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1.
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
2.
J Orthop Surg Res ; 14(1): 349, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703600

RESUMO

BACKGROUND: In recent years, the modified Dunn osteotomy has gained popularity to treat slipped capital femoral epiphysis (SCFE) with various complication rates. Most studies included patients with different severities. This study aimed to determine (1) the radiological and clinical outcome, (2) the health-related quality of life, and (3) the incidence of avascular necrosis of the femoral head (AVN) in patients with severe chronic or acute on chronic SCFE treated by the modified Dunn procedure. METHODS: Out of 150 patients with SCFE treated at our institution between 2001 and 2014, 15 patients (mean age 12.9 years (range 11.8-15)) were treated by the modified Dunn procedure. Eight SCFE were chronic and 7 acute on chronic. All slips were severe with a mean Southwick slip angle (SSA) of 67° (range 60-80). Radiographic and clinical outcomes were measured. Mean time of follow-up was 3.8 years (range 1-10). RESULTS: Anatomical reduction was achieved in all cases. Good radiological results according to the Stulberg Classification (grade 1 + 2) and the Sphericity Deviation Score (< 30) were found in 9 out of 13 patients at the last follow-up. Clinical and functional outcome analysis revealed good results in 8 out of 10 patients (Harris Hip Score > 80). The quality of life measured by the Nottingham Health Profile (NHP) was described good in 10 out of 10 patients. Four out of 15 patients developed an AVN. CONCLUSIONS: The modified Dunn procedure has a great potential to restore proximal femur geometry in severe chronic or acute on chronic SCFE. It should be considered only if there is no other possibility to restore proximal femur geometry, as is the case in severe slips, due to the risk of AVN.


Assuntos
Osteotomia/métodos , Índice de Gravidade de Doença , Escorregamento das Epífises Proximais do Fêmur/diagnóstico por imagem , Escorregamento das Epífises Proximais do Fêmur/cirurgia , Doença Aguda , Adolescente , Criança , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Osteotomia/tendências , Estudos Retrospectivos , Resultado do Tratamento
3.
J Orthop Surg Res ; 14(1): 353, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31706346

RESUMO

BACKGROUND: This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. MATERIAL AND METHODS: Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. RESULTS: Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents' excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). CONCLUSIONS: The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.


Assuntos
Placas Ósseas , Articulação do Cotovelo/diagnóstico por imagem , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Osteotomia/métodos , Impressão Tridimensional , Adolescente , Placas Ósseas/tendências , Articulação do Cotovelo/anormalidades , Feminino , Seguimentos , Humanos , Masculino , Osteotomia/tendências , Impressão Tridimensional/tendências , Estudos Retrospectivos , Resultado do Tratamento
4.
J Orthop Surg Res ; 14(1): 330, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640803

RESUMO

OBJECTIVE: To report the clinical results and surgical tactics of spinal osteotomy for ankylosing spondylitis (AS) kyphosis based on the experiences of 428 patients. METHODS: From January 2003 to January 2015, a total of 428 patients suffering from AS kyphosis who underwent a one- or two-level pedicle subtraction osteotomy (PSO) or vertebral column decancellation (VCD) osteotomy in our hospital were reviewed. Pre- and postoperative radiological parameters and the chin-brow vertical angle (CBVA) were measured. Intraoperative, postoperative, and general complications were recorded. RESULTS: All patients could walk with horizontal vision and lie on their backs postoperatively. The pre- and postoperative average global kyphosis (GK) angles were corrected from 82.6 to 12.7° (p = 0.000) in the two-level group and from 55.8 to 9.6° (p = 0.000) in the one-level group, respectively. The mean sagittal vertical axis (SVA) improved from 29.4 to 8 cm (p = 0.000) in the two-level group and from 18.0 to 4.3 cm (p = 0.000) in the one-level group. The CBVA improved from 68.3 to 8.2° (p = 0.000) in the two-level group and from 46.2 to 4.2° (p = 0.000) in the one-level group. Although no major acute complications such as death or complete paralysis occurred, the complication rate was 6.5% in the one-level group and 23.6% in the two-level group. CONCLUSION: Spinal osteotomy, such as PSO and VCD, can improve the quality of life of AS patients as well as correct kyphotic deformities. The one-level spinal osteotomy showed a lower complication rate, while two-level spinal osteotomy was a relatively aggressive procedure that was more suitable in correcting severe AS kyphotic deformities.


