RESUMO
Clinical and pathologic factors were analyzed in 40 patients with localized muscle-invasive bladder carcinoma treated in a prospective bladder-preserving program consisting of transurethral tumor resection, neoadjuvant chemotherapy (methotrexate, cisplatin, and vinblastine [MCV]), and 4,000 cGy radiotherapy with concurrent cisplatin. Patients with biopsy-proven complete response after chemotherapy and 4,000 cGy radiation received full-dose radiotherapy (6,480 cGy) with cisplatin. Cystectomy was recommended to patients with residual disease. Distant metastasis rate was associated with tumor stage and size: 0% in T2 patients, 39% in T3-4 patients (P = .035), 6% for tumors less than 5 cm, and 59% for tumors greater than or equal to 5 cm (P = .002). Risk of bladder tumor recurrence was higher in patients with tumor-associated carcinoma in situ (CIS; 40%) than those without CIS (6%; P = .075). Papillary tumors and solid tumors both had similar treatment outcomes. By multivariate analysis, tumor stage T2 (P = .04) and absence of CIS (P = .03) were significant predictors of complete response; CIS was predictive of local bladder recurrence (P = .07); and tumor size (P = .03), response after chemoradiotherapy (P = .02), and vascular invasion (P = .08) were associated with distant metastasis. Six of eight local bladder tumor recurrences were superficial tumors. The low actuarial distant metastasis rate of T2 patients (0% at 3 years), the 3-year actuarial overall survival rates for T2 (89%) and T3-4 (50%) patients, and the similar treatment outcomes for papillary versus solid tumors are encouraging when compared with published historical controls. These results provide preliminary evidence (median follow-up, 30 months) that the current chemoradiotherapy regimen may have beneficial effects in the treatment of muscle-invasive bladder carcinoma. The true efficacy of neoadjuvant chemotherapy remains to be proven by ongoing randomized trials.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Bexiga Urinária/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cisplatino/administração & dosagem , Terapia Combinada , Métodos Epidemiológicos , Feminino , Seguimentos , Humanos , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios/métodos , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/radioterapia , Vimblastina/administração & dosagemRESUMO
PURPOSE: To update the efficacy of a selective multimodality bladder-preserving approach by transurethral resection (TURBT), systemic chemotherapy, and radiation therapy. PATIENTS AND METHODS: From 1986 through 1993, 106 patients with muscle-invading clinical stage T2 to T4a,Nx,M0 bladder cancer were treated with induction by maximal TURBT and two cycles of chemotherapy (methotrexate, cisplatin, vinblastine [MCV]) followed by 39.6-Gy pelvic irradiation with concomitant cisplatin. Patients with a negative postinduction therapy tumor site biopsy and cytology (a T0 response, 70 patients) plus those with less than a T0 response but medically unfit for cystectomy (six patients), received consolidative chemoradiation to a total of 64.8 Gy. Surgical candidates with less than a T0 response (13 patients) and patients who could not tolerate the chemoradiation (six patients) went to immediate cystectomy. The median follow-up duration is 4.4 years. RESULTS: The 5-year actuarial overall survival and disease-specific survival rates of all patients are 52% and 60%, respectively. For clinical stage T2 patients, the actuarial overall survival rate is 63%, and for T3-4, 45%. Thirty-six patients (34%) underwent cystectomy, all with evidence of tumor activity, including 17 with an invasive recurrence. The 5-year overall survival rate with an intact functioning bladder is 43%. Among 76 patients who completed bladder-preserving therapy, the 5-year rate of freedom from an invasive bladder relapse is 79%. No patient required cystectomy for treatment-related bladder morbidity. CONCLUSION: Combined modality therapy with TURBT, chemotherapy, radiation, and selection for organ-conservation by response has a 52% overall survival rate. This result is similar to cystectomy-based studies for patients of similar age and clinical stages. The majority of the long-term survivors retain fully functional bladders.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cistectomia , Neoplasias da Bexiga Urinária/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cisplatino/administração & dosagem , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Terapia de Salvação , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/radioterapia , Neoplasias da Bexiga Urinária/cirurgia , Vimblastina/administração & dosagemRESUMO
