia Combinada , Feminino , Fraturas por Compressão/etiologia , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Fraturas por Osteoporose/etiologia , Pós-Menopausa , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia
10.
BMC Musculoskelet Disord ; 20(1): 628, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881878

RESUMO

BACKGROUND: Hip hemiarthroplasty (HHA) is a common treatment for hip fractures in the elderly population. Because of the fatal effects of bone cement implantation syndrome, the safety of cement utilization to enhance implant firmness in the femur is controversial. The aim of this study was to investigate the postoperative survival of elderly patients receiving HHA with and without cement fixation. METHODS: Claim data from the National Health Insurance Database and the National Register of Deaths Database were used for analysis in this retrospective cohort study. From 2008 to 2014, 25,862 patients aged 80 years or older treated with hip hemiarthroplasty were included in the analysis. A Cox proportional risk model was used to analyse the effects of cement utilization on postoperative mortality. RESULTS: The cemented group had a significantly higher mortality risk than the non-cemented group within 7, 30, 180 days and 1 year after the operation. The effect of bone cement on postoperative mortality was significantly stronger within 7 days than within 30, 180 days and 1 year. In addition, the male gender, age > 85 years and higher score on the Charlson Comorbidity Index were also risk factors for mortality (p < 0.05). Patients who received HHA in lower-volume hospitals had higher mortality rates within 180 days and 1 year than those in higher-volume hospitals. Compared with patients who were operated on by high-volume surgeons, those who received surgery performed by lower-volume surgeons were more likely to die within 30 days (aHR = 1.22), 180 days (aHR = 1.16) and 1 year (aHR = 1.19), respectively. CONCLUSIONS: The postoperative mortality rate of elderly patients undergoing HHA was significantly higher in the cemented group than in the non-cemented group.


Assuntos
Cimentos para Ossos/efeitos adversos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Fatores Etários , Idoso de 80 Anos ou mais , Feminino , Hemiartroplastia/instrumentação , Hemiartroplastia/métodos , Prótese de Quadril , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Síndrome , Taiwan/epidemiologia , Resultado do Tratamento
11.
Arch Osteoporos ; 14(1): 109, 2019 11 18.
Artigo em Inglês | MEDLINE | ID: mdl-31741066

RESUMO

Kümmell's disease (eponymous name for osteonecrosis and collapse of a vertebral body due to ischemia and non-union of anterior vertebral body wedge fractures after major trauma) cannot heal spontaneously. Bone-filling mesh container (BFMC) can significantly relieve pain, help the correction of kyphosis, and may prevent cement leakage. This pilot study may provide the basis for the design of future studies. PURPOSE: To compare the effectiveness and safety of BFMC and percutaneous kyphoplasty (PKP) for treatment of Kümmell's disease. METHODS: From August 2016 to May 2018, 40 patients with Kümmell's disease were admitted to Guizhou Provincial People's Hospital. Among them, 20 patients (20 vertebral bodies) received PKP (PKP group) and the other 20 received BFMC (BFMC group). Operation time, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Cobb's angle changes, and related complications were recorded. RESULTS: All patients underwent operations successfully. VAS scores and ODI of both groups at each postoperative time point were lower than preoperatively, with statistically significant difference (p < 0.05). Postoperative Cobb's angle of both groups postoperatively was lower than preoperatively (p < 0.05). Cement leakage occurred in eight vertebrae (8/20) in the PKP group and in one vertebra (1/20) in the BFMC group. No complications such as pulmonary embolism, paraplegia, or perioperative death occurred during operation in both groups. Adjacent vertebral refractures occurred in five patients (5/20) in the PKP group and in four patients (4/20) in the BFMC group, with no significant difference in the incidence rate of refractures in both groups but the material is too small to verify statistically. CONCLUSIONS: Both PKP and BFMC technologies can significantly relieve pain and help the correction of kyphosis while treating Kümmell's disease. Moreover, the BMFC may prevent cement leakage.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Cifose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Telas Cirúrgicas , Idoso , Dor nas Costas/cirurgia , Cimentos para Ossos/efeitos adversos , Cimentos para Ossos/uso terapêutico , Substitutos Ósseos/uso terapêutico , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Humanos , Cifoplastia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Osteonecrose/cirurgia , Medição da Dor/métodos , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Próteses e Implantes/efeitos adversos , Resultado do Tratamento
12.
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
13.
Artigo em Inglês | MEDLINE | ID: mdl-31605583

