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1.
Bone Joint J ; 102-B(7): 868-873, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600137

RESUMO

AIMS: The purpose of this study was to explore the correlation between femoral torsion and morphology of the distal femoral condyle in patients with trochlear dysplasia and lateral patellar instability. METHODS: A total of 90 patients (64 female, 26 male; mean age 22.1 years (SD 7.2)) with lateral patellar dislocation and trochlear dysplasia who were awaiting surgical treatment between January 2015 and June 2019 were retrospectively analyzed. All patients underwent CT scans of the lower limb to assess the femoral torsion and morphology of the distal femur. The femoral torsion at various levels was assessed using the a) femoral anteversion angle (FAA), b) proximal and distal anteversion angle, c) angle of the proximal femoral axis-anatomical epicondylar axis (PFA-AEA), and d) angle of the AEA-posterior condylar line (AEA-PCL). Representative measurements of distal condylar length were taken and parameters using the ratios of the bianterior condyle, biposterior condyle, bicondyle, anterolateral condyle, and anteromedial condyle were calculated and correlated with reference to the AEA, using the Pearson Correlation coefficient. RESULTS: The femoral torsion had a strong correlation with distal condylar morphology. The FAA was significantly correlated with the ratio of the bianterior condyle (r = 0.355; p = 0.009), the AEA-PCL angle (r = 0.340; p = 0.001) and the ratio of the anterolateral condyle and lateral condyle (ALC-LC) (r = 0.309; p = 0.014). The PFA-AEA angle was also significantly correlated with the ratio of the bianterior condyle (r = 0.319; p = 0.008), the AEA-PCL angle (r = 0.231; p = 0.031), and the ratio of ALC-LC (r = 0.261; p = 0.034). In addition, the bianterior condyle ratio showed a significant correlation with the biposterior condyle ratio (r = -0.324; p = 0.027) and the AEA-PCL angle (r = 0.342; p = 0.021). CONCLUSION: Increased femoral torsion correlated with a prominent anterolateral condyle and a shorter posterolateral condyle compared with the medial condyle. The deformities of the anterior and posterior condyles are combined deformities rather than being isolated and individual deformities in patients with trochlear dysplasia and patella instability. Cite this article: Bone Joint J 2020;102-B(7):868-873.


Assuntos
Fêmur/anormalidades , Instabilidade Articular/patologia , Luxação Patelar/patologia , Anormalidade Torcional/patologia , Adolescente , Adulto , Feminino , Fêmur/diagnóstico por imagem , Humanos , Instabilidade Articular/diagnóstico por imagem , Masculino , Luxação Patelar/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnóstico por imagem
2.
Braz J Med Biol Res ; 53(6): e9237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401926

RESUMO

We investigated changes in oxidative biomarkers in brain regions such as brainstem, cerebellum, and cerebral cortex of 3-, 6-, 18-, 24-, and 30-month-old rats. We also assessed the effects of low-intensity exercise on these biomarkers in these regions of 6-, 18-, and 24-month-old rats that started exercise on a treadmill at 3, 15, and 21 months of age, respectively. Radiographic images of the femur were taken for all rats. A total of 25 rats (age: twelve 6-, ten 18-, ten 24-, and three 30-month-old rats) were used. Lipid hydroperoxide levels increased in cerebellum at 18 months. Total antioxidant activity exhibited lowest values in brainstem at 3 months. Superoxide dismutase activity did not exhibit significant changes during aging. Total thiol content exhibited lowest values in brain regions of 24- and 30-month-old rats. Exercise reduced total thiol content in brainstem at 6 months, but no change occurred in other regions and other ages. Femur increased its length and width and cortical thickness with advancing age. No change occurred in medullary width. Radiolucency increased and sclerosis was found in cortical and medullary bone with advancing age. Exercise reduced radiolucency and medullary sclerosis. Therefore, aging differentially changed oxidative biomarkers in different brain regions and radiographic measures of the femur. Low-intensity exercise only ameliorated some radiographic measurements of femur. Since the present study possessed limitations (small number of rats per group), a beneficial effect of regular low-intensity exercise on oxidative markers in brain cannot be ruled out.


Assuntos
Envelhecimento/fisiologia , Encéfalo/metabolismo , Fêmur/diagnóstico por imagem , Peróxidos Lipídicos/análise , Estresse Oxidativo/fisiologia , Condicionamento Físico Animal/fisiologia , Envelhecimento/metabolismo , Animais , Biomarcadores/análise , Fêmur/química , Peroxidação de Lipídeos , Masculino , Oxirredução , Ratos , Ratos Wistar
3.
PLoS One ; 15(5): e0233023, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401826

