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1.
BMC Vet Res ; 15(1): 182, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151444

RESUMO

BACKGROUND: A retrospective case series study was undertaken to describe the magnetic resonance imaging (MRI) findings in Pug dogs with thoracolumbar myelopathy and concurrent caudal articular process (CAP) dysplasia. Electronic clinical records were searched for Pug dogs who underwent MRI for the investigation of a T3-L3 spinal cord segment disease with subsequent confirmation of CAP dysplasia with computed tomography between January 2013 and June 2017. Clinical parameters age, gender, neuter status, body weight, urinary or faecal incontinence, severity and duration of clinical signs were recorded. MRI abnormalities were described. Univariable non-parametric tests investigated the association between the clinical parameters and evidence of extra- or intra-dural spinal cord compression on MRI. RESULTS: 18 Pug dogs were included. The median age was 106 months with median duration of clinical signs 5 months. All presented with variable severity of spastic paraparesis and ataxia; 50% suffered urinary/faecal incontinence. In all cases, MRI revealed a focal increase in T2-weighted signal intensity within the spinal cord at an intervertebral level where bilateral CAP dysplasia was present; this was bilateral aplasia in all but one case, which had one aplastic and one severely hypoplastic CAP. MRI lesions were associated with spinal cord compression in all but one case; intervertebral disc protrusion resulted in extra-dural compression in 10 (56%) cases; intra-dural compression was associated with a suspected arachnoid diverticulum in 4 (22%) cases and suspected pia-arachnoid fibrosis in 3 cases (17%). There was no association between clinical parameters and a diagnosis of intra-dural vs extra-dural compression. CAP dysplasia occurred at multiple levels in the T10-13 region with bilateral aplasia at T11-12 most often associated with corresponding spinal cord lesions on MRI. CONCLUSIONS: All Pugs dogs in this study were presented for chronic progressive ambulatory paraparesis; incontinence was commonly reported. Although intervertebral disc disease was the most common radiologic diagnosis, intra-dural compression associated with arachnoid diverticulae/fibrosis was also common. Bilateral CAP aplasia was present in all but one Pug dog at the level of MRI detectable spinal cord lesions. A causal relationship between CAP dysplasia and causes of thoracolumbar myelopathy is speculated but is not confirmed by this study.


Assuntos
Doenças do Desenvolvimento Ósseo/veterinária , Doenças do Cão/diagnóstico por imagem , Doenças da Medula Espinal/veterinária , Animais , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Cães , Feminino , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/veterinária , Imagem por Ressonância Magnética/veterinária , Masculino , Paraparesia Espástica/veterinária , Estudos Retrospectivos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/veterinária , Doenças da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
2.
J Hand Surg Asian Pac Vol ; 24(2): 229-232, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31035872

RESUMO

We report a patient of Scapholunate (SL) injury in which radiography revealed obvious SL dissociation with dorsal intercalated segment instability deformity, but arthroscopy showed a SL gap of less than 2 mm. Radiographs of the uninjured wrist showed a SL interval of 3.0 mm and a SL angle of 80°. Preoperative magnetic resonance imaging showed low signal intensity in the proximal portion of the scaphoid and a mild SL gap on T1-, T2-weighted, and T2-weighted fat-suppressed images. Midcarpal wrist arthrography revealed a small amount of contrast media leakage through the SL interval. It was considered that incomplete ossification of the scaphoid mimicked obvious radiographic SL dissociation.