Methotrexate, Cisplatin, and Vinblastine (MCV) was followed by Cisplatin plus radiation therapy in 19 patients with muscle-invading clinical Stage T2-4NXM0 transitional cell carcinoma of the urinary bladder (including cystectomy candidates), to achieve local control and prevent distant metastases. Radical cystectomy was recommended for all patients who failed to reach a complete response (CR = biopsy negative and cytology not positive) following MCV and Cisplatin X 2 plus 4000 cGy. Completely responding patients, and those partially responding patients unsuited for cystectomy, were selected for bladder conservation treated with additional irradiation to the bladder tumor volume (total 6,480 cGy) plus one additional Cisplatin treatment. Dose reductions were required for stomatitis in 26%, mild bone marrow depression in 58%, and renal toxicity in 5% of the patients. During the Cisplatin/4000 cGy, mild dysuria occurred in 68% of patients and 36% had mild bowel hyperactivity. Serious complications have occurred in two patients to date. One patient had recurrent pulmonary emboli, marked reduction in bladder capacity, and diarrhea. A second had bladder perforation during cystoscopic evaluation after MCV and a small bowel obstruction after Cisplatin and 4000 cGy. There was no treatment-related sepsis. Three patients had initial complete transurethral resection of their tumors and therefore 16 patients are evaluable for tumor responsiveness to this protocol. Four patients (25%) were biopsy negative and cytology negative, whereas three additional patients (19%) were biopsy negative but cytology positive following initial MCV. Six patients (38%) were biopsy negative and cytology negative whereas three additional patients (19%) were biopsy negative and cytology positive following MCV and Cisplatin X 2 plus 4000 cGy pelvic radiation. Of the entire group, 9 patients were treated with full-dose radiotherapy. All of these patients are alive without evidence of tumor on rebiopsy of the original tumor site, but one has a persistent positive cytology. Seven patients had a radical cystectomy and 6 are disease free. The treatment of 3 patients deviated from the protocol. Overall, only one patient has developed distant metastases and currently 84% of the patients are disease-free, although follow-up is short. To date, this feasibility study has been clinically practical and well tolerated. The proportion of CR's suggests that this program may prove to be an organ-sparing and curative approach for a significant number of patients, but more experience and follow-up are required.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células de Transição/terapia , Neoplasias da Bexiga Urinária/terapia , Adulto , Idoso , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/radioterapia , Carcinoma de Células de Transição/cirurgia , Cisplatino/administração & dosagem , Terapia Combinada , Feminino , Humanos , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/radioterapia , Neoplasias da Bexiga Urinária/cirurgia , Vimblastina/administração & dosagemRESUMO
Fifty-two patients with previously untreated metastatic carcinoma of the prostate were treated with flutamide 250 mg tid. Response was classified according to objective and subjective criteria, and duration of response and total survival were chosen as endpoints. Disease manifestations at presentation and tumor burden were studied to determine their relationship, if any, to treatment response and outcome. Total survival was longest in 26 patients who had objective responses (mean 50 months). Patients who failed to respond (n = 13) and those who had subjective responses (n = 13) survived an average of eleven and 17.2 months, respectively. Tumor burden was correlated with response to treatment and total survival; those judged to have a minimum tumor burden had objective responses and survived an average of sixty months. Sixteen other patients who had been previously treated with diethylstilbestrol were also studied. Nine of these had cardiovascular complications while taking diethylstilbestrol, and tolerated flutamide without further complications. Those in remission stayed in remission, and sexual potency returned to 5 patients.
Assuntos
Adenocarcinoma/tratamento farmacológico , Anilidas/uso terapêutico , Flutamida/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Adenocarcinoma/mortalidade , Idoso , Idoso de 80 Anos ou mais , Dietilestilbestrol/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/mortalidade , Taxa de Sobrevida , Fatores de TempoRESUMO
This study was undertaken to determine the effects of DES (diethylstilbestrol) on prostatic neoplasms and of different dosage levels on the pituitary-gonadal axis. It is recommended that when DES is chosen for treatment plasma testosterone be monitored carefully and for long periods of time to evaluate the ability of the dose to achieve levels comparable to castration in each patient.
