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1.
Sci Rep ; 14(1): 12839, 2024 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-38834604

RESUMO

Corrective osteotomy allows to improve joint loading, pain and function. In complex deformities, the biggest challenge is to define the optimal surgical solution, while considering anatomical, technical and biomechanical factors. While the single-cut osteotomy (SCOT) and focal dome osteotomy (FDO) are well-established treatment options, their mathematical relationship remain largely unclear. The aim of the study was (1) to describe the close mathematical relationship between the SCOT and FDO and (2) to analyze and introduce a novel technique-the stepped FDO-as a modification of the classic FDO. The mathematical background and relationship of SCOT and FDO are described for the example of a femoral deformity correction and visualized using a 3D surface model taking into account the benefits for the clinical application. The novel modifications of the stepped FDO are introduced and its technical and clinical feasibility demonstrated. Both, SCOT and FDO, rely on the same deformity axis that defines the rotation axis k for a 3D deformity correction. To achieve the desired correction using a SCOT, the resulting cutting plane is perpendicular to k, while using a FDO will result in a cylindrical cut with a central axis parallel to k. The SCOT and FDO demonstrate a strong mathematical relation, as both methods rely on the same deformity axis, however, resulting in different cutting planes. These characteristics enable a complementary use when defining the optimal type of osteotomy. This understanding enables a more versatile planning approach when considering factors as the surgical approach, biomechanical characteristics of fixation or soft tissue conditions. The newly introduced stepped FDO facilitates an exact reduction of the bone fragments and potentially expands the clinical applicability of the FDO.


Assuntos
Fêmur , Osteotomia , Osteotomia/métodos , Humanos , Fêmur/cirurgia , Fêmur/anormalidades , Fenômenos Biomecânicos , Feminino , Masculino , Imageamento Tridimensional/métodos
2.
J Orthop Surg Res ; 19(1): 333, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38835085

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) represents a widespread degenerative condition among adults that significantly affects quality of life. This study aims to elucidate the biomechanical implications of proximal fibular osteotomy (PFO), a proposed cost-effective and straightforward intervention for KOA, comparing its effects against traditional high tibial osteotomy (HTO) through in-silico analysis. METHODS: Using medical imaging and finite element analysis (FEA), this research quantitatively evaluates the biomechanical outcomes of a simulated PFO procedure in patients with severe medial compartment genu-varum, who have undergone surgical correction with HTO. The study focused on evaluating changes in knee joint contact pressures, stress distribution, and anatomical positioning of the center of pressure (CoP). Three models are generated for each of the five patients investigated in this study, a preoperative original condition model, an in-silico PFO based on the same original condition data, and a reversed-engineered HTO in-silico model. RESULTS: The novel contribution of this investigation is the quantitative analysis of the impact of PFO on the biomechanics of the knee joint. The results provide mechanical evidence that PFO can effectively redistribute and homogenize joint stresses, while also repositioning the CoP towards the center of the knee, similar to what is observed post HTO. The findings propose PFO as a potentially viable and simpler alternative to conventional surgical methods for managing severe KOA, specifically in patients with medial compartment genu-varum. CONCLUSION: This research also marks the first application of FEA that may support one of the underlying biomechanical theories of PFO, providing a foundation for future clinical and in-silico studies.


Assuntos
Simulação por Computador , Fíbula , Articulação do Joelho , Osteoartrite do Joelho , Osteotomia , Pressão , Humanos , Osteotomia/métodos , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/fisiopatologia , Fíbula/cirurgia , Articulação do Joelho/cirurgia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/diagnóstico por imagem , Tíbia/cirurgia , Tíbia/diagnóstico por imagem , Análise de Elementos Finitos , Fenômenos Biomecânicos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto
3.
BMC Musculoskelet Disord ; 25(1): 441, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840163

