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1.
Medicine (Baltimore) ; 99(14): e19677, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243403

RESUMO

In the Graf method of hip ultrasonography, the diagnosis of the infantile hip with developmental dysplasia of the hip (DDH) is strictly dependent on the bony roof (alpha angle) and the cartilage roof (beta angle) measurements. In this study, we investigated whether the infant hip could be diagnosed with DDH solely by evaluating ultrasound images obtained in the standard plane, without bony roof and cartilage roof measurements, in respect to different professional experience levels.Two hundred ten hip ultrasounds were randomly selected from patients who presented to our hospital for DDH screening. A total of 6 ultrasound images were obtained for each hip. The hip morphology evaluations were made without the bony roof and the cartilage roof measurements by 2 orthopedic surgery residents; 2 orthopedic surgery specialists, trained in the diagnosis and the treatment of the DDH; and 2 pediatric orthopedic surgery professors, highly experienced in the diagnosis and treatment of DDH. After hip morphology evaluations, the bony roof and the cartilage roof measurements were obtained and hip type evaluations were made by the same raters, according to the Graf method of hip ultrasonography.The highest intraobserver agreements between the hip maturity evaluation before and the hip type evaluation after measurements were .676 (P < .001) and .577 (P < .001) in professors 2 and 1, respectively, and the lowest agreements were .185 (P < .01) and .289 (P < .001) in specialist 1 and resident 2, respectively.The diagnosis of the infant hip as DDH could not be made solely by evaluation of the ultrasound images obtained in the standard plane without the bony roof and the cartilage roof measurements. The bony roof and the cartilage roof measurements were obligatory for the diagnosis of the infant hip as DDH, even in the very experienced pediatric orthopedic surgeons.Level of evidence: 2.


Assuntos
Competência Clínica/estatística & dados numéricos , Luxação Congênita de Quadril/diagnóstico por imagem , Cirurgiões Ortopédicos/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Adulto , Cartilagem/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Ossos Pélvicos/diagnóstico por imagem , Reprodutibilidade dos Testes , Ultrassonografia/métodos
2.
Medicine (Baltimore) ; 99(7): e19138, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049835

RESUMO

The study assessed the pelvic dimensions by computed tomography (CT) performed for gluteal muscle contracture women, and evaluated the impact of malformations on several essential obstetric parameters.The CT pelvimetry was retrospectively performed in 25 gluteal muscle contracture women selected consecutively whether they had delivery history or not. Among the pelvic inlet plane, the mid plane and the outlet plane, 12 indicators including the transverse diameter of the pelvic inlet, the conjugate vera, the diagonal conjugate, the biischial diameter, the anteroposterior diameter of the middle pelvis, transverse outlet, the posterior sagittal diameter of outlet, the conjugate of the outlet, the anterior sagittal diameter of the outlet, the curvature and length of the sacrum, the angle of pubic arch were collected.Finally, the mean age of these women was 26.6 ±â€Š5.0 years. Most pelvises had anteroposterior elliptical appearance in inlet and size of the female pelvis. The most statistically different and most clinically significant indicator was the biischial diameter, gluteal muscle contracture women were 95.6 ±â€Š9.3 mm and the normal women from other study were 105.0 ±â€Š7.9 mm, the comparison showed a significant difference (P < .001).Generally, most gluteal muscle contracture women had features of anthropoid pelvis which were quite different from normal Chinese female. These results may serve as a basis for future studies to assess its utility and prognostic value for a safe vaginal delivery in gluteal muscle contracture women.


Assuntos
Nádegas/diagnóstico por imagem , Distocia/etiologia , Músculo Esquelético/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Adolescente , Adulto , Nádegas/patologia , Nádegas/fisiopatologia , Feminino , Fibrose , Humanos , Músculo Esquelético/fisiopatologia , Ossos Pélvicos/patologia , Gravidez , Síndrome , Adulto Jovem
3.
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
4.
Spine (Phila Pa 1976) ; 45(2): 79-87, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31899690

