Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.002
Filtrar
1.
Plast Reconstr Surg ; 146(6): 768e-776e, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234971

RESUMO

BACKGROUND: Despite reports demonstrating feasibility of immediate dental implant placement in mandibular reconstruction with free fibula flaps for benign disease, this practice is not routinely used in the oncologic setting. The authors aim to demonstrate the safety of immediate dental implant placement for oncologic mandible reconstruction. METHODS: In 2017, the authors' center began immediate dental implant placement in free fibula flaps for oncologic patients undergoing mandibulectomy reconstruction. Immediate dental implant placement patients were compared to a historical cohort also reconstructed with computer-aided design and manufacturing technology beginning in 2011 (n = 34) as a noninferiority study design. Primary outcomes of interest included 90-day complications, time to radiotherapy, and time to and number of patients achieving dental restoration. RESULTS: Sixty-one patients underwent free fibula flaps following mandibulectomy using computer-aided design and manufacturing. Seventy-two dental implants were placed in the immediate dental implant placement cohort (n = 27). No differences were noted in major or minor 90-day complications between groups (p > 0.05). Radiotherapy was required in 55 percent in the immediate dental implant placement cohort versus 62 percent in the historical cohort, with no significant difference in time to radiotherapy (67.6 days versus 62.2 days, respectively). One dental implant was removed for nonosseointegration noted during vestibuloplasty. Fourteen (51.8 percent) immediate dental implant patients had complete dental restoration at 90 days compared with none in the historical cohort (p < 0.05). CONCLUSIONS: Immediate dental implant placement is a safe procedure with an unchanged short-term complication profile and no delay in radiotherapy initiation. Patients undergoing immediate dental implant placement are more likely to complete full dental rehabilitation. Long-term and health-related quality-of-life outcomes remain to be determined. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Transplante Ósseo/métodos , Implantação Dentária/métodos , Neoplasias Mandibulares/terapia , Osteotomia Mandibular/efeitos adversos , Reconstrução Mandibular/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Transplante Ósseo/efeitos adversos , Desenho Assistido por Computador , Implantação Dentária/efeitos adversos , Implantação Dentária/instrumentação , Implantes Dentários/efeitos adversos , Feminino , Fíbula/transplante , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/transplante , Humanos , Masculino , Mandíbula/patologia , Mandíbula/cirurgia , Reconstrução Mandibular/efeitos adversos , Reconstrução Mandibular/instrumentação , Pessoa de Meia-Idade , Osseointegração , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento
2.
PLoS One ; 15(11): e0241998, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33166330

RESUMO

Spinal fusion is a commonly performed orthopedic surgery. Autologous bone graft obtained from the iliac crest is frequently employed to perform spinal fusion. Osteogenic bone marrow stromal (a.k.a. mesenchymal stem) cells (BMSCs) are believed to be responsible for new bone formation and development of the bridging bone during spinal fusion, as these cells are located in both the graft and at the site of fusion. Our previous work revealed the importance of mitochondrial oxidative metabolism in osteogenic differentiation of BMSCs. Our objective here was to determine the impact of BMSC oxidative metabolism on osseointegration of the graft during spinal fusion. The first part of the study was focused on correlating oxidative metabolism in bone graft BMSCs to radiographic outcomes of spinal fusion in human patients. The second part of the study was focused on mechanistically proving the role of BMSC oxidative metabolism in osseointegration during spinal fusion using a genetic mouse model. Patients' iliac crest-derived graft BMSCs were identified by surface markers. Mitochondrial oxidative function was detected in BMSCs with the potentiometric probe, CMXRos. Spinal fusion radiographic outcomes, determined by the Lenke grade, were correlated to CMXRos signal in BMSCs. A genetic model of high oxidative metabolism, cyclophilin D knockout (CypD KO), was used to perform spinal fusion in mice. Graft osseointegration in mice was assessed with micro-computed tomography. Our study revealed that higher CMXRos signal in patients' BMSCs correlated with a higher Lenke grade. Mice with higher oxidative metabolism (CypD KO) had greater mineralization of the spinal fusion bridge, as compared to the control mice. We therefore conclude that higher oxidative metabolism in BMSCs correlates with better spinal fusion outcomes in both human patients and in a mouse model. Altogether, our study suggests that promoting oxidative metabolism in osteogenic cells could improve spinal fusion outcomes for patients.


