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1.
Rev. esp. anestesiol. reanim ; 69(10): 654-662, dic. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-VR-19

RESUMO

La fractura de cadera es una afección usualmente observada en pacientes mayores, propensos a presentar complicaciones y aumento de la morbimortalidad durante el ingreso hospitalario. Recientemente se ha descrito el bloqueo del grupo de nervios pericapsulares (PENG) de cadera, diseñado para proporcionar una analgesia de mayor calidad, favoreciendo la deambulación temprana de los pacientes. Se realizó la búsqueda bibliográfica desde noviembre de 2018 hasta julio de 2021 con las siguientes palabras clave: bloqueo del grupo de nervios pericapsulares, bloqueo PENG, fractura de cadera, artroplastia total de cadera. Se excluyeron los estudios realizados en población pediátrica o en adultos con una indicación diferente a cirugía de cadera; obteniendo 18 artículos para leer a texto completo. Los estudios analizados tuvieron resultados positivos a favor de la realización del bloqueo PENG en la cirugía de cadera. Desafortunadamente la evidencia actual es insuficiente para poder integrar los resultados obtenidos y sacar conclusiones acerca de la efectividad y seguridad del bloqueo PENG.(AU)


Hip fracture is a pathology usually observed in older patients, prone to complications and increased morbidity and mortality during hospital admission. The PENG (Pericapsular Nerve Group) block has recently been described to provide higher quality analgesia, favoring early ambulation. The literature search was carried out from November 2018 to July 2021 with the following keywords pericapsular nerve group block, PENG block, hip fracture, total hip arthroplasty. Studies conducted in the pediatric population or in adults with an indication other than hip surgery were excluded; obtaining 18 articles to read in full text. The analyzed studies had positive results in favor of performing the PENG block in hip surgery. Unfortunately, the current evidence is insufficient to be able to integrate the results obtained and draw conclusions about the effectiveness and safety of the PENG block.(AU)


Assuntos
Humanos , Quadril/cirurgia , Lesões do Quadril , Fraturas do Quadril , Artroplastia de Quadril , Anestesiologia
2.
J Am Acad Orthop Surg ; 30(23): 1123-1130, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36400058

RESUMO

Hip and groin injuries are common in ballet dancers, who often begin sport-specific training at a young age. The unique demands of ballet include extreme range of motion, with an emphasis on external rotation and abduction. This creates a distinctive constellation of hip symptoms and pathology in this cohort, which may differ from other flexibility sports. When managing hip symptoms in this cohort, orthopaedic surgeons should consider the unique factors associated with ballet, including ballet-specific movements, morphologic adaptations of the hip, and the culture of the sport. Three common etiologies of hip pain in ballet dancers include femoroacetabular impingement syndrome, hip instability, and extra-articular snapping hip syndrome. First-line treatment often consists of focused physical therapy to strengthen the core and periarticular hip musculature, with surgical management reserved for patients who fail to improve with conservative measures.


Assuntos
Dança , Lesões do Quadril , Humanos , Dança/lesões , Quadril , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/terapia , Dor
4.
Am J Case Rep ; 23: e938966, 2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36408596

RESUMO

The authors have discovered an error in their figures and have provided replacement figures which have been corrected. Specifically, the positions of "Lateral" and "Medial" were reversed, and the positions of "Ischium" and "Sacrum" were reversed. Additionally, the solid lines at the boundaries of each muscle and bone have been removed, and only the nerves have been marked with dotted lines, which is a common notation in ultrasound images. The authors would also like to add the following Acknowledgment: The authors are grateful to Tadashi Kobayashi and Yoshihiko Shiraishi for advising us on the accurate anatomy of ultrasound images. Reference: Mihiro Kaga, Takeshi Ueda. Effectiveness of Hydro-Dissection of the Piriformis Muscle Plus Low-Dose Local Anesthetic Injection for Piriformis Syndrome: A Report of 2 Cases. Am J Case Rep, 2022; 23: e935346. DOI: 10.12659/AJCR.935346.


