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1.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1248721

ABSTRACT

Las fracturas osteocondrales (FOC) traumáticas de rodilla en la edad pediátrica, son lesiones que acompañan hasta un 30% de las luxaciones agudas de rótula (LAR). Si no se mantiene una elevada sospecha clínica, es frecuente su retraso diagnóstico, pudiendo generar potenciales complicaciones. A propósito, presentamos el caso de una paciente de 12 años con una FOC post LAR que pasó inadvertida en la primera consulta, requiriendo la fijación del fragmento osteocondral con tornillos HCS a los 5 meses, logrando un excelente resultado funcional a los 54 meses de seguimiento.


Traumatic osteochondral fractures (OCF) of the knee in pediatric age are injuries that accompany up to 30% of acute patellar dislocations (APD). If high clinical suspicion is not maintained, its diagnostic delay is frequent, and may generate potential complications. Incidentally, we present the case of a 12-year-old patient with a post-APD OCF that went unnoticed in the first consultation, requiring fixation of the osteochondral fragment with HCS screws at 5 months. Achieving an excellent functional result at 54 months follow-up.


As fraturas osteocondrais traumáticas (FOC) do joelho em idade pediátrica são lesões que acompanham até 30% das luxações agudas da patela (LAP). Se uma alta suspeita clínica não for mantida, seu atraso no diagnóstico é frequente e pode gerar complicações potenciais. A propósito, apresentamos o caso de um paciente de 12 anos com FOC pós-LAP que passou despercebido na primeira consulta, exigindo fixação do fragmento osteocondral com parafusos HCS em 5 meses. Obtendo um excelente resultado funcional aos 54 de acompanhamento.


Subject(s)
Humans , Female , Child , Knee Injuries/surgery , Knee Injuries/diagnostic imaging , Bone Screws , Magnetic Resonance Imaging , Follow-Up Studies , Treatment Outcome , Patellar Dislocation/complications , Fracture Fixation , Knee Injuries/etiology
2.
Coluna/Columna ; 20(2): 132-136, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1249654

ABSTRACT

ABSTRACT Objective: In the last three decades, there have been great advances in the surgical treatment of adolescent idiopathic scoliosis. There are few studies that focus on the long-term clinical and radiographic results of AIS operated on with pedicle screws that also consider psychological repercussions. Methods: We conducted an observational longitudinal study. We reviewed the AIS cases that were operated on with pedicle screws in our center between January 2009 and December 2010. We conducted follow-up until July 2019. A short questionnaire was administered to assess patient satisfaction and the long-term impact from both psychological and functional points of view. Results: A total of 19 patients met the inclusion criteria. The mean preoperative Cobb was 58°, the postoperative was 23° and at the end of follow-up it was 26°. No major complications were reported. Ninety percent were very satisfied with the overall results of the surgery. Ninety-five percent had no limitation for sports or daily activities and 90% were satisfied with the cosmetic results. Conclusion: The short- and long-term radiographic evolution in patients treated with third generation material presented good clinical results. In 3 cases (16%) loss of correction greater than 10% was reported. The overall satisfaction index and cosmetic results were very good at the end of follow-up despite the low correction rate (60%). There were no major complications and the incidence of functional limitation and pain at the end of the follow-up was very low. Level of evidence IV; Review article.


RESUMO Objetivo: Nas últimas três décadas houve grandes avanços no tratamento cirúrgico da escoliose idiopática do adolescente. Existem poucos trabalhos que estudam os resultados clínicos e radiográficos a longo prazo de EIA, tratados cirurgicamente com parafusos pediculares que também considerem a repercussão psicológica. Métodos: Realizamos um estudo longitudinal observacional. Analisamos a EIA de pacientes operados entre janeiro de 2009 e dezembro de 2010 que receberam parafusos pediculares em nosso centro. Realizamos o acompanhamento até julho de 2019. Foi realizado um breve questionário para avaliar a satisfação dos pacientes e a repercussão a longo prazo do ponto de vista psicológico e funcional. Resultados: Um total de 19 pacientes satisfizeram os critérios de inclusão. A média de Cobb pré-operatório foi de 58° e o pós-operatório foi de 23° e ao final do acompanhamento, de 26°. Não foram registradas complicações relevantes. Quanto à satisfação, 90% estão muito satisfeitos com o resultado geral da cirurgia, 95% não têm limitações para esportes ou atividades diárias e 90% estão satisfeitos com os resultados estéticos. Conclusões: A evolução radiográfica a curto e longo prazo nos pacientes tratados com material de terceira geração apresentou bons resultados clínicos. Em 3 casos (16%), registrou-se perda de correção superior a 10%. O índice geral de satisfação e resultado estético é muito bom no final do acompanhamento, apesar da baixa taxa de correção (60%). Não se constataram complicações importantes e a incidência de limitação funcional e dor ao final do acompanhamento foi muito baixa. Nível de evidência IV; Artigo de revisão.


