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4.
Eur J Med Res ; 26(1): 19, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557953

RESUMO

BACKGROUND: Diaphragmatic lesions as a result of blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare, but as in our patient can be serious. CASE PRESENTATION: A 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock, an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann-type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7-10 cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3-9 on the left side. CONCLUSION: This is the first report on a primarily established empyema at the time of first surgical intervention for feco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post-traumatic complications.


Assuntos
Colo/patologia , Diafragma/lesões , Traumatismo Múltiplo/complicações , Pneumotórax/etiologia , Ciclismo , Colo/cirurgia , Diafragma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Pneumotórax/cirurgia , Prolapso , Ruptura/etiologia , Ruptura/cirurgia , Traumatismos Torácicos/etiologia
5.
Khirurgiia (Mosk) ; (1): 62-68, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395514

RESUMO

OBJECTIVE: To improve postoperative outcomes in patients with distal Achilles tendon rupture by using of a new method of surgical treatment. MATERIAL AND METHODS: The authors proposed a new method to restore the Achilles tendon for its distal rupture (within 2 cm from attachment to the calcaneus). This approach implies forming a canal in the calcaneus and minimally invasive harvesting of the plantar tendon. At the next stage, the plantar tendon is passed through the canal of the calcaneus in U-shaped fashion and proximal part of Achilles tendon with maximum approximation of its fragments and imposing of interrupted sutures on the plantar and Achilles tendons to hold the position. The end of plantar tendon is used to reinforce damaged area. The schemes and surgical stages are shown in the figures. We reported a patient with distal Achilles tendon rupture and postoperative outcome. RESULTS: An above-mentioned approach was applied in 26 patients. The control group consisted of 21 patients who underwent recovery with anchor fixers. Early and long-term postoperative results, as well as adverse events were analyzed in both groups. Biomechanical parameters of gait were evaluated from the standpoint of evidence-based medicine using podography and functional myography. We confirmed an advantage of treatment in the main group.


Assuntos
Tendão do Calcâneo , Procedimentos Ortopédicos , Traumatismos dos Tendões , Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Calcâneo/cirurgia , Doença Crônica , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Ortopédicos/métodos , Placa Plantar/transplante , Ruptura/cirurgia , Âncoras de Sutura , Técnicas de Sutura , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento
6.
Cochrane Database Syst Rev ; 1: CD012479, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33434949

