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2.
Isr Med Assoc J ; 23(8): 506-509, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392628

RESUMO

BACKGROUND: Flexible flatfoot (FF) is a common foot deformity that can often consist of foot pain. Surgical treatment is designed to lengthen the lateral column. OBJECTIVES: To resolve whether radiographic standing feet measurements of normo-plantigrade feet and FF, symptomatic or not, differ and to determine whether the lateral column is shorter. METHODS: The study comprised 72 patients (127 feet) consecutive patients, 18 years of age and older, who were divided into three groups: normal feet (56), asymptomatic FF (29), and symptomatic FF (42). All patients had a standing anterior posterior (AP) and lateral radiographs. AP images were used for the measurement of the talocalcaneal angle, talar-1st metatarsal angle, and talonavicular coverage. Lateral X-rays were used to estimate the talocalcaneal angle, talar-1st metatarsal angle, calcaneal pitch, naviculocuboid overlap, and column ratio. RESULTS: All three of the AP radiograph measurements differed among groups, and higher values were measured in the symptomatic FF group. Post hoc analysis found that the talonavicular coverage and the talocalcaneal angles also differed between symptomatic and asymptomatic FF patients. While some lateral measurements differed within groups, only the lateral talar-1st metatarsal angle distinguished between asymptomatic and symptomatic patients. The lateral column length was not found to be shorter among FF patients, weather symptomatic or not. CONCLUSIONS: Only the talonavicular coverage, the AP talocalcaneal, and the lateral talar-1st metatarsal angles were found to differ between asymptomatic and symptomatic FF patients. The lateral column was not found to be shorter.


Assuntos
Doenças Assintomáticas , Pé Chato , Dor , Radiografia/métodos , Adulto , Antropometria/métodos , Correlação de Dados , Feminino , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Pé Chato/cirurgia , Deformidades Congênitas do Pé/diagnóstico por imagem , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Dor/diagnóstico , Dor/etiologia , Posicionamento do Paciente/métodos , Articulação Talocalcânea/diagnóstico por imagem , Avaliação de Sintomas/métodos , Tálus/anormalidades , Tálus/diagnóstico por imagem
3.
Medicine (Baltimore) ; 100(30): e26126, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397682

RESUMO

ABSTRACT: It was reported imperative on cervical sagittal alignment reconstruction after anterior multilevel procedures with self-locked stand-alone cage (SSC) or anterior cage-with-plate (ACP) system multilevel while there was little knowledge about the relationship on cervical alignment and clinical outcomes.To identify the importance of cervical sagittal alignment after 3-level anterior cervical discectomy and fusion on cervical spondylotic myelopathy with SSC and ACP system.Seventy-seven patients with SSC system (SSC group) and 52 cases with ACP system (ACP group) from February 2007 to September 2013 were enrolled with well-matched demographics. Cervical alignment included C2-7 lordosis (CL), operated-segment cervical lordosis (OPCL), upper and lower adjacent-segment cervical lordosis, range of motion of upper and lower adjacent segment at preoperation, immediate postoperation, and the final follow-up. Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score, visual analogous scale (VAS) of arm and neck and adjacent segment degeneration (ASD). Patients were then divided into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P < .05) but upper adjacent-segment cervical lordosis/lower adjacent-segment cervical lordosis and range of motion of upper adjacent segment/range of motion of lower adjacent segment were of no significance. NDI, JOA, and VAS got improvement in both groups at immediate postoperation and the final follow-up while ASD was in no difference between SSC and ACP group. A total of 80 patients (39 vs 41) acquired CL improvement with a larger population in ACP group. There were no differences on the rate of ASD, NDI, JOA, VAS, and their change between IM and NIM subgroup. The changes of CL were not correlated to NDI, JOA, VAS, and their change.SSC and ACP group both provide improved OPCL and efficacy on 3-level cervical spondylotic myelopathy with little impact on adjacent segment. The change of CL is not correlated to clinical outcomes.


