Validade e confiabilidade da versão brasileira da Trinity Amputation and Prosthesis Experience Scales - Revised (TAPES-R) / Validity and reliability of the brazilian version of Trinity Amputation and Prosthesis Experience Scales ­ Revised (TAPES-R)

Objetivo: Avaliar a validade e confiabilidade da versão brasileira da TAPES-R em uma população com amputação de membro inferior. Método: Participaram deste estudo transversal 102 pessoas com amputação de membro inferior, usuárias de prótese. Foram avaliadas as propriedades psicométricas (validade concorrente, grau de concordância (Índice de Kappa) e confiabilidade (ICC) intra e interobservador, além da consistência interna dos itens pelo alfa de Cronbach) da versão brasileira da TAPES-R. Para avaliação da validade concorrente foi utilizado o Prosthesis Evaluation Questionnaire (PEQ). Resultados: A TAPES-R se correlacionou com o PEQ, com exceção das subescalas de ajuste social e geral. O ICC interobservador variou de 0,38 a 0,88 na parte 1 e de 0,27 a 0,88 na parte 2, já o ICC intraobservador variou de 0,63 a 0,83 na parte 1 e de 0,27 a 0,79 na parte 2. O índice de Kappa variou de 0,18 a 0,66 na análise interobservador e de 0,25 a 0,69 na análise intraobservador. O Alfa de Cronbach variou de 0,75 a 0,89. Conclusão: A avaliação das propriedades psicométricas permite concluir que a TAPES-R é válida, confiável e apresenta uma boa consistência interna para ser aplicada em adultos brasileiros amputados de membro inferior.

Objective: Evaluate the validity and reliability of the Brazilian version of TAPES-R in people with lower limb amputation. Method: 102 people with lower limb amputation who used a prosthesis participated in this cross-sectional study. The psychometric properties (concurrent validity, degree of agreement (Kappa Index) and intra and interobserver reliability (ICC), in addition to the internal consistency of the items by Cronbach's alpha) of the Brazilian version of TAPES-R were evaluated. To assess concurrent validity, the Prosthesis Evaluation Questionnaire (PEQ) was used. Results: TAPES-R was correlated with PEQ, except for the subscales of social and general adjustment. The inter-observer ICC ranged from 0.38 to 0.88 in part 1 and from 0.27 to 0.88 in part 2, whereas the intra-observer ICC ranged from 0.63 to 0.83 in part 1 and 0.27 to 0.79 in part 2. The Kappa index varied from 0.18 to 0.66 in the inter-observer analysis and from 0.25 to 0.69 in the intra-observer analysis. Cronbach's alpha ranged from 0.75 to 0.89. Conclusion: The evaluation of psychometric properties allows us to verify that a TAPES-R is valid, reliable and has a good internal consistency to be applied to Brazilian adults with lower limb amputations.

Adaptación de pilares rectos sobre implantes con conexión hexagonal interna y externa por microscopía electrónica de barrido / Adaptation of straight pillars on implants with internal and external hexagonal connection by scanning electronic mi-croscopy / Adaptação de pilares retos em implantes com conexão hexagonal interna e externa por microscopia eletrônica de varredura

En implantología oral, ha sido motivo de investigación y constante evolución la interfase implante-pilar, princi-palmente desde el punto de vista biomecánico y biológico. Objetivo: Valorar el espacio o "gap" en la interfase implante-pilar en implantes de conexión hexagonal interna y externa por medio de microscopía electrónica de barrido (MEB). Materiales y Métodos: Estudio in vitro en 24 implantes (Bionnovation®) divididos en dos gru-pos (n=12): conexión hexagonal interna y externa. Para el experimento, se atornillaron pilares rectos con 30N de torque. A su vez 6 implantes por grupo se sometieron a 500000 ciclos de carga dinámica; posteriormente, se evaluó por MEB el espacio de la interfase implante pilar en 3 puntos de todas las muestras, las medias de los resultados de cada espécimen se respaldaron en tablas de Excel y se analizaron en el programa BioEstat 5.3. Resultados: Mediante test T para muestras independientes, con una significancia del 95%, se encontró una diferencia muy significativa luego de la aplicación de la carga dinámica en los implantes de hexágono ex-terno (p= 0.0002). En los implantes de hexágono interno también existió diferencia estadística (p= 0.03). Entre los implantes de hexágono externo e interno existieron diferencias muy significativas en la precisión del ajuste en la interfase implante pilar antes y después de la aplicación de las cargas dinámicas (p= <0.0001 y p= 0.0003 respectivamente). Conclusiones: Las cargas dinámicas aumentaron significativamente la discrepan-cia en la conexión implante-pilar de los implantes de hexágono externo e interno (p= < 0.05); adicionalmente, la distancia del "gap" fue mayor para los implantes de hexágono externo en contraste con los implantes de Hexágono Interno antes y después de la carga dinámica, siendo muy significativo (p= < 0.0003).

