RESUMO
PURPOSE: The effect of a distal femur varization osteotomy on patellofemoral biomechanics in genu valgum is unknown. The purpose of this study was to quantify the influence of frontal leg axis correction on the Q-angle with a novel three-dimensional (3-D) measurement method. METHODS: 3-D surface models of ten lower extremities were generated using patient computed tomography (CT) data. The preoperative 3-D Q-angle was measured using a novel defined and validated 3-D measurement method. Biplanar supracondylar osteotomies were simulated with different degrees of varus correction (from 1° to 15°) in one-degree steps beginning from the preoperative valgus deformity, resulting in a total of 150 simulations. Additionally, mechanical leg axis and 3-D Q-angle measurements were performed on 3-D surface models of the postoperative CT scans of the same individuals. Further, pre- and postoperative TT-TG distance was measured. RESULTS: Mean preoperative Q-angle was 15.8 ± 3.9° (range 10°-21.4°) with a mean preoperative mechanical leg axis of 6.5° ± 2.4 valgus (range 3.8°-11.6° valgus). The Q-angle changed linearly 0.9 ± 0° per 1° of varization. No difference was detected between simulated 3-D Q-angles and effectively corrected postoperative values (n.s.). TT-TG distance changed irregularly and minimally, and with no correlation to the degree of varization. CONCLUSION: Distal femur varization osteotomy has a linear effect on the Q-angle with a change of 1° per 1° of varization. The difference in TT-TG distance was mainly due to an unintentional rotational component implemented during surgery.
Assuntos
Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Geno Valgo/cirurgia , Osteotomia/métodos , Adulto , Fenômenos Biomecânicos , Simulação por Computador , Fêmur/fisiopatologia , Geno Valgo/diagnóstico por imagem , Geno Valgo/fisiopatologia , História do Século XVI , Humanos , Imageamento Tridimensional , Extremidade Inferior/fisiopatologia , Extremidade Inferior/cirurgia , Pessoa de Meia-Idade , Período Pós-Operatório , Tomografia Computadorizada por Raios XRESUMO
Malunions of the forearm and hand cause significant disability. Moreover, intraarticular deformities may contribute to early onset osteoarthritis. Such conditions require precise surgical correction in order to improve functional outcomes and prevent early or late complications. The purpose of this study was to describe the technical advantages of accurate anatomical reconstruction using 3D guided osteotomies and patient specific instruments (PSI) in multiple joints of the hand and forearm. Acquisition of three-dimensional (3D) datasets and surgical implementation of PSI was performed in a series of patients between December 2014 and July 2017. Patients had intra- or extra-articular malunions of the forearm, radiocarpal joint, trapeziometacarpal joint, or proximal interphalangeal joint. A previously described 3D surface model that incorporates CT data was used for segmentation (Mimics®, Materialise™, Belgium). For all the cases, CT scans of both forearms were acquired to use the contralateral uninjured side as the anatomic reconstruction template. Computer-assisted assessment of the deformity, the preoperative plan, and the design of PSI are described. Outcomes were determined by evaluating step-off correction, fusion, changes in range of motion (ROM) and grip strength. Six patients were included in the study; all achieved fusion. Improved clinical outcomes including pain reduction, better ROM and grip strength were obtained. Complete correction of intraarticular step-off was achieved in all cases with intraarticular malunions. 3D guided osteotomies are an established surgical treatment option for malunions of the hand and forearm. 3D analysis is a helpful diagnostic tool that provides detailed information about the underlying deformity. PSI can be developed and used for surgical correction with maximal accuracy for both intraarticular step-off and angular deformity.
Assuntos
Articulações do Carpo/cirurgia , Articulações dos Dedos/cirurgia , Fraturas Mal-Unidas/cirurgia , Imageamento Tridimensional , Cirurgia Assistida por Computador , Articulação do Punho/cirurgia , Adolescente , Adulto , Articulações do Carpo/diagnóstico por imagem , Feminino , Articulações dos Dedos/diagnóstico por imagem , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Articulação do Punho/diagnóstico por imagem , Adulto JovemRESUMO
AIMS: In patients with a rotator cuff tear, tear pattern and tendon involvement are known risk factors for the development of pseudoparalysis of the shoulder. It remains unclear, however, why similar tears often have very different functional consequences. The present study hypothesizes that individual shoulder anatomy, specifically the moment arms (MAs) of the rotator cuff (RC) and the deltoid muscle, as well as their relative recruitment during shoulder abduction, plays a central role in pseudoparalysis. MATERIALS AND METHODS: Biomechanical and clinical analyses of the pseudoparalytic shoulder were conducted based on the ratio of the RC/deltoid MAs, which were used to define a novel anatomical descriptor called the Shoulder Abduction Moment (SAM) index. The SAM index is the ratio of the radii of two concentric spheres based on the centre of rotation of the joint. One sphere captures the humeral head (numerator) and the other the deltoid origin of the acromion (denominator). A computational rigid body simulation was used to establish the functional link between the SAM index and a potential predisposition for pseudoparalysis. A retrospective radiological validation study based on these measures was also undertaken using two cohorts with and without pseudoparalysis and massive RC tears. RESULTS: Decreased RC activity and improved glenohumeral stability was predicted by simulations of SAM indices with larger diameters of the humeral head, being consequently beneficial for joint stability. Clinical investigation of the SAM index showed significant risk of pseudoparalysis in patients with massive tears and a SAM < 0.77 (odds ratio (OR) 11). CONCLUSION: The SAM index, which represents individual biomechanical characteristics of shoulder morphology, plays a determinant role in the presence or absence of pseudoparalysis in shoulders with massive RC tears.