Assuntos
Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Osso Escafoide/diagnóstico por imagem , Adulto , Artroscopia , Articulações do Carpo/fisiopatologia , Feminino , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Osso Semilunar/diagnóstico por imagem , Imagem por Ressonância Magnética , Radiografia
3.
Medicine (Baltimore) ; 98(17): e15349, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027114

RESUMO

The purpose of this study was to estimate the rate of spontaneous improvement in tibial metaphyseal-diaphyseal angle (TMDA) in physiologic bowing in comparison to that in Blount disease and to provide reference values of TMDA for monitoring patients with highly suspected to have Blount disease.We retrospectively reviewed patients with physiologic bowing meeting the following criteria:(1) TMDA greater than 9° before 36 months of age at initial evaluation;(2) two or more standing long bone radiographs available; and(3) follow-up conducted up to resolution of deformity.Patients with Blount disease had(1) more than 2 standing long bone radiographs obtained before 36 months of age and(2) underwent no treatment during the period in which these images were obtained.TMDA measurements were obtained from 174 patients with physiologic bowing and 32 patients with Blount disease. Rates of TMDA improvement were adjusted by multiple factors using a linear mixed model, with sex and laterality as fixed effects and age and individual patients as the random effects.In the physiologic bowing group, TMDA improved significantly, by 3° per 6 months and by 6° per year. Changes in TMDA were not significant in the Blount disease group.Knowing the rate of TMDA change can be helpful for physicians seeking to monitor infants with suspected as having Blount disease with a high TMDA and to avoid unnecessary repeat radiographic evaluations.


Assuntos
Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Genu Varum/diagnóstico por imagem , Osteocondrose/congênito , Tíbia/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/fisiopatologia , Criança , Pré-Escolar , Diáfises/diagnóstico por imagem , Diáfises/crescimento & desenvolvimento , Diáfises/fisiopatologia , Progressão da Doença , Feminino , Seguimentos , Genu Varum/fisiopatologia , Humanos , Lactente , Masculino , Osteocondrose/diagnóstico por imagem , Osteocondrose/fisiopatologia , Estudos Retrospectivos , Tíbia/crescimento & desenvolvimento , Tíbia/fisiopatologia
5.
J Orthop Surg Res ; 14(1): 108, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014379

RESUMO

BACKGROUND: In patients with cervical ankylosis, the chin-brow vertical angle (CBVA) should be taken into consideration. Usually, the correction of sagittal balance is sacrificed to ensure the patient has a horizontal visual field. To our knowledge, a staged osteotomy strategy for ankylosing spondylitis kyphotic deformity with an ankylosed cervical spine has not been reported before. The aim of this study was to describe a new surgical strategy with emphasis on sagittal balance and gaze angle in correction of kyphotic deformity with a rigid cervical spine in ankylosing spondylitis thoracolumbar kyphotic deformity. METHODS: A 36-year-old man has severe thoracolumbar kyphosis accompanied with cervical hyperlordosis caused by ankylosing spondylitis. A two-stage surgery planning was managed. For the first stage, an interrupted two-level osteotomy was performed at the thoracolumbar area. After surgery, sagittal imbalance was corrected but the CBVA was - 21.7°. Cervical osteotomy was performed for the second stage. A flexion osteotomy was performed at C7, using anterior-posterior-anterior approaches. RESULTS: Both sagittal imbalance and gaze angle of the patient were improved markedly. The osteotomy sites were documented fused. Complications were not observed during and after operation. CONCLUSIONS: The aim of osteotomy for ankylosing spondylitis is to reestablish sagittal balance and improve forward gaze and the visual field. A staged cervical osteotomy is an alternative to reduce cervical lordosis to obtain a normal gaze angle. An anterior-posterior-anterior approach is recommended.


Assuntos
Vértebras Cervicais/anormalidades , Vértebras Cervicais/cirurgia , Cifose/cirurgia , Osteotomia/métodos , Espondilite Anquilosante/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Humanos , Cifose/complicações , Cifose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
6.
J Orthop Surg Res ; 14(1): 26, 2019 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-30674325

