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1.
Medicine (Baltimore) ; 99(12): e19578, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195971

RESUMO

INTRODUCTION: Spondyloptosis is a form of vertebral dislocation and the most advanced form of spondylolisthesis. Traumatic spondyloptosis is usually caused by high-energy impact and results in unstable spine deformity and spinal canal deformation, which lead to severe spinal cord injury. Traumatic spondyloptosis is mostly reported in the lumbo-sacral junction, while it is rarely documented in mid-lumbar segments. To the best of the authors' knowledge, only 16 cases of mid-lumbar spondyloptosis have been described previously. Herein, we present a L3 to L4 spondyloptosis case that did not involve neurological deficit. PATIENT CONCERNS: A 42-year-old man presented to the emergency department after an accident involving a fall. The patient developed severe back pain and spinal deformity, while his neurologic function remained intact. Radiological examinations indicated complete posterior vertebral dislocation at L3 to L4 and a fracture at the bilateral pelvic ischial tuberosity without major vessel injury or severe dura sac compression. DIAGNOSES: L3 to L4 complete vertebral dislocation, pelvic ischial tuberosity fracture. INTERVENTIONS: For treatment, the patient underwent fracture reduction, L3 to L4 intervertebral fusion, and internal fixation 7 days post-injury. OUTCOMES: Postoperative digital radiography showed the correction of the spinal deformity. The patient was pain-free and fully rehabilitated 3 months after the surgery. At the 1-year follow-up, the patient was completely asymptomatic and had achieved normal alignment. CONCLUSIONS: We reported an L3 to L4 traumatic spondyloptosis case that involved intact neurology, which is the first-ever reported mid-lumbar spondyloptosis case that involved complete posterior column and neural sparing. For the treatment of traumatic spondyloptosis without neurological deficit, restoring stability and preventing secondary cord injury should be taken into consideration.


Assuntos
Dor nas Costas/diagnóstico , Anormalidades Congênitas/diagnóstico , Vértebras Lombares/lesões , Espondilolistese/diagnóstico por imagem , Acidentes por Quedas , Adulto , Assistência ao Convalescente , Criança , Pré-Escolar , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Ossos Pélvicos/patologia , Radiografia/métodos , Fusão Vertebral/métodos , Coluna Vertebral/anormalidades , Espondilolistese/cirurgia , Resultado do Tratamento
2.
Zhongguo Gu Shang ; 33(1): 43-6, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115923

RESUMO

OBJECTIVE: To compare the relationship between direct lateral approach and posterolateral approach in the treatment of femoral neck fracture, and to provide reference for the choice of the best approach. METHODS: From January 2015 to December 2018, 266 patients with femoral neck fracture underwent hip replacement were selected, including 154 males and 112 females, aged 58 to 74 (69.8±8.1) years. Direct lateral approach and posterolateral approach were used in 133 cases in each group. The difference of reoperation rate and dislocation rate between the two groups was compared. Cox proportional risk regression model was used to evaluate the potential factors of reoperation and dislocation after total hip replacement. RESULTS: The rate of reoperation and dislocation in direct lateral approach group was lower than that in posterolateral approach group (P<0.05) . Cox proportional risk regression model showed that posterolateral approach had higher postoperative reoperation rate and dislocation rate than direct lateral approach, and its relative risk ratio (95%CI) was, reoperationï¼»2.65 (1.23- 5.36) , P=0.02ï¼½; dislocationï¼»5.15 (1.68-9.15) , P=0.01ï¼½. CONCLUSION: Posterolateral approach is the influencing factor of reoperation and dislocation after hip replacement. Age, gender, cognitive dysfunction, replacement position, ASA score and other factors have no effect on reoperation and dislocation.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral , Luxações Articulares , Idoso , Feminino , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/diagnóstico , Fraturas do Colo Femoral/cirurgia , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Reoperação , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(5): e18983, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000432