In oral implantology, the implant-pillar interface has been a subject of research and constant evolution, mainly from the biomechanical and biological point of view. Objective: To assess the gap in the implant-abutment interface in internal and external hexagonal connection implants by means of scanning electron microscopy (SEM). Materials and Methods: In vitro study in 24 implants (Bionnovation®) divided into two groups (n = 12): internal and external hexagonal connection. For the experiment, straight pillars with 30N of torque were screwed. In turn, 6 implants per group underwent 500,000 cycles of dynamic loading; Subsequently, the space of the pillar implant interface at 3 points of all samples was evaluated by MEB, the means of the results of each specimen were supported in Excel tables and analyzed in the BioEstat 5.3 program. Results: Using a T test for independent samples, with a significance of 95%, a very significant difference was found after the application of the dynamic load in the external hexagon implants (p = 0.0002). In the internal hexagon implants there was also a statistical difference (p = 0.03). Between the external and internal hexagon implants there were very significant differences in the accuracy of the adjustment in the abutment implant interface before and after the application of the dynamic loads (p = <0.0001 and p = 0.0003 respectively). Conclusions: Dynamic loads significantly increased the discrepancy in the implant-abutment connection of the external and internal hexa-gon implants (p = <0.05); additionally, the gap distance was greater for external hexagon implants in contrast to Internal Hexagon implants before and after dynamic loading, being very significant (p = <0.0003).

Na implantologia oral, a interface implante-pilar tem sido objeto de pesquisa e evolução constante, principal-mente do ponto de vista biomecânico e biológico. Objetivo: Avaliar o espaço ou "gap" na interface implan-te-pilar em implantes de conexão hexagonal interna e externa por meio de microscopia eletrônica de varre-dura (MEV). Materiais e Métodos: Estudo in vitro em 24 implantes (Bionnovation®) divididos em dois grupos (n = 12): conexão hexagonal interna e externa. Para o experimento, pilares retos com 30N de torque foram parafusados. Por sua vez, 6 implantes por grupo passaram por 500.000 ciclos de carregamento dinâmico; posteriormente, o espaço da interface do implante de pilar em 3 pontos de todas as amostras foi avaliado pelo MEV, as médias dos resultados de cada amostra foram suportadas em tabelas Excel e analisadas no programa BioEstat 5.3. Resultados: Usando um teste T para amostras independentes, com significância de 95%, foi encontrada uma diferença muito significativa após a aplicação da carga dinâmica nos implantes hexagonais externos (p = 0,0002). Nos implantes hexagonais internos também houve diferença estatística (p = 0,03). Entre os implantes hexágono externo e interno, houve diferenças muito significativas na precisão do ajuste na interface do implante de pilar antes e após a aplicação das cargas dinâmicas (p = <0,0001 ep = 0,0003, respectivamente). Conclusões: As cargas dinâmicas aumentaram significativamente a discrepância na conexão implante-pilar dos implantes hexágono externo e interno (p = <0,05); além disso, a distância do gap foi maior para os implantes hexagonais externos, em contraste com os implantes de hexágono interno antes e após o carregamento dinâmico, sendo muito significativa (p = <0,0003).

Finite element analysis of optimization on placement of medial fixed-bearing unicompartmental knee arthroplasty / 中华骨科杂志

Objective@#To investigate the influence of displacement of femoral and tibial components on the biomechanics of femoral or tibial bone in coronal view.@*Methods@#A series of CT and MRI of the left knee joint of a Han male volunteer was taken and a three-dimensional finite element model of the healthy knee joint was established. The femoral component and the tibial component were designed with varus 6°, varus 3°, 0°, valgus 3°, and valgus 6°, and were combined into 25 three-dimensional finite element model (FEM) of medial unicompartmental knee arthroplasty. A 1 000 N load was applied along the femoral mechanical axis. The von Mises cloud stress distribution was observed. Moreover, the lateral compartment load ratio, the high contact stress of cancellous bone and medial cortical bone below the tibial component, the upper surface of the polyethylene liner, and the femoral cartilage in the lateral compartment was measured. The statistically significant indicators compared with the neutral position (0° varus or valgus of the tibia and the femoral prosthesis, and 5° posterior slope of tibia prosthesis) were identified by scatter plots to find the dense and sparse areas of point items. The optimal position of the femoral component and the tibial component was determined by the number of items with statistical significance in the sparse area.@*Results@#When the femoral component was placed at 0° position, there was no significant difference in the high contact stress of cancellous bone below the tibial component in the five groups. When the femoral component was placed at 0° position, the tibial component was 6° varus or 6° valgus and the stress was increased by 9.21±3.38 MPa and 9.08±4.13 MPa (P<0.05), respectively. With the changes of femoral and tibial components from 6° varus to 6° valgus, the high contact stress of the medial cortical bone below the tibia was gradually decreased (P<0.05). When the femoral component was placed at 0°, the tibial component changes from 6° varus to 6° valgus without significant difference in the high contact stress on the upper surface of each group of polyethylene gasket. Compared with the neutral position group, the high contact stress of the 6° varus or 6° valgus group were increased by 2.88±2.53 MPa and 3.47±2.86 MPa, respective ly (P<0.05). The lateral compartment load ratio and the high contact stress of lateral compartment femoral cartilage was gradually decreased (P<0.05), when the femoral and tibial components changed from 6° varus to 6° valgus. The number (2.8%, 1/36) of indicators in the sparse area (the combination of all combinations of femur or tibia from 3° varus to 3° valgus) was less than that (57.8%, 37/64) in the dense area (set of all combinations except sparse area), and the difference was significant (χ2=29.61, P<0.001).@*Conclusion@#It is suggested that the position of the femoral component and the tibial component in fixed medial unicompartmental arthroplasty should not exceed 3° varus or valgus in patients with standard lower limb alignment.

