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1.
Bone Joint J ; 102-B(2): 198-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009433

RESUMO

AIMS: This single-centre observational study aimed to describe the results of extensive bone impaction grafting of the whole acetabular cavity in combination with an uncemented component in acetabular revisions performed in a standardized manner since 1993. METHODS: Between 1993 and 2013, 370 patients with a median age of 72 years (interquartile range (IQR) 63 to 79 years) underwent acetabular revision surgery. Of these, 229 were more than ten years following surgery and 137 were more than 15 years. All revisions were performed with extensive use of morcellized allograft firmly impacted into the entire acetabular cavity, followed by insertion of an uncemented component with supplementary screw fixation. All types of reoperation were captured using review of radiographs and medical charts, combined with data from the local surgical register and the Swedish Hip Arthroplasty Register. RESULTS: Among patients with possible follow-up of ten and 15 years, 152 and 72 patients remained alive without revision of the acetabular component. The number of deaths was 61 and 50, respectively. Of those who died, six patients in each group had a reoperation performed before death. The number of patients with a reoperation was 22 for those with ten-year follow-up and 21 for those with 15 years of follow-up. The Kaplan-Meier implant survival rate for aseptic loosening among all 370 patients in the cohort was 96.3% (95% confidence interval (CI) 94.1 to 98.5) after ten years and 92.8% (95% CI 89.2 to 96.6) after 15 years. CONCLUSION: Extensive bone impaction grafting combined with uncemented revision components appears to be a reliable method with favourable long-term survival. This technique offers the advantage of bone stock restoration and disputes the long-standing perception that uncemented components require > 50% of host bone contact for successful implant survival. Cite this article: Bone Joint J 2020;102-B(2):198-204.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Transplante Ósseo/métodos , Prótese de Quadril , Idoso , Cimentos para Ossos/uso terapêutico , Cimentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Sistema de Registros , Reoperação
2.
J Appl Oral Sci ; 28: e20190435, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049138

RESUMO

OBJECTIVE: To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. METHODOLOGY: For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the "distance" tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. RESULTS: The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. CONCLUSIONS: Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.


Assuntos
Transplante Ósseo/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Mandíbula/transplante , Crânio/transplante , Sítio Doador de Transplante , Adolescente , Adulto , Idoso , Pontos de Referência Anatômicos , Osso Cortical/diagnóstico por imagem , Osso Cortical/transplante , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Ilustração Médica , Pessoa de Meia-Idade , Estudos Retrospectivos , Crânio/diagnóstico por imagem , Sítio Doador de Transplante/diagnóstico por imagem , Adulto Jovem
3.
BMC Oral Health ; 20(1): 22, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992277

RESUMO

BACKGROUND: Periodontally accelerated osteogenic orthodontics (PAOO) is a treatment for bone defects associated with a lack of bone graft stability, especially in coronal locations. This study aimed to compare a modified technique of membrane fixation that utilizes periosteal sutures (using a pouch design) with the traditional approach, which does not use membrane fixation. METHODS: Twenty-eight patients with a total of 168 teeth treated were divided into two groups: 1-A, in which patients were treated using the modified technique (with membrane fixation), and group 2-B, in which patients were treated using the traditional technique (without membrane fixation). The postoperative bone thickness was evaluated via radiographic examination. RESULTS: Postoperative improvements in bone augmentation were detected in both groups. At 12 months, the values of the CHBT (measured from the midpoint of the coronal third to the labial cortical surface, 0.84 ± 0.33 mm) and the values of VBL (measured from the alveolar crest to the cemento-enamel junction, - 2.35 ± 0.80 mm)were significantly greater in the modified technique group than those in the traditional technique group (CHBT:0.12 ± 0.21 mm and VBL:-1.39 ± 0.99 mm; P = 0.00 and P = 0.01). CONCLUSIONS: This study shows that compared to the traditional technique, the modified PAOO technique with membrane fixation using periosteal sutures provides improved graft stabilization, superior coronal augmentation and satisfactory vertical volume.


