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1.
Arthroscopy ; 37(4): 1161-1162, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812520

RESUMO

During hip arthroscopy, when a wave sign is encountered, it is a sign of labrochondral dysfunction, just like a traditional labral tear. Suture anchor fixation to the labrum can eliminate the wave sign and improve patient outcomes. Readers are urged not to equate hip labral pathology with shoulder labral tears, which have different pathomechanics, and subsequently may have different morphological characteristics.


Assuntos
Ombro , Âncoras de Sutura , Artroscopia , Fêmur , Humanos , Ruptura
2.
Arthroscopy ; 37(4): 1212-1213, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812524

RESUMO

Trochlear dysplasia is one of the primary morphologic abnormalities associated with patellar instability. Although qualitative classifications based on trochlear shape such as the Dejour classification exist, radiographic measurements to quantify the severity of trochlear dysplasia are numerous and varied. Each measurement addresses a different element of the complex and wide-ranging presentations that exist along a spectrum of abnormalities in trochlear morphology, and the reported reliability of such measurements are mixed. Overall, our understanding of trochlear dysplasia continues to evolve, and the ability to quantify the morphology of the trochlea, as well as its influence on patellar stability, remains a work in progress. Future directions include developing improved 3-dimensional descriptions of trochlear anatomy, as well as standardizing measurement methods and image slice selection, to better evaluate trochlear morphology in the assessment of patellar instability.


Assuntos
Instabilidade Articular , Articulação do Joelho , Fêmur/diagnóstico por imagem , Humanos , Instabilidade Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Patela/diagnóstico por imagem , Reprodutibilidade dos Testes
3.
Orthop Clin North Am ; 52(2): 111-121, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752832

RESUMO

Periarticular fractures of the lower extremity can be difficult injuries to stabilize effectively. Modern advances in technique and implant design now allow many of these fractures to be fixed with an extreme intramedullary nail. When nailing is not possible, less invasive plating through percutaneous incisions is a reliable option. The decision to perform extreme nailing is multifactorial and is based on the fracture pattern, the condition of the soft tissues, the medical condition of the patient, and the importance of earlier or immediate weightbearing.


Assuntos
Fêmur/lesões , Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Fixadores Internos , Fraturas da Tíbia/cirurgia , Fixação Intramedular de Fraturas/métodos , Humanos
4.
Zhongguo Gu Shang ; 34(3): 288-92, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787177

RESUMO

OBJECTIVE: To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing. METHODS: From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation. RESULTS: All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening). CONCLUSION: It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas não Consolidadas , Adulto , Pinos Ortopédicos , Placas Ósseas , Transplante Ósseo , Feminino , Fraturas do Fêmur/cirurgia , Fêmur , Consolidação da Fratura , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
5.
Orthopade ; 50(4): 287-295, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33751196

RESUMO

BACKGROUND: The success of primary total hip replacement (THR) is predominately determined by the primary stability of the implant and the restoration of the patient-specific joint biomechanics. The three-dimensional (patho-) anatomy, size, geometry, and shape of the acetabulum and proximal femur is highly variable in patients with advanced hip osteoarthritis. Accurate preoperative planning is an essential prerequisite for all replacement procedures. CURRENT SITUATION: Current data demonstrates clinical advantages for patient-specific reconstruction of functional joint geometry via surrogate parameters (offset and leg length). Frequently cited "target zones" for the positioning and orientation of the cup are increasingly in the focus of scientific discussion, as individually adjusted target zones for implant positioning allow for a potential reduction of impingement risk. Patients with spinal fusions or pathologic spinopelvic alignment require that particular attention be paid to patient-specific preoperative preparation, the surgical technique, and implant selection in order to reduce the risk of postoperative instability.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Osteoartrite do Quadril , Procedimentos Cirúrgicos Reconstrutivos , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Fêmur/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia
6.
Rev Fac Cien Med Univ Nac Cordoba ; 78(1): 57-63, 2021 03 12.
Artigo em Espanhol | MEDLINE | ID: mdl-33787031

