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1.
Medicine (Baltimore) ; 99(18): e20153, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358405

RESUMO

At present, the posterior cervical approach with open reduction and internal fixation (ORIF) remains a commonly effective treatment for unstable Atlas fracture. However, the inserted screws into the C1 lateral mass of some unstable atlas fracture are very difficult, so that the operation is forced to change into C0 to C2 fusion. In order to improve the successful rate of lateral mass screw placement, we introduced a method of fixing lateral mass with a towel clamp in posterior transpedicular fixation, and explore the efficacy and feasibility.Twenty-one consecutive patients with unstable atlas fracture were treated via this method from October 2012 to July 2017. All cases had neck pain and restricted motion of neck movement on admission. Electronic medical records and pre- and postoperative radiographs were reviewed. Screw and rod placement, bone fusion, and spinal cord integrity were assessed via long-term follow-up with anteroposterior and lateral radiographs and computed tomography. Follow-up included clinical assessment of neurological function, assessment of pain using the visual analog scale (VAS), and assessment of the activities of daily living using the neck disability index (NDI).The mean follow-up duration was 22.1 months (range: 12-54 months). No screw loosening or breakage, plate displacement, neurovascular injury, and severe complications occurred during follow-up. The mean operative time was 112.4 ±â€Š14.9 min (range: 82-135 min), and mean blood loss was 386.2 ±â€Š147.9 mL (range: 210-850 mL). One patient experienced continuous neck pain postoperatively, but this gradually disappeared with analgesic administration. At final follow-up, all patients had bone fusion, the VAS scores and NDI were significantly improved compared with preoperatively.Fixing the C1 lateral mass with a towel clamp during posterior transpedicular fixation for unstable atlas fracture appears to be a safe and reliable method, with the advantages of being a simple technique with few complications.


Assuntos
Atlas Cervical/lesões , Atlas Cervical/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas da Coluna Vertebral/cirurgia , Atividades Cotidianas , Perda Sanguínea Cirúrgica , Placas Ósseas , Parafusos Ósseos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Amplitude de Movimento Articular , Estudos Retrospectivos
2.
Int J Prosthodont ; 33(3): 272-276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32320179

RESUMO

PURPOSE: To analyze the clinical behavior of screw-retained monolithic lithium disilicate (LDS) implant-supported single crowns (ISSCs) over a 1-year follow-up. MATERIALS AND METHODS: A total of 28 patients were restored with 45 screw-retained monolithic LDS (press-fabricated) ISSCs bonded to titanium bases in posterior sites. Modified United States Public Health Service criteria and Kaplan-Meier survival and success rates were evaluated. RESULTS: A total of 27 patients with 44 ISSCs were evaluated 12 months (mean ± standard deviation: 13.02 ± 2.28) after prosthesis delivery. No implant or crown failures occurred. The Kaplan-Meier survival and success rates were each 100% after 1 year. Minorly increased surface roughness was noted in the occlusal contact point areas of 9 ISSCs (20.5% Bravo rating). Marginal adaptation, color match, and anatomical form stayed favorable over time. CONCLUSION: Press-fabricated LDS monolithic screw-retained implant crowns appear to be a promising treatment option for posterior implants under short-term observation.


Assuntos
Desenho Assistido por Computador , Coroas , Parafusos Ósseos , Porcelana Dentária , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Dados Preliminares , Estudos Prospectivos
3.
Med Sci Monit ; 26: e921507, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32196483

