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1.
Bone Joint J ; 102-B(11): 1542-1548, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135431

RESUMO

AIMS: The primary aim of this study was to describe patient satisfaction and health-related quality of life (HRQoL) following corrective osteotomy for a symptomatic malunion of the distal radius. METHODS: We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. The primary long-term outcome was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the EQ-5D-5L score, complications, and the Net Promoter Score (NPS). Multivariate regression analysis was used to determine factors associated with the PRWE score. RESULTS: Long-term outcomes were available for 89 patients (72%). The mean age was 57 years (SD 15) and 68 were female (76%). The median time from injury to corrective osteotomy was nine months (interquartile range (IQR) 6 to 13). At a mean follow-up of six years (1 to 11) the median PRWE score was 22 (IQR 7 to 40), the median QuickDASH score was 11.4 (IQR 2.3 to 31.8), and the median EQ-5D-5L score was 0.84 (IQR 0.69 to 1). The NPS was 69. Multivariate regression analysis showed that the presence of an associated ulnar styloid fracture was the only significant independent factor associated with a worse PRWE score when adjusting for confounding variables (p = 0.004). CONCLUSION: We found that corrective osteotomy for malunion of the distal radius can result in good functional outcomes and high levels of patient satisfaction. However, the presence of an ulnar styloid fracture may adversely affect function. Level of Evidence: III (cohort study). Cite this article: Bone Joint J 2020;102-B(11):1542-1548.


Assuntos
Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Medidas de Resultados Relatados pelo Paciente , Rádio (Anatomia)/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Recuperação de Função Fisiológica , Estudos Retrospectivos , Articulação do Punho/cirurgia
2.
Acta Chir Orthop Traumatol Cech ; 87(5): 350-355, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33146604

RESUMO

PURPOSE OF THE STUDY Although distal chevron osteotomy (DCO) is considered as an intrinsically stable osteotomy, various fixation methods have been used to date. The purpose of this study was comparison of two commonly used methods in DCO, Kirschner (K)-wire and titanium fully threaded headless cannulated screw fixation, based on the clinical and radiological results, and their complications. MATERIAL AND METHODS Thirty patients were included in K-wire group and 36 patients were included in screw group. Mean age was 43.4 11.1 (rage; 19-65) years, and mean follow-up was 21.2 5.5 (range; 12-35) months. American Orthopaedic Foot Ankle Society (AOFAS) metatarsophalengeal-interphalangeal score was used for clinical evaluation. For radiological evaluation, hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), medial sesamoid grade (MSG), and lateral sesamoid distance (LSD) to mid-axis of the second metatarsal were measured for all patients on both preoperative and postoperative final follow-up radiographs. RESULTS Mean AOFAS scores were significantly improved and radiographic measurements were significantly reduced at postoperatively in both groups (p< 0.01 for AOFAS, HVA, IMA, DMAA and MSG; p = 0.01 for LSD). Mean preoperative and mean postoperative, as well as the mean difference (difference between postoperative and preoperative) of the radiographic measurements, and AOFAS scores were not significantly different between two groups (p > 0.05). A total of 5 complications were observed (four in K-wire group, one in screw group). Complication rates between two groups was not statistically significant (p = 0.12). DISCUSSION Initial description of DCO did not include any fixation material. Afterwards, the procedure was modified by using single K wire in order to enhance the stability of the osteotomy. Previous studies were unable to demonstrate significant differences between K-wire fixation and cortical or Herbert type screw fixation based on clinical and radiological outcomes. Differently, in this study we compared two K-wire fixation with 3.5-mm titanium fully threaded headless cannulated screw fixation. Our results demonstrated that function and radiological measurements significantly improved after both fixation methods. Despite the increased complication rate in K-wire group, it was not statistically significant. Moreover, none of the complications was associated with unstable osteotomy, and required re-operation. CONCLUSIONS Both fixation methods provided comparable radiological and clinical outcomes with favourable results after DCO. Key words: hallux valgus, distal chevron osteotomy, Kirschner wire, headless cannulated screw, fixation method.