Assuntos
Síndrome do Músculo Piriforme , Humanos , Anestésicos Locais , Quadril , Anestesia Local , Músculo Esquelético/diagnóstico por imagem
5.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 66(6): 445-453, Nov-Dic. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-210655

RESUMO

Introducción y objetivos: Los vástagos con doble modularidad buscan restaurar de forma más precisa la anatomía al permitir ajustes intraoperatorios gracias a los cuellos modulares. Nuestro objetivo es comparar la corrección radiográfica de la longitud con el vástago H MAX-M® frente a su homólogo monobloque H MAX-S®. Material y métodos: Se realizó un estudio de cohortes prospectivo mediante muestreo consecutivo sobre pacientes intervenidos de artroplastia total de cadera primaria con el diagnóstico de coxartrosis entre el año 2011 y 2015. Un brazo de la cohorte incluyó a los pacientes intervenidos con vástago modular y el otro con vástago monobloque. Se midió la longitud en la radiografía anteroposterior de pelvis en carga a los seis meses. Las medias de las mediciones obtenidas para cada brazo de la cohorte se compararon entre sí. Resultados: No se han observado diferencias estadísticamente significativas en la corrección de la disimetría entre ambos grupos determinada como la diferencia de longitud entre la cadera operada y la cadera contralateral (p=0,106). Tampoco se observaron diferencias en los valores postoperatorios de longitud (p=0,053). Cabe decir que tanto para el vástago modular como para el vástago monobloque el grupo mayoritario es aquel con longitud restaurada (84,1 y 80,4%, respectivamente; p=0,001). Conclusión: A pesar de la ventaja teórica de la modularidad y que disponer de piezas intercambiables podría ser de gran interés, en nuestro estudio no hemos podido demostrar que exista una superioridad de los diseños modulares frente al monoblock para control de la disimetría postoperatoria.(AU)


Introduction and objective: Dual modularity stems seek to more precisely restore anatomy by allowing intraoperative adjustments thanks to modular necks. Our aim is to compare the radiographic length correction with the H MAX-M® Stem versus its monoblock counterpart H MAX-S®. Material and methods: A prospective cohort study was carried out through consecutive sampling on patients who underwent primary total hip arthroplasty with coxarthrosis diagnosis between 2011 and 2015. One arm of the cohort included patients who were operated with a modular stem and the other with a monobloc stem. Length was measured on the anteroposterior pelvic-bearing radiograph at six months. The mean of the measurements obtained for each arm of the cohort were compared with each other. Results: No statistically significant differences were observed in the correction of asymmetry between both groups, determined as the difference in length between the operated hip and the contralateral hip (P=.106). Nor were differences observed in postoperative length values (P=.053). It should be noted that for both the modular stem and the monobloc stem, the majority group is the one with restored length (84.1% and 80.4%, respectively; P=.001). Conclusion: Despite the theoretical advantage of modularity and that having interchangeable parts could be of great interest, in our study, we have not been able to demonstrate a superiority of modular designs compared to monoblock for control of postoperative leg length discrepancy.(AU)


Assuntos
Humanos , Masculino , Feminino , Lesões do Quadril , Quadril , Artroplastia , Osteoartrite do Quadril , Ataxia Cerebelar , Estudos de Coortes , Estudos Retrospectivos , Ortopedia , Ferimentos e Lesões , Traumatologia
7.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 66(6): T27-T35, Nov-Dic. 2022. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-210669

RESUMO

Introducción y objetivos: Los vástagos con doble modularidad buscan restaurar de forma más precisa la anatomía al permitir ajustes intraoperatorios gracias a los cuellos modulares. Nuestro objetivo es comparar la corrección radiográfica de la longitud con el vástago H MAX-M® frente a su homólogo monobloque H MAX-S®. Material y métodos: Se realizó un estudio de cohortes prospectivo mediante muestreo consecutivo sobre pacientes intervenidos de artroplastia total de cadera primaria con el diagnóstico de coxartrosis entre el año 2011 y 2015. Un brazo de la cohorte incluyó a los pacientes intervenidos con vástago modular y el otro con vástago monobloque. Se midió la longitud en la radiografía anteroposterior de pelvis en carga a los seis meses. Las medias de las mediciones obtenidas para cada brazo de la cohorte se compararon entre sí. Resultados: No se han observado diferencias estadísticamente significativas en la corrección de la disimetría entre ambos grupos determinada como la diferencia de longitud entre la cadera operada y la cadera contralateral (p=0,106). Tampoco se observaron diferencias en los valores postoperatorios de longitud (p=0,053). Cabe decir que tanto para el vástago modular como para el vástago monobloque el grupo mayoritario es aquel con longitud restaurada (84,1 y 80,4%, respectivamente; p=0,001). Conclusión: A pesar de la ventaja teórica de la modularidad y que disponer de piezas intercambiables podría ser de gran interés, en nuestro estudio no hemos podido demostrar que exista una superioridad de los diseños modulares frente al monoblock para control de la disimetría postoperatoria.(AU)