RESUMO

BACKGROUND We compared the clinical and radiographic outcomes between interface fixation using absorbable screws and plate fixation in anterior cervical corpectomy and fusion (ACCF) to evaluate the effectiveness of these 2 fixation methods for the treatment of 2-level cervical spondylotic myelopathy (CSM). MATERIAL AND METHODS From January 2014 to December 2016, a total of 220 patients who received 2-level ACCF were retrospectively collected. Among them, 108 patients were treated with interface fixation using absorbable screws (Group A) and 112 patients underwent plate fixation (Group B). Japanese Orthopedic Association (JOA) score and Neck Disability Index (NDI) score were employed to compare the clinical improvement. Operative time, blood loss, surgical cost, cervical lordosis, complications, and fusion rate were also evaluated. RESULTS The average follow-up time were 35.2±4.5 months in Group A and 35.9±3.9 months in Group B. There was no difference in operative time and blood loss for both groups. The JOA scores and NDI scores were similar in each follow-up (p>0.05 in all). Group A cost an average of 30% less than Group B for the operation. Both groups achieved 100% in the fusion rate with the same conditions in cervical lordosis. Group A (5/108) had a significantly lower complication rate than Group B (17/112) (p<0.05). CONCLUSIONS ACCF with interface fixation using absorbable screws achieved similar clinical outcomes compared to ACCF with plate fixation for 2-level CSM. Moreover, the interface fixation using absorbable screws presented far fewer complications and cost less for the operation.


Assuntos
Parafusos Ósseos , Discotomia/instrumentação , Fusão Vertebral/instrumentação , Espondilose/cirurgia , Vertebroplastia/instrumentação , Placas Ósseas , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Fusão Vertebral/métodos , Espondilose/diagnóstico por imagem , Vertebroplastia/métodos
4.
Zhongguo Gu Shang ; 33(1): 47-52, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115924

RESUMO

OBJECTIVE: To compare the effect of percutaneous bridging plate and retrograde suprapubic intramedullary screw in the treatment of anterior ring fracture of pelvis. METHODS: From January 2013 to June 2017, 40 patients with unstable pelvic fractures involving anterior ring were analyzed retrospectively. According to the fixation method, they were divided into two groups, there were 20 patients in percutaneous bridging plate group (plate group) including 9 males and 11 females; according to tile classification, fractures were classified as type B1 in 1 case, type B2 in 14, type B3 in 2, type C1 in 2 and type C2 in 1. There were 20 cases in retrograde suprapubic intramedullary screw group (screw group) including 10 males and 10 females; according to tile classification, there were 1 case of type B1, 12 cases of type B2, 3 cases of type B3, 3 cases of type C1 and 1 case of type C2. The incision length, operation time, times of fluoroscopy, intraoperative bleeding volume, postoperative Matta score, postoperative complications and the last follow-up Majeed function score of the two groups were compared and analyzed. RESULTS: Both groups were followed up for 8 to 15 (12.25±2.24) months in the plate group and 6 to 18 (12.4±2.6) months in the screw group, there was no significant difference between the two groups. The incision length of screw group was (3.85±0.75) cm shorter than that of steel plate group (7.05±1.39) cm; the operation time of screw group was (27.70±5.36) min longer than that of steel plate group (15.10±2.07) min; the fluoroscopy times of screw group was (6.00±1.83) more than that of steel plate group (3.75±1.33) . The bleeding volume was (22.50±10.82) ml in of screw group, (25.00±9.93) ml in steel plate group, there was no significant difference between the two groups (P>0.05) . There was no significant difference in Matta evaluation and Majeed functional score in the last follow-up. One case of superficial skin infection occurred in screw group, one case of superficial skin infection and one case of transient paralysis of lateral femoral cutaneous nerve occurred in steel plate group. CONCLUSION: Percutaneous bridging plate and retrograde suprapubic intramedullary screw fixation of pelvic anterior ring fracture have the same effect. The operation time of the percutaneous plate group was shorter, the times of intraoperative fluoroscopy was less, and the learning curve was shorter, but the variation of the lateral femoral cutaneous nerve should be noted during the operation.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Placas Ósseas , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(10): e19205, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150059

