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International Eye Science ; (12): 1523-1527, 2022.
Article in Chinese | WPRIM | ID: wpr-940015


AIM:To evaluate the application effect of iris hooks combined with suture fixation of capsular tension ring(CTR)in the treatment of phacoemulsification with secondary glaucoma associated with lens subluxation.METHODS: Retrospective case series. A total of 18 eyes of patients with serious secondary glaucoma associated with lens subluxation were enrolled in Aier Eye Hospital(Changchun)from October 2017 to May 2020 as the observation group. All the patients had iris hooks inserted to support the capsule during the phacoemulsification combined with intraocular lens(IOL)implantation. Iris hooks were inserted through the incisions and placed in the capsulorhexis to support the capsule, then CTR was implanted and sutured onto the sclera of the dislocation side. A total of 11 eyes of patients had intracapsular cataract extraction combined with IOL suspension were enrolled in Aier Eye Hospital(Changchun)from October 2015 to October 2017 as the control group. The postoperative complications were recorded. The postoperative examinations included visual acuity, intraocular pressure(IOP)and positions of the capsule and IOL.RESULTS: The postoperative follow-up at least 12(12-40)mo, both the IOP of observation group and control group returned to normal, with statistically significant difference compared with pre-operation(t=9.994, 8.790, all P<0.001). At 12mo after operation, the best corrected visual acuity of the two groups were significantly improved compared with surgery before(Z=-3.900, P<0.001; Z=-3.002, P=0.003). The IOL in the observation group of the 18 eyes were in the expected position without complications such as an obvious tilt or displacement. In the control group with 11 eyes, the position of IOL in 8 eyes were centered, 3 eyes were slightly biased, and 2 eyes with cystoids macular edema.CONCLUSION: The application of suture fixation capsular tension ring and iris hooks for secondary glaucoma associated with lens subluxation in patients can be used as an effective auxiliary method, it could effectively control the IOP and maintain long-term stability of the capsule.

Article in Chinese | WPRIM | ID: wpr-930448


Objective:To investigate the clinical characteristics of children with Kawasaki disease (KD) complicated with atlantoaxial rotatory subluxation (AARS).Methods:Clinical characteristics of 60 AARS patients complicated with KD (the atlantoaxial rotatory subluxation group) and 60 patients with KD only diagnosed (the control group)in the Children′s Hospital of Chongqing Medical University from December 2010 to December 2019 were retrospectively analyzed.Differences between groups were compared by the Chi- square test and the t test. Results:A total of 8 365 KD patients were diagnosed during the study period, involving 60 cases (0.72%) complicated with AARS.which usually occurred in the acute phase with the onset ages of 3 to 6 years ( P<0.001). Initial clinical symptoms of KD complicated with AARS included fever with restricted neck movement (100.00%), neck mass (66.67%), torticollis (21.67%) and neck pain (11.67%). CT or X-ray exa-mination of the neck indicated AARS, with thickening and swelling of the cervical soft tissues in some cases.Compared with those of control group, red, dry, cracked lips ( P=0.01) and cervical lymph node swollen ( P<0.001) were significantly pronounced in KD patients complicated with AARS.The absolute and relative count of neutrophils were significantly higher in KD patients complicated with AARS (all P< 0.05). Cervical soft tissue swelling and thickening in B-ultrasound were more obvious than those in the control group( P<0.05). However, there were no significant differences in coronary artery lesions and the response to intravenous immunoglobulin (IVIG) combined with Aspirin between groups ( P>0.05). Head traction could relieve neck symptoms to a certain extent, but there was no significant difference between groups ( P>0.05). Conclusions:Cervical lymphadenopathy, red, dry, cracked lips, increase of absolute and relative count of neutrophils, and swelling and thicke-ning of cervical soft tissues were the high-risk factors of KD complicated with AARS.The complication of AARS in KD patients did not increase the risk of coronary artery injury and IVIG resistance.IVIG combined with aspirin achieved a good prognosis in the majority of KD patients complicated with AARS.