Finite element analysis of optimization on placement of medial fixed-bearing unicompartmental knee arthroplasty / 中华骨科杂志

Objective To investigate the influence of displacement of femoral and tibial components on the biomechanics of femoral or tibial bone in coronal view.Methods A series of CT and MRI of the left knee joint of a Han male volunteer was taken and a three-dimensional finite element model of the healthy knee joint was established.The femoral component and the tibial component were designed with varus 6°,varus 3°,0°,valgus 3°,and valgus 6°,and were combined into 25 three-dimensional finite element model (FEM) of medial unicompartmental knee arthroplasty.A 1 000 N load was applied along the femoral mechanical axis.The von Mises cloud stress distribution was observed.Moreover,the lateral compartment load ratio,the high contact stress of cancellous bone and medial cortical bone below the tibial component,the upper surface of the polyethylene liner,and the femoral cartilage in the lateral compartment was measured.The statistically significant indicators compared with the neutral position (0° varus or valgus of the tibia and the femoral prosthesis,and 5° posterior slope of tibia prosthesis) were identified by scatter plots to find the dense and sparse areas of point items.The optimal position of the femoral component and the tibial component was determined by the number of items with statistical significance in the sparse area.Results When the femoral component was placed at 0° position,there was no significant difference in the high contact stress of cancellous bone below the tibial component in the five groups.When the femoral component was placed at 0° position,the tibial component was 6° varus or 6° valgus and the stress was increased by 9.21±3.38 MPa and 9.08±4.13 MPa (P＜0.05),respectively.With the changes of femoral and tibial components from 6° varus to 6° valgus,the high contact stress of the medial cortical bone below the tibia was gradually decreased (P＜ 0.05).When the femoral component was placed at 0°,the tibial component changes from 6° varus to 6° valgus without significant difference in the high contact stress on the upper surface of each group of polyethylene gasket.Compared with the neutral position group,the high contact stress of the 6° varus or 6° valgus group were increased by 2.88±2.53 MPa and 3.47±2.86 MPa,respectively (P＜0.05).The lateral compartment load ratio and the high contact stress of lateral compartment femoral cartilage was gradually decreased (P＜0.05),when the femoral and tibial components changed from 6° varus to 6° valgus.The number (2.8％,1/36) of indicators in the sparse area (the combination of all combinations of femur or tibia from 3° varus to 3° valgus) was less than that (57.8％,37/64) in the dense area (set of all combinations except sparse area),and the difference was significant (x2=29.61,P＜ 0.001).Conclusion It is suggested that the position of the femoral component and the tibial component in fixed medial unicom partmental arthroplasty should not exceed 3° varus or valgus in patients with standard lower limb alignment.

Instalação e controle de próteses totais convencionais / Installation and control of conventional total prostheses

Na reabilitação de pacientes edêntulos com próteses totais convencionais envolve a expectativa no momento da instalação das próteses, tornando-se indispensáveis o acompanhamento e orientações de uso. Este trabalho tem como objetivo descrever os principais fatores envolvidos na etapa de instalação de novas próteses totais. Vários temas importantes para a odontologia foram abordados, como ajustes das próteses, adaptação do paciente, orientações, manejo, tempo de uso, mudanças na alimentação, dicção, higiene, cuidados necessários e o acompanhamento do paciente após a instalação de novas próteses totais(AU)

In the rehabilitation of edentulous patients with conventional total dentures, it is expected that the prostheses will be installed, making it necessary to follow up and use guidelines. This study aims to describe the main factors involved in the installation of new total dentures. Several important themes for dentistry were addressed, such as adjustments of the prosthesis, patient adaptation, guidelines, management, time of use, changes in feeding, diction, hygiene, necessary care and patient follow-up after the installation of new dentures(AU)

Satisfação e ajuste à prótese de indivíduos com amputação de membro inferior / Satisfaction and adjustment to the prosthesis of individuals with lower limb amputation

OBJETIVOS: Avaliar a satisfação e o ajuste à prótese de indivíduos com amputação de membro inferior. MÉTODOS: Participaram 24 indivíduos com amputação de membro inferior com 46,1±17,5 anos e que utilizam prótese há 10,8±8,7 anos. Foi utilizada uma ficha para caracterização dos indivíduos e o questionário Prosthesis Evaluation Questionnaire (PEQ) para avaliar a satisfação e o ajuste à prótese. Os dados foram coletados em instituições que atendem pessoas amputadas nos estados do Rio Grande do Sul e Santa Catarina e analisados pela estatística descritiva e inferencial com nível de significância de 5%. RESULTADOS: Não houve diferença significativa nos resultados do PEQ entre os indivíduos quando comparados em relação ao nível de amputação e ao tempo que utilizam a prótese. Em relação aos escores obtidos entre os grupos com amputação vascular e traumática, houve diferença significativa na subescala de saúde do membro residual, com maiores escores e consequente melhor saúde do membro residual nos indivíduos com amputação de causa vascular, além de melhores escores na escala de satisfação nestes indivíduos. CONCLUSÕES: Foi possível concluir que indivíduos com amputação de causa vascular são mais satisfeitos com sua prótese, com a maneira como andam e como as coisas estão desde a amputação e também possuem melhor saúde do membro residual em relação a indivíduos com amputação traumática. Porém, o nível e o tempo de amputação parecem não influenciar na satisfação e no ajuste à prótese.

AIMS: Evaluate satisfaction and adjustment to the prosthesis of individuals with lower limb amputation. METHODS: Participants were 24 patients with lower limb amputation with 46,1±17,5 years and using the prosthesis for 10,8±8,7 years. A card was used to characterize the individuals and the Prosthesis Evaluation Questionnaire (PEQ) to evaluate satisfaction and adjustment to the prosthesis. Data were collected from institutions that serving amputees in the states of Rio Grande do Sul and Santa Catarina and analyzed by descriptive and inferential statistics at a 5% significance level. RESULTS: There was no significant difference in the results of the PEQ between individuals when compared to the level of amputation and time using the prosthesis. Regarding the scores between groups with vascular and traumatic amputation, was a significant difference in residual limb health subscale, with higher scores and consequently better health of the residual limb in amputees with vascular causes, besides better higher scores on the scale of satisfaction in these individuals. CONCLUSIONS: It was concluded that patients with a vascular cause of amputation are more satisfied with their prosthesis, with the way they walk and how things are from amputation and also have better health of the residual limb in relation to individuals with traumatic amputation. However, the level and time of amputation do not seem to influence the satisfaction and adjustment of the prosthesis.