RESUMO

BACKGROUND: This review compares the outcomes and complication rates of three surgical strategies used for the management of symptomatic os acromiale. The purpose of this study was to help guide best practice recommendations. METHODS: A systematic review of nine prospective studies, seven retrospective studies, and three case studies published across ten countries between 1993 and 2018 was performed. Adult patients (i.e., ≥ 18 years of age) with a symptomatic os acromiale that failed nonoperative management were included in this review. Surgical techniques utilized within the included studies include excision, acromioplasty, and open reduction and internal fixation (ORIF). The primary outcomes of interest included patient satisfaction. Range of motion and several standardized outcome measurement tools were also included in the final analysis. RESULTS: Patient satisfaction was highest in the excision and ORIF groups, with 92% and 82% of patients reporting good to excellent postoperative results, respectively, compared to 63% in the acromioplasty group. All three patient groups experienced improvements in postoperative outcomes (i.e., active range of motion and patient-reported outcome scores). The excision group experienced a complication rate of 1%, while the acromioplasty group experienced a complication rate of 11% and the ORIF group a rate of 67%. CONCLUSION: This study reports on the largest sample of patients who underwent surgical treatment for a symptomatic os acromiale. We have demonstrated that excision of the os with meticulous repair of the deltoid resulted in the best clinical outcomes with the least complications. In healthy adult patients with a large os fragment and a normal rotator cuff, surgical fixation may provide increased preservation of deltoid function while offering good to excellent patient satisfaction. However, patients must be informed that a second procedure may be required to remove symptomatic hardware.


Assuntos
Acrômio/diagnóstico por imagem , Acrômio/cirurgia , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Acrômio/anormalidades , Artroscopia/efeitos adversos , Artroscopia/tendências , Humanos , Redução Aberta/efeitos adversos , Redução Aberta/tendências , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
7.
BMC Med Genet ; 20(1): 16, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642272

RESUMO

BACKGROUND: KBG syndrome is a very rare autosomal dominant disorder, characterized by macrodontia, distinctive craniofacial findings, skeletal findings, post-natal short stature, and developmental delays, sometimes associated with seizures and EEG abnormalities. So far, there have been over 100 cases of KBG syndrome reported. CASE PRESENTATION: Here, we describe two sisters of a non-consanguineous family, both presenting generalized epilepsy with febrile seizures (GEFS+), and one with a more complex phenotype associated with mild intellectual disability, skeletal and dental anomalies. Whole exome sequencing (WES) analysis in all the family members revealed a heterozygous SCN9A mutation, p.(Lys655Arg), shared among the father and the two probands, and a novel de novo loss of function mutation in the ANKRD11 gene, p.(Tyr1715*), in the proband with the more complex phenotype. The reassessment of the phenotypic features confirmed that the patient fulfilled the proposed diagnostic criteria for KBG syndrome, although complicated by early-onset isolated febrile seizures. EEG abnormalities with or without seizures have been reported previously in some KBG cases. The shared variant, occurring in SCN9A, has been previously found in several individuals with GEFS+ and Dravet syndrome. CONCLUSIONS: This report describe a novel de novo variant in ANKRD11 causing a mild phenotype of KGB syndrome and further supports the association of monogenic pattern of SCN9A mutations with GEFS+. Our data expand the allelic spectrum of ANKRD11 mutations, providing the first Brazilian case of KBG syndrome. Furthermore, this study offers an example of how WES has been instrumental allowing us to better dissect the clinical phenotype under study, which is a multilocus variation aggregating in one proband, rather than a phenotypic expansion associated with a single genomic locus, underscoring the role of multiple rare variants at different loci in the etiology of clinical phenotypes making problematic the diagnostic path. The successful identification of the causal variant in a gene may not be sufficient, making it necessary to identify other variants that fully explain the clinical picture. The prevalence of blended phenotypes from multiple monogenic disorders is currently unknown and will require a systematic re-analysis of large WES datasets for proper diagnosis in daily practice.