RESUMO

Zika virus (ZIKV) is a mosquito-transmitted flavivirus, recently linked to microcephaly and central nervous system anomalies following infection in pregnancy. Striking findings of disproportionate growth with a smaller than expected head relative to body length have been observed more commonly among fetuses with exposure to ZIKV in utero compared to pregnancies without ZIKV infection regardless of other signs of congenital infection including microcephaly. This study's objective was to determine the diagnostic accuracy of femur-sparing profile of intrauterine growth restriction for the identification of ZIKV-associated congenital injuries on postnatal testing. A retrospective cohort study of pregnant women with possible or confirmed ZIKV infection between January 1, 2016 and December 31, 2017 were included. Subjects were excluded if no prenatal ultrasound was available. A femur-sparing profile of growth restriction determined using INTERGROWTH-21st sonographic standard for head circumference to femur length (HC: FL). Congenital injuries were determined postnatally by imaging, comprehensive eye exam and standard newborn hearing screen. A total of 111 pregnant women diagnosed with ZIKV infection underwent fetal ultrasound and 95 neonates had complete postnatal evaluation. Prenatal microcephaly was detected in 5% of fetuses (6/111). Postnatal testing detected ZIKV-associated congenital injuries in 25% of neonates (24/95). A HC: FL Z-score ≤ -1.3 had a 52% specificity (95% CI 41-63%), 82% negative predictive value (NPV, 95% CI 73-88%) for the detection of ZIKV-associated congenital injuries in the neonatal period. A more stringent threshold with a Z-score ≤ -2 was associated with a 90% specificity (95% CI 81-95%), 81% NPV (95% CI 77-85%). Excluding cases of fetal microcephaly, HC: FL (Z-score ≤ -2) demonstrated a similar specificity (89%, 95% CI 81-95%) with superior NPV (87%, 95% CI 84-90%). The sonographic recognition of a normally proportioned fetus may be useful prenatally to exclude a wider spectrum of ZIKV-associated congenital injuries detected postnatally.


Assuntos
Fêmur/embriologia , Retardo do Crescimento Fetal/diagnóstico por imagem , Microcefalia/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Infecção por Zika virus/complicações , Feminino , Fêmur/diagnóstico por imagem , Desenvolvimento Fetal , Humanos , Microcefalia/epidemiologia , Cuidado Pós-Natal , Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade , Infecção por Zika virus/congênito
4.
Medicine (Baltimore) ; 99(14): e19455, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243364

RESUMO

The aim of this study is to compare the distal femoral cartilage thickness of patients with type II diabetes mellitus with those of healthy subjects using ultrasonography. The study comprised 34 patients and 36 healthy subjects. Demographic characteristics of all the participants were recorded. The thickness of the femoral articular cartilage was measured using a 5-18MHzlinearprobe.Measurements were performed bilaterally from three points (intercondylar area, medial condyle, and lateral condyle). No significant difference could be found between patients and healthy subjects. Two demographic characteristics correlated positively with diabetic patients.


Assuntos
Cartilagem Articular/patologia , Diabetes Mellitus Tipo 2/patologia , Fêmur/patologia , Articulação do Joelho/patologia , Adulto , Idoso , Índice de Massa Corporal , Cartilagem Articular/diagnóstico por imagem , Estudos Transversais , Feminino , Fêmur/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Ultrassonografia
5.
Medicine (Baltimore) ; 99(15): e19788, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282742

RESUMO

RATIONALE: Idiopathic thrombocytopenic purpura (ITP) is the condition of having a low platelet count of unknown causes and is a poorly understood acquired hemorrhagic disease involving destruction of platelets in the reticuloendothelial system induced by antiplatelet antibodies. Patients with ITP can have traumatic intra-articular, intraosseous or soft tissue hemorrhage which may present as a rare intraosseous pseudotumor on medical imaging. PATIENT CONCERNS: A 30-year old male patient had complaint of pain in the right leg for 1 year. Laboratory test revealed a much lower platelet count (3-12 × 10/L). DIAGNOSES: Radiography and computed tomography showed expansive bone destruction in the distal segment of the right femur, and magnetic resonance imaging revealed heterogeneous signal intensity in the lesion. Lesion curettage and pathology showed an expansion cyst with a really thin cortical bone shell containing serum-like red liquid and some sediment-like deposit. Consequently, the diagnosis of a pseudotumor was confirmed. INTERVENTIONS: Lesion curettage and bone graft surgery were performed, and 8 units of platelet were transfused to the patient. Giant cell reaction was found on the shell of the lesion, but no tumor cell was found on pathological examination. OUTCOMES: The platelet count was 308 × 10/L 5 days after operation, and the clotting time was normal. At 6 month follow-up after lesion curettage, the patient remained normal with no deterioration in the lesion site. CONCLUSION: The diagnosis of a pseudotumor of ITP relies mainly on imaging findings of the lesion and, in particular, knowledge of the underlying bleeding disorders. Radiologist and pathologist should be aware of the characteristics of this rare complication of ITP and other bleeding disorders like hemophilia in order to avoid misinterpretation of the lesion as a tumor or infection disease.