RESUMO

Introduction: Femoral fractures in previously amputated patients (PAP) have been poorly reported in international literature, however it is worth mentioning that advances in the manufacture of orthotics for lower limbs have allowed these patients to remain functionally active. Surgery is then an option but difficulties may appear in positioning the patient for surgery due to the absence of the foot or ankle from where to pull and optimize the fracture reduction. Objective: We report 3 cases of PAP with ipsilateral unstable femur fractures, treated surgically with cervicodiaphyseal endomedular nail. The surgical technique used in each case is described. Results: Good long-term results were obtained demonstrating the effectiveness of surgical treatment and the reduction technique used. Conclusion: Surgical treatment of unstable fractures of the proximal femur with an endomedullary nail should be considered a valid therapeutic option.


Assuntos
Fêmur , Humanos , Estudos Retrospectivos
7.
Niger J Clin Pract ; 24(3): 369-379, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33723111

RESUMO

Background: Proximal femoral geometry(PFG) plays a role in the biomechanics of the hip. During total hip replacement detailed efforts are made to restore this biomechanics in other to ensure patients satisfaction and implant survival. There are variations in these parameters. Ethnicity is one of the most influential factors accounting for these variations. Aim: To determine the values of the parameters of the proximal femoral geometry among the ethnic Igbos of the South Eastern Nigeria, determine any correlation between these parameters, and compare these values with known populations as well as discuss the clinical application in total hip replacement and other hip surgeries. Materials and Method: Seven hundred and sixteen (716) femoral bones taken from the osteology unit of department of anatomy of University of Nigeria Enugu Campus (UNEC) were screened and proximal femoral parameters measured using Vernier calipers. Results: There were 356 right and 360 left femoral bones with the following values: Femoral Neck Anteversion Angle (FNAVA): M=19.04°, SD=2.075°, Proximal Femoral Length(PFL): M=73.24mm,SD=7.622, Femoral Head Vertical Diameter(FHVD):M= 44.64mm, SD=3.134, Femoral Head Transverse Diameter(FHTD),M=44.55mm, SD=3.379mm, Femoral Head Diameter(FHD),M=44.60mm, SD=3.119mm, Femoral Neck Anterior Length(FNAL), M=31.86mm, SD=5.383mm, Femoral Posterior Neck Length(FPNL):M=22.23mm, SD=3.520mm, Femoral Neck Diameter (FND), M=32.71mm,SD= 3.315mm, Proximal Femoral Width Head to Side (PFWHS), M=89mm.80,SD= 10.331mm, Proximal Femoral Width Side to Side (PFWSS), M=31.47mm, SD=2.812mm, Femoral Neck Shaft Angle(FNSA), M=132.15°, 7.305°. Conclusion: The parameters of the proximal femoral geometry of the ethnic Igbos of the South East of Nigeria, differed from other populations and exhibited laterality.


Assuntos
Artroplastia de Quadril , Fenômenos Biomecânicos , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Colo do Fêmur/cirurgia , Humanos , Nigéria
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 307-311, 2021 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-33719238

