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1.
Angiol Sosud Khir ; 27(3): 46-52, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528588

RESUMO

Interventions on bifurcation lesions of the coronary bed are one of the most complicated tasks of interventional cardiology. Recent trends are toward active study of using drug-eluting balloons for interventions in this type of lesions. Using such technique makes it possible to minimize the risks associated with implantation of stents in sites of coronary artery bifurcations with good angiographic results. This article is a review of the literature data concerning the use of drug-coated balloons in interventions on bifurcation lesions of the coronary bed, discussing peculiarities of the balloon catheter design, dynamics of delivery of an antiproliferative drug to the vascular wall. This is followed by considering the experience with using innovative sirolimus-coated balloon catheters, as well as future perspectives of these devices for interventions in coronary artery bifurcation lesions.


Assuntos
Doença da Artéria Coronariana , Reestenose Coronária , Stents Farmacológicos , Preparações Farmacêuticas , Angiografia Coronária , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Desenho de Prótese , Stents , Resultado do Tratamento
2.
Angiol Sosud Khir ; 27(3): 115-124, 2021.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-34528595

RESUMO

AIM: The study was aimed at comparing the immediate clinical and haemodynamic results of open implantation of the balloon-expandable aortic prosthesis 'MedLab-KT' with the respective parameters of standard replacement of the aortic valve by a mechanical prosthesis in high-risk surgical patients. PATIENTS AND METHODS: We analysed a total of 209 cases of prosthetic repair of the aortic valve. The Study Group comprised 28 patients subjected to open implantation of the 'MedLab-KT' prosthesis in conditions of extracorporeal circulation and myocardial ischaemia and belonging to a high-surgical risk cohort. The Comparison Group included 181 patients who endured standard open prosthetic repair of the aortic valve with a mechanical prosthesis. Using the ppropensity score matching method, we selected 28 patients from the Comparison Group, followed by assessing the incidence of adverse clinical events and haemodynamic parameters of the aortic valve prosthesis at the in-hospital stage. RESULTS: There were no lethal outcomes in the study group, with one in the group of standard aortic valve repair - 3.6%. The mean operative time in the Study and Comparison Group patients amounted to 121.5±51.2 and 274.2±55.3 min (p=0.04), the duration of extracorporeal circulation to 56.1±19.5 and 119.9±23.4 min (p=0.04), that of myocardial ischaemia to 38.4±17.1 and 96.7±20.8 (p=0.03), respectively. The mean gradient on the aortic valve in the 'MedLab-KT' group was less (7.5±3.2 mm Hg) than in those of the second group (9±3.5 mm Hg), with no statistically significant differences in the parameters revealed (p=0.096). All patients of the study group were discharged from hospital in a satisfactory condition, with the haemodynamic result of the operation regarded as satisfactory. CONCLUSION: Comparing the main clinical characteristics and haemodynamic parameters in the groups of 'MedLab-KT' and aortic valve prosthetic repair at the hospital stage revealed no statistically significant differences. Open implantation of the 'MedLab-KT' prosthesis proved safe and effective.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Desenho de Prótese , Resultado do Tratamento
3.
Acta Ortop Mex ; 35(1): 33-39, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480437

RESUMO

INTRODUCTION: Loss of bone stock and anatomical alteration of the proximal femur make femoral revision surgery a complex procedure in which the choice of implant will be critical. Our goal is to assess the clinical and radiological results of complete coating Monoblock stems. MATERIAL AND METHODS: Retrospective study of 78 consecutive cases of femoral review surgery intervened by our unit. RESULTS: The average follow-up was 122 months. The average score on the Harris Hip Score was 81.2 ± 11.4 points. An age of less than 65 years, a minor femoral defect according to Paprosky classification (I, II and IIIA), the existence of a single previous surgery and the non-occurrence of intra or postoperative complications, was associated with better clinical and functional outcomes (p < 0.05).Cumulative survival was 96.7% at age 10 if we consider as failure the removal of the stem by aseptic loosening and 92% if we consider withdrawal for any cause to fail. CONCLUSION: Despite the current tendency to use modularity in femoral review surgery and given the results presented, we consider that complete coating monoblock stems provide a firm and stable fixation. However, the worst results in patients with major defects have led to other options being considered.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Idoso , Criança , Fêmur/cirurgia , Humanos , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
4.
Acta Ortop Mex ; 35(1): 69-74, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480443