Assuntos
Dietilestilbestrol/uso terapêutico , Hipófise/efeitos dos fármacos , Neoplasias da Próstata/tratamento farmacológico , Testículo/efeitos dos fármacos , Dietilestilbestrol/administração & dosagem , Dietilestilbestrol/farmacologia , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Masculino , Próstata/patologia , Neoplasias da Próstata/patologia , Testosterona/sangueRESUMO
Sixty-eight patients with transitional cell carcinoma of the renal pelvis were studied with respect to clinical presentation, tumor grade, stage and location, subsequent development of other urothelial tumors, and patient survival. Of the 66 patients with adjacent mucosa available for evaluation, 63 (95 per cent) had abnormal findings with severe dysplasia and CIS common in the high-grade, high-stage tumors. Twenty-eight patients (41 per cent) had transitional cell carcinoma previously, concomitantly, and/or subsequently, and in 14 patients (21 per cent) subsequent bladder tumors developed. Because of the relatively high tumor recurrence rate in the ureter (16 per cent) in patients who underwent subtotal ureterectomies, nephrectomy and complete ureterectomy including a bladder cuff should be the operation of choice in patients with carcinoma of the renal pelvis.
Assuntos
Carcinoma de Células de Transição/patologia , Neoplasias Renais/patologia , Pelve Renal , Neoplasias Urológicas/secundário , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/urina , Seguimentos , Humanos , Neoplasias Renais/cirurgia , Neoplasias Renais/urina , Pelve Renal/cirurgia , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Nefrectomia , Ureter/cirurgia , Neoplasias Ureterais/secundário , Neoplasias da Bexiga Urinária/secundário , Neoplasias Urológicas/mortalidadeRESUMO
The degree of femoral anteversion in a group of obese adolescent children and a group of adolescent children of normal weight was determined by either magnetic resonance imaging or computerized axial tomography. Compared with the children of normal weight, the obese children showed a significantly reduced angle of femoral anteversion. Increased biomechanical forces generated across the hip joint of obese children leads to increased remodeling of the femoral neck. This may account for the association of slipped capital femoral epiphysis, reduced femoral anteversion, and obesity in the adolescent population.
Assuntos
Fêmur/patologia , Obesidade/patologia , Adolescente , Feminino , Fêmur/diagnóstico por imagem , Fêmur/crescimento & desenvolvimento , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Obesidade/diagnóstico por imagem , Obesidade/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
Clinicians at the Massachusetts General Hospital have used two cycles of methotrexate, cisplatin, and vinblastine (MCV) before radiotherapy and cisplatin in 53 patients with muscle-invasive bladder cancer. Eleven patients did not complete the protocol, but overall, the toxicity was not formidable. Of the total patients accessioned, 34 are alive. Of the 34 patients in the series who completed the full treatment protocol, the estimated survival rate at 54 months is 77%. This interim analysis suggests that the treatment is achieving at least limited success in saving lives and bladders.
Assuntos
Neoplasias da Bexiga Urinária/terapia , Adulto , Idoso , Terapia Combinada , Cistectomia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
UNLABELLED: Twenty-three hips in patients with Legg-Perthes disease and twenty-three normal hips were studied. The intra-osseous pressure was measured in the femoral neck in all forty-six hips and was found to be only slightly higher in the hips with Legg-Perthes disease. However, after five milliliters of saline solution was injected intra-osseously, the pressure was significantly higher in the diseased hips than in the controls, and after the pressure had stabilized at five minutes after injection the pressure was even higher in the hips with Legg-Perthes disease. Intra-osseous venography was also performed for all of the hips. All of the control hips had a normal venogram, whereas the venograms in the hips with Legg-Perthes disease were all either mildly or severely abnormal. The rise in the intra-osseous pressure after saline stress in the hips with severe changes on venography was significantly higher than the rise in the hips with mild changes. CLINICAL RELEVANCE: Intra-osseous venography and measurement of changes in intra-osseous pressure might aid in the earlier diagnosis of Legg-Perthes disease and prove to be useful monitors of the results of treatment.
