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1.
Ann R Coll Surg Engl ; 103(4): 272-277, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682473

RESUMO

INTRODUCTION: Aesthetic rhinoplasty remains a challenging procedure with high expectations and narrow tolerance for errors. Considerable training is required to achieve controlled and reliable results. Use of the Piezotome is gaining popularity for performing the nasal osteotomies, a key step in rhinoplasty, where it is reported to improve precision and predictability and to keep tissue damage to a minimum. We compare the outcomes of conventional osteotomy techniques to piezosurgery in human cadavers as undertaken by surgical trainees. MATERIALS AND METHODS: Seven human cadavers were used and a total of 14 osteotomies were performed. Conventional osteotomies and piezosurgery were carried out each on one side of the cadaver. A number of fragments and a blinded assessment of the accuracy of the osteotomy compared with the preprocedure skin markings were carried out by two experienced rhinoplasty surgeons. The Mann-Whitney test for statistical analysis was used. RESULTS: The mean number of fragments was 1.57 in the piezosurgery osteotomy and 2.14 using conventional osteotomies. Four of seven piezosurgery osteotomies achieved an accuracy within 1mm. The conventional osteotomies as performed by the trainees showed a significant mismatch of more than 3mm in three of seven of cases. Accuracy within 1mm was achieved in one of seven cases. DISCUSSION: Piezosurgery offers a safe, reliable and precise method of performing lateral nasal osteotomies. This human cadaver study shows a high accuracy of osteotomy and fewer comminuted fractures using this technique compared with conventional osteotomy techniques.


Assuntos
Osso Nasal/cirurgia , Osteotomia/métodos , Piezocirurgia/métodos , Rinoplastia/métodos , Humanos , Osteotomia/efeitos adversos , Osteotomia/instrumentação , Avaliação de Resultados em Cuidados de Saúde , Piezocirurgia/efeitos adversos , Piezocirurgia/instrumentação , Rinoplastia/efeitos adversos , Rinoplastia/instrumentação
2.
Medicine (Baltimore) ; 100(12): e24330, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761633

RESUMO

ABSTRACT: This study aimed to investigate the therapeutic effects of osteotomy combined with lateral ligament reconstruction on the osteochondral lesion of patients with talar injuries and varus ankles.Seventy five patients with talar injuries and varus ankles who received osteotomy combined with lateral ligament reconstruction for the osteochondral lesions from June 2008 to December 2014 were retrospectively reviewed. Patients were followed up for 32.4 ±â€Š15.3 months after surgeries, and the AOFAS-AH score, VAS score and SF36 score were determined preoperatively and postoperatively. The iconographic data were compared preoperatively and postoperatively, including tibial anterior surface angle (TAS), TTS, TT, and tibial lateral surface angle (TLS) angles.After surgeries, the AOFAS-AF score increased from 43.2 ±â€Š8.1 to 82.1 ±â€Š5.6, the VAS score decreased from 6.9 ±â€Š2.3 to 1.8 ±â€Š1.5, and the SF36 score increased from 48.7 ±â€Š9.4 to 83.5 ±â€Š6.2. TAS increased from 83.3 ±â€Š5.1 to 90.3 ±â€Š6.1, TTS increased from 70.3 ±â€Š6.1 to 82.5 ±â€Š5.4, TT decreased from 12.9 ±â€Š6.1 to 6.9 ±â€Š5.7, and TLS increased from 76.5 ±â€Š4.1 to 81.2 ±â€Š3.3 (P < .05).Osteotomy combined with lateral ligament reconstruction is effective for the treatment of talar osteochondral lesion with varus ankle, which could relieve the arthritic symptoms induced by cartilage lesions. By correcting the force line on lower limbs and metapedes with osteotomy completely, the treatments on talar osteochondral lesion and lateral ligament reconstruction are the critical factors with better results.


Assuntos
Articulação do Tornozelo/anormalidades , Ligamentos Colaterais/cirurgia , Osteotomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tálus/lesões , Articulação do Tornozelo/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Desbridamento/efeitos adversos , Desbridamento/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Tálus/cirurgia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(3): e23978, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545983