RESUMO

INTRODUCTION: The two most commonly used types of prostheses are the total knee prosthesis with posterior cruciate ligament preservation and posterior cruciate ligament replacement. OBJECTIVE: To assess whether there is a difference in functionality between the two procedures. MATERIAL AND METHODS: Observational, retrospective and cross-sectional study with 134 patients divided into group A (N = 67) with ligament preservation and group B (N = 67) with posterior substituting. Using the American Association Scale for Knee Prosthetics with Insall modification to assess functionality. Statistical analysis: use of 2 with Yates correction. RESULTS: In group A the results: excellent (31%); good (24%); regular (22%) bad (22%). In group B the results: excellent (34%); good (31%); regular (16%) and bad (19%); without statistical difference between the two groups. CONCLUSIONS: No statistically significant difference was observed between age, gender, laterality of injury, or between number of patients with excellent results, good regular and bad according to the scale used. The high percentage of poor results in both groups of this series for the knee prosthesis is striking.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Ligamento Cruzado Posterior , Estudos Transversais , Humanos , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular , Estudos Retrospectivos
5.
J Refract Surg ; 37(9): 601-608, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506236

RESUMO

PURPOSE: To evaluate a new extended depth of focus intraocular lens (IOL), the xact Mono-EDOF ME4 (Santen Pharmaceuticals), Conformitè Europëenne-marked as a monofocal IOL, which has four diffractive rings intended to enhance intermediate vision. METHODS: Results are reported for 47 IOLs implanted in 28 patients who underwent cataract surgery and implantation of the xact Mono-EDOF ME4 IOL in one (9 patients) or both (19 patients) eyes. Postoperative follow-up examinations included visual acuity testing (monocular and binocular; uncorrected distance visual acuity [UDVA], corrected distance visual acuity [CDVA], uncorrected intermediate visual acuity [UIVA], distance-corrected intermediate visual acuity [DCIVA]), defocus curve and contrast sensitivity testing, and dysphotopsia evaluation. RESULTS: Follow-up at 6 months postoperatively revealed a monocular UDVA of 0.08 ± 0.15 logMAR, binocular UDVA of -0.02 ± 0.09 logMAR, monocular CDVA of -0.07 ± 0.08 logMAR, binocular CDVA of -0.09 ± 0.09 logMAR, monocular UIVA (70 cm) of 0.18 ± 0.16 logMAR, binocular UIVA (70 cm) of 0.09 ± 0.12 logMAR, monocular DCIVA (70 cm) of 0.25 ± 0.14 logMAR, and binocular DCIVA (70 cm) of 0.13 ± 0.11 logMAR. Defocus curve testing demonstrated a functional defocus of 1.25 diopters at 0.20 logMAR for monocular and 1.50 diopters at 0.20 logMAR for binocular testing. The contrast sensitivity corresponded to the age-appropriate normal values. Patients reported low levels of halo and glare. CONCLUSIONS: The xact Mono-EDOF ME4 IOL showed good functional results for far and intermediate distance visual acuity while inducing a low level of photic phenomena. [J Refract Surg. 2021;37(9):601-608.].


Assuntos
Lentes Intraoculares , Pseudofacia , Percepção de Profundidade , Humanos , Implante de Lente Intraocular , Estudos Prospectivos , Desenho de Prótese , Refração Ocular , Visão Binocular
6.
J Refract Surg ; 37(9): 595-600, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506243

RESUMO

PURPOSE: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a new enhanced monofocal extended depth of focus (EDOF) intraocular lens (IOL). METHODS: Fifty eyes of 25 consecutive patients who underwent implantation of the xact Mono-EDoF IOL (Santen Pharmaceutical Co, Ltd) were enrolled in this study. Main outcome measures were refractive error and monocular corrected (CDVA) and uncorrected (UDVA) distance visual acuity values. Monocular visual acuity at different vergences (defocus curve) was obtained. Patients were evaluated at 12 months postoperatively. RESULTS: At 1 year of follow-up, all eyes showed a postoperative spherical equivalent within ±1.00 diopters (D) and 95% of eyes within ±0.50 D. The mean postoperative spherical equivalent was -0.15 ± 0.28 D. A total of 88% and 100% of eyes showed UDVA and CDVA of 20/25 or better, respectively. The mean values of UDVA and CDVA (Snellen decimal) were 0.94 ± 0.09 (range: 0.70 to 1.00) and 0.99 ± 0.03 (range: 0.79 to 1.00), respectively. Defocus curve showed good visual acuity at distance and intermediate distances with a depth of focus value of 1.25 D. No visual disturbances were reported in the whole sample during the entire follow-up. CONCLUSIONS: The current study shows that this EDOF IOL provides good visual performance at far and intermediate distances. The lens may be considered for patients interested in reducing spectacle independence at intermediate distances. [J Refract Surg. 2021;37(9):595-600.].


