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2.
Bone Joint J ; 102-B(4): 519-523, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228070

RESUMO

AIMS: The purpose of this study was to evaluate the incidence and analyze the trends of surgeon-reported complications following surgery for adolescent idiopathic scoliosis (AIS) over a 13-year period from the Scoliosis Research Society (SRS) Morbidity and Mortality database. METHODS: All patients with AIS between ten and 18 years of age, entered into the SRS Morbidity and Mortality database between 2004 and 2016, were analyzed. All perioperative complications were evaluated for correlations with associated factors. Complication trends were analyzed by comparing the cohorts between 2004 to 2007 and 2013 to 2016. RESULTS: Between 2004 and 2016, a total of 84,320 patients were entered into the database. There were 1,268 patients associated with complications, giving an overall complication rate of 1.5%. Death occurred in 12 patients (0.014%). The three most commonly reported complications were surgical site infection (SSI) (441 patients; 0.52%), new neurological deficit (293; 0.35%), and implant-related complications (172; 0.20%). There was a statistically significant but weak correlation between the occurrence of a SSI and the magnitude of the primary curve (r = 0.227; p < 0.001), and blood loss in surgery (r = 0.111; p = 0.038), while the occurrence of a new neurological deficit was correlated statistically significantly but weakly with age at surgery (r = 0.147; p = 0.004) and magnitude of the primary curve (r = 0.258; p < 0.001). The overall complication rate decreased from 4.95% during 2004 to 2007 to 0.98% during 2013 to 2016 (p = 0.023). CONCLUSION: An overall complication rate of 1.5% was found in our series after surgery for AIS, with a reduction of complication rates found in the second period of the analysis. Cite this article: Bone Joint J 2020;102-B(4):519-523.


Assuntos
Complicações Pós-Operatórias/etiologia , Escoliose/cirurgia , Adolescente , Criança , Bases de Dados Factuais , Feminino , Hong Kong/epidemiologia , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/epidemiologia , Próteses e Implantes/efeitos adversos , Escoliose/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Raízes Nervosas Espinhais/lesões , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/microbiologia
3.
Bone Joint J ; 102-B(2): 170-176, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009432

RESUMO

AIMS: We aimed to examine the long-term mechanical survivorship, describe the modes of all-cause failure, and identify risk factors for mechanical failure of all-polyethylene tibial components in endoprosthetic reconstruction. METHODS: This is a retrospective database review of consecutive endoprosthetic reconstructions performed for oncological indications between 1980 and 2019. Patients with all-polyethylene tibial components were isolated and analyzed for revision for mechanical failure. Outcomes included survival of the all-polyethylene tibial component, revision surgery categorized according to the Henderson Failure Mode Classification, and complications and functional outcome, as assessed by the Musculoskeletal Tumor Society (MSTS) score at the final follow-up. RESULTS: A total of 278 patients were identified with 289 all-polyethylene tibial components. Mechanical survival was 98.4%, 91.1%, and 85.2% at five, ten and 15 years, respectively. A total of 15 mechanical failures were identified at the final follow-up. Of the 13 all-polyethylene tibial components used for revision of a previous tibial component, five (38.5%) failed mechanically. Younger patients (< 18 years vs > 18 years; p = 0.005) and those used as revision components (p < 0.001) had significantly increased rates of failure. Multivariate logistic regression modelling showed revision status to be a positive risk factor for failure (odds ratio (OR) 19.498, 95% confidence interval (CI) 4.598 to 82.676) and increasing age was a negative risk factor for failure (OR 0.927, 95% CI 0.872 to 0.987). Age-stratified risk analysis showed that age > 24 years was no longer a statistically significant risk factor for failure. The final mean MSTS score for all patients was 89% (8.5% to 100.0%). CONCLUSION: The long-term mechanical survivorship of all-polyethylene tibial components when used for tumour endoprostheses was excellent. Tumour surgeons should consider using these components for their durability and the secondary benefits of reduced cost and ease of removal and revision. However, caution should be taken when using all-polyethylene tibial components in the revision setting as a significantly higher rate of mechanical failure was seen in this group of patients. Cite this article: Bone Joint J. 2020;102-B(2):170-176.