Assuntos
Anormalidades Múltiplas/genética , Doenças do Desenvolvimento Ósseo/genética , Epilepsia Generalizada/genética , Estudos de Associação Genética , Predisposição Genética para Doença , Deficiência Intelectual/genética , Mutação , Fenótipo , Proteínas Repressoras/genética , Convulsões Febris/genética , Anormalidades Dentárias/genética , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/etiologia , Anormalidades Múltiplas/fisiopatologia , Adolescente , Alelos , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/etiologia , Doenças do Desenvolvimento Ósseo/fisiopatologia , Brasil , Eletroencefalografia , Epilepsia Generalizada/fisiopatologia , Facies , Feminino , Loci Gênicos , Heterozigoto , Humanos , Deficiência Intelectual/diagnóstico por imagem , Deficiência Intelectual/etiologia , Deficiência Intelectual/fisiopatologia , Canal de Sódio Disparado por Voltagem NAV1.7/genética , Linhagem , Convulsões Febris/fisiopatologia , Anormalidades Dentárias/diagnóstico por imagem , Anormalidades Dentárias/etiologia , Anormalidades Dentárias/fisiopatologia , Sequenciamento Completo do Exoma
8.
Neuroimaging Clin N Am ; 29(1): 29-47, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30466643

RESUMO

Many bone dysplasias, some common and others rare, may involve the temporal bone causing conductive, sensorineural, or mixed hearing loss, vestibular dysfunction, or skull base foraminal narrowing, potentially affecting quality of life. Some conditions may affect only the temporal bone, whereas others may be more generalized, involving different regions of the body. High-resolution computed tomography may detect subtle osseous changes that can help define the type of dysplasia, and MR imaging can help define the degree of activity of lesions and potential associated complications.


Assuntos
Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Otosclerose/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos
9.
Bone Joint J ; 100-B(6): 811-821, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29855234

RESUMO

Aims: The aim of this study was to investigate the changes in femoral trochlear morphology following surgical correction of recurrent patellar dislocation associated with trochlear dysplasia in children. Patients and Methods: A total of 23 patients with a mean age of 9.6 years (7 to 11) were included All had bilateral recurrent patellar dislocation associated with femoral trochlear dysplasia. The knee with traumatic dislocation at the time of presentation or that had dislocated most frequently was treated with medial patellar retinacular plasty (Group S). The contralateral knee served as a control and was treated conservatively (Group C). All patients were treated between October 2008 and August 2013. The mean follow-up was 48.7 months (43 to 56). Axial CT scans were undertaken in all patients to assess the trochlear morphological characteristics on a particular axial image which was established at the point with the greatest epicondylar width based on measurements preoperatively and at the final follow-up. Results: Preoperatively, there were no statistically significant differences between the trochlear morphology in the two groups (sulcus angle, p 0.852; trochlear groove depth, p 0.885; lateral trochlear inclination, p 0.676; lateral-to-medial facet ratio, p 0.468; lateral condylar height, p 0.899; medial condylar height, p 0.816). Many radiological parameters of trochlear morphology were significantly different between the two groups at the final follow-up, including well-known parameters, such as the mean sulcus angle (Group S, 146.27° (sd 7.18); Group C, 160.61° (sd 9.29); p < 0.001), the mean trochlear groove depth (Group S, 6.25 mm (sd 0.41); Group C, 3.48 mm (sd 0.65); p < 0.001) and the mean lateral trochlear inclination (Group S, 20.99° (sd 3.87); Group C, 12.18° (sd 1.85); p < 0.001). Lesser known parameters such as the ratio of the lateral to medial trochlear length (Group S, 1.46 (sd 0.19); Group C, 2.14 (sd 0.42); p < 0.001), which is a measurement of facet asymmetry, and the lateral and medial condylar height were also significantly different between the two groups (p < 0.001). Conclusion: The femoral trochlear morphology can be improved by early (before epiphyseal closure) surgical correction in children with recurrent patellar dislocation associated with femoral trochlear dysplasia. Cite this article: Bone Joint J 2018;100-B:811-21.