Assuntos
Lentes Intraoculares , Facoemulsificação , Humanos , Implante de Lente Intraocular , Satisfação do Paciente , Estudos Prospectivos , Desenho de Prótese , Pseudofacia , Refração Ocular
7.
Rev Med Chil ; 149(2): 286-290, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34479276

RESUMO

The deployment of a percutaneous aortic valve is challenging in patients with a mitral prosthesis. The risk of prosthetic deformation, embolization or dysfunction is higher in this group of patients, which requires a series of technical considerations. We report a successful implantation of an Evolut Pro # 29 self-expanding valve in a 67-year-old female with a previous Starr-Edwards caged-ball mitral prosthesis.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Feminino , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Desenho de Prótese
8.
BMC Musculoskelet Disord ; 22(1): 781, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511090

RESUMO

BACKGROUND: The metal-on-metal large-diameter-head (MoM-LDH) hip replacements increased in popularity during the start of the twenty-first century. Subsequently reports raised concerns regarding adverse reactions due to elevated chromium (Cr) and cobalt (Co) concentrations as well as high rates of other complications and revisions. The purpose was to compare Harris Hip Score and SF-36 at 5-years follow up following MoM-LDH total hip arthroplasty (MoM-LDH-THA) or MoM hip resurfacing (MoM-HR). METHODS: The study was conducted between November 2006 to January 2012 in a tertiary health care center in Denmark. Patients with primary or secondary osteoarthritis were randomly assigned to receive a Magnum (MoM-LDH-THA) or a Recap (MoM-HR) prosthesis. Randomization was computer generated and allocation was concealed in an opaque envelope. Neither patients nor care provider were blinded. Primary outcome was Harris Hip Score at 5-years follow up. RESULTS: Seventy-five were included and allocated to the MoM-LDH-THA (n = 39) and MoM-HR (n = 36) group. The study was prematurely stopped due to numerous reports of adverse events in patients with MoM hip replacements. Thirty-three in the MoM-LDH-THA and 25 in the MoM-HR group were available for primary outcome analysis. Median Harris Hip Score was 100 (IQR: 98-100) for MoM-LDH-THA and 100 (IQR: 93-100) for MoM-HR (p = 0.486). SF-36 score was high in both groups with no significant difference between groups. CONCLUSION: Harris Hip Score and SF-36 score was excellent in both groups with no significant difference at 5-years follow up. Our findings suggest that there is no clinical important difference between the two prostheses implanted 5 years after implantation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04585022 , Registered 23 September 2020 - Retrospectively registered. This study was not prospectively registered in a clinical trial database since it was not an entirely implemented standard procedure in the international orthopedic society when the study was planned.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Próteses Articulares Metal-Metal , Artroplastia de Quadril/efeitos adversos , Cromo , Cobalto/efeitos adversos , Seguimentos , Prótese de Quadril/efeitos adversos , Humanos , Próteses Articulares Metal-Metal/efeitos adversos , Desenho de Prótese , Falha de Prótese , Reoperação
9.
BMC Musculoskelet Disord ; 22(1): 784, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511101