Assuntos
Neoplasias Ósseas/cirurgia , Fêmur/cirurgia , Próteses e Implantes/efeitos adversos , Implantação de Prótese/efeitos adversos , Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Materiais Biocompatíveis , Criança , Análise de Falha de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polietileno , Desenho de Prótese , Falha de Prótese/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
4.
Cardiovasc Intervent Radiol ; 43(1): 84-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31385006

RESUMO

PURPOSE: To evaluate the effect of peri-tumoral metallic implants (MI) on the safety and efficacy of percutaneous irreversible electroporation (IRE) of colorectal liver metastasis (CRLM). MATERIALS AND METHODS: In this retrospective study, 25 patients (12 women, 13 men; MI: 13, no MI: 12) were treated for 29 CRLM. Patient characteristics, tumor location and size, treatment parameters and the presence of MI were evaluated as determinants of local tumor progression (LTP) with the competing risks model (univariate and multivariate analyses). Patient-specific computer models were created to examine the effect of the MI on the electric field used to induce IRE, probability of cell kill and potential thermal effects. RESULTS: Patients had a median follow-up of 25 months, during which no IRE-related major complications were reported. Univariate analysis showed that tumor size (> 2 cm), probe spacing (> 20 mm) and the presence of MI (p < 0.05) were significant predictors of time to LTP, but only the latter was found to be an independent predictor on multivariate analysis (sub-hazard ratio = 6.5; [95% CI 1.99, 21.4]; p = 0.002). The absence of peri-tumoral MI was associated with higher progression-free survival at 12 months (92.3% [56.6, 98.9] vs 12.5% [2.1, 32.8]). Computer simulations indicated significant distortions and reduction in electric field strength near MI, which could have contributed to under-treatment of the tumor. CONCLUSIONS: Peri-tumoral MI increases the risk of treatment failure following IRE of CRLM.


Assuntos
Neoplasias Colorretais/patologia , Eletroporação/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Próteses e Implantes/efeitos adversos , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Metais , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
5.
World Neurosurg ; 134: e37-e45, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31470168

RESUMO

BACKGROUND: Despite advancements in surgical techniques, controversy remains regarding the optimal implant density for the correction of idiopathic scoliosis. Recent evidence has suggested that equivalent radiographic and clinical outcomes can be achieved with lower implant densities for those with moderate curves and good flexibility. Among the experts, the consensus has continued that higher implant densities should be used for larger, stiffer curves. The purpose of the present study was to compare the radiographic results between high-implant density (HID) and low-implant density (LID) constructs in patients with large (>65°), rigid (<50% flexibility) curves who had undergone anterior release and posterior spinal fusion. METHODS: We reviewed the idiopathic scoliosis cases performed at a single institution from 2006 to 2014. Only those meeting the inclusion criteria were selected. The patients were divided into HID and LID groups. The postoperative radiographs were compared for coronal correction, thoracic kyphosis, pelvic tilt, lumbar lordosis, and sagittal vertical axis. RESULTS: A statistically significant improvement in coronal correction was detected in the HID group at all follow-up points (final follow-up: HID, 81.1% vs. LID, 70.4%; P = 0.01). When preoperative thoracic kyphosis was considered, no differences were found between the 2 groups. No differences were found in the other sagittal parameters. CONCLUSION: In patients with large, rigid idiopathic scoliosis undergoing anterior release and posterior spinal fusion, a small, but statistically, significant improvement in the coronal Cobb angle was seen. It remains to be determined whether this small difference in radiographic correction will have any influence on the clinical outcome.


Assuntos
Cifose/cirurgia , Próteses e Implantes , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Criança , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Próteses e Implantes/efeitos adversos , Estudos Retrospectivos , Fusão Vertebral/métodos , Resultado do Tratamento
6.
World Neurosurg ; 135: e116-e125, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31756509

RESUMO

OBJECTIVE: The main objective of the present study was to analyze the efficacy and feasibility of surgical management for patients with monosegmental lumbar or lumbosacral pyogenic vertebral osteomyelitis (PVO) by using one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. METHODS: From February 2014 to May 2016, 27 patients with lumbar or lumbosacral PVO were treated by posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. The degree of damage to the patients' vertebral bodies was one third to one half height. There were 16 male and 11 female, with a mean age of 43.5 years (range, 32-56 years) at the time of surgery. The mean follow-up time was 35.7 months (range, 26-53 months). The clinical efficacy was evaluated on average operation time, blood loss, visual analog scale, erythrocyte sedimentation rate, C-reactive protein level, and neurologic function recovery. RESULTS: PVO was completely cured and the grafted bone was fused in all 27 patients. There was no recurrent vertebral osteomyelitis infection. Erythrocyte sedimentation rate and C-reactive protein level achieved normal limits within 3 months in all patients. The American Spinal Injury Association neurologic classification was improved in all cases. Pain relief was obtained in all patients. CONCLUSIONS: Our results showed that one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion was an effective treatment for patients with one third to one half height of vertebral body damaged in monosegmental lumbar or lumbosacral PVO. The surgical method is characterized as minimum surgical trauma, good pain relief, good neurologic recovery, and good reconstruction of spinal stability.