RESUMO

INTRODUCTION: Basilar invagination (BI) is a common deformity in the occipitocervical region. The traditional surgical method of BI is direct transoral decompression followed by posterior decompression and fixation. Posterior-only decompression and fixation have achieved good efficacy in the treatment of BI in recent years, but complications are common due to the operation in the upper cervical vertebra and the medulla oblongata region. Moreover, posterior-only occipitocervical fusion combined with an intraoperative 3-dimensional (3D) navigation system is relatively rare, and reports of this procedure combined with 3D printing technology have not been published. We present a case of BI treated with posterior-only occipitocervical fusion combined with 3D printing technology and 3D navigation system to reduce the risk of surgical complications. PATIENT CONCERNS: A 55-year-old patient with a history of neck pain and numbness of the extremities for 6 years developed a walking disorder for 1 year. DIAGNOSES: Atlantoaxial dislocation with BI. INTERVENTIONS: The patient underwent posterior-only occipitocervical fusion combined with intraoperative 3D navigation system and 3D printing technology. OUTCOMES: The patient's walking disorder was resolved and he was able to walk approximately 100 m by himself when he was allowed to get up and move around with the help of a neck brace. At 6 months postoperatively, the patient reported that the numbness of the limbs was reduced, and he could walk >500 m by himself. CONCLUSION: Occipitocervical fusion is one of the established techniques for the treatment of BI. The biggest advantage of the 2 technologies was that it ensured precise implant placement. The advantages of intraoperative 3D navigation systems are as follows: real-time intraoperative monitoring of the angle and depth of implant placement; the best nailing point can be determined at the time of implantation, rather than according to the operator's previous experience; and the extent of screw insertion is visible to the naked eye, rather than being dependent on the "hand feel" of the surgeon. At the same time, the 3D printing technology can be applied to clarify the relationship between blood vessels and bone around the implant to minimize injury to important structures during implantation.


Assuntos
Articulação Atlantoaxial/cirurgia , Imageamento Tridimensional , Luxações Articulares/cirurgia , Impressão Tridimensional , Fusão Vertebral/métodos , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osso Occipital/cirurgia , Tomografia Computadorizada por Raios X
5.
World Neurosurg ; 136: 70-72, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931243

RESUMO

BACKGROUND: Although instrumented stabilization of pediatric atlanto-occipital dislocation (AOD) has been described in the literature, there is little evidence regarding instrumentation techniques in pediatric patients presenting with both AOD and a cervical fracture. We present a case of a 2-year-old male involved in a motor vehicle collision with an unstable C2 fracture and AOD, treated with an occiput-C4 posterior arthrodesis using a rod, crosslink, and cable construct. CASE DESCRIPTION: This patient suffered a type III C2 fracture and AOD with 4 mm craniocaudal and 3 mm anterior displacement. In the operating room, 2 cobalt chrome connecting rods (3.5 mm) were connected to 1 another with crosslinks at C2 and C4. These were affixed with suboccipital and sublaminar cables at C1, C2, and C4. At 14 months postoperatively, his spine is clinically and radiographically stable. He has spontaneous movement in all 4 extremities, and remains in a persistent vegetative state because of his underlying central nervous system injury. CONCLUSIONS: Although there is a breadth of literature investigating instrumentation approaches to pediatric AOD, there is minimal evidence on outcomes of patients presenting with both AOD and cervical fracture. The technique we describe has proven safe and effective for this patient.


Assuntos
Articulação Atlantoccipital/cirurgia , Vértebra Cervical Áxis/cirurgia , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes de Trânsito , Artrodese , Articulação Atlantoccipital/diagnóstico por imagem , Articulação Atlantoccipital/lesões , Vértebra Cervical Áxis/diagnóstico por imagem , Vértebra Cervical Áxis/lesões , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Pré-Escolar , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Masculino , Estado Vegetativo Persistente , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem
6.
World Neurosurg ; 136: 315-317, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31991230

RESUMO

Spontaneous atlantooccipital dislocation is a rare clinical entity. Patients may present with neck pain and restriction of movements. Rarely does a patient present with hypoglossal nerve palsy. We report 1 such case, whose 12th nerve palsy promptly recovered after corrective surgery.