RESUMO

BACKGROUND: Patellofemoral overstuffing after total knee arthroplasty (TKA) can cause limited range of motion and anterior knee pain. This study compared anterior prominence of femoral components among different prothesis designs in surgical simulation models utilizing the anterior reference (AR) and posterior reference (PR) techniques. METHODS: Surgical simulations were performed using on a three-dimensional planning system preoperative computed tomography data of consecutive 30 patients with knee osteoarthritis scheduled to undergo TKA. Four implant models were used: Attune, Persona, Journey II, and Legion. Rotational alignment was set parallel to the transepicondylar axis and size was selected based on the absence of notch formation in the femoral anterior cortex and the best fit with the shape of the medial posterior femoral condyle. For each combination of surgical technique (AR or PR method) and implant model, measurements were taken of the maximum medial, central, and lateral prominence of the implant from the anterior femoral cortex. RESULTS: Using either the AR or PR method, the medial and central prominences were significantly lower with Journey II than with the other models. The lateral prominence was the lowest with Attune in the AR method. The AR method was associated with significantly less prominence compared with the PR method, regardless of implant model. CONCLUSIONS: The degree of anterior prominence of the femoral implant is affected by the implant design when the AR method is used. The PR method is associated with greater anterior prominence compared with the AR method, and the pitch size is an additional factor in the PR method. Surgeons should be familiar with implant designs, including the thickness of the anterior flange and the available size selections.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/efeitos adversos , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular
10.
Bone Joint J ; 103-B(9): 1479-1487, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465151

RESUMO

AIMS: The aim of our study was to investigate the effect of asymmetric crosslinked polyethylene liner use on the risk of revision of cementless and hybrid total hip arthroplasties (THAs). METHODS: We undertook a registry study combining the National Joint Registry dataset with polyethylene manufacturing characteristics as supplied by the manufacturers. The primary endpoint was revision for any reason. We performed further analyses on other reasons including instability, aseptic loosening, wear, and liner dissociation. The primary analytic approach was Cox proportional hazard regression. RESULTS: A total of 213,146 THAs were included in the analysis. Overall, 2,997 revisions were recorded, 1,569 in THAs with a flat liner and 1,428 in THAs using an asymmetric liner. Flat liner THAs had a higher risk of revision for any reason than asymmetric liner THAs when implanted through a Hardinge/anterolateral approach (hazard ratio (HR) 1.169, 95% confidence interval (CI) 1.022 to 1.337) and through a posterior approach (HR 1.122, 95% CI 1.108 to 1.346). There was no increased risk of revision for aseptic loosening when asymmetric liners were used for any surgical approach. A separate analysis of the three most frequently used crosslinked polyethylene liners was in agreement with this finding. When analyzing THAs with flat liners only, THAs implanted through a Hardinge/anterolateral approach were associated with a reduced risk of revision for instability compared to posterior approach THAs (HR 0.561 (95% CI 0.446 to 0.706)). When analyzing THAs with an asymmetric liner, there was no significant difference in the risk of revision for instability between the two approaches (HR 0.838 (95% CI 0.633 to 1.110)). CONCLUSION: For THAs implanted through the posterior approach, the use of asymmetric liners reduces the risk of revision for instability and revision for any reason. In THAs implanted through a Hardinge/anterolateral approach, the use of an asymmetric liner was associated with a reduced risk of revision. The effect on revision for instability was less pronounced than in the posterior approach. Cite this article: Bone Joint J 2021;103-B(9):1479-1487.


Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril , Polietileno/química , Desenho de Prótese , Reoperação/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Sistema de Registros
11.
Bone Joint J ; 103-B(9): 1449-1456, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465158

RESUMO

AIMS: The goal of the current systematic review was to assess the impact of implant placement accuracy on outcomes following total knee arthroplasty (TKA). METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Ovid Medline, Embase, Cochrane Central, and Web of Science databases in order to assess the impact of the patient-reported outcomes measures (PROMs) and implant placement accuracy on outcomes following TKA. Studies assessing the impact of implant alignment, rotation, size, overhang, or condylar offset were included. Study quality was assessed, evidence was graded (one-star: no evidence, two-star: limited evidence, three-star: moderate evidence, four-star: strong evidence), and recommendations were made based on the available evidence. RESULTS: A total of 49 studies were identified for inclusion. With respect to PROMs, there was two-star evidence in support of mechanical axis alignment (MAA), femorotibial angle (FTA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), femoral rotation, tibial and combined rotation/mismatch, and implant size/overhang or offset on PROMs, and one-star evidence in support of tibial sagittal angle (TSA), impacting PROMs. With respect to survival, there was three- to four-star evidence in support FTA, FCA, TCA, and TSA, moderate evidence in support of femoral rotation, tibial and combined rotation/mismatch, and limited evidence in support of MAA, FSA, and implant size/overhang or offset impacting survival. CONCLUSION: Overall, there is limited evidence to suggest that PROMs are impacted by the accuracy of implant placement, and malalignment does not appear to be a significant driver of the observed high rates of patient dissatisfaction following TKA. However, FTA, FCA, TCA, TSA, and implant rotation demonstrate a moderate-strong relationship with implant survival. Efforts should be made to improve the accuracy of these parameters in order to improve TKA survival. Cite this article: Bone Joint J 2021;103-B(9):1449-1456.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Medidas de Resultados Relatados pelo Paciente , Humanos , Desenho de Prótese , Falha de Prótese
12.
J Cataract Refract Surg ; 47(9): 1139-1146, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468451