RESUMO

Porous metal augments have been used successfully for management of large acetabular defects during revision hip arthroplasty. This study analyzes and compares the clinical and radiographic outcomes of porous metal augments in cemented and uncemented acetabular revisions, all performed at the same institution. In the period 2015-2017, 36 patients with 37 large acetabular defects were treated with porous metal augments in cemented and uncemented acetabular revisions. Postoperatively, patients were monitored for two years on average period of 24-36 months. Acetabular augments were used when preoperative and intraoperative findings indicated the presence of large acetabular defects that can hinder the stability of the revision implants. We used lateral approach, 36 mm femoral head, and cementless or cemented acetabular cup depending on local bone quality. Postoperatively, all patients followed total hip arthroplasty precautions, with weight bearing as tolerated regimen with use of crutches during 6 weeks after surgery. The follow-up was radiological and clinical. We used HHS. At a mean follow-up of two years (range 24-36 months) one patient had reinfection and one patient had infection. None of the patients shown signs of aseptic augment or acetabular cup loosening. Porous metal augments show comparable excellent radiographic and clinical short-term outcomes, when combined with cemented or uncemented cups in revision hip arthroplasty. They allow good bone ingrowth, adequate implant contact and good stability. Complications were related to infection and not related to the augments itself.


Assuntos
Acetábulo/anormalidades , Acetábulo/cirurgia , Artroplastia de Quadril/instrumentação , Reoperação/métodos , Acetábulo/diagnóstico por imagem , Assistência ao Convalescente , Idoso , Artroplastia de Quadril/métodos , Cimentos para Ossos/efeitos adversos , Cimentação/tendências , Feminino , Prótese de Quadril , Humanos , Masculino , Metais/efeitos adversos , Pessoa de Meia-Idade , Porosidade , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Radiografia/métodos , Reoperação/instrumentação , Resultado do Tratamento
14.
J Vasc Interv Radiol ; 30(11): 1845-1854, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587952

RESUMO

PURPOSE: To evaluate the safety and efficacy of sacroplasty for the treatment of osteoporotic and malignant sacral fractures by performing a systematic review and meta-analysis of existing literature. MATERIALS AND METHODS: PubMed, Web of Science, and SCOPUS databases were searched from their inception until February 2018 for articles describing sacroplasty. Inclusion criteria were as follows: studies reporting > 5 patients, and pain assessment before and after the procedure recorded with visual analog scale (VAS). Demographic data, procedural details, technical success rates, VAS scores before and after the procedure, and procedural complications were recorded. A random-effects meta-analyses of the VAS pain score before the procedure, at 24-48 hours, at 6 months, and at 12 months were calculated. RESULTS: Nineteen studies (18 case series and 1 cohort study) were identified consisting of 861 total patients (682 women and 167 men; mean age 73.89 ± 9.73 years). Patients underwent sacroplasty for the following indications: sacral insufficiency fractures secondary to osteoporosis (n = 664), malignancy (n = 167), and nonspecified sacral insufficiency fractures (n = 30). Technical and clinical successes were achieved in 98.9% (852/861) and 95.7% (623/651) of patients undergoing sacroplasty, respectively. The pooled major complication rate was 0.3%, with 3 patients requiring surgical decompression for cement leakage. Random-effects meta-analyses demonstrated statistically significant differences in the VAS pain level at preprocedure, 24-48 hours, 6 months, and 12 months, with cumulative pain scores of 8.32 ± 0.01, 3.55 ± 0.01, 1.48 ± 0.01, and 0.923 ± 0.01, respectively. CONCLUSIONS: Sacroplasty appears safe and effective for pain relief in patients with osteoporotic or malignant sacral fractures, with statistically significant sustained improvement in VAS pain scores up to 12 months.