RESUMO

BACKGROUND: Various rehabilitation treatments may be offered following surgery for flexor tendon injuries of the hand. Rehabilitation often includes a combination of an exercise regimen and an orthosis, plus other rehabilitation treatments, usually delivered together. The effectiveness of these interventions remains unclear. OBJECTIVES: To assess the effects (benefits and harms) of different rehabilitation interventions after surgery for flexor tendon injuries of the hand. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, MEDLINE, Embase, two additional databases and two international trials registries, unrestricted by language. The last date of searches was 11 August 2020. We checked the reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that compared any postoperative rehabilitation intervention with no intervention, control, placebo, or another postoperative rehabilitation intervention in individuals who have had surgery for flexor tendon injuries of the hand. Trials comparing different mobilisation regimens either with another mobilisation regimen or with a control were the main comparisons of interest. Our main outcomes of interest were patient-reported function, active range of motion of the fingers, and number of participants experiencing an adverse event. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, extracted data, assessed risk of bias and assessed the quality of the body of evidence for primary outcomes using the GRADE approach, according to standard Cochrane methodology. MAIN RESULTS: We included 16 RCTs and one quasi-RCT, with a total of 1108 participants, mainly adults. Overall, the participants were aged between 7 and 72 years, and 74% were male. Studies mainly focused on flexor tendon injuries in zone II. The 17 studies were heterogeneous with respect to the types of rehabilitation treatments provided, intensity, duration of treatment and the treatment setting. Each trial tested one of 14 comparisons, eight of which were of different exercise regimens. The other trials examined the timing of return to unrestricted functional activities after surgery (one study); the use of external devices applied to the participant to facilitate mobilisation, such as an exoskeleton (one study) or continuous passive motion device (one study); modalities such as laser therapy (two studies) or ultrasound therapy (one study); and a motor imagery treatment (one study). No trials tested different types of orthoses; different orthosis wearing regimens, including duration; different timings for commencing mobilisation; different types of scar management; or different timings for commencing strengthening. Trials were generally at high risk of bias for one or more domains, including lack of blinding, incomplete outcome data and selective outcome reporting. Data pooling was limited to tendon rupture data in a three trial comparison. We rated the evidence available for all reported outcomes of all comparisons as very low-certainty evidence, which means that we have very little confidence in the estimates of effect. We present the findings from three exercise regimen comparisons, as these are commonly used in clinical current practice. Early active flexion plus controlled passive exercise regimen versus early controlled passive exercise regimen (modified Kleinert protocol) was compared in one trial of 53 participants with mainly zone II flexor tendon repairs. There is very low-certainty evidence of no clinically important difference between the two groups in patient-rated function or active finger range of motion at 6 or 12 months follow-up. There is very low-certainty evidence of little between-group difference in adverse events: there were 15 overall. All three tendon ruptures underwent secondary surgery. An active exercise regimen versus an immobilisation regimen for three weeks was compared in one trial reporting data for 84 participants with zone II flexor tendon repairs. The trial did not report on self-rated function, on range of movement during three to six months or numbers of participants experiencing adverse events. The very low-certainty evidence for poor (under one-quarter that of normal) range of finger movement at one to three years follow-up means we are uncertain of the finding of zero cases in the active group versus seven cases in the immobilisation regimen. The same uncertainty applies to the finding of little difference between the two groups in adverse events (5 tendon ruptures in the active group versus 10 probable scar adhesion in the immobilisation group) indicated for surgery. Place and hold exercise regimen performed within an orthosis versus a controlled passive regimen using rubber band traction was compared in three heterogeneous trials, which reported data for a maximum of 194 participants, with mainly zone II flexor tendon repairs. The trials did not report on range of movement during three to six months, or numbers of participants experiencing adverse events. There was very low-certainty evidence of no difference in self-rated function using the Disability of the Arm, Shoulder and Hand (DASH) functional assessment between the two groups at six months (one trial) or at 12 months (one trial). There is very low-certainty evidence from one trial of greater active finger range of motion at 12 months after place and hold. Secondary surgery data were not available; however, all seven recorded tendon ruptures would have required surgery. All the evidence for the other five exercise comparisons as well as those of the other six comparisons made by the included studies was incomplete and, where available, of very low-certainty. AUTHORS' CONCLUSIONS: There is a lack of evidence from RCTs on most of the rehabilitation interventions used following surgery for flexor tendon injuries of the hand. The limited and very low-certainty evidence for all 14 comparisons examined in the 17 included studies means that we have very little confidence in the estimates of effect for all outcomes for which data were available for these comparisons. The dearth of evidence identified in this review points to the urgent need for sufficiently powered RCTs that examine key questions relating to the rehabilitation of these injuries. A consensus approach identifying these and establishing minimum study conduct and reporting criteria will be valuable. Our suggestions for future research are detailed in the review.


Assuntos
Traumatismos da Mão/reabilitação , Traumatismos dos Tendões/reabilitação , Adolescente , Adulto , Idoso , Viés , Criança , Terapia por Exercício/efeitos adversos , Terapia por Exercício/métodos , Exoesqueleto Energizado , Feminino , Traumatismos da Mão/cirurgia , Humanos , Imobilização , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Cuidados Pós-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Amplitude de Movimento Articular , Ruptura/reabilitação , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Terapia por Ultrassom , Adulto Jovem
7.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504535

RESUMO

We report a case about a 69-year-old man, suffering from rheumatoid arthritis, diagnosed with a neglected Achilles tendon rupture. Considering the large Achilles tendon gap and the bad quality of the autologous tendons caused by rheumatoid disease, a reconstruction using an Achilles tendon with calcaneus bone block allograft was performed, with excellent clinical and functional outcomes.


Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/transplante , Artrite Reumatoide/complicações , Transplante Ósseo/métodos , Calcâneo/transplante , Ruptura/cirurgia , Idoso , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos , Ruptura/complicações , Transplante Homólogo/métodos
8.
Unfallchirurg ; 124(2): 125-131, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33315118

RESUMO

Ruptures of the pectoralis major (PM) tendon are rare but have increased in recent years, especially during fitness exercising, such as bench pressing. The pathomechanism is an eccentric load under pretension of the PM (falling onto the outstretched arm, injuries during ground combat, boxing and during downward movement when bench pressing). The rupture sequence starts from superior to inferior at the insertion site with initial rupture of the most inferior muscle parts, followed by the sternal part and the clavicular part. Most classifications are based on rupture location, extent and time of injury. In addition to clinical presentation and sonography, magnetic resonance imaging is now established as the gold standard in diagnosing PM pathologies. Surgical management is indicated for all lateral PM ruptures with relevant strength deficits. Treatment in the acute interval (<3 weeks) is the primary goal; however, even in chronic cases or after failed conservative management a secondary operative approach enables notable clinical improvement. Conservative therapy mostly affects patients who have muscular injuries close to the anatomic origin and smaller partial tears. Surgical management aims for anatomic reconstruction of the PM unit with restoration of the original tension to enable optimal strength transmission. Surgical refixation or reconstruction (with autograft/allograft) of acute and chronic PM ruptures shows excellent clinical results with high patient satisfaction. Latissimus dorsi (LD) and teres major (TM) tendon ruptures are rare injuries but can lead to significant impairments in high-performance athletes. In contrast to PM ruptures, LD and TM injuries are primarily treated conservatively with very satisfactory results.


Assuntos
Músculos Peitorais , Ombro , Humanos , Músculos Peitorais/diagnóstico por imagem , Músculos Peitorais/cirurgia , Ruptura/cirurgia , Tendões , Ultrassonografia
9.
Acta Ortop Mex ; 34(2): 139-145, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33244917

RESUMO

INTRODUCTION: Massive and irreparable rotator cuff injury is a clinical problem that results in loss of shoulder function and merits timely intervention that helps preserve it as long as possible before arthropathy. The option of repair of the superior capsule with autograft of Fascia Lata in the massive and irreparable rupture of the rotator cuff, is a technique proposed by Mihata, which has demonstrated an improvement of function in the short and medium term. CASE REPORT: Female of 51 years old with irreparable tear of supraspinatus and infraspinatus, failure in conservative treatment, clinically with intolerable shoulder pain, subjective dysfunction without signs of moderate to severe arthropathy, no bone defects, stiffness or dysfunction of Deltoid, Latissimus Dorsi and Pectoralis Major. Superior capsule reconstruction was performed with autograft of fascia Lata in August 2018, with follow-up for the first 12 weeks. The result of this procedure showed improvement of the SST 58.33 and QD 20.45 scales compared to pre-surgical evaluation (SST 33.3 and QD 27.7). Full active mobilization in abduction, flexion, extension and internal rotation. The external rotation of the shoulder has no functional improvement.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Feminino , Humanos , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ruptura/cirurgia
10.
J Vet Sci ; 21(5): e53, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33016013