Assuntos
Osseointegração , Estresse Oxidativo , Fusão Vertebral , Adolescente , Adulto , Idoso , Animais , Transplante Ósseo/métodos , Criança , Feminino , Humanos , Masculino , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Fusão Vertebral/métodos , Coluna Vertebral/metabolismo , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(40): e22535, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019460

RESUMO

RATIONALE: Adolescent wrist trauma can cause epiphyseal dysplasia and even distal radius deformity malunion. At present, there is no uniform treatment standard for the malunion of the distal radius of adolescents. Osteotomy and autologous bone grafting are currently one of the effective ways to treat the disease. We treated an adolescent patient with distal radius deformity malunion, and used this surgical method to treat the patient and achieved satisfactory results. PATIENT CONCERNS: A 16-year-old boy suffered from a serious distal radius deformity after trauma of the left wrist 8 years ago. DIAGNOSES: Physical examination, X-rays examination, high-resolution computed tomography scan, and 3-dimensional reconstruction images of the affected limb helped us diagnose the distal radius fracture malunion. INTERVENTIONS: The fracture malunion was treated by osteotomy and autologous iliac bone grafting. OUTCOMES: At the 2-year follow-up, wrist flexion returned to 68°, wrist dorsiflexion to 55°, radial deviation to 14°, ulnar deviation to 12°, forearm pronation to 75°, supination to 67°. Grip strength increased to 35.1 kg after 2 years of operation, recovered to 87% of the uninjured side. Quick DASH score at 2-year follow-up was 9. No complication, such as nonunion or infection, was observed. LESSONS: This rare case provides valuable insights for hand surgeons. High-resolution computed tomography scan and 3-dimensional reconstruction can help us effectively diagnose wrist diseases. Small lesions on the articular surface of the distal radius will change the position and function of the wrist joint, and cause traumatic arthritis of the wrist joint. Therefore, it is very important to reconstruct the normal structure of the distal radius articular surface. Osteotomy and autologous iliac bone grafting are effective treatments for serious distal radius fracture malunion in the adolescent patient. During the operation, care should be taken to protect the osteoepiphysis to avoid bone dysplasia.


Assuntos
Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Fraturas do Rádio/complicações , Transplante Autólogo/métodos , Adolescente , Assistência ao Convalescente , Transplante Ósseo/métodos , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Ílio/transplante , Processamento de Imagem Assistida por Computador/instrumentação , Masculino , Radiografia/métodos , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Articulação do Punho/fisiologia
4.
PLoS One ; 15(10): e0241141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33091091

RESUMO

The transfibular approach is a common procedure for tibiotalar fusion. However, this technique has several concerns: inadequate stability to resist rotational and shearing forces, a fibula is suboptimal for bone grafting, and an onlay fibular graft that might prevent impacting and cause distraction. We present a modified transfibular technique using partial fibular resection and onlay bone graft, which may address these potential problems. This study aimed to evaluate whether the ankle joint is well fused with neutral alignment and functionally improved at the final follow-up. For this study, 27 consecutive patients (mean age, 68.5 years; range, 58-83) who underwent tibiotalar fusion with a follow-up period of >1 year were retrospectively included. A modified transfibular lateral approach was performed, in which the distal anterior half fibula was resected and fixed as an onlay graft to achieve fusion between the tibia, fibula, talus, and fibular onlay graft simultaneously. Radiographic outcomes were assessed using computed tomography at 4 months after operation and serial follow-up radiographs. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society hindfoot scale and Foot and Ankle Outcome Score. The mean follow-up period was 17.3 (range, 12-32) months. Four months after operation, complete union was achieved in 13 patients, near-complete union in 8 patients, and partial union in the remaining 6 patients. At the final follow-up, all the patients achieved complete union and maintained neutral ankle alignment. The functional outcome showed a significant increase between the preoperative and postoperative periods. One minor complication occurred, in which medial side ankle pain was relieved after screw removal. This modified technique is safe and effective, and has several merits, including saving the soft tissue of the anterior ankle, saving the course of the peroneal tendons by leaving the posterior half of the fibula, resected fibula serving as a good bone stock, and reducing the likelihood of valgus deformity after fibulectomy.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/métodos , Transplante Ósseo/métodos , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Artrodese/efeitos adversos , Parafusos Ósseos/efeitos adversos , Transplante Ósseo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
J Plast Reconstr Aesthet Surg ; 73(11): 1989-1994, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32917570