RESUMO

STUDY DESIGN: A cross-sectional radiographic study. OBJECTIVE: The aim of this study was to establish the age- and sex-related normative values of whole-body sagittal alignment in asymptomatic Chinese adult population, and to investigate the changes and possible associated compensation mechanisms across age groups. SUMMARY OF BACKGROUND DATA: Previous studies have reported normative data for sagittal spinal alignment in asymptomatic adults. However, there was a lack of comprehensive investigation on age- and sex-related normative values of whole-body sagittal alignment. METHODS: A total of 584 asymptomatic Chinese adults aged 20 to 89 years were recruited. Subjects were grouped according to age and sex. Whole-body standing radiographs were acquired for evaluating sagittal alignment from spine to lower limb. Comparisons of sagittal parameters between sex in different age groups were performed by independent t test. Pearson correlation analysis was used to determine relationships between each parameter. RESULTS: Mean values of each sagittal parameter were presented based on age and sex. Thoracic kyphosis showed steady increasing trend while lumbar lordosis gradual decrease in both sexes. Pelvic tilt (PT) in males is greater than in females across all age groups with age-related gradual increase. There were significant differences between males and females from 20 to 60 years in terms of KneeFlex angle (KA) and AnkleFlex angle, but the differences were not significant after 60s. T1 pelvic angle (TPA) was significantly correlated with spinal, pelvic and lower-limb alignment. The older group (≥50 years) had a stronger correlation of TPA with PT and KA, whereas the younger (<50 years) had stronger correlation with TK. CONCLUSION: This study presented a comprehensive study of whole-body sagittal alignment based on a large asymptomatic population, which could serve as an age- and sex-specific reference value for spine surgeons when planning for correction surgery. Age can influence the recruitment of compensation mechanism that involves more pelvic and lower limb mechanisms for elderly people. LEVEL OF EVIDENCE: 3.


Assuntos
Distinções e Prêmios , Coluna Vertebral/anatomia & histologia , Coluna Vertebral/diagnóstico por imagem , Imagem Corporal Total , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Estudos Transversais , Feminino , Humanos , Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Valores de Referência , Fatores Sexuais , Posição Ortostática , Adulto Jovem
5.
World Neurosurg ; 133: e156-e164, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476474

RESUMO

OBJECTIVE: To elucidate the correlation between changes in spinal/pelvic sagittal parameters and clinical treatment outcomes after oblique lumbar interbody fusion (OLIF). METHODS: Eighty-two patients with lumbar degenerative disease (LDD) treated by OLIF were retrospectively analyzed. The visual analog scale (VAS) score and Oswestry Disability Index (ODI) score were compared before and after surgery. Disk height (DH) and various spinal/pelvic sagittal parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA), were measured preoperatively and at the last postoperative follow-up. The correlation between the changes in sagittal parameters before and after surgery and the clinical treatment outcomes were observed. RESULTS: ODI score, VAS score, and DH were significantly better at the last follow-up compared with before surgery. The change in PI was not statistically significant before and after surgery. PT significantly decreased and SS and LL significantly increased after surgery. Significant linear relationships were found for several independent variables (difference in DH before and after surgery, postoperative LL, difference in LL before and after surgery, PI-LL match status, and SVA status) and the dependent variable ODI. The difference in DH before and after surgery showed the strongest correlation. The percentages of PI-LL match were 37% before surgery and 66% after surgery. The percentage of the normal SVA was 9% before surgery and 62% after surgery. CONCLUSIONS: OLIF for treatment of LDD had significant clinical outcomes, effectively restored the spinal/pelvic sagittal balance, and helped to improve the patients' clinical conditions.


Assuntos
Vértebras Lombares/cirurgia , Ossos Pélvicos/diagnóstico por imagem , Fusão Vertebral/métodos , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/patologia , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/patologia , Resultado do Tratamento
6.
Radiol Med ; 125(3): 280-287, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31823293

RESUMO

OBJECTIVE: To report our experience with the use of intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) and dynamic contrast-enhanced (DCE)-MRI in bone marrow before and after administration of granulocyte colony-stimulating factor (GCSF). Moreover, a small series of patients with bone metastases from breast cancer have been evaluated by IVIM DW-MRI and DCE-MRI before and after GCSF administration. MATERIALS AND METHODS: We studied with IVIM-MRI and DCE-MRI 14 patients with rectal or uterine cervix cancer studied before and 4-18 days after administration of GCSF; the second MR examination was obtained after three chemotherapy courses. IVIM perfusion fraction (f), pseudo-diffusion coefficient (D*), true diffusion coefficient (D) and apparent diffusion coefficient (ADC) as well area under the curve at 60 s (AUC60) were calculated for bone marrow before and after GCSF administration. Moreover, two different IVIM parametric maps (i.e., ADC and ADClow) were generated by selecting two different intervals of b values (0-1000 and 0-80, respectively). Furthermore, four patients affected by pelvic bone metastases from breast adenocarcinoma who received GCSF administration were also qualitatively evaluated for evidence of lesions on ADC maps, ADClow maps and DCE-MRI. RESULTS: ADC, D, D*, f and AUC60 values were significantly higher in hyperplastic bone marrow than in untreated bone marrow (p values < 0.0001, < 0.0001, < 0.001, < 0.001, < 0.0001, respectively). All bone metastases were clearly differentiable from hyperplastic bone marrow on ADClow maps, but not on ADC maps and DCE-MRI. CONCLUSION: MR functional imaging techniques, such as DW-, IVIM DW- and DCE-MRI are effective tools in assessing the response of bone marrow to the administration of growth factors. Although an overlap between signal of hyperplastic bone marrow and lytic bone metastases can occur on ADC maps and DCE-MRI, evaluation of ADClow maps by IVIM DW-MRI could permit to differentiate hyperplastic bone marrow from lytic bone metastases. Further studies are needed to confirm our data.