Hand Functions of Myoelectric and 3D-Printed Pressure-Sensored Prosthetics: A Comparative Study

The loss of an upper limb significantly limits the functional activities of daily living. A huge emphasis is placed on the manipulation, shape, weight, and comfort of a prosthesis, to enable its use as an inherent body part. Even with technological advances, customized upper-extremity myoelectric prosthesis remain heavy and expensive. The high cost of upper-extremity prosthesis is an especially steep economic barrier for patients. Three-dimensional (3D) printing is a promising avenue for reducing the cost of prosthesis. We applied 3D-printed pressure-sensored prosthetics to a traumatic transradial amputee, and compared the hand functions with a customized myoelectric prosthesis. The 3D-printed pressure-sensored prosthetics showed low grip strength and decreased dexterity compared to the conventional myoelectric prosthesis. Although there were a few limitations, the fabrication of prosthesis with 3D printing technology can overcome previous problems such as high production cost, long fabrication period and heavy weight.

Desproporção prótese-paciente em indivíduos submetidos à troca valvar aórtica / Prosthesis-patient mismatch in Individuals undergoing aortic valve replacement

Fundamentos: A desproporção prótese-paciente (DPP) em indivíduos submetidos à cirurgia de troca valvar aórtica é objeto de muitas pesquisas e está associada a piora do prognóstico em longo prazo. Objetivos: Avaliar a incidência da DPP após cirurgia de troca valvar aórtica e caracterizar o perfil clínico dos pacientes submetidos a esta cirurgia. Métodos: Estudo transversal, observacional, retrospectivo com 53 pacientes hospitalizados para tratamento cirúrgico de estenose valvar aórtica grave, no período de janeiro de 2014 a junho de 2015. Foram utilizados três modelos de biopróteses e um modelo de prótese metálica. A área de orifício efetivo indexado (AOEi) foi calculada a partir da divisão da área de orifício efetivo fornecida pelo fabricante da prótese pela área de superfície corporal do paciente receptor. Definiu-se a presença de DPP quando AOEi <0,90cm²/m². Resultados: A média de idade dos pacientes foi 65,8±9,9 anos, predominando o sexo masculino. A mortalidade geral foi 11,3%. A DPP ocorreu em 32,0% dos pacientes, sendo a maioria de grau moderado. A prótese Biocor apresentou 70,5% de DPP enquanto a prótese Braile não demonstrou nenhum caso. Não houve diferença na redução dos gradientes transvalvares aórticos no período pós-operatório entre os grupos com e sem DPP. Conclusões: O perfil dos pacientes assemelha-se ao descrito na literatura, a incidência de DPP é elevada, variando muito entre os modelos de próteses. Não houve diferença na redução dos gradientes pós-operatórios entre os grupos com ou sem DPP.

Background: Prosthesis-patient mismatch (PPM) in patients undergoing aortic valve replacement surgery is the subject of many research studies and is associated with worse prognosis in the long term. Objectives: To evaluate the incidence of PPM after aortic valve replacement surgery and characterize the clinical profile of patients undergoing this surgery. Methods: Cross-sectional observational retrospective study of 53 patients hospitalized for surgical treatment of severe aortic valve stenosis from January 2014 to June 2015. Three models of bioprosthesis and a metal prosthesis model were used. Indexed effective orifice area (iEOA) was calculated by dividing the effective orifice area provided by the prosthesis manufacturer by the body surface area of the recipient patient. The presence of PPM was defined when iEOA <0.90 cm²/m². Results: The average age of patients was 65,8±9,9. Male sex prevailed. Overall mortality rate was 11.3%. PPM occurred in 32.0% of patients, mostly of which were moderate degree. The prosthesis Biocor showed 70.5% of PPM while the Braile prosthesis showed no case. There was no difference in the reduction of transvalvular aortic gradients in the postoperative period between the groups with and without PPM. Conclusions: The patients profile is similar to that described in the literature, the incidence of PPM is high, varying greatly between the prosthesis models. There was no difference in the reduction of postoperative gradients between the groups with or without PPM.

Research progress on positioning accuracy of acetabulum prosthesis / 中国骨伤

In order to prevent the dislocation of total hip arthroplasty (THA) and reduce the wear rate, the position of the acetabular component in THA is very important. However, due to the influence of many potential factors, the accurate implantation of the acetabular component in the operation is still a challenge. Lewinnek safety zone positioning the cup anteversion angle (15±10)°, abduction (40±10)°, has been regarded as acetabular prosthesis installation standards, in an attempt to reduce the risk of instability, but there are still reported a dislocation. Based on the Lewinnek safety zone, Ha proposed the use of acetabular anatomical landmarks. According to patient specific shape positioning the position of the acetabular component methods are used to determine the specificity of the target area, thereby reducing the impact of hip replacement, and to maintain a lower liner wear rate. Image navigation system can improve the positioning of acetabular cup, but it is affected by many factors, such as high cost, difficult operation and so on.