Assuntos
Dor nas Costas/terapia , Cimentos para Ossos/uso terapêutico , Cementoplastia/métodos , Fraturas por Osteoporose/terapia , Sacro/lesões , Fraturas da Coluna Vertebral/terapia , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Cimentos para Ossos/efeitos adversos , Cementoplastia/efeitos adversos , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/etiologia , Fatores de Risco , Sacro/diagnóstico por imagem , Sacro/patologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento
15.
BMC Musculoskelet Disord ; 20(1): 423, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31510985

RESUMO

BACKGROUND: Percutaneous kyphoplasty (PKP) can effectively treat osteoporotic vertebral compression fractures (OVCFs). Although satisfactory clinical outcomes can be achieved, bone cement leakage remains a primary complication of PKP. Previous studies have found many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphologies of different vertebral bodies may be one reason for the leakage. Here, we investigated the effect of posterior vertebral wall morphology in OVCF patients on bone cement leakage into the spinal canal during PKP. METHODS: Ninety-eight OVCF patients with plain computed tomography (CT) scans and three-dimensional (3D) reconstruction images from T6 to L5 were enrolled. 3D-CT and multiplanar reconstructions (MPR) were used to measure the concave posterior vertebral wall depth (PVWCD) and the corresponding midsagittal diameter of the nonfractured vertebral body (VBSD), and the PVWCD/VBSD ratio was calculated. All subjects were divided into the thoracic or lumbar groups based on the location of the measured vertebrae to observe the value and differences in the PVWCD between both groups. The differences in PVWCD and PVWCD/VBSD between the thoracic and lumbar groups were compared. Three hundred fifty-seven patients (548 vertebrae) who underwent PKP within the same period were also divided into the thoracic and lumbar groups. The maximal sagittal diameter (BCSD), the area of the bone cement intrusion into the spinal canal (BCA), and the spinal canal encroachment rate (BCA/SCA × 100%) were measured to investigate the effect of the thoracic and lumbar posterior vertebral wall morphologies on bone cement leakage into the spinal canal through the Batson vein during PKP. RESULTS: The PVWCDs gradually deepened from T6 to T12 (mean, 4.6 mm); however, the values gradually became shallower from L1 to L5 (mean, 0.6 mm). The PVWCD/VBSD ratio was approximately 16% from T6 to T12 and significantly less at 3% from L1 to L5 (P < 0.05). The rate of bone cement leakage into the spinal canal through the Batson vein was 10.1% in the thoracic group and 3.7% in the lumbar group during PKP. In the thoracic group, the BCSD was 3.1 ± 0.5 mm, the BCA was 30.2 ± 3.8 mm2, and the BCA/SCA ratio was 17.2 ± 2.0%. In the lumbar group, the BCSD was 1.4 ± 0.3 mm, the BCA was 14.8 ± 2.2 mm2, and the BCA/SCA ratio was 7.4 ± 1.0%. The BCSD, BCA and BCA/SCA ratio were significantly higher in the thoracic group than in the lumbar group (P < 0.05). CONCLUSIONS: The PVWCD in the middle and lower thoracic vertebrae can help reduce bone cement leakage into the spinal canal by enabling avoiding bone cement distribution over the posterior 1/6 of the vertebral body during PKP. The effect of the difference between the thoracic and lumbar posterior vertebral wall morphology on bone cement leakage into the spinal canal through the Batson vein in OVCF patients during PKP is one reason that the rate of bone cement leakage into the thoracic spinal canal is significantly higher than that into the lumbar spinal canal.


Assuntos
Cimentos para Ossos/efeitos adversos , Corpos Estranhos/epidemiologia , Cifoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Canal Vertebral/lesões , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Imageamento Tridimensional , Cifoplastia/métodos , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Canal Vertebral/irrigação sanguínea , Canal Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/anatomia & histologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veias
16.
World Neurosurg ; 132: e739-e745, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415893

RESUMO

OBJECTIVE: To evaluate and compare clinical outcomes and cement leakage of high-viscosity bone cement versus low-viscosity bone cement vertebroplasty in treating osteoporotic vertebral compression fractures with intravertebral cleft. METHODS: The study included 72 patients with osteoporotic vertebral compression fractures with intravertebral cleft, who were divided into high-viscosity cement (HVC) (38 cases) and low-viscosity cement (LVC) (34 cases) groups according to the viscosity of bone cement used. Cement leakage, visual analog scale score, Oswestry Disability Index, and kyphotic angle (KA) were evaluated. RESULTS: All patients were followed for at least 12 months. Overall cement leakage rate was 18.4% in the HVC group, lower than the rate of 61.8% obtained in the LVC group. A statistically significant difference was found in the overall cement leakage rate between the groups (P < 0.05). Visual analog scale and Oswestry Disability Index scores were significantly improved after percutaneous vertebroplasty without significant differences between the HVC and LVC groups (P > 0.05). The KA of patients from both groups was also significantly corrected immediately after surgery. Although the KA gradually increased in both groups during the follow-up period, there was no statistically significant difference between the HVC and LVC groups in KA during follow-up (P > 0.05). CONCLUSIONS: Percutaneous vertebroplasty using HVC to treat osteoporotic vertebral compression fractures with intravertebral cleft significantly reduces cement leakage and improves the safety of the operation. In terms of clinical efficacy and prevention of augmented vertebral recollapse, HVC may not have obvious advantages.


