ABSTRACT
ABSTRACT Peri-articular giant cell tumours present a unique challenge to the orthopaedic surgeon due to their locally aggressive nature. Native joint-preserving options confer less morbidity in comparison to radical excision and reconstruction; however, recurrence rates tend to be higher. The use of polymethyl methacryllate (PMMA) decreases the recurrence rate, but it has potentially devastating effects on the articular cartilage. To safeguard against this, the use of an insulating layer between the PMMA and the articular cartilage may be utilized with the goal of protecting the latter and is referred to as the Sandwich technique.
RESUMEN Los tumores de células gigantes periarticulares representan un desafío único al cirujano ortopédico debido a su naturaleza localmente agresiva. Las opciones de conservación de las articulaciones nativas confieren menos morbilidad en comparación con la supresión y reconstrucción radicales. Sin embargo, las tasas de recurrencia tienden a ser más altas. El uso de polimetilmetacrilato (PMMA) disminuye la tasa de recurrencia, pero tiene efectos potencialmente devastadores sobre el cartílago articular. Para protegerlo, el uso de una capa aislante entre el PMMA y el cartílago articular puede ser utilizarse con el objetivo de proteger este último, lo que se conoce como la técnica del sándwich.
Subject(s)
Humans , Male , Adolescent , Bone Neoplasms/surgery , Giant Cell Tumor of Bone/surgery , Polymethyl Methacrylate/administration & dosage , Knee Joint , Bone Neoplasms/diagnostic imaging , Treatment Outcome , Giant Cell Tumor of Bone/diagnostic imaging , Limb SalvageABSTRACT
Pathological vertebral fractures are caused by various entities. They cause significant pain and impaired quality of life of patients. The CT-guided kyphoplasty relieves or eliminates pain and stabilizes the fractured vertebral bodies. 49 patients were treated. The procedure is performed percutaneously by inserting a needle that is subsequently removed, leaving a cannula. Through this a balloon-like device is introduced and subsequently inflated to create a cavity, which is then filled with polymethylmethacrylate (PMMA). The technique was performed successfully in all cases without serious complications, with good results. Its advantages are that the needle placement as well as the injection of PMMA can be correctly visualized using real-time CT fluoroscopy. In addition a single needle is used throughout the entire procedure, which minimizes the risk of complications as it is less traumatic.
Las fracturas vertebrales patológicas se originan por diversas entidades. Producen dolor importante y deterioro de la calidad de vida de los pacientes. La cifoplastia guiada por tomografía computarizada (TC) alivia o elimina el dolor y estabiliza los cuerpos vertebrales fracturados. Se han tratado 49 pacientes. El procedimiento se realiza por vía percutánea, mediante la inserción de una aguja que posteriormente se retira dejando una cánula. A través de la misma se introduce un dispositivo que lleva incorporado un balón que se infla creando una cavidad, que se rellena con polimetilmetacrilato (PMMA). La técnica se practicó con éxito en todos los casos sin complicaciones graves, con buenos resultados. Sus ventajas son visualizar correctamente la posición de la aguja y la inyección del PMMA mediante la escopia del TC en tiempo real. Además se utiliza una sola aguja para todo el procedimiento, lo cual minimiza el riesgo de complicaciones siendo menos traumático.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Tomography, X-Ray Computed/methods , Spinal Fractures/therapy , Spinal Fractures/diagnostic imaging , Polymethyl Methacrylate/administration & dosage , Kyphoplasty/methods , Radiography, Interventional , Spinal Fractures/etiologyABSTRACT
No abstract available.