RESUMO

Objective: To evaluate the effectiveness of proximal femoral nail anti-rotation (PFNA) in treatment of high plane intertrochanteric femur fractures. Methods: A retrospective analysis was performed on 33 patients who underwent closed reduction and PFNA fixation for high plane intertrochanteric femur fracture between January 2016 and June 2019. There were 12 males and 21 females with an average age of 75.1 years (mean, 47-89 years). The fractures were caused by falling from height in 21 cases, by traffic accident in 7 cases, and by other injuries in 5 cases. Fractures were classified as type A in 14 cases and type B in 19 cases according to self-defined fracture classification criteria; and as type 31-A1.2 in 14 cases and as type 31-A2.2 in 19 cases according to AO/Orthopedic Trauma Association (AO/OTA) classification criteria. The time from injury to operation was 2-5 days (mean, 2.7 days). The operation time, intraoperative blood loss, hospital stay, fracture reduction quality, fracture healing time, internal fixation failure, and Parker-Palmer score were recorded. Results: The operation time was 40-75 minutes (mean, 55 minutes). The intraoperative blood loss was 50-150 mL (mean, 64 mL). The hospital stay was 5-15 days (mean, 8.7 days). All incisions healed by first intention. Twenty-eight patients were followed up 12-18 months with an average of 13.6 months. The fracture reduction quality was rated as excellent in 9 cases (32.1%), good in 17 cases (60.7%), and poor in 2 cases (7.1%) by Chang's criteria. Parker-Palmer score was 6-9 (mean, 7.9) at last follow-up. Conclusion: High plane intertrochanteric femur fracture is a special type of intertrochanteric fracture, which can be diagnosed by imaging examination. PFNA fixation can achieve satisfactory results and prevent the occurrence of internal fixation failure effectively.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Pinos Ortopédicos , Feminino , Fraturas do Fêmur/cirurgia , Fêmur , Fraturas do Quadril/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
9.
Bone Joint J ; 103-B(3): 456-461, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641428

RESUMO

AIMS: To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (ß-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. METHODS: A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using ß-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. RESULTS: There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. CONCLUSION: IMT using ß-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456-461.


Assuntos
Transplante Ósseo/métodos , Fosfatos de Cálcio/farmacologia , Fêmur/cirurgia , Ílio/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tíbia/cirurgia , Adulto , Artrodese , Desbridamento , Feminino , Fêmur/lesões , Fêmur/patologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato , Estudos Retrospectivos , Tíbia/lesões , Tíbia/patologia , Cicatrização/efeitos dos fármacos
11.
J Vis Exp ; (168)2021 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-33616101

RESUMO

Macrophages are among the most important antigen-presenting cells. Many subsets of macrophages have been identified with unique metabolic signatures. Macrophages are commonly classified as M1-like (inflammatory) and M2-like (anti-inflammatory) subtypes. M1-like macrophages are pro-inflammatory macrophages that get activated by LPS and/or pro-inflammatory cytokines such as INF-γ, IL-12 & IL-2. M1-like polarized macrophages are involved in various diseases by mediating the host's defense to a variety of bacteria and viruses. That is very important to study LPS induced M1-like macrophages and their metabolic states in inflammatory diseases. M2-like macrophages are considered anti-inflammatory macrophages, activated by anti-inflammatory cytokines and stimulators. Under the pro-inflammatory state, macrophages show increased glycolysis in glycolytic function. The glycolytic function has been actively investigated in the context of glycolysis, glycolytic capacity, glycolytic reserve, compensatory glycolysis, or non-glycolytic acidification using extracellular flux (XF) analyzers. This paper demonstrates how to assess the glycolytic states in real-time with easy-to-follow steps when the bone marrow-derived macrophages (BMDMs) are respiring, consuming, and producing energy. Using specific inhibitors and activators of glycolysis in this protocol, we show how to obtain a systemic and complete view of glycolytic metabolic processes in the cells and provide more accurate and realistic results. To be able to measure multiple glycolytic phenotypes, we provide an easy, sensitive, DNA-based normalization method for polarization assessment of BMDMs. Culturing, activation/polarization and identification of the phenotype and metabolic state of the BMDMs are crucial techniques that can help to investigate many different types of diseases. In this paper, we polarized the naïve M0 macrophages to M1-like and M2-like macrophages with LPS and IL4, respectively, and measured a comprehensive set of glycolytic parameters in BMDMs in real-time and longitudinally over time, using extracellular flux analysis and glycolytic activators and inhibitors.