Assuntos
Fêmur/patologia , Granuloma de Células Plasmáticas/diagnóstico por imagem , Púrpura Trombocitopênica Idiopática/complicações , Ferimentos e Lesões/complicações , Adulto , Transplante Ósseo/métodos , Curetagem/métodos , Fêmur/diagnóstico por imagem , Granuloma de Células Plasmáticas/patologia , Granuloma de Células Plasmáticas/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Dor/diagnóstico , Dor/etiologia , Contagem de Plaquetas/estatística & dados numéricos , Transfusão de Plaquetas/métodos , Púrpura Trombocitopênica Idiopática/patologia , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
PLoS One ; 15(4): e0231112, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310975

RESUMO

Tissue engineering represents a promising alternative for reconstructive surgical procedures especially for the repair of bone defects that do not regenerate spontaneously. The present study aimed to evaluate the effects of the elastin matrix (E24/50 and E96/37) incorporated with hydroxyapatite (HA) or morphogenetic protein (BMP) on the bone repair process in the distal metaphysis of rat femur. The groups were: control group (CG), hydrolyzed elastin matrix at 50°C/24h (E24/50), E24/50 + HA (E24/50/HA), E24/50 + BMP (E24/50/BMP), hydrolyzed elastin matrix at 37°C/96h (E96/37), E96/37 + HA (E96/37/HA), E96/37 + BMP (E96/37/BMP). Macroscopic and radiographic analyses showed longitudinal integrity of the femur in all groups without fractures or bone deformities. Microtomographically, all groups demonstrated partial closure by mineralized tissue except for the E96/37/HA group with hyperdense thin bridge formation interconnecting the edges of the ruptured cortical. Histologically, there was no complete cortical recovery in any group, but partial closure with trabecular bone. In defects filled with biomaterials, no chronic inflammatory response or foreign body type was observed. The mean volume of new bone formed was statistically significant higher in the E96/37/HA and E24/50 groups (71.28 ± 4.26 and 66.40 ± 3.69, respectively) than all the others. In the confocal analysis, it was observed that all groups presented new bone markings formed during the experimental period, being less evident in the CG group. Von Kossa staining revealed intense calcium deposits distributed in all groups. Qualitative analysis of collagen fibers under polarized light showed a predominance of red-orange birefringence in the newly regenerated bone with no difference between groups. It was concluded that the E24/50 and E96/37/HA groups promoted, with greater speed, the bone repair process in the distal metaphysis of rat femur.


Assuntos
Regeneração Óssea/efeitos dos fármacos , Fêmur/lesões , Osteogênese/efeitos dos fármacos , Engenharia Tecidual , Tecidos Suporte/química , Animais , Proteínas Morfogenéticas Ósseas/administração & dosagem , Modelos Animais de Doenças , Durapatita/administração & dosagem , Elastina/administração & dosagem , Fêmur/diagnóstico por imagem , Fêmur/efeitos dos fármacos , Humanos , Masculino , Ratos , Fatores de Tempo , Microtomografia por Raio-X
7.
Niger Postgrad Med J ; 27(2): 143-146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32295947

RESUMO

Revision knee arthroplasty is often complicated by the presence of bone loss, making the use of conventional revision implants impossible, due to inadequate bone stock and ligamentous stability. Distal femoral replacement, although traditionally was developed for salvage surgeries for bone tumours, plays an important role in revision surgeries of elderly low-demand adults with marked bone loss and ligamentous instability. Here, we report the case of a 66-year-old female, with a history of bilateral knee replacement 5 years before the presentation, who developed left knee pain, with X-ray features of failed left knee replacement. This patient had a left distal femoral replacement and successfully returned to her pre-operative function.


Assuntos
Artroplastia do Joelho/métodos , Reabsorção Óssea/cirurgia , Fêmur/cirurgia , Articulação do Joelho/cirurgia , Idoso , Artroplastia do Joelho/efeitos adversos , Reabsorção Óssea/diagnóstico por imagem , Reabsorção Óssea/etiologia , Feminino , Fêmur/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Nigéria , Falha de Prótese , Reoperação/métodos , Resultado do Tratamento
8.
Bone Joint J ; 102-B(4): 524-529, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228068

RESUMO

AIMS: The consensus is that bipolar hemiarthroplasty (BHA) in allograft-prosthesis composite (APC) reconstruction of the proximal femur following primary tumour resection provides more stability than total hip arthroplasty (THA). However, no comparative study has been performed. In this study, we have compared the outcome and complication rates of these two methods. METHODS: In a retrospective study, 57 patients who underwent APC reconstruction of proximal femur following the primary tumour resection, either using BHA (29) or THA (28), were included. Functional outcome was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system and Harris Hip Score (HHS). Postoperative complications of the two techniques were also compared. RESULTS: The mean follow-up of the patients was 8.3 years (standard deviation (SD) 5.5) in the BHA and 6.9 years (SD 4.7) in the THA group. The mean HHS was 65 (SD 16.6) in the BHA group and 88 (SD 11.9) in the THA group (p = 0.036). The mean MSTS score of the patients was 73.3% (SD 16.1%) in the BHA and 86.7% (SD 12.2%) in the THA group (p = 0.041). Limping was recorded in 19 patients (65.5%) of the BHA group and five patients (17.8%) of the THA group (p < 0.001). Dislocation occurred in three patients (10.3%) of the BHA group and two patients (7.1%) of the THA group. CONCLUSION: While the dislocation rate was not higher in THA than with BHA, the functional outcome was significantly superior. Based on our results, we recommend THA in APC reconstruction of the proximal femur. Cite this article: Bone Joint J 2020;102-B(4):524-529.