Assuntos
Articulação Atlantoccipital/lesões , Articulação Atlantoccipital/cirurgia , Doenças do Nervo Hipoglosso/etiologia , Doenças do Nervo Hipoglosso/cirurgia , Luxações Articulares/complicações , Luxações Articulares/cirurgia , Adulto , Humanos , Masculino , Recuperação de Função Fisiológica , Fusão Vertebral , Resultado do Tratamento
7.
J Pediatr Orthop ; 40(2): 65-70, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923165

RESUMO

BACKGROUND: There are few studies reporting the use of atlantoaxial pedicle screws and the long-term effects of C1-C2 posterior fusion in children. Our study is to investigate the initial results of C1-C2 pedicle screw fixation for pediatric atlantoaxial dislocation (AAD) and assessed spontaneous change of postoperative radiography after a long-term follow-up period. METHODS: Posterior pedicle screw fixations were performed in 21 pediatric patients with AAD. All the patients underwent implant removal 1 year after their initial surgery and had regular follow-up with an average duration of 76.4 months (range, 52 to 117 mo). Clinical and radiographic data were then collected and compared. RESULTS: Frankel Grade was significantly improved at 3 months follow-up compared with pretreatment values. All patients had good bony fusion at a mean of 4.2±0.9 months (range, 3 to 6 mo) after treatment. None of the patients experienced worsening neurological symptoms or injury to the vertebral artery. However, 2 cases experienced minor complications. Following removal of the implants, no spinal deformities or subaxial instabilities were found. The mean angle of sagittal curvature increased from 12.1±2.4 degrees (range, 0 to 22 degrees) immediately postoperatively to 19.1±2.7 degrees (range, 6 to 31 degrees) at the final follow-up (P>0.05). CONCLUSIONS: The results demonstrated that C1-C2 pedicle screw fixation could achieve satisfactory initial results for the management of the pediatric AAD. Moreover, removal of the metal implant after bony fusion did not increase the risk of spinal deformity or subaxial instability at long-term follow-up.


Assuntos
Articulação Atlantoaxial/cirurgia , Luxações Articulares/cirurgia , Parafusos Pediculares , Implantação de Prótese , Fusão Vertebral/métodos , Vértebra Cervical Áxis/cirurgia , Atlas Cervical/cirurgia , Criança , Pré-Escolar , Remoção de Dispositivo , Feminino , Seguimentos , Humanos , Masculino , Parafusos Pediculares/efeitos adversos , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação
8.
World Neurosurg ; 134: e243-e248, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629147

RESUMO

BACKGROUND: Selection of approach for subaxial cervical fracture-dislocation (SCFD) is controversial. The questions of whether a posterior ligamentous structure (PLS) can be functionally healed in patients with SCFD and how long this healing process takes are critical in these patients. METHODS: This study retrospectively enrolled 394 patients with SCFD who underwent anterior decompression, reduction, and fusion between January 2002 and December 2017. The definition of functional healing of PLS was based on evaluations of clinical function and radiographic stability of PLS. RESULTS: Follow-up was available for 354 patients (89.8%). The PLS of 339 cases was functionally healed at the first follow-up interval without any posterior surgical intervention. No hardware failure or progressive cervical kyphosis was observed at further follow-up. At 12 months postoperatively, interbody fusion was satisfactory. However, the other 15 patients experienced nonhealing PLS at 8 weeks postoperatively and developed cervical deformity at further follow-up. Five patients refused revision surgery; the other 10 patients obtained solid fusion after revision surgeries. CONCLUSIONS: Among 354 patients with SCFD and treated by single anterior reduction and fixation, simple PLS injury without any bony instability at the posterior column of the cervical spine can be functionally healed in 95.8% of patients by external fixation for 8 weeks. Whether this finding is applicable to various types of SCFD should be verified in further prospective studies with larger samples.


