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1.
Unfallchirurg ; 123(2): 143-154, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32016493

RESUMO

Posttraumatic kyphotic deformities of the thoracolumbar spine may result in significant clinical complaints. If conservative treatment is not successful, surgical correction of the kyphosis becomes an option. In contrast to degenerative deformities, posttraumatic kyphotic deformities are usual limited to few segments and can be treated with shorter constructs. The surgical strategy depends on the rigidity and the localization of the posttraumatic kyphotic deformity. In this respect purely posterior approaches and combined posteroanterior surgical approaches are available each with different advantages and disadvantages.


Assuntos
Cifose , Fusão Vertebral , Traumatismos da Coluna Vertebral , Tratamento Conservador , Humanos , Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares , Osteotomia , Traumatismos da Coluna Vertebral/cirurgia , Vértebras Torácicas , Resultado do Tratamento
2.
Instr Course Lect ; 69: 15-24, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017715

RESUMO

Although total hip arthroplasty (THA) surgery is one of the most successful procedures in orthopaedics, the number of revision procedures is predicted to increase by 137% over the next two decades.1 Implant failure modes such as instability, infection, loosening, and wear are becoming more prevalent.2 Instability, infection, extensive bony defects, and soft-tissue damage are the most important concerns and complications associated with revision surgery. More than 50% of revisions involve the acetabular implant.2 Paprosky et al described a classification of acetabular defects that occur in cases of implant failure.3 Treating type 2 and 3 uncontained defects can be technically challenging because the surgeon has to use extensive reconstruction techniques to adequately restore the biomechanics of the hip, structural stability, and leg length. Furthermore, neurovascular structures can be in jeopardy when complex pelvic reconstructive procedures are being conducted. In an attempt to optimize the access to the pelvic bone, to minimize soft-tissue damage and to protect the pelvic neurovascular structures, we use an extensile anterior approach to the acetabulum. This approach has been described by Ganz et al to conduct periacetabular osteotomies (PAO).4,5 This approach uses the Smith Petersen interval and exposes the anterior column and the acetabulum along with its defects. To our knowledge, the approach has not been used or described yet to conduct complex reconstructive surgeries for extensive acetabular defects in THA. The following is a description of a modified extensile surgical technique for challenging acetabular defects that may be encountered in certain revision THA reconstructions, as well as certain primary THA. This is an enhanced technical description of a technique presented by these authors in a previously described series of 48 patients who underwent revision using these techniques.6.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo , Humanos , Osteotomia , Reoperação , Resultado do Tratamento
3.
Instr Course Lect ; 69: 363-370, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017738

RESUMO

The management of bunion deformities in adolescent patients is often a source of consternation for orthopaedic surgeons. Reports of recurrence and surgical failure along with a multitude of procedures to choose from create a wariness to manage the problem surgically. The biggest challenge in managing this problem is a lack of understanding by orthopaedic surgeons that adolescent bunions and adult bunions frequently arise from two distinct etiologies. The main difference between the two is that unlike adult bunion deformities, the hallux metatarsophalangeal joint in the adolescent bunion is congruent as the deformity is caused by a dysplasia of the metatarsal head. This dysplasia results in a valgus orientation of the first metatarsal articular surface (ie, elevated DMAA [distal metatarsal articular angle]). The recognition of this difference has implications for the evaluation and treatment of these deformities in adolescents.