Assuntos
Medula Óssea/efeitos dos fármacos , Medula Óssea/diagnóstico por imagem , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Imagem de Difusão por Ressonância Magnética/métodos , Fator Estimulador de Colônias de Granulócitos/farmacologia , Adulto , Idoso , Área Sob a Curva , Medula Óssea/patologia , Neoplasias da Mama/patologia , Meios de Contraste , Feminino , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/patologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Fatores de Tempo , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/patologia
7.
Emerg Med Clin North Am ; 38(1): 125-142, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757246

RESUMO

Traumatic injuries of the hip and pelvis are commonly encountered in the emergency department. This article equips all emergency medicine practitioners with the knowledge to expertly diagnose, treat, and disposition these patients. Pelvic fractures occurring in young patients tend to be associated with high-energy mechanisms and polytrauma. Pelvic and hip fractures in the elderly are often a result of benign trauma but are associated with significant morbidity and mortality.


Assuntos
Gerenciamento Clínico , Emergências , Fraturas Ósseas/diagnóstico , Traumatismo Múltiplo , Procedimentos Ortopédicos/métodos , Ossos Pélvicos/lesões , Radiografia/métodos , Fraturas Ósseas/terapia , Humanos , Ossos Pélvicos/diagnóstico por imagem
8.
Rheumatology (Oxford) ; 59(1): 84-89, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31236597

RESUMO

OBJECTIVE: To assess associations of spinal-pelvic orientation with clinical and imaging-study findings suggesting axial SpA (axSpA) in patients with recent-onset inflammatory back pain. METHODS: Spinal-pelvic orientation was assessed in DESIR cohort patients with recent-onset inflammatory back pain and suspected axSpA, by using lateral lumbar-spine radiographs to categorize sacral horizontal angle (<40° vs ⩾40°), lumbosacral angle (<15° vs ⩾15°) and lumbar lordosis (LL, <50° vs ⩾50°). Associations between these angle groups and variables collected at baseline and 2 years later were assessed using the χ2 test (or Fisher's exact) and the Mann-Whitney test. With Bonferroni's correction, P < 0.001 indicated significant differences. RESULTS: Of 362 patients, 358, 356 and 357 had available sacral horizontal angle, lumbosacral angle and LL values, respectively; means were 39.3°, 14.6° and 53.0°, respectively. The prevalence of sacroiliitis on both radiographs and MRI was higher in the LL < 50° group than in the LL ⩾50° group, but the difference was not statistically significant. Clinical presentation and confidence in a diagnosis of axSpA did not differ across angle groups. No significant differences were identified for degenerative changes according to sacral horizontal angle, lumbosacral angle or LL. CONCLUSION: Spinal-pelvic balance was not statistically associated with the clinical or imaging-study findings suggesting axSpA in patients with recent-onset inflammatory back pain.


Assuntos
Imagem por Ressonância Magnética/estatística & dados numéricos , Pelvimetria/estatística & dados numéricos , Radiografia/estatística & dados numéricos , Sacroileíte/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Adulto , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/fisiopatologia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Masculino , Orientação Espacial , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Equilíbrio Postural , Estudos Prospectivos , Reprodutibilidade dos Testes , Sacroileíte/fisiopatologia
9.
Forensic Sci Int ; 304: 109963, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31610335

RESUMO

Clinical radiology is increasingly used as a source of data to test or develop forensic anthropological methods, especially in countries where contemporary skeletal collections are not available. Naturally, this requires analysis of the error that is a result of low accuracy of the modality (i.e. accuracy of the segmentation) and the error that arises due to difficulties in landmark recognition in virtual models. The cumulative effect of these errors ultimately determines whether virtual and dry bone measurements can be used interchangeably. To test the interchangeability of virtual and dry bone measurements, 13 male and 14 female intact cadavers from the body donation program of the Amsterdam UMC were CT scanned using a standard patient scanning protocol and processed to obtain the dry os coxae. These were again CT scanned using the same scanning protocol. All CT scans were segmented to create 3D virtual bone models of the os coxae ('dry' CT models and 'clinical' CT models). An Artec Spider 3D optical scanner was used to produce gold standard 'optical 3D models' of ten dry os coxae. The deviation of the surfaces of the 3D virtual bone models compared to the gold standard was used to calculate the accuracy of the CT models, both for the overall os coxae and for selected landmarks. Landmark recognition was studied by comparing the TEM and %TEM of nine traditional inter-landmark distances (ILDs). The percentage difference for the various ILDs between modalities was used to gauge the practical implications of both errors combined. Results showed that 'dry' CT models were 0.36-0.45mm larger than the 'optical 3D models' (deviations -0.27mm to 2.86mm). 'Clinical' CT models were 0.64-0.88mm larger than the 'optical 3D models' (deviations -4.99mm to 5.00mm). The accuracies of the ROIs were variable and larger for 'clinical' CT models than for 'dry' CT models. TEM and %TEM were generally in the acceptable ranges for all ILDs whilst no single modality was obviously more or less reliable than the others. For almost all ILDs, the average percentage difference between modalities was substantially larger than the average percentage difference between observers in 'dry bone' measurements only. Our results show that the combined error of segmentation- and landmark recognition error can be substantial, which may preclude the usage of 'clinical' CT scans as an alternative source for forensic anthropological reference data.