Assuntos
Artroplastia de Quadril/métodos , Neoplasias Femorais/cirurgia , Fêmur/cirurgia , Hemiartroplastia/métodos , Prótese de Quadril , Adolescente , Adulto , Artroplastia de Quadril/efeitos adversos , Feminino , Neoplasias Femorais/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Seguimentos , Hemiartroplastia/efeitos adversos , Luxação do Quadril/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Bone Joint J ; 102-B(4): 530-538, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228080

RESUMO

AIMS: Dual plating of distal femoral fractures with medial and lateral implants has been performed to improve construct mechanics and alignment, in cases where isolated lateral plating would be insufficient. This may potentially compromise vascularity, paradoxically impairing healing. This study investigates effects of single versus dual plating on distal femoral vascularity. METHODS: A total of eight cadaveric lower limb pairs were arbitrarily assigned to either 1) isolated lateral plating, or 2) lateral and medial plating of the distal femur, with four specimens per group. Contralateral limbs served as matched controls. Pre- and post-contrast MRI was performed to quantify signal intensity enhancement in the distal femur. Further evaluation of intraosseous vascularity was done with barium sulphate infusion with CT scan imaging. Specimens were then injected with latex medium and dissection was completed to assess extraosseous vasculature. RESULTS: Quantitative MRI revealed a mean reduction of 21.2% (SD 1.3%) of arterial contribution in the lateral plating group and 25.4% (SD 3.2%) in the dual plating group (p = 0.051); representing a mean decrease in arterial contribution of 4.2%. The only significant difference found between both experimental groups was regionally, at the lateral aspect of the distal femur with a mean drop in arterial contribution in the lateral plating group of 18.9% (SD 2.6%) versus 24.0% (SD 3.2%) in the dual plating group (p = 0.048), representing a mean decrease in arterial contribution of 5.1%. Gross dissection revealed complete destruction of periosteal vessels underneath either medial or lateral plates in both groups. The network of genicular branches contributing to the posterior and distal femoral condyles was preserved in all specimens. A medial vascular pedicle was found dividing from the superficial femoral artery at a mean 12.7 cm (SD 1.7) proximal to the medial epicondyle and was undisrupted in the dual plating group. CONCLUSION: Lateral locking-plate application resulted in mean 21.2% reduction in distal femur vascularity. Addition of medial plates did not further markedly decrease vascularity. As such, the majority of the vascular insult occurred with lateral plating alone. Supplemental medially based fixation did not lead to marked devascularization of the distal femur, and should therefore be considered in the setting of comminution and poor bone stock in distal femoral fractures. Further clinical research is required to confirm the results of this study. Cite this article: Bone Joint J 2020;102-B(4):530-538.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Fêmur/cirurgia , Fêmur/irrigação sanguínea , Traumatismos do Joelho/cirurgia , Adulto , Cadáver , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Tomografia Computadorizada por Raios X/métodos
10.
PLoS One ; 15(3): e0230497, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203530

RESUMO

PURPOSE: Theoretical considerations suggest that femoral tunnel length might cause graft mismatch, and femoral tunnel obliquity could be related to the longevity of graft in anterior cruciate ligament (ACL) reconstruction. However, controversy still exists regarding these issues in the context of the comparison of anatomic and nonanatomic ACL reconstructions. The purpose of this meta-analysis was to compare the length and obliquity of the femoral tunnel created by drilling through either anatomic or nonanatomic ACL reconstructions. MATERIALS AND METHOD: In this meta-analysis, we reviewed studies that compared femoral tunnel length and femoral tunnel obliquity in the coronal plane with the use of anatomic or nonanatomic ACL reconstruction. The major databases were reviewed for appropriate studies from the earliest available date of indexing through December 31, 2018. No restrictions were placed on the language of publication. RESULTS: Twenty-seven studies met the criteria for inclusion in this meta-analysis. The femur tunnel length of anatomic ACL reconstruction was significantly shorter compared with that of nonanatomic ACL reconstruction by 8.66 mm (95% CI: 7.10-10.22 mm; P<0.001), while the femur tunnel obliquity in the coronal plane of anatomic ACL reconstruction was significantly more oblique versus that of nonanatomic ACL reconstruction by 15.29° (95% CI: 8.07°-22.52°; P<0.001). Similar results in terms of femoral tunnel length were found for the subgroup with cadaveric (7.15 mm; 95% CI: 2.69-11.61 mm; P = 0.002) and noncadaveric (8.96 mm; 95% CI: 7.24-10.69 mm; P<0.001) studies, whereas different results in terms of femoral tunnel obliquity were noted for the subgroup with cadaveric (10.62°; 95% CI: -6.12° to 27.37°; P = 0.21) and noncadaveric (15.86°; 95% CI: 8.11°-23.60°; P<0.001) studies. CONCLUSION: Anatomic ACL reconstruction resulted in the femoral tunnel length and femoral tunnel obliquity in the coronal plane being shorter and more oblique, respectively, as compared with nonanatomic ACL reconstruction. LEVEL OF EVIDENCE: Therapeutic study, Level III.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Fêmur , Tíbia , Tomografia Computadorizada por Raios X , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Masculino , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
11.
Ann Agric Environ Med ; 27(1): 66-75, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32208582