Assuntos
Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Osteomielite/cirurgia , Telas Cirúrgicas , Adulto , Desbridamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Estudos Retrospectivos , Fusão Vertebral/métodos , Telas Cirúrgicas/efeitos adversos , Vértebras Torácicas/cirurgia , Titânio/efeitos adversos , Resultado do Tratamento , Tuberculose da Coluna Vertebral/cirurgia
8.
Pol J Microbiol ; 68(3): 343-351, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31880880

RESUMO

The aim of the study was to analyze the reasons for removing implants after breast reconstruction in the course of treatment of breast cancer. The study involved 428 patients, who underwent a total of 648 breast reconstruction procedures using artificial implants. 47 out of 648 cases (7.3%) were identified in which the implant had to be removed. Of the 47 cases, 57.4% had undergone deferred reconstruction, and 42.6% immediate reconstruction; 27.7% had undergone pre-operative chemotherapy and radiotherapy, 27.7% pre-operative chemotherapy, and 2.1% pre-operative radiotherapy; 6.4% were diabetic, 4.3% active smokers, and more than 50.0% had BMI greater than 25 kg/m2. In 83.0% of the analyzed cases, the reason for removal of the implant was infection, in 8.5% it was local recurrence of breast cancer, in 4.3% it was damage (leakage) of the implant, and in 2.1% it was post-operative pain. About 87.0% of infections appeared within one year of implantation; however, less than a half developed within 90 days of the reconstructive surgery, and up to 30 days only about 13.0% had appeared. Among the etiological agents of infections were: coagulase-negative Staphylococcus (31.3%), Staphylococcus aureus (18.7%), Enterococcus faecalis (9.4%), Enterobacter cloacae (18.8%), Pseudomonas aeruginosa (12.5%), Acinetobacter lwoffii (3.1%), and other Gram-negative fermenting rods accounted for 6.2%. Infections were the most common reason for removing the implant after breast reconstruction. and occurred most often as late infections (>30 days after surgery). The time of observation for infectious complications should be at least 1 year.The aim of the study was to analyze the reasons for removing implants after breast reconstruction in the course of treatment of breast cancer. The study involved 428 patients, who underwent a total of 648 breast reconstruction procedures using artificial implants. 47 out of 648 cases (7.3%) were identified in which the implant had to be removed. Of the 47 cases, 57.4% had undergone deferred reconstruction, and 42.6% immediate reconstruction; 27.7% had undergone pre-operative chemotherapy and radiotherapy, 27.7% pre-operative chemotherapy, and 2.1% pre-operative radiotherapy; 6.4% were diabetic, 4.3% active smokers, and more than 50.0% had BMI greater than 25 kg/m2. In 83.0% of the analyzed cases, the reason for removal of the implant was infection, in 8.5% it was local recurrence of breast cancer, in 4.3% it was damage (leakage) of the implant, and in 2.1% it was post-operative pain. About 87.0% of infections appeared within one year of implantation; however, less than a half developed within 90 days of the reconstructive surgery, and up to 30 days only about 13.0% had appeared. Among the etiological agents of infections were: coagulase-negative Staphylococcus (31.3%), Staphylococcus aureus (18.7%), Enterococcus faecalis (9.4%), Enterobacter cloacae (18.8%), Pseudomonas aeruginosa (12.5%), Acinetobacter lwoffii (3.1%), and other Gram-negative fermenting rods accounted for 6.2%. Infections were the most common reason for removing the implant after breast reconstruction. and occurred most often as late infections (>30 days after surgery). The time of observation for infectious complications should be at least 1 year.


Assuntos
Infecções Bacterianas/microbiologia , Neoplasias da Mama/cirurgia , Infecções Relacionadas à Prótese/microbiologia , Adulto , Remoção de Dispositivo , Feminino , Humanos , Mamoplastia/efeitos adversos , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Staphylococcus/classificação , Staphylococcus/genética , Staphylococcus/isolamento & purificação , Staphylococcus aureus/classificação , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação
9.
J Refract Surg ; 35(11): 740-747, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31710377