Assuntos
Vértebras Cervicais/cirurgia , Radiografia/estatística & dados numéricos , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/normas , Idoso , Vértebras Cervicais/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radiografia/métodos , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/fisiopatologia , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(32): e26894, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397914

RESUMO

ABSTRACT: Idiopathic flatfoot is common in infants and children, and patients with this condition are frequently referred to pediatric orthopedic clinics. Flatfoot is a physiologic process, and that the arch of the foot elevates spontaneously in most children during the first decade of life. To achieve a consensus as the rate of spontaneous improvement of flatfoot, the present study aimed to estimate the rate of spontaneous improvement of flatfoot and to analyze correlating factors.We reviewed the records of patients examined between May 2013 and May 2019 so as to identify those factors associated with idiopathic flatfoot below 12 years of age. We included patients with who had been followed for >6 months, and those for whom ≥2 (anteroposterior and lateral) weight-bearing bilateral radiographs of the foot had been obtained. The progression rates of the anteroposterior (AP) talo-first metatarsal angle, talonavicular coverage angle, lateral talo-first metatarsal angle, and calcaneal pitch angle were adjusted by multiple factors using a linear mixed model, with sex, body mass index, and Achilles tendon contracture as the fixed effects and age and each subject as the random effects.We found that 4 of the radiographic measurements improved as patients grew older. The AP talo-first metatarsal angle, talonavicular coverage angle, and the lateral talo-first metatarsal angle decreased, while the calcaneal pitch angle increased. The AP talo-first metatarsal angle (P < .001), talonavicular coverage angle (P < .001), and lateral talo-first metatarsal angle (P < .001) improved significantly; however, the calcaneal pitch angle (P = .367) did not show any significant difference. In general, the flatfeet showed an improving trend; after analyzing the factors, no sex difference was observed (P = .117), while body mass index (P < .001) and Achilles tendon contracture (P < .001) showed a negative correlation.The study demonstrated that children's flatfeet spontaneously improved at the age of 12 years. It would be more beneficial if the clinician shows the predicted appearance of the foot at the completion of growth by calculating the radiographic indices and identifying the correlating factors in addition to explaining that flatfoot may gradually improve. This will prevent unnecessary medical expenses and the psychological adverse effects to the children caused by unnecessary treatment.


Assuntos
Pé Chato/diagnóstico , Ossos do Metatarso/diagnóstico por imagem , Radiografia/métodos , Recuperação de Função Fisiológica/fisiologia , Suporte de Carga/fisiologia , Criança , Progressão da Doença , Feminino , Pé Chato/fisiopatologia , Seguimentos , Humanos , Masculino , Estudos Retrospectivos
5.
Pediatr Emerg Med Pract ; 18(7): 1-20, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34196516

RESUMO

Musculoskeletal pain is a common chief complaint of children in the emergency department. Although nonspecific and typically benign, musculoskeletal pain should be investigated thoroughly with consideration for an underlying bone tumor, especially when it is a recurrent visit for pain. This issue reviews the specific signs, symptoms, and unique presentations the emergency clinician should know when evaluating a pediatric patient with musculoskeletal pain. Additionally, assessment of relevant radiographic findings to assist in differentiating bone tumors and guide further management are discussed.


Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/terapia , Serviço Hospitalar de Emergência , Adolescente , Dor no Peito/diagnóstico , Criança , Pré-Escolar , Feminino , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/terapia , Humanos , Lactente , Masculino , Dor Musculoesquelética/diagnóstico , Osteossarcoma/diagnóstico , Osteossarcoma/terapia , Medicina de Emergência Pediátrica/métodos , Guias de Prática Clínica como Assunto , Radiografia/métodos , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/terapia
6.
Br J Radiol ; 94(1125): 20201341, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34319796

RESUMO

OBJECTIVE: To determine the incidence and causes of pathological fractures in paediatric bone tumours and tumour-like lesions, and to determine if they are predictive of benign lesions. METHODS AND MATERIALS: Retrospective review of children with suspected bone tumours referred to a specialist musculoskeletal oncology service between September 2019 and August 2020. Data recorded included patient age and gender, lesion location, the presence of a pathological fracture on the initial plain radiograph, and the final diagnosis made either by image-guided biopsy/curettage or based on typical imaging features. RESULTS: 231 patients were included with 233 lesions (138 males and 93 females with mean age 10.5 years, range 3 months-18 years). Final diagnosis was based on histology in 85 (36.5%) cases and imaging in 148 (63.5%) cases, 52 (22.3%) lesions classed as non-neoplastic, 139 (59.7%) as benign and 42 (18%) as malignant. Pathological fractures were seen in 41 cases (17.6%) at presentation, involving the humerus in 19 (46.3%), the femur in 14 (34.1%), the tibia in 3 (7.3%), the fibula and radius in two each (4.9%) and the second toe proximal phalanx in 1 (2.4%) (p < 0.001). The commonest underlying lesions included simple bone cyst (n = 17; 41.5%) and non-ossifying fibroma (n = 10; 24.4%). Only 4 cases (9.75%) were malignant, one case each of osteosarcoma, Ewing sarcoma, leukaemia and BCOR undifferentiated round cell sarcoma. Pathological fracture occurred in 27.7% of non-malignant lesions and 9.5% of malignant lesions, this difference being statistically significant (p < 0.001). CONCLUSION: Pathological fractures were seen in 17.6% of paediatric bone tumours, tumour-like lesions, being significantly associated with humeral location and non-malignant diagnosis. ADVANCES IN KNOWLEDGE: Demonstrates the frequency, location and underlying diagnosis of pathological fractures in paediatric bone tumour and tumour-like lesions.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/patologia , Radiografia/métodos , Adolescente , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Biópsia Guiada por Imagem , Lactente , Masculino , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 100(22): e26174, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087881