Assuntos
Hallux Valgus , Ossos do Metatarso , Parafusos Ósseos/efeitos adversos , Fios Ortopédicos , Pré-Escolar , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Lactente , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Osteotomia , Resultado do Tratamento
3.
Zhonghua Wai Ke Za Zhi ; 58(11): 876-881, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120452

RESUMO

Objective: To explore the feasibility of fast and accurate osteotomy using a new angle adjustable osteotomy guide (AAOG) in closing wedge distal femoral osteotomy(CWDFO). Methods: The clinical data of 14 patients (17 knees) with valgus knee treated with CWDFO at Department of Integrated Chinese and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University from January 2018 to July 2019 were analyzed retrospectively. There were 3 males and 11 females, aging (41.4±16.4) years (range: 18 to 56 years). The body mass index was (23.5±3.5) kg/m(2) (range: 18.1 to 28.9 kg/m(2)). The guide pins were placed with the assistance of the self-designed AAOG. Before the surgery, Solidworks software was used to calculate the correction angle and the osteotomy radius accurately. The osteotomy guide was adjusted according to these two parameters. During the surgery, the adjusted osteotomy guide was placed to the surface of bone closely and the guide pins were drilled into the bone through the guide holes. The position of the guide pins was confirmed under fluoroscopy. The osteotomy was finished under guide of pins and fixed with Tomofix plate (Synthes). The times and duration of placement of the guide pins, the times of X-ray examination, the planned and actual thickness of the osteotomy wedge, the top and bottom area of the osteotomy wedge, the posterior distal femoral angle(PDFA), the correction of the weight line, and the American Knee Society Score(AKSS) and Tegner scores were collected and compared by paired t test or Kruskal-Wallis non-parametric test. Healing time after osteotomy and complications were recorded. Results: The guide pins were successfully placed once in 10 knees, adjusted once in 5 knees and twice in 2 knees. The time spent in placing all the 6 pins was 82.4 seconds (range: 51 to 125 seconds), and the times of X-ray examination was 1.5 times (range: 1 to 5 times). The top and bottom areas of the osteotomy wedge were (5.52±0.52)cm(2) and (5.36±0.49)cm(2). PDFA was (85.2±2.6)° preoperatively and (85.5±1.4)° postoperatively (t=-0.401, P>0.05). The thickness of the osteotomy was (11.3±1.9)mm according to the preoperative plan, and the actual thickness was (8.1±1.7)mm. All the patients were followed up for 6 months after surgery and AKSS and Tegner scores improved significantly (all P<0.05). The correction of the weight lines was within the ideal range. Fractures of the hinge point occurred in 3 knees. All of the osseous healing without complications. Conclusion: The new osteotomy guide helps to place the guide pins rapidly and precisely according to the preoperative planning, which should be widely used in clinical applications with promising outcomes.


Assuntos
Fêmur/cirurgia , Osteoartrite do Joelho , Osteotomia , Adolescente , Adulto , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Osteotomia/instrumentação , Osteotomia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
J Am Acad Orthop Surg ; 28(20): e878-e887, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33030854

RESUMO

The talus is unique in having a tenuous vascular supply and 57% of its surface covered by articular cartilage. Fractures of the head, neck, or body regions have the potential to compromise nearby joints and impair vascular inflow, necessitating surgical treatment with stable internal fixation in many cases. The widely preferred approach for many talar neck and body fractures is a dual anterior incision technique to achieve an anatomic reduction, with the addition of a medial malleolar osteotomy as needed to visualize the posterior talar body. Percutaneous screw fixation has also demonstrated success in certain patterns. Despite this modern technique, osteonecrosis and osteoarthritis remain common complications. A variety of new treatments for these complications have been proposed, including vascularized autograft, talar replacement, total ankle arthroplasty, and improved salvage techniques, permitting some patients to return to a higher level of function than was previously possible. Despite these advances, functional outcomes remain poor in a subset of severely injured patients, making further research imperative.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Tálus/lesões , Tornozelo/cirurgia , Artroplastia de Substituição , Autoenxertos/irrigação sanguínea , Parafusos Ósseos , Fraturas Ósseas/complicações , Humanos , Osteoartrite/etiologia , Osteoartrite/terapia , Osteonecrose/etiologia , Osteonecrose/terapia , Osteotomia/métodos , Prognóstico , Recuperação de Função Fisiológica , Tálus/irrigação sanguínea
5.
Medicine (Baltimore) ; 99(40): e22535, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019460