RESUMO

BACKGROUND: An ideal synthetic spacer for medial opening wedge high tibial osteotomy (MOWHTO) has not yet been developed. The authors have developed a new ß-tricalcium phosphate (ß-TCP) spacer with 60% porosity (N-CP60) by modifying the micro- and macro-pore structures of a conventional ß-TCP spacer (CP60) that is widely used in clinical practice. The purpose of this study was to compare the absorbability, osteoconductivity, and in vivo strength of the N-CP60 spacer with those of the CP60 spacer, when used in MOWHTO. METHODS: First, the porosity, diameter distribution of macro- and micropores, and compressive strength of each ß-TCP block were examined using methodology of biomaterial science. Secondly, a clinical study was performed using a total of 106 patients (106 knees) with MOWHTO, who were followed up for 18 months after surgery. In these knees, the N-CP60 and CP-60 spacers were implanted into 49 tibias and 57 tibias, respectively. The absorbability and osteoconductivity were radiologically evaluated by measuring the area of the implanted spacer remaining unabsorbed and assessing with the Hemert's score, respectively. The incidence of cracking in the implanted spacers was determined using computed radiography. Statistical comparisons were made with non-parametric tests. The significance level was set at p = 0.05. RESULTS: The N-CP60 and CP60 blocks had almost the same porosity (mean, 61.0% and 58.7%, respectively). The diameter of macropores was significantly larger (p < 0.0001) in the N-CP60 block than in the CP60 block, while the diameter of micropores was significantly smaller (p = 0.019) in the N-CP60 block. The ultimate strength of the N-CP60 block (median, 36.8 MPa) was significantly greater (p < 0.01) than that of the CP60 block (31.6 MPa). As for the clinical evaluations, the absorption rate of the N-CP60 spacer at 18 months after implantation (mean, 48.0%) was significantly greater (p < 0.001) than that of the CP60 spacer (29.0%). The osteoconductivity of the N-CP60 spacer was slightly but significantly higher (p = 0.0408) than that of the CP60 spacer only in zone 1. The incidence of in vivo cracking of the posteriorly located N-CP60 spacer at one month (mean, 75.5%) was significantly lower (p = 0.0035) than that of the CP60 spacer (91.2%). CONCLUSIONS: The absorbability, osteoconductivity, and compressive strength of the new N-CP60 spacer were significantly improved by modifying the macro- and micro-pore structures, compared with the conventional CP60 spacer. The N-CP60 spacer is more clinically useful than the CP60 spacer. TRIAL REGISTRATION NUMBER: H29-0002.


Assuntos
Fosfatos de Cálcio , Osteotomia , Tíbia , Fosfatos de Cálcio/uso terapêutico , Humanos , Feminino , Tíbia/cirurgia , Tíbia/diagnóstico por imagem , Osteotomia/métodos , Osteotomia/instrumentação , Pessoa de Meia-Idade , Masculino , Idoso , Porosidade , Adulto , Regeneração Óssea , Resultado do Tratamento , Implantes Absorvíveis , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Seguimentos
4.
BMC Musculoskelet Disord ; 25(1): 427, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824507

RESUMO

BACKGROUND: There has long been discussion regarding the impact of medial malleolar osteotomies (MMO) as an adjunctive treatment for osteochondral lesions of the talus (OCLT). MMO may improve the visibility and accessibility of the talus, but they also pose a risk of periprocedural morbidity. There is a lack of research about the prevalence and consequences of MMO in the surgical treatment of OCLT. METHODS: This study retrospectively evaluated data from the German Cartilage Register (KnorpelRegister DGOU) from its implementation in 2015 to December 2020. The impact of MMO on patient-reported outcome measures (PROMs) was investigated. Wherever possible, subgroups were built and matched using a propensity score which matched a group undergoing OCLT without MMO. Matching included age, sex, weight, localization of the OCLT, the international cartilage repair society (ICRS) grading, surgical procedure and preoperative symptoms using the Foot and Ankle Ability Measure (FAAM) and the Activities of Daily Living Subscale (ADL). RESULTS: The prevalence of MMO in the operative treatment of OCLT was 15.9%. Most of the osteotomies were performed in OCL of the medial talar dome (76.8%) and in more serious lesions with an ICRS grade of III (29.1%) and IV (61.4%). More than half of the osteotomies (55.6%) were performed during revision surgery. A matched pair analysis of n = 44 patients who underwent AMIC® via arthrotomy and MMO vs. arthrotomy alone showed no significant differences in patient-reported outcome measures (PROMs, i.e. FAAM-ADL, and FAOS) at 6,12 and 24 months. CONCLUSIONS: MMO are mostly used in the treatment of severe (≥ ICRS grade 3) OCL of the medial talar dome and in revision surgery. Functional and patient-reported outcome measures are not significantly affected by MMO compared to arthrotomy alone. TRIAL REGISTRATION: The German Cartilage Register (KnorpelRegister DGOU) was initially registered at the German Clinical Trials Register ( https://www.drks.de , register number DRKS00005617, Date of registration 03.01.2014) and was later expanded by the ankle module.


