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1.
J. Health Biol. Sci. (Online) ; 10(1): 1-4, 01/jan./2022.
Article in English | LILACS | ID: biblio-1369163

ABSTRACT

Introduction: One of the challenges of maxillofacial surgery is the rehabilitation of patients with severe bone loss, using implant-supported prostheses. This challenge is based on the small remaining bone structure, and on the need to reconstruct the structure for the rehabilitation with autogenous or exogenous grafts. Case report: We report the case of a patient with severe maxillary atrophy, where a skullcap graft was performed associated with implant placement and prosthetic completion 14 months after the start of treatment. Final considerations: We demonstrate clinical safety for the use of extraoral grafts without complications, representing a good alternative treatment for this group of patients.


Introdução: um dos desafios da cirurgia bucomaxilofacial é a reabilitação de pacientes com perda óssea severa, utilizando próteses implantossuportadas. Este desafio baseia-se na pequena estrutura óssea remanescente e na necessidade de reconstrução da estrutura para a reabilitação com enxertos autógenos ou exógenos. Relato de caso: Relatamos o caso de um paciente com atrofia maxilar grave, onde foi realizado enxerto de calota craniana associado à instalação de implante, com finalização protética 14 meses após o início do tratamento. Consideracoes finais: Demonstramos segurança clínica para o uso de enxertos extrabucais sem complicações, representando uma boa alternativa de tratamento para este grupo de pacientes.


Subject(s)
Mandible , Patients , Prostheses and Implants , Atrophy , Skull , Surgery, Oral , Jaw, Edentulous
2.
Rev. flum. odontol ; 2(58): 115-134, maio-ago. 2022. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1390941

ABSTRACT

A reabilitação de maxila atrófica se apresenta ainda nos dias de hoje como um desafio anatômico/fisiológico para os profissionais da área odontológica que visam buscar a instalação de implantes para futuras reabilitações protéticas, tendo em vista o grau de dificuldade de reconstituição do rebordo alveolar perdido. Com o intuito de reabilitar essas maxilas frente às adversidades, diferentes técnicas são propostas tais como enxertos ósseos autógenos, homógenos, substitutos ósseos alógenos, xenógenos e aloplásticos e suas respectivas técnicas. O objetivo deste trabalho foi apresentar um relato de caso clínico, no qual duas técnicas de reconstituição de rebordo alveolar de hemi-arco foram realizadas na mesma maxila utilizando biomaterial em bloco, visando comparar os resultados histológicos e clínicos. Após 5 meses da realização da enxertia, foi coletado material dos enxertos alveolares bilateralmente utilizando-se brocas trefinas para estudo histológico. Através da metodologia empregada, pode-se observar maior formação de estrutura óssea no lado em que foi praticada a metodologia transplantes celular odontológico (TCO), que preconiza a associação de sangue medular mandibular ao biomaterial, em relação a técnica contralateral em que utilizou a metodologia convencional, que preconiza a associação ao biomaterial do sangue periférico. Pode-se observar através da metodologia empregada que a utilização de biomateriais potencializados com sangue medular mandibular apresentou maior crescimento de estrutura óssea, incrementando em torno de 35% a mais na neoformação.de osso vital.


The rehabilitation of atrophic maxilla is still presented today as an anatomical/physiological challenge for professionals in the dental field who aim to seek the installation of implants for future prosthetic rehabilitations, in view of the degree of difficulty in reconstituting the lost alveolar ridge. In order to rehabilitate these jaws in the face of adversity, different techniques are proposed such as autogenous, homogenous bone grafts, allogeneic, xenogenous and alloplastic bone substitutes and their respective techniques. The aim of this study was to present a clinical case report, in which two hemi-arch alveolar ridge reconstruction techniques were performed in the same maxilla using biomaterial en bloc, in order to compare the histological and clinical results. After 5 months of grafting, material was collected from the alveolar grafts bilaterally using trephine burs for histological study. Through the used methodology, it was possible to see greater bone formation of structure on the side in which the dental cell transplantation (TCO) methodology was practiced, which advocates the association of mandibular medullary blood to the biomaterial, in relation to the contralateral technique in which the methodology was used conventional method, which advocates the association with peripheral blood biomaterial. It can be observed through the used methodology that the use of biomaterials potentiated with mandibular medullary blood showed greater growth of bone structure, increasing around 35% more in the neoformation of vital bone.