Assuntos
Músculo Deltoide/fisiopatologia , Debilidade Muscular/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Lesões do Manguito Rotador/fisiopatologia , Manguito Rotador/fisiopatologia , Articulação do Ombro/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Radiografia , Estudos Retrospectivos , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/diagnóstico , RupturaRESUMO
Objetivo: evaluar la información que tiene sobre SIDA un grupo de adolescentes. Material y métodos: encuesta a 100 adolescentes entre 13 y 20 años. Variables investigadas: conocimiento de SIDA, formas de contagio, preocupación respecto al SIDA, prevención, método anticonceptivo y escolaridad. Resultados y conclusiones: 93 por ciento de las adolescentes encuestadas dijeron saber qué es el SIDA, 94 por ciento conocían formas de transmisión, aunque ninguna reconoció la transmisión vertical: 55,59 por ciento mencionó las relaciones sexuales, 25 por ciento la sangre, 14,47 por ciento las inyecciones, agujas. Al 86 por ciento les preocupaba la enfermedad pero sólo el 68 por ciento usaría el condón para evitarlo y lo más impactante es que sólo el 15 por ciento lo utilizaba como método anticonceptivo. ¿Por qué, aún sabiendo, no se protegen efectivamente?. Esta es una muestra pequeña pero a la vez representativa para que los profesionales tengamos en cuenta que debemos revalorizar la importancia de la prevención primaria para evitar que los jóvenes se encuentren en situaciones de riesgo (embarazo, ETS) y la necesidad de programas de educación sexual que permitan aumentar los conocimientos acerca de la salud reproductiva. Las dificultades intrínsecas de ésta etapa de la vida hacen imprescindible la instrumentación de políticas de prevención a fin de concientizar acerca de éste grave problema
Assuntos
Humanos , Feminino , Adolescente , Adulto , Síndrome da Imunodeficiência Adquirida , Conhecimentos, Atitudes e Prática em Saúde , Argentina , Coleta de DadosRESUMO
Objetivos: Avanzar en el conocimiento respecto del deseo de embarazo en las adolescentes, y las relaciones que guardan con las conductas reproductivas, con las representaciones de género y con diversas variables psicosociales. Material y método: Se entrevistaron 100 pacientes, en forma no aleatoria, de la Sección Adolescencia, Hospital B. Rivadavia, que hubieran iniciado relaciones sexuales, 50 por ciento de las cuales habían estado alguna vez embarazadas. Se recogió información a través de dos procedimientos: una modalidad cuantitativa, por medio de una encuesta y otra cualitativa basada en entrevistas semidirigidas. Los datos fueron procesados con el S.P.S.S. resultados: 42 por ciento del total de las pacientes encuestadas manifestaron haber deseado un embarazo en algún momento de sus vidas. 6 por ciento consultaba porque buscaba un embarazo en el momento de la encuesta. Ante la pregunta de cuándo se había manifestado ese deseo 30 por ciento dijo desearlo en la actualidad, 22 por ciento en los últimos 12 meses, y la mitad en años anteriores. El deseo se manifestó en mayor proporción entre quienes habían abandonado sus estudios secundarios o sólo tenían nivel primario: 85 por ciento de las pacientes que estaban estudiando no deseaban quedar embarazadas. Respecto del uso de métodos anticonceptivos, 55 por ciento de las jóvenes que manifestaron no tener deseo de embarzo no utilizaban ninguno. De las pacientes que estuvieron embarazadas, 42 por ciento no refirió deseo de embarazo mientras que 58 por ciento sí lo deseó; 25 por ciento lo deseó en el último año, y 18 por ciento lo deseaba en ese momento. 35 por ciento de estos embarazos deseados fueron buscados y 52 por ciento no buscó el embarazo pero tampoco usó ningún método anticonceptivo. Conclusiones: Los datos obtenidos apoyan nuestra hipótesis acreca de la importancia de indagar en la consulta clínica sobre el deseo de embarazo- manifiesto o no- para crear así adecuadas estrategias asistenciales. Reafirmamos entonces que el deseo de embarazo, juntamente con otras variables, estaría sustentando ciertas conductas reproductivas