Assuntos
Cifose/diagnóstico por imagem , Cifose/cirurgia , Osteotomia/tendências , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/cirurgia , Adolescente , Adulto , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Neurochirurgie ; 65(5): 295-301, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31562883

RESUMO

Treatment of craniosynostosis is complex and has greatly progressed in recent decades. From the early stages in the 1950s to today's most recent techniques, surgeons have faced the challenge of overcoming the deformities often caused by such invasive, complex surgeries. In the most recent years, new techniques have been developed that address surgical sequelae, including those of surgery performed in childhood. After a general introduction on craniosynostosis, the present paper describes the various types of deformity that may result from complex surgery and offers an overview of the various tools available to surgeons. An explanation of each indication and procedure is given.


Assuntos
Craniossinostoses/cirurgia , Anormalidades Maxilofaciais/cirurgia , Osteotomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante Ósseo , Criança , Pré-Escolar , Progressão da Doença , Humanos , Lactente , Osteotomia/tendências , Procedimentos Cirúrgicos Reconstrutivos/tendências , Crânio/cirurgia
6.
J Orthop Surg Res ; 14(1): 179, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200743

RESUMO

BACKGROUND: The purpose of this meta-analysis is to examine changes in radiological variables and clinical outcomes between open and closed wedge high tibial osteotomy (OWHTO and CWHTO, respectively), which have ongoing controversial issues in numerous quantitative clinical studies. METHODS: PubMed, Embase, and the Cochrane Library were systematically searched for suitable controlled trials between Jan 1, 1999, and Feb 2, 2018. The inclusion criteria included studies written in English, studies with a level of evidence of I-IV, and studies presenting comparisons between OWHTO and CWHTO. The main clinical and radiographic results were extracted and pooled using Stata 12.0. RESULTS: After searching for and screening trials, 28 trials involving 2840 knees were eligible for the meta-analysis. After OWHTO or CWHTO, clinical scores, including the American Knee Society Score, Hospital for Special Surgery Knee Score, Lysholm score, and Visual Analog Scale pain score, improved (p < 0.05), but the range of motion was unchanged (p > 0.05). The anatomical femorotibial angle (SMD 0.04, 95% CI - 0.66 to 0.74) and hip-knee-ankle angle (SMD 0.11, 95% CI - 0.11 to 0.33) data suggested that the OWHTO and CWHTO groups were similar in function of correction. Posterior tibial slope increased (SMD - 0.71, 95% CI - 1.04 to - 0.37) after OWHTO but decreased (SMD 0.72, 95% CI 0.35 to 1.08) after CWHTO. OWHTO decreased patellar height (p < 0.05), while patellar height did not change significantly after CWHTO (p > 0.05). CONCLUSION: This meta-analysis indicates that compared with CWHTO, OWHTO increases the posterior slope, decreases the patellar height, and provides a similar accuracy of correction; however, CWHTO leads to a decreased posterior slope and an unchanged patellar height. Therefore, programs should be personalized and customized for the specific situation of each patient.


Assuntos
Osteotomia/métodos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Humanos , Osteotomia/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
7.
J Orthop Surg Res ; 14(1): 121, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068197