RESUMO

INTRODUCTION: Nonunion is a known complication following fracture in the setting of radiotherapy. Free vascularized fibular (FVF) flaps have been used successfully in the treatment of segmental bone defects; however, their efficacy in the treatment of radiated nonunions is limited. The purpose of the study was to evaluate the outcome following FVFG for radiation-associated femoral fracture nonunions. METHODS: 23 (11 male and 12 female; mean age 60 ±â€¯12 years) patients underwent FVF for radiation-associated femoral fracture nonunions. The most common indication for radiotherapy was soft tissue sarcomas (n = 16). The mean follow-up was 5 ±â€¯4 years. Mean radiation dose was 51 ±â€¯14 Gy at a mean of 11 ±â€¯3 years prior to FVF. The mean FVF length was 17 ±â€¯4 cm and placed commonly with an intramedullary nail (n = 18). RESULTS: First time union was 52% (n = 12) following additional bone grafting, the overall union was 78% (n = 18) at a mean of 13 ±â€¯6 months. Musculoskeletal Tumor Society scores improved from 30% preoperatively to 73% at latest follow-up (p < 0.0001). Five fractures failed to unite; 3 were converted to proximal femoral replacements. CONCLUSIONS: FVF are a reasonable treatment option for radiation-associated femoral fracture nonunions, providing a union rate of 78% and an improvement in functional outcome. LEVEL OF EVIDENCE: Therapeutic Level IV.


Assuntos
Transplante Ósseo , Fraturas do Fêmur , Fíbula/transplante , Fixação de Fratura , Fraturas não Consolidadas , Complicações Pós-Operatórias , Lesões por Radiação/cirurgia , Reoperação , Transplante Ósseo/efeitos adversos , Transplante Ósseo/métodos , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fraturas não Consolidadas/etiologia , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Sarcoma/radioterapia , Retalhos Cirúrgicos/irrigação sanguínea
6.
PLoS One ; 15(9): e0238471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870933

RESUMO

Bone scaffolds are widely used as one of the main bone substitute materials. However, many bone scaffold microstructure topologies exist and it is still unclear which topology to use when designing scaffold for a specific application. The aim of the present study was to reveal the mechanism of the microstructure-driven performance of bone scaffold and thus to provide guideline on scaffold design. Finite element (FE) models of five TPMS (Diamond, Gyroid, Schwarz P, Fischer-Koch S and F-RD) and three traditional (Cube, FD-Cube and Octa) scaffolds were generated. The effective compressive and shear moduli of scaffolds were calculated from the mechanical analysis using the FE unit cell models with the periodic boundary condition. The scaffold permeability was calculated from the computational fluid dynamics (CFD) analysis using the 4×4×4 FE models. It is revealed that the surface-to-volume ratio of the Fischer-Koch S-based scaffold is the highest among the scaffolds investigated. The mechanical analysis revealed that the bending deformation dominated structures (e.g., the Diamond, the Gyroid, the Schwarz P) have higher effective shear moduli. The stretching deformation dominated structures (e.g., the Schwarz P, the Cube) have higher effective compressive moduli. For all the scaffolds, when the same amount of change in scaffold porosity is made, the corresponding change in the scaffold relative shear modulus is larger than that in the relative compressive modulus. The CFD analysis revealed that the structures with the simple and straight pores (e.g., Cube) have higher permeability than the structures with the complex pores (e.g., Fischer-Koch S). The main contribution of the present study is that the relationship between scaffold properties and the underlying microstructure is systematically investigated and thus some guidelines on the design of bone scaffolds are provided, for example, in the scenario where a high surface-to-volume ratio is required, it is suggested to use the Fischer-Koch S based scaffold.


Assuntos
Transplante Ósseo/métodos , Osso e Ossos/patologia , Tecidos Suporte/química , Substitutos Ósseos/farmacologia , Força Compressiva , Análise de Elementos Finitos , Hidrodinâmica , Teste de Materiais , Permeabilidade , Porosidade , Pressão , Estresse Mecânico , Engenharia Tecidual/métodos
7.
Clin Interv Aging ; 15: 1221-1230, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32801671

RESUMO

Background: Patients >60 years suffering from non-unions are often unable to perform activities of daily living and often become dependent on nursing care. Evidence regarding treatment options and outcome is nonexistent. This study sought to determine the clinical effectiveness and safety of one- or two-step non-union therapy in elderly patients. Methods: This study was a single-site retrospective database analysis of older adults with long bone non-unions treated via "diamond concept". All medical records of patients receiving surgical treatment of non-unions between 01/01/2010 and 31/12/2016 were reviewed. Clinical and radiological outcome subsequent to non-union therapy were evaluated. Results: A total of 76 patients (37 patients were treated with one-step and 39 patients with Masquelet therapy) suffering from a non-union older than 60 years treated between 01/01/2010 and 31/12/2016 in our institution were included into the current study. Bone consolidation was achieved in 91.9% after one-step and 76.9% after the Masquelet therapy. Analysis of age as a risk factor in the outcome of non-union therapy revealed no significant differences in patients treated with the one-step procedure according to the "diamond concept". On the contrary, age had a significant negative influence on the outcome of the Masquelet therapy (p = 0.027). Conclusion: Non-union therapy according to the "diamond concept" is an effective and reliable treatment option in elderly patients. According to findings of the current study, older adults suffering from an infected non-union benefit from a two-stage procedure, whereas in patients suffering from a non-infected non-union, a one-step surgical treatment is beneficial.