RESUMO

BACKGROUND AND PURPOSE: Medial compartment femoro-tibial osteoarthritis (OA) is a common disease and opening-wedge high tibial osteotomy (OWHTO) is the common surgical procedure carried out for these patients. While most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the pain control effect of femoral nerve block (FNB) for OWHTO patients. METHODS: In this prospective, single-center, randomized controlled trial (RCT) study, 41 patients were operated on by OWHTO for OA during 2017 to 2018. Twenty of them (group A) accepted epidural anesthesia with FNB and 21 patients (group B) only had their single epidural anesthesia. All blocks were successful and all the 41 patients recruited were included in the analysis and there was no loss to follow-up or withdrawal. Systematic records of visual analog scores (VAS), quadriceps strength, mean number of times of patient-controlled intravenous analgesia (PCIA), using of additional opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), and complications were done after hospitalization. The Student t test and Chi-Squared test was used and all P values ≤.05 were considered statistically significant. RESULTS: VAS scores at rest (3.48 ±â€Š1.0 vs 4.68 ±â€Š1.1) and on movemment (4.51 ±â€Š0.6 vs 4.97 ±â€Š0.8) decreased more in group A than group B with significance at follow-up of 12 hours. The quadriceps strength, consumption of additional opioids or NSAID injections and mean number of times that the patients pushed the PCIA button didnot differ significantly within each group. CONCLUSION: This RCT study shows that FNB in patients undergoing OWHTO for unicompartmental osteoarthritis of the knee could result in significant reduction in VAS scores at 12 hours postoperatively.Research registry, Researchregistry4792. Registered April 7, 2019 - Retrospectively registered, http://www.researchregistry.com.


Assuntos
Nervo Femoral/efeitos dos fármacos , Bloqueio Nervoso/normas , Manejo da Dor/normas , Tíbia/cirurgia , Feminino , Nervo Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Bloqueio Nervoso/estatística & dados numéricos , Osteotomia/efeitos adversos , Osteotomia/métodos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Estudos Prospectivos , Tíbia/efeitos dos fármacos
4.
Yonsei Med J ; 62(1): 59-67, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33381935

RESUMO

PURPOSE: This study aimed to present our experiences with a precise surgical strategy for sacrectomy. MATERIALS AND METHODS: This study comprised a retrospective review of 16 patients (6 males and 10 females) who underwent sacrectomy from 2011 to 2019. The average age was 42.4 years old, and the mean follow-up period was 40.8 months. Clinical data, including age, sex, history, pathology, radiographs, surgical approaches, onset of recurrence, and prognosis, were analyzed. RESULTS: The main preoperative symptom was non-specific local pain. Nine patients (56%) complained of bladder and bowel symptoms. All patients required spinopelvic reconstruction after sacrectomy. Three patients, one high, one middle, and one hemi-sacrectomy, underwent spinopelvic reconstruction. The pathology findings of tumors varied (chordoma, n=7; nerve sheath tumor, n=4; giant cell tumor, n=3, etc.). Adjuvant radiotherapy was performed for 5 patients, chemotherapy for three, and combined chemoradiotherapy for another three. Six patients (38%) reported postoperative motor weakness, and newly postoperative bladder and bowel symptoms occurred in 5 patients. Three patients (12%) experienced recurrence and expired. CONCLUSION: In surgical resection of sacral tumors, the surgical approach depends on the size, location, extension, and pathology of the tumors. The recommended treatment option for sacral tumors is to remove as much of the tumor as possible. The level of root sacrifice is a predicting factor for postoperative neurologic functional impairment and the potential for morbidity. Pre-operative angiography and embolization are recommended to prevent excessive bleeding during surgery. Spinopelvic reconstruction must be considered following a total or high sacrectomy or sacroiliac joint removal.


Assuntos
Osteotomia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Feminino , Humanos , Masculino , Osteotomia/efeitos adversos , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/fisiopatologia
5.
J Pediatr Orthop ; 41(1): e7-e13, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32804861

RESUMO

BACKGROUND: Treatment of symptomatic hip dysplasia in skeletally mature patients with spastic cerebral palsy (CP) can be challenging. This study examines our technical experience with the Bernese periacetabular osteotomy (PAO) in combination with adjunctive procedures in the treatment of this complex hip deformity. METHODS: Sixteen consecutive patients (18 hips) with symptomatic CP hip dysplasia were treated with a PAO and variable adjunctive procedures and retrospectively reviewed. Two patient (2 hips) were excluded due to insufficient follow-up. The average age at the time of surgery was 17.7 years (range: 13 to 28 y). We compared the preoperative to postoperative changes in radiographic parameters as well as early outcomes as measured by patient assessment of hip pain and function using the modified Harris Hip Score (mHHS). RESULTS: The average time of follow-up was 3.3 years (range: 2.0 to 6.3 y). Tönnis angles decreased from a median of 30 degrees (range: 18 to 45 degrees) preoperatively to a median of 6 degrees (range: -9 to 21 degrees) postoperatively. Lateral center-edge angles increased from a median of -8 degrees (range: -28 to 15 degrees) to a median of 32 degrees (range: 19 to 38 degrees). Anterior center-edge angles increased from a median of 2 degrees (range: -22 to 39 degrees) to a median of 35 degrees (range: 22 to 47 degrees). The extrusion index decreased from a median of 57% preoperatively (range: 35% to 73%) to a median of 21% (range: 11% to 36%) postoperatively.The median mHHS was 62 (range: 37 to 81) preoperatively and 85 (range: 65 to 100) postoperatively. Notably, the pain component of the mHHS improved from 20 (range: 0 to 44) to 42 (range: 30 to 44). Tönnis osteoarthritis grade preoperatively was either 0 (11 hips) or 1 (5 hips) and remained unchanged in 11 hips and increased by 1 grade in 5 hips. CONCLUSIONS: It has been our experience that the Bernese PAO in combination with appropriate adjunctive treatments has provided a very satisfactory surgical approach in the treatment of CP hip dysplasia. In the adolescent and young adult with spastic CP, utilizing the Bernese PAO technique makes it possible to obtain redirection of often a very severe acetabular dysplasia. Adjunctive soft tissue procedures and a proximal femoral osteotomy are frequently necessary to maintain postoperative stability. A notable improvement in the quality of life and function directly attributable to our surgical treatment of their pre-existing problematic hip dysplasia has been consistently noted in early follow-up for our patients. LEVEL OF EVIDENCE: Level IV-therapeutic.