RESUMO

BACKGROUND: Metatarsalgia of the lesser toes is a common cause of consultation in the podiatric clinic. However, there continues to be a controversy with respect to which is the best surgical technique, and there is few information in the literature regarding objectively comparable results in percutaneous surgery. METHODS: The second metatarsal bones of 30 feet belonging to patients who had attended the podiatric clinic were studied before and after distal metatarsal pecutaneous osteotomy. The degree of shortening of the second metatarsal (RX) and the degree of functional recovery and perception of the well-being of the patient (AOFAS) were evaluated retrospectively. The same bones of 10 cadaveric feet were also studied. The surgical procedure was identical to that used on patients, and electronic callipers were employed to take measurements of the second metatarsal. The integrity of the plantar plate was checked visually. RESULTS: The mean shortening of the second metatarsal bone, as determined by the radiological study, was 2.76 mm. After an average follow-up period of 1.5 years, the final mean score on the AOFAS scale was 95.26 points. In none of the cases was the mobility of the metatarsophalangeal (MTP) joint affected. The mean shortening in the cadaveric feet was 2.10 mm, and in all cases, the plantar plate and flexor apparatus were perfectly preserved. CONCLUSIONS: Percutaneous osteotomy achieved, in our study, a lower degree of shortening than Weil's surgery, according to the data published in the literature. However, it shows good clinical results without causing problems of consolidation or rigidity in the MTP joint. Neither, with the caution that should be taken due to the use of experimental cadaver models, damage of the flexor apparatus of the foot is observed. These results suggest that this could be a safe and effective surgical procedure to be considered for metatarsalgias of the lesser rays.


Assuntos
Ossos do Metatarso/cirurgia , Metatarsalgia/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Osteotomia/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Metatarsalgia/diagnóstico por imagem , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteotomia/métodos , Estudos Retrospectivos , Resultado do Tratamento
8.
J Pediatr Orthop B ; 28(3): 207-213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30830014

RESUMO

Bladder exstrophy is a congenital and rare malformation of the lower abdominal wall with exposure of the bladder mucosa to the external environment, and it is related to pelvis abnormalities. Eighteen patients with bladder exstrophy were treated with bilateral oblique pelvic osteotomy in conjunction with urologic reconstruction after they were stabilized by cast. No failure of midline closure was observed (wound dehiscence or recurrence of bladder exstrophy). Follow-up showed no leg length discrepancy or problems in walking. Bilateral oblique pelvic osteotomy is a safe procedure to treat bladder exstrophy, and it results in good orthopedic and urological function.


Assuntos
Extrofia Vesical/diagnóstico por imagem , Extrofia Vesical/cirurgia , Osteotomia/métodos , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia , Cuidados Pós-Operatórios/métodos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Osteotomia/tendências , Cuidados Pós-Operatórios/tendências , Resultado do Tratamento
9.
BMC Musculoskelet Disord ; 20(1): 102, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30841871

RESUMO

BACKGROUND: This meta-analysis was designed to quantify adduction moment loss, to evaluate the relationship between changes in mechanical axis alignment and adduction moment, and to assess whether sagittal plane moment is altered after medial open wedge high tibial osteotomy (HTO). METHODS: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, all studies reporting preoperative and postoperative peak knee adduction moment or change in peak knee adduction moment from before to after surgery in patients who underwent medial open wedge HTO were included. RESULTS: Nine studies were included in the meta-analysis. The pooled mean difference in adduction moment from before to after medial open wedge HTO was 1.44% Nm/body weight (BW)xheight (HT) (95% confidence interval [CI]: 1.33 to 1.55% Nm/BWxHT; P < 0.001; I2 = 4%). However, flexion (0.18% Nm/BWxHT, 95% CI: -0.50 to 0.86% Nm/BWxHT; P = 0.61; I2 = 79%) and extension (0.15% Nm/BWxHT, 95% CI, - 0.37 to 0.68% Nm/BWxHT; P = 0.56; I2 = 46%) moments did not differ significantly from before to after surgery. Alignment correction amount and postoperative final valgus alignment were not significantly associated with difference in adduction moment from before to after surgery. CONCLUSION: Knee adduction moment after medial open wedge HTO decreased to 60% of the preoperative level. However, this adduction moment decrement was not affected by the magnitude of alignment correction. In addition, there was no change in sagittal plane knee moment, including flexion and extension moments, from before to after medial open wedge HTO. LEVEL OF EVIDENCE: Meta-analysis (Level II).