RESUMO

Retrospective observational cohort study.We used observational measures and retrospective chart reviews to compare elderly patients with osteoporosis who underwent multi-level anterior lumbar interbody fusion (ALIF) with either posterolateral fusion (PLF) or percutaneous pedicle screw fixation.Multi-level ALIF with PLF is used to save the posterior element of the spine and improve fusion rates in elderly patients with osteoporosis. To minimize perioperative invasiveness and improve patients' postoperative quality of life, we perform minimal percutaneous screw fixation.Fifty-three elderly patients with osteoporosis who underwent either PLF with open pedicle screw fixation (n = 28) or percutaneous pedicle screw fixation (PPF) (n = 25) for treatment with 2-level ALIF between January 2010 and December 2013 were compared for clinical outcome including operation time, intraoperative and postoperative blood loss, and hospital day and radiological outcome.Average operation times were significantly shorter and intra- and postoperative blood loss was significantly reduced in the PPF group. There were no significant differences, preoperative and postoperative, in observational measures including visual analog scale, Oswestry disability index, and Rolland-Moris disability. There were no significant differences in the degree of lordosis, changes of motion, or adjacent segmental degeneration. Fusion rates were increased in the PLF group compared to the PPF group 6 months post-surgery, but from 1 year to the last follow-up, the rates were statistically equivalent. There were fewer minor complications in the PPF group, and no major complications at all.Two-level ALIF with PPF results in shorter operation times, less blood loss and minor complications, and similar fusion rate as 2-level ALIF with PLF. It; therefore, represents an effective method, leading to rapid recovery and less complications in elderly patients with osteoporosis.


Assuntos
Parafusos Ósseos , Osteoporose , Espondilolistese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Estudos Retrospectivos , Fusão Vertebral , Espondilolistese/diagnóstico por imagem , Resultado do Tratamento
6.
Prog Orthod ; 21(1): 7, 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32147751

RESUMO

OBJECTIVE: The present study aimed to evaluate the effect of MOP over a 3-month period and to determine the influence of the number of perforations on the rate of canine retraction. In addition, the amount of pain and discomfort caused by the MOP method was evaluated. TRIAL DESIGN: A single-center, split-mouth, triple-blind, randomized, controlled trial was conducted. METHODS: The clinical trial was conducted from December 2018 to July 2019 in the Orthodontic Clinic, Shiraz Dental School. Twenty-eight patients (range from16.3 to 35.2 years) who need fixed orthodontic treatment were recruited and randomly assigned to MOP1 and MOP2 groups. In each patient one side of the mouth worked as a control side which received no MOPs. Four months after first premolars extraction, patients in MOP1 group received 3 MOPs on the buccal surface of alveolar bone in the experimental side to accelerate canine retraction whereas patients in MOP2 group received 3 buccal MOPs and 3 palatal MOPs in the experimental side. The amount of canine retraction was measured every 28 days at three intervals on both sides of the mouth. Pain perception was also measured on the day of MOP procedure and subsequently at 24 h. Randomization was performed using online software RANDOM.ORG; the recruited patients were divided into two parallel groups with a 1:1 allocation ratio then the side of MOPs intervention in each subject was randomly determined with coin tossing. Triple blinding design was employed. RESULTS: The result of the intra-examiner reliability using ICC was 0.97 (P <  0.001), indicating excellent repeatability and reliability of the measurements. The baseline characteristics between the groups were similar (P > 0.05). There was a significant difference in the rate of canine retraction between the MOP groups and the contralateral control sides, as well as between the MOP1 and MOP2 groups (P <  0.05). CONCLUSION: The MOP procedure was effective in accelerating orthodontic tooth movement, although the amount of acceleration was not clinically significant in the case of canine retraction. An increase in the number of MOPs resulted in a significant acceleration of the canine retraction. TRIAL REGISTRATION: The trial was registered 30 November 2018 at the Iranian Registry of Clinical Trials (IRCT20181121041713N1).


Assuntos
Boca , Técnicas de Movimentação Dentária , Parafusos Ósseos , Humanos , Irã (Geográfico) , Reprodutibilidade dos Testes
7.
Medicine (Baltimore) ; 99(11): e19436, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176072