International Eye Science ; (12): 480-484, 2022.
Article in Chinese | WPRIM | ID: wpr-920436


@#AIM: To evaluate the clinical efficiency of phacoemulsification combined with intrascleral fixation of intraocular lens(IOL)by using Yamane's technique in the treatment of acute secondary angle-closure(ASAC)caused by lens subluxation.<p>METHODS: Clinical data of 15 patients(15 eyes)with ASAC caused by lens subluxation who underwent phacoemulsification combined with intrascleral fixation of IOL by using Yamane's technique from June 2019 to December 2020 were reviewed retrospectively. The patients were followed for 3mo. The preoperative and postoperative intraocular pressure(IOP), best corrected visual acuity(BCVA), positions of the IOL and complications were observed. <p>RESULTS: All the operations were successfully completed. The postoperative IOPs were lower than preoperative IOPs. There were overall differences between preoperative and postoperative IOPs(F=165.57, P<0.001). Through further pairwise comparison, the IOPs at 1d, 1wk, 1, and 3mo after operation were significantly different from IOPs before operation(all P<0.001). The IOPs remained normal range at 1wk, 1, and 3mo after operation. The BCVA at 3mo after operation was significantly better than the preoperative BCVA(t=10.717, P<0.001). All IOLs were in the expected position without an obvious tilt or displacement. No serious complications occurred after the operation. <p>CONCLUSION: The surgical strategy of phacoemulsification combined with intrascleral fixation of IOL by using Yamane's technique in the treatment of ASAC caused by lens subluxation was safe and effective by lowing IOP, rescuing visual, maintaining stability of IOL and reducing complications.

FAVE, Secc. Cienc. vet. (En línea) ; 20(2): 97-102, jul. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1375468


Resumen La subluxación sacroilíaca es una enfermedad claudiocógena de los miembros posteriores que se puede presentar de forma aguda o crónica. La causa de esta patología se debe principalmente a resbalones, tropezones o caídas de los miembros posteriores, el diagnóstico es difícil de realizar debido a la profunda ubicación anatómica de la articulación, métodos como la ecografía y pruebas de estrés entre otros, son los procedimientos más usados en el diagnóstico de la subluxación sacroiliaca. Por tratarse de una alteración que fácilmente puede confundirse con otras condiciones patológicas de la columna, la pelvis y/o de los miembros posteriores, el diagnóstico muchas veces se realiza por eliminación de otras causas de cojera. Los tratamientos convencionales aún se proponen en la literatura, sin embargo, cada vez como opción para el tratamiento de esta patología. El presente reporte describe el caso de un equino criollo que padeció una subluxación sacroiliaca aguda del lado derecho, la cual fue diagnosticada con un examen clínico que incluía ecografía percutánea y transrectal, y tratada con infiltraciones ecoguiadas de corticoides y aspirado de médula ósea. Un mes después de la última terapia, el caballo mostró una mejoría clínica en un 80% a 90% aproximadamente y retoma actividad física controlada.

Abstract Sacroiliac subluxation is a claudiogenic disease of the hind limbs that can present acutely or chronically. The cause of this pathology is mainly due to slipping, tripping, or falling of the hind limbs, the diagnosis is difficult to make due to the deep anatomical location of the joint, methods such as ultrasound and stress tests among others, are the procedures most used in the diagnosis of sacroiliac subluxation. As it is an alteration that can easily be confused with other pathological conditions of the spine, pelvis and / or the hind limbs, the diagnosis is often made by eliminating other causes of lameness. Conventional treatments are still proposed in the literature, however regenerative therapy is increasingly used as an option for the treatment of sacroiliac joint injuries. This report describes the case of a Creole horse that suffered an acute sacroiliac subluxation on the right side, which was diagnosed with a clinical examination that included percutaneous and transrectal ultrasound and treated with ultrasound-guided infiltrations of corticosteroids and cells of the bone marrow of the sternum without processing. One month after the last therapy, the horse showed an 80% to 90% recovery and resumed controlled physical activity.

Arq. bras. neurocir ; 40(1): 101-106, 29/06/2021.
Article in English | LILACS | ID: biblio-1362259


Traumatic atlantoaxial rotatory subluxation (AARS) is generally found in pediatric patients, rarely found in adults, being a life-threatening condition especially when early diagnosis is not possible, which can lead to severe late neurological deficits.We describe a 38-year-old patient, victim of physical aggression caused by strangulation attempt who developed AARS, an uncommontraumatic cause. During the hospital care, the early diagnosis allowed us to institute a conservative treatment, which made the case uncommon, since most of the time surgical treatment is imperative. With the patient awake and under analgesia, a closed reduction was performed that promoted immediate pain relief, followed by a prescription of wearing a Philadelphia-type collar for 8 weeks. During the follow-up, cervical spine radiographies demonstrated no subluxation after removing the cervical collar. The patient was asymptomatic after 6months of treatment. This case supports the importance of nonoperative management of AARS in selected cases.