Assuntos
Articulação do Joelho/fisiologia , Osteotomia/tendências , Amplitude de Movimento Articular/fisiologia , Tíbia/cirurgia , Fenômenos Biomecânicos/fisiologia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteotomia/métodos , Estudos Prospectivos , Estudos Retrospectivos , Tíbia/diagnóstico por imagem
10.
J Pediatr Orthop B ; 28(2): 95-99, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30234701

RESUMO

The risk factors for increased perioperative morbidity following pediatric pelvic osteotomies are poorly understood. The purpose of this study was to characterize differences in adverse events, operative time, length of stay, and readmission following pelvic osteotomy for obese and nonobese patients. A retrospective cohort study was carried out using the National Surgical Quality Improvement Program Pediatric database to identify patients that underwent pelvic osteotomy with or without femoral osteotomy. Obesity was found to be an independent risk factor for blood transfusion (relative risk: 1.4, P=0.007) and readmission (relative risk: 2.3, P=0.032) within 30 days. These data can facilitate patient counseling and informed decision-making when planning for surgical correction of hip dysplasia.


Assuntos
Luxação do Quadril/cirurgia , Tempo de Internação/tendências , Duração da Cirurgia , Osteotomia/tendências , Readmissão do Paciente/tendências , Obesidade Pediátrica/cirurgia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Luxação do Quadril/diagnóstico , Luxação do Quadril/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Osteotomia/efeitos adversos , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
11.
J Pediatr Orthop B ; 28(3): 202-206, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30489443

RESUMO

The authors reviewed 54 (58 hips) patients with acetabular dysplasia following developmental dislocation of the hip (DDH), treated by triple pelvic osteotomy according to the Tönnis technique. The aim of our study was to report the long-term clinical and radiographic results of the operation at a mean follow-up of 12 years (from 7 to 20). At diagnosis, all the hips were painful, the Wiberg angle measured less than 20°, and no radiographic signs of osteoarthritis were present. At follow-up, 82.7% of the operated hips showed either excellent or good results, according to Harris, and the Wiberg angle measured an average of 34° (from 26° to 45°). We encountered five complications: one acetabular malrotation and four asymptomatic ischial nonunions. In conclusion, we believe that, although Bernese periacetabular osteotomy is nowadays considered the gold standard for the surgical treatment of the dysplastic hip following DDH, Tönnis osteotomy represents a good treatment option: it is technically easy, enables direct visualization of the three osteotomies, leads to few complications, and its learning curve is short. The absence of radiographic signs of osteoarthritis and hip congruency before surgery are the basic requirements to achieve a successful result.


Assuntos
Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Gerenciamento Clínico , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Osteotomia/métodos , Adolescente , Adulto , Criança , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Osteotomia/tendências , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
J Orthop Surg Res ; 13(1): 305, 2018 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-30497489

RESUMO

BACKGROUND: To compare the clinical and radiological outcomes of the surgical correction of Lenke type 1 to 4 scoliosis by using a multilevel Ponte osteotomy procedure with posterior selective segmental pedicle screw constructs or posterior release and selective segmental pedicle screw constructs only in patients with adolescent thoracic idiopathic scoliosis. METHODS: Retrospective analysis of 65 patients, 32 treated with the multilevel Ponte procedure (Group A) and 33 with posterior soft tissue release only (Group B). The groups were compared with regard to the change in spinal alignment from preoperative to postoperative assessment and over the follow-up period. RESULTS: A correction rate of the main thoracic curve of 63.9 ± 4.5% was obtained for group A and 65.2 ± 2.4% for group B (P = 0.17). However, the Cincinnati correction index was greater for group A (1.8 ± 0.3) than that for group B (1.4 ± 0.2, P < 0.001), with a smaller change in angle over the period from 1 week postoperatively to the 2-year follow-up (P < 0.05). The operative time, volume of blood loss, and volume of transfusion were greater for group A than for group B (P < 0.05). CONCLUSION: The multilevel Ponte osteotomy procedure, with posterior selective segmental pedicle screw constructs, improves the Cincinnati correction index and restores the thoracic kyphosis in patients with adolescent thoracic idiopathic scoliosis.