Assuntos
Técnicas de Cultura de Células/métodos , Polaridade Celular , Separação Celular/métodos , Glicólise , Macrófagos/citologia , Animais , Bioensaio , Fracionamento Celular , Células Cultivadas , Metabolismo Energético , Eritrócitos/citologia , Fêmur/citologia , Macrófagos/metabolismo , Camundongos Endogâmicos C57BL , Fenótipo
12.
Ultrasonics ; 113: 106360, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33561635

RESUMO

Low-intensity pulsed ultrasound (LIPUS) with an intensity (spatial average temporal average, ISATA) of 30 mW/cm2 has been widely proved to be effective on impaired bone healing, but showing little effectiveness in the treatment of osteoporosis. We hypothesized that the intensity of LIPUS may be a key factor in explaining this difference, thus two intensity levels, the widely used 30 mW/cm2 and a higher 150 mW/cm2, were used to simultaneously treat osteoporosis and osteoporotic bone defect in ovariectomized (OVX) rats with a 1-mm drill hole on their left femurs.Results showed that 150 mW/cm2 LIPUS augmented the healing rate of the drill hole than 30 mW/cm2 after 3-week LIPUS treatment, although did not further enhance the healing rate after 6-week LIPUS treatment. For ameliorating osteoporosis, 150 mW/cm2 LIPUS achieved more advantages over 30 mW/cm2 in improving bone density, microstructure and biomechanics 6 weeks after LIPUS intervention. In conclusion, LIPUS with an intensity of 30 mW/cm2 was sufficient to facilitate bone defect healing, but a higher intensity can be considered as a rapid trigger for osteoporotic bone repair. In addition, improving the intensity of LIPUS may be a potentially effective consideration for alleviation of osteoporosis, and the LIPUS regimen in the treatment of osteoporosis remains to be optimized.


Assuntos
Osteoporose/terapia , Fraturas por Osteoporose/terapia , Ondas Ultrassônicas , Animais , Densidade Óssea , Modelos Animais de Doenças , Feminino , Fêmur , Consolidação da Fratura , Ovariectomia , Ratos , Ratos Sprague-Dawley
13.
Praxis (Bern 1994) ; 110(2): 105-107, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33530775

RESUMO

In adults, an isolated non-traumatic fracture of the lesser trochanter should arouse strong suspicion of an underlying malignant pathology. In this article, we present the case of a 55-year-old male patient who presented with a non-traumatic isolated fracture of the lesser trochanter secondary to a delayed diagnosis of metastases of bronchial carcinoma.


Assuntos
Fratura Avulsão , Fraturas do Quadril , Adulto , Fêmur , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
15.
Bone Joint J ; 103-B(2): 398-404, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517739

RESUMO

AIMS: We have evaluated the survivorship, outcomes, and failures of an interlocking, reconstruction-mode stem-sideplate implant used to preserve the native hip joint and achieve proximal fixation when there is little residual femur during large endoprosthetic reconstruction of the distal femur. METHODS: A total of 14 patients underwent primary or revision reconstruction of a large femoral defect with a short remaining proximal femur using an interlocking, reconstruction-mode stem-sideplate for fixation after oncological distal femoral and diaphyseal resections. The implant was attached to a standard endoprosthetic reconstruction system. The implant was attached to a standard endoprosthetic reconstruction system. None of the femoral revisions were amenable to standard cemented or uncemented stem fixation. Patient and disease characteristics, surgical history, final ambulatory status, and Musculoskeletal Tumor Society (MSTS) score were recorded. The percentage of proximal femur remaining was calculated from follow-up radiographs. RESULTS: All 14 at-risk native hip joints were preserved at a mean final follow-up of 6.0 years (SD 3.7), despite a short residual femur, often after proximal osteotomies through the lesser trochanter. Overall, 13 of 14 stems had long-term successful fixation. Eight patients required no reoperation. Three patients required reoperation due to implant-related issues, and three patients required reoperation for wound healing problems or infection. There were no dislocations or fractures. At final follow-up the mean MSTS score was 24.9 (SD 4.1). Nine patients required no ambulation aids, and only one had a Trendelenburg gait. CONCLUSION: This interlocking, reconstruction-mode stem-sideplate reliably preserves native hip joint anatomy and function after large femoral resection with a short remaining proximal femur, both in the primary and revision setting. This is particularly important for preventing or delaying total femoral arthroplasty in young patients after oncological reconstruction. Hip abductor strength and function could be maintained by this method, and the risk of dislocation eliminated. The success of this technique in this modest series should be verified in a larger collaborative study and will be of interest to revision surgeons and oncologists. Cite this article: Bone Joint J 2021;103-B(2):398-404.