RESUMO

BACKGROUND: The TightRope System is a device developed to provide extracapsular stabilization of the cranial cruciate ligament (CCL) rupture in canine stifles. I was then also employed for the extra-articular treatment of shoulder instability and for the intra-articular treatment of hip luxation in dogs and cats. OBJECTIVES: To evaluate the feasibility of the Mini-TightRope (mTR) System for the intra-articular treatment of CCL rupture in small breed dogs. METHODS: A cadaveric canine model was used to record the steps of the surgical procedure. Five client owned dogs weighing from 8 to 10 kg and from 2 to 12 years of age were enrolled in the prospective study in which the mTR device was implanted in the stifle joint to replace the ruptured CCL. The dogs were graded using the Bologna Healing Stifle Injury Index (BHSII) and radiographic osteoarthritis (OA) scores. RESULTS: The outcomes obtained at the time of the surgery (T0) and for the following 12 months (T12) showed an improvement in the functional parameters (BHSII from a median of 74.3 [range, 58.1-82.4] at T0 to 95.6 [range, 94.1-99.3] at T12]). The OA did not change in 3 dogs and increased by only 1 point in 2 dogs. CONCLUSIONS: In this preliminary study, the mTR was a successful and repeatable intra-articular surgical procedure for all dogs. Additional studies related to the clinical application of the technique in medium-large dogs should be encouraged.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Cães/cirurgia , Ruptura/veterinária , Joelho de Quadrúpedes/cirurgia , Animais , Lesões do Ligamento Cruzado Anterior/cirurgia , Cães/lesões , Feminino , Masculino , Estudos Prospectivos , Ruptura/cirurgia
11.
Stroke ; 51(10): 2990-2996, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912090

RESUMO

BACKGROUND AND PURPOSE: Do children have an increased risk for brain arteriovenous malformation (AVM) recurrence compared with adults and does this risk vary depending on initial presentation with AVM rupture? METHODS: We retrospectively studied 115 patients initially presenting with brain AVM under age 25 years who underwent complete surgical resection of the AVM as documented by digital subtraction angiography (DSA) and had delayed follow-up DSA to evaluate for AVM recurrence after apparent initial cure. RESULTS: The mean time from baseline DSA to follow-up DSA was 2.3 years, ranging from 0 to 15 years. Twelve patients (10.4% of the 115 patient cohort and 16.7% of 72 patients with hemorrhage at initial presentation) demonstrated AVM recurrence on follow-up DSA. All patients with recurrence initially presented with intracranial hemorrhage, and intracranial hemorrhage was a significant predictor of recurrence (log rank P=0.037). Among patients with initial hemorrhage, the 5-year recurrence rate was 17.8% (95% CI, 8.3%-35.7%). All recurrences occurred in patients who were children at the time of their initial presentation; the oldest was 15 years of age at the time of initial AVM surgery. The 5-year recurrence rate for children (0-18 years of age) with an initial presentation of hemorrhage was 21.4% (95% CI, 10.1%-41.9%). Using Cox regression, we found the risk of AVM recurrence decreased by 14% per each year increase in age at the time of initial surgical resection (hazard ratio=0.86 [95% CI, 0.75-0.99]; P=0.031). CONCLUSIONS: There is a high rate of recurrence of apparently cured brain AVMs in children who initially present with AVM rupture. Imaging follow-up is warranted to prevent re-rupture.


Assuntos
Fístula Arteriovenosa/cirurgia , Encéfalo/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Adolescente , Angiografia Digital , Fístula Arteriovenosa/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Microcirurgia , Procedimentos Neurocirúrgicos , Recidiva , Estudos Retrospectivos , Ruptura/cirurgia , Resultado do Tratamento , Adulto Jovem
12.
Klin Monbl Augenheilkd ; 237(9): 1070-1078, 2020 Sep.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-32967031

RESUMO

Due to their complexity, globe ruptures are highly compromising traumas for the patient. This is due on the one hand to the eye injury itself with the accompanying loss of vision and on the other hand due to the need for extended treatment with uncertain prognosis and the resulting psychological stress. Globe ruptures are among the prognostically most unfavorable injuries due to the force and peak pressure impacting the eye. Furthermore, contusional retinal necrosis may be of significance prognostically. In the present review, we discuss treatment of globe ruptures involving retinal surgery. We discuss the primary sugery, its chronological planning and extent as well as the necessity for follow-up interventions. We also discuss the origin of traumatic retinal detachment with differential diagnosis of giant retinal tear versus oradialysis as well as secondary sequelae of traumas such as formation of macular holes and their treatment. On this basis, the use of buckling surgery versus pars-plana vitrectomy is discussed. Further focus is set on the role of the iris lens diaphragm in surgery of globe ruptures.