Artificial pupil versus contralateral balanced contact lens fit for presbyopia correction / Pupila artificial vs adaptação contralateral equilibrada de lentes de contato para correção da presbiopia

Purpose: To assess and compare the effects of contact lens-based artificial pupil design and contralateral balanced multifocal contact lens combination (CBMCLC) on visual performance. Methods: This randomized crossover study conducted at the University of Valencia, Spain included 38 presbyopic patients using an artificial pupil contact lens in the nondominant eye and a CBMCLC. After a month of lens wear, the binocular distance visual acuity (BDVA), binocular near visual acuity (BNVA), defocus curve, binocular distance, and near contrast sensitivity and near stereoacuity (NSA) were measured under photopic conditions (85 cd/m2). Moreover, BDVA and binocular distance contrast sensitivity were examined under mesopic conditions (5 cd/m2). Results: Visual acuity at an intermediate distance and near vision was better with the CBMCLC than with the artificial pupil (p<0.05). Statistically significant differences were found in contrast sensitivity between the two types of correction for distance (under mesopic conditions) and for near vision, with the CBMCLC exhibiting better results in both cases (p<0.05). The mean NSA values obtained for the artificial pupil contact lens were significantly worse than those for the CBMCLC (p=0.001). Conclusion: The CBMCLC provided greater visual performance in terms of intermediate and near vision compared with the artificial pupil contact lens. .

Objetivo: Avaliar e comparar os efeitos da pupila artificial baseada em lentes de contato e a combinação equilibrada de lente de contato multifocal contralateral (CBMCLC) sobre o desempenho visual. Métodos: Estudo realizado na Universidade de Valência, Espanha. Em um projeto de estudo do tipo "cross-over", 38 pacientes présbitas foram avaliados utilizando uma lente de contato com pupila artificial no olho não-dominante e CBMCLC. Após 1 mês, foram avaliadas, em condições fotópicas (85 cd/m2), a acuidade visual binocular para distância (BDVA), a acuidade visual binocular para perto (BNVA), a curva de desfocagem, a sensibilidade ao contraste binocular para distância e para perto, assim como a acuidade estereoscópica para perto (NSA). Além disso, a BDVA e a sensibilidade ao contraste binocular para distância foram avaliadas em condições mesópicas (5 cd/m2). Resultados: A acuidade visual em distâncias intermediárias e para perto foram melhores com CBMCLC do que com pupila artificial (p<0,05). Foram encontradas diferenças estatisticamente significativas entre a sensibilidade ao contraste com os dois tipos de correção para distância (em condições mesópicas) e para perto, com CBMCLC ser melhor em ambos os casos (p<0,05). Os valores médios da NSA obtidos com as lentes de contato das pupilas artificiais foram significativamente piores do que com CBMCLC (p=0,001). Conclusão: CBMCLC proporciona melhor desempenho visual para visão intermediária e para perto do que a lente de contato com pupila artificial. .

Adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data / Adaptação a prótese em pacientes com amputações maiores de membros inferiores e sua associação com os dados sociodemográficos e clínicos

CONTEXT AND OBJECTIVE: Lower-limb amputation compromises patients' independence and autonomy, and therefore they should be referred for rehabilitation in order to adapt to prostheses and regain autonomy. The aim here was to assess adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data. DESIGN AND SETTING: This was a cross-sectional study in the city of Aracaju, Brazil. METHODS: The patients were identified by primary healthcare teams. The inclusion criterion was that these should be patients who underwent major lower-limb amputations of any etiology. Associations between sociodemographic and clinical variables and the adaptation to lower-limb prostheses were assessed. RESULTS: 149 patients were examined. Adaptation to the prosthesis occurred in 40% (60/149) of them, but only 62% (37/60) were using it. Adaptation occurred more often among male patients (P = 0.017) and among those who had a higher educational level (P = 0.013), with a longer time since amputation (P = 0.049) and when the etiology was trauma (P = 0.003). The result from logistic regression analysis showed that only patients with low education (P = 0.031) were significantly associated with a lower frequency of adaptation to prostheses. CONCLUSION: It was found that patients with a low educational level became adapted to the prosthesis less frequently. CONTEXTO E OBJETIVO: A amputação de membros inferiores compromete a independência e a autonomia dos pacientes, por isso, eles devem ser encaminhados para a reabilitação para a adaptação das próteses e assim viabilizar a recuperação da autonomia. O objetivo foi avaliar a adaptação de prótese em pacientes com amputações maiores de membros inferiores e sua associação com dados sócio-demográficos e clínicos. .

TIPO DE ESTUDO E LOCAL: Estudo transversal realizado na cidade de Aracaju, Brasil. MÉTODO: Os pacientes foram identificados pelas equipes de atenção primária à saúde. O critério de inclusão foi pacientes submetidos a amputações de membros inferiores principais de todas as etiologias. Foram avaliadas as associações entre variáveis sociodemográficas e clínicas e a adaptação de próteses de membros inferiores. RESULTADOS: Foram examinados 149 pacientes. A adaptação da prótese ocorreu em 40% (60/149) deles, mas apenas 62% (37/60) a utilizavam. Adaptação ocorreu mais frequentemente em pacientes do sexo masculino (P = 0,017) e naqueles que tinham maior nível de escolaridade (P = 0,013), com maior tempo de amputação (P = 0,049) e quando a etiologia (P = 0,003) foi o trauma. O resultado da análise de regressão logística mostrou que apenas a com baixa escolaridade (P = 0,031) foi significativamente associada com uma menor frequência na adaptação de próteses. CONCLUSÃO: Verificou-se que pacientes com baixa escolaridade tiveram menor frequência de ajuste para a prótese. .