Introduction and objective: Dual modularity stems seek to more precisely restore anatomy by allowing intraoperative adjustments thanks to modular necks. Our aim is to compare the radiographic length correction with the H MAX-M® Stem versus its monoblock counterpart H MAX-S®. Material and methods: A prospective cohort study was carried out through consecutive sampling on patients who underwent primary total hip arthroplasty with coxarthrosis diagnosis between 2011 and 2015. One arm of the cohort included patients who were operated with a modular stem and the other with a monobloc stem. Length was measured on the anteroposterior pelvic-bearing radiograph at six months. The mean of the measurements obtained for each arm of the cohort were compared with each other. Results: No statistically significant differences were observed in the correction of asymmetry between both groups, determined as the difference in length between the operated hip and the contralateral hip (P=.106). Nor were differences observed in postoperative length values (P=.053). It should be noted that for both the modular stem and the monobloc stem, the majority group is the one with restored length (84.1% and 80.4%, respectively; P=.001). Conclusion: Despite the theoretical advantage of modularity and that having interchangeable parts could be of great interest, in our study, we have not been able to demonstrate a superiority of modular designs compared to monoblock for control of postoperative leg length discrepancy.(AU)


Assuntos
Humanos , Masculino , Feminino , Lesões do Quadril , Quadril , Artroplastia , Osteoartrite do Quadril , Ataxia Cerebelar , Estudos de Coortes , Estudos Retrospectivos , Ortopedia , Ferimentos e Lesões , Traumatologia
9.
Rev. esp. anestesiol. reanim ; 69(9): 556-566, Nov. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-211678

RESUMO

La cirugía sobre la articulación coxofemoral es muy frecuente. Mejorar el manejo del dolor ha sido y es uno de los pilares fundamentales para optimizar la recuperación funcional de los pacientes. Para ello debemos diseñar un plan anestésico-analgésico multimodal que abarque todo el periodo perioperatorio.Los bloqueos nerviosos periféricos y los bloqueos fasciales son un componente importante de las estrategias analgésicas multimodales. Los bloqueos tradicionales tienen una eficacia moderada, afectación motora prolongada y aumento de riesgo de caídas. Como alternativa, recientemente se describieron los bloqueos capsulares (bloqueo del plano del ileopsoas o «ileopsoas plane block» [IPB] y bloqueo del grupo nervioso pericapsular o «PENG block»), que pretenden evitar la afectación motora manteniendo una óptima eficacia analgésica.El objetivo de esta revisión es la descripción de los nuevos bloqueos capsulares y analizar si permiten mejorar la analgesia postoperatoria y favorecer la recuperación funcional con menos complicaciones, con base en la inervación de la cadera. Para realizarlo se ha llevado a cabo una revisión bibliográfica en las bases de datos de PubMed, Embase y Cochrane Library desde enero 2018 hasta junio de 2020.(AU)


Surgery on the hip joint is very common. Improving pain management has been and is one of the fundamental pillars to optimize the functional recovery of patients. To do this, we must design a multimodal anesthetic-analgesic plan that covers the entire perioperative period.Peripheral nerve blocks and fascial blocks are an important component of multimodal analgesic strategies. Traditional blocks have moderate efficacy, prolonged motor impairment, and increased risk of falls. As an alternative, capsular blocks («ileopsoas plane block» or «IPB» and pericapsular nerve group block or «PENG block») have recently been described that aim to avoid motor impairment while maintaining optimal analgesic efficacy.The objective of this review is to describe the new capsular blocks and to analyze whether they allow to improve postoperative analgesia and promote functional recovery with fewer complications, based on the innervation of the hip. To do this, a bibliographic review was carried out in the PubMed, Embase and Cochrane Library databases from January 2018 to June 2020.(AU)


Assuntos
Humanos , Masculino , Feminino , Artroplastia de Quadril , Quadril , Bloqueio Nervoso , Analgesia , Quadril/cirurgia , Manejo da Dor , Período Perioperatório , Período de Recuperação da Anestesia , Reanimação Cardiopulmonar , Anestesiologia , Espanha
10.
Rev Med Liege ; 77(11): 672-677, 2022 Nov.
Artigo em Francês | MEDLINE | ID: mdl-36354230

RESUMO

Coxalgia is one of the most common painful complaints in orthopedic surgery. The management of a "traumatic" hip is relatively well codified, however atraumatic coxalgia is more difficult to diagnose and explore. The history and a well-conducted clinical examination are essential for the management of coxalgia. The diagnosis is already well oriented by a simple X-ray and the presence or absence of inflammatory signs on the blood test. This article aims to provide a guideline for the diagnostic approach to coxalgia.