RESUMO

PURPOSE: To review the intraoperative and postoperative complications after intracorneal ring segment implantation and to report the explantation rate among the available scientific literature. METHODS: Three different databases (PubMed, Web of Science, and Scopus) were assessed from January 1995 to June 2019. The keywords used were: ring, rings, ICRS (intracorneal ring segments), segment, segments or Intacs, complication, explantation, explanted, retired, and removal. RESULTS: The selection process of this systematic review study is described in a flow diagram. A total of 39 studies published between 1995 and 2019 were included. Sixteen studies were case reports, 21 were case series studies, and 2 were chart analysis works. This study enrolled 1,946 participants, and 2,590 eyes were included. The postoperative complications described in most studies included migration, ring extrusion, corneal thinning, corneal melting, and some type of infective keratitis. These complications together with glare, halos, fluctuating vision, neovascularization, foreign body sensation, or pain represented most of the causes. The percentage rate of explantation ranged from 0.5% up to 83.3%. If we analyze those articles with a high number of implantations (2,124 eyes), an explantation rate between 0% and 1.4% was obtained. CONCLUSIONS: The complication rate and explantation ratio in segments of the intracorneal ring segments analyzed in the available scientific literature are minimal. Therefore, patient selection, surgery planning, and postoperative follow-up are critical to the success of surgery. [J Refract Surg. 2019;35(11):740-747.].


Assuntos
Substância Própria/cirurgia , Remoção de Dispositivo/métodos , Miopia/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Complicações Pós-Operatórias/cirurgia , Próteses e Implantes/efeitos adversos , Substância Própria/patologia , Topografia da Córnea , Humanos , Complicações Pós-Operatórias/diagnóstico
10.
ACS Appl Mater Interfaces ; 11(49): 45511-45519, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31713411

RESUMO

The development of antifibrotic materials and coatings that can resist the foreign body response (FBR) continues to present a major hurdle in the advancement of current and next-generation implantable medical devices, biosensors, and cell therapies. From an implant perspective, the most important issue associated with the FBR is the prolonged inflammatory response leading to a collagenous capsule that ultimately blocks mass transport and communication between the implant and the surrounding tissue. Up to now, most attempts to reduce the capsule thickness have focused on providing surface coatings that reduce protein fouling and cell attachment. Here, we present an approach that is based on the sustained release of a peptide drug interfering with the FBR. In this study, the biodegradable polymer poly(lactic-co-glycolic) acid (PLGA) was used as a coating releasing the relaxin peptide analogue B7-33, which has been demonstrated to reduce organ fibrosis in animal models. While in vitro protein quantification was used to demonstrate controlled release of the antifibrotic peptide B7-33 from PLGA coatings, an in vitro reporter cell assay was used to demonstrate that B7-33 retains activity against the relaxin family peptide receptor 1 (RXFP1). Subcutaneous implantation of PLGA-coated polypropylene samples in mice with and without the peptide demonstrated a marked reduction in capsule thickness (49.2%) over a 6 week period. It is expected that this novel approach will open the door to a range of new and improved implantable medical devices.


Assuntos
Materiais Revestidos Biocompatíveis/farmacologia , Fibrose/prevenção & controle , Reação a Corpo Estranho/prevenção & controle , Fragmentos de Peptídeos/farmacologia , Relaxina/farmacologia , Animais , Materiais Revestidos Biocompatíveis/química , Humanos , Camundongos , Fragmentos de Peptídeos/química , Peptídeos/química , Peptídeos/farmacologia , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/farmacologia , Próteses e Implantes/efeitos adversos , Receptores Acoplados a Proteínas-G/antagonistas & inibidores , Relaxina/química
11.
Molecules ; 24(21)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31731408

RESUMO

Staphylococcus aureus and Staphylococcus epidermidis are considered two of the most important pathogens, and their biofilms frequently cause device-associated infections. Microbial biosurfactants recently emerged as a new generation of anti-adhesive and anti-biofilm agents for coating implantable devices to preserve biocompatibility. In this study, R89 biosurfactant (R89BS) was evaluated as an anti-biofilm coating on medical-grade silicone. R89BS is composed of homologues of the mono- (75%) and di-rhamnolipid (25%) families, as evidenced by mass spectrometry analysis. The antimicrobial activity against Staphylococcus spp. planktonic and sessile cells was evaluated by microdilution and metabolic activity assays. R89BS inhibited S. aureus and S. epidermidis growth with minimal inhibitory concentrations (MIC99) of 0.06 and 0.12 mg/mL, respectively and dispersed their pre-formed biofilms up to 93%. Silicone elastomeric discs (SEDs) coated by R89BS simple adsorption significantly counteracted Staphylococcus spp. biofilm formation, in terms of both built-up biomass (up to 60% inhibition at 72 h) and cell metabolic activity (up to 68% inhibition at 72 h). SEM analysis revealed significant inhibition of the amount of biofilm-covered surface. No cytotoxic effect on eukaryotic cells was detected at concentrations up to 0.2 mg/mL. R89BS-coated SEDs satisfy biocompatibility requirements for leaching products. Results indicate that rhamnolipid coatings are effective anti-biofilm treatments and represent a promising strategy for the prevention of infection associated with implantable devices.