Assuntos
Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/tendências , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/tendências , Adulto , Vértebras Cervicais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem
9.
J Craniofac Surg ; 31(1): 166-168, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31794445

RESUMO

INTRODUCTION: Neck pain is common in the post-operative period after craniofacial procedures. If patients present with neck pain and torticollis, it could be a manifestation of atlantoaxial rotatory subluxlation (AARS), which describes a rare condition in which there is lateral displacement of C1 relative to C2. When this occurs in the post-operative patient, it is termed Grisel syndrome. In this case series, we report on 3 patients diagnosed with Grisel syndrome after a craniofacial procedure. METHODS: A retrospective chart review of a single craniofacial surgeon at a pediatric hospital was conducted over the last 3 decades. Demographics, procedures performed, and management strategies of AARS were included for review. RESULTS: Three patients were identified who were diagnosed with Grisel syndrome after a craniofacial procedure and required inpatient cervical traction. All patients presented with torticollis within 1 week of their operation. Conservative management was ineffective, and all 3 patients were admitted for inpatient cervical traction, for an average of 13 days followed by an average of 47 days of outpatient therapy. No patients showed any signs of recurrence after removal of outpatient traction device. CONCLUSION: Grisel syndrome is a rare, but serious complication of craniofacial procedures. Physicians caring for these patients must have a high degree of suspicion if a patient with a recent craniofacial procedure presents with torticollis. Delaying the initiation of therapy has been shown to lead to higher rates of recurrence and increases the likelihood that patients will require surgical intervention.


Assuntos
Articulação Atlantoaxial , Luxações Articulares/diagnóstico por imagem , Articulação Atlantoaxial/diagnóstico por imagem , Criança , Feminino , Síndrome de Goldenhar/cirurgia , Humanos , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Masculino , Lesões do Pescoço/etiologia , Cervicalgia/etiologia , Estudos Retrospectivos , Crânio/cirurgia , Torcicolo
10.
Vet Clin North Am Small Anim Pract ; 50(1): 231-239, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31653535

RESUMO

Sacroiliac fracture-luxation is a common injury that is associated with ilial and acetabular fractures of the opposite hemipelvis. Sacroiliac fracture-luxation results in an unstable pelvis and potentially collapse of the pelvic canal. A minimally invasive approach to the reduction and insertion of a screw for fixation of sacroiliac fracture-luxation using fluoroscopic guidance is viable. The advantages of using this technique are that a small incision is made with minimal soft tissue disruption and the surgical time is short. Recent publications have documented that this technique provided superior repair of sacroiliac fracture-luxations.


Assuntos
Fixação Interna de Fraturas/veterinária , Luxações Articulares/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Articulação Sacroilíaca/cirurgia , Animais , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/veterinária , Luxações Articulares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Articulação Sacroilíaca/patologia
11.
Medicine (Baltimore) ; 98(51): e18433, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861012

RESUMO

RATIONALE: Posterior sternoclavicular joint dislocations (PSCJDs) are particularly rare injuries, accounting for 3% to 5% of sternoclavicular joint dislocations. With very few cases reported in the literature, these injuries are often misdiagnosed and imaging is not always clear, thus making physicians often unaware of them. The present case report aims to investigate a rare case involving a clavicular Salter-Harris II fracture with associated posterior displacement of the diaphysis, a term coined a "pseudodislocation." PATIENT CONCERNS: We present a case of a 14-year-old adolescent who sustained a traumatic injury to the shoulder while falling during a soccer match. His main concern was about recovery time and the return to daily life activities. DIAGNOSES: Multiple imaging studies imaging (X-rays, computed tomography, magnetic resonance imaging) revealed a Salter-Harris II fracture of the right clavicle with posterior displacement of the diaphysis. INTERVENTIONS: The patient underwent primary surgery to reduce the fracture, using an articular locking compression plate, and secondary surgery to remove the hardware. OUTCOMES: Following the removal of the hardware at 60 days after the initial surgery and a number of cycles of physiotherapy the patient reported a pain-free range of motion with slight limitation at extremes. Full return to recreational and everyday life activities were achieved at 3 months from the initial surgery. LESSONS: The PSCJDs are challenging injuries, as they are surrounded by delicate structures inside the mediastinum. Attention must be taken while diagnosing and treating these injuries as the risk of complications and iatrogenic injuries is high. To the author's knowledge, this case is one of the first of its kind described in the literature where we have a Salter-Harrys type II fracture associated with a posterior pseudodislocation of the lateral clavicle. Given the positive results of the case, we recommend the above-mentioned treatment protocol in PSCJD with associated Salter-Harris II fractures in adolescent patients.