RESUMO

PURPOSE: To evaluate visual performance and optical quality of an extended depth-of-focus intraocular lens (EDoF IOL) compared with a monofocal aspheric IOL. SETTING: Department of Ophthalmology, Charité-Medical University Berlin, Germany. DESIGN: Prospective case series. METHODS: After phacoemulsification, a total of 28 patients (56 eyes) underwent bilateral implantation of either the Mini Well (EDoF IOL) or the Mini 4 (monofocal IOL). Assessments including refraction, distance, intermediate and near visual acuity, defocus curves, contrast sensitivity, glare disability, higher-order aberrations (HOAs), and patient satisfaction were performed at 1 month and 3 months postoperatively. RESULTS: Both study groups comprised 14 patients (28 eyes) each. At 3-month follow-up, the EDoF IOL showed better results in monocular uncorrected intermediate visual acuity (-0.04 vs 0.10 logMAR, P = .000) and in uncorrected near visual acuity (0.13 vs 0.36 logMAR, P = .000), whereas no statistically significant difference was found between groups in monocular uncorrected distance visual acuity (0.04 vs 0.00 logMAR, P = .110). The monocular depth of focus was 0.8 D greater in the Mini Well IOL group. Measurements of internal HOAs revealed a greater negative primary spherical aberration in the EDoF group at pupil sizes of 2.0 to 5.0 mm. At 5.0 mm, total internal HOAs did not differ statistically significantly (0.376 vs 0.340 µm root mean square, P = .068). CONCLUSIONS: The Mini Well IOL provided greater depth of focus with superior outcomes at intermediate and near distances and comparable outcomes at far distance. Although inducing higher amounts of spherical aberration, it showed good results under low lighting conditions with little subjective dysphotopsia.


Assuntos
Lentes Intraoculares , Facoemulsificação , Percepção de Profundidade , Humanos , Implante de Lente Intraocular , Estudos Prospectivos , Desenho de Prótese , Pseudofacia , Refração Ocular
13.
World J Surg Oncol ; 19(1): 235, 2021 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-34365976

RESUMO

BACKGROUND: Long-lasting reconstruction after extensive resection involving peri-knee metaphysis is a challenging problem in orthopedic oncology. Various reconstruction methods have been proposed, but they are characterized by a high complication rate. The purposes of this study were to (1) assess osseointegration at the bone implant interface and correlated incidence of aseptic loosening; (2) identify complications including infection, endoprosthesis fracture, periprosthetic fracture, leg length discrepancy, and wound healing problem in this case series; and (3) evaluate the short-term function of the patient who received this personalized reconstruction system. METHODS: Between September 2016 and June 2018, our center treated 15 patients with malignancies arising in the femur or tibia shaft using endoprosthesis with a 3D-printed custom-made stem. Osseointegration and aseptic loosening were assessed with digital tomosynthesis. Complications were recorded by reviewing the patients' records. The function was evaluated with the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score at a median of 42 (range, 34 to 54) months after reconstruction. RESULTS: One patient who experienced early aseptic loosening was managed with immobilization and bisphosphonates infusion. All implants were well osseointegrated at the final follow-up examination. There are two periprosthetic fractures intraoperatively. The wire was applied to assist fixation, and the fracture healed at the latest follow-up. Two patients experienced significant leg length discrepancies. The median MSTS-93 score was 26 (range, 23 to 30). CONCLUSIONS: A 3D-printed custom-made ultra-short stem with a porous structure provides acceptable early outcomes in patients who received peri-knee metaphyseal reconstruction. With detailed preoperative design and precise intraoperative techniques, the reasonable initial stability benefits osseointegration to osteoconductive porous titanium, and therefore ensures short- and possibly long-term durability. Personalized adaptive endoprosthesis, careful intraoperative operation, and strict follow-up management enable effective prevention and treatment of complications. The functional results in our series were acceptable thanks to reliable fixation in the bone-endoprosthesis interface and an individualized rehabilitation program. These positive results indicate this device series can be a feasible alternative for critical bone defect reconstruction. Nevertheless, longer follow-up is required to determine whether this technique is superior to other forms of fixation.