Assuntos
Joanete , Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Adolescente , Humanos , Osteotomia
4.
Plast Reconstr Surg ; 145(2): 403-406, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985631

RESUMO

Humpectomy is one of the most common steps in reduction rhinoplasty among Caucasian patients. The most widespread procedures to address hump removal are both the "en bloc humpectomy" (with reconstruction of the middle third with spreader grafts) and the "split hump technique" (with confection of spreader flaps). The spare roof technique, for rhinoplasty reduction, has been developed over the past 4 years. In this technique, the upper lateral cartilages are completely preserved-even the hidden part under the caudal aspect of the nasal bones. It consists of five main steps: step 1, the upper lateral cartilages are released from the dorsal aspect of the nasal septum; step 2, a 1-mm strip of the dorsal septum is taken in each movement as required; step 3, ostectomy of the caudal aspect of nasal bones, keeping the upper lateral cartilages intact and releasing the "lateral" (left and right) pyriform aperture ligament; step 4, classic medial and lateral osteotomies (closing the open bony roof); and step 5, suturing the upper lateral cartilages to the dorsal septum and thus avoiding the natural spring effect. The outcomes of the first 100 patients have been validated by a prospective, interventional, and longitudinal study performed on patients undergoing primary rhinoplasty by means of the spare roof technique. This study confirms that the spare roof technique significantly improved patient quality of life regarding nose function and appearance. It is a reliable technique that can help deliver consistently good results in Caucasian and Mediterranean patients with a dorsal hump seeking rhinoplasty.


Assuntos
Septo Nasal/cirurgia , Rinoplastia/métodos , Humanos , Osso Nasal/cirurgia , Osteotomia/métodos , Cuidados Pós-Operatórios/métodos , Retalhos Cirúrgicos
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 37-40, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939232

RESUMO

Objective: To evaluate the short-term effectiveness of the first ray tri-plane osteotomy and other metatarsal basal osteotomy in treatment of hallux valgus with moderate and severe metatarsus adductus. Methods: Between February 2012 and September 2016, 10 patients (12 feet) of hallux valgus with moderate and severe metatarsus adductus were admitted and treated with the first ray tri-plane osteotomy and other metatarsal basal osteotomy and lateral soft tissue release. There were 1 male (2 feet) and 9 females (10 feet) with an average age of 34.5 years (range, 21-55 years). The disease duration ranged from 3 to 10 years (mean, 5.8 years). The degree of metatarsal adductus was moderate in 4 feet and severe in 8 feet according to modified Sgarlato measurement method. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 46.4±9.3. The metatarsus adductus angle (MAA) was (25.41±3.66)°, hallux valgus angle (HVA) was (41.42±9.67)°, and the first-second intermetatarsal angle (1-2IMA) was (10.72±2.26)°. Results: All incisions healed by first intention. All patients were followed up 18-24 months, with an average of 21.4 months. One patient (1 foot) had metastatic metatarsalgia after operation, but the symptoms disappeared after symptomatic treatment. X-ray re-examination showed that all osteotomies healed, and the healing time was 2.4-3.2 months, with an average of 2.8 months. At last follow-up, MAA was (8.42±0.71)°, HVA was (13.29±1.03)°, 1-2IMA was (4.41±0.48)°, and AOFAS score was 89.8±5.9. There were significant differences in clinical and radiographic indexes between pre- and post-operation ( P<0.05). Conclusion: The first ray tri-plane osteotomy combined with other metatarsal basal osteotomy has a significant short-term effectiveness in the treatment of hallux valgus with moderate and severe metatarsus adductus.


Assuntos
Hallux Valgus , Ossos do Metatarso , Metatarso Varo , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Resultado do Tratamento , Adulto Jovem
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 41-45, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939233