Assuntos
Osteotomia/instrumentação , Osteotomia/tendências , Parafusos Pediculares/tendências , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
13.
Rev. Soc. Andal. Traumatol. Ortop. (Ed. impr.) ; 35(4): 8-17, oct.-dic. 2018. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-178327

RESUMO

La luxación congénita de rodilla es una patología poco frecuente en la población general, suponiendo un reto para el cirujano ortopédico. Se diagnostica al nacimiento tras las primeras exploraciones, en las que se detecta una hiperextensión de la rodilla. Se clasifica según la severidad de la deformidad en recurvatum, subluxación y luxación. Actualmente no hay algoritmos de manejo consensuados ni evidencias claras acerca del manejo de estos pacientes. El tratamiento de elección inicialmente es conservador mediante manipulación y yesos. La cirugía se indica cuando el tratamiento conservador fracasa, el diagnóstico se alcanza de forma tardía o la deformidad inicial es severa. Las técnicas más frecuentemente empleadas pretenden actuar sobre el tendón del cuádriceps para alargar el aparato extensor y permitir la reducción articular y recuperar la flexión. En cualquier caso, se asocian a mejor pronóstico los casos no asociados a síndromes y aquellos que reciban un tratamiento precoz


Congenital dislocation of the knee is an un-common pathology in general population and therefore it presents a challenge for the orthopedic surgeon. It is diagnosed at birth, when knee hyperextension is detected during the first physical examinations. It is classified according to severity into recurvatum, subluxation and luxation. Currently there is no management algorithm or clear scientific evidence related to the treatment of these patients. Initially, a conservative treatment consisting of manipulation and casting is generally chosen. Surgery is indicated in case of failure of conservative treatment, delayed diagnosis or severe initial deformity. The most commonly used techniques aim at acting on the quadriceps tendon in order to lengthen it and allow joint reduction and improved knee flexion. In any case, both non syndromic and early treated cases are associated with a better prognosis


Assuntos
Humanos , Luxação do Joelho/terapia , Luxação do Joelho/congênito , Tenotomia/métodos , Procedimentos Ortopédicos/tendências , Prognóstico , Osteotomia/tendências
14.
BMC Musculoskelet Disord ; 19(1): 228, 2018 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-30021642

RESUMO

BACKGROUND: We aimed to evaluate clinical and radiological results after simultaneous open-wedge high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction in patients with ACL deficiency combined with medial uni-compartmental osteoarthritis (OA) and varus deformity. METHODS: This retrospective study was performed using data collected from 2005 to 2011 on a total of 24 patients who were diagnosed with ACL injury and medial unicompartmental OA with varus deformity, and who subsequently underwent simultaneous open-wedge HTO and arthroscopic ACL reconstruction. The mean follow-up duration was 5.2 years. For clinical outcomes, we evaluated Lysholm score, Tegner activity score, range of motion, Lachmann test, and pivot-shift test, and for radiological outcomes, we evaluated the degree of varus deformity, progression of medial OA, tibial posterior slope, anterior instability, and postoperative complication. RESULTS: There were no limitations in range of motion found in any cases. Three patients showed progressive osteoarthritis on the medial compartment. The mechanical femorotibial angle was significantly corrected from varus 7.0 degrees to valgus 1.2 degrees, and the tibial posterior slope was not significantly changed. The Lysholm and Tegner activity scores were significantly improved after surgery (from 58 to 94 points on the Lysholm scale and from 4.0 to 5.3 points on the Tegner activity scale). Although the Lachman test and the pivot-shift test showed significant improvements after surgery, instability greater than Gr II was observed in three patients on the Lachman test and in four patients on the pivot-shift test. The side-to-side difference improved from 9.6 mm to 4.2 mm postoperatively as assessed using a Telos® arthrometer. There were no cases of nonunion or fixation loss. CONCLUSIONS: Simultaneous open-wedge HTO and ACL reconstruction in patients with ACL injury with medial compartmental OA showed satisfactory functional outcomes and postoperative activity level scores. However, some patients showed residual instability and progression of OA.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/tendências , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Osteotomia/tendências , Adulto , Reconstrução do Ligamento Cruzado Anterior/métodos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
15.
BMC Musculoskelet Disord ; 19(1): 130, 2018 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-29703255