Assuntos
Artroscopia/métodos , Doenças do Desenvolvimento Ósseo/cirurgia , Fêmur/anormalidades , Luxação Patelar/cirurgia , Articulação Patelofemoral/fisiopatologia , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Criança , Tratamento Conservador/métodos , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Seguimentos , Humanos , Variações Dependentes do Observador , Patela/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Estudos Prospectivos , Recidiva , Tomografia Computadorizada por Raios X/métodos
11.
J Pediatr Orthop ; 38(7): e404-e410, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29782394

RESUMO

BACKGROUND: Our study of a large patient group reports on the behavior and postoperative recurrence of osteofibrous dysplasia (OFD). METHODS: We reviewed the medical records of 55 patients who were diagnosed with OFD of the tibia and showed typical features of this tumor. The patients' presentation, disease course, history of pathologic fracture, typical radiographic features, surgical treatment history, and surgical results were investigated. RESULTS: The longitudinal OFD lesion size peaks at a mean 13.3 years of age with a mean maximum proportionate size of 0.33. These lesions in 92% of the patients spontaneously presented with a stable disease course, while those in the other 8% continued increasing. There were no significant predictive factors of disease course. Among surgically treated lesions, we noted a higher rate of recurrence after curettage than after excision (P<0.001). Patients who underwent curettage and developed recurrence were significantly younger than those who did not (P=0.01). CONCLUSIONS: Our data suggest that observation can be the primary form of treatment for patients with OFD and that the disease would stop advancing with time. During observation, clinicians should carefully observe all patients with OFD because the relation between OFD and adamantinoma is unclear. If surgery is necessary due to severe morbidity, we recommend excision rather than curettage to prevent recurrence, especially for younger patients. LEVEL OF EVIDENCE: Level III.


Assuntos
Doenças do Desenvolvimento Ósseo/terapia , Neoplasias Ósseas/terapia , Progressão da Doença , Tíbia , Adulto , Fatores Etários , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/patologia , Neoplasias Ósseas/patologia , Criança , Tratamento Conservador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Recidiva Local de Neoplasia/terapia , Estudos Retrospectivos , Adulto Jovem
12.
J Pediatr Orthop ; 38(6): e318-e324, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29521938

RESUMO

BACKGROUND: Femoral trochlear dysplasia is a known risk factor for patellar instability. The growth pattern of the normal trochlea is known, but there have been no studies investigating the growth and development of the dysplastic trochlea. The purpose of this study was to assess the growth pattern of trochlear dysplasia in adolescents. METHODS: In a retrospective analysis, magnetic resonance images of adolescents with patellar instability and trochlear dysplasia were evaluated. These images were measured for lateral and medial condylar height, trochlear height, cartilaginous and bony trochlear bump, and cartilaginous and bony sulcus angle. The type of trochlear dysplasia was classified as per Dejour classification. These measurements were plotted against age, and their growth patterns were evaluated using statistical methods. RESULTS: Of 235 knees with patellar instability, trochlear dysplasia was present in 175 knees (74% knees) and these were further analyzed. With increasing age, the mean lateral and medial condylar heights and mean trochlear height showed statistically significant increase (P<0.01). Cartilaginous trochlear bump (slope=0.15, P=0.013) and bony trochlear bump (slope=0.22, P<0.01) increased with age, with some reaching the pathologic value by age of 15.1 years. After age 11 years, there were no significant changes for cartilaginous and bony sulcus angles (cartilage: slope=0.03, P=0.96; bony: slope=-0.90, P=0.11). The mean cartilaginous sulcus angle was significantly greater than the mean bony sulcus angle (P<0.01). All Dejour types of trochlear dysplasia were present across all age groups. CONCLUSIONS: All linear measurements of trochlear dysplasia (condylar height, trochlear height, trochlear bump) increased with age. However, the shape of trochlear dysplasia, as reflected by sulcus angle and Dejour classification, did not change with increasing age. The shape of trochlear dysplasia is most likely a genetic predisposition and does not necessarily change during skeletal growth. LEVEL OF EVIDENCE: Level II-diagnostic, cross-sectional.