Subject(s)
Humans , Bone Cements , Extravasation of Diagnostic and Therapeutic Materials/prevention & control , Fluoroscopy , Injections , Kyphoplasty/methods , Needles , Polymethyl Methacrylate/administration & dosage , Time Factors , Vertebroplasty/methodsSubject(s)
Humans , Hyaluronic Acid/administration & dosage , Collagen/administration & dosage , Skin Aging , Face , Rejuvenation , Botulinum Toxins/administration & dosage , Cosmetic Techniques , Hyperhidrosis/drug therapy , Injections , Biocompatible Materials/administration & dosage , Polymethyl Methacrylate/administration & dosageABSTRACT
Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Bone Cements/therapeutic use , Fluoroscopy , Injections, Intralesional , Pain, Intractable/etiology , Polymethyl Methacrylate/administration & dosage , Radiography, Interventional , Sacrum , Spinal Neoplasms/complications , Vertebroplasty/methodsABSTRACT
Few studies have been conducted to explain the pain patterns resulting from osteoporotic vertebral compression fractures (OVCF). We analyzed pain patterns to elucidate the pain mechanism and to provide initial guide for the management of OVCFs. Sixty-four patients underwent percutaneous vertebroplasty (N=55) or kyphoplasty (N=9). Three pain patterns were formulized to classify pains due to OVCFs: midline paravertebral (Type A), diffuse paravertebral (Type B), and remote lumbosacral pains (Type C). The degree of compression was measured using scale of deformity index, kyphosis rate, and kyphosis angle. Numerical rating scores were serially measured to determine the postoperative outcomes. As vertebral body height (VBH) decreased, paravertebral pain became more enlarged and extended anteriorly (p<0.05). Type A and B patterns significantly showed the reverse relationship with deformity index (p<0.05), yet Type C pattern was not affected by deformity index. Postoperative pain severity was significantly improved (p<0.05), and patients with a limited pain distribution showed a more favorable outcome (p<0.05). The improvement was closely related with the restoration of VBH, but not with kyphosis rate or angle. Thus, pain pattern study is useful not only as a guide in decision making for the management of patients with OVCF, but also in predicting the treatment outcome.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Fracture Fixation, Internal/methods , Fractures, Compression/etiology , Kyphosis/therapy , Magnetic Resonance Imaging , Osteoporosis/complications , Pain/etiology , Pain Measurement , Pain, Postoperative/etiology , Polymethyl Methacrylate/administration & dosage , Surveys and Questionnaires , Sickness Impact Profile , Spinal Fractures/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Introdução: além das causas mais freqüentes de perdasnasais-traumaecâncer-observamososurgimento de novas situações geradoras de mutilação do nariz, requerendo adaptações à abordagem do problema. Objetivo: apresentar dois casos de reconstrução nasal após injeção de polimetilmetacrilato para preenchimento estético na face. Método: Duas pacientes submetidas à reconstrução nasal por necrose conseqüente à injeção de polimetilmetacrilato. Resultados: visibilizados nas figuras 4, 5 e 6. Discussão: o polimetilmetacrilato é uma das substâncias utilizadas na bioplastia. A necrose conseqüente à injeção do polimetilmetacrilato para fins estéticos é uma nova entidade clínica, cuja incidência é desconhecida e a fisiopatologia sujeita à discussão. Modificações na rotina de reconstrução foram necessárias em virtude das condições locais. Retalhos septais, melhor escolha para a reparação do forro, foram contraindicados por comprometimento vascular. Utilizaram-se retalhos de pele previamente enxertada, associados a enxertos de cartilagem auricular e rotação de retalho frontal paramediano, procurando-seres peitar o princípio das subunidades anatômicas. Conclusão:a necrosedesegmentos da face após a injeção de polimetilmetecrilato é uma nova entidade clínica, cuja incidência é desconhecida, acrescentando nova etiologia às perdas nasais. Os fundamentos da reconstrução de nariz devem ser aplicados,buscando-se soluções individuais que adaptem- se às peculiaridades de cada situação.
Introduction: Inaddiction to the most frequentcauses of nasal tissue lost- cancer and trauma- new situations generating the mutilation ofthen osehavearrived, requiring adaptations to the problem-solving approach. Objective:To report two cases of nasal reconstruction after polimetilmetacrilate injection for aesthetic purposes on the face. Methods: Two female patients underwent nasal reconstruction after necrosis caused by injection of polimetilmetacrilate.Discussion:Polimetilmetacrilatehave been used as a substance for inclusion. The necrosis caused by the injection of polimetilmetacrilate is a new clinical entity, with unknown incidence and ongoing discussion of its phisiopathology. Changes in the routine of the nasal reconstruction were necessary due to local conditions. Septal flaps, the first choice for lining repair, were discarted because of previous vascular damage. Cutaneous flaps made of previously grafted skin were utilized in association with cartilage grafts and rotation of a paramedian frontal flap, following anatomical subunits principles. Conclusion: The necrosis of facial segments after injection of polimetilmetacrilate is a new clinical entity, with unknown incidence, that can be added as a new etiology of nasal tissue lost. The fundaments of nasal reconstruction should be applied, looking for individual solutions wich adapt to the peculiarities of each situation.