RESUMO

BACKGROUND: Concurrent prophylactic femoral varization osteotomy (FVO) for stable hips has been performed in patients with cerebral palsy (CP) undergoing hip reconstructive surgery for the contralateral displaced hip. However, there is currently a lack of studies investigating the outcome after the prophylactic FVO in stable hip. This study investigated the outcomes after FVO in stable hips with CP and influencing factors. In addition, this study compared the outcomes with those after hip reconstructive surgery in the contralateral displaced hip. METHODS: This study included 119 CP patients with 224 hips (80 stable, 144 displaced) undergoing hip reconstructive surgery including FVO. Migration percentage (MP), neck-shaft angle (NSA), and head-shaft angle (HSA) were measured through preoperative and follow-up hip radiographs. All hips were divided into the stable (MP ≤ 33%) and displaced hip groups (MP > 33%) according to the preoperative radiographs, and the annual changes in the radiographic indices after FVO were analyzed. RESULTS: In stable hip group, MP did not significantly increase over time (p = 0.057) after prophylactic FVO. In displaced hip group, MP significantly increased over time (1.6%/year, p < 0.001). MP was significantly decreased in cases of concomitant Dega pelvic osteotomy in both stable (14.5%, p < 0.001) and displaced hips (18.9%, p < 0.001). CONCLUSIONS: Prophylactic FVO in the stable hip in patients with CP showed good surgical outcomes, without a risk of hip displacement throughout the follow-up duration, while hip reconstructive surgery in the displaced hip was associated with a risk of increased hip displacement.


Assuntos
Paralisia Cerebral/cirurgia , Fêmur/cirurgia , Luxação do Quadril/cirurgia , Osteotomia/tendências , Procedimentos Cirúrgicos Profiláticos/tendências , Procedimentos Cirúrgicos Reconstrutivos/tendências , Adolescente , Adulto , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/epidemiologia , Criança , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/epidemiologia , Humanos , Masculino , Osteotomia/métodos , Procedimentos Cirúrgicos Profiláticos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto Jovem
16.
J Pediatr Orthop B ; 27(3): 250-256, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28609328

RESUMO

We aimed to investigate the early radiological effects of Dega and Pemberton iliac osteotomies that were performed in patients aged 4-8 years with developmental dysplasia of the hip on development of hip joint. Dega osteotomy or Pemberton osteotomy was performed in 76 hips of 58 patients because of developmental dysplasia of the hip between September 2011 and June 2015 and were evaluated retrospectively. Of a total of 76 hips, Pemberton osteotomy was performed on 39 (19 unilateral) and Dega osteotomy was performed on 37 (21 unilateral). In all hips, the acetabular index, acetabular depth ratio, centre-edge angle of Wiberg, and Reimer's index values were recorded preoperatively and at the final follow-up. We measured the surface areas of the femoral head ossific nucleus in patients with unilateral dysplastic hips and compared results before both osteotomy procedures and at the final follow-up. There were no statistically significant differences between the groups in terms of the acetabular index and acetabular depth ratio values (P>0.05) preoperatively and at the final follow-up, but the mean centre-edge angle of Wiberg and Reimer's index values showed significant statistical differences in favor of the Dega procedure (P<0.05). There was a statistically significant difference in favor of the Pemberton procedure when the mean ratio of the surface area of the femoral head ossific nucleus on the dysplastic side in relation to the normal side was compared preoperatively (P=0.042) and at the final follow-up (P=0.027) in unilateral hips. Although Dega and Pemberton osteotomies produce satisfactory radiological outcomes at early stages in children aged 4-8 years with developmental dysplasia of the hip, a higher rate in the surface area of the femoral head ossific nucleus was observed in the Pemberton osteotomy group, which also had a lower mean age than the Dega osteotomy group.