Assuntos
Neoplasias Ósseas , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Humanos , Articulação do Joelho , Porosidade , Prognóstico , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
14.
Stomatologiia (Mosk) ; 100(4): 98-103, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34357736

RESUMO

Total nasal defects after injures or surgical interventions can negatively affect patient's quality of life. Maxillofacial prosthesis is a contemporarily and reliable solution. This method gives us opportunity to restore missing tissues and helps patients to overcome social and psychological difficulties. In this article we demonstrated advantages and disadvantages of the method in two clinical cases. The application of magnetic and adhesive retention in different cases is described. Also, we outlined clinical and technological steps of maxillofacial prosthesis manufacture. Modified procedure of impression obtaining is offered.


Assuntos
Prótese Maxilofacial , Qualidade de Vida , Cimentos Dentários , Humanos , Nariz/cirurgia , Desenho de Prótese
15.
Stomatologiia (Mosk) ; 100(4): 127-131, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34357741

RESUMO

This systematic literature review presents the history of the development of temporomandibular joint reconstruction, discusses the problems and difficulties faced by engineers and surgeons. Better understanding of the history of temporomandibular joint prostheses explains the origin of negative public opinion about the prosthesis. TMJ prostheses design evolution and used biomaterials are discussed to justify the lack of variability of commercially available TMJ-reconstruction systems.


Assuntos
Artroplastia de Substituição , Prótese Articular , Transtornos da Articulação Temporomandibular , Humanos , Desenho de Prótese , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia
16.
Bone Joint J ; 103-B(8): 1333-1338, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34334038

RESUMO

AIMS: Reverse total shoulder arthroplasty (RTSA) using trabecular metal (TM)-backed glenoid implants has been introduced with the aim to increase implant survival. Only short-term reports on the outcomes of TM-RTSA have been published to date. We aim to present the seven-year survival of TM-backed glenoid implants along with minimum five-year clinical and radiological outcomes. METHODS: All consecutive elective RTSAs performed at a single centre between November 2008 and October 2014 were reviewed. Patients who had primary TM-RTSA for rotator cuff arthropathy and osteoarthritis with deficient cuff were included. A total of 190 shoulders in 168 patients (41 male, 127 female) were identified for inclusion at a mean of 7.27 years (SD 1.4) from surgery. The primary outcome was survival of the implant with all-cause revision and aseptic glenoid loosening as endpoints. Secondary outcomes were clinical, radiological, and patient-related outcomes with a five-year minimum follow-up. RESULTS: The implant was revised in ten shoulders (5.2%) with a median time to revision of 21.2 months (interquartile range (IQR) 9.9 to 41.8). The Kaplan-Meier survivorship estimate at seven years was 95.9% (95% confidence interval (CI) 91.7 to 98; 35 RTSAs at risk) for aseptic mechanical failure of the glenoid and 94.8% (95% CI 77.5 to 96.3; 35 RTSAs at risk) for all-cause revision. Minimum five-year clinical and radiological outcomes were available for 103 and 98 RTSAs respectively with a median follow-up time of six years (IQR 5.2 to 7.0). Median postoperative Oxford Shoulder Score was 38 (IQR 31 to 45); median Constant and Murley score was 60 (IQR 47.5 to 70); median forward flexion 115° (IQR 100° to 125°); median abduction 95° (IQR 80° to 120°); and external rotation 25° (IQR 15° to 40°) Scapular notching was seen in 62 RTSAs (63.2%). CONCLUSION: We present the largest and longest-term series of TM-backed glenoid implants demonstrating 94.8% all-cause survivorship at seven years. Specifically pertaining to glenoid loosening, survival of the implant increased to 95.9%. In addition, we report satisfactory minimum five-year clinical and radiological outcomes. Cite this article: Bone Joint J 2021;103-B(8):1333-1338.