La coxalgie est une des plaintes douloureuses les plus fréquentes en chirurgie orthopédique. La prise en charge d'une hanche «traumatique¼ est relativement bien codifiée, par contre les coxalgies atraumatiques sont plus difficiles à diagnostiquer et explorer. L'anamnèse et un examen clinique bien conduit sont primordiaux pour la prise en charge de la coxalgie. Le diagnostic est déjà bien orienté par une simple radiographie et la présence ou non de signe inflammatoire à la prise de sang. Cet article vise à donner une ligne de conduite à la démarche diagnostique face à la coxalgie.


Assuntos
Quadril , Dor , Humanos , Quadril/cirurgia , Dor/diagnóstico , Dor/etiologia , Radiografia
11.
Sci Rep ; 12(1): 18540, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329237

RESUMO

The obturator internus, gemelli, and quadratus femoris muscles are thought to be postural muscles. Thus, they are in the focus of research. Although these muscles are described in other species, detailed descriptions are still lacking for the albino rat. We hypothesized that the rat's ischiotrochanteric muscle group is comparable to that of humans. We aimed to provide a detailed description, and to compare the rat's condition with other species including humans. Both hind limbs of 30 adult male formalin-fixed albino rats were carefully dissected and photo documented. Our results were then compared with data for other species and descriptions of human anatomy. The gemellus muscle was one single muscle mass, originating from the lesser sciatic notch and an unnamed groove on the dorsal aspect of the ischium. The obturator internus muscle arose from the inner aspect of the tabula of ischium. Both muscles formed a continuum and inserted as one complex on the medial aspect of the greater trochanter. The quadratus femoris muscle originated from the outer aspect of the tabula of ischium and inserted on the distal portion of the intertrochanteric crest, and the dorsal aspect of the lesser trochanter. Despite minor differences, the topographical conditions of these muscles are comparable between rats and other mammals including humans.


Assuntos
Quadril , Coxa da Perna , Adulto , Animais , Masculino , Humanos , Ratos , Músculo Esquelético/fisiologia , Ísquio , Fêmur , Mamíferos
12.
Trials ; 23(1): 924, 2022 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335403

RESUMO

BACKGROUND: The HemiSPAIRE trial is being conducted to determine whether a modified muscle sparing technique (SPAIRE-"Save Piriformis and Internus, Repairing Externus") in hip hemiarthroplasty brings clinical benefits compared to the standard lateral technique in adults aged 60 years or older, with a displaced intracapsular hip fracture. This article describes the detailed statistical analysis plan for the trial.  METHODS AND DESIGN: HemiSPAIRE is a definitive, pragmatic, superiority, multicentre, randomised controlled trial (with internal pilot) with two parallel groups. Participants, ward staff and all research staff involved in post-operative assessments are blinded to allocation. This article describes in detail (1) the primary and secondary outcomes; (2) the statistical analysis principles, including a survivor average causal effect (SACE) method chosen specifically to address the issue of potential bias from differential survival between trial arms, which was seen from data review by the Trial Steering Committee, the participants that will be included in each analysis, the covariates that will be included in each analysis, and how the results will be presented; (3) planned main analysis of the primary outcome; (4) planned analyses of the secondary outcomes; and (5) planned additional analyses of the primary and secondary outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04095611. Registered on 19 September 2019.