Assuntos
Traumatismos Oculares/diagnóstico , Traumatismos Oculares/cirurgia , Traumatismos Oculares/terapia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Humanos , Estudos Retrospectivos , Ruptura/cirurgia , Vitrectomia
13.
Am J Sports Med ; 48(10): 2465-2470, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32667821

RESUMO

BACKGROUND: Hip arthroscopy has been shown to be effective in athletes who have femoral acetabular impingement and labral tearing. The effect of complete capsular closure versus nonclosure on return to play is unknown. HYPOTHESIS: Complete capsular closure after hip arthroscopy would lead to a higher rate and faster return to sports in high-level athletes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A nonrandomized retrospective review was performed of high school, collegiate, and professional athletes undergoing hip arthroscopy by a single high-volume hip arthroscopic surgeon. Athletes were divided into those undergoing complete capsular closure (CC group) and non-capsular closure (NC group) after hip arthroscopy. Rate and time to return to play were determined between the 2 groups. Patient-reported outcomes including modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) were obtained at a minimum of 2 years. RESULTS: A total of 111 athletes with a minimum 2-year follow-up were included in the study. There were 62 in the CC group and 49 in the NC group. A higher percentage of athletes in the CC group returned to play compared with that in the NC group (90.3% vs 75.5%, respectively; P = .03). The CC group returned to play at a mean ± SD of 4.7 ± 1.9 months compared with 5.8 ± 2.6 months in the NC group (P < .001). Patients in the CC group met the minimal clinically important difference for the mHHS, HOS-ADL, and HOS-SSS patient-reported outcomes at higher percentages: mHHS, 98.3% vs 87.7% for CC vs NC, respectively (P = .02); HOS-ADL, 98.3% vs 87.7% (P = .02); and HOS-SSS, 96.7% vs 89.7% (P = .13). The difference between groups was statistically significant for mHHS and HOS-ADL. CONCLUSION: Complete capsular closure after hip arthroscopy was associated with faster return to play and a higher rate of return compared with that of nonclosure of the capsule in this sample population of high-level athletes. At a minimum 2-year follow-up, complete capsular closure was associated with significantly higher patient-reported outcomes compared with those of nonclosure in athletes who underwent hip arthroscopy.


Assuntos
Artroscopia , Impacto Femoroacetabular , Articulação do Quadril/cirurgia , Atividades Cotidianas , Atletas , Impacto Femoroacetabular/cirurgia , Humanos , Estudos Retrospectivos , Ruptura/cirurgia , Resultado do Tratamento
14.
Medicine (Baltimore) ; 99(27): e21047, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629730

RESUMO

Repair of medial meniscus posterior root tear (MMPRT) is considered as an effective early intervention strategy for osteoarthritis. We aimed at evaluating whether or not single-photon emission computed tomography/computed tomography (SPECT/CT) could predict the treatment outcome.Eleven patients with MMPRT who underwent preoperative SPECT/CT were retrospectively enrolled. Clinical symptoms were evaluated based on the knee injury and osteoarthritis outcome score (KOOS) and visual analogue scale (VAS) for pain. The uptake pattern of the medial tibial plateau (MTP) on SPECT/CT was visually assessed. Additionally, the maximum lesion-to-cortical counts ratio (LCRmax) for the anterior and posterior aspects of MTP and anterior-posterior MTP ratio (APR) were quantitatively assessed. Spearman correlation analyses were performed between the change in clinical symptom scores and preoperative SPECT/CT patterns.All patients showed increased radiotracer uptake in MTP. Among them, 8 (73%) showed dominant uptake in the anterior aspect of MTP. The rest 3 (27%) showed posterior-dominant uptake. Patients with anterior-dominant patterns tended to show better outcomes in terms of the postoperative KOOS score (P = .07). Anterior MTP LCRmax showed a negative correlation with the change in VAS (ρ = -0.664, P < .03). APR showed a correlation with the change in the KOOS score (ρ = 0.655, P < .03).Patients with MMPRT with relatively higher uptake in the anterior aspect of MTP could have better clinical outcomes after the repair. The preoperative SPECT/CT pattern may have a predictive value in selecting patients with good postoperative outcomes.