Assuntos
Fixação Interna de Fraturas/instrumentação , Luxações Articulares/cirurgia , Futebol/lesões , Articulação Esternoclavicular/diagnóstico por imagem , Adolescente , Placas Ósseas , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino
12.
Acta Med Acad ; 48(2): 225-229, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31718223

RESUMO

OBJECTIVE: The hypermobile lateral meniscus of the knee is a rarely described entity. In this case report we aim to draw attention to the clinical presentation and MR imaging findings of this pathology. CASE REPORT: We review the clinical and imaging findings that led to the diagnosis of hypermobile lateral meniscus with transient subluxation causing intermittent locking, and which subsequently led to successful surgical treatment. CONCLUSION: Hypermobile lateral meniscus is rarely diagnosed prospectively on MR imaging. A better understanding of this uncommon condition will lead to prompt diagnosis and effective treatment, with a better outcome for the patient.


Assuntos
Luxações Articulares/patologia , Instabilidade Articular/patologia , Meniscos Tibiais/patologia , Adolescente , Artroscopia , Feminino , Humanos , Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Meniscos Tibiais/cirurgia , Recidiva , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(44): e17776, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689843

RESUMO

RATIONALE: To our knowledge, this is the first report of traumatic combined vertical atlanto-occipital dislocation (AOD) and atlanto-axial dislocation (AAD) with 2-part fracture of the atlas. PATIENT CONCERNS: The first case was of a 31-year-old woman admitted to the emergency room comatose after a traffic accident. The second case was of a 21-year-old woman admitted to the emergency room comatose after a fall. DIAGNOSES: Traumatic combined vertical AOD and AAD with 2-part fractures of the atlas was diagnosed using plain radiography, 2-dimensional computed tomography, and/or magnetic resonance imaging of the cervical spine. INTERVENTION: The first patient received immediate intubation and cardiopulmonary resuscitation in the emergency room. The second patient also received immediate intubation in the emergency room. After her vitals stabilized, she underwent occipitocervical fusion with instrumentation. OUTCOMES: The first patient died 2 days after the accident. The second patient remained quadriplegic in a ventilatory-dependent state at 1 year after surgery. She continues to receive comprehensive rehabilitation. LESSONS: Immediate respiratory support and surgical stabilization are important for saving lives in this kind of extremely unstable and fatal complex upper cervical spine injury.


Assuntos
Articulação Atlantoaxial/lesões , Articulação Atlantoccipital/lesões , Atlas Cervical/lesões , Luxações Articulares/cirurgia , Fraturas Cranianas/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Articulação Atlantoaxial/cirurgia , Articulação Atlantoccipital/cirurgia , Atlas Cervical/cirurgia , Feminino , Humanos , Luxações Articulares/etiologia , Fraturas Cranianas/etiologia , Fraturas da Coluna Vertebral/etiologia , Fusão Vertebral/métodos , Adulto Jovem
14.
BMC Musculoskelet Disord ; 20(1): 558, 2019 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-31759395

RESUMO

BACKGROUND: Traumatic bilateral locked facet joints at L4-5 level are a rare entity. A careful review only revealed four case reports. This case presented with an unusual mechanism of injury. CASE PRESENTATION: We present a case of a 40-year-old male who suffered bilateral L4-5 traumatic facet fracture dislocation following a fall injury. The dislocation was associated with fractures of bilateral L4 inferior articular processes, left L4 pedicle, L4 spinous process and postero-inferior body of L4. He presented with cauda-equina syndrome and underwent emergency decompression, reduction and instrumented fusion. CONCLUSION: The biomechanics of the lumbar spine may differ with each individual. L4-5 dislocation may be a variant to lumbosacral (L5-S1) dislocation, owing to hyperextension injury.