Assuntos
Processo Alveolar/cirurgia , Transplante Ósseo/métodos , Ortodontia Corretiva/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteogênese/fisiologia , Osteotomia/métodos , Aumento do Rebordo Alveolar/métodos , Humanos , Ortodontia Corretiva/instrumentação , Técnicas de Movimentação Dentária/métodos , Resultado do Tratamento
4.
Orthop Clin North Am ; 51(1): 65-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739880

RESUMO

Surgical strategies for scaphoid nonunions become more complex based on time from injury to treatment. The decision-making process, however, can follow a logical sequence. Scaphoid nonunions less than 1 year after trauma and no carpal malalignment can be treated with percutaneous screw fixation under fluoroscopic and/or arthroscopic guidance. Reinterventions or patients with avascular proximal poles that do not need substantial grafts are reliably treated with pedicle vascularized bone grafts. Resection of the distal pole of the scaphoid is a good option in old nonunions or after a failed scaphoid procedures. When there are radioscaphoid degenerative changes, salvage procedures such as proximal row carpectomy (PRC) should be considered.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Osteonecrose/cirurgia , Osso Escafoide/lesões , Artroscopia/métodos , Transplante Ósseo/métodos , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/classificação , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Osteonecrose/epidemiologia , Osteonecrose/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Estudos Retrospectivos , Osso Escafoide/irrigação sanguínea , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/patologia , Resultado do Tratamento , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem
5.
World Neurosurg ; 135: e468-e476, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31843726

RESUMO

OBJECTIVE: To investigate the clinical and imaging outcomes of posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and instrumentation compared with the traditional posterior-only method for treating monosegment spinal tuberculosis. METHODS: Fifty-four patients underwent posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and internal fixation (group A), and 60 patients underwent 1-stage posterior debridement, laminectomy decompression, bone grafting fusion and instrumentation (group B). The clinical and radiographic outcomes of these groups were analyzed and compared. RESULTS: Group A had less intraoperative blood loss, shorter hospitalization, and a shorter fusion time than did group B (P < 0.05). At 3 months postoperatively, group A had a lower mean Oswestry Disability Index than did group B (P < 0.05). At the final follow-up, group A had a lower mean visual analog scale pain score and a lower mean ODI than did group B (P < 0.05). Group A had a smaller kyphotic angle loss (1.2° ± 0.6°) and loss rate (4.8% ± 2.5%) than did group B (P < 0.05). CONCLUSIONS: The procedure of posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and internal fixation is safe and effective in treating monosegment spinal tuberculosis. Compared with the conventional posterior-only approach, this method maximizes the retention and reconstruction of the posterior column and is minimally invasive, achieving faster postoperative recovery with fewer complications.


Assuntos
Transplante Ósseo/métodos , Desbridamento/métodos , Fusão Vertebral/métodos , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
6.
World Neurosurg ; 135: e671-e678, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31884124

RESUMO

OBJECTIVE: The purposes of the present study were to introduce an indirect decompression using oblique lateral lumbar interbody fusion combined with anterolateral screw fixation (OLIF-AF) for the treatment of lumbar degenerative disc disease and examine the clinical efficacy and radiographic outcomes. METHODS: A total of 65 patients had undergone single-level OLIF-AF at L2-L5 from December 2017 to August 2018. The cross-sectional area of the thecal sac was evaluated using magnetic resonance imaging. The disk height, foraminal height (FH), and degree of upper vertebral slippage were evaluated using computed tomography. The visual analog scale score and Oswestry disability index were recorded pre- and postoperatively. RESULTS: The visual analog scale scores and Oswestry disability index had significantly improved after surgery (P < 0.001). At 3 days postoperatively, the cross-sectional area had improved from 93.2 ± 14.4 mm2 to 124.2 ± 7.5 mm2 (P < 0.001), the disk height had increased from 9.9 ± 1.7 mm to 12.7 ± 1.0 mm (P < 0.001), the left FH had increased from 16.6 ± 2.0 mm to 19.6 ± 2.0 mm (P < 0.001). In contrast, the right FH had increased from 16.7 ± 2.1 mm to 19.9 ± 2.0 mm (P < 0.001), and the degree of upper vertebral slippage had decreased from 14.2% ± 3.1% to 4.6% ± 2.8% (P < 0.001), respectively. At the 12-month follow-up examination, these parameters showed no statistically significant differences compared with the values at 3 days postoperatively (P > 0.05). Adverse events were observed in 15 patients (23.1%) patients and included pain at the iliac bone donor site in 1 (1.5%), left thigh pain/numbness in 2 (3.1%), quadriceps weakness in 2 (3.1%), psoas weakness in 3 (4.6%), intraoperative endplate injury in 2 (3.1%) and cage subsidence in 5 (7.7%). CONCLUSIONS: Our results have shown that OLIF-AF surgery is a relatively safe and effective surgical option for LDDD at L2-L5. Cage subsidence was the most common operative complication.