Assuntos
Fraturas do Fêmur/cirurgia , Consolidação da Fratura , Fraturas não Consolidadas/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Atividades Cotidianas , Idoso , Transplante Ósseo/métodos , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
8.
J Ayub Med Coll Abbottabad ; 32(3): 389-394, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32829557

RESUMO

BACKGROUND: Various methods for mandibular reconstruction have been demonstrated in literature from autogenous bone graft to free flaps and more recently tissue engineered materials. We share our experience of mandibular reconstruction with free fibular flap and evaluate its efficiency as a viable option for mandibular reconstruction. METHODS: It was a cross-sectional study, conducted at Plastic surgery department combined military hospital, Rawalpindi. Study was carried out over a period of two years from November 2016 to November 2018. The data of demography, mode of presentation, pattern of reconstruction and procedural complications of the patients who underwent free fibula flap for segmental mandibular loss, were collected and analysed. Patients with segmental loss of mandible ranging from 6 to 15 cm and those who could sustain surgery were included in the study, while the patients with metastatic malignancy and recurrent disease were excluded from the study. Each patient was called for first follow up after 2 weeks then subsequent follow up after 1 month. Descriptive statistics were done with the help of SPSS-20. RESULTS: A total of 57 patients with segmental mandibular loss treated with free fibula flap, fulfilling inclusion and exclusion criteria were included in this study. Thirtyeight patients were male while 19 were female with mean age 56±3 years. Cause of mandibular loss was malignancy in 52 (91.2%), trauma in 3 (5.2%), and ameloblastoma in 2 (3.5%) patients. Major complications like flap failure was seen in one (1.75%), bone exposure in 1 (1.75%) and recurrence was observed in 1 (1.75%) patient. Minor complications like hematoma, wound dehiscence and oro-cutaneous fistula were seen in 2, 1 and 3 patients respectively. CONCLUSIONS: Free fibular flap shows good functional results with a high degree of consistency, and acceptable complications rate, so it should be the first choice for mandibular reconstruction.


Assuntos
Transplante Ósseo/métodos , Fíbula/transplante , Retalhos de Tecido Biológico/transplante , Mandíbula/cirurgia , Estudos Transversais , Feminino , Humanos , Masculino , Traumatismos Mandibulares/cirurgia , Neoplasias Mandibulares/cirurgia , Reconstrução Mandibular , Pessoa de Meia-Idade
9.
J Vis Exp ; (162)2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32831300

RESUMO

We are in the midst of the 3D era in most aspects of life, and especially in medicine. The surgical discipline is one of the major players in the medical field using the constantly developing 3D planning and printing capabilities. Computer-assisted design (CAD) and computer assisted manufacturing (CAM) are used to describe the 3D planning and manufacturing of the product. The planning and manufacturing of 3D surgical guides and reconstruction implants is performed almost exclusively by engineers. As technology advances and software interfaces become more user-friendly, it raises a question regarding the possibility of transferring the planning and manufacturing to the clinician. The reasons for such a shift are clear: the surgeon has the idea of what he wants to design, and he also knows what is feasible and could be used in the operating room. It allows him to be prepared for any scenario/unexpected results during the operation and allows the surgeon to be creative and express his new ideas using the CAD software. The purpose of this method is to provide clinicians with the ability to create their own surgical guides and reconstruction implants. In this manuscript, a detailed protocol will provide a simple method for segmentation using segmentation software and implant planning using a 3D design software. Following the segmentation and stl file production using segmentation software, the clinician could create a simple patient specific reconstruction plate or a more complex plate with a cradle for bone graft positioning. Surgical guides can be created for accurate resection, hole preparation for proper reconstruction plate positioning or for bone graft harvesting and re-contouring. A case of lower jaw reconstruction following plate fracture and nonunion healing of a trauma sustained injury is detailed.