Assuntos
Imageamento Tridimensional , Ossos Pélvicos/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Cadáver , Simulação por Computador , Feminino , Antropologia Forense , Humanos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/anatomia & histologia
10.
J Pediatr Orthop ; 39(10): 521-526, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599863

RESUMO

BACKGROUND: Biplanar radiography with 3-dimensional (3D) modeling (EOS) provides a comprehensive assessment of lower limb alignment in an upright weight-bearing position with less radiation than conventional radiography. A study was performed to assess the consistency and reliability of 2 lower extremity 3D biplanar radiograph models created at least 1 year apart in a pediatric population. METHODS: All patients who had 2 lower extremity radiographic evaluations with EOS performed at visits a minimum of 1 year apart were reviewed. Digital radiographs, of lower extremities in both frontal and sagittal planes, were acquired simultaneously, using the EOS system. The 3D reconstruction of the images was achieved utilizing the SterEOS software. Pelvic position, femoral and tibial anatomy, and the torsional profile were evaluated and compared using t tests. RESULTS: In total, 53 patients with a mean age of 11.7 years (range, 6.1 to 18.9 y) met inclusion criteria. When comparing 3D models between visits, minimal differences were noted in proximal femoral anatomy and pelvic alignment (pelvic incidence, sacral slope, sagittal tilt, neck shaft angle). Expected differences in femoral and tibial length corresponded with normal longitudinal growth between visits. Sagittal plane knee position varied widely between examinations. Femoral and/or tibial rotational osteotomies were performed in 37% of extremities between examinations. After femoral derotational osteotomy, a significant difference in femoral anteversion was appreciated when comparing preoperative and postoperative 3D models. However, this difference was less than the expected difference based on the anatomic correction achieved intraoperatively. No differences were noted in tibial torsion measures after tibial derotational osteotomy. CONCLUSIONS: The 3D modeling based on biplanar radiographs provides consistent and reliable measures of pelvic and hip joint anatomy of the lower extremity. Patient positioning may influence the reproducibility of knee alignment. The torsional profile assessment did not accurately reflect changes obtained by derotational osteotomy. LEVEL OF EVIDENCE: Level III.


Assuntos
Articulação do Quadril/diagnóstico por imagem , Imageamento Tridimensional/métodos , Extremidade Inferior/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Adolescente , Criança , Simulação por Computador , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Masculino , Osteotomia , Radiografia , Reprodutibilidade dos Testes , Rotação , Software , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Fatores de Tempo
11.
J Radiol Case Rep ; 13(2): 26-33, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31565169

RESUMO

Fibrous Dysplasia is a benign fibro-osseous lesion occurring throughout the skeletal system with a predilection for craniofacial bones, long bones, and ribs. Fibrous dysplasia develops during bone formation and growth with a variable natural evolution. It is considered a genetic nonheritable disease resulting from missense mutations that occur postzygotically in the GNAS1 gene. This mutation leads to a focal congenital failure of proper bone formation and arrest at the woven bone stage. In turn, this leads to a decreased mechanical strength, causing bone pain, pathological fractures, and skeletal deformities. Besides clinical examination, fibrous dysplasia is diagnosed based on the results of radiographic imaging and the microscopic histopathological findings. On CT scan, fibrous dysplasia shows the characteristic "Ground-glass" appearance with well-defined borders. On MRI, fibrous dysplasia has a low signal intensity on T1-weighted MRI and variable signal intensity on T2-weighted MRI. We hereby report a case of an unusual presentation of fibrous dysplasia in a 67-year-old female presenting to the emergency department with generalized malaise and lower limb pain. Fibrous dysplasia may present in the elderly population and can be difficult to differentiate from other malignant and benign lesions affecting the skeletal system.