RESUMO

OBJECTIVE: The aim of the study was to determine the effect of nesfatin-1 on bone properties in female rats in the conditions of developing osteopenia induced by ovariectomy (OVX). MATERIAL AND METHODS: The experiment was performed on 21 female Wistar rats assigned to 3 groups receiving intraperitoneally physiological saline (SHO, OVX-PhS) and nesfatin-1 in dose 2 µg/kg BW of (OVX-NES) once a day for 8 wks. At the end of the experiment, the rats were scanned using the DXA method to determine the body composition, tBMC, and tBMD. The isolated femora and tibia were tested with the DXA method for BMD and BMC, and with the pQCT method for separate analysis of the cortical and trabecular bone tissue. The bone strength parameters were also determined. The immunohistochemical method was used for determination of nesfatin-1 localization in growth cartilage. Bone metabolism markers (osteocalcin, bALP, and NTx) were identified using an ELISA kit. RESULTS: OVX exerts a negative effect on bone tissue. The nesfatin-1 administration influenced positively the DXA parameters of tibia. TvBMD and TbvBMD measured by pQCT in metaphysis of bones were significantly higher in the OVX-NES group than in OVX-PhS. No differences were found in the values of bone strength parameters between SHO and OVX-NES females. Extra- and intracellular immunohistochemical reaction for nesfatin-1 was observed in all zones of growth cartilage, with the strongest reaction detected in the calcifying zone. Nesfatin-1 administration caused a significant increase in the osteocalcin and bALP concentration in relation to the OVX-PhS animals. CONCLUSIONS: The results of the experiment indicate that nesfatin-1 exerts a protective effect on bone tissue properties and can be used in the prevention of osteoporosis.


Assuntos
Densidade Óssea/efeitos dos fármacos , Doenças Ósseas Metabólicas/tratamento farmacológico , Nucleobindinas/farmacologia , Absorciometria de Fóton , Fosfatase Alcalina/efeitos dos fármacos , Fosfatase Alcalina/metabolismo , Animais , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/metabolismo , Cartilagem/efeitos dos fármacos , Cartilagem/metabolismo , Feminino , Fêmur/diagnóstico por imagem , Fêmur/efeitos dos fármacos , Osteocalcina/metabolismo , Ovariectomia , Ratos Wistar , Tíbia/diagnóstico por imagem , Tíbia/efeitos dos fármacos
12.
Scand J Med Sci Sports ; 30(5): 885-893, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32096249

RESUMO

BACKGROUND: Patellofemoral pain (PFP) patients show increased prevalence of patellar malalignment. Structural and alignment abnormalities of the patellofemoral joint (PFJ) may play a role in development of PFP and patellofemoral osteoarthritis (PFOA). OBJECTIVES: Evaluating associations of patellofemoral alignment and femoral geometry with bony and cartilaginous abnormalities in PFP patients and healthy control subjects. METHODS: Data from a case-control study were used (64 PFP subjects, 70 control subjects, 57% female, age 23.2 (6.4)). Alignment and femoral geometry measures in the PFJ were determined using MRI. Structural abnormalities in the PFJ associated with OA (bone marrow lesions, osteophytes, minor cartilage defects and Hoffa-synovitis), quantified cartilage composition (T1ρ relaxation times) in the PFJ and perfusion within the patellar bone were examined using different MRI techniques. Associations were analyzed using regression analyses, adjusted for potential confounders. RESULTS: Lateral patellar tilt was negatively associated with presence of osteophytes on both patella (OR 0.91; 95% CI 0.84 to 0.98), anterior femur (OR 0.92; 95% CI 0.84 to 0.99) and minor cartilage defects on patella (OR 0.91; 95% CI 0.84 to 0.99). Patella alta was positively associated with the presence of bone marrow lesions in the patella and minor cartilage defects (OR 48.33; 95% CI 4.27 to 547.30 and OR 17.51; 95% CI 1.17 to 262.57, respectively). Patella alta and medial patellar translation were positively associated with T1ρ relaxation times within trochlear cartilage (ß 5.2; 95% CI 0.77 to 9.58, and 0.36; 95% CI 0.08 to 0.64, respectively). None of the alignment and geometry measures were associated with bone perfusion. CONCLUSION: Our study implies that associations between patellofemoral alignment and geometry and structural joint abnormalities linked to OA are already present in both PFP patients and healthy control subjects.


Assuntos
Artralgia/fisiopatologia , Fêmur/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Articulação Patelofemoral/fisiopatologia , Adolescente , Adulto , Artralgia/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Fêmur/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Adulto Jovem
13.
Cancer Invest ; 38(4): 250-256, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32098517

RESUMO

This study investigates the distribution of femoral metastases in cancer patients, specifically addressing the incidence of distal femoral metastases. PET/CT examinations routinely extend only to mid-thigh level, precluding detection of distal metastases. We found a total of 208 femoral metastases in 112 patients. 30% had distal femoral metastases in addition to other areas of involvement. 7% of patients with femoral metastases had only distal femur disease. 6 patients had distal pathologic fractures. Exclusion of the distal femur during PET/CT may result in a missed or delayed diagnosis that could contribute to the development of a pathologic fracture with increased morbidity.