Assuntos
Osteotomia , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Tálus , Humanos , Feminino , Masculino , Osteotomia/métodos , Osteotomia/efeitos adversos , Tálus/cirurgia , Estudos Retrospectivos , Adulto , Alemanha/epidemiologia , Pessoa de Meia-Idade , Resultado do Tratamento , Cartilagem Articular/cirurgia , Adulto Jovem , Incidência , Articulação do Tornozelo/cirurgia , Atividades Cotidianas , Adolescente , Recuperação de Função Fisiológica
5.
Clin Orthop Surg ; 16(3): 461-469, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38827764

RESUMO

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common surgery for severe hallux valgus. However, joint-preserving surgery can maintain the mobility of the joint. This study aimed to investigate the clinical and radiographic outcomes of distal chevron metatarsal osteotomy (DCMO) for correcting hallux valgus deformity associated with RA. Methods: Between August 2000 and December 2018, 18 consecutive patients with rheumatoid forefoot deformities (24 feet) underwent DCMO for hallux valgus with/without lesser toe surgery. Radiological evaluations were conducted, assessing the hallux valgus angle, the intermetatarsal angle between the first and second metatarsals, and the Sharp/van der Heijde score for erosion and joint space narrowing. Clinical outcomes were quantified using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society forefoot scores to measure function and alignment. Results: The mean hallux valgus angle decreased from 38.0° (range, 25°-65°) preoperatively to 3.5° (range, 0°-17°) at the final follow-up (p < 0.05). The mean intermetatarsal angle decreased from 14.9° (range, 5°-22°) preoperatively to 4.3° (range, 2°-11°) at the final follow-up. (p < 0.05). Regarding the Sharp/van der Heijde score, the mean erosion score (0-10) showed no significant change, decreasing from 3.83 (range, 0-6) preoperatively to 3.54 (range, 0-4) at the final follow-up (p = 0.12). Recurrent hallux valgus was observed in 1 patient and postoperative hallux varus deformity was observed in 2 feet. Spontaneous fusion of the metatarsophalangeal joint developed in 1 case. Conclusions: DCMO resulted in satisfactory clinical and radiographic outcomes for correcting RA-associated hallux valgus deformity.


Assuntos
Artrite Reumatoide , Hallux Valgus , Osteotomia , Humanos , Hallux Valgus/cirurgia , Hallux Valgus/diagnóstico por imagem , Artrite Reumatoide/cirurgia , Artrite Reumatoide/complicações , Feminino , Pessoa de Meia-Idade , Osteotomia/métodos , Masculino , Idoso , Adulto , Estudos Retrospectivos
8.
J Craniofac Surg ; 35(4): 1231-1235, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38829147

RESUMO

OBJECTIVE: A deviated nose is traditionally classified as bony, cartilaginous, or combined deviation. Osteotomy is commonly used to correct bony deviation, and accurate surgical techniques and postoperative patient management are important for favorable outcomes. The authors investigated the change in the external nasal deviation angle over time using sequential clinical photographs to identify the optimal postoperative follow-up duration. METHODS: Medical records and sequential standardized clinical photographs of 22 patients who underwent bilateral medial and lateral osteotomies without dorsal augmentation from January 1, 2014 to May 31, 2021, were retrospectively reviewed. Clinical photographs were classified into 4 periods: "a" preoperative, "b" postoperative day (POD) ≤3 weeks, "c" POD ≤9 weeks, and "d" POD >9 weeks. The angle of deviation (AoD) was measured in both frontal and chin-on-chest views for each period. Differences in AoD between temporally adjacent periods were analyzed. RESULTS: Nineteen men and 3 women (mean age: 28.8 y) were included. Thirteen patients showed rightward deviation, whereas 9 showed leftward deviation. Eleven patients underwent surgery through an endonasal approach, whereas the other 11 underwent surgery through an external approach. In the frontal view, AoD differences (mean ± SD) between periods "a" and "b," "b" and "c," and "c" and "d" were 5.79 ± 3.36 degrees (P < 0.001), 1.44 ± 1.14 degrees (P < 0.001), and 1.07 ± 1.24 degrees (P < 0.05), respectively. In the chin-on-chest view, the values were 5.17 ± 2.69 degrees (P < 0.001), 2.06 ± 2.63 degrees (P < 0.001), and 1.46 ± 1.31 degrees (P < 0.001), respectively. No statistically significant difference in AoD differences was observed between the two approaches. CONCLUSIONS: Angle of deviation can change even 9 weeks after bilateral osteotomy. Thus, long-term follow-up using sequential clinical photographs is mandatory. If needed, close follow-up with early postoperative interventions may be required. The chin-on-chest view showed better sensitivity for assessing AoD than the frontal view.