Assuntos
Biofilmes/efeitos dos fármacos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Tensoativos/farmacologia , Materiais Revestidos Biocompatíveis/química , Materiais Revestidos Biocompatíveis/farmacologia , Humanos , Testes de Sensibilidade Microbiana , Próteses e Implantes/efeitos adversos , Próteses e Implantes/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Elastômeros de Silicone/química , Elastômeros de Silicone/farmacologia , Silicones/química , Silicones/farmacologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/patogenicidade , Staphylococcus epidermidis/patogenicidade , Tensoativos/química
12.
Spine Deform ; 7(6): 971-978, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31732010

RESUMO

STUDY DESIGN: Single-center retrospective analysis of a prospectively collected registry. OBJECTIVES: Identify factors predictive of rib-based distraction (RBD) instrumentation wound complication. Create a risk stratification model for RBD instrumentation wound complication. SUMMARY OF BACKGROUND DATA: RBD instrumentation procedures have a high rate of wound complications, often requiring unplanned operative treatment. Currently, there is a relative lack of understanding of RBD complication risk factors compared with the comprehensive understanding of complication risk factors for other spine surgeries. METHODS: Between January 2011 and September 2015, patients treated with RBD instrumentation at a single institution were analyzed for risk factors associated with surgical wound complications that resulted in unplanned operative treatment. Univariate logistic regression determined predictors of wound complication and multivariate regression determined independent predictive factors; α = 0.10. RESULTS: A total of 122 patients aged 0-18 years underwent 140 implant surgeries in which 22 resulted in complications: 18 (82%) infectious and 4 (18%) noninfectious. Mean age at surgery was 5.2 years. Univariate analysis showed a correlation between wound complication rates and the following: male gender (p = .097), diapered patient with lower back incision (p = .004), bilateral procedure (p = .008), more than three incisions (p = .011), left iliac incision (p = .097), right iliac incision (p = .009), patient age ≤4 years (p = .10), and operative time >150 minutes (p = .079). Multivariate analysis identified the following independent predictors: age ≤ 4 years (p = .002), male gender (p = .04), number of skin incisions (p = .001), left iliac incision (p = .018), and nutritionally challenged (p = .044). The multivariate model predicted wound complications with an area under the receiver operating characteristic curve of 0.88. CONCLUSIONS: Knowledge of risk factors for RBD instrumentation wound complications can be used to construct patient risk models. This can identify patients at higher risk for complications and influence clinical decision making. LEVEL OF EVIDENCE: Level II.


Assuntos
Osteogênese por Distração/instrumentação , Próteses e Implantes/efeitos adversos , Costelas/cirurgia , Ferida Cirúrgica/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Duração da Cirurgia , Osteogênese por Distração/efeitos adversos , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Ferida Cirúrgica/classificação , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia
13.
Spine Deform ; 7(6): 992-1002, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31732013

RESUMO

STUDY DESIGN: Retrospective case series. OBJECTIVES: To describe the indications, operative course, and outcomes in eight pediatric patients who underwent occiput-to-pelvis (O-P) spinal arthrodesis. SUMMARY: Spinal arthrodesis from the occiput to pelvis is needed for some children with extensive spine deformity. There are few reports of patients with O-P arthrodesis. METHODS: We reviewed records of pediatric patients who underwent spinal arthrodesis to treat spine deformity between 1987 and 2017 at one institution. Eight patients (six girls) who underwent staged O-P arthrodesis were identified. Underlying conditions, indications for surgery, medical comorbidities, operative courses, complications, and imaging of these patients were recorded. RESULTS: Diagnoses were neuromuscular disorders in five patients and syndromic disorders in three patients. Mean ages were 9.7 ± 4.1 years at index surgery and 16.8 ± 4.6 years at completion of O-P arthrodesis. Patients underwent a mean of three operations (range, two to five). Occipitocervical arthrodesis was the final operation in six of eight patients (all but the two patients with Loeys-Dietz syndrome). Mean follow-up after the last procedure was 8.5 ± 7.1 years. Two patients underwent revision for protruding occipital implants, and one patient underwent revision for thoracic pseudarthrosis. No patients developed postoperative infections or new neurologic deficits. At final follow-up, Scoliosis Research Society-22r questionnaire scores were lowest for Function (2.6 ± 1.0 of 5 possible points) and highest for Satisfaction (4.1 ± 1.4). CONCLUSIONS: O-P arthrodesis can benefit patients with extensive spine deformity from neuromuscular or syndromic causes. Patients were young at first operation, which may suggest that younger patients are at higher risk than older patients of major progression of deformity in other spinal regions after deformity correction. Health-related quality of life and radiographic outcomes suggest that patients who underwent O-P arthrodesis had satisfactory outcomes and maintenance of correction during a mean of 8.5 years of follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Artrodese/instrumentação , Osso Occipital/cirurgia , Pelve/cirurgia , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Adolescente , Assistência ao Convalescente , Artrodese/efeitos adversos , Artrodese/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Síndrome de Loeys-Dietz/complicações , Síndrome de Loeys-Dietz/diagnóstico , Masculino , Doenças Neuromusculares/complicações , Doenças Neuromusculares/diagnóstico , Próteses e Implantes/efeitos adversos , Pseudoartrose/epidemiologia , Qualidade de Vida , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Coluna Vertebral/anormalidades , Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
14.
Arch Osteoporos ; 14(1): 109, 2019 11 18.
Artigo em Inglês | MEDLINE | ID: mdl-31741066