RESUMO

RATIONALE: Adolescent wrist trauma can cause epiphyseal dysplasia and even distal radius deformity malunion. At present, there is no uniform treatment standard for the malunion of the distal radius of adolescents. Osteotomy and autologous bone grafting are currently one of the effective ways to treat the disease. We treated an adolescent patient with distal radius deformity malunion, and used this surgical method to treat the patient and achieved satisfactory results. PATIENT CONCERNS: A 16-year-old boy suffered from a serious distal radius deformity after trauma of the left wrist 8 years ago. DIAGNOSES: Physical examination, X-rays examination, high-resolution computed tomography scan, and 3-dimensional reconstruction images of the affected limb helped us diagnose the distal radius fracture malunion. INTERVENTIONS: The fracture malunion was treated by osteotomy and autologous iliac bone grafting. OUTCOMES: At the 2-year follow-up, wrist flexion returned to 68°, wrist dorsiflexion to 55°, radial deviation to 14°, ulnar deviation to 12°, forearm pronation to 75°, supination to 67°. Grip strength increased to 35.1 kg after 2 years of operation, recovered to 87% of the uninjured side. Quick DASH score at 2-year follow-up was 9. No complication, such as nonunion or infection, was observed. LESSONS: This rare case provides valuable insights for hand surgeons. High-resolution computed tomography scan and 3-dimensional reconstruction can help us effectively diagnose wrist diseases. Small lesions on the articular surface of the distal radius will change the position and function of the wrist joint, and cause traumatic arthritis of the wrist joint. Therefore, it is very important to reconstruct the normal structure of the distal radius articular surface. Osteotomy and autologous iliac bone grafting are effective treatments for serious distal radius fracture malunion in the adolescent patient. During the operation, care should be taken to protect the osteoepiphysis to avoid bone dysplasia.


Assuntos
Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Fraturas do Rádio/complicações , Transplante Autólogo/métodos , Adolescente , Assistência ao Convalescente , Transplante Ósseo/métodos , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Ílio/transplante , Processamento de Imagem Assistida por Computador/instrumentação , Masculino , Radiografia/métodos , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Articulação do Punho/fisiologia
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1258-1262, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063490

RESUMO

Objective: To investigate the effectiveness of two surgical approaches in the treatment of type Ⅳ Pipkin fracture. Methods: The clinical data of 15 patients with type Ⅳ Pipkin fracture treated surgically between July 2013 and June 2018 were retrospectively analyzed. According to different surgical approaches, they were divided into group A (8 cases, using K-L posterior approach) and group B (7 cases, using greater trochanter osteotomy approach). There was no significant difference in gender, age, cause of injury, and interval from injury to operation between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, fracture healing time, and complications of the two groups were recorded. Hip joint function recovery was evaluated according to Thompson-Epstein functional evaluation system. Results: All the 15 patients were followed up 1-5 years, with an average of 2.5 years. There was no significant difference in operation time between the two groups ( t=14.681, P=0.100); the incision length, intraoperative blood loss, and fracture healing time in group A were all greater than those in group B, and the hospital stay was shorter than that in group B, showing significant differences ( P<0.05). In group A, 1 patient presented hip pain, clasthenia, and limited mobility after operation, 1 patient presented ossifying myositis, 1 patient presented osteonecrosis of the femoral head, 1 patient presented fat liquefaction of incision, and 1 patient presented sciatica, with a complication incidence of 62.5%. Postoperative hip pain occurred in 1 patient and ossifying myositis in 2 patients in group B, with a complication incidence of 42.9%. There was no significant difference in the incidence of complications between the two groups ( χ 2=-0.735, P=0.462). At last follow-up, according to Thompson-Epstein functional evaluation system, the results in group A were excellent in 3 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 62.5%; in group B, the results were excellent in 4 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 85.7%. There was no significant difference in good and fair rate between the two groups ( χ 2=-0.990, P=0.322). Conclusion: K-L posterior approach is more convenient in the fracture treatment during operation, but it has greater trauma, greater vascular damage, and more blood loss. The greater trochanter osteotomy approach can better protect the blood supply of femoral head, shorten the operation time, reduce intraoperative blood loss, and reduce postoperative complications. It is an ideal way in the surgical treatment of type Ⅳ Pipkin fracture.