RESUMEN Objetivo: En las últimas tres décadas han habido grandes avances en el tratamiento quirúrgico de las escoliosis idiopática del adolescente. Existen pocos trabajos que estudien el resultado clínico y radiográfico a largo plazo en las EIA intervenidas con tornillos pediculares que además contemplen repercusión psicológica. Métodos: Realizamos un estudio longitudinal observacional. Revisamos las EIA intervenidas entre enero de 2009 y diciembre de 2010 con tornillos pediculares en nuestro centro. Realizamos seguimiento hasta julio de 2019. Se realizó un breve cuestionario para evaluar satisfacción de los pacientes y la repercusión a largo plazo de punto de vista psicológico y funcional. Resultados: Un total de 19 pacientes cumplieron los criterios de inclusión. La media del Cobb pre operatorio fue de 58° y el post operatorio de 23° y al final del seguimiento, de 26°. No se registraron complicaciones mayores. El 90% está muy satisfecho con el resultado global de la cirugía. El 95% no presenta limitación para el deporte o actividad cotidiana y el 90% está conforme con resultado cosmético. Conclusiones: La evolución radiográfica a corto y largo plazo en pacientes tratados con material de tercera generación presentó buenos resultados clínicos. En 3 casos (16%) se registró perdida de corrección mayor a 10%. El índice de satisfacción global y resultado cosmético es muy bueno al final del seguimiento a pesar de la baja tasa de corrección (60%). No se constataron complicaciones mayores y la incidencia de limitación funcional y dolor al final del seguimiento fue muy baja. Nivel de evidencia IV; Estudio de revisión.


Subject(s)
Humans , Scoliosis , General Surgery , Bone Screws , Adolescent
3.
Rev. chil. ortop. traumatol ; 62(1): 11-18, mar. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1342590

ABSTRACT

OBJETIVO: Realizar la evaluación clínica, imagenológica y funcional de pacientes con fracturas avulsivas tibiales del ligamento cruzado posterior (FTALCPs) fijadas con tornillos canulados con técnica abierta. MÉTODOS: Los pacientes con FTALCP operados entre 2010 y 2017 fueron revisados retrospectivamente. Criterios de inclusión: fracturas agudas, desplazadas, test de cajón posterior grado III, lesiones combinadas de rodilla, seguimiento > 12 meses. Se excluyeron pacientes > 65 años, con FTALCPs bilaterales, lesiones del ligamento cruzado posterior (LCP) intrasustancia, test de cajón posterior grados I-II, fracturas expuestas, lesiones neurovasculares, y seguimientos < 12 meses. Objetivo primario: medir la estabilidad clínica mediante test de cajón posterior y radiografía de estrés arrodillada comparativa. Objetivos secundarios: nvaluar la consolidación en radiografías, complicaciones y funcionalidad con las escalas de Lysholm y Tegner. Resultados Se incluyeron 20 pacientes, con edad media de 41 años (rango: 32 a 61 años). El seguimiento promedio fue de 33,9 meses (rango: 12 a 82 meses). La estabilidad clínica mejoró en 93% (cajón posterior postoperatorio grados 0 y I) de los pacientes. La radiografía de estrés arrodillada mostró una diferencia promedio de 2,6 mm (rango: 0,1 mm a 6,8 mm) de traslación posterior al comparar con el lado sano. Todas las fracturas consolidaron. Siete pacientes presentaron complicaciones. El puntaje promedio de la escala de Lysholm al final del seguimiento fue de 85,17. El promedio preoperatorio del puntaje en la escala de Tegner no varió significativamente en comparación con el postoperatorio. CONCLUSIONES: La fijación de fracturas avulsivas tibiales del LCP con tornillos canulados con técnica abierta es efectiva en restaurar la estabilidad posterior y lograr la consolidación ósea. La funcionalidad clínica a mediano plazo es buena, a pesar del alto número de complicaciones y lesiones concomitantes. NIVEL DE EVIDENCIA: tipo IV.


