Osseointegration and Success in Hip Arthroplasty Acetabular Revision Using Structured Homologous Graft Average 9.6 Years Follow-up / Osteointegração e sucesso em revisão acetabular de artroplastia total de quadril com enxerto estrutural homólogo seguimento médio de 9, 6 anos

Abstract Objective To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting. Methods A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve. Results Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration. Conclusion We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.

Resumo Objetivo Avaliarosresultadosclínicos, radiográficos e a sobrevida da cirurgia de revisão acetabular de artroplastia total de quadril com implante cimentado sem uso de anel de reforço, associado à enxertia óssea homóloga estrutural. Métodos Um total de 40 pacientes (44 quadris) operados de 1995 a 2015 foram analisados retrospectivamente. As radiografias foram avaliadas de acordo com a classificação do defeito ósseo acetabular, o formato do enxerto e à presença de osteointegração. Foram considerados casos de insucesso a migração do implante > 5 mm em qualquer direção e/ou a progressão de linhas de radioluscência em torno do componente acetabular > 2mm. Verificamos a associação dos achados radiográficos com os casos de falha utilizando testes estatísticos e analisamos a sobrevida utilizando a curva de Kaplan-Meier. Resultados Dos 44 quadris, 45,5% dos defeitos acetabulares eram Paprosky tipo 3A e 50%, 3B. Em 65% dos quadris, a configuração do enxerto foi classificada como tipo 1 de Prieto e em 31% como tipo 2. Não foi observada evidência radiográfica de osteointe-gração em 13,6% dos casos. Observamos 9 (20,5%) falhas de reconstrução. Foi observada correlação entre falha da reconstrução com a ausência de sinais radiográficos de osteointegração do enxerto. Conclusão Observamos bons resultados clínicos e radiográficos, com sobrevida de 79,54% em seguimento médio de 9,65 anos. Também houve associação entre ausência de sinais radiográficos de osteointegração do enxerto estrutural e falha nesta série de pacientes com grandes defeitos ósseos. As falhas não se correlacionaram com a severidade do defeito ósseo acetabular, espessura ou configuraçãodoenxerto.

Glenoid Bone Loss - A Retrospective Evaluation of Functional Outcomes after Bone Block Surgery for Anterior Shoulder Instability in High-demand Athletes / Falha óssea na glenoide - Uma avaliação retrospectiva dos desfechos funcionais após cirurgia de bloqueio ósseo para instabilidade anterior do ombro em atletas de alta demanda

Abstract Objective This study assesses the relationship between the glenoid bone loss size and range of motion, functional outcomes, and complications in high-performance athletes undergoing bone block surgery for anterior shoulder instability. Methods This retrospective study evaluated postoperative outcomes in athletes submitted to bone block surgery for anterior shoulder instability. In 5 years, 41 shoulders underwent the procedure; 20 had bone losses up to 15%, and 21 shoulders presented bone losses ranging from 15% and 25%. Results There was no statistically significant difference regarding postoperative complications, new dislocations, and the rate of return to sports. In addition, the quantitative criteria evaluated, i.e., ranges of motion and functional scores, showed no statistically significant difference between groups. Conclusion The size of the bone loss per se does not seem to affect functional outcomes and complications from these procedures, which are safe techniques for small and large bone losses.

Resumo Objetivo Avaliar a relação do tamanho do defeito ósseo da glenoide no arco de movimento, nos resultados funcionais e nas complicações em pacientes atletas de alta performance submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Método Estudo retrospectivo no qual foram avaliados os resultados pós-operatórios de atletas submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Em 5 anos foram 41 ombros operados, sendo 20 deles com até 15% de defeito ósseo e 21 com defeitos entre 15% e 25%. Resultados Não houve diferença estatisticamente significativa com relação a complicações pós-operatórias, novas luxações, e na taxa de retorno ao esporte. Os critérios quantitativos avaliados - arcos de movimento e escores funcionais - também não apresentaram diferença estatisticamente significativa entre os grupos. Conclusão O tamanho do defeito ósseo por si só não parece afetar os resultados funcionais e as complicações desses procedimentos, sendo uma técnica segura tanto para defeitos pequenos, quanto para os maiores.

Alloderm e PepGen P-15 na reabilitação oral em um periodonto reduzido: acompanhamento de quatro anos / Alloderm and PepGen P-15 for oral rehabilitation in a patient with reduced periodontium: four years of follow-up

O objetivo deste relato foi analisar os resultados obtidos com a utilização da matriz dérmica acelular (MDA) e matriz óssea bovina inorgânica ligada ao peptídeo P-15 (MOI/P-15), para a preservação óssea alveolar após a extração dentária e posterior reabilitação com implantes, em uma paciente periodontalmente comprometida. Uma paciente do gênero feminino, que apresentava problemas periodontais severos nos elementos 11, 12, 21 e 22, recebeu tratamento periodontal básico. O planejamento do caso consistiu na remoção dos dentes condenados associada ao tratamento de preservação óssea do rebordo alveolar e subsequente reabilitação oral com implantes

The objective of this report was to analyze the results achieved with the use of acellular dermal matrix (ADM) with or without the inorganic bovine bone matrix (ABM) linked to cell binding peptide P-15 for socket preservation after tooth extraction and subsequent rehabilitation with dental implants of a periodontally compromised patient. A female patient who had a severe periodontal condition in the elements 11, 12, 21 and 22 received basic periodontal treatment. A surgical approach for this case included the removal of hopeless teeth and alveolar bone reservation. Subsequent rehabilitation with oral implants had been done