Assuntos
Neoplasias Ósseas/diagnóstico , Fêmur/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/secundário , Feminino , Fêmur/patologia , Fluordesoxiglucose F18/administração & dosagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
Br J Radiol ; 93(1108): 20190556, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31977237

RESUMO

OBJECTIVE: Anatomical analysis of the hips and pelvis was performed using MRI to evaluate morphological characteristics and associations between them. We identified correlations between the ischiofemoral space (IFS), quadratus femoris space (QFS), femoral version angle (FVA) and cervicodiaphyseal angle (CDA). METHODS: This study involved a retrospective search of a database of consecutive reports of adult hip MRI examinations carried out between January and September 2016. Patients with a medical history likely to affect pelvic and hip morphometry were excluded. RESULTS: A total of 137 adult patients were enrolled in the study (45.3% males and 54.7% females), with a mean age of 50.16 ± 13.87 years. The mean IFS was 20.88 ± 5.96 mm, mean QFS was 15.2 ± 6.18 mm, mean FVA was 12.43 ± 6.98, and mean CDA was 121.27 ± 4.6°. The IFS measurements were significantly correlated with femoral measurements (p = 0.025). These visible differences showed a slight negative relationship (-0.191), and females had a smaller distance between these anatomical structures than males (p < 0.001). Females had a significantly smaller QFS than males (12.42 ± 5.94 vs 18.73 ± 4.48 mm, p = 0.000). There was a small but significant positive relationship between CDA and FVA (p = 0.022), with a correlation coefficient of 0.195. CONCLUSION: A higher FVA was correlated with a smaller IFS. Furthermore, an increase in the CDA appeared in tandem with an increase in the FVA. ADVANCES IN KNOWLEDGE: A single conventional MRI sequence can alert us to how anatomical factors could predispose individuals to a decrease in IFS.


Assuntos
Imagem por Ressonância Magnética , Ossos Pélvicos/diagnóstico por imagem , Síndrome do Músculo Piriforme/diagnóstico por imagem , Ciática/diagnóstico por imagem , Tendinopatia/diagnóstico por imagem , Artralgia/etiologia , Nádegas/diagnóstico por imagem , Suscetibilidade a Doenças , Feminino , Fêmur/diagnóstico por imagem , Humanos , Ísquio/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Síndrome
15.
Nat Commun ; 11(1): 401, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31964879

RESUMO

Magnesium-based biodegradable metals (BMs) as bone implants have better mechanical properties than biodegradable polymers, yet their strength is roughly less than 350 MPa. In this work, binary Zn alloys with alloying elements Mg, Ca, Sr, Li, Mn, Fe, Cu, and Ag respectively, are screened systemically by in vitro and in vivo studies. Li exhibits the most effective strengthening role in Zn, followed by Mg. Alloying leads to accelerated degradation, but adequate mechanical integrity can be expected for Zn alloys when considering bone fracture healing. Adding elements Mg, Ca, Sr and Li into Zn can improve the cytocompatibility, osteogenesis, and osseointegration. Further optimization of the ternary Zn-Li alloy system results in Zn-0.8Li-0.4Mg alloy with the ultimate tensile strength 646.69 ± 12.79 MPa and Zn-0.8Li-0.8Mn alloy with elongation 103.27 ± 20%. In summary, biocompatible Zn-based BMs with strength close to pure Ti are promising candidates in orthopedics for load-bearing applications.


Assuntos
Implantes Absorvíveis , Ligas/química , Fixadores Internos , Desenho de Prótese , Zinco/química , Animais , Interface Osso-Implante/diagnóstico por imagem , Linhagem Celular , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fixação Interna de Fraturas/instrumentação , Células Endoteliais da Veia Umbilical Humana , Humanos , Teste de Materiais , Microscopia Eletrônica de Varredura , Osteoblastos , Ratos , Resistência à Tração , Suporte de Carga , Microtomografia por Raio-X
16.
Acta Orthop ; 91(2): 171-176, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31960731