Assuntos
Artroplastia de Quadril/instrumentação , Neoplasias Femorais/cirurgia , Fêmur/cirurgia , Tumor de Células Gigantes do Osso/cirurgia , Prótese de Quadril , Desenho de Prótese , Sarcoma/cirurgia , Adulto , Artroplastia de Quadril/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 258-264, 2021 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-33624484

RESUMO

Objective: To review the research progress of location methods and the best femoral insertion position of medial patellofemoral ligament (MPFL) reconstruction of femoral tunnel, and provide reference for surgical treatment. Methods: The literature about femoral insertion position of the MPFL reconstruction in recent years was extensively reviewed, and the anatomical and biomechanical characteristics of MPFL, as well as the advantages and disadvantages of femoral tunnel positioning methods were summarized. Results: The accurate establishment of the femoral anatomical tunnel is crucial to the success of MPFL reconstruction. At present, there are mainly two kinds of methods for femoral insertion: radiographic landmark positioning method and anatomical landmark positioning method. Radiographic landmark positioning method has such advantages as small incision and simple operation, but it can not be accurately positioned for patients with severe femoral trochlear dysplasia. It is suggested to combine with the anatomical landmark positioning method. These methods have their own advantages and disadvantages, and there is no unified positioning standard. In recent years, the use of three-dimensional design software can accurately assist in the MPFL reconstruction, which has become a new trend. Conclusion: Femoral tunnel positioning of the MPFL reconstruction is very important. The current positioning methods have their own advantages and disadvantages. Personalized positioning is a new trend and has not been widely used in clinic, its effectiveness needs further research and clinical practice and verification.


Assuntos
Doenças Ósseas , Ferida Cirúrgica , Artéria Femoral , Fêmur/cirurgia , Humanos , Ligamentos Articulares/cirurgia
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 188-194, 2021 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-33624472