Humans , Female , Adult , Atlanto-Axial Joint/injuries , Cervical Vertebrae/injuries , Joint Dislocations/therapy , Spinal Injuries/therapy , Traction/rehabilitation , Manipulation, Spinal/methods , Joint Dislocations/diagnostic imaging
Rev. colomb. ortop. traumatol ; 35(3): 295-300, 2021. ilus.
Article in Spanish | LILACS, COLNAL | ID: biblio-1378729


La inestabilidad de hombro es una condición frecuente en personas involucradas en actividades deportivas de alta demanda física. Debido a sus particularidades anatómicas, los adolescentes presentan mayor riesgo de recidiva luego de un primer episodio de luxación de hombro. El sexo masculino, edad y participación en actividades deportivas de alto impacto son los principales factores de riesgo para recurrencia. En esta publicación, reportamos el caso de una adolescente porrista con inestabilidad anterior de hombro con evolución favorable luego de estabilización abierta complementado por una revisión del estado del arte de las aproximaciones terapéuticas de la inestabilidad recurrente de hombro en adolescentes.

Shoulder instability is a frequent condition in people involved in sport activities of high-physical demand. Due to their anatomical features, adolescents are at greater risk of recurrence after a first episode of shoulder dislocation. Male gender, age and participation in high-impact sport activities are the main risk factors for recurrence. We report the case of a cheerleader teenager with anterior shoulder instability with favorable evolution after open stabilization complemented by a review of the state of the art of the therapeutic approaches of recurrent shoulder instability in adolescents.

Humans , Adolescent , Shoulder Dislocation , Shoulder Joint , Joint Instability
Article in Chinese | WPRIM | ID: wpr-912867


According to Chinese medicine, the atlantoaxial joint is a composite joint composed of tendons and bones, and the stability of the joint depends on the 'tendon-bone balance' involving tendons, ligaments, atlas and axis. Multiple causes of 'tendon off-position, joint subluxation' will lead to joint 'tendon-bone imbalance', which will evolve into atlantoaxial subluxation (AAS), endangering human health. Chinese therapeutic massage (tuina) is a very effective treatment for AAS in adults, but conventional manipulations are prone to ineffectiveness or accidents due to neglect of the causal relationship of the 'tendon-bone imbalance' and inappropriate manipulations. Compared with conventional manipulations, the rational choice of modified manipulations under the guidance of 'tendon-bone balance' theory is more effective and less risky, and more worthy of clinical promotion. From the 'tendon-bone balance' theory, we considered the shortcomings of conventional manipulations, and introduced several modified manipulations that have their own strengths in 'tendon smoothing' and 'bone setting', in order to provide new ideas for treatment of AAS in adults.

Article in Chinese | WPRIM | ID: wpr-912352


Objective:To observe the clinical characteristics of primary retinitis pigmentosa (RP) complicated with glaucoma.Methods:A retrospective clinical study. From June 2008 to March 2020, the diagnosis of primary RP were included in the diagnosis confirmed by the eye examination of West China Hospital of Sichuan University included 4794 eyes of 2432 patients. Among them, 4679 eyes (97.2%, 2364/2432) were in 2364 cases with RP alone, and 115 eyes were in 68 cases with RP combined with glaucoma (2.80%, 68/2432). All affected eyes underwent best corrected visual acuity (BCVA) and intraocular pressure examination. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. The 67 eyes of 40 patients with RP and glaucoma with complete follow-up data were analyzed to observe the proportion of different glaucoma types, logMAR BCVA, intraocular pressure and other clinical characteristics, as well as treatment methods and post-treatment intraocular pressure control. After treatment, the intraocular pressure ≤21 mm Hg (1 mm Hg=0.133 kPa) was regarded as intraocular pressure (IOP) control; >21 mm Hg was regarded as uncontrolled IOP.Results:Among the 67 eyes of 40 cases with complete follow-up data, 5 cases (7 eyes) with primary open-angle glaucoma (10.45%, 7/67), 56 cases (58 eyes) with angle-closure glaucoma (ACG) (86.57%, 58/67), 4 cases (4 eyes) with neovascular glaucoma (5.97%, 4/67), 2 of them had both ACG and neovascular glaucoma. Among 58 ACG eyes, 17 eyes were acute ACG (25.37%, 17/67), 21 eyes were chronic ACG (31.34%, 21/67), and 2 eyes were suspicious angle closure (2.99%, 2/67), lens dislocation secondary to angle-closure glaucoma in 8 eyes (11.94%, 8/67), chronic angle-closure glaucoma after anti-glaucoma surgery, intraocular lens shift in 5 eyes (7.46%, 5/67), 5 eyes (7.46%, 5/67) secondary to glaucoma with true small eyeballs. The logMAR BCVA 3.50 of the affected eye,<3.50->2.00, ≤2.00-≥1.30,<1.30->1.00, ≤1.00- 0.52,<0.52 were 9 (13.43%, 9/67), 30 (44.78%, 30/ 67), 7 (10.45%, 7/67), 4 (5.97%, 4/67), 11 (16.42%, 11/67), 6 (8.96%, 6/67) eyes, which correspond to mean intraocular pressure were 32.31±11.67, 30.15±14.85, 28.17±13.19, 31.50±17.25, 18.71±8.85, 14.12±4.25 mm Hg. Among 67 eyes, 37eyes (55.22%, 37/67), 18eyes (26.86%, 18/67), and 6 (8.96%, 6/67) eyes underwent surgery, medication alone, and peripheral iris laser perforation treatment, respectively. The treatment of 6 eyes was abandoned (8.96%, 6/67). Malignant glaucoma occurred in 3 eyes (8.11 %, 3/37) after the operation, all of which were after trabeculectomy of the ACG eye. After treatment, intraocular pressure was controlled in 37 eyes (55.22%, 37/67), 19 eyes were not controlled (28.36%, 19/67), and 11 eyes were lost to follow-up (16.42%, 11/67).Conclusions:The incidence of glaucoma in patients with primary RP is 2.80%. ACG is more common, and the combined lens dislocation or intraocular lens shift is more common.