Assuntos
Fraturas do Quadril , Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos , Osteotomia , Estudos Retrospectivos , Resultado do Tratamento
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1269-1274, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063492

RESUMO

Objective: To introduce a self-designed adjustable operation frame and explore the feasibility and safety in the treatment of severe kyphosis secondary to ankylosing spondylitis with posterior osteotomy. Methods: Between March 2016 and May 2018, 7 cases of severe kyphosis secondary to ankylosing spondylitis were treated with posterior osteotomy using self-designed adjustable operation frame with prone position. There were 5 males and 2 females with an average age of 49.4 years (range, 40-55 years). The disease duration was 10-21 years (mean, 16.7 years). The apical vertebrae of kyphosis were located at T 11 in 2 cases, T 12 in 1 case, L 1 in 1 case, and L 2 in 3 cases. Among the 7 cases, 2 were classified as typeⅠ, 4 as type ⅡB, and 1 as type ⅢA according to 301 classification system. There was no neurological deficit of all cases; but 1 case suffered bilateral hip joints ankylosed in non-functional position. The parameters of chin-brow vertical angle (CBVA), global kyphosis (GK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sagittal vertical axis (SVA) were measured; and the operation time, the intraoperative blood loss, and the complications were also collected and analyzed. Results: All operations completed successfully. The operation time was 310-545 minutes (mean, 409.7 minutes) and the intraoperative blood loss was 1 500-2 500 mL (mean, 1 642.9 mL). There were 2 cases treated with one-level osteotomy of sagittal translation, 1 case of radiculopathy symptom of L 3, and 3 cases of tension of abdominal skin. All patients were followed up 20-35 months (mean, 27.9 months). There were significant differences in CBVA, GK, TLK, LL, and SVA between pre- and post-operation ( P<0.05); but no significant difference between 1 week after operation and last follow-up ( P>0.05). All the osteotomies and bone grafts fused well and no complications of loosening and breakage of internal fixator occurred during the follow-up. Conclusion: In the posterior osteotomy for correction of severe kyphosis secondary to ankylosing spondylitis, the self-designed adjustable operation frame is convenient for the patient to be placed in prone position. It is safe, feasible, and effective to perform osteotomy correction with the aid of the self-designed adjustable operation frame.


Assuntos
Cifose , Espondilite Anquilosante , Adulto , Feminino , Humanos , Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/cirurgia , Resultado do Tratamento
8.
J Orofac Orthop ; 81(6): 385-395, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33034698