RESUMO

Objective: To summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle (DMAA). Methods: Between June 2014 and December 2017, 64 patients (94 feet) of severe hallux valgus with an increased DMAA were treated with the double metatarsal osteotomy (distal metatarsal Reverdin osteotomy+proximal metatarsal open wedge osteotomy) combined with Akin osteotomy and soft tissue surgery to correct the deformity. There were 10 males (15 feet) and 54 females (79 feet) with an average age of 44.5 years (range, 26-66 years), including 34 of unilateral foot and 30 of bilateral feet. The Maryland metatarsophalangeal joint score of the American Orthopaedic Foot and Ankle Society (AOFAS) was 54.3±7.4 and the visual analogue scale (VAS) score was 6.0±2.0. The pre- and post-operative AOFAS score, VAS score, DMAA, hallux valgus angle (HVA), first-second intermetatarsal angle (1-2IMA), and the first metatarsal length (FML) were recorded and compared. Results: All incisions healed by first intention. All patients were followed up 12-15 months, with an average of 13.2 months. The complications occurred in 4 feet, including 1 foot of hallux stiffness, 1 foot of numbness at the edge of the wound, 1 foot of metastatic metatarsalgia, and 1 foot of metatarsal bone necrosis. At 1 year after operation, the Maryland metatarsal joint score of AOFAS was 89.2±7.4, showing significant difference compared with preoperative score ( t=18.427, P=0.000); and the effectiveness was rated as excellent in 78 feet, good in 12 feet, poor in 3 feet, and bad in 1 foot, with an excellent and good rate of 95.7%. The VAS score was 1.5±2.0, showing significant difference compared with the preoperative score ( t=10.238, P=0.000). The X-ray films showed that the osteotomies achieved bony healing at 3 months after operation. There were significant differences ( P<0.05) in HVA, 1-2IMA, and DMAA between preoperation and 6 months and 1 year after operation; but no significant difference was found in FML between preoperation and 1 year after operation ( t=0.136, P=0.863). Conclusion: For the patients with severe hallux valgus with increased DMAA, the double metatarsal osteotomy can significantly relieve the clinical symptoms and improve the imaging parameters with less postoperative complications.


Assuntos
Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Radiografia , Resultado do Tratamento
7.
J Surg Oncol ; 121(3): 570-577, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31902136

RESUMO

BACKGROUND: Joint-preserving intercalary tumor resection can result in better proprioception and a more normal joint function after reconstruction. However, most reported reconstruction techniques are usually associated with frequent complications. Therefore, the approach of reconstruction following joint-preserving tumor resection warrants further study. METHODS: Between September 2016 and October 2018, 12 patients with metaphyseal malignant bone tumors around the knee joint were treated by joint-preserving intercalary resections with the aid of three-dimensional (3D)-printed osteotomy guide plates and reconstructions using 3D-printed intercalary prostheses. We assessed the accuracy of the resection by comparing the cross sections at the resection plane with 3D-printed matching surface of the prostheses. The functional outcomes, complications and oncological status were also evaluated. RESULTS: All patients were observed for 7 to 32 months with an average follow-up of 22.5 months. The achieved resection was accurate, with accurate matching between the residual bone and prosthesis. The mean MSTS score was 28 (range, 26-30). Superficial infection occurred in two patients. Local recurrence was observed in one patient, while pulmonary metastasis was identified in one patient. CONCLUSIONS: The personalized osteotomy guide plate and prosthesis based on 3D printing technique facilitate joint-preserving tumor resection and functional reconstruction. However, longer follow-up and larger sample size are required to clarify its long-term outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Doenças Ósseas/cirurgia , Neoplasias Ósseas/cirurgia , Articulação do Joelho/cirurgia , Tratamentos com Preservação do Órgão/métodos , Impressão Tridimensional/instrumentação , Implantação de Prótese , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Neoplasias Ósseas/patologia , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Prognóstico , Desenho de Prótese , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 99(4): e18910, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977905

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a common disease in the elderly, which seriously reduces the quality of life of patients and increases the social burden. proximal fibula osteotomy (PFO) and high tibial osteotomy (HTO) are effective methods to treat KOA. However, it is not entirely clear which method has the advantage. Therefore, we evaluated the efficacy and safety of HTO and PFO in the treatment of KOA. METHODS: Randomized controlled trials from online databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Data and Chinese Biomedical Literature Database that compared the efficacy of HTO and PFO in the treatment of KOA were retrieved. The main outcomes included hospital for special surgery (HSS) knee scores, knee society knee scoring system (KSS) score, visual analog scale (VAS) knee pain scores, western ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, complications. The Cochrane risk of bias tool was used to assess methodological quality. RESULTS: The literature will provide a high-quality analysis of the current evidence supporting HTO for KOA based on various comprehensive assessments including HSS scores, KSS score, VAS scores, western Ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, and complications. CONCLUSION: This proposed systematic review will provide up-to-date evidence to assess the effect of HTO in the treatment for patients with KOA.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Fíbula/cirurgia , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisão Sistemática como Assunto , Tíbia/cirurgia
9.
Medicine (Baltimore) ; 99(1): e18613, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895814