Assuntos
Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Adolescente , Doenças Ósseas , Criança , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos
13.
Neurol Sci ; 39(5): 821-827, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29455398

RESUMO

The aim of this work is to review the MR imaging of neoplastic and non-neoplastic lesions of the brain and spine in neurofibromatosis type I. Neoplastic lesions are optic pathway gliomas, brain stem gliomas, other gliomas of the brain, and peripheral nerve sheath tumors. Structural changes in the brain include unidentified bright objects, macrocephaly, and enlarged corpus callosum. Bony dysplasia changes as sphenoid ridge dysplasia, spinal scalloping, dural ectasia, and meningoceles. Vasculopathy and cortical cerebral and cerebellar malformations of the brain have been reported.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Imagem por Ressonância Magnética , Neurofibromatose 1/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Humanos
14.
Head Neck ; 39(12): 2562-2566, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28963787

RESUMO

BACKGROUND: The purpose of this article is to introduce the modified technique of preservation of the inferior alveolar nerve (IAN) during mandibulectomy for a benign lesion. METHODS: Five cases of osteofibrous hyperplasia and 3 cases of centricity osteomyelitis were included. During surgery, the IAN was marked using a planned cutting guide. Using an oscillating saw, the depth of the osteotomy along the IAN was controlled until the bone cortex was cut through. After splitting, the bony section was removed, leaving the neurovascular bundle intact. The sensation of the lower lip was evaluated using current perceptive threshold testing during follow-up. RESULTS: After follow-up for 6-27 months, no recurrence or secondary deformity was found. One patient had severe sensory disturbance. CONCLUSION: With the use of a cutting guide and osteotomy tricks, mandibulectomy with preservation of the IAN can be accurately performed.


Assuntos
Imagem Tridimensional , Mandíbula/cirurgia , Nervo Mandibular , Tratamentos com Preservação do Órgão/métodos , Osteotomia/métodos , Adolescente , Adulto , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/patologia , Doenças do Desenvolvimento Ósseo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Doenças Mandibulares/diagnóstico por imagem , Doenças Mandibulares/patologia , Doenças Mandibulares/cirurgia , Segurança do Paciente , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Amostragem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
15.
Arthroscopy ; 33(11): 2026-2034, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28847574

RESUMO

PURPOSE: To determine best practices for consistent and accurate evaluation of coronal alignment in patients with patellofemoral (PF) instability. METHODS: Six reviewers examined 239 knee magnetic resonance images (MRIs) in patients with PF instability and anterior cruciate ligament (ACL) rupture. Measurements included tibial tubercle-to-trochlear groove (TT-TG) distance measured at the most proximal and distal portions of the trochlea, tibial tubercle-to-PCL (TT-PCL) distance, and Dejour classification of trochlear dysplasia. RESULTS: Interrater reliability was low for Dejour classification (k = 0.289), but improved to moderate (k = 0.448) when patients were separated into normal/Dejour A and Dejour B/C/D. Interrater reliability was high for proximal and distal TT-TG measurements (interclass correlation coefficients [ICCs] = 0.807 and 0.936, respectively). TT-PCL was moderately reliable (ICC = 0.625), and correlated with TT-TG (r = 0.457, P < .001 proximal and r = 0.451, P < .001 distal). No significant difference was found between the proximal and distal measurements of TT-TG in each patient, though the PF group exhibited higher values than the ACL group (P < .001 for both). TT-PCL was significantly higher for the PF group than the ACL group (P = .015), but this difference lost significance when the group was divided by the TT-PCL cutoff of 24 mm (P = .371). CONCLUSIONS: The proximal and distal techniques for measuring the TT-TG distance are similar to each other, and reliable despite level of reviewer training or presence of dysplasia. The TT-TG distance was predictive of patellofemoral instability. The TT-PCL distance was found to be less reliable than either method of measuring the TT-TG distance. Thus, this study demonstrated TT-TG to be superior to TT-PCL as a measurement of coronal malalignment. Given the variability in Dejour classification in this and other studies, a more reliable classification system for trochlear dysplasia as defined on cross-sectional imaging is warranted. LEVEL OF EVIDENCE: Level III, retrospective clinical trial.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Mau Alinhamento Ósseo/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Articulação Patelofemoral/diagnóstico por imagem , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/patologia , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Feminino , Humanos , Instabilidade Articular/patologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Variações Dependentes do Observador , Articulação Patelofemoral/patologia , Ligamento Cruzado Posterior , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/patologia , Adulto Jovem
16.
Biomed Res Int ; 2017: 4636809, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28804716