RESUMO

OBJECTIVE: The present study compared the skeletal effects of surgically assisted rapid maxillary expansion (SARME) with different surgeries in three representative finite element (FE) models. STUDY DESIGN: According to the ossification level of midpalatal suture, three FE models, with different elasticity moduli of sutures (E = 1 MPa, 500 MPa, and 13,700 MPa) were constructed, to represent three age groups of patients. Within each model, four groups were set up according to different surgeries: group I (control group without surgery), II (paramedian osteotomy), III (pterygomaxillary separation), and IV (paramedian osteotomy and pterygomaxillary separation). An expansion force of 100 N and 1 mm displacement were applied via a bone-borne distraction to simulate the expansion process. RESULTS: By analyzing these models, the maximum displacement of maxilla was observed in group IV, with E = 1 MPa model exhibiting the most displacement (28.5â€¯× 10-6 mm), followed by group II (21.4â€¯× 10-6 mm). Group IV showed a unique backward-downward rotation with minimum stress distributions in three models (9 MPa, 131 MPa, and 140 MPa, respectively), and group II exhibited comparable low stress distributions (12 MPa, 151 MPa, and 230 MPa, respectively). Lowest stress was found in E = 1 MPa model, compared with the other two models. CONCLUSION: There is no need to perform surgeries when the midpalatal suture is open, and surgery guidelines are the same for partial and complete fusion sutures. Furthermore, exclusive use of partial paramedian osteotomy is sufficient enough to reduce stress and expand the posterior part of maxilla, and it is less invasive.


Assuntos
Maxila , Técnica de Expansão Palatina , Análise de Elementos Finitos , Humanos , Maxila/cirurgia , Osteotomia
9.
Medicine (Baltimore) ; 99(41): e22529, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031295

RESUMO

BACKGROUND: Reduction malarplasty is a routine clinical procedure among Asian women, but the traditional surgical methods are still associated with serious complications, such as nonunion of the osteotomy sites. Revisional surgery to correct such complications is common, but poor bone healing in the osteotomy area presents a challenge to plastic surgeons. In this report, the authors present a new technique for revision malarplasty that uses the piezosurgery (piezoelectric bone surgery) approach. PATIENT AND DIAGNOSIS: A 30-year-old female patient underwent reduction malarplasty with titanium plate fixation in the zygomatic region at another hospital 4 years ago, but the root of the zygomatic arch was not fixed. The patient was diagnosed with bone nonunion, facial asymmetry, and soft tissue sagging on the right side of the face after malarplasty. INTERVENTION: We used piezosurgery to truncate the displaced healed broken end of the zygomatic bone according to the original osteotomy line. Following this, the malar was re-fixed with micro-titanium mesh, and the zygomatic arch was fixed with a titanium plate. OUTCOME: The patient was followed up for 11 months after the revision procedure. Her facial appearance was satisfactory, and no complications were observed on computed tomography images. LESSONS: This report presents a novel therapeutic option for surgical revision of failed malarplasty. Piezosurgery can help overcome the limitations of traditional surgical methods by reducing bone resorption, preventing resorption of the bone in revision malarplasty, modifying the degree of inward and upward movement of the zygomatic bone by facilitating adjustment of the position of the drill hole in the cortex of the bone stump for stable fixation. Hence piezosurgery can be a simple, accurate, and non-invasive osteotomy method for revision malarplasty.


Assuntos
Assimetria Facial/cirurgia , Piezocirurgia , Complicações Pós-Operatórias/cirurgia , Zigoma/cirurgia , Adulto , Grupo com Ancestrais do Continente Asiático , Placas Ósseas , Feminino , Humanos , Osteotomia , Procedimentos Cirúrgicos Reconstrutivos , Reoperação
10.
Arthroscopy ; 36(10): 2728-2730, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33039043

RESUMO

The posterior tibial slope (PTS), as part of the complex 3-dimensional bony knee morphology, has been a topic of interest for many years but has recently become a hot topic in the scope of reconstructive knee ligament surgery. Biomechanical and clinical evidence suggests that the PTS is an independent and well-accepted risk factor for primary and recurrent anterior cruciate ligament (ACL) injuries. As part of an individualized approach to anatomic ACL reconstruction, the PTS should be respected, and if necessary, addressed, which is especially true for the treatment of multiple failed ACL reconstructions.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Osteotomia , Sobrevivência , Tíbia/cirurgia
13.
Arthroscopy ; 36(9): 2476-2477, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891248