RESUMO

Postoperative fever in pediatric patients following reconstructive hip surgery is of unknown significance. This study identifies the prevalence of postoperative fever after corrective hip surgery, its relationship to infection, and whether preventative use of anti-pyretics affects patient outcomes.Overall, 222 patients who underwent a varus derotational osteotomy (VDRO) between 11/1/2004 to 8/1/2014 with minimum 6 months follow up were retrospectively identified. Variables included diagnosis, inpatient stay, daily maximum temperature, duration of fever, fever workup, and administration of scheduled anti-pyretics. Fever was defined as temperature ≥38°C.In total, 123/222 (55.4%) and 70/222 (31.5%) had postoperative fevers of ≥38°C and ≥38.5°C, respectively. Average inpatient stay was 2.7 days postoperatively. Temperature (mean = 38.0°C) was greatest on postoperative day 1 (POD1), and 43.7% of patients had T ≥38°C on POD1. Anti-pyretics did not influence the duration of fever. Anti-pyretics on the day of surgery (POD0) did not influence the incidence of fever. Acetaminophen on POD0 significantly reduced likelihood of fever on POD1 (P = .02). Average length of fevers ≥38°C and 38.5°C were 8.4 and 4.2 hours, respectively. 3/18 (16.7%) fever workups administered were positive. Postoperative fever did not predict infection. 9/222 (4/1%) patients had postoperative infection - 5/123 (4.1%) with fever ≥38°C and 4/70 (5.7%) with fever ≥38.5°C. Rates of infection in patients with and without fevers were not significantly different (P = .97 for T ≥38°C and P = .38, for T ≥38.5°C).Though common, postoperative fever does not increase risk of infection. The low prevalence of positive cultures indicates routine fever workups can safely be avoided in most patients.Level of Evidence: III, retrospective comparative study.


Assuntos
Coxa Vara/cirurgia , Febre/etiologia , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Criança , Febre/epidemiologia , Humanos , Los Angeles/epidemiologia , Osteotomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
10.
Medicine (Baltimore) ; 99(4): e18636, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977853

RESUMO

RATIONALE: Knee osteoarthritis (KOA) is a common disease. It has long been believed that the main causes of KOA are knee degenerative diseases, trauma, overwork, and labor habits. However, long-term deformity leads to uneven stress on the surface of the knee joint, and the cause of lower limb force line damage has not been taken seriously. Comprehensive application of high tibial osteotomy (HTO), chronic distraction tissue regeneration, and computer-assisted external fixation for the treatment of severe KOA has many advantages over total knee arthroplasty, such as lasting and thorough orthopedic effects, a lower cost, and a faster recovery. PATIENT CONCERNS: The patient was a 48-year-old male with KOA caused by long-term genu varus, resulting in pain in both knees, especially in the right knee. The right knee pain had been aggravated for 2 years, and he was admitted to the hospital for left knee pain for 1 month. DIAGNOSES: X-ray: The patient has right KOA and varus deformity INTERVENTIONS: Comprehensive application of HTO, chronic distraction tissue regeneration technology, and computer-assisted external fixation technology has a good therapeutic effect for patients with KOA and varus. OUTCOMES: The patient's severe genu varus was corrected, the bone and soft tissue regeneration was good, the lower limb force line was improved, lower limb function was restored well, and the treatment was satisfactory. CONCLUSION: For the treatment of KOA patients with genu varus, the combination of HTO, chronic distraction tissue regeneration, and computer-assisted adjustment of external fixation technology have a good effect on the correction of genu varus deformity and the recovery of the lower limb force line. This treatment method is also conducive to preventing postoperative infection and avoiding secondary trauma caused by the removal of internal fixation plates.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Fixadores Externos , Regeneração Tecidual Guiada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tíbia/cirurgia
11.
Int J Oral Maxillofac Implants ; 35(1): 141­149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31184630