RESUMO

Objective: To discuss the feasibility and accuracy of distal femoral patient-specific cutting guide in total knee arthroplasty (TKA) based on knee CT and full-length X-ray film of lower extremities. Methods: Between July 2016 and February 2017, 20 patients with severe knee joint osteoarthritis planned to undergo primary TKA were selected as the research object. There were 9 males and 11 females; aged 53-84 years, with an average of 69.4 years. The body mass index was 22.1-31.0 kg/m 2, with an average of 24.8 kg/m 2. The preoperative range of motion (ROM) of the knee joint was (103.0±19.4)°, the pain visual analogue scale (VAS) score was 5.4±1.3, and the American Hospital of Special Surgery (HSS) score was 58.1±11.3. Before operation, a three-dimensional model of the knee joint was constructed based on the full-length X-ray film of lower extremities and CT of the knee joint. The distal femoral patient-specific cutting guide was designed and fabricated, and the thickness of the distal femoral osteotomy was determined by digital simulation. The thickness of the internal and external condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy were compared. The intraoperative blood loss, postoperative drainage loss, and hidden blood loss were recorded. The ROM of knee joint, VAS score, and HSS score at 3 months after operation were recorded to evaluate effectiveness. The position of the coronal and sagittal plane of the distal femoral prosthesis were assessed by comparing the femoral mechanical-anatomical angle (FMAA), anatomical lateral distal femoral angle (aLDFA), mechanical femoral tibial angle (mFTA), distal femoral flexion angle (DFFA), femoral prosthesis flexion angle (FPFA), anatomical lateral femoral component angle (aLFC), and the angle of the femoral component and femoral shaft (α angle) between pre- and post-operation. Results: TKA was successfully completed with the aid of the distal femoral patient-specific cutting guide. There was no significant difference between the thickness of the internal and lateral condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy ( P>0.05). All patients were followed up 3 months. All incisions healed by first intention, and there was no complications such as periarticular infection and deep vein thrombosis. Except for 1 patient who was not treated with tranexamic acid, the intraoperative blood loss of the rest 19 patients ranged from 30 to 150 mL, with an average of 73.2 mL; the postoperative drainage loss ranged from 20 to 500 mL, with an average of 154.5 mL; and the hidden blood loss ranged from 169.2 to 1 400.0 mL, with an average of 643.8 mL. At 3 months after operation, the ROM of the knee was (111.5±11.5)°, and there was no significant difference when compared with the preoperative one ( t=-1.962, P=0.065). The VAS score was 2.4±0.9 and HSS score was 88.2±7.5, showing significant differences when compared with the preoperative ones ( t=7.248, P=0.000; t=-11.442, P=0.000). Compared with the preoperative measurements, there was a significant difference in mFTA ( P<0.05), and there was no significant difference in aLDFA, FMAA, or DFFA; compared with the preoperative plan, there was no significant difference in FPFA, aLFC, or α angle ( P>0.05). Conclusion: The use of distal femoral patient-specific cutting guide based on knee CT and full-length X-ray film of lower extremity can achieve precise osteotomy, improve coronal and sagittal limb alignment, reduce intraoperative blood loss, and obtain satisfactory short-term effectiveness.


Assuntos
Articulação do Joelho , Filme para Raios X , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
18.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542007

RESUMO

A 65-year-old female patient has a history of malignant triton tumour of the right upper lobe of the lung. She underwent right upper lobectomy and lymphadenectomy in May 2018. She presented in November 2019 with pathological fracture of the left proximal femur. It was not associated with neurofibromatosis. We decided to do an excisional biopsy of the mass and proximal femoral replacement followed by radiotherapy. Four months later, she presented with local recurrence. We organised a multidisciplinary team between the orthopaedic, histopathology and oncology teams. Then, we decided to treat her with chemotherapy. After 2 months of follow-up, she responded well to the chemotherapy with no further deterioration of her condition.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Fêmur , Fraturas Espontâneas/cirurgia , Neoplasias Pulmonares/cirurgia , Idoso , Artroplastia de Quadril , Neoplasias Ósseas/secundário , Feminino , Humanos , Recidiva Local de Neoplasia , Tomografia Computadorizada por Raios X
19.
Bone Joint J ; 103-B(2): 338-346, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517724

RESUMO

AIMS: This study aimed to identify the tibial component and femoral component coronal angles (TCCAs and FCCAs), which concomitantly are associated with the best outcomes and survivorship in a cohort of fixed-bearing, cemented, medial unicompartmental knee arthroplasties (UKAs). We also investigated the potential two-way interactions between the TCCA and FCCA. METHODS: Prospectively collected registry data involving 264 UKAs from a single institution were analyzed. The TCCAs and FCCAs were measured on postoperative radiographs and absolute angles were analyzed. Clinical assessment at six months, two years, and ten years was undertaken using the Knee Society Knee score (KSKS) and Knee Society Function score (KSFS), the Oxford Knee Score (OKS), the 36-Item Short-Form Health Survey questionnaire (SF-36), and range of motion (ROM). Fulfilment of expectations and satisfaction was also recorded. Implant survivorship was reviewed at a mean follow-up of 14 years (12 to 16). Multivariate regression models included covariates, TCCA, FCCA, and two-way interactions between them. Partial residual graphs were generated to identify angles associated with the best outcomes. Kaplan-Meier analysis was used to compare implant survivorship between groups. RESULTS: Significant two-way interaction effects between TCCA and FCCA were identified. Adjusted for each other and their interaction, a TCCA of between 2° and 4° and a FCCA of between 0° and 2° were found to be associated with the greatest improvements in knee scores and the probability of fulfilling expectations and satisfaction at ten years. Patients in the optimal group whose TCCA and FCCA were between 2° and 4°, and 0° and 2°, respectively, had a significant survival benefit at 15 years compared with the non-optimal group (optimal: survival = 100% vs non-optimal: survival = 92%, 95% confidence interval (CI) 88% to 96%). CONCLUSION: Significant two-way interactions between the TCCA and FCCA demonstrate the importance of evaluating the alignment of the components concomitantly in future studies. By doing so, we found that patients who concomitantly had both a TCCA of between 2° and 4° and a FCCA of between 0° and 2° had the best patient-reported outcome measures at ten years and better survivorship at 15 years. Cite this article: Bone Joint J 2021;103-B(2):338-346.