RESUMO

Medial meniscal root tears are biomechanically similar to a total meniscectomy. Repair is clinically indicated and supported by evidence. Increased contact pressures can result in cartilage degeneration and early onset of osteoarthritis. Once diffuse grade 3 or 4 osteoarthritis has settled in, repair may not be indicated anymore. Combining medial meniscal root repair with a high tibial osteotomy for grade 3 or 4 medial-compartment osteoarthritis is not beneficial, and osteotomy alone provides very similar clinical outcomes at 2 years. Meniscal healing was observed in only 18% of patients, and the rate of "cartilage recovery" during second-look arthroscopy was between 8% and 24%. The low sample size, short follow-up, and historical control group limit the validity and generalizability of these conclusions.


Assuntos
Meniscectomia , Meniscos Tibiais , Artroscopia , Humanos , Articulação do Joelho , Osteotomia
14.
Arthroscopy ; 36(9): 2568-2571, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891254

RESUMO

Although the literature has presented results that favored arthroscopic procedures in treating borderline developmental dysplasia of the hip (BDDH), it remains controversial whether arthroscopic surgery would be better than periacetabular osteotomy for BDDH. Instead of a debate on the application of arthroscopy, the issue worthy of discussion should be distinguishing suitable BDDH candidates for hip arthroscopy. First, identification of patients with real BDDH is critical for making management choices. Second, it should be distinguished whether the major symptoms result from mechanical lesions or functional hip instability. Third, once hip arthroscopy is suggested for BDDH patients, relative contraindications such as advanced age and osteoarthritis should be taken into consideration, in addition to labral repair and capsular closure or plication intraoperatively. In conclusion, more long-term and high-grade evidence is still demanded to end the debate, but we believe that an individualized management strategy based on an accurate diagnosis and comprehensive assessment will bring optimal outcomes for BDDH patients.


Assuntos
Luxação Congênita de Quadril , Luxação do Quadril , Artroscopia , Articulação do Quadril , Humanos , Osteotomia
15.
Bone Joint J ; 102-B(9): 1151-1157, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862676

RESUMO

AIMS: Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion requirements in patients undergoing orthopaedic surgery. There remains a lack of prospective evidence for the use of TXA in patients undergoing periacetabular osteotomy (PAO). The purpose of this study was to determine if intravenous (IV) TXA is effective in reducing calculated blood loss and transfusions after PAO. METHODS: This was a single-centre prospective double-blind placebo-controlled randomized trial of 81 patients aged 12 to 45 years undergoing elective PAO by a single surgeon. The intervention group (n = 40) received two doses of IV TXA of a maximum 1 g in each dose; the control group (n = 41) received two doses of 50 ml 0.9% saline IV. The primary outcome was perioperative calculated blood loss. Secondary outcomes included allogenic transfusions and six-week postoperative complications. RESULTS: There were no differences in demographics or intraoperative variables between study groups. The TXA group demonstrated lower mean calculated blood loss (1,265 ml, (SD 321) vs 1,515 ml, (SD 394); p = 0.002) and lower frequency of allogenic transfusion (10%/n = 4 vs 37%/n = 15; p = 0.008). Regression analyses associated TXA use with significant reductions in calculated blood loss (p < 0.001) and transfusion (p = 0.007) after adjusting for age, sex, body mass index, preoperative haemoglobin, cell-saver volume, intraoperative mean arterial blood pressure, and operating time. No patients suffered venous thromboembolic complications. CONCLUSION: In this trial, IV TXA decreased postoperative calculated blood loss by 293 ml and reduced the frequency of allogenic transfusions by 73% (37% vs 10%) following PAO. TXA may be safe and effective for reducing blood loss in patients undergoing PAO. Cite this article: Bone Joint J 2020;102-B(9):1151-1157.