Assuntos
Artroplastia de Quadril , Hemiartroplastia , Fraturas do Quadril , Adulto , Humanos , Hemiartroplastia/efeitos adversos , Hemiartroplastia/métodos , Fraturas do Quadril/cirurgia , Artroplastia de Quadril/métodos , Quadril/cirurgia , Músculos/cirurgia , Resultado do Tratamento
13.
Rev. esp. anestesiol. reanim ; 69(8): 502-505, Oct. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-210291

RESUMO

En la enfermedad quirúrgica de cadera es esencial el manejo y el control efectivo del dolor peri y postoperatorio que minimice el uso de opioides y sus efectos adversos. Una de las dificultades de la analgesia regional eficaz para el control del dolor de cadera es la compleja inervación de la articulación que procede de múltiples nervios. Las técnicas regionales comúnmente realizadas se asocian en ocasiones a complicaciones, entre las que se han descrito la anestesia parcial, la hipotensión o la debilidad de los miembros inferiores. Presentamos el caso de una niña de 5 años con antecedentes de parálisis cerebral infantil que fue intervenida de osteotomía derrotativa y varizante de ambas caderas y tenotomía de los aductores por luxación paralitica a la que se le realizó un bloqueo PENG bilateral asociado al bloqueo del nervio femorocutáneo, por ser una técnica sencilla que no requiere de punciones múltiples para cubrir cada uno de los nervios implicados en la inervación sensitiva de la cápsula articular.(AU)


Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.(AU)


Assuntos
Humanos , Masculino , Criança , Quadril/cirurgia , Pediatria , Manejo da Dor , Dor Pós-Operatória , Período Intraoperatório , Analgesia , Bloqueio Nervoso , Pacientes Internados , Paralisia Cerebral , Pelve/diagnóstico por imagem , Anestesiologia , Reanimação Cardiopulmonar , Anestesia , Exame Físico , Anamnese
14.
Rehabilitación (Madr., Ed. impr.) ; 56(4): 399-403, Oct-Dic. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-210854

RESUMO

Los pacientes con COVID-19 grave pueden desarrollar restricciones dolorosas del rango de movimiento de las grandes articulaciones debido a osificaciones heterotópicas. Presentamos el caso de un paciente que desarrolló dolor en las caderas después de un ingreso prolongado por neumonía COVID-19 severa. La radiografía convencional, la tomografía computarizada y la gammagrafía ósea mostraron extensas osificaciones heterotópicas en caderas. Es probable que tanto factores locales como sistémicos contribuyan al desarrollo de osificaciones heterotópicas, y es necesario descartar esta entidad cuando estos pacientes refieran dolor articular. El diagnóstico precoz es importante para proporcionar intervenciones no farmacológicas como la movilización pasiva suave y medicación antiinflamatoria y en casos refractarios considerar la resección quirúrgica del hueso ectópico.(AU)


Patients with severe COVID-19 can develop painful range-of-motion restrictions of large joints due to heterotopic ossification. We present the case of a patient who developed hip pain after prolonged admission for severe COVID-19 pneumonia. Conventional radiography, computed tomography and bone scan showed extensive heterotopic ossification in the hips. It is probable that both local and systemic factors contribute to the development of heterotopic ossifications and it is necessary to rule out this entity when these patients reported joint pain. Early diagnosis is important to provide non-pharmacological interventions such as mild passive mobilization and anti-inflammatory medication and in refractory cases surgical resection of the ectopic bone is consider.(AU)


Assuntos
Humanos , Masculino , Idoso , Ossificação Heterotópica , Cintilografia , Radiografia , Vírus da SARS , Infecções por Coronavirus , Betacoronavirus , Lesões do Quadril , Quadril , Dor , Articulações , Pacientes Internados , Reabilitação , Exame Físico
15.
PLoS One ; 17(10): e0275650, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36197941

RESUMO

The objectives of this study were to 1) assess the differences between youth soccer and basketball players with and without past year groin pain (GP) in hip adduction and abduction strength and several training characteristics (age at the start of regular training, weekly training frequency, warm-up and training duration, use of stretching and/or stabilisation exercises during warm-up, use of resistance training); 2) present strength reference values for youth soccer and basketball players. 227 players participated (age 16.9 ± 1.4 years; height 184.2 ± 8.5 cm; mass 75.5 ± 11.9 kg). Hip adduction and abduction strength was measured in supine position (hip, knee and ankle in neutral position) using a MuscleBoard dynamometer. Interlimb asymmetries and hip adduction:abduction ratios were calculated. Past year GP and training characteristics were assessed with a retrospective questionnaire. 11.9% of players reported past year GP (16.9% in soccer and 6.4% in basketball). The only significant difference between the past year GP and the control groups was found in the age of the players at the start of regular training (7.2 ± 1.8 years for the GP group vs. 8.5 ± 2.6 years for the control group). Additionally, soccer players without past year GP have significantly higher hip adduction strength (1.1 ± 0.2 Nm/kg vs. 1.0 ± 0.2 Nm/kg) and adduction:abduction strength ratio (1.10 ± 0.18 vs. 1.03 ± 0.16) compared to basketball players. Our results show that hip adduction and abduction strength, interlimb asymmetry and hip adduction:abduction ratio do not differentiate between players with and without past year GP (p = 0.29-0.90), which means that their adduction or abduction strength can be analysed regardless of the GP presence in the past year. Additionally, players with past year GP started regularly training at significantly lower age, which could indicate the problematic nature of early/premature sports specialisation.