Assuntos
Paralisia Cerebral/complicações , Fêmur/cirurgia , Luxação do Quadril/cirurgia , Osteotomia/métodos , Acetábulo/cirurgia , Adolescente , Adulto , Artralgia , Feminino , Luxação do Quadril/etiologia , Humanos , Masculino , Osteotomia/efeitos adversos , Qualidade de Vida , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
J Med Life ; 13(2): 160-163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32728403

RESUMO

A first ray dorsiflexion osteotomy is commonly performed for cavovarus foot correction. There are multiple techniques to fix this osteotomy, ranging from wires, screws, and plates or a combination of these. We present our results using a varisation staple (Biomet©) as an alternative fixation device. We performed a retrospective outcome analysis of a consecutive series of 10 cavovarus feet that underwent a dorsiflexion osteotomy (dorsal closing wedge) of the first metatarsal fixed with two varisation staples. The results were measured at a mean three monthly follow-ups and included union and complication rates, as well as clinical and radiographic assessment of cavus deformity correction. There was a 100% union rate with no complications or cases of delayed union. No metalwork removal was requested in any case at follow-up. First ray dorsiflexion osteotomies are most commonly fixed using a 3.5mm cortical screw. We demonstrate that our alternative and novel technique using varisation staples achieved a 100% union rate while avoiding the prominent hardware complications known to occur with cortical screws or plates.


Assuntos
Ossos do Metatarso/cirurgia , Osteotomia/métodos , Humanos , Ossos do Metatarso/diagnóstico por imagem , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Zhonghua Wai Ke Za Zhi ; 58(7): 551-554, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32610426

RESUMO

As an effective way to reconstruct the spinal alignment, osteotomy has been widely used to reconstruct the sagittal alignment of spine and achieved significant results.In order to avoid the secondary sagittal disequilibrium caused by the inaccurate osteotomy angle, it is very important to make an appropriate operation plan before the operation and evaluate the osteotomy angle accurately.At present, scholars have proposed different targets for sagittal reconstruction of the spine with different patients and diseases.They also proposed various prediction methods of osteotomy angle according to different reconstruction standards and principles, as well as the selection of osteotomy sites and methods.In this paper, the preoperative evaluation of the osteotomy angle was reviewed in terms of the target of sagittal reconstruction, the prediction of osteotomy angle and the selection of osteotomy method and osteotomy site.


Assuntos
Osteotomia/métodos , Curvaturas da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Humanos , Osteotomia/efeitos adversos , Cuidados Pré-Operatórios
8.
Jt Dis Relat Surg ; 31(2): 298-305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584729

RESUMO

OBJECTIVES: This study aims to report the physiological and radiological long-term results of total hip arthroplasty (THA) combined with or without subtrochanteric osteotomy in a group of developmental dysplasia of hip (DDH) patients. PATIENTS AND METHODS: This retrospective study included 90 hips of 59 patients (3 males, 56 females; mean age 45.7±10.9 years; range, 24 to 67 years) who underwent THA between January 1979 and March 2006. Thirteen patients needed subtrochanteric shortening. The evaluation was performed through Harris hip scores, physical examination, and radiological imaging. RESULTS: The follow-up period ranged from 5 to 32 years, and the mean follow-up period was 10.3±6.4 years. Revision was required in 17 hips out of 90. Twelve revisions were needed because of aseptic loosening of femoral or acetabular component, three were for fracture of the femoral stem, and two for protrusio acetabuli. Four patients had transient nerve palsy, and one had permanent nerve function loss. In one patient, nonunion was observed around the femoral osteotomy site. Harris hip score was remarkably improved compared to top preoperative values (48 vs. 88.2, p<0.01). CONCLUSION: Although revision rates tend to increase in long-term follow-up, THA is one of the best treatment options in DDH patients to relieve pain, improve daily activity levels, and minimize the damage of the knee and lumbar region.