Subject(s)
Humans , Female , Middle Aged , Necrosis , Nose , Polymethyl Methacrylate , Nose/abnormalities , Nose/surgery , Necrosis/surgery , Necrosis/rehabilitation , Necrosis/therapy , Polymethyl Methacrylate/administration & dosage , Polymethyl Methacrylate/adverse effects , Polymethyl Methacrylate/toxicityABSTRACT
BACKGROUND: Vertebral compression fracture (VCF) is the most common complication of osteoporosis. It results in significant mortality and morbidity. Percutaneous vertebroplasty (PVP) is a procedure that injects percutaneously bone cement into a collapsed vertebra. OBJECTIVE: To determine the results of PVP in pain reduction from osteoporosis VCF and its complications. MATERIAL AND METHOD: Thirty-five patients (34 women, 1 man, 48-98 years) with persistent back pain due to VCF underwent 66 percutaneous injection of polymethylmethacrylate (PMMA) into the vertebrae (27 thoracic levels, 39 lumbar levels) under fluoroscopic guidance between December 2003 and July 2005. Severity of back pain was assessed by using visual analog scale (VAS) before and after the operation. RESULTS: Thirty-two patients (91%) reported significant pain relief the mean VAS of 35 patients, before PVP and after an 8-week period, post-operatively, were 6.9 +/-1.8 and 2.0+/-1.8 (p = 0.001). There was only one minor complication. Two patients experienced intermittent sciatic shooting pain. This improved and disappeared within three months. CONCLUSION: P VP is a minimally invasive procedure providing safe, immediate, and sustained pain reduction in patients with refractory pain and disability caused by painful VCF
Subject(s)
Aged , Aged, 80 and over , Bone Cements , Female , Fractures, Compression/complications , Humans , Injections , Male , Middle Aged , Osteoporosis/complications , Pain/etiology , Polymethyl Methacrylate/administration & dosage , Retrospective Studies , Spinal Fractures/complicationsABSTRACT
A injeção de polimetilmetacrilato (PMMA) é prática difundida na medicina estética como medida rejuvenecedora. No entanto, a injeção facial do PMMA carreia sérios riscos, especialmente se realizada na região glabelar. Descrevemos o caso de uma mulher que imediatamente após injeção glabelar de PMMA apresentou amaurose e oftalmoplegia total, revendo ainda a literatura pertinente.
Subject(s)
Female , Humans , Middle Aged , Blindness/chemically induced , Cosmetic Techniques/adverse effects , Ophthalmoplegia/chemically induced , Polymethyl Methacrylate/adverse effects , Face , Injections, Intradermal , Microspheres , Polymethyl Methacrylate/administration & dosage , RejuvenationABSTRACT
Relatamos um caso de compressão medular e radicular durante vertebroplastia percutanea transpedicular com polimetilmetacrilato (VPTP) para tratamento de fratura com compressão por osteoporose. O início súbito de dor lancinante na distribuição do 6º nervo intercostal direito, com hiperemia ao longo de seu trajeto, determinou a interrupção do procedimento. Sob sedação com narcóticos, a paciente foi levada ao CTI, sendo administrados 10mg de dexametazona por via endovenosa. Após algumas horas, ela desenvolveu paraplegia com preservação do tato, e a TC e a RM mostraram extravazamento epidural de polimetilmetacrilato com compressão medular e radicular. Descompressão cirúrgica resultou em recuperação neurológica. O cimento foi removido após ter sua espessura diminuída com o uso de broca de alta rotação, usando técnica microcirúrgica através de laminectomia ampla de tres níveis de T5 a T7. Extravazamento de cimento é comumente encontrado em VPTP, sendo assintomático na maioria das vezes. Compressão radicular pode requerer intervenção cirúrgica se não responsiva ao tratamento com corticosteróides. Compressão medular é vista com menos frequência e requer cirurgia de emergência. O cimento não adere à dura-máter e pode ser removido facilmente.