Gac. méd. boliv ; 43(1): 100-102, ago. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1124809


El trauma ocular es una causa frecuente de consulta en los servicios de oftalmología, es más frecuente en el género masculino. Dependiendo de la gravedad del daño ocasionado, el tratamiento representa un reto para el oftalmólogo, porque, se enfrenta ante un daño patológico integral y complejo. El presente caso corresponde a un paciente masculino con baja de agudeza visual importante en ojo derecho, con antecedente de trauma ocular contuso, ocasionado con una piedra, en su ambiente laboral, que acude dos meses posterior al trauma ocular. Al examen presenta secuelas del trauma ocular contuso, fibrosis capsular anterior, catarata traumática, subluxación de cristalino, etc. El pronóstico visual tras un procedimiento quirúrgico es bueno, sin embargo, el paciente rechaza la cirugía. Por lo tanto, es muy importante el uso de lentes de trabajo que puede prevenir accidentes laborales.

The ocular trauma is a frequent cause of consultation in ophthalmology services, it is more frequent in males. Depending on the severity of the damage caused, the treatment represents a challenge for the ophthalmologist, because, he faces an integral and complex pathological damage. The present case corresponds to a male patient with low visual acuity in the right eye, with a history of blunt eye trauma, caused by a stone, in his work environment, who came two months after the eye trauma. On examination, he presented sequels of blunt ocular trauma, anterior capsular fibrosis, traumatic cataract, lens subluxation, etc. The visual prognosis after a surgical procedure is good, however, the patient rejects the surgery. Therefore, it is very important to wear work glasses that can prevent workplace accidents.

Arq. bras. oftalmol ; 83(4): 329-331, July-Aug. 2020. graf
Article in English | LILACS | ID: biblio-1131599


ABSTRACT Despite the recent developments in modern cataract surgery and the application of a vast array of new devices and machines, late in-the-bag intraocular lens dislocation remains a devastating, albeit rare, complication. Various nonsurgical and surgical techniques have been used to manage this complication. We report a case of spontaneous repositioning in the left eye of an anteriorly subluxated in-the-bag intraocular lens. The spontaneous repositioning may have been caused by antagonistic effects related to the topical administration of brimonidine and prednisolone. The dislocation was treated without aggressive manipulation or surgical intervention.

RESUMO Apesar dos recentes avanços na cirurgia moderna de catarata e da aplicação de uma ampla gama de novos dispositivos, o deslocamento tardio de uma lente intraocular dentro do saco capsular continua a ser uma complicação devastadora, ainda que rara. Várias técnicas cirúrgicas e não cirúrgicas têm sido usadas para tratar esta complicação. Este é o relato de um caso de reposicionamento espontâneo de uma lente intraocular sub-luxada anteriormente dentro do saco capsular do olho esquerdo. Este reposicionamento pode ter sido causado pelos efeitos opostos da aplicação tópica simultânea de brimonidina e prednisolona. O deslocamento foi tratado sem manipulação agressiva ou intervenção cirúrgica.