Resurfacing arthroplasty for hip dysplasia:evaluation of treatment outcome / 中华骨科杂志

Objective To assess the functional restoration in patients with developmental dysplasia of the hip (DDH) who underwent hip resurfacing arthroplasty and to determine whether greater abduction angle of the acetabular component is relat?ed to larger diameter of femoral head component. Methods We reviewed 34 DDH cases (9 hips of 8 males and 25 hips of 24 fe?males, mean age 44.6±11.85 years at the time of surgery) on whom we performed hip resurfacing arthroplasty (HRA) from October 2006 to September 2009. The total hip Arthroplasty (THA) group was consisted of 35 DDH cases (8 hips of 8 males and 27 hips of 25 females, mean age 43.7±10.4 years at the time of surgery). All operations were performed by the same doctor over the same peri?od. Assessment of the functional hip scores was conducted by Harris Hip Scores. A radiographic study was also performed to evalu?ate the implants stability and abduction angle of the acetabular components. All the data was analyzed with Kolmogorov?Smirnov method. Results The mean follow?up was 6.2 years in the HRA group. The Harris Hip Score improved from 54.9±13.2 to 97.3± 6.2 after the surgery. The mean abduction angle of the acetabular component was 51.6° ± 5.33°, hip flexion was 127° ± 6.9° and mean diameter of femoral head was 46.5±1.5 mm. The mean follow?up was 5.9 years in the THA group. The Harris Hip Score im?proved from 51.6±19.7 to 95.6±7.9 after the surgery. The mean abduction angle of the acetabular component was 43.9°±4.90°, hip flexion was 117°±4.2°. There was no failure of the prosthesis, peri?prosthetic fracture and infection in either group. There was sig?nificant difference in the abduction angle of the acetabular component (P<0.05) and flexion of the hip between the two groups (P<0.05). Conclusion Patients in the HRA group had a better functional restoration and larger range of motion. Furthermore, a larger diameter of femoral head component could be achieved by placing the acetabular component in a greater abduction angle, which may contribute to a better long?term stability.

The effect of selectively upward placement of acetabular implants on limb length and post-operative function of develop-mental dysplasia of the hip patients with shortened legs / 中华骨科杂志

Objective To investigate the effect of selectively upward placement of acetabular implants on limb length and post?operative function of developmental dysplasia of the hip patients with shortened legs during total hip arthroplasty (THA). Methods Twenty?six cases of developmental dysplasia of the hip received THA between January 2008 and December 2013, in?cluding 12 cases of Crowe typeⅠ, 8 of Crowe typeⅡ, 6 of Crowe typeⅢ. There were 5 males and 21 females with an average age of 62.7 years (range, 36-80 years). The left hip was involved in 9 cases and the right hip in 17 cases. The preoperative mean Har?ris score was 42.30±12.84, and the preoperative mean WOMAC score was 59.08±13.84 at the last follow?up. The anteroposterior X?ray films and CT scan of the pelvis, anteroposterior and lateral X?ray films of the femur, and TraumaCad analysis were conducted routinely preoperation. More than 70%of the bone?implant interface was covered by appropriate upward distance of acetabular im?plant. Results The follow?up time ranged from 6 to 73 months (mean, 36 months). The Harris score improved to 91.18±7.09, and WOMAC score reduced to 9.85±3.75. According to postoperative measurement, affected limb had been lengthened by 0-5 mm in 8 cases, 6-10 mm in 5 cases, 11-15 mm in 5 cases,>15 mm in 7 cases, and shortening increased 1 mm in 1 case, but the average lengthening was 9.23±7.54 mm. The upward distance of acetabular implant was 0-5 mm in 10 cases, 6-10 mm in 7 cases and>10 mm in 9 cases. The average lengthening was 6.60±6.72 mm in patients having 0-5 mm upward distance, 11.90±5.64 mm in patients having 6-10 mm upward distance and 10.11 ± 9.35 mm in patients having>15 mm upward distance, showing no significant differ?ence. The leg length discrepancy was-3.70±6.43 mm in patients having 0-5 mm upward distance, 1.71±6.24 mm in patients having 6-10 mm upward distance and 0.56 ± 7.70 mm in patients having>15 mm upward distance, showing no significant difference. Con?clusion The limb length could be improved by selectively upward placement of acetabular implants in developmental dysplasia of the hip patients with anatomically abnormal acetabulum during THA, with reasonable preoperative design and corrective operation.

Application of gyroscope to acetabular cup positioning in total hip arthroplasty / 中国组织工程研究

BACKGROUND:Good position of acetabular prosthesis during total hip replacement plays a key role in success of the operation. Traditional location tool has poor accuracy, is too complicated, and limits its application. OBJECTIVE:To compare the advantages and disadvantages of gyroscope with the traditional technique in acetabular component orientation in total hip arthroplasty. METHODS:Using lateral approach, physicians with different experiences used traditional technique to locate acetabular cup 100 times (20 times in each person; 40° abduction and 15° anteversion), and then used gyroscope to locate 60 times at the same angle in the same plastic hip model. The error between the planed and measured values was recorded. RESULTS AND CONCLUSION: Compared to the traditional technique, the error of the abduction and anteversion decreased obviously. These indicated that the gyroscope can make the orientation of acetabular component more precise in total hip arthroplasty.