Assuntos
Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Osteotomia/métodos , Criança , Pré-Escolar , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Seguimentos , Articulação do Quadril/crescimento & desenvolvimento , Humanos , Masculino , Osteotomia/tendências , Estudos Retrospectivos , Resultado do Tratamento
17.
J Pediatr Orthop B ; 27(3): 194-199, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28537994

RESUMO

Medial femoral torsion (MFT) is a common pathologic gait in cerebral palsy (CP) children that can be corrected by femoral derotational osteotomy (FDO). It is not clearly known as to how much various gait parameters change after FDO. The aim of this study was to quantify changes in gait parameters after FDO. The study group included 19 young CP patients (28 limbs, age<20 years, average age: 13.2 years) with symptomatic MFT, treated with distal FDO. The study group was divided into two groups: the unilateral FDO group (UG) and the bilateral FDO group (BG). The mean degree of derotation was 24.6° (25.0° for UG, 24.4° for BG). Pre-FDO and post-FDO values of Staheli's rotational profiles and kinematic data were compared. A paired t-test and Pearson's correlation were used for statistical analysis. The mean internal hip rotation was 71.4±6.9° before surgery and 48.6±10.7° after surgery in the UG (P<0.05) and it was 63.8±15.8° before surgery and 40.9±9.2° after FDO in the BG (P<0.05). The change in the foot progression angle (FPA) was 12.9° in the UG group (P<0.05) and 12.6° in the BG group (P<0.05). The degree of FPA had changed by about a half of the surgical derotation angle. Changes in the mean hip rotation during gait were 14.8° in the UG (P<0.05) and 6.7° in the BG (P<0.05) groups. The overall pelvic rotation was not changed after surgery. However, in patients with preoperative compensatory pelvic rotation of more than 5°, there was a change of 5.3±4.8° in the UG and 6.6±1.54° in the BG after surgery (P<0.05). There was also a trend showing that the younger the patient, the more the pelvic rotation changed (P=0.069). In-toeing gait because of MFT improved with FDO in CP patients. The expected degree of postoperative correction of FPA and hip rotation is about a half of the FDO degree. The degree of compensatory pelvic rotation should be considered to determine the correction angle of FDO, especially in young patients with preoperative pelvic rotation of more than 5°.


Assuntos
Paralisia Cerebral/cirurgia , Fêmur/cirurgia , Marcha/fisiologia , Osteotomia/tendências , Anormalidade Torcional/cirurgia , Adolescente , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Osteotomia/métodos , Estudos Retrospectivos , Rotação , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/fisiopatologia , Adulto Jovem
18.
J Pediatr Orthop B ; 27(3): 257-263, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28678149

RESUMO

The periacetabular quadruple osteotomy of the pelvis (QOP), with the osteotomy of ischial spine to release the sacrospinal ligament, is reserved for older children with low potential of remodeling. Different parameters were studied with computed tomography (CT) scan before (pre-OH) and after surgery (post-OH) and for nonoperated hip (NOH). The study determined an optimal method to avoid retroversion and excessive anterior coverage. Fifteen QOP were performed in 13 patients, ranging in age from 10 to 15 years. The morphology of pelvis was analyzed with a CT scan before the surgery and 2 years after. Pathologies were Legg-Calve-Perthes (seven hips) and dysplasia (eight hips). The two-dimensional exam measured the acetabular index, the coverage, and the version of the acetabulum. The three-dimensional images measured the frontal lateral inclinations of the lips and the sagittal anterior acetabular inclination. The mean anterior acetabular index was 50.4° (NOH), 56° (pre-OH), and 58.7° (post-OH). The posterior acetabular index was 48.5° (NOH), 52.2° (pre-OH), and 40° (post-OH). The anterior coverage angle was 37.1° in (pre-OH), 27.6° (post-OH), and 30.1° (NOH). The posterior coverage was 20.4° (pre-OH), 17.2° (post-OH), and 12.4° (NOH). The acetabular version was 2.1° (pre-OH), 8.3° (post-OH), and 2.5° (NOH). The anterolateral lip inclination was 50.3° (pre-OH), 35.3° (post-OH), and 43.8° (NOH). The posterolateral lip inclination was 56.7° (pre-OH), 43.7° (post-OH), and 55.8° (NOH). The anterior acetabular inclination was 21.3° (pre-OH), 15.6° (post-OH), and 18° (NOH). The QOP enabled significant range of coverage of the hip in adolescents in whom the potential of remodeling is very low. External rotation related to figure-of-four should be omitted, whereas the maneuver to be applied, preventing the anterior impingement and decrease of the posterior coverage, should be performed by placing the acetabular fragment below the iliac bone, with a lateral inclination in the frontal plane similar to a steering wheel movement. This maneuver preserves comparable morphology of the OH with NOH and avoids retroversion with the excessive anterior coverage responsible for pain and early osteoarthritis.