Assuntos
Acetábulo/cirurgia , Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/estatística & dados numéricos , Osteotomia , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Administração Intravenosa , Adolescente , Adulto , Criança , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
16.
Medicine (Baltimore) ; 99(37): e22204, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925797

RESUMO

Many surgical procedures have been developed for the treatment of post-traumatic thoracolumbar kyphosis. But there is a significant controversy over the ideal management. The aim of this study was to illustrate the technique of modified grade 4 osteotomy for the treatment of post-traumatic thoracolumbar kyphosis and to evaluate clinical and radiographic results of patients treated with this technique.From May 2013 to May 2018, 42 consecutive patients experiencing post-traumatic thoracolumbar kyphosis underwent the technique of modified grade 4 osteotomy, and their medical records were retrospectively collected. Preoperative and postoperative sagittal Cobb angle, visual analog scale (VAS), Oswestry disability index (ODI), and American Spinal Injury Association (ASIA) were recorded. The average follow-up period was 29.7 ±â€Š14.2 months.The operation time was 185.5 ±â€Š26.8 minutes, the intraoperative blood loss was 545.2 ±â€Š150.1 mL. The Cobb angles decreased from 38.5 ±â€Š3.8 degree preoperatively to 4.2 ±â€Š2.6 degree 2 weeks after surgery (P < .001). The VAS reduced from 6.5 ±â€Š1.1 preoperatively to 1.5 ±â€Š0.9 at final follow-up (P < .001), and the ODI reduced from 59.5 ±â€Š15.7 preoperatively to 15.9 ±â€Š5.8 at final follow-up (P < .001). Kyphotic deformity was successfully corrected and bony fusion was achieved in all patients. Neurologic function of 7 cases was improved to various degrees.Modified grade 4 osteotomy, upper disc, and upper one-third to half of pedicle are resected, is an effective treatment option for post-traumatic thoracolumbar kyphosis. However, the long-term clinical effect still needs further studies.


Assuntos
Cifose/cirurgia , Vértebras Lombares/cirurgia , Osteotomia/métodos , Vértebras Torácicas/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Escala Visual Analógica
17.
Medicine (Baltimore) ; 99(39): e22294, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991433

RESUMO

RATIONALE: Kirner's deformity is an uncommon deformity of finger, characterized by palmo-radial curvature of distal phalanx of the fifth finger. The specific mechanism remains unknown yet. This study aims to present a case report to add the knowledge on this type of deformity. PATIENT CONCERNS: A 9-year-old girl presenting with deformity of her fifth finger since she was born was admitted to our hand surgery clinic. MRI findings showed widened epiphyseal plate, L-shaped physis, but normal flexor digitorum profundus tendon insertion, without any significantly enhanced soft issues. DIAGNOSIS: Kirner's deformity of the fifth finger. INTERVENTIONS: We presented 2 surgical choices for the patient: one was wedge osteotomy of the distal phalanx to correct the mechanical line of the distal phalanx and fixation with Kirschner wire and the other one was cut-off of deep flexor tendon insertion with brace immobilization, but her guardians refused either of them. OUTCOMES: Consecutive follow-up was performed for 19 months after the first visit, showing no any change in finger shape and function. LESSONS: The L-shaped epiphyses may be the cause of Kirner's deformity and further attention should be paid on in the clinic. This case report provided a basis for the etiological diagnosis and future treatment of Kirner's deformity.


Assuntos
Falanges dos Dedos da Mão/anormalidades , Deformidades Congênitas da Mão/diagnóstico por imagem , Osteotomia/instrumentação , Assistência ao Convalescente , Fios Ortopédicos/normas , Braquetes/normas , Criança , Feminino , Falanges dos Dedos da Mão/cirurgia , Lâmina de Crescimento/anormalidades , Lâmina de Crescimento/diagnóstico por imagem , Deformidades Congênitas da Mão/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Osteotomia/métodos , Tendões/diagnóstico por imagem , Tendões/cirurgia , Recusa do Paciente ao Tratamento
18.
J Vet Sci ; 21(4): e62, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32735099