Assuntos
Cimentos para Ossos/uso terapêutico , Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos/efeitos adversos , Avaliação da Deficiência , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Medição da Dor , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Viscosidade
17.
J Orthop Surg Res ; 14(1): 262, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426816

RESUMO

PURPOSE: Optimal type of prosthesis in total knee arthroplasty (TKA) remains controversial for young patients. The objective of this meta-analysis is to compare cementless and cemented fixation in TKA. METHODS: In this meta-analysis, we conducted electronic searches of PubMed, Embase, Cochrane Library, and Web of Science in December 2018. We collected randomized controlled trials (RCTs) comparing cementless and cemented TKA in young patients. The outcome measurements consisted of functional outcomes, Knee Society Score, range of motion, radiological outcomes, pain score, and complications. Stata 12.0 software was used for our meta-analysis. Quality assessment for RCTs was conducted according to the Cochrane Handbook for systematic review of interventions. RESULTS: Four RCTs met our inclusion criteria with 255 patients in cemented groups and 229 patients in cementless groups. The present meta-analysis indicated that there was a significant difference between the groups in terms of radiological outcomes and pain score. No significant difference was found regarding KSS, range of motion, or complications. CONCLUSION: Cementless TKA was associated with superior outcomes in terms of radiological outcomes and pain score compared with cemented fixation. We found no significant difference regarding the functional outcome or aseptic loosening between groups. High-quality RCTs were still required for further investigation.


Assuntos
Artroplastia do Joelho/métodos , Cimentos para Ossos/uso terapêutico , Medição da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Artroplastia do Joelho/instrumentação , Cimentos para Ossos/efeitos adversos , Humanos , Falha de Prótese/efeitos adversos , Resultado do Tratamento
18.
BMC Musculoskelet Disord ; 20(1): 372, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412841

RESUMO

BACKGROUND: This study aimed to investigate the risk factors for mechanical failure of cement spacers and the impact on hip function after two-stage exchange arthroplasty for periprosthetic joint infection (PJI). METHODS: Thirty-one patients (19 males and 12 females) with hip PJIs underwent resection arthroplasty and implantation of cement spacers from January 2014 to December 2015. Patients who encountered spacer-associated mechanical complications in the interim period (14 of 31) were compared with those without complications (17 of 31). Complications were defined as spacer dislocation, spacer fracture, spacer fracture with dislocation, and femoral fracture during or following spacer implantation. Hip functional outcome was assessed using the Harris hip score (HHS). Treatment success was defined according to the following criteria: (1) no symptoms or signs indicative of infection; (2) no PJI-related mortality; and (3) no subsequent surgical intervention for infection after reimplantation surgery. Multivariate logistic regression and Kaplan-Meier survival curves were used for analysis. RESULTS: Fourteen patients (14/31 = 45%) suffered at least one spacer-related complication within the interim period. The development of spacer complications was associated with a younger age (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.83-1.00, p = 0.045) and chronic PJI (OR 14.7, 95% CI 1.19-182, p = 0.036). Patients with spacer complications also had a lower median HHS (37 vs. 60, p < 0.001) before reimplantation in comparison to those without spacer complications. After reimplantation, the two groups had a similar median HHS (90 vs. 89, p = 0.945). Two patients did not undergo reimplantation due to extensive comorbidities, and subsequently retained the antibiotic spacer for definitive treatment. The 2-year treatment success rate was 84.6% in the spacer-complication group and 87.5% in the non-spacer-complication group (p = 0.81). CONCLUSION: There was a high complication rate for articulating PMMA spacers during the interim period of two-stage revision total hip arthroplasty. A young age and chronic infection were the primary risk factors associated with mechanical complications. Patients at high risk of spacer-related mechanical complications should be advised accordingly by surgeons. Knowing the possible risk factors, surgeons should educate patients thoroughly to avoid spacer complications, thereby increasing patient satisfaction in the interim stage. LEVEL OF EVIDENCE: Prognostic Level III.