RESUMO

PURPOSE: Autogenous bone grafts are considered a "gold standard." The success of autografts mainly depends on their ability to promote an osteogenic response. The aim of this study was to collect autogenous bone during implant osteotomy preparation using two different drilling protocols and to evaluate and compare the proliferation and differentiation ability of the collected bone particles. MATERIALS AND METHODS: Autogenous bone particles were harvested from 20 patients during implant osteotomy preparation using two different drilling protocols: (1) standard drilling protocol with saline irrigation (according to the manufacturer's recommendation) and (2) low-speed drilling protocol without saline irrigation (speed < 200 rpm). Bone samples collected were cultured in growth medium, and after 2 to 3 weeks, cells that grew out from bone grafts were cultured in the normal medium as well as in osteogenic medium for days 0, 4, 7, and 20. Scanning electron microscopy, alizarin red/toluidine blue staining, DNA, ALP, and calcium content measurements were performed. Repeated measures analysis of variance (ANOVA) with Bonferroni's test was employed to analyze the data of this study. RESULTS: The total DNA content was significantly higher for the low-speed drilling samples compared with the standard drilling on day 4 (P < .05), day 7 (P < .01), and day 20 (P < .001) in the normal medium and on day 7 (P < .01) and day 20 (P < .01) in the osteogenic medium. Besides, calcium measurements and mineralized matrix formation observed with alizarin red/toluidine blue staining were significantly higher for the low-speed drilling group compared with the standard drilling group. CONCLUSION: Osteogenic efficacy (differentiation and proliferation) of autogenous bone particles collected using low-speed drilling was superior compared with standard drilling samples.


Assuntos
Diferenciação Celular , Proliferação de Células , Osteoblastos , Transplante Ósseo , Humanos , Osteotomia
12.
Orthopade ; 49(1): 18-25, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31025043

RESUMO

BACKGROUND: High tibial osteotomy (HTO) is a good joint-preserving alternative to joint replacement in the treatment of isolated medial varus gonarthrosis. It is, however, accompanied by a number of complications, which can compromise the outcome of the treatment. OBJECTIVES: Analysis and comparison of the complication structure after angle-stable navigated closed wedge (CW) HTO and conventional angle-stable open wedge (OW) HTO, as well as determination of influence factors. MATERIAL AND METHODS: 281 HTO (187 CW- and 94 OWHTO) were analyzed retrospectively. Age, sex, BMI, time of surgery and radiological parameters were included as possible influence factors. A statistical analysis was performed with binary logistic regression. RESULTS: An overall complication rate of 21.4% was revealed (25.1% after CW- and 13.8% after OWHTO, p = 0.02); the major complications occurred after 13.9% CW- and 10.6% OWHTO (p = 0.27); minor complications were observed after 11.2% CW- and 3.2% OWHTO (p = 0.03). This difference results from complications specific to CWHTO (peroneal lesions and pseudarthrosis fibulae). The incidence of pseudarthrosis tibiae was equal in both procedures (7.5%). Age ≥ 52 years and body mass index (BMI) ≥ 30 kg/m2 were the relevant predictors for mechanical complications after CWHTO; these were not relevant for OWHTO. CONCLUSION: The correct patient selection is essential to avoid postoperative complications after HTO. The overall complication rates are lower after OWHTO, mainly through the avoidance of complications typical for CWHTO. OWHTO offers a wider choice with respect to the selection of patients.