RESUMO

A 5-month old Shih Tzu was diagnosed with congenital elbow luxation and uniapical complex angular deformity of the radius. Single radial oblique and dynamic ulnar osteotomies were performed, using patient-specific 3D-printed osteotomy guide. External skeletal fixation was maintained for three weeks to prevent re-luxation of elbow joint. Three months after the surgery, objective gait analysis indicated markedly improved limb function. In addition, radiograph showed improved congruity of elbow joint and appropriate bone healing. In dogs with congenital radial head luxation and concurrent complex angular deformity, a single oblique osteotomy might be a viable option to preserve bone length and correct the luxation of elbow joint.


Assuntos
Cães/cirurgia , Luxações Articulares/veterinária , Osteotomia/veterinária , Animais , Cães/anormalidades , Luxações Articulares/congênito , Luxações Articulares/cirurgia , Masculino , Radiografia/veterinária , Rádio (Anatomia)/anormalidades , Rádio (Anatomia)/cirurgia
19.
J Vet Sci ; 21(4): e67, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32735102

RESUMO

BACKGROUND: Tibial tuberosity transposition (TTT) causes caudalization of the patellar ligament insertion in canine medial patellar luxation, which can lead to increases in patellofemoral contact pressure. OBJECTIVES: The purpose of this study is to confirm the effect of patellofemoral contact mechanics after craniolateral and caudolateral transposition of tibial tuberosity in normal canine hindlimbs. METHODS: Craniolateral and caudolateral transposition of tibial tuberosity was performed in 5 specimens, respectively. The pressure was measured in the specimen before TTT, and then in the same specimen after TTT. In this process, data was obtained in 10 specimens. The measurement results were output as visualization data through the manufacturer's software and numerical data through spreadsheet. Based on these 2 data and the anatomical structure of the patellofemoral joint (PFJ) surface, whole measurement area was analysed by dividing into medial, lateral and central area. RESULTS: In craniolateralization of tibial tuberosity, total, medial, central contact pressure was decreased and lateral contact pressure was not statistically changed lateral contact pressure than normal PFJ. In caudolateralization of tibial tuberosity, total, lateral contact pressure was increased and medial contact pressure was not statistically changed than normal PFJ. Although not statistically significant changed, central contact pressure in caudolateralization of tibial tuberosity was increased in all 5 specimens. CONCLUSIONS: These results imply that traditional TTT, prone to caudal shift of patellar tendon, can increase retropatellar pressure may lead to various complications and diseases of the stifle joint.


Assuntos
Doenças do Cão/cirurgia , Instabilidade Articular/cirurgia , Osteotomia/veterinária , Patela/cirurgia , Luxação Patelar/veterinária , Ligamento Patelar/cirurgia , Tíbia/cirurgia , Animais , Fenômenos Biomecânicos , Cães , Instabilidade Articular/fisiopatologia , Luxação Patelar/complicações , Luxação Patelar/cirurgia
20.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 111-113, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856449

RESUMO

Medial open-wedge (MOW) high tibial osteotomy (HTO) is proven treatment option, indicated in medial unicompartimental knee osteoarthritis (OA) and in varus OA. New devices and techniques were developed in last years, such as Activemotion plates with polyaxial locking system (Dualtec System®, NewClip-Technics) and PSI technique. We describe outcomes and rate of complications in patients treated with Activemotion plates and PSI technique. From January 2019 to August 2019 a sample of 77 cases (72 NCT plates, 5 PSI technique) was observed, evaluating the rate of complications and the return to activity. The rate of complications is 2.6% and the mean time to return to activity is 10 weeks. MOW HTO with Activemotion plate has showed good results with a low rate of complications. About PSI technique, the preliminary results are excellent, but we need to increase the sample.


Assuntos
Osteotomia , Tíbia , Placas Ósseas , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Radiografia , Tíbia/cirurgia , Resultado do Tratamento
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