Assuntos
Artroplastia de Quadril , Luxação Congênita de Quadril/cirurgia , Quadril , Efeitos Adversos de Longa Duração , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Feminino , Seguimentos , Quadril/diagnóstico por imagem , Quadril/fisiopatologia , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/epidemiologia , Efeitos Adversos de Longa Duração/etiologia , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
9.
Jt Dis Relat Surg ; 31(2): 353-359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584737

RESUMO

OBJECTIVES: This study aims to describe a stepped osteotomy technique applied to the femoral head autograft to keep the graft volume at a sufficient level, provide primary stability, and direct cancellous-cancellous bone contact. PATIENTS AND METHODS: In this retrospective study, 24 hips of 20 patients (5 males, 15 females; mean age 53 years; range, 43 to 68 years) with dysplasia of the hip (DDH) who underwent total hip arthroplasty with femoral head stepped osteotomy technique were evaluated between April 2003 and June 2010. Patients' age, gender, operation side, and postoperative complications were recorded. Aseptic loosening of the acetabular cup and graft integration/resorption were evaluated radiographically. Radiological evaluations were performed according to the methods of DeLee and Charnley, and Mulroy and Harris. Functional status of the patients was determined according to the criteria of Merle d'Aubigné and Postel, and Harris hip score (HHS). RESULTS: The mean follow-up period was 5.5 years (range, 3 to 12 years). None of the patients had any complications in the early postoperative period. In all patients, the percentage of acetabular component coverage by the graft was measured as 27% (range, 19 to 38%) on average. At the last follow-up, all patients were satisfied with the result and there was no sign of clinically loosening, osteointegration was complete, and there was no radiographic evidence of graft resorption or collapse of any hip. The overall Merle d'Aubigné scores and HHSs of the patients significantly improved at the final follow-up. CONCLUSION: This stepped osteotomy technique increases the probability of osteointegration, reduces the need for early revision, and provides reliable stability with satisfactory clinical and radiological midterm results.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril , Cabeça do Fêmur/cirurgia , Luxação Congênita de Quadril/cirurgia , Osteotomia , Complicações Pós-Operatórias , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Autoenxertos/diagnóstico por imagem , Feminino , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/etiologia , Efeitos Adversos de Longa Duração/prevenção & controle , Masculino , Pessoa de Meia-Idade , Osseointegração , Osteotomia/efeitos adversos , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Radiografia/métodos , Estudos Retrospectivos
10.
Jt Dis Relat Surg ; 31(2): 382-385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584741

RESUMO

Although Kirschner (K)-wire is among the most commonly used implants in orthopedic surgeries, the migration of this material is a very rare complication. In this article, we present the case of a K-wire migration four years after the surgery detected during the routine control of a 10-year-old male patient who underwent surgical treatment due to the diagnosis of developmental hip dys-plasia on the cerebral palsy. The aim of this study was to raise the awareness regarding this complication particularly for the pediatric orthopedic surgeons, and to recommend the removal of the K-wire as soon as bone union occurs.


Assuntos
Fios Ortopédicos/efeitos adversos , Paralisia Cerebral/complicações , Remoção de Dispositivo/métodos , Luxação do Quadril , Falha de Prótese , Espaço Retroperitoneal/diagnóstico por imagem , Criança , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Humanos , Masculino , Osteotomia/efeitos adversos , Osteotomia/instrumentação , Osteotomia/métodos , Ossos Pélvicos/cirurgia , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/cirurgia , Radiografia/métodos , Resultado do Tratamento
11.
Ulus Travma Acil Cerrahi Derg ; 26(4): 586-592, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589253

RESUMO

BACKGROUND: This research aimed to evaluate the functional outcomes of intra-articular distal humeral fractures treated through a combined medial-lateral approach and comparing with olecranon osteotomy simultaneously. METHODS: In this study, 62 distal humeral fractures patients were assessed retrospectively. The olecranon osteotomy was used in 30 cases (14 males, 16 females) and combined medial-lateral in 32 cases (15 males, 17 females). The outcomes of function were assessed by the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. The follow-up time was 15.4±3.5 months (range 10-24 months) for a combined medial-lateral group and 14.6±2.6 months (range 10-20 months) for olecranon osteotomy. LEVEL OF EVIDENCE: Level, retrospective study. RESULTS: The flexion-extension of elbows was 115.3°±16.1° in the combined medial-lateral group, and the olecranon osteotomy group was 110.1°±15.2°. A significant difference was observed between the two groups for flexion-extension of the elbows (p=0.041). Pronation-supination of the forearms had a significant difference (p=0.025) between the combined medial-lateral group (160.6°±7.2°) and the olecranon osteotomy group (154.1°±9.3°). Mean MEPS, DASH, excellent and good rate and complication rate for combined medial-lateral approaches were 88.6±6.9 points, 9.8±6.6 points, 90.6% and 9.4%, respectively. Significant differences were not noted between the two groups for mean MEPS, DASH scores and excellent and good rate (p=0.594, p=0.505, p=0.934, respectively) except complication rate (p=0.005). CONCLUSION: The combined medial-lateral approach is successful approach in the treatment of intra-articular distal humeral fractures (especially type C1 and C2) that provides better outcomes for the motion of the elbow, bleeding volume in surgery and complications than olecranon osteotomy.