RESUMO

The purpose of this study was to investigate the change in patellar position after open wedge high tibial osteotomy (OWHTO) with distal tubercle osteotomy (DTO), comparing outcomes of conventional OWHTO in young adults with proximal tibia varus deformity but no arthritic manifestations. Thirty-three patients (mean age, 31.8 years) subjected to OWHTO/DTO were matched with 30 patients (mean age, 33.5 years) undergoing conventional OWHTO. Patellar position, as measured in pre- and postoperative standing lateral radiographs, was compared. Patellar height was assessed via Insall-Salvati ratio, modified Insall-Salvati ratio, Blackburne-Peel (BP) index, Caton-Deschamps (CD) index, and modified Miura-Kawamura index. Computed tomography was used to measure lateral patellar tilt and shift. In the OWHTO group, all patellar height indices decreased significantly following surgery. Although mean values of BP and CD indices decreased significantly in the OWHTO/DTO group, other determinants of patellar height showed no significant postoperative differences. Significant postoperative declines in average lateral patellar tilt were also evident in both groups, but pre- and postoperative lateral patellar shift did not differ significantly. OWHTO/DTO can be performed without significant changes in patellar height. The results obtained support that OWHTO/DTO is suitable for relatively young patients with proximal tibia vara but no arthritic change.


Assuntos
Doenças do Desenvolvimento Ósseo , Osteocondrose/congênito , Osteotomia , Patela , Tíbia , Adulto , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/cirurgia , Humanos , Masculino , Osteocondrose/diagnóstico por imagem , Osteocondrose/cirurgia , Patela/anormalidades , Patela/diagnóstico por imagem , Patela/cirurgia , Estudos Retrospectivos , Tíbia/anormalidades , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
17.
Curr Osteoporos Rep ; 15(5): 419-424, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28808977

RESUMO

PURPOSE OF REVIEW: This review highlights how skeletal dysplasias are diagnosed and how our understanding of some of these conditions has now translated to treatment options. RECENT FINDINGS: The use of multigene panels, using next-generation sequence technology, has improved our ability to quickly identify the genetic etiology, which can impact management. There are successes with the use of growth hormone in individuals with SHOX deficiencies, asfotase alfa in hypophosphatasia, and some promising data for c-type natriuretic peptide for those with achondroplasia. One needs to consider that a patient with short stature has a skeletal dysplasia as options for management may be available.


Assuntos
Osteocondrodisplasias/diagnóstico , Acondroplasia/diagnóstico , Acondroplasia/diagnóstico por imagem , Acondroplasia/tratamento farmacológico , Acondroplasia/genética , Fosfatase Alcalina/uso terapêutico , Doenças do Desenvolvimento Ósseo/diagnóstico , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/tratamento farmacológico , Doenças do Desenvolvimento Ósseo/genética , Terapia de Reposição de Enzimas , Testes Genéticos , Sequenciamento de Nucleotídeos em Larga Escala , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Hipofosfatasia/diagnóstico , Hipofosfatasia/diagnóstico por imagem , Hipofosfatasia/tratamento farmacológico , Hipofosfatasia/genética , Imunoglobulina G/uso terapêutico , Natriuréticos/uso terapêutico , Peptídeo Natriurético Tipo C/uso terapêutico , Osteocondrodisplasias/diagnóstico por imagem , Osteocondrodisplasias/tratamento farmacológico , Osteocondrodisplasias/genética , Osteogênese Imperfeita/diagnóstico , Osteogênese Imperfeita/diagnóstico por imagem , Osteogênese Imperfeita/tratamento farmacológico , Osteogênese Imperfeita/genética , Radiografia , Proteínas Recombinantes de Fusão/uso terapêutico , Proteínas Recombinantes , Análise de Sequência de DNA , Proteína de Homoeobox de Baixa Estatura/deficiência , Proteína de Homoeobox de Baixa Estatura/genética
18.
J Pediatr Orthop ; 37 Suppl 2: S26-S31, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28799991