Connecting accuracy of interchanged prosthetic abutments to different dental implants using scanning electron microscopy

The present study evaluated the interchangeability of prosthetic components for external hexagon implants by measuring the precision of the implant/abutment (I/A) interface with scanning electron microscopy. Ten implants for each of three brands (SIN, Conexão, Neodent) were tested with their respective abutments (milled CoCr collar rotational and non-rotational) and another of an alternative manufacturer (Microplant) in randomly arranged I/A combinations. The degree of interchangeability between the various brands of components was defined using the original abutment interface gap with its respective implant as the benchmark dimension. Accordingly, when the result for a given component placed on an implant was equal to or smaller then that gap measured when the original component of the same brand as the implant was positioned, interchangeability was considered valid. Data were compared with the Kruskal-Wallis test at 5% significance level. Some degree of misfit was observed in all specimens. Generally, the non-rotational component was more accurate than its rotational counterpart. The latter samples ranged from 0.6-16.9 µm, with a 4.6 µm median; and the former from 0.3-12.9 µm, with a 3.4 µm median. Specimens with the abutment and fixture from Conexão had larger microgap than the original set for SIN and Neodent (p<0.05). Even though the latter systems had similar results with their respective components, their interchanged abutments did not reproduce the original accuracy. The results suggest that the alternative brand abutment would have compatibility with all systems while the other brands were not completely interchangeable.

O presente estudo avaliou a intercambiabilidade dos componentes protéticos de implantes de hexágono externo medindo-se a precisão da interface implante/pilar com microscopia eletrônica de varredura. Foram utilizados dez implantes para cada uma de três marcas (SIN, Conexão, Neodent) com seus respectivos pilares (base metálica de CoCr , rotacional e não rotacional) e um de marca alternativa (Microplant) em um arranjo com todas as combinações de implante/pilar possíveis. O valor de referência para a intercambiabilidade das várias marcas de componentes foi definido pela diferença do pilar original para com seu respectivo implante. Dessa maneira, a intercambiabilidade foi considerada válida quando o resultado para um dado pilar colocado sobre um implante fosse igual ou menor que a diferença medida quando o pilar da mesma marca do implante fora posicionado. Os dados foram comparados pelo teste de Kruskal-Wallis com nível de significância de 5%. Um grau de desajuste foi observado em todos os espécimes. De uma maneira geral, o pilar anti-rotacional foi mais preciso do que o rotacional. Estes variaram de 0,6-16,9 µm, com mediana 4,6 µm; enquanto o anti-rotacional foi de 0,3-12,9 µm, com mediana de 3,4 µm. Os espécimes com o pilar e o implante Conexão tiveram uma diferença maior que o conjunto original para SIN e Neodent (p<0,05). Apesar destes últimos apresentarem resultados semelhantes com seus respectivos pilares, quando trocados não mantiveram a mesma precisão original. Os resultados sugerem que a marca alternativa seria a única que apresentaria compatibilidade com todos os sistemas, enquanto as outras marcas não seriam completamente intercambiáveis.

Desajuste vertical entre implante e componentes protéticos pré-fabricados ou fundidos / Vertical misfit between prefabricated or casting prosthetic abutments and implant

Objetivo: O objetivo deste estudo foi avaliar o desajuste marginal vertical entre implante e diferentes componentes protéticos (pré-fabricados e fundidos). Material e método: Foram utilizados três grupos (n  =  4): grupo MP - componentes pré-fabricados preparáveis; grupo UI - UCLA calcináveis com base metálica em Co-Cr; grupo UF - UCLA com base metálica fundida em Co-Cr. Os espécimes foram analisados em microscópio eletrônico de varredura, no qual foi avaliado o desajuste marginal vertical. Os dados foram submetidos aos testes estatísticos de Kruskal-Wallis e Mann-Whitney (a  =  0,05). Resultado: As médias de desajuste (µm) encontradas foram: MP  =  1,52  (±2,1); UI  =  6,15 (±2,5); UF  =  6,04 (±2,9). O munhão personalizável apresentou menor desajuste marginal vertical quando comparado ao pilar UCLA com base metálica em Co-Cr antes e após processo de fundição. Conclusão: Apesar das diferenças observadas, todos os componentes apresentaram níveis de adaptação aceitáveis para utilização clínica.

Objective: The aim of the study was to evaluate the vertical marginal misfit between implant and different prosthetic abutments (prefabricated and castings). Material and method: The samples were divided into three groups (n = 4): group MP - personalized abutment; group UI - UCLA with metallic base in Co-Cr; group UF - UCLA with metallic base casting in Co-Cr. The specimens were analyzed in scanning electronic microscope, where it was evaluated the vertical marginal misfit. The data were submitted to the Kruskal-Wallis and Mann-Whitney statistical tests (a = 0.05). Result: The misfit means were: MP = 1.52 (±2.1); UI = 6.15 (±2.5); UF = 6.04 (±2.9). The personalized abutment showed the smallest vertical marginal misfit when compared to the UCLA abutment with metallic base in Co-Cr before and after casting process. Conclusion: All components presented acceptable fit levels for the use clinical, despite the observed differences.

Prosthetic misfit of implant-supported prosthesis obtained by an alternative section method

PURPOSE: Adequate passive-fitting of one-piece cast 3-element implant-supported frameworks is hard to achieve. This short communication aims to present an alternative method for section of one-piece cast frameworks and for casting implant-supported frameworks. MATERIALS AND METHODS: Three-unit implant-supported nickel-chromium (Ni-Cr) frameworks were tested for vertical misfit (n = 6). The frameworks were cast as one-piece (Group A) and later transversally sectioned through a diagonal axis (Group B) and compared to frameworks that were cast diagonally separated (Group C). All separated frameworks were laser welded. Only one side of the frameworks was screwed. RESULTS: The results on the tightened side were significantly lower in Group C (6.43 +/- 3.24 microm) when compared to Groups A (16.50 +/- 7.55 microm) and B (16.27 +/- 1.71 microm) (P<.05). On the opposite side, the diagonal section of the one-piece castings for laser welding showed significant improvement in the levels of misfit of the frameworks (Group A, 58.66+/-14.30 microm; Group B, 39.48+/-12.03 microm; Group C, 23.13+/-8.24 microm) (P<.05). CONCLUSION: Casting diagonally sectioned frameworks lowers the misfit levels. Lower misfit levels for the frameworks can be achieved by diagonally sectioning one-piece frameworks.