Assuntos
Artroplastia do Joelho/métodos , Hemiartroplastia/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Fenômenos Biomecânicos , Feminino , Fêmur/patologia , Fêmur/fisiologia , Fêmur/cirurgia , Seguimentos , Hemiartroplastia/instrumentação , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Tíbia/patologia , Tíbia/fisiologia , Tíbia/cirurgia , Resultado do Tratamento
20.
Int J Mol Sci ; 22(3)2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33540821

RESUMO

Colorectal cancer (CRC) is a leading cause of cancer-related death, and the prevalence of CRC in young adults is on the rise, making this a largescale clinical concern. Advanced CRC patients often present with liver metastases (LM) and an increased incidence of cachexia, i.e., musculoskeletal wasting. Despite its high incidence in CRC patients, cachexia remains an unresolved issue, and animal models for the study of CRC cachexia, in particular, metastatic CRC cachexia, remain limited; therefore, we aimed to establish a new model of metastatic CRC cachexia. C57BL/6 male mice (8 weeks old) were subcutaneously (MC38) or intrasplenically injected (mMC38) with MC38 murine CRC cells to disseminate LM, while experimental controls received saline (n = 5-8/group). The growth of subcutaneous MC38 tumors was accompanied by a reduction in skeletal muscle mass (-16%; quadriceps muscle), plantarflexion force (-22%) and extensor digitorum longus (EDL) contractility (-20%) compared to experimental controls. Meanwhile, the formation of MC38 LM (mMC38) led to heighted reductions in skeletal muscle mass (-30%; quadriceps), plantarflexion force (-28%) and EDL contractility (-35%) compared to sham-operated controls, suggesting exacerbated cachexia associated with LM. Moreover, both MC38 and mMC38 tumor hosts demonstrated a marked loss of bone indicated by reductions in trabecular (Tb.BV/TV: -49% in MC38, and -46% in mMC38) and cortical (C.BV/TV: -12% in MC38, and -8% in mMC38) bone. Cell culture experiments revealed that MC38 tumor-derived factors directly promote myotube wasting (-18%) and STAT3 phosphorylation (+5-fold), while the pharmacologic blockade of STAT3 signaling was sufficient to preserve myotube atrophy in the presence of MC38 cells (+21%). Overall, these results reinforce the notion that the formation of LM heightens cachexia in an experimental model of CRC.


Assuntos
Adenocarcinoma/secundário , Caquexia/etiologia , Neoplasias Colorretais/complicações , Neoplasias Hepáticas/secundário , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Animais , Caquexia/patologia , Caquexia/fisiopatologia , Linhagem Celular Tumoral , Neoplasias Colorretais/patologia , Progressão da Doença , Fêmur/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Contração Muscular , Fibras Musculares Esqueléticas/ultraestrutura , Debilidade Muscular/etiologia , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Atrofia Muscular/etiologia , Fator de Transcrição STAT3 , Tela Subcutânea , Microtomografia por Raio-X
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