Assuntos
Parafusos Ósseos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transplante Ósseo/métodos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Ílio/transplante , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos , Implantação de Prótese/métodos , Estudos Retrospectivos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Sítio Doador de Transplante , Resultado do Tratamento
7.
Cient. dent. (Ed. impr.) ; 16(3): 167-172, sept.-dic. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-185990

RESUMO

Introducción: En el presente estudio se evalúa la densidad ósea alcanzada, mediante las unidades Hounsfield, por un nuevo biomaterial, compuesto por fosfato cálcico con agregado de silicio, en comparación con la hidroxiapatita de origen bovino en la preservación alveolar pos-textracción. La preservación alveolar pos-textracción se presenta como una técnica quirúrgica dirigida a reducir el colapso del reborde alveolar tras la extracción dental mediante la utilización de un biomaterial. La finalidad del tratamiento es facilitar la posterior rehabilitación implantológica. Material y método: Se llevó a cabo un estudio sobre 6 pacientes procedentes de la Facultad de Odontología de la Universidad Complutense de Madrid a los que se les realizó la técnica de preservación alveolar postextracción. Se establecieron dos grupos: un grupo test en el que el alveolo se rellenó con fosfato cálcico con agregado de silicio y un grupo control en el que se rellenó con hidroxiapatita de origen bovino. Transcurridos 3 meses, se realizó una tomografía computerizada de haz de cono para evaluar la densidad ósea alcanzada por los biomateriales. Resultados: La densidad mineral media alcanzada en el grupo tratado con fosfato cálcico con agregado de silicio fue de 1.100,40 ± 111,19 unidades Hounsfield, mientras que en el grupo que fue tratado con hidroxiapatita de origen bovino fue de 1.029,46 ± 95,16 unidades Hounsfield. Conclusiones: Ambos biomateriales parecen presentar un comportamiento similar en cuanto a los resultados densitométricos obteniendo una densidad superior a 1.000 unidades Hounsfield, siendo el fosfato cálcico con agregado de silicio el que mayor densidad presenta


Introduction: In the present study, bone density from the new biomaterial composed by calcium phosphate and added silica is compared with bovine hydroxyapatite by means of Hounsfield units in alveolar ridge preservation. Alveolar ridge preservation is a surgical technique proposed to reduce bone resorption caused by dental extraction, using a bone graft. This technique ́s final goal is to facilitate implant insertion and rehabilitation. Materials and methods: A study was carried out on 6 patients from the Faculty of Dentistry of the Complutense University of Madrid performing the technique of alveolar ridge preservation. Two groups were established, a test group in which the alveolar socket was filled with calcium phosphate and added silica and a control group where the socket was filled with bovine hydroxyapatite. After 3 months, a cone-beam computed tomography was performed to evaluate the bone density achieved by both biomaterials. Results: The average bone density achieved in the group treated with calcium phosphate and added silica was 1100,40 ± 111,19 Hounsfield units whereas in the group treated with bovine hydroxyapatite the average bone density was 1029,46 ± 95,16 Hounsfield units. Conclusions: Both biomaterials seem to present a similar behaviour in terms of densitometric results obtaining a density greater than 1000 Hounsfield units, having the calcium phosphate and added silica the highest density


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Densitometria , Materiais Biocompatíveis/uso terapêutico , Fosfatos de Cálcio/uso terapêutico , Durapatita/uso terapêutico , Projetos Piloto , Estudos de Coortes , Densidade Óssea , Extração Dentária , Implantes Dentários , Transplante Ósseo/métodos , Transplante Ósseo/reabilitação , Estudos Retrospectivos
8.
Cient. dent. (Ed. impr.) ; 16(3): 201-207, sept.-dic. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-185995

RESUMO

Introducción: El empleo de dientes autógenos, como material de injerto, es una opción terapéutica actual en casos de regeneración ósea. Su obtención se ha facilitado con la introducción de dispositivos capaces de procesar los dientes. El objetivo de este trabajo es realizar, a propósito de un caso clínico, una revisión de la literatura sobre el uso de dientes autólogos como material de injerto óseo y los dispositivos para su procesamiento. Caso clínico: Paciente varón de 18 años que acude a consulta presentando un cordal inferior retenido. El diagnóstico determinó la necesidad de extraer el diente y se informó al paciente de la posibilidad de utilizarlo como material de regeneración ósea. Tras la exodoncia, el diente procesado con el dispositivo Tooth Transformer(R) (Imbiodent), fue utilizado como material de injerto autólogo. El postoperatorio no presentó ninguna complicación y la evaluación radiográfica, tras 8 días y tras 10 semanas, mostró una evolución favorable del tratamiento. Discusión: La dentina desmineralizada es un material orgánico cuyo potencial reside en los factores de crecimiento que contiene para estimular la formación y reparación ósea. No obstante, no existe consenso sobre el grado de desmineralización o tamaño de partícula ideal. La reciente introducción de dispositivos, capaces de procesar dientes, facilita la obtención de un material de injerto dental para su uso en terapias de regeneración ósea. Conclusión: El uso de dientes autólogos constituye una alternativa prometedora en el campo de los injertos óseos. La técnica de transformación del diente es sencilla con el empleo de los dispositivos actuales