Assuntos
Basquetebol , Treinamento de Força , Futebol , Adolescente , Criança , Pré-Escolar , Virilha , Quadril , Humanos , Masculino , Força Muscular , Músculo Esquelético , Dor Pélvica , Treinamento de Força/métodos , Estudos Retrospectivos
16.
Orthop Clin North Am ; 53(4): 393-401, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36208882

RESUMO

There are many soft tissue structures around the hip joint that may serve as a source of pain in both the native and prosthetic hip. In this review, the role of the gluteal, piriformis, iliopsoas, and rectus femoris musculotendinous units in the etiology of pathology around the hip joint will be discussed. Management options ranging from tailored physical therapy regimens to local steroid infiltration along with more invasive open and arthroscopic surgical techniques will be reviewed for each pathological entity. While not all conditions are well understood, advancements have been made in the management of each of these often challenging cases in both the native and prosthetic hip settings. This review explores these advancing treatment methods which will supplement the practice of any hip surgeon who is presented with problematic tendinopathy around both the native and prosthetic hip joint.


Assuntos
Tendinopatia , Artroscopia/efeitos adversos , Quadril , Articulação do Quadril/cirurgia , Humanos , Dor , Tendinopatia/diagnóstico , Tendinopatia/etiologia , Tendinopatia/terapia
17.
Artigo em Inglês | MEDLINE | ID: mdl-36293688

RESUMO

The representative clinical features of adhesive capsulitis of the hip (ACH) are restricted range of motion (ROM) and pain. However, reports on kinetics such as strength and dynamic balance that explain physical functions are rare. This study compared subjective hip scores using Copenhagen Hip and Groin Outcome Score (HAGOS) and ROM using a manual goniometer as well as strength using isokinetic equipment, and dynamic balance through the Y-balance test, between patients with ACH and healthy individuals. Data of 193 middle-aged participants (men: 99 and women: 94) were analyzed. The ACH group scored significantly lower in all six HAGOS sub-sections. Hip joint flexion, abduction, internal and external rotation ROM were significantly lower in ACH compared to healthy group. These results were the same for men and women. In the strength of men and women, flexion, adduction, and abduction, and dynamic balance in all three directions were significantly decreased in ACH. Meanwhile, there were no significant between-group differences in the functional decrease in extension and adduction of ROM, and extension strength. In conclusion, subjective evaluation and dynamic balance of patients with ACH were decreased in the all parts. In ROM, flexion, abduction, internal rotation, and external rotation were restricted except for extension and adduction. Men and women with ACH maintained extensor strength, but had weakened strength in flexion, adduction and abduction. This information will be useful for therapists to understand the biomechanical properties of ACH and to design effective rehabilitation programs.


Assuntos
Bursite , Articulação do Quadril , Pessoa de Meia-Idade , Masculino , Humanos , Feminino , Força Muscular , Fenômenos Biomecânicos , Quadril , Amplitude de Movimento Articular
18.
Plast Reconstr Surg ; 150(6): 1321-1331, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36126198

RESUMO

BACKGROUND: Sirenomelia is a rare syndrome in which the infant is born with the legs fused from the pelvis to the feet. Sirenomelia is often fatal in the neonatal period because of multiple other anomalies. The feet may be absent; if present, they are often splayed outward or face backward. There are no case reports of any patient with this syndrome who has been able to walk after separation of the legs. METHODS: The authors report on their patient with sirenomelia who was born with the feet facing backward but otherwise normal-appearing hips and thighs and no other anomalies that would lead to fatality in the near future. After preoperative tissue expansion, the authors performed separation of the legs with through-knee amputations, utilizing a vascularized flap from the lower part of the legs based on the sciatic vessels for coverage of the perineum. There was no need for skin grafts or dermal matrices and the patient was referred to physical therapy after recovery from surgery in an attempt to allow her to ambulate. RESULTS: The patient began to ambulate on her stumps early after surgical repair and is now walking with stubby prostheses. Her other medical issues have remained stable and nonproblematic. CONCLUSIONS: Selected patients with sirenomelia may be able to walk after separation of the legs, depending on the status of other congenital differences as well as the status of the legs when separated. Careful workup with multidisciplinary planning of overall care as well as surgical care is essential.