Assuntos
Osteotomia , Fotografação , Rinoplastia , Humanos , Masculino , Feminino , Adulto , Osteotomia/métodos , Estudos Retrospectivos , Rinoplastia/métodos , Deformidades Adquiridas Nasais/cirurgia , Nariz/anormalidades , Nariz/cirurgia , Resultado do Tratamento , Adolescente
9.
BMC Musculoskelet Disord ; 25(1): 454, 2024 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-38851696

RESUMO

BACKGROUND: Ulnar impingement syndrome is a prevalent source of ulnar carpal pain; however, there is ongoing debate regarding the specific location of shortening, the method of osteotomy, the extent of shortening, and the resulting biomechanical alterations. METHOD: To investigate the biomechanical changes in the distal radioulnar joint (DRUJ) resulting from different osteotomy methods, a cadaveric specimen was dissected, and the presence of a stable DRUJ structure was confirmed. Subsequently, three-dimensional data of the specimen were obtained using a CT scan, and finite element analysis was conducted after additional processing. RESULTS: The DRUJ stress did not change significantly at the metaphyseal osteotomy of 2-3 mm but increased significantly when the osteotomy length reached 5 mm. When the osteotomy was performed at the diaphysis, the DRUJ stress increased with the osteotomy length, and the increase was greater than that of metaphyseal osteotomy. Stress on the DRUJ significantly increases when the position is changed to pronation dorsi-extension. Similarly, the increase in stress in diaphyseal osteotomy was greater than that in metaphyseal osteotomy. When the model was subjected to a longitudinal load of 100 N, neither osteotomy showed a significant change in DRUJ stress at the neutral position. However, the 100 N load significantly increased stress on the DRUJ when the position was changed to pronation dorsi-extension, and the diaphyseal osteotomy significantly increased stress on the DRUJ. CONCLUSIONS: For patients with distal oblique bundle, metaphyseal osteotomy result in a lower increase in intra-articular pressure in the DRUJ compared to diaphyseal osteotomy. However, it is crucial to note that regardless of the specific type of osteotomy employed, it is advisable to avoid a shortening length exceeding 5 mm.


Assuntos
Cadáver , Análise de Elementos Finitos , Osteotomia , Ulna , Articulação do Punho , Humanos , Osteotomia/métodos , Osteotomia/efeitos adversos , Articulação do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Ulna/cirurgia , Ulna/diagnóstico por imagem , Fenômenos Biomecânicos/fisiologia , Estresse Mecânico , Suporte de Carga/fisiologia , Masculino
10.
Res Vet Sci ; 175: 105322, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38851052

RESUMO

During tibial plateau leveling osteotomy (TPLO), the laceration of the cranial tibial artery (LCTA) may occur, and the ligation of the cranial tibial artery might lead to impaired blood supply to the osteotomy site. The present case-control study aimed to evaluate the effect of LCTA on TPLO healing and the occurrence of perioperative complications. The incidence and predisposing factors to LCTA were also investigated. Fourteen cases experiencing LCTA were retrospectively enrolled from medical records of two veterinary teaching hospitals (LCTA group), whereas 28 randomly selected TPLOs that did not experience LCTA were included in the control group. Signalment data, proximal tibial epiphysis conformation, osteotomy features, perioperative complications, and bone healing were compared between the two groups. Bone healing was evaluated using the modified radiographic union scale for tibial fracture and the visual analog scale. The mean incidence was 9.6%. Bodyweight was significantly higher in the LCTA group compared to the control group (P = 0.009). Dogs belonging to the LCTA groups were significantly younger (P = 0.01). Intraoperative hypotension was significantly overreported in the LCTA group (P = 0.0001). None of the other variables differed significantly between the two groups. Dogs' size seems to be a predisposing factor, with dogs weighing >15 kg having 22 times more chance of experiencing LCTA. Due to the well-developed collateral blood supply of the canine hindlimb, LCTA and the closure of the cranial tibial artery did not appear to delay the radiographic bone healing or affect the incidence of perioperative complications.