RESUMO

In syndesmosis injury, whether the syndesmosis screw should be removed prior to weight-bearing remains controversial. The aim of this study was to compare the functional outcome between removed screw and retained groups and between recurrence of diastasis and no diastasis groups.Fifty-six patients who had undergone open reduction and internal fixation due to syndesmosis injury were retrospectively evaluated and divided into four groups: (A) removed syndesmotic screw before weight-bearing (postoperative 3 months, n = 28), (B)retained (n = 28), (C) recurrence of diastasis (n = 9), and (D) no diastasis (n = 47). Radiological diastasis, American Orthopedic Foot Ankle Society Score (AOFAS), Short Form Health Survey-12 (SF-12), and complications (screw loosening and breakage) were evaluated between groups.AOFAS ankle-hindfoot score was 75.10 ±â€Š10.40 in group A, 77.07 ±â€Š10.60 in group B. SF-12 was 45.78 ±â€Š5.68 in group A and 47.33 ±â€Š5.83 in group B, showing no significant difference in AOFAS ankle-hindfoot score or SF-12 (P = .487, P = .319, respectively) between groups A and B. Radiological diastasis developed significantly (P = .025) more in group A (8/28) compared to that in group B (1/28). However, screw loosening or breakage developed significantly (P = .001) more in group B (4/28) compared to that in group A (0/28). AOFAS ankle-hindfoot score was 70.33 ±â€Š6.22 in group C and 76.50 ±â€Š10.26 in group D. SF-12 was 49.85 ±â€Š3.83 in group C and 47.40 ±â€Š8.01 in group D, showing no significant difference between groups C and D in AOFAS ankle-hindfoot score or SF-12 (P = .808, P = .948, respectively).Removal of syndesmotic screw before weight-bearing does not influence clinical outcomes. Although unrelated to clinical progress, recurrence of diastasis significantly increased in screw removed group. Therefore, removal of syndesmotic screw is unnecessary before weight-bearing.


Assuntos
Traumatismos do Tornozelo/cirurgia , Parafusos Ósseos , Remoção de Dispositivo , Caminhada , Suporte de Carga , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos
8.
Int J Oral Implantol (Berl) ; 13(1): 11-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32186285

RESUMO

PURPOSE: To assess the technical and biological complications of screw- and cement-retained implant-supported full-arch dental prostheses. MATERIALS AND METHODS: An electronic search was conducted on Medline/PubMed and Cochrane databases in February 2019; irrespective of any time restrictions using MeSH terms. All studies were first reviewed by abstract and subsequently by full-text reading. Further hand search was performed to identify other related references. Articles only related to cement-retained and/or screw-retained reconstructions in full-arch fixed dental prostheses (FDP) were included. RESULTS: The initial literature search resulted in 3670 papers. 3478 articles remained after removing duplicate articles, and 3439 articles were further excluded by the reviewers after the abstract screening, which resulted in a selection of 39 studies. 12 studies were further excluded due to not fulfilling the inclusion criteria. Hand searching resulted in two additional papers being included, and finally, 29 articles were included in this review. Screw-retained full-arch fixed dental prostheses have fewer complications than cemented reconstructions. Biological complications such as marginal bone loss > 2 mm occurred more frequently in cemented reconstructions, and technical complications such as screw-loosening and screw fracture occurred more in screw-retained reconstructions. CONCLUSION: Cemented reconstructions exhibited more biological complications (implant loss, bone loss > 2 mm) and screw-retained prostheses exhibited more technical problems. Clinical outcomes were influenced by both fixations in different ways. The screw-retained restorations were more easily retrievable than cemented ones, therefore, technical and eventually biological complications could be treated more easily. For this reason, and for their higher biological compatibility, these reconstructions are preferable.


Assuntos
Implantes Dentários , Retenção em Prótese Dentária , Parafusos Ósseos , Cimentação , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária
9.
Arthroscopy ; 36(3): 696-700, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32139049

RESUMO

Latarjet technique via open or arthroscopic approach is a very complex surgery that includes several steps. The coracoid placement that is performed at the end of this procedure represents the key point to avoid complications and attain the best clinical results. Mechanics and biology need to work as a whole to improve the integration of the graft on the glenoid neck.


Assuntos
Instabilidade Articular , Articulação do Ombro , Parafusos Ósseos , Humanos , Escápula , Torque
10.
Arthroscopy ; 36(3): 795-796, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32139056

RESUMO

The management of osteochondritis dissecans (OCD) continues to baffle even the savviest of surgeons, with unclear etiology, unknown relationship of presentation to outcome, bewildering response to various treatments, and frustratingly difficult-to-predict prognosis. Whether skeletal immaturity may be indicative of surgical success, at least when it comes to lesions requiring screw fixation, remains debatable. Treatment may include activity modification, drilling, fixation, or osteochondral replacement of OCD lesions in the knee. Regardless, each OCD lesion must be followed until osseous integration is confirmed by imaging -otherwise, progression of disease to osteoarthritis is likely.