Assuntos
Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos/efeitos adversos , Prótese de Quadril/efeitos adversos , Falha de Prótese , Infecções Relacionadas à Prótese/cirurgia , Fatores Etários , Idoso , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Doença Crônica , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/mortalidade , Reoperação/efeitos adversos , Reoperação/instrumentação , Reoperação/métodos , Fatores de Risco , Resultado do Tratamento
19.
Dtsch Med Wochenschr ; 144(15): 1069-1073, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31350751

RESUMO

HISTORY AND CLINICAL FINDINGS: Emergency admission of a 66-years-old man with right-sided and partly breath-dependent chest pain in the interdisciplinary emergency room. The complaints existed for several days and had a progressive character. Purulent expectoration and fever were negated. There was a history of COPD with occasional pulmonary exacerbations. Several weeks before the current event, community-acquired pneumonia had been treated with antibiotics. Moreover, the patient reported on multiple spine surgery procedures performed in recent months. INVESTIGATIONS AND DIAGNOSIS: In transthoracic echocardiography (TTE), detection of a foreign body (Palacos) in the right ventricle, which was confirmed to be a toothpick-like structure in the supplementary CT scan of the thorax and the transoesophageal echocardiography (TOE). TREATMENT AND COURSE: Foreign body extraction using right anterior mini thoracotomy. Subsequently, iatrogenic pneumothorax with bilateral nosocomial pneumonia and drainage. After short-term convalescence, renewed admission with bilateral pulmonary infiltrates. Under invasive ventilation, new left-sided pneumothorax was diagnosed, which was supplied with a Bülau drainage. Due to the detection of positive blood cultures, re-conducting of a TOE examination. Now first diagnosis of tricuspid valve endocarditis. Despite successful surgical biologic tricuspid valve replacement with an epicardial pacemaker electrode placement, the patient died approximately three quarters of a year after he became an emergency patient due to dyspnoea. DISCUSSION: The present case shows that a typical clinical symptom, associated with a previously known chronic illness, has to be reminded again and again of other and less common diseases. Even everyday diagnostic and therapeutic procedures are associated with a residual risk of possible complications.


Assuntos
Dispneia , Corpos Estranhos , Ventrículos do Coração , Complicações Pós-Operatórias , Vertebroplastia/efeitos adversos , Idoso , Cimentos para Ossos/efeitos adversos , Dispneia/diagnóstico , Dispneia/etiologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Masculino , Polimetil Metacrilato/efeitos adversos , Toracotomia , Tomografia Computadorizada por Raios X
20.
J Orthop Surg Res ; 14(1): 228, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324196

RESUMO

OBJECTIVE: Vertebroplasty is the most widely used method for treating osteoporotic vertebral compression fractures (OVCF). During this procedure, bone cement is injected into the vertebral body. Fracture and additional fractures can occur adjacent to the treatment site. Thus, we studied factors causing such vertebral fractures after vertebroplasty and calculated the appropriate amount of bone cement to inject. METHODS: From September 2012 to March 2016, 187 patients with OVCF undergoing vertebroplasty were selected, and 112 patients with complete follow-up information were selected. Of these, 28 had adjacent vertebral fractures (refracture group) during the follow-up period, and 84 patients had no adjacent vertebral fractures (control group). Then, sex, age, body weight, bone mineral density (BMD), and bone cement injection (bone cement injection volume and bone fracture vertebral volume percent) were compared. RESULTS: All patients had significant pain relief within 24 h (preoperative and postoperative [24 h later] VAS scores were 7.4 ± 0.8 and 2.3 ± 0.5, respectively). The age and weight were not statistically significantly different (P > 0.05). BMD values were statistically significantly different between groups as was sex (P < 0.05). CONCLUSIONS: Bone cement injection volume, BMD values, and sex were statistically significantly related to adjacent vertebral fractures after vertebroplasty, and cement injection volumes exceeding 40.5% caused adjacent vertebral fractures.


Assuntos
Cimentos para Ossos/efeitos adversos , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Fatores de Risco , Fatores Sexuais , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/tendências
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