Assuntos
Meniscos Tibiais/patologia , Osteoartrite/cirurgia , Ruptura/cirurgia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Idoso , Osso e Ossos/diagnóstico por imagem , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Meniscectomia/métodos , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica
15.
Medicine (Baltimore) ; 99(27): e21134, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629748

RESUMO

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before.


Assuntos
Implantes de Mama/efeitos adversos , Comportamento de Escolha/fisiologia , Mastectomia/efeitos adversos , Cirurgia Plástica/efeitos adversos , Feminino , Hospitalização , Humanos , Responsabilidade Legal/economia , Imagem por Ressonância Magnética/métodos , Imperícia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Ruptura/complicações , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Cirurgiões/psicologia , Ultrassonografia/métodos
16.
Medicine (Baltimore) ; 99(27): e21139, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629749

RESUMO

INTRODUCTION: Most symptomatic large-to-massive rotator cuff tears (RCTs) should be operated, but the surgical reparability depended on the degree of rotator cuff muscle atrophy or fatty infiltration. The orthopedic surgeons will decide whether the teared stump is reparable during the surgery, but preoperative evaluation can be done by some assessment tools. Magnetic resonance imaging (MRI) was used in recent studies to predict the reparability of large-to-massive RCTs, but the clinical availability was not as good as ultrasound. We hypothesize that the ultrasound elastography can predict the reparability of large-to-massive RCTs. METHODS: This is a prospective observational study and participants with large-to-massive RCTs who are going to have surgeries will be included. Out investigators will evaluate the shoulder passive range of motion (ROM) and strength of all participants. Participants' degree of shoulder pain and activities of daily living (ADLs) will be assessed by American Shoulder and Elbow Surgeons (ASES) score. The ultrasound elastography will be used to evaluate the tissue quality of supraspinatus muscle and infraspinatus muscle. To test the reliability of the ultrasound elastography, two physicians will perform the ultrasound elastography independently and twenty participants will be selected for the reliability test. Besides, MRI will be used to evaluate the size of tear, the degree of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, the orthopedic surgeons will perform surgeries and decide whether the teared stump can be completely repaired intraoperatively. The primary analysis is the predictive validity of ultrasound elastography for the reparability of large-to-massive RCTs. Before the predictive validity of ultrasound elastography is measured, our investigators will assess the reliability of ultrasound elastography when administered to cases with large-to-massive RCTs, and we will check the correlations between the findings of ultrasound elastography and MRI. DISCUSSION: The outcome will provide the evidence of ultrasound elastography for preoperative evaluation of large-to-massive RCTs. The relationships between the findings of ultrasound elastography and MRI will also be examined for further analysis. TRIAL REGISTRATION: Clinicaltrials.gov NCT03682679. Date of Registration: 25 September 2018, https://clinicaltrials.gov/ct2/show/NCT03682679?cond=rotator+cuff&cntry=TW&draw=2&rank=1.


Assuntos
Lesões do Manguito Rotador/diagnóstico por imagem , Ruptura/cirurgia , Ombro/fisiopatologia , Atividades Cotidianas , Tecido Adiposo/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Atrofia Muscular/patologia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(6): 726-729, 2020 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-32538563