Assuntos
Osteotomia , Tíbia , Artérias da Tíbia , Animais , Cães , Osteotomia/veterinária , Feminino , Masculino , Estudos de Casos e Controles , Estudos Retrospectivos , Tíbia/cirurgia , Tíbia/irrigação sanguínea , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/lesões , Artérias da Tíbia/cirurgia , Complicações Pós-Operatórias/veterinária , Complicações Pós-Operatórias/etiologia , Doenças do Cão/cirurgia , Doenças do Cão/diagnóstico por imagem , Consolidação da Fratura , Lacerações/veterinária , Lacerações/cirurgia
11.
Math Biosci Eng ; 21(4): 5394-5410, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38872540

RESUMO

Knee medial compartment osteoarthritis is effectively treated by a medial open-wedge high tibial osteotomy (MOWHTO). The feasibility and safety of MOWHTO for mild lateral meniscal tears are unknown. This study examined the feasibility and safety of knee joint weight-bearing line ratio (WBLr) adjustment during MOWHTO with lateral meniscal injuries. We used a healthy adult male's lower extremities computed tomography scans and knee joint magnetic resonance imaging images to create a normal fine element (FE) model. Based on this model, we generated nine FE models for the MOWHTO operation (WBLr: 40-80%) and 15 models for various lateral meniscal injuries. A compressive load of 650N was applied to all cases to calculate the von Mises stress (VMS), and the intact lateral meniscus' maximal VMS at 77.5% WBLr was accepted as the corrective upper limit stress. Our experimental results show that mild lateral meniscal tears can withstand MOWHTO, while severe tears cannot. Our findings expand the use of MOWHTO and provide a theoretical direction for practical decisions in patients with lateral meniscal injuries.


Assuntos
Análise de Elementos Finitos , Articulação do Joelho , Imageamento por Ressonância Magnética , Osteoartrite do Joelho , Osteotomia , Estresse Mecânico , Tíbia , Lesões do Menisco Tibial , Tomografia Computadorizada por Raios X , Suporte de Carga , Humanos , Masculino , Osteotomia/métodos , Tíbia/cirurgia , Tíbia/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Lesões do Menisco Tibial/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Adulto , Articulação do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Fenômenos Biomecânicos , Meniscos Tibiais/cirurgia , Meniscos Tibiais/diagnóstico por imagem
12.
Artigo em Inglês | MEDLINE | ID: mdl-38834537

RESUMO

Neglected untreated developmental hip dysplasia can result in severe deformities and functional disabilities. This report describes the treatment and 11-year follow-up of a patient who underwent the procedure in two stages. At the time of treatment, the patient was 7 years of age and was diagnosed with acetabular dysplasia and neglected right hip dysplasia. A stepwise treatment approach, including gradual distraction of the iliofemoral joint, open reduction, and pelvic osteotomy, was performed. Subsequent postoperative rehabilitation and regular follow-up assessments were performed over 11 years. The long-term results indicated notable improvements in hip joint congruency, functional range of motion, and overall quality of life. Early diagnosis and appropriate intervention are crucial for patients with developmental hip dysplasia, and the treatment methods described here are effective.


Assuntos
Displasia do Desenvolvimento do Quadril , Osteotomia , Criança , Feminino , Humanos , Displasia do Desenvolvimento do Quadril/cirurgia , Fêmur/cirurgia , Seguimentos , Luxação Congênita de Quadril/cirurgia , Osteogênese por Distração/métodos , Osteotomia/métodos , Ossos Pélvicos/cirurgia
13.
Rehabilitación (Madr., Ed. impr.) ; 58(2): 1-9, abril-junio 2024.
Artigo em Espanhol | IBECS | ID: ibc-232115