Subject(s)
Humans , Female , Middle Aged , Biocompatible Materials , Bone Regeneration , Dental Implants , Bone Transplantation , Maxilla
3.
Rev. flum. odontol ; 1(57): 54-69, jan.-abr. 2022.
Article in Portuguese | LILACS, BBO | ID: biblio-1391238

ABSTRACT

A colocação de implantes osseointegráveis requer volume ósseo adequado, porém, a extração de dentes leva a diferentes padrões de remodelaç ão e reabsorção óssea. A reabsorção do rebordo alveolar tem sido considerada uma consequência inevitável da extração dentária e pode ser um problema significativo em Implantodontia. Após a extração dentária, mesmo com a instalação de implantes imediatos, o sítio desdentado do processo alveolar sofre substancial modelagem óssea, com a diminuiç ão das dimensões da crista alveolar. Após a inserção de um implante em um local de extração fresco, um defeito marginal (GAP) ocorre, frequentemente, entre o rebordo e a superfície do implante, A fim de superar esse problema e para facilitar a formaç ão de osso no defeito marginal, vários processos de enxerto têm sido utilizados, associados ou não ao uso de membranas de barreira, bem como diversos tipos de substitutos ósseos que podem ser utilizados para tal procedimento. Esse trabalho tem por objetivo revisar e discutir a literatura relacionada ao uso de biomateriais sintéticos para preenchimento desses defeitos que se formam ao redor de implantes instalados em alvéolos frescos. No entanto, ainda não existe um biomaterial ideal que possua todas as pro- priedades desejáveis. Além disso, o volume de osso residual deve ser avaliado antes da extração de dentes, de modo que os cirurgiões possam utilizar técnicas diferentes para preservar o osso alveolar.


Subject(s)
Tooth Extraction , Biocompatible Materials , Bone Resorption , Alveolar Process
4.
Article in Chinese | WPRIM | ID: wpr-932299

ABSTRACT

Objective:To evaluate the clinic efficacy of channel bone grafting [preservation of the sclerotic bone at the broken nonunion ends and fixation with limited contact dynamic compression plate (LC-DCP)] in the treatment of postoperative atrophic nonunion of middle clavicular fracture.Methods:The 41 patients were retrospectively analyzed who had been treated at Department of Orthopaedics and Traumatology, Xi'an Hong-Hui Hospital for atrophic nonunion after internal fixation of middle clavicular fracture from June 2015 to December 2019. They were 23 males and 18 females, with a mean age of 47.6 years (from 28 to 63 years). The left side was affected in 25 cases and the right side in 16 cases. The time interval between initial fracture surgery and nonunion surgery averaged 18.5 months (from 9 to 40 months). Thirty-six cases had undergone one operation and 5 cases 2 operations before admission. The length of bone defect was measured during operation. All nonunions were treated with construction of a graft channel, iliac bone graft and LC-DCP internal fixation above the clavicle. The upper limb function of the affected side was evaluated by the Disabilities of Arm, Shoulder and Hand (DASH) 12 months after operation.Results:The 41 patients were followed up for an average of 13.6 months (from 12 to 15 months). A bone defect ≤2.0 cm was found in 25 cases and that >2.0 cm in 16 ones. Nonunion healed in all patients after an average time of 14 weeks (from 12 to 16 weeks). One patient reported continuous pain in the donor area after operation and the other developed deep venous thrombosis at the right lower limb. The DASH upper limb scores at 12 months after operation averaged 14.7.Conclusion:Channel bone grafting is a feasible clinical treatment of postoperative atrophic nonunion of middle clavicular fracture, because it preserves the sclerotic bone at the broken nonunion ends, reduces the amount of iliac bone graft and leads to fine clinic efficacy.

5.
Journal of Chinese Physician ; (12): 477-480, 2022.
Article in Chinese | WPRIM | ID: wpr-932086

ABSTRACT

The incidence of spinal tuberculosis ranks the first place among the bone and joint tuberculosis, and surgery is an important method of therapy, which can shorten the course of spinal tuberculosis, reduce treatment time and disability rate, and improve the quality of life. One-stage posterior debridement, interbody fusion with instrumentation is a safe and effective surgical approach that conforms to the " minimally invasive" concept, and has gradually become the mainstream surgical method for the treatment of spinal tuberculosis. In addition, radical debridement is relative, and strong internal fixation can better correct deformities and increase the stability of the spine.

6.
Article in Chinese | WPRIM | ID: wpr-928318

ABSTRACT

OBJECTIVE@#To investigate the clinical effect of using lengthened trochanteric osteotomy wire fixation combined with autologous bone graft in patients undergoing revision total hip arthroplasty.@*METHODS@#From December 2010 to December 2018, 18 patients underwent revision of total hip arthroplasty with extended trochanteric osteotomy wire fixation and autogenous bone graft, including 8 males and 10 females with an average age of (78.89±3.32) years old ranging from 68 to 82 years. The time from the initial replacement to the revision was 9 to 22 (16.33±2.93) years. The patients were followed up regularly after operation. The healing time of osteotomy, the time of full weight-bearing activity, Harris score of hip joint and complications were recorded.@*RESULTS@#All 18 patients were followed up for 16 to 38 months with an average of (25.78±6.65) months. The incision length was 16 to 21 cm with an average of (18.89±1.32) cm; the operation time was 105 to 128 min with an average of (115.44±6.59) min, the bleeding volume was 240 to 285 ml with an average of (267.44±13.77) ml. The healing time of osteotomy was 12 to 18 weeks with an average of (15.61±1.75) weeks. Harris score of hip joint was (47.11±5.04) before operation, (76.39±3.85) during full weight-bearing activities, and (82.22±2.76) at the final follow-up(P<0.05). During the follow-up period, there were no complications such as limb shortening, infection, poor incision healing, prosthesis loosening and sinking, and periprosthetic fracture.@*CONCLUSION@#In revision total hip arthroplasty, the use of extended trochanteric osteotomy wire fixation combined with autologous bone graft can achieve satisfactory clinical results, but the surgeon needs to make a systematic plan for the pre-revision, intraoperative and postoperative recovery.