Assuntos
Displasia Fibrosa Óssea/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Displasia Fibrosa Óssea/genética , Displasia Fibrosa Óssea/patologia , Humanos , Imagem por Ressonância Magnética , Mutação de Sentido Incorreto , Ossos Pélvicos/diagnóstico por imagem , Radiografia , Tomografia Computadorizada por Raios X
12.
BMC Musculoskelet Disord ; 20(1): 454, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31630684

RESUMO

BACKGROUND: The paraspinal and psoas muscles have been considered to be essentially important for stabilizing the spinal column, and the muscle degeneration was found to exist in degenerative spinal kyphosis (DSK) patients. However, it is still not clear the relationship between muscle degeneration and spinal-pelvic alignment. The purpose of this study was to determine the correlations between the individual muscle degeneration at each lumbar spinal level and spinal-pelvic parameters in DSK patients. METHODS: The imaging data of 32 patients with DSK were retrospectively analyzed. The fat infiltration (FI) and relative cross-sectional area of muscle (RCSA) were quantitatively measured for multifidus (MF), erector spinae (ES) and psoas (PS) at each spinal level from L1/2 to L5/S1. The correlations were analyzed between RCSA and the sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). RESULTS: The FI of MF and ES at L3/4, L4/5 and L5/S1 were higher than that at L1/2 and L2/3. The FI of PS at L4/5 and L5/S1 were lower than that of L1/2, L2/3 and L3/4. The RCSA of ES and PS from L1/2 to L5/S1 gradually increased, whereas the RCSA of ES from L1/2 to S5/S1 gradually decreased. The RCSA of MF at the L1/2 level was negatively correlated SVA (r = - 0.397,p = 0.024); the RCSA at L3/4, L4/5 and L5/S1 levels were negatively correlated with TK (r = - 0.364, p = 0.04; r = - 0.38, p = 0.032; r = - 0.432, p = 0.014); the RCSA at L4/5 level was positively correlated with LL (r = 0.528, p = 0.002). The RCSA of ES at L3/4 and L4/5 levels were positively correlated with PI (r = 0.377, p = 0.037) and SS (r = 0.420, p = 0.019). CONCLUSIONS: FI of MF and ES at lower lumbar level is higher than that at upper level, but FI of PS at upper lumbar level is higher than that at lower level. MF and ES have different roles for maintaining the sagittal spinal-pelvic balance.


Assuntos
Cifose/complicações , Atrofia Muscular/fisiopatologia , Músculos Paraespinais/patologia , Postura/fisiologia , Músculos Psoas/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cifose/fisiopatologia , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/etiologia , Músculos Paraespinais/diagnóstico por imagem , Músculos Paraespinais/fisiopatologia , Ossos Pélvicos/anatomia & histologia , Ossos Pélvicos/diagnóstico por imagem , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/fisiopatologia , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 98(37): e17150, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517858

RESUMO

RATIONALE: Obturator dislocation of the femoral head combined with ipsilateral femoral neck and pubic fracture is a rare injury. We used cannulated screws combined with a femoral neck medial plate for the first time to treat this type of injury and achieved good follow-up results. PATIENT CONCERNS: The patient was hospitalized due to an accident resulting in swelling and deformity accompanied by limited mobility of the right hip and left knee. DIAGNOSES: X-ray examination and computed tomography confirmed that the patient suffered from right hip obturator dislocation, femoral head and neck fracture, pubic fracture, as well as open fracture of the left femoral shaft. INTERVENTIONS: Open reduction and internal fixation with cannulated screws and a medial support plate of the femoral neck were performed for the right hip obturator dislocation, femoral head and neck fracture, and the pubic fracture. Artificial bone grafting was performed to support the femoral head defect. Debridement and the second phase of internal fixation were executed to cure the open fracture of the left femoral shaft. OUTCOMES: The patient was followed-up for 6 months and showed good hip function. X-ray examination and computed tomography indicated that the fractures healed well without fracture displacement or loosening of the implants. Meanwhile, there were no signs of femoral neck valgus and femoral head necrosis observed. LESSONS: The combination of cannulated screws and medial support plate was suggested for the treatment of hip obturator dislocation and femoral head and neck fracture. Furthermore, partial weight loading exercise should be performed promptly to reduce the risk of muscular atrophy and myasthenia.


Assuntos
Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/cirurgia , Luxação do Quadril/complicações , Luxação do Quadril/cirurgia , Ossos Pélvicos/lesões , Ossos Pélvicos/cirurgia , Adulto , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/lesões , Cabeça do Fêmur/cirurgia , Fixação Interna de Fraturas , Luxação do Quadril/diagnóstico por imagem , Humanos , Ossos Pélvicos/diagnóstico por imagem
14.
J Forensic Leg Med ; 68: 101866, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31518882