Introduction: The use of autogenous teeth, as graft material, is a current therapeutic option in cases of bone regeneration. Its obtention has been facilitated by the introduction of devices capable of processing teeth. The aim of this article is to perform, based on a clinical case, a review of the literature about the use of autologous teeth as bone graft material and the devices for its processing. Clinical case: Male patient, 18 years of age, who comes to the dental office presenting a lower wisdom retained. Extraction of the tooth was determined by diagnosis and the patient was informed about the possibility of using it as bone regeneration material. After the extraction, the tooth was processed by the Tooth Transformer(R) (Imbiodent) device and was used as autologous graft material. No postoperative complications were presented and the radiographic evaluation, at 8 days and 10 weeks, showed a favorable evolution of the treatment. Discusion: Demineralized dentin is a organic material whose potential relies in the growth factors it contains to stimulate bone formation and repair. However, there is no consensus on the degree of demineralization or the ideal particle size. The recent introduction of devices, capable of processing teeth, enables the obtention of a dental graft material for bone regeneration therapies. Conclusion: The use of autologous teeth is a promising alternative in the bonev grafts field. The technique of tooth transformation is simple with the use of the current devices


Assuntos
Humanos , Masculino , Adolescente , Regeneração Óssea , Polpa Dentária/citologia , Dentina , Carga Imediata em Implante Dentário/métodos , Transplante Ósseo/métodos , Procedimentos Cirúrgicos Reconstrutivos , Desmineralização do Dente , Esmalte Dentário/química , Procedimentos Cirúrgicos Bucais/métodos
9.
Cient. dent. (Ed. impr.) ; 16(3): 209-216, sept.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185996

RESUMO

Antecedentes: La técnica de elevación de suelo del seno maxilar con osteótomos (OSFE) consiste en la realización de un lecho en la cresta ósea por don-de se despega y eleva la membrana de Schneider usando los osteótomos con el fin de colocar implantes de una manera menos invasiva, reduciendo el tiempo de la cirugía y disminuyendo las molestias postoperatorias. Hay diferentes factores a la hora de realizar la técnica, como es la cantidad de hueso residual que posee el maxilar atrófico o el tipo de injerto que se va a situar en el seno. El objetivo principal es evaluar la tasa de supervivencia de los implantes colocados de manera simultánea en maxilares atróficos de ≤ 5 mm RBH (hueso residual) y sin colocación de injerto en la cavidad sinusal. Material y métodos: El estudio consiste en una revisión sobre la realización de elevaciones crestales ≤ 5 mm de hueso residual sin el uso de injertos. Para ello hemos analizado 7 estudios, 2 RCT (en-sayos clínicos aleatorizados), 3 estudios retrospectivos y 2 estudios prospectivos. Resultados: Se produjeron 24 perdidas de implantes, siendo 17 tempranas (antes del año) en 379 implantes colocados. Obteniendo tasas de supervivencia de entre 91,4% al 100% en los respectivos estudios analizados. La pérdida ósea marginal del grupo injerto y grupo no injerto era similar. La ganancia ósea sinusal era mayor en el grupo injerto que en el grupo no injerto. Conclusiones: La tasa de supervivencia de la elevación crestal con colocación simultánea de implantes ≤ 5 mm de hueso residual sin colocación de injerto, mostró ser un tratamiento seguro y eficaz, aunque se necesitan más estudios al respecto


Background: The osteotome maxillary sinus floor elevation technique (OSFE) consists in the realization of a bed at the top of the ocean where the Schneider’s membrane is detached and raised using the osteotomes in order to place implants in a lesser invasive manner, reducing the time of surgery and reducing postoperative discomfort. There are different factors when performing the technique, such as the amount of residual bone that has the maximum flow type or the type of injection that will be placed in the breast. The main objective is to evaluate the survival rate of implants placed simultaneously in atrophic maxillae of ≤ 5 mm RBH (residual bone) and without graft placement in the sinus cavity. Material and methods: The study consists of a systematic review approach on the performance of crestal elevations ≤ 5 mm of residual bone without the use of grafts. This analysis is based on 7 studies, 2 RCT (randomized clinical trials), 3 retrospective studies and 2 prospective studies. Results: There were 24 implants lost, 17 in the short-term (prior to a year) from the 379 implants placed. Obtaining survival rates of between 91.4% to 100% for the cases analyzed. The marginal bone loss of the injected group and non-injected group was similar. Sinus bone gain was greater in the group that participated in the non-graft group. Conclusions: The survival rate of crestal elevations with the simultaneous placement of implants ≤ 5 mm of residual bone was a safe and effective work, although greater detailed investigations are required