RESUMO

Kümmell's disease (eponymous name for osteonecrosis and collapse of a vertebral body due to ischemia and non-union of anterior vertebral body wedge fractures after major trauma) cannot heal spontaneously. Bone-filling mesh container (BFMC) can significantly relieve pain, help the correction of kyphosis, and may prevent cement leakage. This pilot study may provide the basis for the design of future studies. PURPOSE: To compare the effectiveness and safety of BFMC and percutaneous kyphoplasty (PKP) for treatment of Kümmell's disease. METHODS: From August 2016 to May 2018, 40 patients with Kümmell's disease were admitted to Guizhou Provincial People's Hospital. Among them, 20 patients (20 vertebral bodies) received PKP (PKP group) and the other 20 received BFMC (BFMC group). Operation time, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Cobb's angle changes, and related complications were recorded. RESULTS: All patients underwent operations successfully. VAS scores and ODI of both groups at each postoperative time point were lower than preoperatively, with statistically significant difference (p < 0.05). Postoperative Cobb's angle of both groups postoperatively was lower than preoperatively (p < 0.05). Cement leakage occurred in eight vertebrae (8/20) in the PKP group and in one vertebra (1/20) in the BFMC group. No complications such as pulmonary embolism, paraplegia, or perioperative death occurred during operation in both groups. Adjacent vertebral refractures occurred in five patients (5/20) in the PKP group and in four patients (4/20) in the BFMC group, with no significant difference in the incidence rate of refractures in both groups but the material is too small to verify statistically. CONCLUSIONS: Both PKP and BFMC technologies can significantly relieve pain and help the correction of kyphosis while treating Kümmell's disease. Moreover, the BMFC may prevent cement leakage.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Cifose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Telas Cirúrgicas , Idoso , Dor nas Costas/cirurgia , Cimentos para Ossos/efeitos adversos , Cimentos para Ossos/uso terapêutico , Substitutos Ósseos/uso terapêutico , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Humanos , Cifoplastia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Osteonecrose/cirurgia , Medição da Dor/métodos , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Próteses e Implantes/efeitos adversos , Resultado do Tratamento
15.
ACS Appl Mater Interfaces ; 11(49): 45489-45497, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31714730

RESUMO

Stainless steels used as metal implants in the medical field have been attracting intensive attention due to their advantages in mechanical properties, anticorrosion properties, and cost effectiveness. Good osteoconductivity, low toxicity, and low inflammatory reactions are essential to stainless steel implant in vivo. However, there are few cases about the surface modification performed for enhancing the corrosion resistance, and there are few researches on the relationship between the surface properties of stainless steel and osteoconductivity when used as implants. This study employed 316L and 304 stainless steel for surface modification including hydrothermal treatment after acid immersion and anodizing treatment, while the as-polished stainless steel was used as a control group. Anticorrosion properties, protein adsorption properties, osteoconductivity, and anti-inflammation property of these specimens were intensively investigated in vitro and in vivo. It was found that specimen subjected to hydrothermal treatment at 230 °C after immersion in 18 M H2SO4 had the lowest metal ions release, while the anodized specimen had the highest release of Fe and Cr due to corrosion. The protein adsorption amount of the specimens was positively related to the osteoconductivity, suggesting protein adsorption is the prerequisite for good osteoconductivity. The osteoconductivity decreased first and then increased with the increase in water contact angle (WCA) value. The specimen with the surface modified by hydrothermal treatment after acid immersion had the highest protein adsorption amount and the best osteoconductivity due to its superhydrophilicity property. The protein adsorption capacity and osteoconductivity for stainless steel tended to be the same as Ti alloys studied before, indicating the surface hydrophilicity property of the implanted metals was the dominant factor affecting the osteoconductivity. From an anti-inflammation perspective, the specimen with the surface modified by hydrothermal treatment after acid immersion also exhibited the lowest thickness of the fibrous capsule membrane from the in vivo tests, suggesting its advantageous biocompatibility. Thus, this research can provide new insight into the application of austenitic stainless steel for implanted material purposes.