RESUMO

Objective: To investigate the effectiveness of autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture. Methods: Between June 2015 and June 2018, 16 patients with chronic Achilles tendon ruptures were treated by autogenous tendon reconstruction under total arthroscopy. Of the 16 patients, 11 were males and 5 were females. Their mean age was 40.7 years (range, 21-55 years). The disease duration was 14-20 months (mean, 16.4 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 41.2±2.2 and the pain visual analogue scale (VAS) score was 7.9±1.2. MRI and B-ultrasonography examinations showed that the Achilles tendon was not continuous. The length of Achilles tendon defect was 5.0-10.3 cm, with an average of 5.8 cm. The rupture of the Achilles tendon happened on top of the insertion of the tendon in 4 cases and at the tendon-muscle belly connection in 12 cases. The operation time, intraoperative blood loss, hospital stay, and related complications were recorded. The AOFAS score and VAS score were used to evaluate the improvement of ankle joint function and pain. Results: The average operation time was 77.2 minutes (range, 60-90 minutes). The average intraoperative blood loss was 20.5 mL (range, 15-30 mL). The average hospital stay was 7.2 days (range, 5-10 days). All incisions healed by first intention. There was no skin necrosis, infection, or deep vein thrombosis. All the patients were followed up 8-18 months, with an average of 12 months; and 10 cases were followed up more than 12 months. During the follow-up, there was no Achilles tendon re-rupture, and the symptoms of pain and heel lifting failure significantly improved. MRI reexamination showed that the continuity of Achilles tendon recovered. At 1, 3, 6, and 12 months postoperatively, AOFAS scores significantly improved and VAS scores significantly reduced, except for 1 month postoperatively, the scores at other time points were superior to that before operation, the differences were significant ( P<0.05). Conclusion: Autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture has the advantages of small trauma, rapid functional recovery, and satisfactory surgical efficacy.


Assuntos
Tendão do Calcâneo , Artroscopia , Ruptura , Traumatismos dos Tendões , Tendão do Calcâneo/cirurgia , Adulto , Artroscopia/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento , Adulto Jovem
18.
Eur J Ophthalmol ; 30(5): 1172-1178, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32525428

RESUMO

PURPOSE: To report how to manage a specific type of Descemet's membrane (DM) rupture during manual DALK with a concurrent donor-recipient disparity of curvature. METHODS: Case report of two patients that had DM rupture during manual DALK with a concurrent donor-recipient disparity of curvature; the recipient bed was flatter (post-infectious scar, case 1) and steeper (keratoglobus, case 2) than the donor. Preoperative diagnosis, clinical exam, and best spectacle correct visual acuity (BSCVA) have been reported. A subtotal full-thickness circular cut of the recipient bed was performed to resolve a persistent double AC in case 1 (recipient flatter than donor). A total full-thickness circular cut of the recipient bed, creating a graft made by a DALK allograft and a "DSEK autograft," was performed to avoid a refractory double AC in case 2 (recipient steeper than donor). Evaluated outcomes included postoperative BSCVA, endothelial cell count (ECC), graft clarity, rejection, and presence/absence of double AC. RESULTS: Surgery was successful in resolving/avoiding double AC. VA improved in both cases. No episodes of rejection were recorded. Graft remained clear at the last follow-up (6 years for case 1 and 4 years for case 2). CONCLUSION: The existence of a donor-recipient curvature disparity should be investigated as a possible underlying mechanism of refractory double AC. Total or subtotal full thickness recipient bed cut may be considered to repair donor-recipient curvature disparity in cases of DM rupture occurring during manual DALK. Repairing the DM rupture and avoiding a conversion to PK in high-risk transplant cases are crucial.


Assuntos
Transplante de Córnea/efeitos adversos , Lâmina Limitante Posterior/lesões , Complicações Intraoperatórias , Procedimentos Cirúrgicos Oftalmológicos , Ruptura/cirurgia , Adulto , Idoso , Doenças da Córnea/cirurgia , Opacidade da Córnea/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Ruptura/etiologia , Doadores de Tecidos , Transplantados , Acuidade Visual/fisiologia
19.
Foot Ankle Spec ; 13(5): 431-434, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32527147