RESUMO

ABSTRACT: Percutaneous vertebroplasty (VP) and kyphoplasty (KP) are well-established minimally invasive surgical procedures for the treatment of osteoporotic vertebral compression fractures (OVCF). However, some drawbacks have been reported regarding these procedures, including height loss, cement leakage, and loss of the restored height after balloon deflation. We performed a novel VP technique to minimize these limitations of conventional procedures. This study aimed to compare radiological and clinical outcomes of our method using a larger-diameter needle versus conventional VP (using a smaller needle) for thoracolumbar OVCF.From April 2016 to May 2017, 107 consecutive patients diagnosed with thoracolumbar OVCF were enrolled. Patients were divided into two groups: group 1 underwent conventional VP, i.e., using a smaller diameter needle, and group 2 underwent VP through a modified method with a larger-diameter needle. For radiological evaluation, parameters related to anterior vertebral height (AVH) and segmental angle were assessed using plain standing radiographs, and patient-reported outcomes were evaluated using the visual analog scale. Cement injection amount and leakage pattern were also analyzed. Group 2 showed a larger anterior vertebral height change than group 1 immediately postoperatively and one year postoperatively. The 1-year postoperatively-AVH maintained better in group 2 than in group 1. Group 2 showed more significant improvement of segmental angle immediately postoperatively than group 1 (3.15° in group 1 vs 9.36° in group 2). IYPo-visual analog scale significantly improved in both groups, with greater improvement in group 2 (3.69 in group 1 vs 5.63 in group 2). A substantially larger amount of cement was injected, with a lower leakage rate in group 2 than in group 1.A novel VP technique using a larger-diameter needle showed superior radiological and clinical outcomes than conventional VP. Therefore, it can be considered a useful treatment option for OVCF.


Assuntos
Fraturas por Compressão/cirurgia , Agulhas/efeitos adversos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Estatura/fisiologia , Cimentos Ósseos/efeitos adversos , Cimentos Ósseos/uso terapêutico , Estudos de Casos e Controles , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/etiologia , Humanos , Cifoplastia/métodos , Vértebras Lombares/cirurgia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Agulhas/estatística & dados numéricos , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Radiografia/métodos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas/cirurgia , Vertebroplastia/estatística & dados numéricos , Escala Visual Analógica
9.
Int J Comput Assist Radiol Surg ; 16(7): 1189-1199, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34152567

RESUMO

PURPOSE: Periodontitis is the sixth most prevalent disease worldwide and periodontal bone loss (PBL) detection is crucial for its early recognition and establishment of the correct diagnosis and prognosis. Current radiographic assessment by clinicians exhibits substantial interobserver variation. Computer-assisted radiographic assessment can calculate bone loss objectively and aid in early bone loss detection. Understanding the rate of disease progression can guide the choice of treatment and lead to early initiation of periodontal therapy. METHODOLOGY: We propose an end-to-end system that includes a deep neural network with hourglass architecture to predict dental landmarks in single, double and triple rooted teeth using periapical radiographs. We then estimate the PBL and disease severity stage using the predicted landmarks. We also introduce a novel adaptation of MixUp data augmentation that improves the landmark localisation. RESULTS: We evaluate the proposed system using cross-validation on 340 radiographs from 63 patient cases containing 463, 115 and 56 single, double and triple rooted teeth. The landmark localisation achieved Percentage Correct Keypoints (PCK) of 88.9%, 73.9% and 74.4%, respectively, and a combined PCK of 83.3% across all root morphologies, outperforming the next best architecture by 1.7%. When compared to clinicians' visual evaluations of full radiographs, the average PBL error was 10.69%, with a severity stage accuracy of 58%. This simulates current interobserver variation, implying that diverse data could improve accuracy. CONCLUSIONS: The system showed a promising capability to localise landmarks and estimate periodontal bone loss on periapical radiographs. An agreement was found with other literature that non-CEJ (Cemento-Enamel Junction) landmarks are the hardest to localise. Honing the system's clinical pipeline will allow for its use in intervention applications.