Assuntos
Transplante Ósseo/métodos , Desenho Assistido por Computador/instrumentação , Impressão Tridimensional/instrumentação , Próteses e Implantes/normas , Cirurgia Assistida por Computador/métodos , Feminino , Humanos , Masculino
10.
Medicine (Baltimore) ; 99(27): e20715, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629645

RESUMO

To understand the feasibility, clinical effect, and complications related to biological reconstruction techniques for long limb malignant bone tumors after excision.This retrospective study included eighty patients with malignant bone tumors treated at our hospital between January 2007 and January 2019. After tumor resection, 52 cases of intercalary and 28 cases of osteoarticular bone grafts were used. The implanted bone included devitalized recycling bone, fibular, and allograft.The average follow up period was 42.19 months for 80 patients, among whom 15 (18.75%) died. The 5-year EFS and OS were 58% and 69%, respectively. The average length of the replanted bone was 18.57 cm. The MSTS scores of intercalary and osteoarticular bone grafts were 87.24% and 64.00%, respectively. In 23 cases (44.23%) of metaphyseal and 26 cases (32.5%) of the diaphysis, bone graft union was obtained at the first stage. The factors affecting bone union were the patient's gender, age, devitalization bone methods and whether the implanted bone was completely fixed. Postoperative complications included delayed bone union in 15 patients, fractures in 25 cases, nonunion in 22 cases, bone resorption in 14 cases, and postoperative infection in 4 cases. Twenty-eight cases of bone grafting required revision surgery, including replacement of internal fixation, autologous bone graft, debridement, removal of internal fixation, and replacement with prosthetic replacement.Biological reconstructions with massive bone grafts are useful in the reconstruction of certain malignant extremity bone tumors after wide excision.


Assuntos
Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Neoplasias Femorais/cirurgia , Úmero/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sarcoma/cirurgia , Tíbia/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
11.
World Neurosurg ; 142: 375-378, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32702496

RESUMO

BACKGROUND: Forehead reconstruction is challenging. Reconstruction of the innate curvature of the forehead is difficult, and the forehead is an esthetically important part of the face. Although synthetic implants and autologous split bone grafts are useful, these cannot be used in infants. CASE DESCRIPTION: A 4-month-old girl was presented with a right frontal bone Ewing sarcoma. The tumor was removed, and the defect was reconstructed with an autologous contralateral parietal bone graft. The parietal bone defect was repaired with a bioabsorbable hydroxyapatite and collagen complex. Good reconstruction of the forehead and ossification of the donor site was achieved within 3 years after surgery. CONCLUSIONS: After removal of an extensive frontal bone tumor in an infant, exchange cranioplasty with an autograft using a bioabsorbable hydroxyapatite and collagen complex at the donor site yielded good results.


Assuntos
Substitutos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Osso Parietal/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sarcoma de Ewing/cirurgia , Autoenxertos , Neoplasias Ósseas/cirurgia , Substitutos Ósseos/química , Colágeno/uso terapêutico , Craniotomia/efeitos adversos , Durapatita/uso terapêutico , Feminino , Testa , Osso Frontal , Humanos , Lactente
12.
World Neurosurg ; 142: 239-245, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32659359

RESUMO

BACKGROUND: For the surgical treatment of spinal malignant tumor, spinal reconstruction with bone graft and instrumentation is necessary after tumor resection, but postoperative complications, including grafted bone resorption, may arise. CASE DESCRIPTION: A 42-year-old Asian woman presented with neck pain, tumorous masses on the neck, and left arm pain. Magnetic resonance imaging and computed tomography of the cervical spine showed extensive malignant spinal tumor. Histological examination of tumor biopsy revealed grade I chondrosarcoma. Complete resection of the tumor was performed using an anterior-posterior approach, followed by anterior iliac bone grafting and posterior spinal instrumentation. No tumor recurrence was observed on magnetic resonance imaging at final follow-up after 10 years. However, grafted bone resorption was identified immediately after surgery due to stress shielding by robust spinal instrumentation. To inhibit resorption of grafted bone, the bisphosphonate minodronate was administered for 5 years from 3 years postoperatively, before being replaced by denosumab from 8 years postoperatively. After use of these antibone resorptive agents, grafted bone resorption stopped. CONCLUSIONS: Anteriorly grafted bone resorption due to stress shielding may occur after reconstructive cervical spine surgery with robust posterior spinal instrumentation. Bisphosphonates and denosumab may be considered to inhibit grafted bone resorption.