Effects of resin luting agents and 1 percent NaOCl on the marginal fit of indirect composite restorations in primary teeth

OBJECTIVE: The purpose of this study was to provide information regarding the marginal adaptation of composite resin onlays in primary teeth previously treated with 1 percent sodium hypochlorite (NaOCl) (pulp irrigant) using two different resin luting agents. MATERIAL AND METHODS: Forty extracted sound primary molars had their crowns prepared in a standardized machine and were randomly divided into 4 groups (n=10): G1 (1 percent NaOCl irrigation+EnForce); G2 (EnForce); G3 (1 percent NaOCl irrigation+Rely X); G4 (Rely X). The onlays were made with Z250 composite resin on plaster models. After luting, the tooth/restoration set was stored in 100 percent relative humidity at 37ºC for 24 h and finished with Soflex discs. Caries Detector solution was applied at the tooth/restoration interface for 5 s. The specimens were washed and four digital photos of each tooth were then taken. The extents of the gaps were measured with Image Tool 3.0 software. The percentage data were submitted to a Kruskal-Wallis test (α=0.05). The Relative Risk test analyzed the chance of a gap presence correlated to each group. RESULTS: There were no statistically significant differences (p>0.05) among the groups. The relative risk test revealed that some groups were more apt to have a presence of gaps than others. CONCLUSION: Neither the 1 percent NaOCl treatment nor the resin luting agents caused any alterations in the dental substrate that could have influenced the marginal adaptation of composite onlays in primary teeth.

Porcelain application and simulation of firing cycle: effect on marginal misfit of implant-supported frameworks

Aim: Success of implant-supported prostheses is related to the frameworks’ passive fit, henceinaccuracies can generate stress, leading to bone resorption and rehabilitation failure. This study evaluated misfit levels of implant-supported frameworks after different coverage treatments.Methods: Twenty commercially pure titanium (CP Ti) frameworks were manufactured with 5Branemark type multi-unit abutments. Frameworks were distributed in two groups as follows: G1- porcelain application (n=10); G2 - porcelain firing cycle simulation (n=10). Using a traveling microscope, marginal misfit was measured before and after undertaking the techniques, following the single-screw test protocol. All data were submitted to ANOVA and Tukey’s test (p<0.05).Results: Initial marginal misfit values were not significantly different, but both groups presented significantly higher misfit values after treatment: G1: 233.99 ìm (p=0.0003); G2: 119.75 ìm(p<0.0001). In addition, G1 presented higher misfit than G2 (p<0.0001). Conclusions: Porcelain application promoted significantly higher increase of misfit, which indicates that such procedure should be considered on misfit analysis of implant-supported prostheses.

Relation between implant/abutment vertical misfit and torque loss of abutment screws

This study investigated whether there is a direct correlation between the level of vertical misfit at the abutment/implant interface and torque losses (detorque) in abutment screws. A work model was obtained from a metal matrix with five 3.75 x 9 mm external hex implants with standard platform (4.1 mm). Four frameworks were waxed using UCLA type abutments and one-piece cast in commercially pure titanium. The misfit was analyzed with a comparator microscope after 20 Ncm torque. The highest value of misfit observed per abutment was used. The torque required to loose the screw was evaluated using a digital torque meter. The torque loss values, measured by the torque meter, were assumed as percentage of initial torque (100 percent) given to abutment screws. Pearson's correlation (α=0.05) between the misfit values (29.08 ± 8.78 µm) and the percentage of detorque (50.71 ± 11.37 percent) showed no statistically significant correlation (p=0.295). Within the limitations of this study, it may be concluded that great vertical misfits dot not necessarily implies in higher detorque values.

Este trabalho teve como objetivo correlacionar o nível de desajuste vertical pilar/implante a perda do torque aplicado (destorque). Um modelo de trabalho foi obtido a partir de uma matriz metálica com cinco implantes tipo hexágono externo (Titamax, Neodent, Curitiba, Brasil) com plataforma regular (4,1 mm). Sobre esta matriz, quatro infra-estruturas foram enceradas utilizando pilares tipo UCLA e fundidas em monobloco com titânio comercialmente puro (Tritan grau I, Dentaurum, Alemanha). Os desajustes foram analisados com um microscópio óptico comparador (Mytutoyo, Japão) após torque de 20 Ncm. O maior valor de desajuste observado por pilar foi utilizado. O valor do torque de desaperto, avaliado com um torquímetro digital (TQ-680, Instrutherm, Brasil), foi calculado em porcentagem do valor do torque inicial (100 por cento) dado aos parafusos protéticos. O teste de correlação de Pearson (p<0,05), entre os valores de desajuste (29,08 ± 8,78 µm) e as porcentagens da perda de torque (50,71 ± 11,37 por cento), não mostrou correlação estatisticamente significante (p=0,295) entre tais fatores. Dentro das limitações do estudo, pode ser concluído que não necessariamente grandes valores de desajustes verticais implicarão em grades perdas de torque.