Assuntos
Osteoartrite do Joelho , Osteotomia , Tíbia , Humanos , Articulação do Joelho , Radiografia , Estudos Retrospectivos
13.
Int J Oral Maxillofac Surg ; 49(1): 28-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31285096

RESUMO

The aim was to compare clinical and radiological features of the two juvenile ossifying fibroma (JOF) variants, trabecular (JTOF) and juvenile psammomatoid ossifying fibroma (JPOF). An electronic search was undertaken in March 2019. Eligibility criteria included publications having sufficient clinical, radiological, and histological information to confirm the diagnosis. A total of 185 publications and 491 cases were included. Most JOFs, including both variants, showed bone expansion, were painless, presented no cortical perforation and no secondary aneurysmal bone cyst, did not cause tooth root resorption, and had a mixed unilocular radiodensity appearance and well-defined limits on radiological examination. Patients with JPOF were on average older than those with JTOF. Enucleation and curettage was associated with a considerably high recurrence rate, regardless of the anatomical location or variant type of the lesion. Enucleation followed by either curettage or peripheral osteotomy showed lower recurrence rates than enucleation only. When resection was performed, only one case of JTOF presented recurrence. In conclusion, JOF lesions presented high rates of recurrence after treatment by curettage and enucleation only. Although surgical resection of JOFs resulted in the virtual absence of recurrence, enucleation followed by peripheral osteotomy/curettage should be the treatment of choice for both JOF variants to avoid the disfigurement usually associated with surgical resection.


Assuntos
Neoplasias Ósseas , Fibroma Ossificante , Seios Paranasais , Humanos , Recidiva Local de Neoplasia , Osteotomia
14.
Orthop Clin North Am ; 51(1): 109-120, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739874

RESUMO

Reconstruction of the flexible adult-acquired flatfoot deformity (AAFD) is controversial, and numerous procedures are frequently used in combination, including flexor digitorum longus transfer, medializing calcaneal osteotomy (MCO), heel cord lengthening/gastrocnemius recession, lateral column lengthening (LCL), Cotton osteotomy or first tarsometatarsal fusion, and spring ligament reconstruction. This article summarizes recent studies demonstrating that patients have significant improvements after operative treatment of flexible AAFD. It reviews current literature on clinical and radiographic outcomes of the MCO, LCL, and Cotton osteotomies. The authors describe how this information can be used in surgical decision making in order to tailor operative treatment to an individual patient's deformity.


Assuntos
Pé Chato/cirurgia , Pé/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transferência Tendinosa/métodos , Adulto , Artrodese/métodos , Calcâneo/cirurgia , Terapia Combinada/métodos , Tomada de Decisões/ética , Feminino , Pé Chato/diagnóstico por imagem , Pé Chato/patologia , Pé/diagnóstico por imagem , Pé/patologia , Humanos , Ligamentos Articulares/cirurgia , Masculino , Osteotomia/métodos , Medidas de Resultados Relatados pelo Paciente , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
15.
Orthop Clin North Am ; 51(1): 37-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739878

RESUMO

In situ pinning of slipped capital femoral epiphysis (SCFE) is a safe and effective treatment modality, but often results in residual deformity leading to femoroacetabular impingement, which may limit patient activities and predispose to early onset arthritis. Enhanced understanding of the implications of femoroacetabular impingement and new surgical techniques have prompted interest in treating post-slipped capital femoral epiphysis deformity to both improve current symptoms and delay or prevent hip arthrosis.