Assuntos
Reabsorção Óssea/tratamento farmacológico , Transplante Ósseo/métodos , Vértebras Cervicais/cirurgia , Condrossarcoma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Autoenxertos/diagnóstico por imagem , Autoenxertos/efeitos dos fármacos , Reabsorção Óssea/diagnóstico por imagem , Transplante Ósseo/tendências , Vértebras Cervicais/diagnóstico por imagem , Condrossarcoma/diagnóstico por imagem , Difosfonatos/administração & dosagem , Feminino , Seguimentos , Humanos , Imidazóis/administração & dosagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Fatores de Tempo
13.
Knee ; 27(4): 1167-1175, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32711878

RESUMO

BACKGROUND: The aim of the present study was to confirm the effectiveness of adding nanohydroxyapatite (NHA) to a heterologous bone graft in open-wedge high tibial osteotomy (OWHTO) by measuring the bone density via multislice computed tomography (CT) of the tibial osteotomy gap in a mid-term follow-up (five years). METHODS: Twenty-six patients undergoing OWHTO were randomly assigned to two groups: a pure graft group (Group A), in which the osteotomy gap was filled with only heterologous bone graft, and an NHA group (Group B), in which the osteotomy gap was filled with heterologous bone graft and NHA. CT was performed within one week of the operation, after two months, after 12 months and after five years. CT volume acquired in Hounsfield units (HU) was measured on three planes. RESULTS: The normal bone density was 110.2 ± 11.7 HU. The value of mean density at five years in Group A was 296.8 ± 81.8 HU, while in Group B, it was 202.2 ± 45.1 HU, showing a density more similar to normal bone and greater bone uniformity inside the osteotomy. The difference between the two groups was statistically significant (p < 0.05). Furthermore, both groups showed excellent mid-term clinical outcomes without significant differences. CONCLUSIONS: This study revealed that absorbability and bone formation at the osteotomy site in the NHA group was significantly higher as compared with the pure graft group at five years postoperatively.


Assuntos
Substitutos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Durapatita/uso terapêutico , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Tíbia/cirurgia , Adulto , Densidade Óssea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nanopartículas , Osteoartrite do Joelho/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Am J Otolaryngol ; 41(6): 102637, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32707427

RESUMO

OBJECTIVE: To asses using cortical bone and bone pate with and without glass ionomer bone cement (GIBC) for reconstructing the outer attic wall (OAW) defect during cholesteatoma surgery without mastoid cavity obliteration. METHOD: This is a prospective case series of 25 patients who underwent primary surgery for cholesteatoma with presence of OAW defect that was reconstructed by cortical bone graft and bone pate, further fixation of the cortical bone graft in place was done by GIBC in 18 patients. RESULTS: There was significant improvement of persistent otorrhea and hearing loss after surgery (P < 0.001). Recurrence of cholesteatoma was found in 2 patients (8%), residual TM perforation was found in one patient (4%). CONCLUSION: Reconstruction of OAW by cortical bone and bone pate is an effective surgical option to decrease the incidence of recurrence in cholesteatoma surgery. Glass ionomer bone cement can be added safely to fix the cortical bone graft in the OAW defect.


Assuntos
Resinas Acrílicas , Cimentos para Ossos , Transplante Ósseo/métodos , Colesteatoma da Orelha Média/cirurgia , Osso Cortical/cirurgia , Orelha Média/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Dióxido de Silício , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
15.
Am J Sports Med ; 48(9): 2105-2114, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32667269

RESUMO

BACKGROUND: Since the description of the arthroscopic Latarjet technique, discussion about the superiority of the open or arthroscopic procedure has arisen. The appropriate placement of the coracoid graft (CG) on the anterior glenoid neck is reported to be the most important step of the Latarjet procedure. PURPOSE: To verify if there are differences in the parameters that may affect the final position and fixation of CG obtained from the open and arthroscopic Latarjet techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty fresh-frozen human paired cadaveric shoulder specimens were randomly distributed in 2 surgery groups (open group [OG] and arthroscopic group [AG]) with 10 specimens in each. Two surgeons, each with experience performing open and arthroscopic Latarjet techniques, executed these procedures: one surgeon performed all open techniques, and the other performed all arthroscopic techniques, respectively. After surgery, a computerized tomography scan was performed. The surgical time, the position of each CG, a series of variables that might affect the CG fixation, and the level of the subscapularis muscle split were evaluated. RESULTS: The mean surgical time was significantly longer in the AG (mean, 26 minutes for OG and 57 minutes for AG). Three intraoperative complications (30%) were identified in the AG, consisting of graft fractures. The CG was determined to be in an optimal cranial-caudal position in 90% of specimens of the OG and 44% of the AG (Fisher, P = .057). In both groups, the CG was placed in an optimal medial-lateral position in all specimens. In the OG, the degree of parallelism between the major axes of the glenoid surface and CG was significantly greater than in the AG (mean, 3.8º for OG and 15.1º for AG). No significant differences were observed in superior and inferior screw orientation between the groups. In the longitudinal and transverse directions, significant differences were found in the centering of the superior screw, being closer to the ideal point in the OG than in the AG. The location where the longitudinal subscapularis muscle split was performed was significantly higher in the AG. CONCLUSION: The open Latarjet technique required less surgical time; presented a lower number of intraoperative complications; and allowed more adequate placement of the CG, better centering of the screws, and a subscapularis muscle split closer to the ideal position. CLINICAL RELEVANCE: The reported benefits of the arthroscopic Latarjet technique seem less clear if we take into account the added surgery time and complications.