RESUMO

The 3D imaging technologies have become of paramount importance for example in disciplines such as forensic anthropology and bioarchaeology, where they are being used more and more frequently. There are several new possibilities that they offer; for instance, the easier and faster sharing of data among institutions, the possibility of permanent documentation, or new opportunities of data analysis. An important requirement, however, is whether the data obtained from different scanning devices are comparable and whether the possible varying outputs could affect further analyses, such as the estimation of the biological profile. Therefore, we aimed to investigate two important questions: (1) whether 3D models acquired by two different scanning technologies (structured light and laser) are comparable and (2) whether the scanning equipment has an effect on the anthropological analyses, such as age-at-death estimation and sex assessment. 3D models of ossa coxa (n = 29) were acquired by laser (NextEngine) and structured light (HP 3D Structured Light Scanner PRO 2) scanners. The resulting 3D models from both scanners were subjected to age-at-death analyses (via the quantitative method of Stoyanova et al., 2017) and sex analyses (via Diagnose Sexuelle Probabiliste 2 of Bruzek et al., 2017). Furthermore, high quality scans of a small sample (n = 5) of pubic symphyseal surfaces with the RedLux Profiler device were acquired as reference surfaces to which the outputs from both scanners were compared. Small deviations between surfaces were more evident in more rugged surfaces (in areas of depression and protrusion). Even though small differences from the reference surfaces were found, they did not have a significant effect on the age and sex estimates. It never resulted in the opposite sex assignment, and no significant differences were observed between age estimates (with the exception of those with the TPS/BE model).


Assuntos
Determinação da Idade pelo Esqueleto , Simulação por Computador , Imageamento Tridimensional , Lasers , Ossos Pélvicos/diagnóstico por imagem , Determinação do Sexo pelo Esqueleto , Feminino , Antropologia Forense , Humanos , Masculino , Variações Dependentes do Observador , Análise de Regressão
15.
BMC Musculoskelet Disord ; 20(1): 366, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391039

RESUMO

BACKGROUND: During ambulatory follow-up of patients with cerebral palsy (CP) systematic radiographic screening is required firstly to evaluate hip migration and development in the prevention of hip dislocation and secondly to analyse lower limb alignment and leg length. The Migration Percentage (MP) is a radiographic measurement used to describe the extent of femoral head lateralisation on conventional supine pelvic radiographs. Our goal was to assess the comparability of the MP measured on low radiation dose EOS® standing full-leg radiographs with that of conventional supine pelvic radiographs. METHODS: Patients presenting with CP were prospectively selected from our outpatient follow-up consultation at our institutions CP reference centre and underwent conventional supine pelvic and EOS® standing full-leg radiographs the same day for diagnostic and screening reasons. RESULTS: Out of 28 prospectively selected patients we included 21 (42 hips), of which 10 were female, with a mean age of 9.25 years and GMFCS levels of I, II and III. Seven out of 28 patients were excluded due to insufficient quality of radiographic images. The absolute differences in MP measured on both conventional supine pelvic and EOS® standing full-leg radiographs ranged between - 8 and 6% with an absolute mean difference of 0% (SD ±3.5) and were not statistically significant (p = 0.99). A Bland-Altman plot showed acceptable agreement between both measurements without proportional bias. CONCLUSION: There is no statistical significant difference between the Migration Percentage measured on conventional supine pelvic radiographs and EOS® standing full-leg radiographs in ambulant patients. These images use lower radiation doses and contain more radiographic information. TRIAL REGISTRATION: Approved by the Medical Research Ethics committee of the University Hospitals Leuven ( MP001492 ).


Assuntos
Paralisia Cerebral/complicações , Luxação do Quadril/diagnóstico por imagem , Criança , Feminino , Seguimentos , Luxação do Quadril/etiologia , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Ossos Pélvicos/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Decúbito Dorsal
16.
Iowa Orthop J ; 39(1): 179-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413692

RESUMO

Background: Elderly patients who fall account for more than two million emergency department visits each year. In 4-10 % of these patients, initial plain radiographs do not identify a hip or pelvis fracture later diagnosed with advanced imaging. No consensus exists about what type of imaging, CT or MRI, should be obtained in elderly patients with hip or pelvic pain after a low energy trauma. The purpose of this study was to determine whether CT or MRI is more likely to result in a definitive fracture diagnosis in elderly patients with hip or pelvic pain after low energy trauma. Methods: A retrospective chart review was conducted of all patients who presented to the ED at a single level one trauma center over a 4.5 year period. Inclusion criteria were age greater than fifty years old, presentation with hip and/ or pelvis pain due to a low energy trauma, and radiographic imaging including both plain radiographs and at least one pelvis MRI or CT. Results: Of the 218 patients who met inclusion criteria and had negative initial plain radiographs, CT or MRI later diagnosed a fracture in 69 patients (32%). Seventy eight patients underwent MRI (24 fractures, 32%), 132 underwent CT imaging (41 fractures, 31%), and eight had both CT and MRI (5 fractures, 63%). Patients who underwent CT spent less time in the ED on average (430 minutes) than those who underwent MRI, or MRI and CT (502 minutes and 620 minutes respectively). Patients who underwent CT were just as likely to be diagnosed with a fracture as those who underwent MRI (p= 0.002). We encountered no cases where CT imaging did not identify a fracture that was later identified on MRI. Fifty six patients (26%) had at least one contraindication to MRI. Conclusions: Our study suggests CT may be adequate to rule out hip and pelvic fractures in this patient population. CT may be preferable to MRI based on decreased time spent in the ED and the large percentage of elderly patients with contraindications to MRI.Level of Evidence: III.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Fraturas do Quadril/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/lesões , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Avaliação Geriátrica , Fraturas do Quadril/cirurgia , Humanos , Masculino , Ossos Pélvicos/cirurgia , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Traumatologia
17.
J Orthop Surg Res ; 14(1): 270, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455329