Humans , Drug Repositioning , Lenses, Intraocular , Postoperative Complications , Visual Acuity , Lens Subluxation , Retrospective Studies
Indian J Ophthalmol ; 2020 Mar; 68(3): 466-470
Article | IMSEAR | ID: sea-197829


Purpose: To assess the role of surgical peripheral iridectomy (PI) in preventing iris-related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis. Methods: Nonrandomized interventional case series of 34 eyes of 17 children (<15 years of age) who underwent pars plana lensectomy (PPL) and GIOL surgery between January 2013 and December 2016. Eyes with surgical PI (January 2013–June 2015) were compared with those without surgical PI (July 2015–December 2016). The primary outcome measure of the role of surgical PI in GIOL surgery was to account for complications such as optic capture, secondary glaucoma, intraocular lens (IOL) dislocation, or repeat surgery. The secondary outcomes were changes in the best-corrected visual acuity (BCVA). Results: The mean age at surgery was 8.8 years (range: 3.5–15 years). Surgical PI was conducted in 15 eyes. Among the 19 eyes without PI, 9 eyes had complications (optic capture –6; rise in IOP –4; IOL subluxation –4; repeat surgery –5). The complications were significantly less in the PI group, P = 0.02. There was a statistically significant improvement in BCVA (P = 0.0001) in all the patients. The mean presenting BCVA was 0.99 (±0.79) logMAR (Snellen ? 20/200) and post BCVA was 0.40 (±0.50) (Snellen ? 20/50). The mean preoperative refraction was ? 9 D (±8D) (range: ?5 D to ?23D) and postoperative was ?1 (±1.15) D. The mean follow-up was 25.4 months. Conclusion: Surgical PI along with GIOL surgery in children undergoing PPL is shown to reduce optic-capture-related complications.

Article in Chinese | WPRIM | ID: wpr-827238


OBJECTIVE@#To observe the application of modified traction therapy in traumatic atlantoaxial subluxation in adults.@*METHODS@#The clinical data of 31 patients with atlantoaxial subluxation treated from March 2018 to June 2019 were restropectively analyzed. There were 15 males and 16 females, aged from 18 to 68 years old with an average of 39 years old, including 10 cases of 18-40 years, 15 cases of 41-60 years, 6 cases of 51-68 years. The main manifestations of the patients were limited neck movement, pain, and atlantoaxial CT scan showed different degrees of atlantoaxial subluxation. Three dimensional multifunctional traction bed was used for traction for 2 min, relaxation for 10 s. The traction angle starts from the rearward extension of 5°-10° and weight from 3-6 kg. The weight increased by 1 kg every two days until the symptoms were improved. Traction time was 30 min twice a day and 10 days for a course of treatment. One course of treatment was performed in patients with 1-2 mm left and right equal width of atlantoaxial space, and two courses of treatment were performed in patients with 3-4 mm left and right equal width of atlantoaxial space, and the course of treatment could be increased to 3 months in especially patients with serious problems, such as 4 mm left and right equal width of atlantoaxial space and no improvement after conventional treatment. The criteria to evaluate the clinical effect was cure:no pain in the neck, normal range of neck movement, CT showed normal atlantoaxial space and odontoid process was in the middle, patients with normal neck movement were followed up 1 month after the end of treatment;improvement:neck pain was significantly improved and CT showed that the left and right atlantoaxial space was less than 1 mm in equal width.@*RESULTS@#Among the 31 patients, 17 cases were cured by one course of treatment, 11 cases were cured by 2 courses of treatment, and 2 caseswere improved.@*CONCLUSION@#The modified traction therapy has obvious effect on adult traumatic atlantoaxial subluxation, especially the subluxation of 3-4 mm equal width in left and right atlantoaxial space, and this method is safe and reliable with good efficacy and the patients without discomfort.

Adolescent , Adult , Aged , Atlanto-Axial Joint , Female , Humans , Joint Dislocations , Male , Middle Aged , Odontoid Process , Spinal Fusion , Traction , Young Adult
International Eye Science ; (12): 921-923, 2020.
Article in Chinese | WPRIM | ID: wpr-820924


@#AIM:To analyze the effectiveness and safety of different surgical strategies for cataract combined with subluxated lens. <p>METHODS: This is a retrospective study. Data are acquired from patients who diagnosed with cataract combined with subluxated lens between November 2018 to May 2019 in the ophthalmological center of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine. There are 11 eyes in 11 patients(9 males and 2 females), 10 eyes were caused by trauma and 1 eye was unknown. Cataract combined with subluxated lens were treated with different surgery procedures according to the degree of dislocation. Four eyes with lens dislocation larger than 270° underwent intraocular lens suspension; Four eyes with lens dislocation about 180° underwent IOL and tension ring implant in capsular, at the same time, the iris hook was hooked to the lens capsule bag and fixed to the sclera. Three eyes with lens dislocation less than 180° underwent IOL implantation combined with 5-0 polypropylene suture, iris hook was also hooked to the lens capsule bag and fixed to the sclera. If the anterior chamber has vitreous prolapse, anterior vitrectomy was performed. Best corrected visual acuity(BCVA)and intraocular pressure(IOP)were observed before and after surgery. <p>RESULTS: All eyes were successfully implanted with intraocular lens(IOL). Best corrected visual acuity(LogMAR)increased from 0.77±0.26 to 0.35±0.28. Mean IOP decreased from 24.33±13.55 to 13.85±3.80mmHg. No intraoperative complications occurred in all cases.<p>CONCLUSION: In the treatment of lens dislocation with cataract, individualized surgical plan and flexible treatment measures can make cataract surgery safe and effective.