Assuntos
Acetábulo/cirurgia , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Osteotomia/métodos , Tomografia Computadorizada por Raios X/métodos , Acetábulo/diagnóstico por imagem , Adolescente , Criança , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/prevenção & controle , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Osteotomia/tendências , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia , Estudos Prospectivos , Tomografia Computadorizada por Raios X/tendências
19.
J Pediatr Orthop B ; 27(3): 264-270, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28277416

RESUMO

Proximal femoral osteotomy has been used in cerebral palsy, Perthes disease, hip dysplasia, idiopathic femoral anteversion, and various hip diseases in children and adolescents. Conventionally, a blade plate (BP) has been used. However, the pediatric locking compression plate (LCP) has recently been applied widely. We compared the hardware-related complications of the BP and the LCP as well as the factors influencing these complications in patients who have undergone a proximal femoral osteotomy in children and adolescents. We enrolled consecutive patients aged less than or equal to 20 years who had undergone proximal femoral osteotomy with BP or LCP between May 2003 and December 2014, and who were followed up until 6 months after hardware removal. Following consensus building, hardware-related complications were identified from the patients' medical records and hip radiographs. Patient age, sex, type of plate, and Gross Motor Function Classification System (GMFCS) level in cerebral palsy patients were evaluated as possible risk factors, and a generalized estimating equation was used to assess the risk factors for hardware-related complications. A total of 417 hips from 251 patients were finally included in this study. Seven losses of fixation around the plate (five patients, 3.0%) occurred in the BP, three implant-related fractures (three patients, 3.6%) occurred in the LCP, and there was no significant difference (P=0.74). All hardware-related complications occurred in cerebral palsy patients, and the implant-related fractures occurred in patients with GMFCS IV/V. The risk of complications increased with age (P=0.002). The risk of loss of fixation around the BP is a well-known complication. However, LCP is not without hardware-related complications. The LCP provides strong stability of fixation. However, it is speculated that the LCP is related to implant-related fractures because of the stress shielding effect. Therefore, care should be exercised when using a locking plate in patients with osteoporosis, such as cerebral palsy with GMFCS IV/V. LEVEL OF EVIDENCE: Therapeutic Level III.


Assuntos
Placas Ósseas/efeitos adversos , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese/efeitos adversos , Adolescente , Placas Ósseas/tendências , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Osteotomia/instrumentação , Osteotomia/tendências , Falha de Prótese/tendências , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
Clin Podiatr Med Surg ; 35(1): 53-62, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29156167

RESUMO

Advancement in orthopedics have been increasing rapidly. The most important advances have been in fixation. With time, metallic hardware will begin to be replaced by materials that become one with the body. This progress will not only aid in the repair process it will allow permanent and improved reinforcement of the fixated region. Biointegrative technology is a promising new generation of materials capable of achieving this goal. Over time, it is expected that plates, screws, pins, interference screws, and even possibly joint replacements will incorporate into patients' bodies, negating the need for hardware removal and adding structure and stability to an iatrogenically weakened area.


Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Osseointegração/fisiologia , Osteotomia/métodos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/tendências , Humanos , Dispositivos de Fixação Ortopédica , Osteotomia/instrumentação , Osteotomia/tendências
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