Assuntos
Anormalidades Múltiplas , Ectromelia , Feminino , Humanos , Recém-Nascido , Anormalidades Múltiplas/cirurgia , Ectromelia/diagnóstico , Ectromelia/cirurgia , Quadril , Pelve , Síndrome
19.
J Clin Densitom ; 25(4): 464-469, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36096901

RESUMO

Age related trends of the indices of hip structure help understanding how bone strength changes with age and the increased bone fragility in old age. Community-dwelling women aged 20-70years (n = 419) were selected by stratified random method and divided into age categories; 20-29years (n-69), 30-39years (n = 60), 40-49years (n = 69), 50-59years (n = 107) and 60-70years (n = 114). All subjects underwent dual energy x-ray absorptiometry (DXA) and hip structure analysis using Hologic Discovery scanner (Hologic Inc, Bedford, USA). Measured indices included hip axis length (HAL) and neck shaft angle (NSA) of the proximal femur. Cross sectional area (CSA), cross sectional moment of inertia (CSMI), section modulus (SM), cortical thickness (CT), buckling ration (BR) of three regions of interest; narrow neck, intertrochanteric region and femoral shaft, were also measured. Age related trends of all indices were studied with Locally Weighted Scatterplot Smoothing lines (LOESS) and ANOVA. Mean HAL and NSA values were not different between age categories. CSA, CSMI, SM and CT in three different regions showed curvilinear relationships with age. These indices gradually increased with age between 20-50 years and the maximum values were seen in the 40-49years age category and they declined afterwards. The decline of these indices was more rapid in the narrow neck and intertrochanter regions when compared with femoral shaft and the lowest mean CSA, CSMI, SM and CT in these two regions were seen in the 60-70 age category. BR showed a gradual decrease with age between 20-50 years and the lowest mean value was seen in the 40-49 age category. BR increased afterwards and the maximum mean value was seen in the 60-70 age category. This study demonstrates the dynamics of structural properties of proximal femur in the three selected cross sections of community-dwelling women aged 20-70 years and the increased bone fragility in old age.


Assuntos
Densidade Óssea , Fêmur , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Absorciometria de Fóton/métodos , Fêmur/diagnóstico por imagem , Colo do Fêmur/diagnóstico por imagem , Quadril , Sri Lanka , Idoso
20.
Int Orthop ; 46(12): 2963-2969, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36123405

RESUMO

PURPOSE: Apart from bone conditions, muscle and soft tissue parameters might also influence hip fractures. We aimed to evaluate the association between hip muscle and trochanteric soft tissue parameters and hip fractures. METHODS: We retrospectively reviewed 60 patients with hip fractures and 114 controls without hip fractures. Cases and controls were matched for age, sex, and body mass index using propensity score matching. Muscle cross-sectional area (CSA), mean attenuation, and fatty infiltration rate (FIR) (proportion of intramuscular fat content) were measured on CT images for the gluteus maximus, the gluteus medius/minimus, and the anterior and medial compartments of the upper thigh. Trochanteric soft tissue thickness (TSTT) and femoral neck attenuation were also measured. Univariate and multivariate analyses were conducted to identify potential risk factors of hip fractures. RESULTS: Patients with hip fractures had significantly lower femoral neck attenuation, TSTT, and CSA of the gluteus maximus and anterior compartment than controls. FIR of all hip muscle groups were significantly higher in hip fracture patients than controls. Multivariate analysis revealed that every 1% increase in FIR of medial compartment independently increased the odds of hip fractures by 23.7% (OR = 1.237, 95% CI = 1.093-1.401) and every 1 cm longer TSTT independently decreased the odds by 32.8% (OR = 0.672, 95% CI = 0.477-0.946). CONCLUSION: Fatty infiltration of hip muscles can better discriminate hip fractures than muscle area. Increased TSTT is independently associated with low fracture risk.


Assuntos
Fraturas do Quadril , Coxa da Perna , Humanos , Idoso , Estudos Retrospectivos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Quadril , Músculo Esquelético/diagnóstico por imagem
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