Assuntos
Fixação Interna de Fraturas , Fraturas do Úmero/cirurgia , Olécrano/cirurgia , Osteotomia , Articulação do Cotovelo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/estatística & dados numéricos , Humanos , Masculino , Osteotomia/efeitos adversos , Osteotomia/métodos , Osteotomia/estatística & dados numéricos , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
13.
Ann Vasc Surg ; 69: 217-223, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32497616

RESUMO

BACKGROUND: Definitive treatment of Paget-Schroetter syndrome (PSS) involves first rib resection (FRR), division of the anterior scalene muscle, and resection of the subclavius muscle. This is a single-institution experience with PSS, according to a treatment algorithm of preoperative venogram (accompanied by lysis and percutaneous mechanical thrombectomy as needed) followed by transaxillary FRR. In the later period of this experience, patients have often been discharged on aspirin only, with no plan for anticoagulation postoperatively. We sought to evaluate outcomes in light of this experience and these practice patterns. METHODS: Between 2007 and 2018, 125 transaxillary FRRs were performed in 123 patients. All patients presented with documented venous thrombosis, underwent diagnostic venography and-if indicated-lysis and percutaneous mechanical thrombectomy (VPT) before FRR. The patient was not offered FRR if the vein could not be crossed with a wire and patency was not re-established during percutaneous treatment. The experience was divided into early (before 2012, n = 50) and late (n = 75) periods. RESULTS: Mean patient age was 28.4 (12-64 years) years. Of the cohort, 33 were high-level competitive athletes, 13 presented with documented pulmonary embolism in addition to local symptoms, and 3 had a cervical rib fused to the first rib. Patients underwent FRR a median of 50 (4 days to 18 years) days after their initial symptoms, and a median of 22 (1 day to 9 months) days after their percutaneous intervention. Postoperative VPT was required in 23 patients and performed a median of 5 (1-137 days) days postoperatively; in 19 of these patients, postoperative VPT was required for postoperative re-thrombosis, whereas in 4 patients, postoperative VPT was planned before FRR due to vein stenosis or residual thrombus. All these patients were prescribed postoperative anticoagulation. No operative venous reconstruction or bypass was performed. Median follow-up time after FRR was 242 days; at last follow-up, 98.4% (123/125) of axillosubclavian veins were patent by duplex ultrasound (and all those patients were asymptomatic). Postoperative anticoagulation was less frequently prescribed in the late experience, with no difference in the rate of early re-thrombosis or follow-up patency. CONCLUSIONS: This experience demonstrates 98.4% patency at last follow-up with standard preoperative percutaneous venography and intervention, transaxillary FRR, and postoperative endovascular re-intervention only in cases with persistent symptoms, stenosis, or re-thrombosis. Patients presenting with both acute and chronic PSS did not require surgical venous reconstruction. In the later experience, patients frequently have not been anticoagulated postoperatively. Advantages of this algorithm include the following: (1) the cosmetic benefits of the transaxillary approach, (2) the preoperative assessment of the ability to recanalize the vein to determine which patients will benefit from surgery, (3) the capacity to use thrombolysis preoperatively, and (4) potential elimination of the risk and inconvenience of postoperative anticoagulation.


Assuntos
Anticoagulantes/administração & dosagem , Osteotomia , Cuidados Pós-Operatórios , Costelas/cirurgia , Trombose Venosa Profunda de Membros Superiores/cirurgia , Adolescente , Adulto , Anticoagulantes/efeitos adversos , Criança , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Philadelphia , Flebografia , Cuidados Pós-Operatórios/efeitos adversos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Trombectomia , Terapia Trombolítica , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/fisiopatologia , Grau de Desobstrução Vascular , Adulto Jovem
14.
Zhonghua Wai Ke Za Zhi ; 58(6): 425-429, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498480