RESUMO

The rupture of the Achilles tendon (AT) usually occurs in high-caliber athletes, but low-demand patients are also are risk, mainly if they are under corticoids or quinolones. The diagnosis of the AT rupture is usually neglected, and this could result in a worse prognosis for the patient if not treated in an appropriate time. For these patients or for those with high surgical risk, an option of minimally invasive surgery remains attractive. Classical techniques consist of direct repair or augmentation with the tendon of the flexor hallucis longus as well as nonanatomical tendon transfers which can generate issues with the donor site. We present a pioneering technique that is analogous to that used for the surgical treatment of distal rupture of the biceps tendon, which consist of a transfer technique of flexor hallucis longus by extracortical fixation interference screw associated to a direct tendon reinsertion performed through a bone tunnel on the superior and posterior aspect of the calcaneus using an extracortical drilling system and an interference screw within the calcaneal tunnel. The arthroscopic approach may be technically challenging, and a high-level of arthroscopic skills are required to complete the procedure but after a learning curve it represents a feasible a safe technique.Levels of Evidence:Therapeutic, Level IX: Evidence from opinion of authorities and/or reports of expert committee.


Assuntos
Tendão do Calcâneo/cirurgia , Artroscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Calcâneo/cirurgia , Estudos de Viabilidade , Humanos
20.
Rev. cuba. ortop. traumatol ; 34(1): e219, ene.-jun. 2020. ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139113

RESUMO

RESUMEN Introducción: La ruptura espontánea del tendón de Aquiles es una afección frecuente en los pacientes jóvenes que practican deportes. Cuando no se realiza el diagnóstico inicial, pasa a ser una lesión crónica, donde su diagnóstico y tratamiento es aún más complejo. En la mayoría de estos casos son necesarios los injertos tendinosos. Objetivo: Demostrar la eficacia y resultados clínicos funcionales de la reparación quirúrgica de la ruptura crónica del tendón de Aquiles mediante transferencia del tendón peroneo lateral corto. Presentación del caso: Paciente masculino de 38 años de edad con antecedentes de una caída mientras practicaba deportes. Se constató ruptura crónica del tendón de Aquiles. Se realizó una cirugía a cielo abierto, con transferencia tendinosa del tendón peroneo lateral corto hacia el cabo distal del tendón de Aquiles. Se reforzó la plastia con el tendón del plantar delgado. Se colocó una inmovilización tipo bota para el tobillo con 30o de flexión plantar por seis semanas. Pasado este tiempo, se colocó una bota de marcha y comenzó la deambulación, así como la rehabilitación con apoyo parcial hasta cumplir tres meses. A los seis meses se incorporó a su vida normal con adecuada función del pie y el tobillo. Conclusiones: La reparación quirúrgica de la ruptura crónica del tendón de Aquiles mediante transferencia del tendón peroneo lateral corto constituye un método eficaz y ofrece buenos resultados clínicos y funcionales(AU)


ABSTRACT Introduction: Spontaneous rupture of the Achilles tendon is a frequent condition in young patients who practice sports. When the initial diagnosis is not made, it becomes a chronic injury, consequently, diagnosis and treatment is even more complex. In most of these cases, tendon grafts are necessary. Objective: To demonstrate the efficacy and functional clinical results of the surgical repair of the chronic rupture of the Achilles tendon by transferring the short lateral peroneal tendon. Case report: We report the case of a 38-year-old male patient with a history of a fall while playing sports. A chronic rupture of the Achilles tendon was found. Open surgery was performed, the short lateral peroneal tendon was transferred to the distal end of the Achilles tendon. The plasty was reinforced with the thin plantar tendon. Ankle boot-type immobilization was placed with 30° plantar flexion for six weeks. After this time, the patient received a walker boot, ambulation and rehabilitation began. The latter started with partial support during three months. At six months this patient returned to his normal life with adequate foot and ankle function. Conclusions: Surgical repair of chronic Achilles tendon rupture by transferring the short lateral peroneal tendon is an effective method and offers good clinical and functional results(AU)


Assuntos
Humanos , Masculino , Adulto , Ruptura/cirurgia , Tendão do Calcâneo/lesões , Transferência Tendinosa/métodos , Ligamentos Laterais do Tornozelo/transplante
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