RESUMO

La utilización de la terapia de ultrasonidos pulsados de baja intensidad para la cicatrización ósea y el tratamiento de fracturas es considerada cada vez más como una alternativa terapéutica de coste económico moderado y con efectos adversos nulos o mínimos (p. ej. leve reacción al gel conductor).Con todo, existe cierta controversia con relación a su evidencia científica. La presente revisión busca arrojar algo de luz sobre esta controversia y cubrir un espacio de estudio no ocupado por trabajos previos ni actuales sobre la terapia mediante ultrasonidos. Es necesario conocer el impacto real del tratamiento con ultrasonidos pulsados de baja intensidad en pacientes sometidos a osteotomía, así como su aplicabilidad como protocolo poscirugía para mejorar los procesos de recuperación, rehabilitación y, con ello, disminuir los tiempos de incapacidad. (AU)


The use of low intensity pulsed ultrasound (LIPUS) therapy for bone healing and fracture treatment is increasingly considered as a therapeutic alternative with moderate economic cost and none or minimal adverse effects (e.g., low reaction to the conductive gel).However, there is some controversy regarding its scientific evidence. The present review seeks to shed some light on this controversy and to cover an area of study not occupied by previous or current work on ultrasound therapy. It is necessary to know the real impact of the treatment with low intensity pulsed ultrasound in patients with osteotomy, as well as its applicability as a post-surgery protocol to improve the recovery and rehabilitation processes and, at the end of the day, to reduce the time of disability. (AU)


Assuntos
Humanos , Terapia por Ultrassom , Osteotomia , Fraturas Ósseas , Terapêutica
15.
J Craniofac Surg ; 35(4): 1225-1230, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38738894

RESUMO

Traditional horizontal osteotomies for small and short chins often yield suboptimal results due to limited bone advancement, resulting in deep labiomental folds and heightened bone resorption risks. This study investigates the effectiveness of an innovative inverted V-shaped osteotomy technique in enhancing esthetic outcomes for patients with such chin concerns. Thirty-eight patients who underwent inverted V-shaped osteotomy for recessed chins between January 2018 and June 2022 were included. Excluding cases involving simultaneous mandibular contouring surgery, patients were followed up for a median duration of 1.2±0.5 years. Preoperation and postoperation soft tissue pogonion (Pg') and labiomental fold depth (LMF) changes were measured. IBM SPSS (version 27.0) was used for statistical analysis, with significance defined as P <0.05. Patient satisfaction was assessed using a visual analog scale. Successful advancement genioplasty was performed on all patients without any severe complications. The average change in soft tissue pogonion (Pg') measured 6.2 (1.9) mm, and the mean alteration in labiomental depth was 0.42 (0.4) mm. The procedure achieved a bone to soft tissue movement ratio of 1:0.96. Patient satisfaction was notably high, with a mean VAS score of 8.7. An inverted V-shaped osteotomy enables greater bone advancement for small and short chins, leading to improved esthetic outcomes and offering a mechanically advantageous condition for bone segments.


Assuntos
Estética , Mentoplastia , Osteotomia , Satisfação do Paciente , Humanos , Feminino , Masculino , Mentoplastia/métodos , Adulto , Queixo/cirurgia , Osteotomia/métodos , Resultado do Tratamento
16.
J Craniofac Surg ; 35(4): 1280-1283, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38738867

RESUMO

Craniofacial fibrous dysplasia (CFD) is a rare developmental disease of bone, which typically presents as a painless, expansile mass causing deformity of the craniofacial skeleton. In rare circumstances, compression of neurovascular structures may arise, causing symptoms such as pain, visual impairment, and hearing loss. Traditionally, CFD debulking has been performed with "freehand" techniques using preoperative imaging and anthropometric norms to determine the ideal amount of tissue removal. The advent of computer-assisted surgery, computer-aided design, and computer-aided manufacturing (CAD/CAM) has revolutionized the management of CFD. Surgeons can now fabricate patient-specific osteotomy/ostectomy guides, allowing for increased accuracy in bone removal and improved cosmetic outcomes. This series of 3 cases describe our institution's technique using patient-specific ostectomy "depth guides", which allow for maximum removal of fibro-osseous tissue while sparing deep and adjacent critical structures. These techniques can be widely applied to the craniofacial skeleton to assist in the surgical management of CFD.