Assuntos
Osteocondrite Dissecante/cirurgia , Parafusos Ósseos , Lâmina de Crescimento , Humanos , Articulação do Joelho , Reoperação
11.
Zhonghua Yi Xue Za Zhi ; 100(9): 674-678, 2020 Mar 10.
Artigo em Chinês | MEDLINE | ID: mdl-32187910

RESUMO

Objective: To explore and analyze the clinical efficacy of fixation bone fragments by screw though cortical bone tunnel combined with limited open reductionin treating 31A3 type irreducible femoral intertrochanteric fractures in elderly people. Methods: Clinical data of 18 elderly patients with 31A3 type irreducible femoral intertrochanteric fractures treated from July 2017 to June 2018 in Orthopedics Department of Jiangsu Province Hospital were collected and analyzed retrospectively. There were 8 males and 10 females, aged from 65 to 88 years (mean age,(76±4) years). When confirmed as irreducible femoral intertrochanteric fractures by C-arm machine during operation, limited open reduction and fixation bone fragments by screw though cortical bone tunnel and intramedullary nail fixation were conducted. General surgical data,the quality of fracture reduction and functional recovery scale (FRS) score were collected.Data before and after operation were compared with paired t-test. Results: All patients were followed up for a mean of 13.6 months (10 to 22 months). The surgical time was (55±13) min (42 to 95 min), the intraoperative blood loss was (223±26) ml (180 to 320 ml), the number of intraoperative fluoroscopy was 23±4 (18-32 times), and the fracture healing time was (4.8±0.7) months. The quality of fracture reduction was rated as grade Ⅰ in 15 cases andgrade Ⅱ in 3 cases, with an excellent to good rate of 100% according to Kim classification. FRS score was 84±10 at the last follow-up and it was comparable with that before injury (84±11) (t=0.144, P=0.887). Conclusion: For elderly patients with 31A3 type irreducible femoral intertrochanteric fractures, fixation bone fragments by screw though cortical bone tunnel combined with limited open reduction is an efficient treating method with advantages of high quality of fracture reduction and fixation without increasing of surgical time and blood loss.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Parafusos Ósseos , Osso Cortical , Feminino , Fêmur/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
BMC Infect Dis ; 20(1): 236, 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32192457

RESUMO

BACKGROUND: Melioidosis-associated peri-prosthetic infection is extremely rare. To date, melioidosis associated septic arthritis of the ankle joint following a medial malleolar internal fixation has not been reported. CASE PRESENTATION: We describe a 49-year-old male with a history of long standing diabetes who presented with fever, constitutional symptoms and right ankle pain for 1 week. Ten years ago, he underwent a medial malleolar screw fixation following a traumatic closed fracture. His initial right ankle radiographs showed no evidence of osteomyelitis. He underwent a wound debridement and washout of the right ankle joint. The peripheral blood and pus from the ankle joint was culture positive for Burkholderia pseudomallei with very high antibody titres. His subsequent radiographs showed features of chronic osteomyelitis. He was treated with a prolonged course of antibiotics and repeated wound debridement. At follow up after 6 months, he had no clinical features of recurrent infection. CONCLUSIONS: Melioidosis should be entertained in the differential diagnosis of peri-prosthetic infections in high risk patients.