Assuntos
Humanos , Taxa de Sobrevida , Implantação Dentária/métodos , Levantamento do Assoalho do Seio Maxilar/métodos , Atrofia/terapia , Transplante Ósseo/métodos , Implantes Dentários/normas , Materiais Biocompatíveis , Materiais Dentários , Transplante Ósseo/estatística & dados numéricos , Procedimentos Cirúrgicos Bucais/métodos
10.
J Craniofac Surg ; 30(8): e780-e784, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689740

RESUMO

The calvarium can provide large amount of good quality corticocancellous autogenous bone graft. Although many studies have highlighted the advantages of the split cranial bone graft, there is no published work available in the literature about the fate of donor site of the split cranial bone graft. The present study was undertaken to assess the donor site as regards to the thickness, volume, and the density of the residual bone over a period of 12 months in the postoperative period. A total of 30 patients in the age group of 15 to 43 years were studied from January 2015 to January 2016. Postoperative computer tomography scans were taken at 2 weeks, 6 months, and 1 year postoperative to measure the bone thickness, volume, and density at the donor site of the split cranial bone graft harvest. The bone thickness at the donor site showed progressive increase in the thickness over the period of study and the average increase in thickness was about 12.4% at the end of 1 year. The average increase in volume at the donor site was of 2.65% after 12 months. Similarly, the average bone density increased by 3.7% at the end of 1 year. This prospective study conclusively proves that the residual bone at the donor site of the split cranial bone graft harvest site continues to grow in thickness and density over a period of 1 year.


Assuntos
Crânio/cirurgia , Adolescente , Adulto , Transplante Ósseo/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Medicine (Baltimore) ; 98(44): e17685, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689790

RESUMO

To compare imaging indicators and clinical effects of extreme lateral interbody fusion (XLIF) using allogenic bone, autologous bone marrow + allogenic bone, and rhBMP-2 + allogenic bone as bone graft materials in the treatment of degenerative lumbar diseases.This was a retrospective study of 93 patients with lumbar interbody fusion who underwent the extreme lateral approach from May 2016 to December 2017. According to the different bone graft materials, patients were divided into allogenic bone groups (group A, 31 cases), rhBMP-2 + allogenic bone (group B, 32 cases), and autologous bone marrow + allogenic bone (group C, 30 cases). There were no significant differences in gender, age, lesion segment, preoperative intervertebral space height, and preoperative Oswestry Dysfunction Index (ODI) and visual analogue scale (VAS) scores among the 3 groups (P > .05). Intervertebral space height, bone graft fusion rate, and ODI and VAS scores were compared immediately after surgery, and at 3, 6, and 12 months after surgery.All groups were followed up for 12 months. The intervertebral space height was significantly higher in the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery, in comparison to before surgery (P < .05). There was no significant difference in the intervertebral space height among the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery (P > .05). The fusion rate of group B and C was higher than that of groups A at 3, 6, and 12 months after surgery (P < .05). In the 3 groups, the VAS and ODI scores at 3, 6, and 12 months after surgery were significantly improved compared with the preoperative scores (P < .05). The VAS and ODI scores in groups B and C were significantly higher than those in group A (P < .05), but there was no significant difference between groups B and C (P > .05).The rhBMP-2 + allograft bone combination had good clinical effects and high fusion rate in XLIF.


Assuntos
Transplante de Medula Óssea/métodos , Proteína Morfogenética Óssea 2/administração & dosagem , Transplante Ósseo/métodos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Fator de Crescimento Transformador beta/administração & dosagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Desempenho Físico Funcional , Proteínas Recombinantes/administração & dosagem , Estudos Retrospectivos
12.
J Hand Surg Asian Pac Vol ; 24(4): 428-434, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690195