Assuntos
Perda do Osso Alveolar/diagnóstico , Redes Neurais de Computação , Periodontite/diagnóstico , Radiografia/métodos , Humanos , Variações Dependentes do Observador
11.
Medicine (Baltimore) ; 100(23): e26124, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114995

RESUMO

ABSTRACT: Various osteotomy methods have been proposed in the treatment of cubitus varus. We designed an improved stepped osteotomy to achieve improved deformity correction. We refer to this new approach as double-closed wedge broken-line osteotomy and report a series of clinical and imaging results (deformity correction, range of motion [ROM], function, osteotomy healing, and complications) of patients with cubitus varus treated with this technique.Between July 2014 and July 2019, we treated 9 cases of cubitus varus using the new technique. The study was conducted in accordance with the principles of the Declaration of Helsinki, and the study protocol was approved by the ethics committee of Shenzhen Children's Hospital. We obtained written parental consent for the minors before the study was begun. We compared preoperative and postoperative clinical and imaging parameters (humeral elbow-wrist angle, elbow ROM) in all patients. Postoperative evaluation was performed by telephone interview and outpatient review. The median follow-up was 23.2 months (range, 3-63 months).The median humeral elbow-wrist angle modified from -14.27 to 15.15. The median clinical and imaging parameters after correction of deformity were not different from that of the normal side. Using our rehabilitation program, all patients recovered preoperative elbow ROM at the last follow-up.Our double-closed wedge broken-line osteotomy has a larger cancellous bone contact surface. The deformity correction is satisfactory, the osteotomy healing is reliable, and the incidence of complications is low.Level of Evidence: Level IV.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero/complicações , Deformidades Articulares Adquiridas , Osteotomia/métodos , Criança , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Masculino , Período Pós-Operatório , Radiografia/métodos , Amplitude de Movimento Articular , Resultado do Tratamento
12.
J Clin Neurosci ; 89: 297-304, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119284

RESUMO

This retrospective cohort study describes adult cervical deformity(ACD) patients with Ames-ACD classification at baseline(BL) and 1-year post-operatively and assesses the relationship of improvement in Ames modifiers with clinical outcomes. Patients ≥ 18yrs with BL and post-op(1-year) radiographs were included. Patients were categorized with Ames classification by primary deformity descriptors (C = cervical; CT = cervicothoracic junction; T = thoracic; S = coronal) and alignment/myelopathy modifiers(C2-C7 Sagittal Vertical Axis[cSVA], T1 Slope-Cervical Lordosis[TS-CL], Horizontal Gaze[Horiz], mJOA). Univariate analysis evaluated demographics, clinical intervention, and Ames deformity descriptor. Patients were evaluated for radiographic improvement by Ames classification and reaching Minimal Clinically Important Differences(MCID) for mJOA, Neck Disability Index(NDI), and EuroQuol-5D(EQ5D). A total of 73 patients were categorized: C = 41(56.2%), CT = 18(24.7%), T = 9(12.3%), S = 5(6.8%). By Ames modifier 1-year improvement, 13(17.8%) improved in mJOA, 26(35.6%) in cSVA grade, 19(26.0%) in Horiz, and 15(20.5%) in TS-CL. The overall proportion of patients without severe Ames modifier grades at 1-year was as follows: 100% cSVA, 27.4% TS-CL, 67.1% Horiz, 69.9% mJOA. 1-year post-operatively, severe myelopathy(mJOA = 3) prevalence differed between Ames-ACD descriptors (C = 26.3%, CT = 15.4%, T = 0.0%, S = 0.0%, p = 0.033). Improvement in mJOA modifier correlated with reaching 1-year NDI MCID in the overall cohort (r = 0.354,p = 0.002). For C descriptors, cSVA improvement correlated with reaching 1-year NDI MCID (r = 0.387,p = 0.016). Improvement in more than one radiographic Ames modifier correlated with reaching 1-year mJOA MCID (r = 0.344,p = 0.003) and with reaching more than one MCID for mJOA, NDI, and EQ-5D (r = 0.272,p = 0.020). In conclusion, improvements in radiographic Ames modifier grades correlated with improvement in 1-year postoperative clinical outcomes. Although limited in scope, this analysis suggests the Ames-ACD classification may describe cervical deformity patients' alignment and outcomes at 1-year.