Assuntos
Fixação Interna de Fraturas/métodos , Luxações Articulares/cirurgia , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Adulto , Fixação Interna de Fraturas/instrumentação , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem
15.
Medicine (Baltimore) ; 98(48): e18175, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770268

RESUMO

RATIONALE: Hereditary multiple exostoses (HME) is an autosomal dominant disease that causes multiple exostoses throughout the body. It usually occurs around the metaphysis of the long bones, and when it involves the hip, symptoms arise due to deformity and the mass effect. If the lesion does not involve the joint or is not associated with arthritis, symptoms can be relieved by surgical excision of the osteochondroma. However, if secondary osteoarthritis (OA) or subluxation of the joint has progressed, joint replacement arthroplasty should be considered. PATIENT CONCERNS: A 57-year-old woman with HME visited our outpatient department with severe right hip pain. She complained of difficulty walking and severe discomfort during activities of daily living. She was short in stature and had a family history of HME. DIAGNOSIS: A physical examination revealed limited motion in the hip joint and a limb length discrepancy. Plain radiography and a computed tomography scan revealed huge osteochondromas on bilateral proximal femurs and advanced OA with subluxation of the right hip joint. INTERVENTIONS: Cementless total hip arthroplasty of the right hip joint via the modified posterolateral approach was done. OUTCOMES: The patient showed good clinical scores and functional improvement at the 2-year follow-up. LESSONS: Total hip arthroplasty for an anatomically deformed joint is technically difficult, and there are many factors to consider that can make surgeons reluctant to use this modality. However, with careful preparation, arthroplasty is a good surgical option for symptomatic and functional recovery in HME patients with hip joint involvement.


Assuntos
Artroplastia de Quadril/métodos , Neoplasias Ósseas , Exostose Múltipla Hereditária , Fêmur , Articulação do Quadril , Luxações Articulares , Neoplasias Ósseas/complicações , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Exostose Múltipla Hereditária/complicações , Exostose Múltipla Hereditária/patologia , Exostose Múltipla Hereditária/cirurgia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/patologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Pessoa de Meia-Idade , Radiografia/métodos , Recuperação de Função Fisiológica , Resultado do Tratamento
16.
BMC Musculoskelet Disord ; 20(1): 440, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601273

RESUMO

BACKGROUND: Several methods have been reported to correct deformity and shortening of the distal radius. However, the results are not entirely satisfactory. The results of bifocal osteosynthesis were retrospectively analyzed in this study. METHODS: Eight patients treated with bifocal osteosynthesis were evaluated retrospectively. Pre-operative and post-operative clinical and radiographic examinations were performed. Subjective symptoms and objective joint function were assessed. Radiographic data of the extent of radial lengthening and distal radial articular angle were collected. RESULTS: The mean follow-up period was 46 months (37-68 months). Satisfactory wrist appearance and radial lengthening was achieved in all patients. All patients were satisfied with the wrist appearance and willing to undergo the same treatment again. The range of motion (ROM) of the forearm and wrist was significantly improved. Pin-track infections occurred in two patients, for which they received wound care and oral antibiotics. Complications such as fixation device failure, tendon rupture, fracture of regenerated bone or nerve impairment did not occur. The duration of lengthening depended on the shortening of the radius. Delayed union in the docking site was observed in two patients and union was achieved after bone grafting. CONCLUSIONS: Bifocal osteosynthesis using the Ilizarov method provides a useful method for correction of radial shortening deformity with dislocation of the inferior radioulnar joint. Despite the fact that we did not validate pre-and post-operation functional outcome scores, all patients were satisfied with the wrist appearance and function.


Assuntos
Técnica de Ilizarov , Luxações Articulares/cirurgia , Rádio (Anatomia)/cirurgia , Articulação do Punho/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Masculino , Satisfação do Paciente , Rádio (Anatomia)/anatomia & histologia , Rádio (Anatomia)/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Punho/fisiopatologia
17.
J Craniofac Surg ; 30(8): 2512-2516, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31567763