RESUMO

High tibial osteotomy(HTO) is an effective method for the treatment of knee osteoarthritis by transferring the weight bearing line to the lateral tibial plateau, which can significantly reduce the pressure and cartilage lesion of medial knee compartment.However, under- and over-correction of weight bearing line can lead to early postoperative failure.It is necessary to define the standard of axis correction, make correct preoperative plan, ensure the accuracy of operation and consider the risk factors of under- and over-correction of axis.With the advent of the era of intelligent medicine, the application of patient-specific instrumentation technology based on three dimention printing and navigation technology will help to achieve the precise control of axial alignment in high tibial osteotomy.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Osteotomia/tendências , Tíbia/cirurgia , Mau Alinhamento Ósseo/etiologia , Mau Alinhamento Ósseo/prevenção & controle , Humanos , Articulação do Joelho/cirurgia , Extremidade Inferior/cirurgia , Osteotomia/efeitos adversos , Cirurgia Assistida por Computador
15.
Zhonghua Wai Ke Za Zhi ; 58(6): 435-440, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498482

RESUMO

Objective: To investigate the sagittal and torsional changes in the tibia after a medial open wedge high tibial osteotomy (OWHTO) and their correlation with the corrective angle of proximal tibial coronal plane. Methods: A prospective analysis was conducted on patients who underwent OWHTO at Department of Orthopaedic Surgery, Beijing Chaoyang Emergency Medical Center from March 2019 to July 2019.The operation were performed by the same surgeon. X-ray and CT were performed before and 3 days after the operation. The mechanical axis angle (mFTA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and tibial torsion angle (TTA) were measured and compared by paired t-test. Pearson correlation coefficient was used to analyze the correlation between the changes of PTS and TTA and the correction angle of MPTA. Results: A total of 13 patients (19 knees) were recruited. There were 9 males (13 knees) and 4 females (6 knees), aged (39.4±14.4) years (range:20 to 60 years). The mFTA improved from (8.1±2.8) degrees preoperatively to (-1.4±1.6) degrees postoperatively (t=14.819, P=0.000). The MPTA was changed from (81.1±2.4) degrees pre-operatively to (90.4±3.4) degrees postoperatively (t=-15.579, P=0.000). The PTS decreased from (79.6±3.2) degrees to (76.8±3.1) degrees (t=9.709, P=0.000). The differences of mFTA, MPTA and PTS were statistically significant. There was no significant difference in TTA between before and after operation ((28.2±1.5) ° vs. (27.3±6.3) °,t=1.925, P=0.070). There was no correlation between the correction angle of MPTA and the change of PTS and TTA (r=0.384, P=0.105; r=0.321, P=0.181). Conclusions: Even if the intra-operative measures were used to control tibial slope, the PTS still increased significantly after OWHTO, while the TTA has no significant change. No correlation was seen between the change of sagittal and torsional and the corrective angle of proximal tibial coronal plane.


Assuntos
Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Osteotomia/métodos , Tíbia/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Adulto , Feminino , Humanos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Período Pós-Operatório , Estudos Prospectivos , Tíbia/cirurgia , Anormalidade Torcional/etiologia , Adulto Jovem
16.
Zhonghua Wai Ke Za Zhi ; 58(6): 447-451, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498484

RESUMO

Objective: To analyze the incidence of recent complications in patients with osteoarthritis of the knee (OA) after medial opening wedge high tibial osteotomy(MOWHTO) and its influence on clinical effect. Methods: The clinical data of 131 patients with knee OA who received MOWHTO at Department of Sports Medicine and Arthroscopy,Tianjin Hospital from April 2017 to September 2018 were analyzed retrospectively. There were 75 males and 56 females, aged (62.8±5.1) years (range:48 to 70 years). Complications and clinical outcomes of patients were recorded and the proximal medial angle of tibia (MPTA), the International Knee Documentation Committee Subjective Knee Form (IKDC), the Western Ontario and McMaster Universities(WOMAC) Osteoarthritis Index and Knee Injury and Osteoarthritis Outcome score(KOOS) were collected before and 1 year after operation and compared between complication group and non-complication group. Data were analyzed by paired-samples t test, independent samples t test and χ(2) test. Results: The follow-up time was (18.5±3.4) months (range:13 to 22 months). Complications occurred in 22 patients(16.8%), including 8 cases(6.1%) of hematoma, 5 cases(3.8%) of neurosensory abnormality, 4 cases(3.1%) of intramuscular venous thrombosis, 2 cases(1.5%) of deep venous thrombosis, 3 cases(2.3%) of loss of correction angle, 3 cases(2.3%) of superficial infection, 2 cases(1.5%) of deep infection, 2 cases(1.5%) of delayed union of fracture, 1 case(0.8%) of postoperative stiffness, 1 case (0.8%) of hinge point cortex fracture. There were no significant difference in MPTA ((86.5±2.0)° vs. (86.7±2.1)°, t=-0.41, P=0.68) , IKDC ((86.4±4.8) vs.(85.5±6.9), t=0.74, P=0.50) , WOMAC ((87.7±6.5) vs. (86.1±5.8), t=1.16, P=0.25). There were no significant difference in knee scores except for the KOOS pain score ((79.4±4.4) vs. (87.2±5.9), t=-5.90, P<0.01) and sports and recreation score ((83.2±3.0) vs. (88.0±4.7), t=-6.14, P<0.01) . Conclusion: Short-term complications of MOWHTO can be managed appropriately through early diagnosis and individualized treatment and have no significant negative effect on knee function recovery of patients.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/efeitos adversos , Tíbia/cirurgia , Idoso , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
17.
Orthop Clin North Am ; 51(3): 403-422, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498959