RESUMO

Background and purpose - Compressive osseointegration fixation is an alternative to intramedullary fixation for endoprosthetic reconstruction. Mechanical failure of compressive osseointegration presents differently on radiographs than stemmed implants, therefore we aimed to develop a reliable radiographic method to determine stable integration.Patients and methods - 8 reviewers evaluated 11 radiographic parameters from 29 patients twice, 2 months apart. Interclass correlation coefficients (ICCs) were used to assess test-retest and inter-rater reliability. We constructed a fast and frugal decision tree using radiographic parameters with substantial test-retest agreement, and then tested using radiographs from a new cohort of 49 patients. The model's predictions were compared with clinical outcomes and a confusion matrix was generated.Results - 6 of 8 reviewers had non-significant intra-rater ICCs for ≥ one parameter; all inter-rater ICCs were highly reliable (p < 0.001). Change in length between the top of the spindle sleeve and bottom of the anchor plug (ICC 0.98), bone cortex hypertrophy (ICC 0.86), and bone pin hypertrophy (ICC 0.81) were used to create the decision tree. The sensitivity and specificity of the training cohort were 100% (95% CI 52-100) and 87% (CI 74-94) respectively. The decision tree demonstrated 100% (CI 40-100) sensitivity and 89% (CI 75-96) specificity with the test cohort.Interpretation - A stable spindle length and at least 3 cortices with bone hypertrophy at the implant interface predicts stable osseointegration; failure is predicted in the absence of bone hypertrophy at the implant interface if the pin sites show hypertrophy. Thus, our decision tree can guide clinicians as they follow patients with compressive osseo-integration implants.


Assuntos
Interface Osso-Implante/diagnóstico por imagem , Árvores de Decisões , Extremidade Inferior/cirurgia , Osseointegração , Falha de Prótese/etiologia , Estudos de Coortes , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Hiperostose , Extremidade Inferior/diagnóstico por imagem , Variações Dependentes do Observador , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Prognóstico , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Radiografia/métodos , Sensibilidade e Especificidade , Estresse Mecânico
17.
Radiol Med ; 125(4): 398-405, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31916103

RESUMO

PURPOSE: The purpose of this study was to compare the accuracy of the planimetric methods on volume estimations by using cone beam computed tomography (CBCT). MATERIALS AND METHODS: Thirty-one prepared intraosseous bone defects from thirteen bovine femur condyles were scanned with CBCT. The defect volumes were estimated by point counting (PC), manual segmentation (MS) and semiautomatic segmentation (SAS) methods at 0.3-mm section thickness without any intersection gap. The estimated volumes were compared with the results of the Archimedes' method. The planimetric methods were analyzed using a Friedman's two-way analysis of variance test. RESULTS: The estimated volumes of MS and SAS methods were compatible with the volumes of Archimedes' method (p = 0.768, p = 0.140, respectively), but the volumes from the PC method were not compatible with Archimedes' method (p < 0.001). CONCLUSION: SAS was approximately 2.5 times faster than MS. Both MS and SAS are valid methods for volume estimation; however, SAS may be preferred due to its practicability.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Fêmur/diagnóstico por imagem , Animais , Bovinos
18.
J Pediatr Orthop ; 40(2): e109-e114, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31166245

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries in skeletally immature patients are increasingly recognized and surgically treated. However, the relationship between the footprint anatomy and the physes are not clearly defined. The purpose of this study was to identify the origin and insertion of the ACL and MCL, and define the footprint anatomy in relation to the physes in skeletally immature knees. METHODS: Twenty-nine skeletally immature knees from 16 human cadaver specimens were dissected and divided into 2 groups: group A (aged 2 to 5 y), and group B (aged 7 to 11 y). Metallic markers were placed to mark the femoral and tibial attachments of the ACL and MCL. Computed tomography scans were obtained for each specimen used to measure the distance from the center of the ligament footprints to the respective distal femoral and proximal tibial physes. RESULTS: The median distance from the ACL femoral epiphyseal origin to the distal femoral physis was 0.30 cm (interquartile range, 0.20 to 0.50 cm) and 0.70 cm (interquartile range, 0.45 to 0.90 cm) for groups A and B, respectively. The median distance from the ACL epiphyseal tibial insertion to the proximal tibial physis for groups A and B were 1.50 cm (interquartile range, 1.40 to 1.60 cm) and 1.80 cm (interquartile range, 1.60 to 1.85 cm), respectively. The median distance from the MCL femoral origin on the epiphysis to the distal femoral physis was 1.20 cm (interquartile range, 1.00 to 1.20 cm) and 0.85 cm (interquartile range, 0.63 to 1.00 cm) for groups A and B, respectively. The median distance from the MCL insertion on the tibial metaphysis to the tibial physis was 3.05 cm (interquartile range, 2.63 to 3.30 cm) and 4.80 cm (interquartile range, 3.90 to 5.10 cm) for groups A and B, respectively. CONCLUSION: Surgical reconstruction is a common treatment for ACL injury. Computed tomography scanning of pediatric tissue clearly defines the location of the ACL and MCL with respect to the femoral and tibial physes, and may guide surgeons for physeal respecting procedures. CLINICAL RELEVANCE: In addition to ACL reconstruction, recent basic science and clinical research suggest that ACL repair may be more commonly performed in the future. MCL repair and reconstruction is also occasionally required in skeletally immature patients. This information may be useful to help surgeons avoid or minimize physeal injury during ACL/MCL reconstructions and/or repair in skeletally immature patients.