Subject(s)
Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Bone Transplantation , Bone Wires , Female , Femur/surgery , Humans , Male , Osteotomy/methods
7.
Article in Chinese | WPRIM | ID: wpr-928300

ABSTRACT

OBJECTIVE@#To investigate the early efficacy of arthroscopic autologous osteochondral grafting in the treatment of recurrent anterior shoulder dislocation.@*METHODS@#From January 2019 to January 2021, 17 patients with recurrent anterior dislocation of shoulder who underwent arthroscopic autologous osteochondral grafting were selected, including 12 males and 5 females, ranging in age from 17 to 55 years old, with a mean of (32.88±12.33) years old. Rowes rating system for Bankart repair(Rowe), Oxford Shoulder Instability Score (OSIS) and Simple Shoulder Test (SST) were compared before operation, 6 months after operation and at the latest follow-up. OSIS and SST used to evaluate shoulder function were recorded before surgery and at the latest follow-up. The shoulder mobility and intraoperative and postoperative complications were also recorded.@*RESULTS@#All 17 patients were followed up, and the duration ranged from 7 to 25 months, with a mean of (18.4±5.4) months. During the follow-up period, there was no re-dislocation, no vascular or nerve injury. Rowe score increased from 26.2±6.0 before operation to 74.4±4.0 and 82.4±3.1 after 6 months and the latest follow-up. There was significant difference in Rowe score between different time points after operation and before operation (P<0.05). The OSIS increased from 37.0±3.6 before operation to 47.4±2.6 and 52.7±2.6 after 6 months and the latest follow-up. There was significant difference in OSIS between different time points after operation and before operation (P<0.05). The SST score increased from 6.8±0.7 before operation to 9.8±0.8, 11.6±2.6 after 6 months and the latest follow-up. There was significant difference in SST score between different time points after operation and before operation (P<0.05). At the latest follow-up, the lateral external rotation and abduction external rotation activities of the patient were significantly improved compared with those before operation.@*CONCLUSION@#This study provides preliminary evidence that arthroscopic autologous osteochondral grafting can achieve satisfactory early clinical outcomes and stability in patients with recurrent anterior shoulder dislocation with glenoid fracture and defect less than <20%, which is a reliable and effective procedure.


Subject(s)
Adolescent , Adult , Arthroscopy/methods , Female , Humans , Joint Instability/surgery , Male , Middle Aged , Range of Motion, Articular , Shoulder Dislocation/surgery , Shoulder Joint/surgery , Young Adult
8.
Article in Chinese | WPRIM | ID: wpr-928292

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy of locking plate fixation with a fibular strut allograft (FA group) and locking plate fixation alone (LP group) in the treatment of proximal humeral fractures in adults by Meta-analysis.@*METHODS@#Databases including PubMed, The Cochrane Library, Embase, Chinese BioMedical Literature Database(CBM), China National Knowledge Infrastructure(CNKI), WanFang Data, and China Science and Technology Journal Database (cpvip Database) were searched by computer from establishing to March 2020 to collect studies about locking plate fixation with fibular strut allograft versus locking plate fixation alone for proximal humeral fractures in adults. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. The postoperative humeral head height changes, neck-shaft angle changes, Constant-Murley score, American Shoulder and Elbow Surgeons(ASES)score, visual analogue scale(VAS), varus malunion rate, and screw penetration rate were compared by RevMan 5.3 software for Meta-analysis.@*RESULTS@#Ten cohort studies were enrolled in a total of 749 patients, 300 patients in the FA group and 449 patients in the LP group. The results of Meta-analysis showed that locking plate with fibular strut allograft was superior to locking plate fixation alone in the changes in humeral head height [MD=-2.69, 95%CI(-3.24, -2.13), P<0.000 01], the changes in neck-shaft angle [MD=-5.65, 95%CI(-7.18, -4.12), P<0.000 01], Constant-Murley score [MD=9.00, 95%CI(4.26, 13.73), P=0.000 2], the ASES score [MD=5.56, 95%CI(4.29, 6.84), P=0.000 01], VAS score [MD=-0.23, 95%CI(-0.37, -0.09), P=0.001], the varus malunion rate [RR=0.22, 95%CI(0.09, 0.53), P=0.000 7] and the screw penetration rate [RR=0.26, 95%CI(0.13, 0.55), P=0.000 3], respectively.While there was no significant difference in the rate of osteonecrosis of the humeral head [RR=1.18, 95%CI(0.57, 2.45), P=0.65].@*CONCLUSION@#For proximal humeral fractures in adults, current evidence shows that locking plate fixation with fibular strut allograft is superior to single locking plate fixation in improving postoperative radiological outcomes and shoulder function, relieving postoperative pain, reducing varus malunion rate and screw penetration rate. However, the efficacy in decreasing the osteonecrosis rate is not clear. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.