Assuntos
Artroplastia do Ombro/métodos , Placas Ósseas , Falha de Prótese , Escápula/cirurgia , Prótese de Ombro , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Desenho de Prótese , Radiografia , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Fatores de Tempo , Resultado do Tratamento
17.
Bone Joint J ; 103-B(8): 1339-1344, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34334039

RESUMO

AIMS: This aim of this study was to assess the reliability and validity of the Unified Classification System (UCS) for postoperative periprosthetic femoral fractures (PFFs) around cemented polished taper-slip (PTS) stems. METHODS: Radiographs of 71 patients with a PFF admitted consecutively at two centres between 25 February 2012 and 19 May 2020 were collated by an independent investigator. Six observers (three hip consultants and three trainees) were familiarized with the UCS. Each PFF was classified on two separate occasions, with a mean time between assessments of 22.7 days (16 to 29). Interobserver reliability for more than two observers was assessed using percentage agreement and Fleiss' kappa statistic. Intraobserver reliability between two observers was calculated with Cohen kappa statistic. Validity was tested on surgically managed UCS type B PFFs where stem stability was documented in operation notes (n = 50). Validity was assessed using percentage agreement and Cohen kappa statistic between radiological assessment and intraoperative findings. Kappa statistics were interpreted using Landis and Koch criteria. All six observers were blinded to operation notes and postoperative radiographs. RESULTS: Interobserver reliability percentage agreement was 58.5% and the overall kappa value was 0.442 (moderate agreement). Lowest kappa values were seen for type B fractures (0.095 to 0.360). The mean intraobserver reliability kappa value was 0.672 (0.447 to 0.867), indicating substantial agreement. Validity percentage agreement was 65.7% and the mean kappa value was 0.300 (0.160 to 0.4400) indicating only fair agreement. CONCLUSION: This study demonstrates that the UCS is unsatisfactory for the classification of PFFs around PTS stems, and that it has considerably lower reliability and validity than previously described for other stem types. Radiological PTS stem loosening in the presence of PFF is poorly defined and formal intraoperative testing of stem stability is recommended. Cite this article: Bone Joint J 2021;103-B(8):1339-1344.


Assuntos
Fraturas do Fêmur/classificação , Prótese de Quadril , Fraturas Periprotéticas/classificação , Complicações Pós-Operatórias/classificação , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Fraturas Periprotéticas/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Desenho de Prótese , Radiografia , Reprodutibilidade dos Testes
18.
Bone Joint J ; 103-B(8): 1405-1413, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34334040

RESUMO

AIMS: Rotating-hinge knee prostheses are commonly used to reconstruct the distal femur after resection of a tumour, despite the projected long-term burden of reoperation due to complications. Few studies have examined the factors that influence their failure and none, to our knowledge, have used competing risk models to do so. The purpose of this study was to determine the risk factors for failure of a rotating-hinge knee distal femoral arthroplasty using the Fine-Gray competing risk model. METHODS: We retrospectively reviewed 209 consecutive patients who, between 1991 and 2016, had undergone resection of the distal femur for tumour and reconstruction using a rotating-hinge knee prosthesis. The study endpoint was failure of the prosthesis, defined as removal of the femoral component, the tibial component, or the bone-implant fixation; major revision (exchange of the femoral component, tibial component, or the bone-implant fixation); or amputation. RESULTS: Multivariate Fine-Gray regression analyses revealed different hazards for each Henderson failure mode: percentage of femoral resection (p = 0.001) and extent of quadriceps muscle resection (p = 0.005) for overall prosthetic failure; extent of quadriceps muscle resection (p = 0.002) and fixation of femoral component (p = 0.011) for type 2 failure (aseptic loosening); age (p = 0.009) and percentage of femoral resection (p = 0.019) for type 3 failure (mechanical failure); and type of joint resection (p = 0.037) for type 4 (infection) were independent predictors. A bone stem ratio of > 2.5 reliably predicted aseptic loosening. CONCLUSION: We identified independent risk factors for overall and cause-specific prosthetic failure after rotating-hinge knee distal femoral arthroplasty using a competing risk Fine-Gray model. A bone stem ratio > 2.5 reliably predicts aseptic loosening. An accurate knowledge of the risks of distal femoral arthroplasty after resection for tumour assists surgical planning and managing patient expectations. Cite this article: Bone Joint J 2021;103-B(8):1405-1413.