Assuntos
Vértebras Cervicais/cirurgia , Lordose/classificação , Complicações Pós-Operatórias/etiologia , Índice de Gravidade de Doença , Doenças da Medula Espinal/etiologia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Humanos , Lordose/diagnóstico por imagem , Lordose/cirurgia , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Complicações Pós-Operatórias/epidemiologia , Radiografia/métodos , Radiografia/normas , Doenças da Medula Espinal/epidemiologia
13.
J Pediatr Orthop ; 41(Suppl 1): S6-S13, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096531

RESUMO

BACKGROUND: Distal radius physeal bar with associated growth arrest can occur because of fractures, ischemia, infection, radiation, tumor, blood dyscrasias, and repetitive stress injuries. The age of the patient as well as the size, shape, and location of the bony bridge determines the deformity and associated pathology that will develop. METHODS: A search of the English literature was performed using PubMed and multiple search terms to identify manuscripts dealing with the evaluation and treatment of distal radius physeal bars and ulnar overgrowth. Single case reports and level V studies were excluded. RESULTS: Manuscripts evaluating distal radial physeal bars and their management were identified. A growth discrepancy between the radius and ulna can lead to distal radioulnar joint instability, ulnar impaction, and degenerative changes in the carpus and triangular fibrocartilage complex. Advanced imaging aids in the evaluation and mapping of a physeal bar. Treatment options for distal radius physeal bars include observation, bar resection±interposition, epiphysiodeses of the ulna±completion epiphysiodesis of the radius, ulnar shortening osteotomy±diagnostic arthroscopy to manage associated triangular fibrocartilage complex pathology, radius osteotomy, and distraction osteogenesis. CONCLUSIONS: Decision-making when presented with a distal radius physeal bar is multifactorial and should incorporate the age and remaining growth potential of the patient, the size and location of the bar, and patient and family expectations.


Assuntos
Deformidades Adquiridas da Mão , Procedimentos Ortopédicos/métodos , Rádio (Anatomia) , Ulna , Articulação do Punho , Desenvolvimento Ósseo , Criança , Deformidades Adquiridas da Mão/diagnóstico , Deformidades Adquiridas da Mão/etiologia , Deformidades Adquiridas da Mão/cirurgia , Humanos , Seleção de Pacientes , Radiografia/métodos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/crescimento & desenvolvimento , Rádio (Anatomia)/cirurgia , Ulna/diagnóstico por imagem , Ulna/crescimento & desenvolvimento , Ulna/cirurgia , Articulação do Punho/patologia , Articulação do Punho/fisiopatologia
14.
Acta Orthop Traumatol Turc ; 55(3): 220-226, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100362

RESUMO

OBJECTIVE: The aim of this study was to evaluate glenohumeral morphologic differences and their correlation between glenohumeral instability and rotator cuff pathology. METHODS: Two-hundred radiographs and 100 MRI scans of 100 patients in whom the diagnosis of Anterior Shoulder Instability (Anl) or Rotator Cuff Tear (RCT) was arthroscopically verified were retrospectively identified and included in the study. All the patients were categorized into two groups: 50 patients with Anl (23 female, 28 male; mean age = 29 ± 7.4) and 50 patients with RCT (28 female, 22 male). Two separate control groups were then formed, one of which included contralateral shoulders of patients in the AnI group, and the other consisted of contralateral shoulders of patients in the RCT group. The x-ray and MRI scans were examined by an orthopedic surgeon and a radiologist. The Acromial Index (AI) and the Critical Shoulder Angle (CSA) were measured on true anteroposterior shoulder radiographs; Glenoid Inclination (GI), Glenoid Version (GV), and Acromion Angulation (AA) were measured on MRI. RESULTS: In the AnI group, the measurements were as followed: AI, 0.66 ± 0.03; CSA, 33 ° ± 2.85; GI, 3.4° ± 6.2; GV, 4.1 ± 4.3; and AA, 12.9 ± 8.3. In the RCT group, AI 0.71 ± 0.04; CSA, 36° ± 2.69; GI, 9.1 ± 5; GV, 6.7 ° ± 5.7; and AA, 14.3° ± 8.7. A moderate correlation was found between CSA and GI (r = 0.41, P = 0.001) and between AI and GI (r = 0.42, P = 0.014). A weak correlation was found between AI and GI in the AnI group (r = 0.22, P = 0.001). The inter- and intra-observer intraclass correlation coefficients were respectively 0.81 and 0.84 for AI, 0.88 and 0.92 for CSA, 0.72 and 0.76 for GI, 0.69 and 0.73 for GV, and 0.72 and 0.77 for AA. CONCLUSION: The results of this study have shown that lower AI, GI, and antevert GV may be associated with AnI. Investigating CSA, AI, and GV could be useful for diagnostic evaluation of patients with AnI. LEVEL OF EVIDENCE: Level III, Diagnostic Study.