RESUMO

Background: Although there have been many studies of the vascularized bone graft (VBG) or unloading procedures alone for the treatment of Kienböck disease, little information has been reported about patients treated with VBG combined with unloading procedures. The purpose of this study is to 1) describe the outcomes in patients treated with VBG combined with unloading procedures, 2) compare the outcomes according to the unloading procedures and 3) find any radiologic parameters affecting revascularization in Kienböck disease. Methods: A retrospective review was performed involving in 20 patients undergoing 4th and 5th extensor compartmental VBG with unloading procedures for Kienböck disease from 2010-2015. After VBG in all patients, unloading procedures were additionally performed depending on the ulnar variance. These additional operations included joint leveling procedures (radial and capitate shortening osteotomy) or temporary scaphocapitate pinning. Radiologic outcome was evaluated according to Lichtman stage and presence of revascularization evidence. Clinical evaluations included wrist range of motion, grip strength, visual analogue scale (VAS), and Mayo wrist score. Results: VBG with joint leveling procedures was performed in 11 patients (5 radial shortening and 6 capitate shortening) and VBG with temporary scaphocapitate pinning was performed in 9 patients. Although clinical outcomes were not significantly different according to the unloading procedures, there were significantly more patients with evidence of healing of osteonecrosis on radiographs in joint leveling procedure group than temporary scaphocapitate pinning group. Overall, evidence of healing of osteonecrosis was found on plain radiographs in 11 patients and was not found in 9 patients. However, there were no significant preoperative radiological parameters affecting revascularization on radiographs. Conclusions: Not all patients had evidence of revascularization on radiography after VBG combined with unloading procedures for Kienböck disease. However, among the unloading procedures, joint-leveling procedures positively influenced the revascularization process.


Assuntos
Pinos Ortopédicos , Transplante Ósseo/métodos , Capitato/cirurgia , Osteonecrose/cirurgia , Rádio (Anatomia)/transplante , Osso Escafoide/cirurgia , Articulação do Punho/cirurgia , Adolescente , Adulto , Capitato/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Radiografia , Rádio (Anatomia)/irrigação sanguínea , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
13.
Tech Hand Up Extrem Surg ; 23(4): 155-159, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31738737

RESUMO

Pedicled vascularized bone graft (VBG) is a useful method in treating the scaphoid fracture nonunion, especially when the avascular necrosis exists. Humpback deformity is an important issue that we have to correct it during the treatment. We describe a method by using combined wedge non-VBG to correct the nonunion deformity when treating scaphoid nonunion with pedicled VBG. The wedge bone graft was harvested just proximal to the 2,3 intercompartmental supraretinacular artery VBG and was used as an inlay at the volar site to correct the humpback deformity, whereas the VBG was set at the dorsal site for bone bridging and blood supply. We also present our results of 10 patients with scaphoid fracture nonunion and humpback deformity treated with this method. Bone healing was achieved and the lateral intrascaphoid angles could be improved in all the 10 patients. Functional outcomes, including the Visual Analog Pain Scale for pain during activity, grip strength, the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the modified Mayo Wrist Scores, were significantly improved.


Assuntos
Vasos Sanguíneos/transplante , Rádio (Anatomia)/transplante , Osso Escafoide/anormalidades , Osso Escafoide/cirurgia , Adolescente , Adulto , Transplante Ósseo/métodos , Osso Esponjoso/irrigação sanguínea , Osso Esponjoso/transplante , Osso Cortical/irrigação sanguínea , Osso Cortical/transplante , Feminino , Fraturas Ósseas/cirurgia , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/irrigação sanguínea , Osso Escafoide/lesões , Adulto Jovem
14.
J Craniofac Surg ; 30(6): 1873-1874, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31756876

RESUMO

Bone graft augmentation in the anterior maxilla has a high successful rate. However, suture dehiscence and consequent bone graft exposure can compromise and fail this procedure. Therefore, this article presents a new strategy of closure technique to guarantee the bone graft augmentation. The sutures occur in muscular and mucous planes to avoid suture tension, thus decreasing complications of bone graft augmentation in the anterior maxilla.


Assuntos
Transplante Ósseo/métodos , Maxila/cirurgia , Implantação Dentária Endo-Óssea , Implantes Dentários , Humanos
15.
J Bone Joint Surg Am ; 101(18): 1636-1644, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31567800