RESUMO

This article presents the indications, contraindications, preoperative surgical planning, surgical technique, and postoperative management of some of the most common percutaneous procedures in orthopedic foot and ankle surgery. The background of each procedure also is presented, supported by the latest in published literature to educate surgeons. Such topics include percutaneous bunionectomy, lesser toe deformity and bunionette correction, calcaneal osteotomy, cheilectomy, and first metatarsophalangeal joint arthrodesis.


Assuntos
Ossos do Pé/cirurgia , Procedimentos Ortopédicos/métodos , Tornozelo/diagnóstico por imagem , Tornozelo/cirurgia , Artrodese/efeitos adversos , Artrodese/métodos , Pé/diagnóstico por imagem , Pé/cirurgia , Ossos do Pé/diagnóstico por imagem , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Ortopédicos/efeitos adversos , Osteotomia/efeitos adversos , Osteotomia/métodos , Falanges dos Dedos do Pé/diagnóstico por imagem , Falanges dos Dedos do Pé/cirurgia
18.
Rev. Soc. Andal. Traumatol. Ortop. (Ed. impr.) ; 37(2): 69-74, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198468

RESUMO

El desplazamiento epifisario medial o lateral -ad latum- es un problema no deseado que altera el eje mecánico de la extremidad en las correcciones progresivas de deformidades angulares mediante osteotomías con aparatos de fijación externa monolateral. Los autores explican este fenómeno en modelos anatómicos y proponen una sencilla recomendación técnica para evitar dicho fenómeno. TÉCNICA: Tras la correcta colocación de los tornillos del fijador externo, el cabezal epifisario no se aprieta completamente para que permita el deslizamiento de los tornillos que se insertan en la epífisis en la mordaza del aparato. CONCLUSIONES: Esta sencilla recomendación evita el efecto ad latum no deseado cuando se realiza una osteomía y corrección gradual con fijación externa monolateral


Medial or lateral epiphyseal displacement -ad latum- is an undesired problem that alters the mechanical axis of the limb in progressive corrections of angular deformities by osteotomies with monolateral external fixation devices.The authors explain this phenomenon in anatomical models and propose a simple technical recommendation to avoid it. TECHNIQUE: After a proper placement of the screws, the epiphyseal head of the external fixator is not fully tightened in order to allow the sliding of the screws that are inserted into the epiphysis in the clamp of the device. CONCLUSION: This simple recommendation avoids the undesired ad latum effect when performing an osteomy and gradual correction with monolateral external fixation and survival status. Combined with current hip fracture management guidelines, exchange perioperative management and postoperative rehabilitation experience


Assuntos
Humanos , Osteotomia/efeitos adversos , Osteotomia/métodos , Fixadores Externos/efeitos adversos , Epífises/cirurgia , Falha de Equipamento , Modelos Anatômicos , Parafusos Ósseos
19.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(3): 151-159, mayo-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196335

RESUMO

ANTECEDENTES Y OBJETIVO: La osteotomía periacetabular (OPA) es una técnica utilizada para el tratamiento de la displasia residual, incluso en caderas inestables con cobertura acetabular limitada. El objetivo de este estudio es analizar los resultados funcionales, radiológicos y las complicaciones en pacientes tratados mediante OPA mini-invasiva. MATERIALES Y MÉTODOS: Estudio retrospectivo que analiza 131 casos intervenidos con OPA en nuestro centro. Se determinó de forma prequirúrgica y al final del seguimiento el grado de degeneración articular con la escala de Tönnis, el ángulo de Wiberg, el índice acetabular, el ángulo de cobertura anterior, el espacio articular, las posibles complicaciones y el resultado funcional mediante la escala Non-Arthritic Hip Score. RESULTADOS: La edad media de 32,3±9,5 (DE) años, 102 (77,9%) fueron mujeres y 29 (22,1%) fueron hombres. El seguimiento fue de 7,7±2,8 (DE) años. Se obtuvo una mejora en los parámetros radiológicos entre el momento prequirúrgico y al final del seguimiento, ángulo de Wiberg de+18,5° (18,3° versus 36,8°, IC 95%: 17,3 a 19,7), ángulo de cobertura anterior de+13,5° (26,2° versus 39,7°, IC 95%: 11,6 a 15,4) y el índice acetabular de -11,1° (19,5° versus 8,4°; IC 95%: -12,1 a -10,1). Además, los resultados funcionales con la escala Non-Arthritic Hip Score mejoraron en+31,3 puntos (60,7 prequirúrgico versus 92 último seguimiento posquirúrgico; IC 95%: 28,7 a 33,8). La complicación más frecuente fue la disestesia transitoria del nervio fémoro-cutáneo lateral en 10 casos (7%). CONCLUSIÓN: La osteotomía periacetabular mediante el abordaje mini-invasivo es una técnica reproducible, permite restaurar la cobertura acetabular y proporciona una mejora en las escalas funcionales según confirma nuestra serie