Assuntos
Acrômio , Instabilidade Articular , Lesões do Manguito Rotador , Articulação do Ombro , Acrômio/diagnóstico por imagem , Acrômio/patologia , Adulto , Artroscopia/métodos , Correlação de Dados , Feminino , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Radiografia/métodos , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia
15.
Acta Orthop Traumatol Turc ; 55(3): 253-257, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100367

RESUMO

OBJECTIVE: This study aimed to investigate the possible relationship between Scheuermann disease (SD) and the pathophysiological factors of thoracic spinal stenosis (TSS), including ossification of the ligamentum flavum (OLF), ossification of the posterior longitudinal ligament (OPLL), and thoracic disc herniation (TDH) in patients with symptomatic TSS. METHODS: Demographic and radiological data from 66 consecutive patients diagnosed with symptomatic TSS from 2013 to 2018 were retrospectively collected and divided into 3 groups depending on the underlying pathomechanism of TSS: TDH group (18 patients; 6 women; mean age ± standard deviation [Sd] = 59.89 ± 11.34), OPLL group (12 patients; 8 women; mean age ± Sd = 56.08 ± 14.74), and OLF group (36 patients; 20 women; mean age ± Sd = 58.69 ± 9.77). A total of 41 age-matched healthy individuals (19 women; mean age ± Sd = 54.88 ± 13.63) were designated as the control group. In each group, both typical and atypical SD criteria were radiologically examined. The demographic data and presence of SD between the control group and 3 subgroups of TSS pathomechanisms were evaluated. RESULTS: SD characteristics were identified in 83.33% (15/18) of patients in the TDH group, 44.44% (16/36) in the OLF group, 25% (3/12) in the OPLL group, and 17.07% (7/41) of the control individuals. When analyzed by the chi-squared test and logistic regression analysis, the presence of SD was significantly associated with TDH (P < 0.01) and OLF (P < 0.05) but not OPLL (P > 0.05). Patients with TDH and OLF showed peak involvement of T10/11, and patients with OPLL did not. Furthermore, we determined that age, sex, body-mass index, and smoking status were not the risk factors for TDH, OPLL, and OLF (P > 0.05). SD was found to be a risk factor for TDH (P < 0.01) and OLF (P < 0.05) but not for OPLL (P > 0.05). CONCLUSION: Evidence from this study indicated that SD might be a risk factor for OLF and TDH but not for OPLL.


Assuntos
Doença de Scheuermann , Estenose Espinal , Vértebras Torácicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/diagnóstico , Ossificação do Ligamento Longitudinal Posterior/etiologia , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Doença de Scheuermann/complicações , Doença de Scheuermann/fisiopatologia , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia
16.
Acta Orthop Traumatol Turc ; 55(3): 258-264, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100368

RESUMO

OBJECTIVE: The aim of this study was to compare clinical and radiological outcomes of screw fixation alone versus screw with small locking plate fixation techniques in the management of intra-articular calcaneal fractures by minimal invasive surgery. METHODS: A total of 42 patients treated with minimally invasive surgery because of an intra-articular calcaneal fracture were retrospectively reviewed and included in the study. The patient were then divided into two groups based on the implemented surgical technique: Group A, 20 patients (16 male, 4 female; mean age = 43.41 ± 15.50) receiving screw fixation alone and group B, 22 patients (17 male, 5 female; mean age = 43.38 ± 14.00) receiving screw with small locking plate fixation. The radiographic assessment included Bohler's, Gissane, joint line parallel, and calcaneal varus angles at immediate post-operative and 2-year follow up period through the calcaneal axial and lateral foot radiographs. RESULTS: There was a significant increase in joint line parallel angle from post-operative period to 2-year follow up in Group A compared to Group B, mean (SD) 3.27 (2.15) degrees versus (vs) 0.44 (3.00) degrees, P = 0.025. No statistical significant difference of the immediate, 2-year post-operative period and the change in Bohler's-Gissane angle, calcaneal varus, and FAAM of ADL between groups were observed, P > 0.05. For time-point comparisons in each group, there was a significant loss of calcaneal varus and increase in joint line parallel angle from post-operative period to 2-year follow up in Group A, from mean (SD) 1.82 (11.22) to 4.41 (9.73) degrees and 4.09 (5.32) to 7.36 (5.24) degrees, P = 0.047 and <0.0001, respectively. Group A had statistical significant less complications as zero vs 5, P = 0.049. CONCLUSION: The screw fixation alone seems to provide inferior stability of posterior facet fixation and calcaneal varus reduction with lower complication rates compared to screw with small-locking plate fixation. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Calcâneo , Traumatismos do Pé , Fixação Interna de Fraturas , Fraturas Intra-Articulares , Complicações Pós-Operatórias , Adulto , Placas Ósseas , Parafusos Ósseos , Calcâneo/diagnóstico por imagem , Calcâneo/lesões , Calcâneo/cirurgia , Feminino , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Radiografia/métodos , Estudos Retrospectivos
17.
Acta Orthop Traumatol Turc ; 55(3): 281-284, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100372