Subject(s)
Adult , Allografts , Bone Plates , Fracture Fixation, Internal/methods , Humans , Humeral Fractures , Retrospective Studies , Shoulder Fractures/surgery , Treatment Outcome
9.
Article in Chinese | WPRIM | ID: wpr-928270

ABSTRACT

Developmental dysplasia of the hip (DDH) is a major cause of hip arthritis and ultimately total hip arthroplasty. Due to the dysplastic acetabulum, how to place the acetabular cup becomes a challenge in acetabular reconstruction for such patients. Especially in the acetabula classified as Crowe typeⅡand type Ⅲ, the dislocation of the femoral head causes bone defects above the true acetabulum, which will affect the stability of the acetabular cup when the acetabular reconstruction is performed at the true acetabulum. Many acetabular reconstruction methods such as bone grafting, the use of small acetabular cups, socket medialization technique, and high hip center technique are used to increase the host bone coverage of the cup. However, each method has its own shortcomings that can not be ignored so that there is no unified conclusion on the acetabular reconstruction methods for Crowe typeⅡand type Ⅲ hip dysplasia. This article summarized and evaluated various reconstruction methods in combination with the acetabular morphology of DDH, and put forward the research direction in the future.


Subject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip , Developmental Dysplasia of the Hip , Hip Dislocation/surgery , Hip Dislocation, Congenital/surgery , Hip Prosthesis , Humans , Treatment Outcome
10.
Gac. méd. boliv ; 45(1)2022.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1385000

ABSTRACT

Resumen Las fracturas de cadera representan una causa importante de morbimortalidad en la población adulta, más del 50% corresponden a fracturas laterales, y entre ellas están las inestables que son de difícil manejo. Objetivo: analizar los resultados clínico-radiológicos de pacientes tratados con artroplastía parcial de cadera por fracturas transtrocantericas, utilizando injerto autólogo de calcar femoral. Métodos: el estudio prospectivo de enfoque cuantitativo. La muestra fue de 11 pacientes con fractura transtrocanterica de cadera, en quienes se realizó artroplastía utilizando un injerto de calcar femoral, con un seguimiento entre 4 a 6 meses, en el Hospital Obrero N°2 de Cochabamba. Se analizaron características clínicas, radiológicas y se realiza una descripción de la técnica quirúrgica. Resultados: la edad promedio de la población de estudio fue de 83,4 años, siendo el sexo femenino el 63,6% (7 pacientes) y el sexo masculino 36,4% (4 pacientes). Según la clasificación de la AO para fracturas laterales de cadera, el tipo 31A2.2 fue el principal con 45,5%. Mas del 50% tenían buena estabilidad según las zonas de Gruen. Mas del 60% evolucionaron entre bueno y excelente, según la escala de Harris, con un promedio de 83,65 (rango de 67,1 a 90,8) al tercer mes y un promedio de 84,74 al sexto mes. Conclusiones: el tratamiento de las fracturas laterales de cadera mediante esta técnica, creemos que puede ser una alternativa para el manejo de pacientes con fractura inestable, con altas probabilidades de falla de osteosíntesis y principalmente cuando el paciente y familiares estén de acuerdo con el procedimiento.


Abstract Hip fractures represent an important cause of morbimortality in the adult population, more than 50% correspond to lateral fractures, anc these include unstable fractures that are difficult to manage. Objective: to analyze the clinical and radiological results of patients treatec with partial hip arthroplasty for transtrochanteric fractures, using autologous femoral calcar graft. Methods: prospective study with a quantitative approach. The sample consisted of 11 patients with transtrochanteric hip fracture, who underwent arthroplasty using a femoral calcar graft, with a follow-up of 4 to 6 months, at the Hospital Obrero N°2 of Cochabamba. Clinical and radiological characteristics were analyzed and a description of the surgical technique was made. Results: the average age of the study population was 83.4 years with 63.6% female (7 patients) and 36.4% male (4 patients). According to the AO classification for lateral hip fractures, type 31A2.2 was the main one with 45.5%. More than 50% of the patients had good stability according to the Gruen zones. More than 60% evolved between good and excellent, according to the Harris scale, with an average of 83.65 (range from 67.1 to 90.8) at the third month and an average of 84.74 at the sixth month. Conclusions: we believe that the treatment of lateral hip fractures using this technique can be an alternative for the management of patients with unstable fractures, with a high probability of osteosynthesis failure and mainly when the patient and relatives agree with the procedure.