BACKGROUND AND OBJECTIVE: Periacetabular osteotomy (PAO) is an accepted and worldwide technique recognized for residual dysplasia treatment and even in unstable hips with limited acetabular coverage. The aim of this study is to analyse the functional, radiological and complication results in patients treated with mini-invasive PAO. MATERIAL AND METHODS: We performed a retrospective study in which we analysed 131 cases undergoing mini-invasive PAO at our centre. The degree of joint degeneration was evaluated with Tönnis scale, Wiberg angle, acetabular index (AI), anterior coverage angle (AC), joint space, complications and functional outcome with the Non-Arthritic Hip Score (NAHS) were analysed preoperatively and at the end of follow-up. RESULTS: The average age was 32.3±9.5 (SD) years, 102 (77.9%) were female and 29 (22.1%) were male. 7.7±2.8 (SD) years follow up. The radiological parameters improved between the pre-surgical phase and the end of follow-up, Wiberg angle+18.5° (18.3° versus 36.8°, 95% CI 17.3 to 19.7), AC angle+13.5° (26.2° versus 39.7°, 95%CI 11.6 to 15.4) and the AI -11.1° (19.5° versus 8.4°; 95%CI -12.1 to -10,1). In addition, the functional results, with the NAHS scale, improved+31.3 points (60.7 pre-surgical versus 92 at the end of follow-up, 95% CI 28.7 to 33.8). The most common complication was transient lateral femoral cutaneous nerve hypoaesthesia in 10 cases (7%). CONCLUSION: The mini-invasive PAO approach is a reproducible technique, it allows restoration of acetabular coverage and provides an improvement in functional scales as confirmed by our series


Assuntos
Humanos , Masculino , Feminino , Adulto , Luxação do Quadril/cirurgia , Osteotomia/métodos , Osteotomia/efeitos adversos , Estudos Retrospectivos , Radiografia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Período Pré-Operatório , Período Pós-Operatório
20.
Vet Surg ; 49(5): 930-939, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32359005

RESUMO

OBJECTIVE: To identify factors associated with surgical site infection (SSI) after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 541) that underwent TPLO (n = 659). METHODS: Medical records of dogs that underwent TPLO from 2011-2018 were reviewed. Data collected included perioperative and postoperative antimicrobial administration, stifle inspection, duration of surgery and anesthesia, comorbidities, and development of SSI including timing, microbiological investigation, and implant removal. Referring veterinarians were contacted for all dogs without a recorded return visit. Risk factors for SSI were assessed by using a multivariable logistic regression model built by using a stepwise approach. RESULTS: Surgical site infection was documented in 71 of 659 (11%) TPLO, with methicillin-resistant Staphylococcus pseudintermedius accounting for 20 of 71 (28%) infections. Protective factors against SSI included administration of postoperative antimicrobials (odds ratio [OR] 0.263; 95% CI = 0.157, 0.442) and timing of preoperative antimicrobial administration. Preoperative antimicrobial timing was protective against SSI when it was administered more than 60 minutes before the first incision compared with administration within 30 minutes (OR 0.275; 95% CI = 0.112, 0.676) or within 60 minutes (OR 0.419; 95% CI = 0.189, 0.929) of the first incision. CONCLUSION: Early administration of perioperative antimicrobials and postoperative antimicrobial administration were protective against SSI after TPLO. CLINICAL SIGNIFICANCE: Antimicrobials can influence the risk of SSI after TPLO. Perioperative and postoperative antimicrobial administration timing should be considered to reduce SSI.


Assuntos
Doenças do Cão/etiologia , Osteotomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Animais , Antibacterianos/uso terapêutico , Remoção de Dispositivo , Doenças do Cão/cirurgia , Cães , Feminino , Seguimentos , Masculino , Osteotomia/efeitos adversos , Período Pós-Operatório , Registros , Estudos Retrospectivos , Fatores de Risco , Staphylococcus , Joelho de Quadrúpedes/cirurgia , Tíbia/cirurgia
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