OBJECTIVE: To report mid-term clinical, radiographic, and functional outcomes following open reduction and fixation of posterior cruciate ligament tibial avulsion fractures (PCLTAFs) with cannulated screws. METHODS: This is a retrospective analysis of patients with PCLTAF operated on from August 2010 to April 2017. Patients with acute fractures, with more than 2 mm of displacement and grade III on the posterior drawer test, combined or not to knee injuries, were included. Patients older than 65 years of age, with bilateral avulsion fractures, intrasubstance posterior cruciate ligament (PCL) lesions, stable grade-I to -II on the posterior drawer test, concomitant neurovascular injuries, mid-substance tears, open fractures, and less than 12 months of follow-up were excluded. Primary outcomes: the clinical stability was assessed using the posterior drawer test and a single comparative knee stress radiograph. Secondary outcomes: radiographic consolidation, complications, Lysholm score, and Tegner activity score. RESULTS: In total, 20 patients with a mean age of 41 years (range: 32 to 61 years) were included. The mean follow-up was of 33.9 months (range: 12 to 82 months). Clinical stability (grade 0 or I on the posterior drawer test) was observed in 93% of the patients. The mean difference in contralateral posterior displacement was of 2.6 mm (range: 0.1 mm to 6.8 mm) on a single comparative knee stress radiograph. All fractures presented radiological consolidation. Seven patients developed complications. The mean Lysholm score at the last follow-up visit was of 85.17. The postoperative Tegner activity scores did no vary significantly compared to the preinjury scores. CONCLUSIONS: Cannulated screw fixation of a displaced PCLTAF through a posterior approach restores clinical and radiographic stability and has excellent union rates. The mid-term functional outcomes are good despite the high rates of combined knee lesions and postoperative complications. LEVEL OF EVIDENCE: IV.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Tibial Fractures/surgery , Tibial Fractures/diagnostic imaging , Bone Screws , Posterior Cruciate Ligament/surgery , Posterior Cruciate Ligament/diagnostic imaging , Fracture Fixation/methods , Tibial Fractures/physiopathology , Retrospective Studies , Follow-Up Studies , Posterior Cruciate Ligament/physiopathology , Treatment Outcome , Fractures, Avulsion , Fracture Fixation/instrumentation
4.
Rev. chil. ortop. traumatol ; 62(1): 27-33, mar. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1342658

ABSTRACT

INTRODUCCIÓN: Una de las complicaciones de la osteosíntesis retrógrada del escafoides es la protrusión del tornillo en la articulación radiocarpiana, dada la limitada visualización intraoperatoria del polo proximal del escafoides con las proyecciones tradicionales. OBJETIVO: Evaluar la capacidad de una nueva proyección radiológica, la proyección "tangencial del escafoides dorsal", o TED, para identificar tornillos prominentes radiocarpianos durante la osteosíntesis retrógrada del escafoides con tornillos canulados. MATERIALES Y MÉTODOS: Estudio cadavérico en muñecas frescas congeladas. Se introdujo en el escafoides un tornillo canulado con técnica retrógrada estándar. La proyección TED fue evaluada en 5 muñecas, con angulaciones del antebrazo de 15°, 30° y 45° para definir la mejor visualización del polo proximal del escafoides y del tornillo. Se comparó la capacidad para identificar la prominencia del tornillo en el polo proximal de la proyección TED de 30° con 5 proyecciones tradicionales de escafoides en 9 muñecas. El tornillo se posicionó a nivel de la superficie del escafoides, y luego se avanzó a intervalos de 0,5 mm bajo visualización directa por artrotomía dorsal. Tras cada intervalo, se repitieron todas las proyecciones para determinar su capacidad de detectar tornillos prominentes en el escafoides. RESULTADOS: La mejor visualización del polo proximal del escafoides se logró con la proyección TED de 30°. Al comparar la proyección TED de 30° y las tradicionales, con la TED se logró identificar tornillos prominentes a 0,8 mm promedio, seguida por la proyección posteroanterior con cubitalización y extensión a 1.3 mm (p » 0.014), con una alta precisión y correlación interobservador de estas proyecciones. CONCLUSIÓN: La proyección TED demostró ser la más sensible para detectar tornillos prominentes en la articulación radiocarpiana. Su uso rutinario podría evitar complicaciones durante la osteosíntesis.