RESUMO

BACKGROUND: Osteonecrosis of the femoral head was gradually concerned as a global disease for its progression to collapse of the femoral head, ultimately causing the arthritic change. Due to the high incidence of this disease in young people, arthroplasty tends to be suspected for its uncertain long-term efficiency. Vascularized pedicle iliac bone grafts, as a hip-preserving surgery, were regarded as an effective option in hip-preserving protocol since the 1970s. Nevertheless, there exist no unified standards widely agreed as the optimal operative program since the lack and heterogeneity of related studies. Thus, we execute this systematic review to synthesize and analyze existing studies, and further suggest a direction of future researches. METHODS: Data were collected by searching electronic database (PubMed, Embase, and Cochrane Library) and including the eligible studies of all types of clinical researches except case report. Through our extraction and synthesis of included study results in respect of clinical evaluation (rating scales), radiographic evaluation, joint survival rate, viability of implanted flap, and complications by transform varied assessment method into a unified standard, we qualitatively analyze and discuss the efficacy of VPIBG according to the quality of individual study and the heterogeneity across the included studies. RESULTS: Our systematic review includes 1 RCT, 2 case-control studies, and 13 case series studies, resulting in a significant improvement of postoperative scores. Minority of hips progressed for joint replacement. Some researches suggested a high collapse rate in the collapsed femoral head before the operation. Compared with some other hip-preserving surgeries, the complications of VPIBG are relatively slight and barely affect clinical efficiency. CONCLUSIONS: A better clinic response was obtained after this treatment, especially in femoral heads before the appearance of a crescent sign. The fixation of the implanted iliac bone flap increases the clinical effect. The majority of complications were slight and rarely affected clinical efficacy.


Assuntos
Transplante Ósseo/métodos , Necrose da Cabeça do Fêmur/cirurgia , Ílio/transplante , Ossos Pélvicos/cirurgia , Retalhos Cirúrgicos/transplante , Estudos de Casos e Controles , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Humanos , Ílio/irrigação sanguínea , Ossos Pélvicos/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Retalhos Cirúrgicos/irrigação sanguínea
18.
J Orthop Surg Res ; 14(1): 276, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455401

RESUMO

BACKGROUND: There were several reports describing the biomechanics and microstructure of multifidus muscles in patients with lumbar disc herniation. However, correlations between lumbar multifidus muscle atrophy (LMA), spinopelvic parameters, and severity of adult degenerative scoliosis (ADS) have not been investigated. The study evaluated the impact of LMA and spinopelvic parameters on the severity of ADS. METHODS: One hundred and thirty-two patients with ADS were retrospectively reviewed. Standing whole-spine X-ray was used to evaluate the coronal (coronal Cobb angle, CA; coronal vertical axis, CVA) and sagittal (sagittal vertical axis, SVA; thoracic kyphosis, TK; lumbar lordosis, LL; pelvic incidence, PI; pelvic tilt, PT; sacral slope, SS) parameters. LMA was evaluated on axial T2-weighted magnetic resonance imaging (MRI) at intervertebral levels above and below the vertebra at the apex of the scoliotic curve. Clinical symptoms were evaluated by the Oswestry Disability Index (ODI) and the Japanese Orthopaedic Association (JOA) score. Multiple linear regression was used to assess correlations between LMA, spinopelvic parameters, and severity of scoliosis. RESULTS: LL and PT were negatively correlated with CA (P < 0.001); LL was positively correlated with SVA (P < 0.001). PI was positively correlated with CA (P < 0.001) and CVA (P < 0.001). PT (P < 0.001) and SS (P < 0.001) were negatively correlated with CVA. SS was negatively correlated with SVA (P < 0.001). Concave LMA at the upper or lower intervertebral level of the apical vertebra was positively correlated with CA (P ≤ 0.001); convex LMA at the upper or lower intervertebral level was negatively correlated with CA (P < 0.001). Convex LMA at the upper intervertebral level and concave LMA at the lower intervertebral level of the apical vertebra were negatively correlated with the SVA (P ≤ 0.001). At the upper intervertebral level, LMA on the concave side was positively correlated with CVA (P = 0.028); LMA on the convex side was negatively correlated with CVA (P = 0.012). PI was positively correlated with ODI (P < 0.001); PT (P < 0.001) and SS (P < 0.001) were negatively correlated with ODI. At the lower intervertebral level, LMA on the concave side was positively correlated with ODI (P = 0.038); LMA on the convex side was negatively correlated with ODI (P = 0.011). PI was positively correlated with JOA (P < 0.001); PT (P < 0.001) and SS (P < 0.001) were negatively correlated with JOA. CONCLUSIONS: Spinopelvic parameters are correlated with the severity of ADS. Asymmetric LMA at both upper and lower intervertebral levels of the apical vertebra is positively correlated with CA. LMA on the diagonal through the apical vertebra is very important to maintain sagittal imbalance via parallelogram effect. LMA at lower intervertebral levels of the apical vertebra may have a predictive effect on ODI. JOA score seems to be more correlated with spinopelvic parameters than LMA.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Atrofia Muscular/diagnóstico por imagem , Músculos Paraespinais/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Escoliose/diagnóstico por imagem , Índice de Gravidade de Doença , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/epidemiologia , Estudos Retrospectivos , Escoliose/epidemiologia
19.
BMC Musculoskelet Disord ; 20(1): 332, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315587