Assuntos
Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/microbiologia , Artrite Infecciosa/microbiologia , Parafusos Ósseos/microbiologia , Burkholderia pseudomallei/imunologia , Fixação Interna de Fraturas/efeitos adversos , Melioidose/etiologia , Osteomielite/microbiologia , Articulação do Tornozelo/patologia , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Burkholderia pseudomallei/isolamento & purificação , Desbridamento , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Melioidose/diagnóstico , Melioidose/tratamento farmacológico , Melioidose/microbiologia , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Radiografia , Resultado do Tratamento
13.
Einstein (Sao Paulo) ; 18: e0AO5052, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32159606

RESUMO

OBJECTIVE: To compare screw fixation strength for subtalar arthrodesis. METHODS: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP Group), and the other foot, plantar to dorsal orientation (PD Group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix ® 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD Groups using Student's t test, with p=0.05 used to determine statistical significance. RESULTS: Statistical analysis demonstrated that the mean torque to failure slightly favored the DP Group (37.3Nm) to the PD Group (32.2Nm). However, the difference between the two groups was not statistically significant (p=0.55). CONCLUSION: In subtalar arthrodesis, there is no significant difference in construct strength between dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation.


Assuntos
Artrodese/métodos , Parafusos Ósseos , Articulação Talocalcânea/cirurgia , Artrodese/instrumentação , Fenômenos Biomecânicos , Cadáver , Calcâneo/cirurgia , Humanos , Reprodutibilidade dos Testes , Tálus/cirurgia , Torque , Falha de Tratamento
14.
Unfallchirurg ; 123(4): 269-279, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32215668

RESUMO

BACKGROUND: Spinal injuries in pediatric patients are overall very rare. Current reference studies including large patient numbers that enable the formulation of evidence-based recommendations on diagnostics and treatment of these injuries do not exist. OBJECTIVE: The aim of the current study was to formulate recommendations on the diagnostics and treatment for injuries of the thoracic and lumbar spine in pediatric patients. MATERIAL AND METHODS: Firstly, a search for primary and secondary literature on the topic of diagnostics and treatment of spinal injuries in children was carried out. From this, a literature database was established and maintained. Secondly, within the framework of 9 meetings in the time period from April 2017 to December 2019 the members of the Pediatric Spinal Trauma Group of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) documented recommendations on diagnostics and treatment of injuries of the thoracic and lumbar spine in pediatric patients by a consensus process. RESULTS: Recommendations on the diagnostics and treatment of injuries of the thoracic and lumbar spine could be given for 3 age groups (age group I: 0-6 years; age group II: 7-9 years; age group III: 10-16 years). Diagnostic and therapeutic principles known from adult patients suffering from injuries to the thoracic or lumbar spine cannot easily be transferred to pediatric patients. CONCLUSION: Spinal injuries in childhood are rare and should be treated in specialized spine centers. Pediatric patients with a stable cardiopulmonary status should undergo magnetic resonance imaging (MRI) if a spinal trauma is suspected. The basic principles of the treatment of spinal trauma in children is the restoration of spinal stability and correct anatomical parameters as well as the protection of all neural structures. The potential for correction and regeneration of the individual spinal sections depending on the age of the patient must be considered for deciding between operative vs. conservative treatment. Whenever operative treatment is needed, it should be performed by minimally invasive techniques as a sole instrumentation without spondylodesis. An early removal of the screw-rod-system should be performed.


Assuntos
Fraturas da Coluna Vertebral , Fusão Vertebral , Traumatismos da Coluna Vertebral , Parafusos Ósseos , Criança , Humanos , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/cirurgia , Vértebras Torácicas
15.
World Neurosurg ; 136: 462-469, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32204298

RESUMO

Chiari malformation comprises a spectrum of congenital malformations characterized by a herniation of the cerebellar tonsils below the foramen magnum. Chiari malformation type I (CM-I) is the most prevalent subtype seen in clinical practice. This condition variably compresses the cerebellum and medulla-spinal cord junction secondary to malformation of the posterior fossa. Most neurologists and neurosurgeons recognize the sensorimotor and lower brainstem manifestations that result in the clinical picture of CM-I. The effects of CM-I on cognitive functioning, however, and their impact on neuropsychological performance are poorly understood, despite having long been recognized. This article reviews neuropsychological deficits demonstrated by individuals with CM-I, and explores cerebellocortical neuroanatomic pathways to provide possible rationale for the neurocognitive impairments present in affected individuals.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia , Parafusos Ósseos , Procedimentos Neurocirúrgicos/métodos , Crânio/diagnóstico por imagem , Crânio/cirurgia , Adolescente , Adulto , Malformação de Arnold-Chiari/psicologia , Cadáver , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Fixação Interna de Fraturas , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuronavegação , Fusão Vertebral , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
16.
World Neurosurg ; 136: 470-478, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32204299