RESUMO

We, herein, presented a rare case of bilateral brachial artery infiltration by tumoral calcinosis located on both elbows. A 58-yearold man presented with a history of painless, palpable solid mass restricting the range of motion of both elbows. These masses were located on the anterior aspect of the elbows and gradually enlarged. After clinical, laboratory and radiological examinations, tumoral calcinosis was suspected, and excisional biopsy was planned for a definite diagnosis. Surgery was first performed on the left elbow. The median nerve was found to be compressed but not infiltrated by the mass. Interestingly, the brachial artery was totally infiltrated throughout the entire mass. Occlusion was observed in the brachial artery located within the mass. The tumor on the left elbow, 8.5 × 5.5 × 2.5 cm in size, was totally excised with approximately 12-cm brachial artery segment. The artery was resected until the healthy tissue was reached. The defect was reconstructed with saphenous vein graft obtained from the ipsilateral lower extremity. The same surgical procedure was performed on the right elbow after 3 months. The tumor size on the right elbow was 7 × 3.5 × 1.7 cm. Approximately 15-cm brachial artery segment was excised, and the defect was reconstructed with saphenous vein graft. Tumoral calcinosis is a rare benign condition that can be located in close relationship with neurovascular structures. In such cases, detailed neurologic and vascular examination, including imaging modalities, for arterial flow is essential to establish a more accurate surgical plan and avoid any unexpected situation during surgery.


Assuntos
Artéria Braquial , Calcinose , Descompressão Cirúrgica/métodos , Articulação do Cotovelo , Nervo Mediano , Veia Safena/transplante , Enxerto Vascular/métodos , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/cirurgia , Artéria Braquial/patologia , Artéria Braquial/cirurgia , Calcinose/diagnóstico , Calcinose/fisiopatologia , Calcinose/cirurgia , Dissecação/métodos , Articulação do Cotovelo/irrigação sanguínea , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/inervação , Articulação do Cotovelo/cirurgia , Humanos , Masculino , Nervo Mediano/patologia , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Radiografia/métodos , Amplitude de Movimento Articular , Resultado do Tratamento
18.
Medicine (Baltimore) ; 100(23): e26274, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115026

RESUMO

ABSTRACT: This study aimed to explore the characteristics of changes in the sagittal arrangement of the spine between adolescent patients with idiopathic scoliosis (AIS) and normal adolescents, the risk factors for AIS and the factors affecting the progress of AIS.X-ray images of the full length of the spine in standing position were taken in AIS patients and normal adolescents. Radiographic measurements made at intermediate follow-up included the following:C1 and C2 cervical lordosis and C2 - C7 curvature of cervical lordosis, C2-C7sagittal horizontal distance (C2-C7SagittalVerticalAxis, C2-C7SVA), TS-CL, after thoracic lobe (Thoracic Kyphosis, TK), thoracic lumbar segment Angle (thoracolumbar kyphosis, [TLK]), lumbar lordosis Angle (Lumbar Lordosis, LL), sacral slope Angle (Sacrum Slope, SS), pelvic tilt Angle (Pelvic Tilt, PT), pelvic incidence (PI), L5 Incidence (Lumbar5 Slope (L5S), L5 incidence (Lumbar5 Incidence (L5I), sagittal horizontal distance (CSVA), lower depression Angle of the 2nd cervical spine. The difference of sagittal plane parameters between AIS group and normal adolescent group was compared. To evaluate the progress of AIS, correlation analysis was conducted between diagonal 2 and other parameters. The main risk factors of AIS were determined by binary Logistic analysis.The CSVA of AIS patients was higher than that of healthy adolescents (AIS: 27.64 ±â€Š19.56) mm. Healthy adolescents: (17.74 ±â€Š12.8) mm), L5S (AIS: 19.93°= 7.07° and healthy adolescents: 15.38°= 7.78°, P = .024 < .05), C2 downward sag Angle (AIS: 15.12°= 2.7°;Healthy adolescents: 12.97°= 4.56°); AIS patients had lower TS-CL (AIS: 22.48 ±â€Š6.09 and healthy adolescents: 28.26°= 10.32°), PT (AIS: 10.42°= 4.53° and healthy adolescents: 15.80°=7.68°), (AIS: 41.87°=9.72° and healthy adolescents: 48.75°= 8.22°). The main risk factor for idiopathic scoliosis in adolescents was L5 (OR = 1.239, 95%CI = 1.049-1.463, P = .012 < .05).L5S is a major risk factor for idiopathic scoliosis in adolescents. The larger PI is, the higher the risk of scoliosis progression is. In AIS patients, lumbar lordosis is increased, cervical lordosis is reduced, and even cervical kyphosis occurs.