Assuntos
Displasia Fibrosa Craniofacial , Osteotomia , Cirurgia Assistida por Computador , Humanos , Cirurgia Assistida por Computador/métodos , Feminino , Osteotomia/métodos , Displasia Fibrosa Craniofacial/cirurgia , Displasia Fibrosa Craniofacial/diagnóstico por imagem , Masculino , Desenho Assistido por Computador , Tomografia Computadorizada por Raios X , Adulto
17.
Am J Sports Med ; 52(7): 1813-1819, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38767945

RESUMO

BACKGROUND: Satisfactory clinical results of meniscal allograft transplantation (MAT) have been reported in recent years. However, it remains unclear whether the clinical outcomes of MAT when combined with an osteotomy are inferior to those of isolated MAT. PURPOSE: To compare the survival rates and clinical outcomes of patients who received isolated medial MAT with those of patients undergoing medial MAT combined with high tibial osteotomy (HTO). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 55 patients underwent arthroscopic medial MAT using the soft tissue technique and HTO (mean age, 41.3 ± 10.4 years; 9 female); after fuzzy case-control matching on demographics, 55 controls who underwent isolated medial MAT were also included. Survival analyses were performed using the Kaplan-Meier method with surgical failure, clinical failure (Lysholm score, <65), and reoperation as endpoints. Subjective clinical scores were collected preoperatively and at the final follow-up. RESULTS: The mean follow-up time was 5.4 years, up to 8 years. All outcomes significantly improved at the last follow-up (P < .001). No differences were identified between MAT and MAT + HTO groups preoperatively and at the last follow-up (P > .05). At the final follow-up, 8 of 55 (14.5%) of the MAT + HTO patients and 9 of 55 (16.4%) of the MAT patients had a Lysholm score <65 (P = .885). Overall, 90% of the patients declared they would repeat the surgery regardless of the combined procedure. Surgical failure was identified in 6 of 110 (5.5%) patients: 5 of 55 (9.1%) in the MAT + HTO group and 1 of 55 (1.8%) in the MAT group (P = .093). Clinical failure was identified in 19 of 110 (17.3%) patients: 11 of 55 (20%) in the MAT + HTO group and 8 of 55 (14.5%) in the MAT group (P = .447). A significantly lower survivorship from surgical failure was identified in the MAT + HTO group (hazard ratio, 5.1; P = .049), while no differences in survivorship from reoperation and clinical failure were identified (P > .05). CONCLUSION: Patients undergoing medial MAT + HTO showed similar clinical results to patients undergoing isolated medial MAT at midterm follow-up, and thus a surgically addressed malalignment does not represent a contraindication for medial MAT. However, the need for a concomitant HTO is associated with a slightly higher failure rate over time.


Assuntos
Meniscos Tibiais , Osteotomia , Tíbia , Humanos , Feminino , Masculino , Adulto , Osteotomia/métodos , Estudos de Casos e Controles , Pessoa de Meia-Idade , Meniscos Tibiais/cirurgia , Meniscos Tibiais/transplante , Seguimentos , Tíbia/cirurgia , Tíbia/transplante , Resultado do Tratamento , Reoperação/estatística & dados numéricos , Aloenxertos , Transplante Homólogo , Artroscopia
18.
J Plast Reconstr Aesthet Surg ; 93: 127-132, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38691947

RESUMO

BACKGROUND: Pectus arcuatum, also known as horns of steer anomaly or Currarino-Silverman Syndrome, is a distinct chest wall anomaly characterized by severe manubriosternal angulation, a shortened sternum, and mild pectus excavatum. The anomaly is typically repaired using open techniques, employing orthopedic fixation devices. Here, we report the results of a minimally invasive hybrid procedure to repair pectus arcuatum. METHODS: The procedure combines a standard Nuss procedure to correct the depressed sternum with a short upper chest (in boys) or inter-mammary (in girls) incision for bilateral subperichondrial resection of the upper costal cartilages, osteotomy, and correction of the manubrial angulation. The medical records of all patients who underwent the procedure over the last 10 years were reviewed. RESULTS: Five patients, 3 boys and 2 girls, aged 14 to 17 years, underwent the procedure. Three patients had their pectus bars removed 3-4 years after repair. Follow-up after correction ranged from 6 months to 7 years. Good correction resulted in all patients achieving recovery without complications and recurrence. To date, all patients have been satisfied with their results. CONCLUSIONS: The minimally invasive hybrid procedure adequately corrects pectus arcuatum with minimal scarring and high satisfaction.