11.
CES odontol ; 34(2): 159-172, jul.-dic. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1374786

ABSTRACT

Resumen En los últimos años, la tecnología y la medicina han podido complementarse para la optimización de tiempo, conocimientos y recursos, aumentando la posibilidad de tratamientos personalizados en más pacientes. A nivel maxilofacial, la reconstrucción de defectos mandibulares se ha visto en la necesidad de progresar sus técnicas debido a la serie de orígenes que afectan el hueso mandibular de manera drástica, como lesiones traumáticas, cáncer, infecciones, enfermedad congénita u otros, y las innumerables consecuencias tanto estéticas como funcionales, restringiendo significativamente la calidad de vida. El objetivo de este artículo es revisar conceptos básicos del uso de tecnologías de impresión 3D en la reconstrucción mandibular. La impresión 3D ha aparecido en diversos ámbitos, siendo en el área de la medicina, un aporte fundamental para la creación de formas anatómicas de alta precisión con el que se pueden diseñar objetos con reproducción de detalles de manera rápida, luego de una serie de pasos que incluyen la obtención de una imagen radiográfica, uso de software y reparación de archivos, y la obtención de un modelo tridimensional. Los últimos estudios han validado el uso de impresiones 3D para una reconstrucción mandibular, con claros beneficios de costos y calidad de detalles. Es necesario crear un enfoque en las técnicas quirúrgicas utilizadas con un objeto impreso tridimensionalmente y un análisis post operatorio de los pacientes sometidos a estos procedimientos más allá de los detalles técnicos.


Abstract In recent years, technology and medicine have been able to complement each other to optimize time, knowledge and resources, increasing the possibility of personalized treatments in more patients. At the maxillofacial level, the reconstruction of mandibular defects has seen the need to progress its techniques due to the series of origins that drastically affect the mandibular bone, such as traumatic injuries, cancer, infections, congenital disease or others, and the innumerable both aesthetic and functional consequences, significantly restricting the quality of life. The objective of this article is to review basic concepts of the use of 3D printing technologies in mandibular reconstruction. 3D printing has appeared in various fields, being in the area of medicine, a fundamental contribution to the creation of high-precision anatomical shapes with which objects with reproduction of details can be designed quickly, after a series of steps which include obtaining a radiographic image, use of software and file repair, and obtaining a three-dimensional model. The latest studies have validated the use of 3D impressions for mandibular reconstruction, with clear benefits in cost and quality of details. It is necessary to create a focus on the surgical techniques used with a three-dimensional printed object and a post-operative analysis of the patients undergoing these procedures beyond the technical details.


Resumo Nos últimos anos, tecnologia e medicina têm se complementado para otimizar tempo, conhecimento e recursos, aumentando a possibilidade de tratamentos personalizados em mais pacientes. No nível maxilofacial, a reconstrução dos defeitos mandibulares tem visto a necessidade de progredir em suas técnicas devido à série de origens que afetam drasticamente o osso mandibular, como lesões traumáticas, câncer, infecções, doenças congênitas ou outras, e as inúmeras ambas estéticas. e consequências funcionais, restringindo significativamente a qualidade de vida. O objetivo deste artigo é revisar os conceitos básicos do uso das tecnologias de impressão 3D na reconstrução mandibular. A impressão 3D tem surgido em vários campos, sendo na área da medicina uma contribuição fundamental para a criação de formas anatômicas de alta precisão com as quais objetos com reprodução de detalhes podem ser desenhados rapidamente, após uma série de etapas que incluem a obtenção de uma imagem radiográfica, uso de software e reparo de arquivos e obtenção de um modelo tridimensional. Os estudos mais recentes têm validado o uso de impressões 3D para reconstruções mandibulares, com claros benefícios em custo e qualidade de detalhes. É necessário criar um foco nas técnicas cirúrgicas utilizadas com um objeto impresso tridimensional e uma análise pós-operatória dos pacientes submetidos a esses procedimentos para além dos detalhes técnicos.

12.
Article in English | LILACS-Express | LILACS | ID: biblio-1374886

ABSTRACT

ABSTRACT Introduction: The combination of non-vascularized iliac crest bone graft and distraction osteogenesis in a second surgical intervention has only been described to achieve alveolar ridge augmentation. This technique is not recommended to treat bone defects of the jaws caused by firearm projectile. Case presentation: 40-year-old woman with a segmental mandibular defect in the mandible body caused by the impact of a firearm projectile at the age of 1 year. The patient developed a severe Class II dentofacial anomaly that required a two-stage treatment; she underwent mandibular reconstruction with free iliac crest bone graft followed by a bilateral mandibular distraction at the level of the iliac crest bone graft. With these interventions, a remarkable improvement of the patient's malformation was achieved. Conclusion: Horizontal distraction of the free iliac crest bone graft is a safe and predictable procedure to treat dentolabial anomalies requiring mandibular reconstruction. This procedure was performed in the patient without complications. Further studies on the effectiveness of this technique are required.