RESUMO

Although the core principles of managing infantile Blount disease generally remain unchanged, treatment modalities have evolved over the years. Consensus has yet to be reached regarding the efficacy of bracing. Children with Blount disease commonly have advanced bone age, which may impact the timing and magnitude of (over) correction of angular deformity. Techniques of growth modulation, based on the tension band principle, continue to gain popularity. Although there are limited reports in the last decade on proximal tibial osteotomy for this developmental disorder, both acute and gradual correction remain viable treatment options in the appropriate setting. In certain older children (>7 y old) with advanced stages of the disease, a medial hemiplateau elevation combined with lateral proximal tibial hemiepiphysiodesis may be needed to address the epiphyseal deformity. Given the possibility of unpredictable proximal tibial physeal activity, all children with Blount disease should be followed at regular intervals till skeletal maturity. To provide sufficient granularity for pooled analyses and help establish evidence-based clinical guidelines, standardization of reporting clinical outcomes among children with Blount disease is encouraged.


Assuntos
Doenças do Desenvolvimento Ósseo/cirurgia , Lâmina de Crescimento/cirurgia , Osteocondrose/congênito , Osteotomia/métodos , Tíbia/cirurgia , Adolescente , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Braquetes , Criança , Pré-Escolar , Epífises/cirurgia , Feminino , Humanos , Masculino , Osteocondrose/diagnóstico por imagem , Osteocondrose/cirurgia , Osteotomia/efeitos adversos , Radiografia , Tíbia/diagnóstico por imagem
19.
Bone Joint J ; 99-B(6): 724-731, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28566390

RESUMO

AIMS: The aim of this study was to evaluate the long-term clinical and radiographic outcomes of the Birmingham Interlocking Pelvic Osteotomy (BIPO). PATIENTS AND METHODS: In this prospective study, we report the mid- to long-term clinical outcomes of the first 100 consecutive patients (116 hips; 88 in women, 28 in men) undergoing BIPO, reflecting the surgeon's learning curve. Failure was defined as conversion to hip arthroplasty. The mean age at operation was 31 years (7 to 57). Three patients (three hips) were lost to follow-up. RESULTS: Survivorship was 76% at ten years and 57% at a mean of 17 years. Younger patients (< 20 years) had the best survivorship (20 hips at risk; 90% at 17 years; 95% confidence interval 65 to 97). Post-operative complications occurred after 12 operations (10.4%) over the duration of the study. Increasing patient age and hip arthritis grade were primary determinants of surgical failure. CONCLUSION: BIPO provides good to excellent survivorship in appropriately selected patients, with a relatively low rate of complications. Our results are comparable with other established methods of periacetabular osteotomy (PAO), such as the Bernese PAO, even during the surgeon's initial learning curve. Cite this article: Bone Joint J 2017;99-B:724-31.


Assuntos
Doenças do Desenvolvimento Ósseo/cirurgia , Osteotomia/métodos , Ossos Pélvicos/cirurgia , Adolescente , Adulto , Artroplastia de Quadril , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Criança , Feminino , Humanos , Ílio/cirurgia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Ossos Pélvicos/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Clin Nucl Med ; 42(8): e375-e376, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28525454

RESUMO

A 17-year-old girl had pain in the right front lower leg while road racing 2 months earlier. Radiography and CT showed osteolytic lesions in the medial part of the bilateral tibia. Bone scintigraphy showed focally increased radiotracer uptake in the bilateral tibia. The lesions showed hypermetabolism on FDG PET/CT. Osteofibrous dysplasia was suspected from the radiographic findings, but adamantinoma or metastases could not be excluded. Surgical biopsies were performed, and histopathologic studies confirmed the diagnosis of bilateral osteofibrous dysplasia.


Assuntos
Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tíbia/diagnóstico por imagem , Adolescente , Doenças do Desenvolvimento Ósseo/patologia , Doenças do Desenvolvimento Ósseo/cirurgia , Feminino , Humanos , Metástase Neoplásica , Tíbia/patologia
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