Assuntos
Coxa Magna/cirurgia , Quadril/diagnóstico por imagem , Osteoartrite do Quadril/prevenção & controle , Escorregamento das Epífises Proximais do Fêmur/cirurgia , Artroscopia/métodos , Pinos Ortopédicos/efeitos adversos , Pinos Ortopédicos/normas , Impacto Femoroacetabular/etiologia , Impacto Femoroacetabular/cirurgia , Fêmur/cirurgia , Quadril/cirurgia , Luxação do Quadril/cirurgia , Humanos , Procedimentos Ortopédicos/métodos , Osteoartrite do Quadril/cirurgia , Osteotomia/métodos , Cuidados Pós-Operatórios , Estudos Retrospectivos , Resultado do Tratamento
16.
Artigo em Inglês | MEDLINE | ID: mdl-31815980

RESUMO

The predictability of transcrestal sinus floor elevation (tSFE) in elevating the sinus membrane following posterior maxillary ridge resorption has been widely demonstrated. To minimize complications and increase success, a literature search was conducted to validate procedures used for tSFE. A decision tree based upon timing of perforations was then developed to improve membrane-perforation management during the procedure. At each surgical procedure, the clinician is encouraged to use size of the perforation, time during the procedure in which the perforation occurred, and resulting symptoms to determine the best treatment approach. This article discusses all possible sinus membrane perforations based on timing of that surgical procedure, allowing the clinician to recognize and successfully rectify this clinical complication while successfully completing the surgery. With this aim, a classification of sinus membrane perforations occurring during tSFE is proposed, simultaneously providing guidelines to effectively manage these complications.


Assuntos
Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endo-Óssea , Seio Maxilar , Mucosa Nasal , Osteotomia
17.
Oral Maxillofac Surg Clin North Am ; 32(1): 83-88, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31685346

RESUMO

Patients and orthodontists seek to reduce treatment time in braces. Rapid canine retraction through dentoalveolar distraction osteogenesis is one of several treatment approaches to reduce treatment in braces. This article provides an overview of technique of dentoalveolar distraction osteogenesis to accomplish rapid canine retraction and associated outcomes. When this treatment protocol is implemented well, rapid canine retraction is achieved predictably with minimal side effects. Although current evidence suggests that adverse sequelae, such as root resorptions and pulp devitalization, are rare, prospective clinical studies that are adequately powered and documenting long-term follow-up of these outcomes are lacking.


Assuntos
Procedimentos Cirúrgicos Bucais/métodos , Procedimentos de Ancoragem Ortodôntica , Desenho de Aparelho Ortodôntico , Osteogênese por Distração/métodos , Osteotomia/métodos , Técnicas de Movimentação Dentária/métodos , Humanos , Maxila , Procedimentos de Ancoragem Ortodôntica/efeitos adversos , Procedimentos de Ancoragem Ortodôntica/instrumentação , Aparelhos Ortodônticos , Procedimentos Cirúrgicos Ortognáticos , Estudos Prospectivos , Resultado do Tratamento
18.
Am J Orthod Dentofacial Orthop ; 156(6): 846-857, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31784019

RESUMO

Orthodontic treatment to upright an inclined molar adjacent to an edentulous space is often necessary before implant placement. The implant site may also require a ridge augmentation if the bony volume is not sufficient. The time required for both treatment steps can be lengthy and can discourage patients from accepting dental implants. This case report presents a novel interdisciplinary approach to implant site development. Selective osteotomy and simultaneous ridge augmentation were performed on the bilateral mesially inclined second molars before orthodontic uprighting. The severely inclined second molars were uprighted in 5 months, and the enhanced implant sites were ready for implant placement without complications. A finite element analysis revealed that the osteotomy partially affected the biomechanical responses of the dentoalveolar structures during molar uprighting.