RESUMEN Introducción. La combinación del injerto de la cresta ilíaca no vascularizado y la distracción osteogénica del injerto en una segunda intervención quirúrgica solo ha sido descrita para lograr un aumento del reborde alveolar. Esta técnica no se recomienda para tratar defectos óseos en la mandíbula causados por proyectil de arma de fuego. Presentación del caso. Mujer de 40 años con un defecto mandibular segmentario en el cuerpo mandibular causado por el impacto de un proyectil de arma de fuego a la edad de 1 año. La paciente desarrolló una anomalía dentofacial grave Clase II que requirió dos tratamientos en diferentes momentos: en primer lugar, se le practicó una reconstrucción mandibular con injerto de cresta ilíaca libre y posteriormente, una distracción mandibular bilateral que incluyó un injerto libre de cresta ilíaca. Con estas intervenciones se logró una mejoría notable de la malformación de la paciente. Conclusión. La distracción horizontal del injerto de cresta ilíaca libre es un procedimiento seguro y predecible para tratar anomalías dentolabiales que requieran reconstrucción de la mandíbula; no obstante, es necesario realizar más estudios sobre la efectividad de la técnica frente este tipo de malformaciones.

13.
Acta ortop. bras ; 29(4): 211-218, Aug. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1339048

ABSTRACT

ABSTRACT Objective: This study aimed to explore the clinical application of preoperative precise design for 3D printing and thumb reconstruction, which could help manage the patients with thumb defect and achieve better function and appearance. Methods: This was a retrospective study of 20 patients who underwent the surgery of harvesting toe transplant and thumb reconstruction between January 2015 and December 2016. The 3D model of the thumb defect was created and printed. The dimensions of skin and bones from donor site were precisely designed as reference for surgical operation. The surgery was performed according to the model. Results: Perfect repair of defects was achieved with satisfying appearance and function. The reconstructed thumbs all survived (survival rate of 100%). Follow-up was 3-9 months. The maximum dorsiflexion was 8-30° and the maximum flexion was 38-58°. The two-point sensory discrimination was 9-11 mm. In total, 17 patients reposted "Excellent" satisfaction and three "Good", each for the reconstructed thumb and hand function, respectively. The satisfaction rate was 85%. Conclusion: Preoperative digital design and 3D printing according to the donor and recipient sites allowed a tailored operation. The operation was more precise, the appearance of the reconstructed thumb was good. Level of Evidence II, Retrospective Study.


RESUMO Objetivo: Este estudo explorou a aplicação clínica do desenho pré-operatório preciso para impressão 3D e reconstrução do polegar, para ajudar no controle e melhorar função e aparência. Métodos: Estudo retrospectivo de 20 pacientes submetidos à cirurgia de colheita de transplante de dedo do pé e reconstrução do polegar entre janeiro de 2015 e dezembro de 2016. O modelo 3D do defeito do polegar foi confeccionado e impresso. As dimensões da pele e dos ossos da área doadora foram precisamente projetadas como referência para a operação cirúrgica, realizada de acordo com o modelo. Resultados: O reparo perfeito foi alcançado com aparência e função satisfatórias. Todos os polegares reconstruídos sobreviveram (taxa de sobrevivência de 100%). O acompanhamento foi de 3-9 meses. A dorsiflexão máxima foi de 8-30° e a flexão máxima foi de 38-58°. A discriminação sensorial de dois pontos foi de 9-11 mm. No total, 17 pacientes reportaram índice "Excelente" e três índice "Bom" cada para a função reconstruída do polegar e da mão, respectivamente. O índice de satisfação foi de 85%. Conclusão: O design digital pré-operatório e a impressão 3D de acordo com os locais doador e receptor permitiram uma operação customizada. A operação foi mais precisa, com bom aspecto. Nível de Evidência II, Estudo Retrospectivo.

14.
J. oral res. (Impresa) ; 10(3): 1-7, jun. 30, 2021. ilus, tab
Article in English | LILACS | ID: biblio-1391477

ABSTRACT

Objectives: To evaluate the use of extracted autogenous teeth for socket preservation after tooth extraction. Material and Methods: Cochrane, Scopus, and PubMed databases search was conducted to identify human clinical studies reporting the clinical, radiographic and/or histological outcomes of socket preservation techniques with autogenous extracted tooth Only studies published in English language in the last 10 years were included in the study. Results: In total, 82 articles were identified. Five articles were included in the review. They included 58 teeth that were prepared as a graft for socket preservation. The grafts derived from autogenous teeth were presented in three forms: particles, blocks and powder. The mean bone loss ranged from 0.28 mm to 0.41mm in height and 0.15 mm in width. Conclusion: Immediate autogenous extracted tooth as a grafting material for fresh socket preservation is promising for future daily clinical practice. More clinical comparative studies are needed.


Objetivo: Evaluar el uso de dientes extraídos autógenos para la preservación del alveolo tras la extracción dental.Material y Métodos: Se realizó una búsqueda en las bases de datos Cochrane, Scopus y PubMed para identificar estudios clínicos en humanos que informaban los resultados clínicos, radiográficos y / o histológicos de las técnicas de preservación de alveolos con dientes extraídos autógenos. Solo se incluyeron estudios publicados en inglés en los últimos 10 años. Resultados: En total se identificaron 82 artículos. Se incluyeron cinco artículos en la revisión. Incluyeron 58 dientes que se prepararon como injerto para la preservación del alveolo. Los injertos derivados de dientes autógenos se presentaron en tres formas: partículas, bloques y polvo. La pérdida ósea media osciló entre 0,28 mm y 0,41 mm de altura y 0,15 mm de ancho. Conclusión: El diente autógeno extraído de forma inmediata utilizado como material de injerto para la conservación del alveolo fresco es prometedor para la práctica clínica diaria futura. Se necesitan más estudios clínicos comparativos.