Assuntos
Estatura/fisiologia , Radiografia/métodos , Medição de Risco , Escoliose , Coluna Vertebral/diagnóstico por imagem , Adolescente , Biometria/métodos , Vértebras Cervicais/diagnóstico por imagem , Progressão da Doença , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Escoliose/diagnóstico por imagem , Escoliose/patologia , Coluna Vertebral/patologia
19.
Medicine (Baltimore) ; 100(23): e26284, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115031

RESUMO

ABSTRACT: To investigate the clinical outcomes of arthroscopy-assisted transosseous fixation of tibial eminence fractures with the Versalok suture anchor in adults.A total of 23 adult cases of tibial eminence fractures treated between June 2016 and March 2019 were retrospectively analyzed. The results of the preoperative drawer test and Lachman test were positive. Radiography and computed tomography were performed before and after the procedure. Magnetic resonance imaging was performed in every patient after admission. Arthroscopy-assisted fracture reduction and Orthocord high-strength suture fixation with two Versalok anchors were performed in all the patients. The International Knee Documentation Committee scale and the Lysholm Knee Scoring Scale were used to evaluate outcomes during the follow-up period. Additionally, the KT-2000 knee stability test was performed.At the final follow-up, all the fractures had proceeded to bony union and no wound infection was observed. The average Lysholm Knee Score of the affected knees was 93.1 (range, 90-98), which was not significantly different from that of the healthy knees (t = 0.732, P = .132). Based on the International Knee Documentation Committee scale results, 21 patients were graded as normal and the other 2 patients were graded as nearly normal. The KT-2000 test showed that the anterior displacement of the affected side and the healthy side was less than 3.6 mm in all cases.The outcomes indicated firm fixation and good fracture healing with minimal trauma. Thus, arthroscopy-assisted transosseous fixation with Versalok suture anchors for adult tibial eminence fractures seems to have satisfactory clinical outcomes.


Assuntos
Artroscopia , Fixação Interna de Fraturas , Articulação do Joelho/cirurgia , Tíbia , Fraturas da Tíbia , Adulto , Artroscopia/efeitos adversos , Artroscopia/instrumentação , Artroscopia/métodos , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Radiografia/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos , Âncoras de Sutura , Tíbia/diagnóstico por imagem , Tíbia/lesões , Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia
20.
AJR Am J Roentgenol ; 217(1): 117-123, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33955775

RESUMO

OBJECTIVE. The purpose of this study was to reassess the outcome and potential consequences of intraperitoneal barium leakage during radiologic evaluation of the gastrointestinal tract. MATERIALS AND METHODS. This retrospective study included 18 patients who had significant intraperitoneal leakage of barium from gastrointestinal perforations that were not suspected or diagnosed before the radiologic procedures. This complication occurred during a barium enema examination in nine patients, an upper gastrointestinal study in seven, and a small bowel series in two patients. All patients underwent urgent laparotomy for repair of perforation, with vigorous peritoneal lavage and antibiotic therapy. RESULTS. All patients had an uneventful recovery and were followed for 4-17 years (mean, 8.5 years). Radiographs obtained during this interval showed that a significant amount of residual barium was retained in the abdominal cavity. Six patients had a total of 10 subsequent abdominal operations for unrelated conditions, and some had developed barium granulomas and peritoneal adhesions. However, none of the patients in this series experienced intestinal obstruction or any clinical symptoms related to barium deposits in the abdominal cavity. CONCLUSION. Intraperitoneal leakage of barium is a rare complication of radiologic gastrointestinal examinations, and this series of 18 cases reflects 3 decades of experience at two major medical centers. The presented data indicate that the commonly held and perpetuated concept about the high rate of morbidity and mortality of this complication would not be valid in the modern era of medical and surgical management.


Assuntos
Sulfato de Bário , Meios de Contraste , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Radiografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Enema , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
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