Assuntos
Neoplasias Femorais/cirurgia , Prótese do Joelho , Falha de Prótese , Adulto , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(7): 697-703, 2021 Jul 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34382585

RESUMO

OBJECTIVES: As the main implant material, coronary stent is one of the main factors that affect clinical treatment outcome and patient cost. The choice for coronary stent in clinic depends on multiply factors including patient preference, medical personnel expertise and current technology, and no recognized method has been established for the evaluation and choice of coronary stent. In this study, we aim to evaluate the safety, effectiveness, and economy of a few drug-eluting coronary stents in clinic. METHODS: A retrospective analysis was employed to study the cases treated by drug-eluting stent intervention in a third grade hospital from January 2018 to December 2019. Based on the specific products, these cases were assigned into a domestic stent A group, a domestic stent B group, a domestic stent C group, and an imported stent group. According to the severity of the disease, they were divided into an angina pectoris, an acute myocardial infarction, and an ischemic heart disease subgroups. Layer analysis was carried out for inter-subgroup comparisons in terms of safety (indicated by mortality rate, complication rate, and infection rate), efficacy (indicated by 31-day return rate, 365-day myocardial infarction rate, restenosis rate, secondary intervention rate, and thrombosis rate), and economy (indicated by averaged total cost and coronary stent cost). RESULTS: Among the 4 products, there was no difference in safety (P>0.05). Except for patients with acute myocardial infarction, there was no significant difference in the effectiveness of the 4 products for the other 2 diseases. The economical aspect of the domestic stent B and the domestic stent C was better than that of the domestic stent A and the imported stent (all P<0.05). CONCLUSIONS: With all the indicators of these 4 stents taken into consideration, we conclude that hospitals may appropriately increase the share of domestic coronary stent in product selection and in-hospital management. This measure helps increase product localization rate and ease the financial burden for patients by reducing coronary stent cost.


Assuntos
Stents Farmacológicos , Preparações Farmacêuticas , Humanos , Desenho de Prótese , Estudos Retrospectivos , Stents , Resultado do Tratamento
20.
Prog Cardiovasc Dis ; 66: 92-100, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34332665

RESUMO

Stroke is a major driver of increased morbidity and mortality in patients with non-valvular atrial fibrillation (NVAF). While systemic oral anticoagulation (OAC) continues to be the mainstay for stroke reduction therapy in patients with NVAF, several barriers prevent the sustained long-term use of OAC, including increased risk of bleeding, non-compliance, cost, drug-drug interactions, and the need for ongoing laboratory testing. Given the need for continued stroke reduction therapies in patients who are intolerant of or non-compliant with OAC, percutaneous left atrial appendage (LAA) occlusion (LAAO) has emerged as a nonpharmacologic alternative to OAC. The development of percutaneous LAAO techniques is based on data suggesting that more than 90% of thrombi in patients with NVAF originate in the LAA. Two percutaneous LAAO devices are currently in widespread clinical use: Watchman (United States and Europe) and the Amplatzer type of devices (Europe); randomized trial data exist only for the Watchman device. Multiple randomized and nonrandomized trials and registries have demonstrated the safety and effectiveness of LAAO in patients who are suitable for short-term anticoagulation using a variety of post-procedural antithrombotic strategies. Ongoing randomized clinical trials on LAAO are focused on OAC-ineligible patients to compare efficacy of LAAO devices against a multitude of antithrombotic options. This review aims to discuss the rationale and evidence for LAAO and post procedural antithrombotic strategies and opportunities for research examination. In addition, we discuss the need for continued investigation of LAAO in populations not well represented in clinical trials or registries, including women, older patients, and underrepresented racial and ethnic groups.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/terapia , Cateterismo Cardíaco/instrumentação , Fibrinolíticos/uso terapêutico , Dispositivo para Oclusão Septal , Acidente Vascular Cerebral/prevenção & controle , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/mortalidade , Tomada de Decisão Clínica , Fibrinolíticos/efeitos adversos , Humanos , Seleção de Pacientes , Desenho de Prótese , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
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