RESUMO

OBJECTIVES: Various techniques have been described to correct caudal septum dislocations but the issue has not been resolved conclusively. This study aimed to describe a suture technique that can be used to correct and stabilize the caudal septum on the maxillary spine and also to evaluate the effects on patientsymptoms. METHODS: Fifty-two patients with caudal septal dislocation were included in this study. Nineteen of the patients underwent open septoplasty and 33 patients underwent endonasal septoplasty. The caudal cartilage septums were fixed to the maxillary spine with horizontal mattress suturing in all patients. The patient followed up between 3 and 24th month. The modified "NOSE" survey was used to assess surgical outcome in all patients. The degree of septal correction was also classified. RESULTS: Complete correction was achieved in the postoperative period in 96% of the patients. The status was near complete correction in 2 (3.8%) of the patients. But in these 2 patients, degree of caudal septal dislocation was corrected from severe to moderate after surgery and the fixation suture side is correct and stable. Postoperative modified NOSE survey scores were lower than the preoperative scores in all open and endonasal septoplasty groups (P <0.05). NOSE 2 (nasal blockage or obstruction) and NOSE 4 (trouble sleeping) scores were higher in patients with higher follow-up duration in open septoplasty group. CONCLUSION: Suturing technique is quite suitable for caudal septum dislocations and can easily be used in open and endonasal septoplasty. This suture reduces postoperative NOSE scores and the patients are satisfied with the results of the surgery. The septal stability may decrease in open septoplasty group with the longer post-operative duration. However, wide exposure can be ensured with an open septorhinoplasty approach. We concluded that it will be better to use endonasal septoplasty in appropriate cases and suture with nonabsorbable sutures.


Assuntos
Luxações Articulares/cirurgia , Septo Nasal/cirurgia , Adolescente , Adulto , Cartilagem/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/cirurgia , Período Pós-Operatório , Rinoplastia/métodos , Inquéritos e Questionários , Técnicas de Sutura , Suturas , Resultado do Tratamento , Adulto Jovem
18.
Spine (Phila Pa 1976) ; 44(20): 1412-1417, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31589199

RESUMO

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of fluoroscopy-guided atlantoaxial pedicle screw fixation in patients younger than 12 years. SUMMARY OF BACKGROUND DATA: C1-C2 pedicle screw fixation is a widely accepted treatment method for atlantoaxial dislocation (AAD). However, data regarding its use for atlantoaxial fusion (AAF) in children are limited. METHODS: Thirty-six consecutive patients younger than 12 years underwent C1-C2 pedicle screw fixation for AAD between 2007 and 2017. Anatomical parameters of the C1 pedicle were measured on preoperative computed tomography (CT). Accuracy of pedicle screw fixation was assessed on postoperative CT using the following definitions: Type I, screw threads completely within the bone; Type II, less than half the diameter of the screw violating the surrounding cortex; and Type III, clear violation of the transverse foramen or spinal canal. Demographic, surgical, radiation dose, and clinical data were recorded. RESULTS: Patients underwent 144 screw fixations (67 C1 pedicle screws, 68 C2 pedicle screws, 5 C1 lateral mass screws, and 4 C-2 laminar screws) for a variety of pediatric AADs, with 36.5 ±â€Š8.5 months of follow-up. Among the 135 pedicle screws, 96.3% were deemed "safe" (Type I or II) and 80.7% (109/135) of the screws were rated as being ideal (Type I); five screws (3.7%) were identified as unacceptable (Type III). Average estimated blood loss (EBL) was 92 mL, and the average total radiation exposure during the operation was 6.2 mGy (in the final 26 cases). There were no neurovascular injuries. All patients showed radiographic stability and symptom resolution. CONCLUSION: C1-C2 pedicle screw fixation under fluoroscopy is safe and effective for the treatment of AAD in children younger than 12 years. However, it may be technically challenging owing to the special anatomical features of children and should be performed by experienced surgeons. LEVEL OF EVIDENCE: 3.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Parafusos Pediculares , Fusão Vertebral , Cirurgia Assistida por Computador , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Criança , Fluoroscopia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/estatística & dados numéricos
19.
BMC Musculoskelet Disord ; 20(1): 451, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615503