RESUMO

OBJECTIVE: Patients who undergo decompression surgery for Chiari malformation frequently require occipitocervical fixation. This is typically performed with occipital plates, which may cause intracranial injuries due to multiple fixation points. We undertook this study to assess the feasibility of occipital condyle (OC) screw placement as an alternative method of occipitocervical fixation in this patient population. METHODS: Using a cadaveric model with navigational assistance, we performed the complete surgical procedure for occipitocervical fixation with OC screws. We then performed a morphometric analysis using measurements from computed tomography scans of 49 patients (32 adult, 17 pediatric) who had undergone occipitocervical fusion with instrumentation following decompression surgery for Chiari malformation. Bilateral morphometric data were analyzed for the adult and pediatric subgroups separately, as well as for the overall group. RESULTS: The surgical procedure was successfully performed in the cadaveric model, demonstrating the feasibility of the proposed method. Ninety-eight OCs were studied in the morphometric analysis, and 80 (81.6%) met our eligibility criteria for OC screw placement. However, in 14.1% of adult OCs and 26.5% of pediatric OCs studied, placement of condylar screws would have been challenging or unsafe, according to our criteria. CONCLUSIONS: Our findings suggest that OC screws provide a useful option for occipitocervical fixation in a substantial proportion of patients with Chiari malformation. However, rigorous preoperative analysis would be essential to identify appropriate candidates for this technique and exclude those in whom it should not be attempted. Additional study is warranted.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia , Parafusos Ósseos , Procedimentos Neurocirúrgicos/métodos , Osso Occipital/diagnóstico por imagem , Osso Occipital/cirurgia , Adolescente , Adulto , Cadáver , Criança , Pré-Escolar , Descompressão Cirúrgica , Estudos de Viabilidade , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Neuronavegação , Fusão Vertebral , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
17.
Bone Joint J ; 102-B(2): 212-219, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009435

RESUMO

AIMS: In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw (SS). The aim of this study was to compare clinical and radiological outcomes for these treatment groups after five years. METHODS: A total of 97 patients with acute syndesmotic injury were randomized to SS or SB. The five-year follow-up rate was 81 patients (84%). The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. Secondary outcome measures included Olerud-Molander Ankle (OMA) score, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of movement, complications, reoperations, and radiological results. CT scans of both ankles were obtained after surgery, and after one, two, and five years. RESULTS: The SB group had higher median AOFAS score (100 (interquartile range (IQR) 92 to 100) vs 90 (IQR 85 to 100); p = 0.006) and higher median OMA score (100 (IQR 95 to 100) vs 95 (IQR 75 to 100); p = 0.006). The SS group had a higher incidence of ankle osteoarthritis (OA) (24 (65%) vs 14 (35%), odds ratio (OR) 3.4 (95% confidence interval (CI) 1.3 to 8.8); p = 0.009). On axial CT we measured a significantly smaller mean difference in the anterior tibiofibular distance between injured and non-injured ankles in the SB group (-0.1 mm vs 1.2 mm; p = 0.016). CONCLUSION: Five years after syndesmotic injury treated with either SB or SS, we found better AOFAS and OMA scores, and lower incidence of ankle OA, in the SB group. These long-term results favour the use of SB when treating an acute syndesmotic injury. Cite this article: Bone Joint J 2020;102-B(2):212-219.


Assuntos
Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Âncoras de Sutura , Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Seguimentos , Humanos , Resultado do Tratamento
18.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 162-167, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030945

RESUMO

Objective: CT three-dimensional reconstruction technology was used to simulate the placement of the lumbar cortical bone trajectory (CBT), to determine the starting point and direction of the screw trajectory. Methods: Between February 2017 and April 2018, 24 patients with lumbar CT were selected as the study object. There were 7 males and 17 females, with an average age of 50.4 years (range, 37-68 years). The CT DICOM data of patients were imported into Mimics 16.0 software, and the three-dimensional model of lumbar spine was established. A 5 mm diameter cylinder was set up to simulate the CBT by using Mimics 16.0 software. According to the different implant schemes, the study was divided into groups A, B, and C, the track of the screw respectively passed through the upper edge, the medial edge, and the lower edge of the isthmus of the pedicle. The intersection of simulated screw and lumbar spine was marked as region of interest (ROI) and a mask was generated. The average CT value [Hounsfield unit (HU)] and the screw length of ROI were automatically measured by Mimics 16.0 software. In addition, the head inclination angle and head camber angle of the screw were measured respectively. Point F was the intersection of the level of the lowest edge of the transverse process and the lumbar isthmus periphery. The horizontal and vertical distance between point F and the starting point were measured, and the relationship between the three schemes and the position of the zygapophysial joint and spinous process was observed. Results: Plan A has the highest ROI average HU, with the maximum value appearing in L 4; plan B has the longest screw length, with the maximum value appearing in L 5; plan C has the largest nail track head inclination angle, with the maximum value appearing in L 4; plan B has the largest nail track head camber angle, with the maximum value appearing in L 3. The screw length and head camber angle of the nail in group B were significantly greater than those in groups A and C ( P<0.05); the head inclination angle in groups A, B, and C was gradually increased, showing significant differences ( P<0.05); there was no significant difference in the average HU value of ROI between the 3 groups ( P>0.05). In plan A, 74.48% (143/192) screws had a horizontal distance of -2 to 4 mm from point F, a vertical distance of 6-14 mm from point F, a head inclination angle of (14.64±2.77)°, and a head camber angle of (6.55±2.09)°, respectively; in plan B, 84.58% (203/240) screws had a horizontal distance of 1-6 mm from point F, a vertical distance of 1-5 mm from point F, a head inclination angle of (26.93±2.21)°, and a head camber angle of (10.29±2.46)°, respectively; in plan C, 85.94% (165/192) screws had a horizontal distance of -2 to 3 mm from point F, a vertical distance of -2 to 4 mm from point F, a head inclination angle of (33.50±3.69)°, and a head camber angle of (6.47±2.48)°, respectively. Conclusion: Plan B should be selected as the starting point of the L 1-L 5 CBT implant. It is located at the intersection of the lowest horizontal line of the transverse process root and the lateral edge of the lumbar isthmus, which is 1-6 mm horizontally inward, 1-5 mm vertically upward, with a head inclination angle of (26.93±2.21)°, and a head camber angle of (10.29±2.46)°, respectively.


Assuntos
Osso Cortical , Adulto , Idoso , Parafusos Ósseos , Osso Cortical/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Vértebras Lombares , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Fusão Vertebral
19.
Medicine (Baltimore) ; 99(7): e19046, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049803

RESUMO

INTRODUCTION: It is well known that the main segments of spinal fracture is thoracolumbar (T11-L11). Therefore, in addition to the lumbar, the lower thoracic vertebra (T9-T12) often has the clinical needs of implantation of cortical bone trajectory (CBT) screws. However, the anatomic parameters of the lower thoracic vertebrae are quite different from those of the lumbar vertebrae, which means that if CBT screws are to be implanted in the lower thoracic vertebrae, the selection of the screw entry point, the length, diameter, angle and path of the screws in each segment need to be redefined. Methods In this part, 3-dimensional finite element model was established to analyze the stress and fixation efficiency of CBT screws in thoracic vertebrae after 5000 times of fatigue loading of normal model and osteoporosis model. Discussion If the outcomes indicate the trial is feasible and there is evidence to provide some basic anatomical parameters for CBT screw implantation in the lower thoracic spine, so that the ideal insertion point, length, diameter, and angle of CBT screw in different segments of the lower thoracic spine were determined.Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026915.Registered on September 26, 2019.


Assuntos
Procedimentos Ortopédicos/instrumentação , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Fenômenos Biomecânicos , Parafusos Ósseos , Osso Cortical/anatomia & histologia , Osso Cortical/cirurgia , Estudos de Viabilidade , Feminino , Análise de Elementos Finitos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Vértebras Torácicas/anatomia & histologia , Adulto Jovem
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