Assuntos
Ligamento Cruzado Anterior/anatomia & histologia , Ligamento Cruzado Anterior/diagnóstico por imagem , Lâmina de Crescimento/anatomia & histologia , Lâmina de Crescimento/diagnóstico por imagem , Ligamento Colateral Médio do Joelho/anatomia & histologia , Ligamento Colateral Médio do Joelho/diagnóstico por imagem , Cadáver , Criança , Pré-Escolar , Dissecação , Fêmur/anatomia & histologia , Fêmur/diagnóstico por imagem , Humanos , Masculino , Tíbia/anatomia & histologia , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
J Pediatr Orthop ; 40(2): e96-e102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31107711

RESUMO

BACKGROUND: Despite the critical role the trochlea plays in patellofemoral (PF) pathology, the development of the trochlea is poorly understood. The purpose of this study was 2-fold: (1) Describe quantitative osseous and soft tissue anatomy of the patella and trochlea in skeletally immature cadaveric specimens utilizing known measurements used in PF instability, and (2) evaluate additional measurement techniques in the sagittal plane as they relate to PF morphologic development. METHODS: Thirty-one skeletally immature fresh frozen cadaveric knees between the ages of 2 and 11 years old were evaluated using 0.625 mm computed tomography scans. In the axial plane, measurements included condylar height asymmetry, trochlear facet asymmetry, trochlear depth, osseous sulcus angle, cartilaginous sulcus angle, patella sulcus angle, and tibial tubercle-trochlear groove distance. In the sagittal plane, measurements included previously undescribed measurements of trochlear length and condylar height asymmetry which are based on the anterior femoral cortex. RESULTS: Analysis of trochlear morphology using condylar height asymmetry (both axial and sagittal), trochlear facet asymmetry, and trochlear depth and length demonstrated an increase in the size of the medial and lateral trochlea as age increased. There was more variability in the change of size of the medial trochlea (height, length, and facet length) than the lateral trochlea. The osseous sulcus angle, cartilaginous sulcus angle, and patella sulcus angle decreased (became deeper) with age until after 8 years and then plateaued. CONCLUSIONS: This cadaveric analysis demonstrated that there is an increase in the medial and lateral trochlear height as age increased by all measurements analyzed. The findings also demonstrate that the shape of the patella and trochlea change concurrently, which suggests that there may be interplay between the 2 during development. These new sagittal measurement techniques evaluating the medial, central, and lateral trochlear height and length with respect to age may help guide clinicians when investigating patellar instability in skeletally immature patients. LEVELS OF EVIDENCE: Level IV.


Assuntos
Fêmur/anatomia & histologia , Patela/anatomia & histologia , Articulação Patelofemoral/anatomia & histologia , Cadáver , Criança , Pré-Escolar , Epífises/anatomia & histologia , Epífises/diagnóstico por imagem , Epífises/crescimento & desenvolvimento , Feminino , Fêmur/diagnóstico por imagem , Fêmur/crescimento & desenvolvimento , Humanos , Masculino , Patela/diagnóstico por imagem , Patela/crescimento & desenvolvimento , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/crescimento & desenvolvimento , Tíbia/anatomia & histologia , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Knee Surg Sports Traumatol Arthrosc ; 28(2): 629-636, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31732754

RESUMO

PURPOSE: To evaluate the effect of using intraoperative fluoroscopy on femoral and tibial tunnel positioning variability in single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: A total of 80 consecutive patients with single-bundle ACL reconstruction between 2014 and 2016 were retrospectively reviewed. Among them, 40 underwent ACL reconstruction without fluoroscopy (non-fluoroscopy group) and 40 underwent fluoroscopy-assisted ACL reconstruction (fluoroscopy group). Femoral and tibial tunnel locations were evaluated using a standardized grid system with three-dimensional computed tomography images. Femoral and tibial tunnel location variability was compared between the groups. RESULTS: The operation time was longer in the fluoroscopy group than in the non-fluoroscopy group (61.3 ± 5.2 min vs. 55.5 ± 4.5 min, p < 0.001). In the fluoroscopy group, a guide pin was repositioned in 16 (40%) cases on the femoral side and 2 (5%) cases on the tibial side. No significant difference in the femoral tunnel location was observed between the fluoroscopy and non-fluoroscopy groups (anterior-posterior plane, 29.0% ± 3.2% vs. 30.0% ± 6.1%; proximal-distal plane, 30.8% ± 4.8% vs. 29.4% ± 8.3%; all parameters, n.s.); variability was significantly lower in the fluoroscopy group (p < 0.001 for both anterior-posterior and proximal-distal planes). No significant difference in the tibial tunnel location and variability was observed between the fluoroscopy and non-fluoroscopy groups (medial-lateral plane, 45.8% ± 2.0% vs. 46.6% ± 2.4%; anterior-posterior plane, 31.2% ± 4.0% vs. 31.0% ± 5.4%) (all parameters, n.s.). CONCLUSIONS: Tunnel positioning with fluoroscopic assistance is feasible and effective in achieving consistency in femoral tunnel placement despite a slightly longer operation time. Intraoperative fluoroscopy can be helpful in cases wherein identifying anatomical landmarks on arthroscopy was difficult or for surgeons with less experience who performed ACL reconstruction. LEVEL OF EVIDENCE: IV.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fluoroscopia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia/métodos , Feminino , Humanos , Imageamento Tridimensional , Período Intraoperatório , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
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