Assuntos
Necrose da Cabeça do Fêmur/fisiopatologia , Colo do Fêmur/irrigação sanguínea , Doença de Legg-Calve-Perthes/fisiopatologia , Criança , Pré-Escolar , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Masculino , Flebografia , Cloreto de Sódio , Pressão VenosaRESUMO
Eighteen children with unilateral dysplasia of the hip were found to have asymmetrical gluteal folds and an apparent limb-length inequality secondary to pelvic obliquity caused by an abduction contracture of the contralateral hip. The dysplastic hip was on the left in all but one patient. As a result of the pelvic obliquity, the femoral head on the high side of the pelvis was directed superolaterally, stretching the relaxed capsule still farther. The femoral head was then not concentrically reduced, and the pressure it caused on the superior border of the labrum contributed to the development of the acetabular dysplasia. The eighteen dysplastic hips were treated with abduction splinting and stretching exercises of the contralateral hip to decrease the abduction contracture. All of the dysplastic hips returned to a normal roentgenographic appearance with this treatment. Acetabular dysplasia without dislocation of the hip is not always appreciated by clinical examination, but the asymmetry of the gluteal folds and the apparent limb-length inequality that were seen in all of the children in this series were obvious clinical signs. These findings must be differentiated from the anterior thigh-fold asymmetry that is frequently seen without underlying pathology.
Assuntos
Contratura/complicações , Luxação Congênita de Quadril/complicações , Desigualdade de Membros Inferiores/etiologia , Braquetes , Contratura/terapia , Terapia por Exercício , Feminino , Quadril , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Radiografia , ContençõesRESUMO
Sixteen split posterior tibial-tendon transfers, usually with heel-cord lengthening, were performed on sixteen children with spastic cerebral palsy and equinovarus deformities. The patients were followed for a minimum of two years postoperatively. All of the varus deformities were corrected, although two patients required an osteotomy of the calcaneus because of fixed varus deformity. There were no recurrences of the varus deformities, nor were any valgus or calcaneal deformities produced, and the equinus element of the gait was eliminated.
Assuntos
Paralisia Cerebral/cirurgia , Espasticidade Muscular/cirurgia , Transferência Tendinosa , Criança , Pré-Escolar , Deformidades Congênitas do Pé , Marcha , Hemiplegia/cirurgia , Humanos , TíbiaRESUMO
An analysis of the serial radiographs of sixty-eight patients who were treated for congenital dislocation of the hip revealed that a growth disturbance of the proximal end of the femur that was caused by partial or complete physeal closure developed in thirty-three of these patients. The disturbances were related to the character of the metaphyseal growth-disturbance lines and were subsequently classified according to the site and extent of physeal closure. In order to study this problem, we divided the physis of the proximal end of the femur into two contiguous sections: a medial and a lateral portion. Two typical patterns of premature closure were identified: one located at the junction of the medial and lateral portions of the physis and the other located in the area of the medial portion of the physis alone. The pattern of physeal closure, together with the age of the patient at the time of closure, determines the subsequent growth of the proximal end of the femur. The final outcome of growth of the proximal end of the femur can be predicted within six months after the initial treatment. Epiphyseal changes were found to be of no prognostic significance in the absence of physeal closure.
Assuntos
Fêmur/fisiopatologia , Transtornos do Crescimento/diagnóstico por imagem , Luxação Congênita de Quadril/complicações , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Transtornos do Crescimento/classificação , Transtornos do Crescimento/fisiopatologia , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , RadiografiaRESUMO
Six children who were habitual toe-walkers were studied using electromyographic techniques. In the initial gait evaluation, the muscle synergy pattern was found to be abnormal during the toe-toe gait as well as during the heel-toe gait. After treatment with casts, each patient had a normal electromyographic pattern during heel-toe gait.