Assuntos
Artroscopia/métodos , Transplante Ósseo/métodos , Instabilidade Articular , Músculo Esquelético/transplante , Articulação do Ombro , Cadáver , Humanos , Instabilidade Articular/cirurgia , Escápula/cirurgia , Articulação do Ombro/cirurgia
16.
Bone Joint J ; 102-B(7): 838-844, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600141

RESUMO

AIMS: The aim of this study was to report the medium-term outcomes of impaction bone allograft and fibular grafting for osteonecrosis of the femoral head (ONFH) and to define the optimal indications. METHODS: A total of 67 patients (77 hips) with ONFH were enrolled in a single centre retrospective review. Success of the procedure was assessed using the Harris Hip Score (HHS) and rate of revision to total hip arthroplasty (THA). Risk factors were studied, including age, aetiology, duration of hip pain, as well as two classification systems (Association Research Circulation Osseous (ARCO) and Japanese Investigation Committee (JIC) systems). RESULTS: After a mean follow-up period of 8.61 years (SD 1.45), 81.3% (52/64) of enrolled cases had a good or excellent HHS at latest follow-up (declining to 76.0% (38/50) for those with more than eight years of follow-up). Overall survival was 92.1% at eight years' follow-up (95% CI 83.2% to 96.4%). A total of 12 hips (19.0%) failed (reoperation or HHS < 70 points) at final follow-up. Rate of success was adversely affected by increasing age, duration of pain, and more severe disease as measured using the ARCO and JIC classifications, but not by aetiology of the ONFH. CONCLUSION: We report favourable medium-term results of this procedure. Best outcomes can be expected in patients matching the following indications: younger than 40 years; less 12-month hip pain before surgery; femoral head collapse being less than 2 mm; and integrated lateral wall of femoral head. Cite this article: Bone Joint J 2020;102-B(7):838-844.


Assuntos
Transplante Ósseo/métodos , Necrose da Cabeça do Fêmur/cirurgia , Fíbula/transplante , Adulto , Fatores Etários , Aloenxertos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Reoperação , Estudos Retrospectivos , Fatores de Risco
17.
Acta Orthop ; 91(5): 605-610, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32507071

RESUMO

Background and purpose - Congenital pseudarthrosis of the tibia (CPT) is caused by local periosteal disease that can lead to bowing, fracturing, and pseudarthrosis. Current most successful treatment methods are segmental bone transport and vascularized and non-vascularized bone grafting. These methods are commonly hampered by discomfort, reoperations, and long-term complications. We report a combination of a vascularized fibula graft and large bone segment allograft, to improve patient comfort with similar outcomes.Patients and methods - 7 limbs that were operated on in 6 patients between November 2007 and July 2018 with resection of the CPT and reconstruction with a vascularized fibula graft in combination with a bone allograft were retrospectively studied. The mean follow-up time was 5.4 years (0.9-9.6). Postoperative endpoints: time to discharge, time to unrestricted weight bearing, complications within 30 days, consolidation, number of fractures, and secondary deformities.Results - The average time to unrestricted weight bearing with removable orthosis was 3.5 months (1.2-7.8). All proximal anastomoses consolidated within 10 months (2-10). 4 of the 7 grafts fractured at the distal anastomosis between 6 and 14 months postoperatively. After reoperation, consolidation of the distal anastomosis was seen after 2.8 months (2-4). 1 patient required a below-knee amputation.Interpretation - This case series showed favorable results of the treatment of CPT through a combination of a vascularized fibula graft and large bone segment allograft, avoiding the higher reintervention rate and discomfort with ring frame bone transport, and the prolonged non-weight bearing with vascularized fibula transfer without reinforcement with a massive large bone segment allograft.