Assuntos
Materiais Biocompatíveis/farmacologia , Regeneração Óssea/efeitos dos fármacos , Próteses e Implantes/efeitos adversos , Aço Inoxidável/farmacologia , Adsorção , Materiais Biocompatíveis/química , Corrosão , Humanos , Interações Hidrofóbicas e Hidrofílicas , Inflamação/microbiologia , Teste de Materiais , Níquel/química , Níquel/uso terapêutico , Próteses e Implantes/microbiologia , Aço Inoxidável/química , Propriedades de Superfície , Titânio/química , Titânio/uso terapêutico
16.
Plast Reconstr Surg ; 144(4): 575e-585e, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568287

RESUMO

BACKGROUND: Little is known about contributory factors of unremoved periimplant capsule causing nasal deformities after postrhinoplasty silicone implant extraction. This study investigated the impact of retained capsule causing contracture deformity and effect of subsequent capsulectomy in preventing and correcting the deformity. METHODS: A total of 103 patients underwent secondary surgery for silicone implant removal and grafted cartilage between May of 2015 and June of 2017. Among them, 67 patients without septal extension graft or open wound and with 8-week or more follow-up were analyzed retrospectively. All operations were approached with an intranasal incision. Three procedures were performed: (1) removal of implant plus tip graft only (n = 12), (2) removal of implant plus tip graft plus subtotal capsulectomy (n = 47), and (3) removal of implant plus tip graft plus subtotal capsulectomy in patients with contraction and thick capsule (n = 8). Preremoval/postremoval of nasal bridge length index and nasolabial angle were measured with the lateral view. RESULTS: In group 1, nasal bridge length index decreased by 6.2 percent and nasolabial angle increased by 5.7 percent. In group 2, nasal bridge length index increased by 2.5 percent and nasolabial angle decreased by 2.2 percent. In group 3, nasal bridge length index increased by 8.6 percent and nasolabial angle decreased by 7.9 percent. CONCLUSIONS: For patients undergoing surgical removal of a nasal silicone implant with or without cartilage, a concomitant capsulectomy is required to prevent potential contractures and to minimize tip deformity. Capsulectomy can release and lengthen the contracted nose without septal extension or derotation grafting. Dorsal skin irregularity did not occur regardless of whether capsulectomy was performed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Remoção de Dispositivo , Contratura Capsular em Implantes/cirurgia , Próteses e Implantes , Rinoplastia , Adulto , Cartilagem/transplante , Feminino , Humanos , Contratura Capsular em Implantes/etiologia , Masculino , Próteses e Implantes/efeitos adversos , Reoperação , Estudos Retrospectivos , Silicones
17.
Acta Cir Bras ; 34(7): e201900703, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531538

RESUMO

PURPOSE: To compare four types of mesh regarding visceral adhesions, inflammatory response and incorporation. METHODS: Sixty Wistar rats were divided into four groups, with different meshes implanted intraperitoneally: polytetrafluoroethylene (ePTFE group); polypropylene with polydioxanone and oxidized cellulose (PCD); polypropylene (PM) and polypropylene with silicone (PMS). The variables analyzed were: area covered by adhesions, incorporation of the mesh and inflammatory reaction (evaluated histologically and by COX2 immunochemistry). RESULTS: The PMS group had the lowest adhesion area (63.1%) and grade 1 adhesions. The ePTFE and PM groups presented almost the total area of their surface covered by adherences (99.8% and 97.7% respectively) The group ePTFE had the highest percentage of area without incorporation (42%; p <0.001) with no difference between the other meshes. The PMS group had the best incorporation rate. And the histological analysis revealed that the inflammation scores were significantly different. CONCLUSIONS: The PM mesh had higher density of adherences, larger area of adherences, adherences to organs and percentage of incorporation. ePTFE had the higher area of adherences and lower incorporation. The PMS mesh performed best in the inflammation score, had a higher incorporation and lower area of adherences, and it was considered the best type of mesh.