Radiographic evaluation of the symphysis menti as a donor site for an autologous bone graft in pre-implant surgery

PURPOSE: This study was performed to obtain a quantitative evaluation of the cortical and cancellous bone graft harvestable from the mental and canine regions, and to evaluate the cortical vestibular thickness. MATERIALS AND METHODS: This study collected cone-beam computed tomographic (CBCT) images of 100 Italian patients. The limits of the mental region were established: 5 mm in front of the medial margin of each mental foramen, 5 mm under the apex of each tooth present, and above the inferior mandibular cortex. Cortical and cancellous bone volumes were evaluated using SimPlant software (SimPlant 3-D Pro, Materialize, Leuven, Belgium) tools. In addition, the cortical vestibular thickness (minimal and maximal values) was evaluated in 3 cross-sections corresponding to the right canine tooth (3R), the median section (M), and the left canine tooth (3L). RESULTS: The cortical volume was 0.71+/-0.23 mL (0.27-1.96 mL) and the cancellous volume was 2.16+/-0.76 mL (0.86-6.28 mL). The minimal cortical vestibular thickness was 1.54+/-0.41 mm (0.61-3.25 mm), and the maximal cortical vestibular thickness was 3.14+/-0.75mm(1.01-5.83 mm). CONCLUSION: The use of the imaging software allowed a patient-specific assessment of mental and canine region bone availability. The proposed evaluation method might help the surgeon in the selection of the donor site by the comparison between bone availability in the donor site and the reconstructive exigency of the recipient site.

Evaluation of alveolar bone grafting in unilateral cleft lip and palate patients using a computer-aided diagnosis system

PURPOSE: This study aimed to evaluate the trabecular bone changes after alveolar bone grafting in unilateral cleft lip and palate (UCLP) patients using a computer-aided diagnosis (CAD) system. MATERIALS AND METHODS: The occlusal radiographs taken from 50 UCLP patients were surveyed retrospectively. The images were categorized as: 50 images in group 0 (before bone grafting), 33 images in group 1 (one month after bone grafting), 24 images in group 2 (2-4 months after bone grafting), 15 images in group 3 (5-7 months after bone grafting), and 21 images in group 4 (8 or more months after bone grafting). Each image was grouped as either "non-cleft side" or "cleft side". The CAD system was used five times for each side to calculate the pixel area based on the mathematical morphology. Significant differences were found using a Wilcoxon signed ranks test or paired samples t test. RESULTS: The pixel area showed a significant difference between the "non-cleft side" and "cleft side" in group 0 (404.27+/-103.72/117.73+/-92.25; p=0.00), group 1 (434.29+/-86.70/388.31+/-109.51; p=0.01), and group 4 (430.98+/-98.11/366.71+/-154.59; p=0.02). No significant differences were found in group 2 (423.57+/-98.12/383.47+/-135.88; p=0.06) or group 3 (433.02+/-116.07/384.16+/-146.55; p=0.19). CONCLUSION: Based on the design of this study, alveolar bone grafting was similar to normal bone within 2-7 months postoperatively.

Endoscopic and pathologic findings in acute graft versus host disease after allogeneic bone marrow transplantation / 中华消化内镜杂志

Objective To analyze the endoscopic and pathologic characters of acute graft versus host disease(aGVHD) after aUogeneie bone marrow transplantation.Methods The endoscopic and pathologic findings of 4 patients with acute aGVHD were retrospectively analyzed.Results The clinical manifestations of 4 patients were abdominal pain and diarrhea occurred 21～57 days after bone marrow transplantation.The eolonoseopy detected mucosa edema,erosion and multiple ulcers.The pathological findings included epithelial necrosis accompanied with infiltration of lympbocytes and plasmacytes,no cytomegalovirus was found in biopsies,and aGVHD was diagnosed.Three patients recovered after the treatment with corticosteroids,while the other one died.Conclusion The intestine is involved in aGVHD after allogeneie bone marrow transplantation,and the diagnosis depends on eolonoscopy and biopsy.

Comparative Research of Interfixation and Non-interfixation Applied to Treate the Thoracolumbar Spinal Tuberculosis / 中国医师杂志

Objective Compare the curative effect of simply bone grafting with bone grafting, sequentially or simultaneously instrumentation planting in surgical treatment of thoracolumbar spinal tuberculosis,to verify the possibility and curative effect of radical debridement,bone grafting, sequentially or simultaneously instrumentation planting.Methods Twenty-five cases were treated with radical debridement,bone grafting,21 patients with sequentially or simultaneously instrumentation planting.Evaluating the bony fusion rate,correction of deformity and the status of lesion contrastively.Results Forty-three patients were followed-up for an average of 21 monthes,all of them were cured and shown bony union. With instrumentation we got shorter bony union,better correction and no obviously correction lost.Conclusion Radical debridement,bone grafting, sequentially or simultaneously instrumentation planting can offer a complete removal of lesion as well as restruction of spinal stability which make the local immobilization possible.Through this procedure ,early rehabilitation will be possible and the cure rate fo spinal tuberculosis increased.