Assuntos
Aumento do Rebordo Alveolar , Implantes Dentários , Osteotomia , Implantação Dentária Endo-Óssea , Humanos , Dente Molar
19.
Zhonghua Yi Xue Za Zhi ; 99(45): 3592-3596, 2019 Dec 03.
Artigo em Chinês | MEDLINE | ID: mdl-31826577

RESUMO

Objective: To observe the effect of traditional and modified Ilizarov transverse tibial bone transport on microvascular regeneration of lower limbs in dogs. Methods: After general anesthesia on 10 experimental dogs, traditional and modified transverse tibial bone transport were performed on both tibias respectively. The control group was treated with the traditional method (the periosteum and bone flap were completely isolated), while the experimental group was treated with the modified method (the fibular periosteum of the open window bone flap was retained). All the external fixators were pulled outwards at a speed of 1 mm every day from 5 days after operation;after one week, the external fixators were moved back every 3 days for one week. The situation of wounds and activity of lower limbs were observed. Simultaneously, the angiogenesis was observed by digital subtraction angiography (DSA) through femoral artery at different stages, and the density of vascular endothelial cells measured by local tissue sections. The data before and after the operation were compared with paired t test. Results: The operation was successfully completed in 10 experimental dogs, and all wounds healed about 1 week after the operation. There was no significant abnormality in lower limb movements in all dogs. Peripheral blood vessel area in middle leg of lower limb in 4 weeks and 8 weeks after operation was (5.9±0.4) mm(2) and (6.9±0.6) mm(2) in control group and it was (6.2±0.6) mm(2) and (8.0±0.6) mm(2) in experimental group, respectively; all were significantly improved than those before the operation ((5.0±0.4) mm(2), (4.9±0.4) mm(2), respectively) (F=446.457, 829.192, both P<0.05). There was no significant differences in vessel area between the two groups at the 4th week after operation (t=1.216, P=0.240), but there was significant difference at the 8th week after operation between the two groups (t=4.423, P=0.000). The percentage of vascular endothelial cells in stained cells under endoscopy was 4.42%±0.28% and 5.63%±0.53% in the control group at the 8th week; and in the experimental group, it was 5.35%±0.26% and 7.18%±0.25%, respectively;all were significantly elevated than those before the operation; and there were significant differences between the two groups (t=7.35, 8.30, both P<0.05). Conclusion: Transverse tibial bone transport and microvascular network regeneration technology can reconstruct the microvasculature below the calf of dogs; the method of window-opening osteotomy is improved to "door" type window-opening, it can retain the lateral periosteum of tibial crest and regenerate the microvasculature network more abundantly.


Assuntos
Tíbia , Animais , Cães , Células Endoteliais , Fixadores Externos , Microcirculação , Osteotomia
20.
Indian J Dent Res ; 30(5): 767-771, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31854371

RESUMO

Background: Implant success and survival rate ranges from 93% to 97%; however, failures are not very uncommon. These failures can be caused due to a variety of reasons out of which increased heat during drilling of osteotomies is a major contributor. Aim: The aim of this study was to develop a new generation diamond-coated drill and compare the thermal changes between commercially available drills and the experimental diamond coated drill during implant site preparation in artificial bone. Material and Methods: Three types of drills were selected for the study; Group A (Carbide), Group B (Stainless Steel), and Group C (Experimental). A total of 60 implant site preparations were performed with all the drills in artificial bone using a surgical unit linked to a testing device, in order to standardize implant drilling procedures. Bone temperature variations were recorded when drilling at a depth of 10 mm. A constant irrigation of 50 ml/minute and drilling speed of 800 r.p.m. was maintained. Results: The mean temperature of Group A, Group B, and Group C was 35.57°C, 36.83°C and 34.23°C, respectively. The results were assessed and statistically analyzed using ANOVA test and post hoc Bonferroni test. Statistically significant higher temperatures were obtained with stainless steel drill and carbide drill when compared with the experimental diamond coated drill. (P = 0.000). Conclusions: Diamond coated osteotomy drills have shown promising results in reducing heat generation at the osteotomy. Further studies need to be conducted to maximize the potential use of diamond as components of drills in implant dentistry.


Assuntos
Temperatura Alta , Osteotomia , Implantação Dentária Endo-Óssea , Desenho de Equipamento , Humanos , Temperatura Ambiente , Irrigação Terapêutica
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