Rev. cuba. reumatol ; 21(3): e108, sept.-dic. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1093834


Introducción: la subluxación atloaxoidea es un trastorno de la columna cervical, a nivel de las vértebras C1 y lC2 que causa deterioro en la rotación del cuello porque la faceta anterior de C1 se fija en la faceta de C2. Objetivo: enfatizar la importancia del diagnóstico temprano de la subluxación atlantoaxoidea en pacientes con o sin evidencia de trauma para que sea identificada como emergencia clínico quirúrgica. Desarrollo: en el presente trabajo se enfatiza en la necesidad de identificar eventos o complicaciones de la subluxación atloaxoidea que pongan en peligro la vida de los pacientes y requieran de la atención clínico quirúrgica de manera emergente por la compresión de médula espinal que puede ocasionar, de modo que en algunos reportes bibliográficos es clasificada como una emergencia. Conclusiones: existen muchas formas de presentación de la subluxación atloaxoidea, muchas de ellas pueden cursar con complicaciones que constituyan emergencias, así como variados tratamientos que deben ser valorados críticamente porque pueden ocasionar consecuencias mayores que la propia enfermedad, lo que habla a favor de lo imprescindible de un diagnóstico certero y de un enfoque multidisciplinar(AU)

Introduction: the atlantoaxial subluxation is a disorder of the cervical spine, at the level of the C1 and C2 vertebrae that causes deterioration in the rotation of the neck because the anterior facet of C1 is fixed on the facet of C2. Objective: To emphasize the importance of early diagnosis of atlantoaxial subluxation in patients with or without evidence of trauma to be identified as a surgical clinical emergency. Development: In the present work, emphasis is placed on the need to identify events or complications of atlantoaxial subluxation that endanger the life of patients and require surgical clinical attention in an emergent manner due to the compression of the spinal cord that may result from so that in some bibliographic reports it is classified as an emergency. Conclusions: There are many forms of presentation of atlantoaxial subluxation, many of them can present complications that constitute emergencies, as well as various treatments that must be critically evaluated because they can cause greater consequences than the disease itself, which speaks in favor of the essential of an accurate diagnosis and a multidisciplinary approach(AU)

Humans , Wounds and Injuries , Cervical Vertebrae/injuries , Cervical Vertebrae/diagnostic imaging , Emergencies , Early Diagnosis , Joint Dislocations/complications
Rev. chil. ortop. traumatol ; 60(2): 58-66, oct. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1095955


El objetivo primario de esta revisión es realizar una actualización de los conceptos básicos relacionados a los cambios morfológicos glenoideos durante la artrosis glenohumeral primaria, métodos de medición relevantes y describir las modificaciones en la nueva clasificación de Gilles Walch. La medición de esos parámetros influyen en forma directa tanto en el acto quirúrgico dentro una prótesis de hombro como en los resultados clínicos post operatorios. Los diferentes métodos de medición descritos en la literatura han permitido evaluar la magnitud de esos fenómenos morfológicos y describir la "glenoides bicóncava", caracterizada por presentar 3 subtipos: la paleoglena, neoglena y la glena intermedia. A partir de esos conceptos, Walch en 1999 describe la clasificación de los cambios morfológicos glenoideos en artrosis primaria, la cual ha presentado una reciente modificación debido a la mala concordancia intra e interobservador de esa medición obtenida por varios investigadores, además de reconocer una carencia en la precisión para describir cada subtipo. A la fecha, diferentes autores investigan la influencia de esos factores morfológicos preoperatorios en los resultados post operatorios, y hasta que valor límite podrían guiar un tratamiento especifico. Conclusión: Enfatizamos que un análisis acabado y minucioso de la morfología glenoidea es importante para una adecuada planificación quirúrgica en artroplastia de hombro, ya que eso puede guiarnos en cuál técnica o implante puede ser el más adecuado para cada tipo de glenoides.