Assuntos
Tórax em Funil , Procedimentos Cirúrgicos Minimamente Invasivos , Osteotomia , Humanos , Masculino , Feminino , Adolescente , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tórax em Funil/cirurgia , Osteotomia/métodos , Esterno/cirurgia , Esterno/anormalidades , Resultado do Tratamento , Parede Torácica/cirurgia , Parede Torácica/anormalidades , Estudos Retrospectivos , Seguimentos
19.
Orthop Surg ; 16(6): 1257-1268, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38693601

RESUMO

The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended or elevated position while the finger is in a relaxed state. At first, it garnered considerable interest as a complication It is worth noting that this condition is particularly common in children under the age of 8, which usually disappears as the individual reaches maturity. Studies have shown that with the aggravation of floating toe deformity, its adverse effects on patients' gait and overall quality of life also increase. Despite the prevalence of floating toe deformity in clinical settings, there is a lack of comprehensive literature investigating its underlying causes and potential preventive strategies. This scope review follows the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) statement guidelines for scope reviews. The literature was obtained from various full-text databases, including China National Knowledge Infrastructure Database (CNKI), Wanfang Database, PubMed, and Web of Science Database. Our search focused on published literature related to floating toes, Weil osteotomy, and distal metatarsal osteotomy, up until March 1, 2023. The literature search and data analysis are conducted by two independent reviewers. If there are any disagreements, a third researcher will participate in the discussion and negotiate a decision. Furthermore, two experienced foot and ankle surgeons conducted a thorough literature analysis for this review. Sixty-two articles were included. Through the clinical analysis of the structural changes of the forefoot before and after operation, the classification of floating toe was described, the causes of pathological floating toe were summarized, and the possible intervention measures for the disease were put forward under the advice of foot and ankle surgery experts. We comprehensively summarize the current knowledge system about the etiology of floating toe and put forward the corresponding intervention strategy. We recommend that future studies will focus on the improvement of surgical procedures, such as the combination of Weil osteotomy, proximal interphalangeal (PIP) arthrodesis and flexor tendon arthrodesis.


Assuntos
Osteotomia , Dedos do Pé , Humanos , Osteotomia/métodos , Osteotomia/efeitos adversos , Dedos do Pé/cirurgia , Complicações Pós-Operatórias
20.
Semin Vasc Surg ; 37(1): 35-43, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38704182

RESUMO

The physical demands of sports can place patients at elevated risk of use-related pathologies, including thoracic outlet syndrome (TOS). Overhead athletes in particular (eg, baseball and football players, swimmers, divers, and weightlifters) often subject their subclavian vessels and brachial plexuses to repetitive trauma, resulting in venous effort thrombosis, arterial occlusions, brachial plexopathy, and more. This patient population is at higher risk for Paget-Schroetter syndrome, or effort thrombosis, although neurogenic TOS (nTOS) is still the predominant form of the disease among all groups. First-rib resection is almost always recommended for vascular TOS in a young, active population, although a surgical benefit for patients with nTOS is less clear. Practitioners specializing in upper extremity disorders should take care to differentiate TOS from other repetitive use-related disorders, including shoulder orthopedic injuries and nerve entrapments at other areas of the neck and arm, as TOS is usually a diagnosis of exclusion. For nTOS, physical therapy is a cornerstone of diagnosis, along with response to injections. Most patients first undergo some period of nonoperative management with intense physical therapy and training before proceeding with rib resection. It is particularly essential for ensuring that athletes can return to their baselines of flexibility, strength, and stamina in the upper extremity. Botulinum toxin and lidocaine injections in the anterior scalene muscle might predict which patients will likely benefit from first-rib resection. Athletes are usually satisfied with their decisions to undergo first-rib resection, although the risk of rare but potentially career- or life-threatening complications, such as brachial plexus injury or subclavian vessel injury, must be considered. Frequently, they are able to return to the same or a higher level of play after full recovery.


Assuntos
Atletas , Síndrome do Desfiladeiro Torácico , Síndrome do Desfiladeiro Torácico/diagnóstico , Síndrome do Desfiladeiro Torácico/terapia , Síndrome do Desfiladeiro Torácico/fisiopatologia , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/cirurgia , Humanos , Resultado do Tratamento , Fatores de Risco , Recuperação de Função Fisiológica , Traumatismos em Atletas/terapia , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/fisiopatologia , Osteotomia/efeitos adversos , Volta ao Esporte , Valor Preditivo dos Testes , Descompressão Cirúrgica/efeitos adversos , Modalidades de Fisioterapia
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