RESUMO

BACKGROUND: There is no consensus on managing severe patellar bone loss after total knee arthroplasty. We previously described an initial series involving a novel technique of patellar bone-grafting with a short follow-up. The purpose of this study was to determine long-term survivorship and the radiographic and clinical results of patellar bone-grafting during revision total knee arthroplasty in a larger series with an extended follow-up. METHODS: We identified 90 patients from a single institution who underwent 93 patellar bone-grafting procedures for severe patellar bone loss from 1997 to 2014. The mean age of the patients was 70 years, and 46% of patients were female. Forty-five knees (48%) underwent first-time revisions, and 19 knees (20%) had undergone a failed attempt at patellar resurfacings. Intraoperative patellar caliper thickness increased from a mean of 7 to 25 mm after patellar bone-grafting (p < 0.01). Radiographic review determined changes in patellar height, tracking, and remodeling. Knee Society scores (KSSs) were calculated. The mean follow-up was 8 years (range, 2 to 18 years). Kaplan-Meier methods determined survivorship free of any revision and any reoperation. Cox proportional hazards analysis determined predictive factors for failure. RESULTS: Survivorship free of patellar revision was 96% at 10 years. Survivorship free of any revision was 84% at 10 years. Survivorship free of any reoperation was 78% at 10 years. Increasing patient age was the only protective factor against further patellar revision (hazard ratio, 0.95; p < 0.01). When comparing initial radiographs with final radiographs, patellar height decreased from 22 to 19 mm (p < 0.01), 80% compared with 59% of patellae articulated centrally in the trochlea (p = 0.01), and 32% compared with 77% had remodeling over the lateral femoral condyle (p < 0.01). Anterior knee pain decreased from 51% to 27% postoperatively (p = 0.01). The mean knee flexion improved from 101° to 108° (p = 0.03). The mean KSS improved from 50 to 85 points (p < 0.01). CONCLUSIONS: Reliable long-term clinical results can be expected with patellar bone-grafting for severe patellar bone loss during revision total knee arthroplasty. Pain, range of motion, and other reported outcomes improve despite radiographic changes to patellar height, tracking, and remodeling. This technique is a durable and reliable option when standard patellar resurfacing is not possible. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia do Joelho/métodos , Transplante Ósseo/métodos , Patela/cirurgia , Reoperação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Patela/transplante , Modelos de Riscos Proporcionais , Falha de Prótese , Radiografia , Amplitude de Movimento Articular , Sistema de Registros
16.
Anticancer Res ; 39(10): 5605-5610, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570456

RESUMO

BACKGROUND/AIM: We analyzed the process of healing at osteotomy sites and timing of achievement of full weight-bearing in sarcoma patients who underwent hemicortical or intercalary reconstruction using the extracorporeal irradiated autologous bone graft technique. PATIENTS AND METHODS: We studied 10 patients who had undergone tumor resection and reconstruction with hemicortical extracorporeal irradiated autologous bone graft at mid-shaft femur or tibia. The control group consisted of 30 patients who received the reconstruction using intercalary bone graft. RESULTS: Full weight-bearing was achieved in all 10 patients at a median time of 4.8 months. Function was excellent in all patients. When comparing the clinical outcome among the patients who received intercalary and hemicortical grafts, the duration to full weight-bearing achievement in patients who received hemicortical graft was shorter than that in those with intercalary graft. CONCLUSION: Early full weight-bearing may be achieved in patients undergoing hemicortical resection and reconstruction using extracorporeal irradiated autologous bone graft.


Assuntos
Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Sarcoma/patologia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo/métodos , Osso e Ossos/patologia , Osso e Ossos/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Transplante Autólogo/métodos , Resultado do Tratamento
17.
J Craniofac Surg ; 30(8): 2593-2596, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31577650

RESUMO

OBJECTIVE: Severe hydrocephalic macrocephaly can cause significant morbidity in infants due to positioning difficulties, skin breakdown, and poor cosmesis. Many surgeons over the past decades have described a variety of surgical techniques of reduction cranioplasty. In this article, the authors describe a novel technique for skull reduction cranioplasty with modified bilateral Pi craniectomy. METHODS: Anterior coronal and posterior lambdoid bone cuts are performed to extend inferiorly toward the sqamous bone. Last bone cuts are made connecting the parasagittal burr holes bilaterally, thus isolating and de-roofing of the sagittal suture. Bilateral peninsular bone flaps are reduced medially aiming to approximate the upper borders of both flaps. Edges of frontal and occipital bone can be resected and shaved to achieve smooth round contour of the reconstruct. The final reconstruct can be fixated with metal meshes. RESULTS: In our technique, modified bilateral Pi craniectomy is simple and effective reduction cranioplasty technique, as the technique does not require bone graft resection and reconstruction of the grafts making the time of the surgery short with decreased possible complications. Also, the amount of bone resection, bone bending, and shaving of the bone edges can be controlled and adjusted during the. An important issue is that this technique avoids posterior skull reconstruction which is more risky, as many patients are bed ridden with secondary compressed and flat occiput. CONCLUSIONS: Modified bilateral Pi craniectomy is a simple and effective technique for cranial vault reduction, especially in flat-occiput cases. Good understanding of the structural abnormality and the pathophysiological mechanisms of the possible complications is very important for performing proper surgical reconstruction.


Assuntos
Craniotomia/métodos , Transplante Ósseo/métodos , Pré-Escolar , Suturas Cranianas/cirurgia , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Retalhos Cirúrgicos/cirurgia , Telas Cirúrgicas , Resultado do Tratamento , Trepanação
18.
J Am Podiatr Med Assoc ; 109(5): 379-388, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31599669

RESUMO

A 36-month follow-up of the management of bilateral adolescent unicameral bone cysts in a high school gymnast treated with a calcium sulfate/calcium phosphate (CSCP) bone void filler (BVF) is presented. The more developed left calcaneal cyst was managed with a traditional, open approach consisting of allogenic bone graft, CSCP BVF mixed with platelet-rich plasma. The less developed right calcaneal cyst was managed with a less used approach, a percutaneous bone cortex incision with only the CSCP BVF. The rationale for the selection between the open and percutaneous approaches, long-term BVF incorporation, and positive patient outcome allowing a quick return to athletics are presented.