Subject(s)
Humans , Tooth Extraction , Bone Transplantation/methods , Tooth Socket/surgery , Bone Remodeling , Dental Implants, Single-Tooth , Autografts
15.
Article in English | LILACS-Express | LILACS | ID: biblio-1385187

ABSTRACT

ABSTRACT: Osseointegrated implants are currently the prosthetic treatment by predilection in the oral cavity when dental organs have been lost. Bone deficiency interferes with the placement of these prosthetic attachments; To solve this lack of bone tissue in alveolar ridges, autologous, homologous or heterologous bone grafting techniques are proposed. The ultra-low speed drilling without irrigation, it is possible to collect autologous bone at the time of preparing the surgical site before placing the dental implant, which provides the best properties for bone regeneration without the need for another wound or more morbidity for the patient. We describe our ultra-low speed drilling protocol step by step, obtaining autologous bone from the same surgical site to rehabilitate small bone defects around the implant reducing comorbidities and surgical times.

16.
Article in Chinese | WPRIM | ID: wpr-879431

ABSTRACT

OBJECTIVE@#To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing.@*METHODS@#From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation.@*RESULTS@#All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening).@*CONCLUSION@#It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.


Subject(s)
Adult , Bone Nails , Bone Plates , Bone Transplantation , Female , Femoral Fractures/surgery , Femur , Fracture Fixation, Intramedullary , Fracture Healing , Fractures, Ununited/surgery , Humans , Male , Middle Aged , Quality of Life , Treatment Outcome
17.
Article in Chinese | WPRIM | ID: wpr-847201

ABSTRACT

BACKGROUND: Research evidence shows hip arthroplasty has become the final treatment of osteonecrosis of femoral head, but early-and middle-stage osteonecrosis of femoral head or young patients often give priority to hip preservation treatment, including conservative treatment and surgical treatment. OBJECTIVE: To summarize the progress of hip preservation in the treatment of osteonecrosis of femoral head. METHODS: The literature about hip-preserving treatment of osteonecrosis of femoral head in PubMed, VIP, CNKI and Web of Science databases from 2010 to March 2020 was searched by computer. The key words were “osteonecrosis of femoral head, hyperbaric oxygen, pulsed electromagnetic fields, extracorporeal shock wave, hip arthroscopy, core decompression, stem cell transplantation, non-vascularized free bone grafting, vascularized free bone grafting, porous tantalum rod implantation, intertrochanteric osteotomy, medication”. A total of 197 articles were retrieved, and the full text was consulted. According to the inclusion criteria, 59 articles were included for result analysis. RESULTS AND CONCLUSION: (1) Drug therapy should be used cautiously because of its potential side effects and insufficient research. (2) Physiotherapy is effective for early lesions, and it has the advantages of non-invasion and convenient operation. (3) At present, there are different types of hip preservation surgery. Core decompression is the basic therapy for the treatment of osteonecrosis of femoral head, but it is seldom used alone. At present, it is often treated in combination with other hip preservation therapies. Osteotomy has higher requirements in the selection of patients’ indications and surgical skills, so it should be chosen carefully in clinic. There are some problems in porous tantalum rod implantation, such as long operation time, large blood loss and difficulty of hip replacement in the later stage. Stem cells and arthroscopic therapy show good results, and the research process should be accelerated. Vascularized bone grafting has a good effect on both middle-and late-stage patients.

18.
Chinese Journal of Microsurgery ; (6): 261-266, 2021.
Article in Chinese | WPRIM | ID: wpr-912241

ABSTRACT

Objective:To investigate the clinical effect of the free medial femoral condylar bone flap in treatment of scaphoid nonunion.Methods:From May, 2012 to May, 2016, 15 patients, which were 10 males and 5 females and aged from 18 to 63 (mean 43.5±15.5) years, with scaphoid nonunion were treated with transfer of free medial femoral condyle bone flaps. After debridement of the fractural segment in surgery, the bone flap was transferred to scaphoid and had the bone defect filled. The artery of the bone flap was end-to-side or end-to-end anastomosed to the radial artery. The concomitant vein of the bone flap was end-to-end anastomosed to the concomitant vein of the radial artery. Thirteen patients were treated with the free osteoperiosteal medial femoral condylar graft, and 2 were treated with the free osteochondral medial femoral condylar graft. Fracture healing was evaluated based on X-ray evidence. The clinical effect was evaluated by visual analogue scale (VAS), strength of grip and modified Mayo wrist score. The t-test was used to compare the function between before and after surgery. Results:All patients were entered into a followed-up for an average of 32.5 (8-60) months, 11 of them took the follow-up reviews at the outpatient clinic and 4 via WeChat distanced interviews. All fractures of the 15 patients healed with an average healing time at 12.5 (10-16) weeks. The VAS score decreased from (3.5±1.5) before the surgery to (1.0±1.0) after the surgery. The strength of grip increased from (16.5±4.3) kg before the surgery to (31.5±3.5) kg at the last follow-up review. The modified Mayo wrist score increased from (46.2 ±11.4) before the surgery to (68.5 ±10.8) at the last follow-up review. The wrist function was excellent in 8 patients, good in 6 and fair in 1. There was significant difference in functional evaluation ( P<0.05). Conclusion:The transfer of free medial femoral condylar bone flap is effective in the treatment of scaphoid nonunion. This technique provides both of sufficient blood supply and a structural support for defected scaphoid bone and promotes the healing of fracture. Osteochondral flap transfer may be used as an alternative measure to prevent wrist osteoarthritis and collapse, in the case that there is an avascular necrosis of the proximal pole of the scaphoid. It has an advantage in the treatment of refractory scaphoid nonunion.