The main purpose of this review is to up date the basic concepts regarding the glenoid morphological changes in primary glenohumeral osteoarthritis, relevant measuring methods, and a description of the modifications in the Gilles Walch classification. The measurement of these parameters influences both surgical indications for total shoulder arthroplasty and the post op clinical outcomes. The different measuring methods described in literature have allowed to evaluate the magnitude of these morphological phenomena describing the "biconcave glenoid", which characteristically presents 3 subtypes: paleoglenoid, neoglenoid and intermediate glenoid. Based on these concepts, Walch classified the glenoid morphological changes in primary ostheoarthritis in 1999, which has been recently modified due to the poor inter-observer and intra-observer reliability described by a vast number of researchers, and also because of an observed lack of precision when describing each sub-type. Up to date, different authors are debating the influence of these pre operative morphological factors on the post op outcomes; and the cut-off value up to which this could lead to a specific treatment. As a conclusion, we emphasize that a deep and thorough analysis of the glenoid morphology is important for an adequate surgical planning of a shoulder arthroplasty, as this can guide us to the most adequate technique and type of implant for each type of glenoid.

Humans , Osteoarthritis/pathology , Arthroplasty/methods , Shoulder Joint/pathology , Osteoarthritis/classification
Rev. MED ; 27(1): 73-84, ene.-jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1115221


Resumen: En este artículo se presenta el caso de una niña de 13 años con historia de cefalea de 2 años de evolución, la cual ha sido estudiada por subluxación del cristalino y fenotipo marfonoide. Para llevar a cabo la investigación se realizó una tomografía cerebral simple que evidenció trombosis de varios senos cerebrales. Posteriormente se hospitalizó a la paciente en la unidad de cuidados intensivos, mientras se anticoagulaba con enoxaparina. Se solicitó un estudio para trombofilia junto con homocisteina en sangre, ante la sospecha de homocistinuria. Luego de confirmarse el diagnóstico se recetó piridoxina y ácido fólico, con lo cual la paciente evolucionó de manera satisfactoria y recuperó las funciones perdidas. El seguimiento de este caso para la investigación permitió encontrar una disminución mayor del 20 % de la homocisteina, sin que sus niveles estuvieran por debajo de 50 µmol/L, hecho que hace a la paciente respondedora parcial a la piridoxina.

Abstract: This article presents the case of a 13-year-old girl with a 2-year history of headache, which has been studied for lens subluxation and Marfanoid phenotype. To carry out this research, a simple brain tomography was performed that showed thrombosis of several sinuses. Subsequently, the patient was hospitalized in the intensive care unit and anticoagulated with enoxaparin. A study was requested for thrombophilia along with homocysteine in blood, on suspicion of homocystinuria. After confirming the diagnosis, pyridoxin and folic acid were prescribed, with which the patient evolved satisfactorily and recovered lost functions. Follow-up on this case for the research allowed us to find a decrease in homocysteine greater than 20 %, without its levels being below 50 µmol/L, which makes the patient partially responsive to pyridoxine.

Resumo: Neste artigo, é apresentado o caso de uma menina de 13 anos, com história de cefaleia de dois anos de evolução, a qual tem sido estudada por subluxação do cristalino e fenótipo marfanoide. Para realizar a pesquisa, foi tomada uma tomografia cerebral simples que evidenciou trombose de vários seios cerebrais. Em seguida, a paciente foi internada na unidade de tratamento intensivo onde recebeu tratamento anticoagulante com enoxaparina. Foi solicitado um estudo para trombofilia junto com homocisteina em sangue, diante da suspeita de homocistinúria. Após o diagnóstico ter sido confirmado, foram receitados piridoxina e ácido fólico, com os quais o estado da paciente evoluiu de maneira satisfatória e ela recuperou as funções perdidas. O seguimento do caso para a pesquisa permitiu verificar uma diminuição maior de 20% da homocisteina, sem que seus niveis estivessem abaixo de 50 µmol/L, fato que torna a paciente apta parcialmente à piridoxina.

Humans , Female , Adolescent , Homocystinuria , Lens Subluxation , Thrombophilia , Intracranial Thrombosis , Homocysteine
Article | IMSEAR | ID: sea-211202


Arthrogryposis includes heterogeneous disorders, characterized by congenital contractures of multiple joints. Knee involvement is very common (38–90 % of patients with amyoplasia) ranging from soft-tissue contractures (in flexion or hyperextension) to subluxation and dislocation. Children who present late will require surgery involving quadricepsplasty or lengthening of the contracted quadriceps muscle. Curtis and Fisher describe an open V-Y lengthening of the quadriceps femoris with post-operative immobilization in 30-45 ° of flexion. The main issue of this technique was limited degree of flexion that can be achieved, and the fibrous replacement of the quadriceps muscle. This is a neglected case of hyperextension deformity and congenital dislocation of knee in children with arthrogryposis resistant to conservative management and successfully treated by open quadricepsplasty.