RESUMO

BACKGROUND: Head breakage is a serious complication following total hip arthroplasty when using Ceramic on Ceramic bearings surfaces. There is still in controversy about the selection of bearing surfaces when conducting revision surgery. CASE PRESENTATION: We describe the case of a fifty-year-old man who had undergone right total hip arthroplasty (THA) with ceramic-on-ceramic prostheses in 2011. After a fall 6 years after the primary procedures, radiographs suggested a ceramic head breakage for revision THA with exchange of metal-on-polyethylene bearing. However, 8 months later, severe metallosis and multiple pseudotumor was confirmed in pelvis and surrounding hip after re-revision THA with ceramic-on-polyethylene prostheses. Analysis of the serum metal ion indicated massive wear of the metal head and erosion of the stem neck and taper. CONCLUSIONS: This case vividly demonstrates metal bearings should be avoided and revision with complete synovectomy and thorough debridement should be performed whenever possible for a fractured ceramic bearing.


Assuntos
Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Falha de Prótese/efeitos adversos , Reoperação/efeitos adversos , Artroplastia de Quadril/instrumentação , Cerâmica/efeitos adversos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Articulação do Quadril/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Metais/efeitos adversos , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/patologia , Cintilografia , Reoperação/instrumentação , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
World Neurosurg ; 130: e1077-e1083, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323412

RESUMO

BACKGROUND: Lateral interbody fusion (LIF) is an effective adjuvant for circumferential minimally invasive surgery (CMIS) treatment of adult spinal deformity (ASD). Accessing L5-S1 via an oblique LIF (OLIF) approach (OLIF 5-1) allows for anterior LIF (ALIF) at the lumbosacral junction without repositioning the patient. We review the early outcomes and complications of OLIF 5-1 at the bottom of a long construct for an MIS approach to treat ASD. METHODS: We queried a prospectively collected registry of 111 consecutive patients with ASD (Cobb angle >20°, sagittal vertical alignment [SVA] >50, or pelvic incidence [PI]-lumbar lordosis [LL] mismatch>10) patients who underwent CMIS correction between January 2015 and January 2019. Sixty patients had ≥4 levels fused and OLIF 5-1. Multilevel pre-psoas LIF + OLIF 5-1 were performed in the first stage. Three days later, stage 2 involved MIS installation of pedicle screws with aggressive rod contouring and derotation/translation. RESULTS: The mean patient age was 66.8 years (range, 48-79 years), and the mean duration of follow-up was 24 months (range, 3-60 months). A mean of 7 levels were fused (range, 4-9). Significant improvements in L5-S1 segmental lordosis (SL), LL, SVA, PI-LL mismatch, and pelvic tilt were seen following the first stage (P < 0.05). There was no intraoperative vascular, ureteral, or sympathetic chain injury, and no transient or permanent lumbar plexopathy. In 2 patients, OLIF 5-1 was abandoned due to difficult access, and transforaminal LIF was done at L5-S1 at the second stage. Five patients required intraoperative transfusion. No patient experienced postoperative ileus or L5-S1 pseudarthrosis. Significant improvements in visual analog scale pain score, Oswestry Disability Index, 36-Item Short Form Health Survey, and Scoliosis Research Society Outcomes Questionnaire were found. CONCLUSIONS: A single-position MIS OLIF 5-1 at the bottom of a long construct in conjunction with multilevel pre-psoas LIF seems to be a safe and effective technique for improving SL, global LL, and SVA with a low risk of perioperative and postoperative complications.


Assuntos
Lordose/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ossos Pélvicos/cirurgia , Sacro/cirurgia , Fusão Vertebral/métodos , Idoso , Estudos de Coortes , Feminino , Humanos , Lordose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Ossos Pélvicos/diagnóstico por imagem , Estudos Prospectivos , Sacro/diagnóstico por imagem , Fusão Vertebral/instrumentação
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