Assuntos
Marcha , Dedos do Pé , Criança , Pré-Escolar , Eletromiografia , Feminino , Calcanhar , Humanos , Perna (Membro) , Masculino , Músculos/fisiologiaRESUMO
In eight children with primary subacute osteomyelitis of a femoral or tibial epiphysis, the only complaints were pain and limp. Plain roentgenograms and tomograms showed a well defined lytic lesion in the epiphysis and no evidence of any connection to the metaphysis. Although the bone of the epiphysis was involved in every instance, and the lesion extended to the articular cartilage in most patients, the cartilage itself was not damaged. When the lesions were curetted, six were sterile on routine and anaerobic cultures and on culture for tuberculous and fungal organisms, and Staphylococcus was grown from the other two. In every case the curetted tissue had the characteristic histological appearence of osteomyelitis. All patients were treated with oxacillin and recovered completely. Postoperative roentgenograms showed complete healing with no evidence of damage to the physis or the joint after follow-up of two to eight years.
Assuntos
Epífises , Osteomielite/diagnóstico , Doença Aguda , Pré-Escolar , Drenagem , Fêmur , Humanos , Masculino , Osteomielite/tratamento farmacológico , Osteomielite/cirurgia , Oxacilina/uso terapêutico , TíbiaRESUMO
Forty-one children who had forty-two open fractures of the tibial metaphysis or diaphysis were studied retrospectively. Twelve fractures were Type I; eighteen, Type II; six, Type IIIA; four, Type IIIB; and two, Type IIIC, according to the classification of Gustilo et al. All fractures were irrigated and debrided, and antibiotics were given for a minimum of forty-eight hours after the injury. Twenty fractures were initially treated with external fixation and twenty-two, with immobilization in a plaster cast. Three patients had an early infection of the wound, one of which was associated with osteomyelitis; all were successfully treated. The average time to healing of the fracture was five months (range, two to twenty-one months). The time to union was related to the severity of the soft-tissue injury, the pattern of the fracture, the amount of segmental bone loss, the occurrence of infection, and the use of external fixation. There were six delayed unions. Four patients had an angular malunion of more than 10 degrees, which spontaneously corrected in three. One patient who had a proximal metaphyseal-diaphyseal segmental fracture had a progressive valgus deformity. Four patients who had a severe fracture that was treated with external fixation had more than one centimeter of tibial over-growth. There were no amputations. The incidences of compartment syndrome, vascular injury, infection, and delayed union were similar to those reported for open tibial fractures in adults.
Assuntos
Fraturas Expostas/terapia , Fraturas da Tíbia/terapia , Síndrome do Compartimento Anterior/etiologia , Criança , Pré-Escolar , Fraturas Expostas/complicações , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Humanos , Osteomielite/etiologia , Radiografia , Fraturas da Tíbia/complicações , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Cicatrização , Infecção dos FerimentosRESUMO
We examined twenty-five patients who had a unilateral or bilateral slip of the capital femoral epiphysis and determined the degree of anteversion of the thirty-nine involved hips with computerized axial tomography. Thirteen patients (eighteen hips) were seen at the time of the original diagnosis (Group I), and twelve patients (twenty-one hips) were seen one to seven years after operative treatment (Group II). The mean amount of anteversion for all of the involved hips was +1.0 +/- 8.2 degrees. The mean amount of anteversion for the Group-I hips was -0.7 +/- 7.4 degrees and the mean amount for the Group-II hips was 2.5 +/- 8.7 degrees. The mean amount of anteversion for the hips in both Groups I and II was less than the predicted mean amount for individuals of the same age. The mean amount of anteversion of the unaffected hips of our patients who had a unilateral slip was +6.3 +/- 8.2 degrees. The amount of internal rotation of the hip in extension exceeded the amount when it was in flexion in all of the patients. A decreased angle of femoral anteversion appears to be specifically associated with the development of slipped capital femoral epiphysis. The mechanical forces that act across the proximal femoral physis may be altered by this rotational abnormality, and this may lead to an increased shear stress that ultimately causes failure of the growth plate.