Article | IMSEAR | ID: sea-205732


Background: Shoulder subluxation in stroke is one of the most common and challenging squeals. Shoulder subluxation limits the patient’s daily activities, and it may lead to permanent disability. NMES (NeuroMuscular Electrical Stimulation) had been studied widely on shoulder subluxation with controversial results, but no evidence is reported of its effectiveness in shoulder subluxation. As NMES helps in producing strong contraction and thereby helps in improving the strength of the muscles and as it also helps in learning to contract appropriate muscles, this study was made to examine the Effectiveness of Electrical Stimulations in reducing Subluxation of the Shoulder after Stroke. Method: Study design, A Randomized control experimental design of 30 subjects. Subjects were randomly assigned into two groups, experimental (NMES group) and control (Non-NMES group) with 15 subjects in each group. Outcome measures were taken before and after the intervention on both the groups by using ‘Pain Estimation Scale’ (PES), 'Subluxation Grading’ by X-rays (AP view) and upper arm section of ‘Motor Assessment Scale’(MAS). Experimental group electrodes were placed over posterior deltoid and supraspinatus. Treatment time was 30 mints two times a day for five days in a week and six weeks. Results: Comparison of electrical stimulation with non-electrical stimulation was done by considering the differences of pre and post treatments in both groups and significance is observed by using independent sample t-test. Statistical analysis proved that there was significant (p<0.05) improvement using NMES compared to NON-NMES in all the three parameters. Conclusion: Electrical stimulation has shown significant improvement in reducing shoulder subluxation, pain and increased motor recovery of the arm in stroke patients compared to the patient's given non-electrical stimulation training.

International Eye Science ; (12): 2135-2138, 2019.
Article in Chinese | WPRIM | ID: wpr-756852


@#AIM:To investigate whether there is a difference in the probability of partial zonular dehiscence and subluxation in patients with angle-closure glaucoma and shallow anterior chamber combined with cataract. <p>METHODS: A retrospective analysis was performed,for patients with angle-closure glaucoma and patients of shallow anterior chamber with cataract admitted to our hospital from February 2017 to March 2019. The patients underwent cataract surgeries and were divided into two groups: Group A(visual axis <22mm)and Group B(visual axis ≥22mm). Central anterior chamber depth(ACD)was measured with ultrasound biomicroscopy(UBM); Axial length(AL, length of optic axis)was measured with IOL-Master; Calculation of the ratio of AC depth to axial length(ACD/AL)was performed. The consistency of the anterior chamber depth in all directions in UBM images was analyzed. In cataract surgeries, partial zonulysis with or without lens subluxation was recorded.<p>RESULTS: The result indicated that the rate of partial zonular dehiscence in group B was higher than that in group A(8.46%±1.44% <i>vs</i> 7.56%±1.51%, <i>P</i><0.05). <p>CONCLUSION: When performing cataract surgery in patients of angle-closure glaucoma and shallow anterior chamber in group B, attention should be paid to the probability of zonular abnormality.

Asian Spine Journal ; : 713-720, 2019.
Article in English | WPRIM | ID: wpr-762996


STUDY DESIGN: Retrospective case series. PURPOSE: To evaluate surgical outcomes and effectiveness of an autogenic rib graft for upper cervical fixation in pediatric patients. OVERVIEW OF LITERATURE: Autogenic bone grafts have long been considered the ‘gold standard’ bone source for posterior cervical fusion in pediatric patients. However, there are some unsolved problems associated with donor-site morbidity and amount of bone grafting. METHODS: We studied five consecutive pediatric patients who underwent atlantoaxial fixation or occipitocervical fixation (OCF) using an autogenic rib graft with at least 2 years of follow-up (mean age, 9.8 years; mean follow-up period, 73.0 months). Two patients underwent OCF without screw-rod constructs and three patients with screw-rod constructs. Autogenic rib grafts were used in all patients. We evaluated the surgical outcomes including radiographic parameter, bony union, and perioperative complications. RESULTS: The atlantoaxial interval (ADI) was corrected from 11.6 to 6.0 mm, and the C1–2 angle was corrected −14.8° to 7.8°. The C2–7 angle was reduced from 31° to 9° spontaneously. Two patients with OCF required revision surgery due to loss of correction. Patients did not experience any complication associated with the donor sites (rib bone grafts). Six months postoperation X-rays clearly showed regeneration of the rib at the donor sites. Bony fusion was achieved in all patients; however, bony fusion occurred more slowly in patients without screw-rod constructs compared with patients with screw-rod constructs. Bone regeneration of the rib was observed in all patients with no complications at the donor site. CONCLUSIONS: Autogenic rib grafts have advantages of potential bone regeneration, high fusion rate, and low donor-site morbidity. In addition, a screw-rod construct provides better bony fusion in pediatric patients with OCF and atlantoaxial fixation.