Assuntos
Hérnia Incisional/cirurgia , Inflamação/patologia , Próteses e Implantes , Telas Cirúrgicas/normas , Aderências Teciduais/patologia , Parede Abdominal/patologia , Animais , Celulose Oxidada/efeitos adversos , Masculino , Teste de Materiais , Polipropilenos/efeitos adversos , Politetrafluoretileno/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Próteses e Implantes/efeitos adversos , Ratos , Ratos Wistar , Silicones/efeitos adversos , Estatísticas não Paramétricas , Telas Cirúrgicas/efeitos adversos , Aderências Teciduais/prevenção & controle , Vísceras/fisiologia
18.
J Orthop Sci ; 24(6): 979-984, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537426

RESUMO

BACKGROUND: To investigate dural sac enlargements and spinal alignments in patients who underwent indirect decompression with interspinous spacers. METHODS: The subjects were 20 patients who underwent indirect decompression using an interspinous spacer (X-STOP) without laminectomy. Of these 20 patients, 1 patient underwent implant removal surgery 1 month after X-STOP surgery and two patients dropped out. Ultimately, 17 patients were included in this study. MRI and X-ray images were investigated before surgery, 1 week after surgery, 3 months after surgery, and 2 years after surgery. RESULTS: On MRI, the mean cross-sectional areas of the dural sac were 52.7 mm2 before surgery, 73.2 mm2 1 week after surgery, 62.4 mm2 3 months after surgery, and 58.3 mm2 2 years after surgery. There was a significant 37% increase at 1 week postoperatively compared with that before surgery, but there were no significant differences between 3 months postoperatively and 2 years postoperatively. The disc angle in an extension posture was significantly decreased at 1 week after surgery compared with that before surgery, but there were no significant differences between before surgery, 3 months after surgery, and 2 years after surgery. CONCLUSIONS: The interspinous process spacer increased the dural sac area by 37% 1 week after surgery, but the enlargement was not maintained at 3 months or 2 years after surgery. The use of interspinous process spacers produced an enlargement of the dural sac by limiting extension of the stenotic level only. However, its effect diminished 2 years after surgery.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Dura-Máter/patologia , Próteses e Implantes/efeitos adversos , Estenose Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Hipertrofia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estenose Espinal/diagnóstico por imagem
19.
BMC Musculoskelet Disord ; 20(1): 437, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554516

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. CASE PRESENTATION: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.


Assuntos
Abscesso/terapia , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Fusão Vertebral/efeitos adversos , Abscesso/etiologia , Antibacterianos/uso terapêutico , Vértebras Cervicais/microbiologia , Desbridamento , Remoção de Dispositivo/efeitos adversos , Drenagem , Quimioterapia Combinada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Aparelhos Ortopédicos , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Fusão Vertebral/instrumentação , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo , Titânio/efeitos adversos , Resultado do Tratamento
20.
J Pediatr Orthop ; 39(9): e698-e702, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503227

RESUMO

BACKGROUND: Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices. METHODS: We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our institution treated with rib-based distraction devices from 2013 to 2016. Surgery type (implantation, expansion, revision/removal), and surgeon adjudicated surgical site infection (SSI) were collected. For this study, we developed a novel, rib-based distraction device surgical site labeling system in which incisions could be labeled as either proximal or distal surgical exposure areas. Treating surgeons documented the operative site, procedure, and SSI site in real-time. RESULTS: A total of 166 unique patients underwent 670 procedures during the study period, producing 1537 evaluable surgical sites; 1299 proximal and 238 distal. Patients were 6.81±4.0 years of age on average. Forty-seven procedures documented SSIs (7.0%), while 40 (24.1%) patients experienced an infection. Analysis showed significant variation in the rate of infection between implantation, and expansion, and revision procedures, with implantation procedures having the highest infection rate at 13.1% (P<0.01). Infections occurred more frequently at distal sites than proximal ones (P=0.02). CONCLUSIONS: Our novel, surgeon-entered, prospective quality improvement database has identified distal surgical sites as being at higher risk for SSI than proximal ones. Further, rib-based distraction device implantation procedures were identified as being at a greater risk for SSI than expansion or revision procedures. We believe this data can lead to improved prevention measures, anticipatory guidance, and patient care. LEVEL OF EVIDENCE: Level II-prognostic study.


Assuntos
Osteogênese por Distração/efeitos adversos , Costelas/cirurgia , Escoliose/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Humanos , Philadelphia/epidemiologia , Próteses e Implantes/efeitos adversos , Melhoria de Qualidade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Doenças Torácicas/cirurgia
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