19.
Article in Chinese | WPRIM | ID: wpr-888310

ABSTRACT

OBJECTIVE@#To investigate the short-term clinical effect of double channel decompression and bone grafting through the greater trochanter combined with allograft fibula propping in the treatment of osteonecrosis of femoral head (ONFH).@*METHODS@#Twenty two patients (23 hips) with osteonecrosis of the femoral head were included from November 2017 to February 2019. According to Association Research Cirulation Osseous(ARCO) staging, there were 13 hips at stageⅡgroup, aged from 20 to 48 years old with an average of(32.5±8.5)years old;10 hips at stageⅢgroup, aged from 18 to 45 years old with an average of(32.7±8.6) years old. A single approach through the greater trochanterwas used for decompression, bone grafting and fibula support. Harris scoring system was used to evaluate the function of hip joint before and after implantation, and the anteroposterior and lateral X-ray films of hip joint were taken at 3, 6, 12 and 18 months after implantation to observe and analyze the progress of femoral head necrosis and regeneration.@*RESULTS@#All patients were followed up, and the duration ranged from 12 to 18 months with an average of (14.6±2.1) months. Harris score of stageⅡand stageⅢpatients increased from 73.2± 5.5 and 66.5±3.4 to 87.6±8.7(@*CONCLUSION@#The effect of double trochanteric decompression and bone grafting combined with fibular allograft propping in the treatment of early and middle stage avascular necrosis of the femoral head is good, especially suitable for young and middle aged patients with ARCOⅡstage avascular necrosis of the femoral head.


Subject(s)
Adolescent , Adult , Allografts , Bone Transplantation , Decompression , Femur Head , Femur Head Necrosis , Fibula , Follow-Up Studies , Humans , Middle Aged , Treatment Outcome , Young Adult
20.
Article in Chinese | WPRIM | ID: wpr-910061

ABSTRACT

Objective:To compare the efficacy of minimally invasive percutaneous pedicle screw fixation combined with injured vertebra bone grafting (PPSF+BG) and simple percutaneous pedicle screw fixation (PPSF) in the treatment of single segmental thoracolumbar compression fracture.Methods:The data were analyzed retrospectively of the 56 patients who had undergone PPSE at Department of Spine Surgery, Wuhan Puren Hospital from February 2017 to May 2019. Of them, 29 were treated by PPSF+BG [17 males and 12 females with an age of (50.6±8.4) years] and 27 by simple PPSF [13 males and 14 females with an age of (49.3±8.2) years]. The 2 groups were compared in terms of operation time, intraoperative blood loss, hospital stay and incidence of complications. The height of anterior edge of injured vertebra, cobb angle of injured kyphosis, visual analogue scale (VAS) and Oswestry disability index (ODI) at postoperative 1, 6 and 12 months were also compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). All of them were followed up for more than 12 months. There was no significant difference between the 2 groups in operation time, intraoperative blood loss, hospital stay or incidence of complications ( P>0.05). There was no significant difference between the 2 groups either in the height of anterior edge of injured vertebra, cobb angle of injured kyphosis or ODI score at 1 or 6 months after operation ( P>0.05). At 12 months after operation, PPSF+BG group had a significantly greater height of injured vertebra [(19.5±0.9) mm], a significantly smaller cobb angle of kyphosis (7.1°±0.5°) and a significantly lower ODI score (11.1±2.9) than PPSF group [(18.2±1.3) mm, 8.1°±0.5° and 19.5±1.6] ( P<0.05). At postoperative 6 and 12 months, the VAS scores in PPSF+BG group were significantly lower than those in PPSF group ( P<0.05). In all the patients, the postoperative height of anterior edge of injured vertebra, cobb angle of injured kyphosis, VAS and ODI scores were significantly improved than the preoperative values ( P<0.05). Conclusion:Although both minimally invasive percutaneous pedicle screw fixation combined with bone grafting and simple percutaneous pedicle screw fixation can achieve good therapeutic outcomes for single segmental thoracolumbar compression fractures, the former may be superior in effectively promoting rapid recovery of the patients and improving the quality of life of the patients after operation.

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