Assuntos
Cistos Ósseos/cirurgia , Substitutos Ósseos , Calcâneo/cirurgia , Fosfatos de Cálcio , Sulfato de Cálcio , Adolescente , Cistos Ósseos/complicações , Cistos Ósseos/diagnóstico por imagem , Transplante Ósseo/métodos , Calcâneo/diagnóstico por imagem , Feminino , Seguimentos , Pé/diagnóstico por imagem , Ginástica , Humanos , Imagem por Ressonância Magnética , Dor/etiologia , Plasma Rico em Plaquetas , Radiografia , Transplante Homólogo
19.
BMC Cancer ; 19(1): 969, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31627719

RESUMO

BACKGROUND: The aim of this study is to present and evaluate surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors. METHODS: From January 2009 until January 2015, a total of 20 primary pelvic malignancy cases involving the acetabulum were retrospectively investigated. Surgical resections and reconstructions were conducted based on the type of the tumor with custom osteotomy guides and autologous femoral head bone-grafting. In all cases, prosthesis survival period, complication occurrence, and clinical outcomes data were collected and analyzed. RESULTS: Thirteen male and 7 female patients with an average age of 48 years old (range 23-69 years old) were followed for a median of 69 months (range 48-112 months). Of these cases, 17 included chondrosarcomas and 3 additional patients with a malignant giant cell tumor of bone (MBGCT) as proven by pathology. During follow-up, 3 cases of chondrosarcoma recurred (15%), of which two cases received hemi-pelvic amputation, 1 case of MBGCT relapsed and developed pulmonary metastases. Two cases of acetabular prosthesis with an impending dislocation received closed reduction followed by 6 weeks of hip abduction brace fixation. One case of prosthesis loosening was revised. In another case a deep infection occurred with debridement and prosthesis removal. Musculoskeletal Tumor Society 1993 (MSTS-93) score was utilized to conduct functional evaluation: 13 cases were good, 6 were average and one was poor. CONCLUSION: The precision of the osteotomies performed is likely crucial for this type of reconstructive strategy to be successful. The use of custom guides for acetabular osteotomies and femoral head reconstruction can improve functional outcomes with relatively low complications at the intermediate length of follow-up.


Assuntos
Acetábulo/patologia , Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Condrossarcoma/cirurgia , Cabeça do Fêmur/transplante , Neoplasias Pélvicas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante Autólogo/métodos , Adulto , Idoso , Feminino , Seguimentos , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Falha de Prótese , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Biomed Res Int ; 2019: 7679319, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531367

RESUMO

Aims: To assess the bone dimensional changes after extraction and alveolar ridge preservation (ARP) using primary coverage (closed flap technique, CFT) or healing by secondary intention (open flap technique, OFT). Materials and Methods: Ten patients (split mouth design) were planned for extraction and ARP. All sites received ARP with freeze-dried bone allograft (FDBA) and nonresorbable membrane after extraction. Clinical standardized measurements were used to assess the dimensional alterations of the alveolar ridge. Results: All patients completed the study, and a total of 20 sites were randomized to CFT or OFT group. Center height (mean difference of 8.1 mm, SD =1.9 CFT, and 7.5 mm, SD= 1.8 OFT) and buccal height (mean difference of 0.8 mm, SD =1.0 CFT, and 0.3 mm, SD= 1.1 OFT) were significantly different within the same group. However, there was no statistically significant difference between groups. In the OFT group, the keratinized tissue width was higher and the pain VAS scores at 24 hours were lower compared with the CFT (p = 0.004 and p = 0.006, respectively). Conclusions: Leaving the flap open did not have any effects on the dimensional changes of bone height or width. However, there was a wider band of keratinized tissue and less pain with the CFT compared with the OFT. The study protocol was registered at ClinicalTrials.gov, Identifier NCT03136913.


Assuntos
Processo Alveolar/cirurgia , Aumento do Rebordo Alveolar/métodos , Preservação Biológica/métodos , Retalhos Cirúrgicos/fisiologia , Idoso , Transplante Ósseo/métodos , Feminino , Liofilização/métodos , Humanos , Masculino , Membranas Artificiais , Pessoa de Meia-Idade , Projetos Piloto , Extração Dentária/métodos
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