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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.
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
3.
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
4.
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
5.
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
6.
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
7.
Orv Hetil ; 161(30): 1260-1265, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32653869

RESUMO

Surgical guides and three-dimensional (3D) planning softwares used in everyday dental implantology open new possibilities in other fields of dentistry. While using the operation microscope in endodontic microsurgery provides more precise apicectomy, there is still no consent on the exact localisation and size of the bony window to be prepared for this surgery. Our aim is to describe a new, guided endodontic microsurgery method when osteotomy and apicectomy are planned in a 3D software and performed with a trephine bur. Based on data from Cone Beam Computed Tomography, planning of the surgical guide was performed with a 3D planning software (Smart Guide, dicomLAB, Hungary) in order to define the size of the bony window, the angulation and the depth of the trephine bur during the apicectomy. After preparing a mucoperiosteal flap, with the help of the dentally supported surgical guide, the trephine bur removes the cortical bone and the apex of the root simultaniously. Following the modern microsurgical protocol, after performing the ultrasonic retrograde preparation, mineral trioxide aggregate (ProRoot MTA; Dentsply Maillefer, Ballaigues, Switzerland) is placed as a retrograde filling to close the resected area. After the uneventful healing period, a complete bony regeneration can be seen on the 1-year follow up X-ray. The patient is symptom-free. This technique is considered to be faster and more precise than the non-guided endodontic microsurgery carried out without the utilization of a trephine bur. Orv Hetil. 2020; 161(30): 1260-1265.


Assuntos
Apicectomia/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Cavidade Pulpar/cirurgia , Endodontia/métodos , Microcirurgia/métodos , Osteotomia/métodos , Impressão Tridimensional , Materiais Restauradores do Canal Radicular , Tratamento do Canal Radicular/métodos , Compostos de Alumínio , Compostos de Cálcio , Cavidade Pulpar/diagnóstico por imagem , Combinação de Medicamentos , Humanos , Hungria , Óxidos , Radiografia Dentária , Silicatos , Dente , Resultado do Tratamento , Procedimentos Cirúrgicos Ultrassônicos
8.
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
9.
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
10.
Yonsei Med J ; 61(7): 635-639, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32608208

RESUMO

Cavovarus deformity is considered an anatomical risk factor for chronic lateral ankle instability (CLAI). However, subtle deformity can be difficult to detect, and its correction is controversial. The current study aimed to evaluate clinical and radiographic outcomes of a modified Broström procedure (MBP) with additional procedures for CLAI with subtle cavovarus deformity and a positive peek-a-boo heel sign. We reviewed the records of 15 patients who underwent MBP with additional procedures for CLAI with a positive peek-a-boo heel sign between August 2009 and April 2015. Consecutive physical and radiographic examinations were performed. The visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Karlsson-Peterson (KP) ankle score were applied to assess clinical outcomes. Weight bearing radiographs, hindfoot alignment view, and ankle stress radiographs were also examined. The mean follow-up period was 58.5 months. Calcaneal lateral closing wedge osteotomy was performed in seven patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy was performed in 11 patients to correct plantarflexion of the first ray. Three patients underwent both procedures. Mean VAS, AOFAS, and KP ankle scores improved significantly (p=0.001), and instability did not recur. Radiographically, all stress parameters improved significantly (p=0.007). Simultaneous correction of a positive peek-a-boo heel sign and cavovarus deformity with MBP for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for subtle cavovarus deformity should be followed when treating patients with CLAI. This trial is registered on Clinical Research Information Service (CRiS, KCT0003287).


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Osteotomia/métodos , Adulto , Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Articulação do Tornozelo/diagnóstico por imagem , Feminino , , Calcanhar/diagnóstico por imagem , Calcanhar/fisiopatologia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/diagnóstico por imagem , Masculino , Ossos do Metatarso , Metatarso/diagnóstico por imagem , Metatarso/cirurgia , Pessoa de Meia-Idade , Radiografia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Pé Cavo/diagnóstico por imagem , Pé Cavo/cirurgia , Resultado do Tratamento , Escala Visual Analógica
11.
J Am Acad Orthop Surg ; 28(14): 570-584, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692092

RESUMO

Kienböck disease, osteonecrosis of the lunate, is a well-known but poorly understood complication seen by hand surgeons. This review presents the background and important patient-specific parameters of the disease and reviews the numerous treatment options that exist for the disease.


Assuntos
Osso Semilunar/cirurgia , Osteonecrose/cirurgia , Adolescente , Adulto , Idoso , Fenômenos Biomecânicos , Transplante Ósseo , Capitato/cirurgia , Tratamento Conservador , Descompressão Cirúrgica , Feminino , Humanos , Imobilização , Isquemia , Osso Semilunar/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Osteonecrose/etiologia , Osteonecrose/terapia , Osteotomia/métodos , Medição de Risco , Adulto Jovem
12.
Zhonghua Wai Ke Za Zhi ; 58(6): 420-424, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498479

RESUMO

High tibial osteotomy (HTO) is an effective treatment for knee osteoarthritis. With the application of bi-planer open wedge osteotomy high tibial osteotomy and new angular stable locking plates, HTO has become more accuracy, minimally invasive and standard, achieved satisfactory long-term treatment outcome. The indications of HTO are expanding. We need to comprehensively consider whether the patient has varus deformity, the location and severity of the deformity, the stage of osteoarthritis, age and the demand of activity, as well as individual factors such as weight, gender, bone condition and joint activity, and strive to give the best individualized treatment to osteoarthritis patients in different stages.


Assuntos
Aprendizado Profundo , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Tíbia/cirurgia , Humanos , Articulação do Joelho/cirurgia
13.
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
14.
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
15.
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
16.
Orthop Clin North Am ; 51(3): 345-360, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498953

RESUMO

Lower extremity deformities in children rely on osteotomies for correction. Percutaneous osteotomies offer a method for cutting bone that is advantageous for soft tissue healing. These low-energy osteotomies preserve the blood supply to bone, which maximizes the ability of bone to heal. Some of these techniques are technically demanding and should be performed first with an experienced operator. The key to maintaining safety in these osteotomies is to remain in a subperiosteal location. The categories of percutaneous osteotomy include multiple drill hole osteotomy, corticotomy, and Gigli saw osteotomy. This article discusses the advantages and indications for each type of osteotomy.


Assuntos
Osso e Ossos/anormalidades , Osso e Ossos/cirurgia , Anormalidades Musculoesqueléticas/cirurgia , Osteotomia/métodos , Criança , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
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.
Bratisl Lek Listy ; 121(6): 379-385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484700

RESUMO

AIM: The purpose of this retrospective study was to perform an evaluation of postoperative positional changes of the condyle and mandibular function after bilateral sagittal split osteotomy (BSSO) with manual proximal segment positioning. PATIENTS: 45 patients were divided into the 2 groups ‒ G1 (advancement ‒ 14 patients) and G2 (setback - 31 patients). Rigid internal fixation screws were utilized in all cases. Inclusion criteria were only BSSO, no TMJ symptoms preoperatively and age 18 or older. RESULTS: The differences between pre- and postoperative condyle position were evaluated using measurements taken from preoperative CT scans and compared to CT scans made a minimum of 6 months postoperatively. The positional changes in both the axial and sagittal planes were measured and compared. The recovery of mandibular function was evaluated by measuring maximal interincisal opening (MIO). The results revealed that condylar positional changes after BSSO in both groups were minimal and not significantly different for all three dimensions measured. The recovery of mandibular function was faster in the group G2 than in the group G1. Mandibular function reached almost preoperative level in 6-12 months postoperatively in both groups. CONCLUSION: The results demonstrated that following BSSO, only insignificant condylar displacement and functional changes occurred within 6 to 12 months postoperatively (Tab. 4, Fig. 2, Ref. 47).


Assuntos
Mandíbula , Côndilo Mandibular , Osteotomia , Humanos , Côndilo Mandibular/cirurgia , Osteotomia/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
20.
J Pediatr Orthop ; 40(6): e454-e459, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501914

RESUMO

BACKGROUND: ε-Aminocaproic acid (EACA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion requirements in several populations undergoing various surgical procedures. However, the efficacy of EACA has not been assessed in pediatric patients with cerebral palsy undergoing bilateral varus rotational femoral osteotomies. The purpose of this study was to assess the efficacy of intravenous EACA in reducing calculated intraoperative blood loss and transfusions in this population. METHODS: Patients aged 18 years or younger were eligible. Patients were randomized to receive EACA or placebo (saline), and randomization was stratified based on sex and whether or not additional soft tissue or osseous procedures were performed. On the basis of retrospective data, the calculated sample size was 12 patients per arm to detect a difference of 250-mL blood loss. The primary outcome was calculated intraoperative blood loss. Secondary outcomes included transfusion requirements, 24-hour drain output, length of stay, and incidence of complications. RESULTS: The mean age of patients in this study was 8 years (SD: 2.4 y). There were no differences in age, sex, height, weight, type of anesthesia, operative time, and associated procedures between the EACA and placebo groups (P>0.05). Preoperative hematocrit was lower in the EACA group (37.1 vs. 40.0, P=0.04). Calculated intraoperative blood loss was 536 mL in the EACA group and 628 mL in the placebo group (P=0.45). Transfusions were required in 62% of patients in the EACA group and 67% of patients in the placebo group (P=0.68). Total 24-hour drain output was 72.5 mL in the EACA group and 103.3 mL in the placebo group (P=0.37). Length of stay was similar between both groups, and there were no drug or placebo-related complications in either group. CONCLUSIONS: There was no difference in blood loss or transfusion requirements associated with EACA compared with placebo; however, this study is underpowered to detect smaller differences in blood loss. Additional studies with larger sample sizes are needed to confirm these findings and further elucidate the indications for antifibrinolytic agents in pediatric patients. LEVEL OF EVIDENCE: Level I.


Assuntos
Ácido Aminocaproico/administração & dosagem , Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Osteotomia/métodos , Administração Intravenosa , Adolescente , Paralisia Cerebral/complicações , Criança , Método Duplo-Cego , Feminino , Fêmur/cirurgia , Hematócrito , Humanos , Masculino , Estudos Prospectivos
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