RESUMO

BACKGROUND: To compare the imaging parameters pre- and post- reductive procedure for atlantoaxial dislocation via posterior fixation using pedicle screw and rod. METHODS: Thirty-seven patients suffering from atlantoaxial dislocation underwent posterior reduction and internal fixation by pedicle screw and rod. We measured pre-operative and post-operative atlantodental interval (ADI), clivus-canal angle (CCA), cervicomedullary angle (CMA), sum of lateral mass interspace (SLMI) of the operation and the control group. ADI, CCA, CMA, and SLMI between the pre-operative and post-operative conditions of the operation group and the control group were compared. RESULTS: The ADI, CCA, CMA, and SLMI in the pre-operative condition of the operation group were 8.3 ± 4.3 mm, 130.2 ± 14.2°, 133.8 ± 16.7°, and 3.7 ± 1.3 mm, respectively, those in the post-operative condition of the operation group were 1.0 ± 0.9 mm, 148.5 ± 9.4°, 156.0 ± 8.2°, and 8.0 ± 2.7 mm, respectively, while those in the control group were 1.2 ± 0.3 mm, 152.7 ± 5.3°, 160.2 ± 6.3°, and 4.5 ± 1.0 mm respectively. Post-operative ADI, CCA, CMA, and SLMI were statistically different (p < 0.01) from pre-operative assessments. The SLMI has no significant difference between the pre-operative condition and the control group. Post-operative SLMI was statistically different from that of the control group. CONCLUSIONS: The lateral mass joints were widened after the anatomical reduction of atlantoaxial dislocation by pedicle screw and rod. Widening of the lateral mass exists in both atlantoaxial fusion and occipital-cervical fusion.


Assuntos
Articulação Atlantoaxial/lesões , Fixação Interna de Fraturas/instrumentação , Luxações Articulares/cirurgia , Parafusos Pediculares , Fusão Vertebral/instrumentação , Adolescente , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Criança , Estudos Transversais , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
20.
Orthop Traumatol Surg Res ; 105(7): 1361-1367, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31628034

RESUMO

BACKGROUND: Lateral wedge augmentation trochleoplasty (LWAT) was the earliest described trochleoplasty technique but was gradually replaced by other methods for the treatment of patello-femoral instability with trochlear dysplasia. Data on the outcomes of this procedure in adults are limited. We therefore performed a retrospective study in patients managed by LWAT to assess (1) clinical (recurrent instability and functional scores), (2) and radiological (patello-femoral osteoarthritis) outcomes. HYPOTHESIS: LWAT is associated with a low long-term rate of recurrent patello-femoral dislocation and with no risk of progression to severe patello-femoral osteoarthritis. MATERIAL AND METHODS: Between 1988 and 1995, LWAT was performed on 66 knees in 58 patients to treat patello-femoral instability with trochlear dysplasia. Among them, 17 knees in 13 patients were re-evaluated 16 then 25 years after surgery and were included in the study. At both time points, the following were recorded: stability, pain, the Lille patello-femoral function score, and changes in radiographic and computed tomography findings. In addition to LWAT, Insall's realignment vastus medialis advancement was performed in 4 cases, sartorius muscle transposition in 9 cases, and anterior tibial tubercle osteotomy in 10 cases. RESULTS: No episodes of patello-femoral dislocation were recorded during the 25-year follow-up. The mean Lille patello-femoral function score (0 worst to 100 highest) was 90±15 (range, 48-99) after 16 years and 86±23 (range, 33-94) after 25 years. After 16 years, 8/17 knees had evidence of patello-femoral osteoarthritis, which was Iwano stage 1 in 7 cases and Iwano stage 2 in 1 case. Patello-femoral osteoarthritis was noted in 12 of 13 knees after 25 years but was mild (Iwano stage 1 or 2) in 8 cases. After 25 years, arthroplasty had been performed for 4 of the 17 knees, with 2 cases each of patello-femoral arthroplasty and total knee arthroplasty. CONCLUSION: LWAT is a reliable procedure that provides sustained protection against patello-femoral dislocation and good functional scores when used to treat patello-femoral instability due to trochlear dysplasia. Our results do not support claims that LWAT may be associated with high rates of severe osteoarthritis even after more than 20 years. LEVEL OF EVIDENCE: IV, retrospective observational study with no control group.


Assuntos
Artroplastia do Joelho/métodos , Previsões , Luxações Articulares/cirurgia , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Adolescente , Adulto , Progressão da Doença , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/etiologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Radiografia , Amplitude de Movimento Articular/fisiologia , Recidiva , Estudos Retrospectivos
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