Assuntos
Transplante Ósseo/métodos , Fíbula/irrigação sanguínea , Fíbula/transplante , Pseudoartrose/congênito , Tíbia/cirurgia , Adolescente , Aloenxertos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pseudoartrose/cirurgia , Estudos Retrospectivos
18.
Medicine (Baltimore) ; 99(23): e20563, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502025

RESUMO

Unicameral bone cyst (UBC) is a benign fluid-filled lesion, mainly located in the metaphyses of long bones in children and adolescents. Elastic stable intramedullary nail (ESIN) is adopted in our institute for UBCs since 2010, and bone grafting was performed simultaneously. This study aims to evaluate the efficacy of ESIN decompression combined with different bone graft materials.All patients with the diagnoses of UBCs of the humerus, treated with ESINs and bone grafting between January 2010 and June 2018, were analyzed retrospectively. The bone grafting included injectable calcium sulfate, a mixture of the autologous iliac bone and allogeneic bone. All patients were categorized into 2 groups: ICS (injectable calcium sulfate) group and MIX (a mixture of the autologous iliac bone and allogeneic bone, ratio: 1:3) group. All the information was collected from the Hospital Database.In all, 17 patients (8.8 ±â€Š2.3-year-old, male 8, female 9) in the ICS group and 19 patients (8.9 ±â€Š1.9-year-old, male 10, female 9) in the MIX group were included in this study. Patients in both groups were followed up for more than 2 years (average, 3.4 ±â€Š1.3 years). No recurrence was observed in either group. There was no significant difference between the two groups concerning the patient's demographic parameters, including sex, age, and affected side. All patients in both groups displayed excellent and good shoulder function, and there was no significant difference between the 2 groups (P = .29). As for the Capanna classification, there was no significant difference between these 2 groups (P = .78).Intramedullary nailing has the advantage of a minimally invasive procedure, immediate stability, and continuous decompression. ICS showed similar results as a mixture of the autologous iliac bone and allogeneic bone.


Assuntos
Cistos Ósseos/cirurgia , Transplante Ósseo/métodos , Fixação Intramedular de Fraturas/instrumentação , Transplante Homólogo/métodos , Cistos Ósseos/complicações , Pinos Ortopédicos , Sulfato de Cálcio/administração & dosagem , Criança , Descompressão Cirúrgica/métodos , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Úmero/lesões , Úmero/patologia , Úmero/cirurgia , Ílio/transplante , Masculino , Estudos Retrospectivos , Resultado do Tratamento
19.
J Craniofac Surg ; 31(6): e560-e563, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32516214

RESUMO

Recently, a technical note describing a promising method for the management of infections after sinus bone grafting by irrigating the corresponding area with hydrogen peroxide based solution with an aid of a drain has been published. The aim of this paper was to present the histological and radiological results of the above mentioned technique. A total of 17 patients who have presented with infections secondary to sinus bone grafting enrolled in the study. During implant placement, bone was collected from the originally grafted site with a trephine burr for radiological examination via micro-computed tomography and histological examination. According to the results of the current study, Bio-Oss acted as a scaffold, and mature fibrous bone formed trabeculae, which assembled to an interlinked trabecular structure. Average results obtained from the microradiography confirmed the higher percentage of Bio-Oss (27.21% ±â€Š3.31%) at the corresponding area; whereas the amount of newly formed bone was slightly lower (6.79% ±â€Š1.13%) As a conclusion, this simple and minimally invasive technique might be beneficial in avoiding removal of bone graft material and could help in rescuing the former laborious procedure.


Assuntos
Transplante Ósseo , Implantação Dentária Endo-Óssea/métodos , Seio Maxilar/cirurgia , Idoso , Substitutos Ósseos , Transplante Ósseo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minerais , Microtomografia por Raio-X
20.
Orthop Clin North Am ; 51(3): 373-381, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498956

RESUMO

Arthroscopic Latarjet is a relatively new, but viable option for the treatment of anterior shoulder instability. Arthroscopic Latarjet has the advantage of faster recovery, reduced stiffness, identification of additional shoulder pathology, and improved cosmesis when compared with open Latarjet. By the majority of clinical and radiographic parameters, arthroscopic Latarjet produces equivalent outcomes compared with open Latarjet. A relatively substantial learning curve for arthroscopic Latarjet exists at about 25 cases; however, multiple studies have demonstrated comparable outcomes and surgical time after the learning curve.


Assuntos
Artroscopia/métodos , Transplante Ósseo/métodos , Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Artroscopia/reabilitação , Transplante Ósseo/reabilitação , Humanos , Instabilidade Articular/diagnóstico por imagem , Luxação do Ombro , Articulação do Ombro/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA