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1.
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
2.
Zhongguo Gu Shang ; 33(1): 59-63, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115926

RESUMO

OBJECTIVE: To evaluate the effect of open reduction assisted by wrist arthroscopy in the treatment of Diepunch fracture of the distal radius. METHODS: The clinical data of 50 patients with die punch fracture of distal radius from December 2015 to May 2017 were analyzed retrospectively, including 31 males and 19 females, aged 20 to 45 (34.12±2.56) years. All patients were treated with open reduction and internal fixation of volar plate through volar approach under the assistance of wrist arthroscope. The range of wrist movement and Cooney wrist function score before and after treatment were compared. RESULTS: All patients were followed up with an average of 18 months. DR scan showed that all fractures healed and no shortening of radial axis. Three cases of incision infection occurred and disappeared after treatment. At 18 months after operation, the range of wrist movement was significantly larger than that before operation (P<0.05) . At 18 months after operation, Cooney wrist function score was higher than that before operation (P<0.05) , excellent in 33 cases, good in 13 cases, fair in 3 cases and poor in 1 case. CONCLUSION: The treatment of die punch fracture of the distal radius with open reduction assisted by arthroscopy can restore the flatness of the joint surface, promote the recovery of the function of the wrist joint quickly, and has high safety, which is worth popularizing.


Assuntos
Fraturas do Rádio , Rádio (Anatomia) , Adulto , Artroscopia , Placas Ósseas , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Punho , Articulação do Punho , Adulto Jovem
3.
Zhonghua Wai Ke Za Zhi ; 58(3): 213-219, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187925

RESUMO

Objective: To explore the operative effect and treatment strategies for the low distal humerus fracture. Methods: A retrospective analysis was conducted on the clinical data of 16 patients with the low distal humerus fracture between January 2016 and January 2018 at Department of Orthopaedics, Shanghai Tongji Hospital Affiliated to Tongji University.All fractures were coronal fractures of humeral head, partly combined fractures of humeral trochlea or posterior part. Fractures were classified according to Dubberley classification as 9 cases in type Ⅰ, 3 cases in typeⅡ and 4 cases in type Ⅲ.Selection of the kind of operative approach and internal fixation was made according to the fracture type and shape. For simple coronal fractures of humeral head or combining humeral trochlea fractures, which were relatively stable, single or multiple countersunk screws fixation by the lateral approach were chosen.For humeral head coronal fractures, which combining obviously displaced comminuted humeral trochlea factures, posterolateral locking plates and countersunk screws internal fixation by the olecranon osteotomy approach were chosen. The incision and elbow soft tissues were observed within 2 weeks after operation.The radiographic evaluation of fracture reduction, bone healing, internal fixation, arthritis and elbow range of motion were made at 3, 6, 12 months after operation. The Mayo elbow functional scores were documented for analysis of elbow joint function, and compared between different surgery groups by Kruskal-Wallis H test. Results: The follow-up time was (22.1±9.2)months(range: 15 to 39 months). The incisions healed well in 2 weeks after operation without soft tissue infection, necrosis or vascular complications. There was no fracture reduction loss or internal fixation loosening according to radiographic evaluation 3 months after operation. One case of ectopic ossification was observed 6 months after operation and inhibited by the treatment of non steroidal anti-inflammatory drugs.One case of ulnar neuritis occurred after operation and released after removing the long screw and loosing the ulnar.Osteoarthritis images were observed at the end of follow-up.Arc of motion was (120.4±11.2) ° in flexion and (5.5±1.9) ° in extension. The Mayo score was 88.7±9.1, including 11 excellent, 4 good, and 1 fair.The Mayo score was 90.1±3.7 in Dubberley classification type Ⅰcases, 89.7±4.6 in type Ⅱ cases and 84.5±5.8 in type Ⅲ cases. There were no significant differences in Mayo scores between 3 types cases according to Kruskal-Wallis H test. Conclusion: Choosing the appropriate surgical approach and composite internal fixation according to the fracture types and shapes of low distal humerus fracture, anatomic reduction of the articular surface and early functional exercise are the keys to obtain ideal curative effect.


Assuntos
Fixação Interna de Fraturas , Fraturas do Úmero/cirurgia , Placas Ósseas , China , Articulação do Cotovelo/cirurgia , Humanos , Úmero/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(8): e19195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080105

RESUMO

RATIONALE: Less-Invasive Stabilization System (LISS) plate is an internal fixation commonly used for the periprosthetic distal femur fractures. Failure associated with LISS plate has been rarely reported, and the reasons for LISS plate failure are multitudinous. Various advantages have been reported, but failures continue. PATIENT CONCERNS: We present 3 cases illustrating the failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures. The shaft screws of the LISS plate broke in 2 cases, and the plate placement was incorrect in 1 case. Early weight bearing, obesity, osteoporosis, and lateral collateral ligament injury due to incorrect plate placement constituted the etiologies of LISS plate failure. DIAGNOSIS: Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures after Total knee arthroplasty. INTERVENTIONS: Three patients underwent Less-Invasive Stabilization System plates removal with replacement of the total knee arthroplasty revision surgery with rotating hinged knee prosthesis. OUTCOMES: After completing the total knee arthroplasty revision surgery, all patients underwent regular follow-up examinations. Case 2 could walk unaided, without pain, final union was confirmed for both case 1 and case 3. CONCLUSION: Less-Invasive Stabilization System (LISS) plate provides satisfactory results in periprosthetic fractures after Total knee arthroplasty (TKA). The LISS plate has many advantages, but failures continue to occur. The causes for failure were early weight bearing, obesity, osteoporosis, and lateral collateral ligament (LCL) injury due to incorrect plate placement in our series. We recommend that protection or properly delay of weight-bearing, active anti-osteoporosis treatment, and intraoperative fluoroscopy are the effective methods to avoid failure.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/cirurgia , Idoso , Artroplastia do Joelho/métodos , Falha de Equipamento , Feminino , Fraturas do Fêmur/epidemiologia , Humanos , Obesidade/epidemiologia , Osteoporose/epidemiologia , Fraturas Periprotéticas/epidemiologia , Suporte de Carga/fisiologia
5.
Medicine (Baltimore) ; 99(8): e19259, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080133

RESUMO

BACKGROUND: The aim of this study was to evaluate the effectiveness and safety of surgical treatment of intra-articular distal radius fractures (DRFs) with the assistance of three-dimensional (3D) printing technique. METHODS: Patients with intra-articular DRFs in our hospital from February 2017 to November 2018 were enrolled in this study, and were randomly assigned to 2 parallel groups to receive surgical treatment with the assistance of 3D printing technique or not. For patients in the 3D printing group, the surgical procedure was simulated with 3D physical model before surgery. Volar plate and K-wire fixation were performed in all patients. Patients in the 2 groups were compared in terms of intraoperative indexes and postoperative function. RESULTS: A total of 32 patients were included in our study. During surgery, mean operation time in the 3D model group was significantly lower than that in the routine group (P < .001). Besides, significantly less blood was lost in the 3D model group than that in the routine group (P < .001). Furthermore, the 3D model group had a significantly less times of intraoperative fluoroscopy than that in the routine group (P = .002). However, the 3D model group showed no significant difference in visual analog scale (VAS) score, the disabilities of the arm, shoulder, and hand (DASH) score, or active wrist range of motion (ROM) in comparison with the routine group (P > .05). CONCLUSION: With the assistance of 3D printing technique, the operation time, amount of intraoperative bleeding, and times of intraoperative fluoroscopy can be reduced during the surgical treatment of intra-articular DRFs with volar plating and K-wire fixation. This technique is safe and effective, and is worth spreading in other orthopedic surgeries.


Assuntos
Simulação por Computador , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Impressão Tridimensional , Fraturas do Rádio/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Placas Ósseas , Fios Ortopédicos , Avaliação da Deficiência , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Duração da Cirurgia , Cuidados Pré-Operatórios , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X , Escala Visual Analógica
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 151-156, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030943

RESUMO

Objective: To compare differences in the maintenance of cervical curvature after anterior cervical surgery between zero-profile and self-locking intervertebral cage and plate-cage construct (PCC). Methods: A clinical data of 100 patients with single-segment cervical disc herniation who were treated with anterior cervical discectomy and fusion were retrospectively analyzed between January 2015 and January 2016. Among them, 50 patients were treated with the zero-profile and self-locking intervertebral cage (group A) and 50 patients with the PCC (group B). There was no significant difference between the two groups in age, gender, bone mineral density, disease duration, operative segment, and preoperative visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height ( P>0.05). The operation time and intraoperative blood loss were recorded. The postoperative VAS and JOA scores were used to evaluate the clinical efficacy. The C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height were measured on lateral X-ray films, and the interbody fusion was evaluated according to Pitzen's criteria. Results: The operation time in group A was significantly shorter than that in group B ( t=2.442, P=0.021), but there was no significant difference in the intraoperative blood loss between the two groups ( t=0.812, P=0.403). All patients were followed up 24-36 months, with an average of 28.5 months. According to Pitzen's criteria for cervical interbody fusion, bone fusion achieved in both groups. The VAS score, JOA score, C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height of the two groups at 1 and 24 months after operation were significantly improved when compared with those before operation ( P<0.05). The C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height of group A at 24 months changed significantly compared with those at 1 month ( P<0.05). The other indexes of the two groups showed no significant difference between the different time points after operation ( P>0.05). There were significant differences in C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height between the two groups at 24 months after operation ( P<0.05); but there was no significant difference in the clinical indexes at 1 and 24 months and the imaging indexes at 1 month between the two groups ( P>0.05). Conclusion: Compared with the PCC, the zero-profile and self-locking intervertebral cage can significantly shorten the operation time and obtain the same clinical efficacy, but the intervertebral height loss and secondary cervical curvature change after operation is more serious.


Assuntos
Placas Ósseas , Fusão Vertebral , Vértebras Cervicais , Discotomia , Humanos , Estudos Retrospectivos , Espondilose , Resultado do Tratamento
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 260-265, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030961

RESUMO

Objective: To review the research progress in the treatment of proximal humeral fractures with fibular allograft and locking plate. Methods: The literature about the treatment of proximal humeral fractures with fibular allograft and locking plate was reviewed and analyzed from the aspects such as the biomechanics, imaging prognosis, and clinical prognosis. Results: Fibular allograft and locking plate can provide effective medial support for proximal humeral fracture and increase the strength of internal fixation system. Compared with locking plate, fibular allograft combined with locking plate can maintain better humeral neck-shaft angle and the humeral head height after operation in the treatment of proximal humeral fractures, and has better shoulder mobility and shoulder joint function, and does not increase the risk of complications. Conclusion: Fibular allograft combined with locking plate may be a new and effective treatment for proximal humeral fractures. However, the long-term follow-up results are insufficient, the final outcome of fibula is uncertain, and the long-term potential adverse reactions caused by this treatment are still indefinite.


Assuntos
Fíbula , Fraturas do Ombro , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Fraturas do Ombro/cirurgia , Transplante Homólogo , Resultado do Tratamento
8.
Instr Course Lect ; 69: 433-448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017744

RESUMO

Lower extremity fractures, ranging from the proximal femur to the distal tibia, come in a variety of patterns and complexity. Treatment modalities typically consist of using plates and intramedullary nails; however, each has its advantages and disadvantages in each anatomic region. In this instructional course, salient points and nuances in setup and implant choice are reviewed. Furthermore, the essential tips and tricks to avoid pitfalls and achieve a desired clinical result are discussed.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fixação Intramedular de Fraturas , Fraturas Ósseas , Extremidade Inferior , Humanos , Tíbia
9.
Unfallchirurg ; 123(1): 76-79, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31915877

RESUMO

A 60-year-old patient suffered an ankle distortion resulting in a comminuted fracture of the fifth metatarsal. On the same day the accident occurred the patient presented to an emergency department and immediate operative treatment of the fracture was performed by intramedullary Kirschner wires with closed reduction and internal fixation. The aftercare was carried out on an outpatient basis by a registered orthopedist in accordance with the surgeon's instructions. In the radiological control 14 days after surgery a dislocation of the fracture was detected and 1 week later a rectification operation was carried out in a second clinic with removal of the Kirschner wires, open reduction and internal fixation with a locking plate. The patient suspected inadequate treatment by the first clinic, which in turn did not accept any inadequacies in the surgical treatment or the aftercare. In the subsequent legal dispute the appointed experts came to the conclusion that an initial good fracture position was achieved but that the aftercare treatment with a forefoot relief shoe was inadequate for the type of internal fixation chosen. The arbitration board came to the conclusion that the multifragmented fracture situation was treated by a questionably stable osteosynthesis using Kirschner wires. This should have required a very strict aftercare with partial weight bearing on crutches and immobilization in a stable orthosis or cast.


Assuntos
Assistência ao Convalescente , Fraturas Ósseas , Ossos do Metatarso , Placas Ósseas , Fios Ortopédicos , Fixação Interna de Fraturas , Fraturas Ósseas/terapia , Humanos , Ossos do Metatarso/lesões , Pessoa de Meia-Idade , Resultado do Tratamento
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 27-31, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939230

RESUMO

Objective: To investigate the application and effectiveness of self-made spring plate in surgical treatment of acetabular posterior wall fracturejavascript:void(0)s. Methods: Between June 2013 and June 2017, 38 patients with acetabular posterior wall fractures were treated. There were 27 males and 11 females with an average age of 53 years (range, 28-68 years). The injury caused by traffic accident in 18 cases, falling from height in 15 cases, and tumble in 5 cases. There were 4 cases of simple posterior wall fracture, 18 cases of posterior wall fracture with posterior dislocation of hip joint, 10 cases of posterior wall fracture with posterior column fracture, and 6 cases of posterior wall fracture with transverse fracture. The time from injury to admission was 1-4 days (mean, 2.5 days). The time from injury to operation was 4-8 days (mean, 5 days). After fracture reduction via the Kocher-Langenbeck approach (35 cases) or the combined ilioinguinal approach (3 cases), the spring plate was used to press the posterior wall fracture, and then the reconstruction plate was pressed against the spring plate and fixed to the posterior column. Results: All the incisions healed by first intention. All patients were followed up 12-36 months (mean, 28 months). Five cases of post-traumatic sciatic nerve injury and 2 cases of sciatic nerve injury caused by traction during operation were fully recovered at 3 months after operation. The imaging examination showed that all the fractures healed. The fracture healing time was 10-16 weeks (mean, 12 weeks). There was no ruptures or failures of internal fixation during the follow-up period. There were 2 cases of femoral head necrosis, 1 case of traumatic arthritis, and 1 case of osteomyositis at last follow-up. The hip joint function was rated as excellent in 27 cases, good in 5 cases, fair in 2 cases, and poor in 4 cases according to the Harris scores at 12 months after operation. Conclusion: For the acetabular posterior wall fracture, it has the advantages of easy to use and reliable fixation that the posterior wall fracture is fixed with spring plate firstly, and the spring plate is pressed to fix the posterior column with the reconstruction plate finally.


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Acetábulo , Adulto , Idoso , Placas Ósseas , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
11.
Oper Orthop Traumatol ; 32(1): 35-46, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31940051

RESUMO

OBJECTIVE: The aim of surgical treatment is reconstruction of the coronoid process' bony anatomy. INDICATIONS: Large shear fractures of the coronoid process (Regan-Morrey type II-III, O'Driscoll "tip" subtype 2 and "basal" subtype 1-2) and fractures of the anteromedial facet (O'Driscoll "anteromedial" subtype 1-3) can occur isolated or as part of the "terrible triad" injuries to the elbow. Due to the resulting instability of these injuries, surgical reconstruction is generally indicated. CONTRAINDICATIONS: In case of major accompanying soft tissue injuries to the elbow or an elbow infection, primary operative treatment using anatomical plate osteosynthesis is contraindicated. SURGICAL TECHNIQUE: Plate osteosynthesis of the coronoid process is performed through a medial approach (Hotchkiss or M. flexor carpi ulnaris split). After repositioning of the fracture fragments, a preformed anatomical plate can be fixed to the coronoid process. POSTOPERATIVE MANAGEMENT: The arm is immobilized in an over-the-elbow cast until the wounds are dried. Afterwards, the elbow should preferably be treated functionally without varus or valgus stress. RESULTS: Between January 2015 and July 2018, a total of 11 patients underwent osteosynthesis of the coronoid using anatomically preformed plate osteosynthesis. After a mean follow-up of 10.7 months, the mean Mayo Elbow Performance Score showed an excellent result with 78.89 points. The Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) score showed a median of 18.64 points with a mean functional arc of 118°.


Assuntos
Placas Ósseas , Articulação do Cotovelo , Fixação Interna de Fraturas , Fraturas da Ulna , Fixação Interna de Fraturas/métodos , Humanos , Amplitude de Movimento Articular , Resultado do Tratamento , Ulna , Fraturas da Ulna/cirurgia
12.
Oral Maxillofac Surg ; 24(1): 19-24, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31713697

RESUMO

PURPOSE: This study was to assess the efficiency of using a combination of one microplate and one miniplate for management of patients with parasymphyseal mandibular fractures versus two miniplates through measurement of the biting force. PATIENTS AND METHODS: The study sample consisted of sixteen patients with an isolated mandibular fracture and randomly divided into two groups; group I was managed using two miniplates, while group II was managed using a combination of one microplate at subapical region and one miniplate at the inferior border of the mandible. The biting force was measured at 1 week, 1 month, and 3 months follow-up visits. A control group consisted of 40 healthy adult volunteers was selected to measure the normal biting force. RESULTS: The mean of the normal biting force of the control group was 435 N ± 219, 103.2 N ± 4.8, and 390.6 N ± 195.4 at right molar, incisor, and left molar regions respectively. There was a statistically non-significant difference regarding the bite force of both study groups, with a progressive increase through the different follow-up visits and a period of 3 months is sufficient for recovery of patients to regain their normal biting force. CONCLUSION: Consequently a combination of one microplate and one miniplate is efficient for the management of isolated parasymphyseal mandibular fracture in the same way as two miniplates.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Fraturas Mandibulares , Adulto , Força de Mordida , Humanos , Mandíbula
13.
World Neurosurg ; 133: e683-e689, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568915

RESUMO

OBJECTIVE: The middle fossa craniotomy for tegmen defect repair provides wide access. This approach often requires temporal lobe manipulation, lumbar drain placement, and longer recovery. We describe a keyhole middle fossa approach with a simple titanium skull base repair that allows for wide access with no temporal lobe manipulation and does not require lumbar drain placement, which results in a dramatic reduction in hospital length of stay. METHODS: A retrospective review was performed on 14 consecutive patients with spontaneous cerebrospinal fluid (CSF) otorrhea. Each patient underwent a keyhole middle fossa approach followed by multilayer dural repair with titanium mesh "gull wing" skull base reconstruction. Postoperative measures included operative time, length of hospital stay, CSF leak recurrence, and surgical complications (seizures, hemorrhage, aphasia, infection). RESULTS: The average age of the patients was 60.7 ± 12.7 years old, and average body mass index was 32.8 ± 7.9 kg/m2. Nine of the patients were female. The average operative time was 103 ± 32.8 minutes. The average hospital length of stay was 1.4 days. There were no cases of postoperative CSF otorrhea, meningitis, aphasia, or seizures. There were no recurrences over a mean follow-up of 20.3 months (range: 5-48 months). CONCLUSIONS: A minimally invasive keyhole middle fossa approach with a multilayer dural reconstruction including titanium mesh "gull wing" skull base repair provides a quick, effective treatment for a broad spectrum of tegmen defects and meningoencephaloceles. This exposure and reconstruction technique do not require the use of a lumbar drain and result in minimal hospitalization.


Assuntos
Fossa Craniana Média/cirurgia , Craniotomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Placas Ósseas , Otorreia de Líquido Cefalorraquidiano/cirurgia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Titânio
15.
World Neurosurg ; 133: e342-e347, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562968

RESUMO

OBJECTIVE: This study was carried out to analyze the surgical effect of cervical spine sagittal alignment for patients with Hirayama disease (HD). METHODS: Forty-four subjects were retrospectively analyzed for the parameters of cervical spine sagittal alignment. The case group consisted of 23 patients with HD, whereas the control group consisted of 21 healthy adolescent subjects. Pre- and postoperative cervical spine sagittal parameters of the patients with HD were collected; the cervical sagittal parameters of the healthy adolescent subjects were also collected. Sagittal alignment parameters were compared between the patients with HD and the healthy adolescent subjects, and between the pre- and postoperative parameters for the patients with HD. RESULTS: Forty-four subjects completed the follow-up, with the average follow-up period being 18.0 months. No significant differences were detected between the HD and control groups for clinical parameters (P > 0.05). The preoperative HD group had smaller values compared with the control group in the sagittal parameters of C2-7 cervical lordosis (CL) angle, T1 slope, thoracic inlet angle (TIA), and cervical tilt angle (P < 0.05). For the patients with HD, the preoperative values were smaller compared with the postoperative HD values for the parameters of C2-7 CL angle, T1 slope, and cervical tilt angle (P < 0.05). We found no significant differences between the postoperative patients with HD and the healthy subjects, including C2-7 CL angle, C2-7 sagittal vertical axis, T1 slope, TIA, neck tilt angle, cervical tilt angle, and cranial tilt angle (P > 0.05). CONCLUSIONS: Patients with HD have sagittal imbalance of the cervical spine compared with age-matched healthy adolescent subjects, and surgical treatment could correct the sagittal imbalance.


Assuntos
Vértebras Cervicais/patologia , Discotomia , Fusão Vertebral , Atrofias Musculares Espinais da Infância/cirurgia , Adolescente , Adulto , Antropometria , Placas Ósseas , Parafusos Ósseos , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Cifose/etiologia , Cifose/patologia , Lordose/diagnóstico por imagem , Lordose/etiologia , Lordose/patologia , Masculino , Aparelhos Ortopédicos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Atrofias Musculares Espinais da Infância/complicações , Adulto Jovem
16.
Int J Oral Maxillofac Surg ; 49(1): 13-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31230767

RESUMO

Three-dimensionally (3D) printed patient-specific surgical plates have been proposed to facilitate mandibular reconstruction and are attracting extensive attention. We have recently reported the high accuracy of 3D-printed patient-specific surgical plates used in head and neck reconstruction. Based on this previous work, the current study proposes a novel 'surgeon-dominated' approach to the design of 3D-printed patient-specific surgical plates. The aim of this proof-of-concept study was to explore the workflow and technical procedures of the surgeon-dominated approach. The workflow includes virtual surgery, the design and printing of patient-specific surgical devices, and real surgery. The prototype of the patient-specific surgical plate was designed by surgeons and further optimized for 3D printing by engineers. Different types of mandibular defect were tested to confirm the wide applicability of this approach. Cases in which this approach was used were reviewed and the duration of time spent on each case studied. Based on a total of 16 patients, the time spent on virtual surgery and plate design was 18.83±13.19hours, and the time taken for 3D printing, post-processing, and product delivery was 162.9±55.15hours. Therefore, this novel surgeon-dominated approach is feasible and time-saving, which would likely promote the wide application of patient-specific surgical plates and lead to a new era of 'digitization and precision' in mandibular reconstruction. ClinicalTrials.gov registration: NCT03057223.


Assuntos
Reconstrução Mandibular , Procedimentos Cirúrgicos Reconstrutivos , Cirurgiões , Cirurgia Assistida por Computador , Placas Ósseas , Projeto Auxiliado por Computador , Humanos , Mandíbula , Impressão Tridimensional
18.
J Craniomaxillofac Surg ; 48(1): 1-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31884028

RESUMO

PURPOSE: The treatment of hemimandibular hyperplasia (HH) is difficult by performing condylectomy and orthognathic surgery in one stage. This study investigated the clinical feasibility of treating HH with computer-aided design and computer-aided manufacturing (CAD/CAM) cutting and drilling guides and the pre-bent titanium plates to improve the accuracy of operation to avoid condyle reconstruction. METHODS: 12 patients diagnosed with HH were included in this study from 2014 to 2018. Conservative condylectomy and bimaxillary orthognathic surgery were performed in all patients. The CAD/CAM cutting and drilling guides and the pre-bent titanium plates were used to guide surgeries. Follow-up and radiographic examinations were performed. The difference between virtually simulated and postoperative models was measured. RESULTS: All patients got satisfactory and stable results, without complications or obvious relapse during follow-up. Occlusion relationship, temporomandibular joint function and facial symmetry were improved obviously after surgery. Comparison between simulated plans and actual postoperative outcomes showed that the surgical plans were transferred accurately. CONCLUSIONS: CAD/CAM cutting and drilling guides and the pre-bent titanium plates described in this paper can help transferring the results from computer simulation to the operating room accurately. Conservative condylectomy can be operated exactly matching bimaxillary orthognathic surgery for treating HH, avoiding condyle reconstruction.


Assuntos
Placas Ósseas , Cirurgia Assistida por Computador , Simulação por Computador , Projeto Auxiliado por Computador , Humanos , Hiperplasia , Titânio
19.
Vet Clin North Am Small Anim Pract ; 50(1): 23-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635912

RESUMO

Indirect fracture reduction is used to align diaphyseal fractures when using minimally invasive fracture repair. Indirect reduction achieves functional fracture reduction without opening the fracture site. The limb is restored to length and spatial alignment is achieved to ensure proper angular and rotational alignment. Fracture reduction can be accomplished using a variety of techniques and devices, including hanging the limb, manual traction, distraction table, external fixators, and fracture distractors.


Assuntos
Placas Ósseas/veterinária , Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Mesas Cirúrgicas/veterinária
20.
Vet Clin North Am Small Anim Pract ; 50(1): 263-271, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635913

RESUMO

As the saying goes, "cats are not small dogs." Throughout veterinary medicine history, most of the literature focus has been on the canine. Feline patients, however, now constitute a larger proportion of the pet population and are unique in many aspects. They differ anatomically and biomechanically from canines and have specific recovery needs and different pain-related behaviors. It is important that veterinary surgeons understand these differences and improve their knowledge base in the treatment of cats. This article highlights the differences in cats relevant to minimally invasive fracture repair and how they affect a surgeon's approach to fractures in cats.


Assuntos
Placas Ósseas/veterinária , Doenças do Gato/cirurgia , Gatos/lesões , Fraturas Ósseas/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Especificidade da Espécie
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