Assuntos
Epifise Deslocada/fisiopatologia , Fêmur/fisiopatologia , Adolescente , Fenômenos Biomecânicos , Criança , Feminino , Fêmur/diagnóstico por imagem , Colo do Fêmur/diagnóstico por imagem , Crescimento , Humanos , Masculino , Obesidade/fisiopatologia , Estresse Fisiológico/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
Hip rotation in extension and flexion was studied in 23 patients with idiopathic intoeing gait. In extension all the hips had markedly increased medial rotation and limited lateral rotation, fulfilling the criteria of excessive femoral anteversion. In flexion, however, rotation varied widely; in one group of patients medial rotation remained greater than lateral, but in the second group lateral rotation was equal to or greater than medial. CT scans showed that the hips in the first group were significantly more anteverted than those in the second. Clearly measurement of hip rotation in extension alone does not provide a dependable indication of femoral anteversion in children with intoeing gait; rotation in flexion also needs to be measured.
Assuntos
Colo do Fêmur/anormalidades , Marcha , Articulação do Quadril/fisiologia , Criança , Pré-Escolar , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Movimento , Tomografia Computadorizada por Raios XRESUMO
Bryant's traction in children in whom the proper prerequisites are present, 90-90 traction for proximal third fractures in children over three, all shaft fractures in children between three and 10 years of age, and split Russell skeletal traction for those over 10 years of age are effective methods for treating femural fractures. Attention to detail is necessary to correct angulation and to obtain and maintain the appropriate amount of over-riding based upon age. Excessive over-riding, distraction, and unreasonable angulation cause functional disability that may require corrective surgery.
Assuntos
Fraturas do Fêmur/terapia , Adolescente , Moldes Cirúrgicos , Criança , Pré-Escolar , Fraturas não Consolidadas/terapia , Humanos , Lactente , Tração/métodosRESUMO
Our experience in the treatment of Legg-Perthes disease using non-containment, containment, and surgical treatment supports the concept that containment is a key factor in the treatment of Legg-Perthes disease. Patients without excessive lateral extrusion or other signs of "head at risk" and half or more of the femoral head involved probably can be treated for short periods of time in an abduction orthosis. If less than half the femoral head is involved but lateral extrusion is minimal, a period of traction to obtain range of motion and decrease the synovitis may be sufficient treatment. In the more severely involved heads that show the poor prognostic signs of excessive lateral extrusion, bed rest in addition to abduction may statistically offer the best chances for a good result. For patients with severe involvement and excessive lateral extrusion of the femoral head, intertrochanteric osteotomy gave us a better percentage of good results than treatment with abduction and weight bearing. Our intertrochanteric osteotomy series results were comparable to those in the Katz and Brotherton and McKibbin patients treated by abduction and nonweight bearing. Regardless of the method of treatment chosen for a specific patient, it is essential that a good range of motion be obtained and maintained throughout the course of treatment. If this is successfully done, regardless of other factors, the outcome should be satisfactory.
Assuntos
Necrose da Cabeça do Fêmur/terapia , Doença de Legg-Calve-Perthes/terapia , Fatores Etários , Repouso em Cama , Moldes Cirúrgicos , Criança , Fêmur/cirurgia , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Humanos , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Doença de Legg-Calve-Perthes/cirurgia , Aparelhos Ortopédicos , Osteotomia/métodos , Planejamento de Assistência ao Paciente , Prognóstico , Radiografia , Fatores de Tempo , TraçãoRESUMO
Three-dimensional computer reconstructions of bony anatomy based on computed tomographic images and radiographs may be used to analyze, simulate, and design certain orthopedic procedures. In osteotomy surgery, the computer-reconstructed models may be used to measure critical angles, surface area, and congruity of the joint surfaces. Computer reconstructions may be used in total joint replacement surgery to simulate the effect of surgical reamers and rasps, to select the geometrically optimum standard implant, or to design a custom implant. In allograft reconstructive surgery, computer reconstructions may be used to measure bony defects and to identify the appropriate allografts for the reconstruction. Plastic models may be sterilized and used as templates to sculpt the allografts immediately preoperatively. In all three applications in orthopedic surgery, three-dimensional, computer-aided reconstructions have the potential to improve results and reduce morbidity.