INTRODUCTION: One of the complications of the retrograde percutaneous scaphoid fixation is the protrusion of the screw in the radiocarpal joint due to the limited intraoperative visualization of the proximal pole of the scaphoid with the traditional radiographic views. OBJETIVE: To evaluate the sensitivity of a novel radiographic view (the skyline scaphoid view, SSV) to detect screws protruding in the radiocarpal joint during the retrograde fixation of the scaphoid. MATERIALS AND METHODS: We studied nine cadaverous fresh frozen wrists. A retrograde cannulated screw was inserted in the scaphoid. To validate the SSV, 5 wrists were studied, comparing 3 forearm angulations (15°, 30° and 45°) to get the best visualization of the proximal pole and screw. We compared the ability to identify the protrusion of the screw in the proximal pole of the 30° SSV with that of 5 standard scaphoid radiographic views in 9 wrists. The screw was positioned at the level of the surface of the scaphoid, and was sequentially protruded in 0.5 mm increments, with direct visualization of its tip through a dorsal capsulotomy. After each increment, all views were repeated to determine if they were able to detect screws projecting from the scaphoid. RESULTS: The best visualization of the proximal pole of the scaphoid was found with the 30° SSV. In the comparison of the 30° SSV and the standard views, with the SSV we were able to identify the protrusion of the screws at an average of 0.8 mm, followed by the posterior-anterior view with ulnar deviation and extension at 1.3 mm (p » 0.014), with high precision and interobserver agreement regarding these views. CONCLUSION: The SSV was the most sensitive view to detect protruding screws in the proximal pole of the scaphoid. Its routine use could avoid complications during osteosynthesis.


Subject(s)
Humans , Wrist Joint/diagnostic imaging , Bone Screws/adverse effects , Scaphoid Bone/diagnostic imaging , Fracture Fixation, Internal/adverse effects , Radiology/methods , Wrist Joint/surgery , Cadaver , Observer Variation , Scaphoid Bone/surgery , Fracture Fixation, Internal/instrumentation
5.
Article in Chinese | WPRIM | ID: wpr-879465

ABSTRACT

OBJECTIVE@#To explore clinical effect of early incision and decompression combined with screw fixation in treating Lisfranc injury and foot osteofascial compartment syndrome.@*METHODS@#Clinical data of 5 patients with Lisfranc injury and foot osteofascial compartment syndrome were retrospective analysized from January 2017 to December 2018, including 4 males and 1 female, aged from 19 to 62 years old. All patients were suffered from closed injuries. The time from injury to treatment ranged from 1 to 14 h. According to Myerson classification, 1 patient was type A, 1 patient was type B, and 3 patients were type C. All patients were performed early incision decompression and screw fixation. Maryland foot functional scoring standard at 12 months after opertaion was used to evaluate clinical effect.@*RESULTS@#All patients were followed up for 10 to 48 months. All fractures were achieved bone union, and healing time ranged from 3 to 9 months. All metatarsal and tarsal joints were reached to anatomical reduction. No infection, osteomyelitis, loosening or breaking of internal fixation occurred. Postopertaive Maryland foot function score at 12 months was from 44 to 97, and 2 patients got excellent result, 2 good, and 1 poor.@*CONCLUSION@#Early incision and decompression with screw fixation for the treatment of Lisfranc injury and foot osteofascial compartment syndrome, which has advantages of simple opertaion, thoroughly decompression, screw fixation does not occupy space, stable decompression and fixation, and could receive satisfied clinical effect.


Subject(s)
Adult , Bone Screws , Compartment Syndromes/surgery , Decompression , Female , Foot Injuries , Fracture Fixation, Internal , Fractures, Bone/surgery , Humans , Male , Middle Aged , Retrospective Studies , Tarsal Joints , Treatment Outcome , Young Adult
6.
Article in Chinese | WPRIM | ID: wpr-879418

ABSTRACT

OBJECTIVE@#To measure the maximum corridor parameters of the infra acetabular screw and evaluate the feasibility of screw insertion through digital analysis of the acetabular structure.@*METHODS@#The pelvic CT data of 100 patients who received plain pelvic CT scan from April 2013 to June 2015 were retrospectively analyzed. There were 50 males, aged 20 to 84 years, with an average age of (48.42±17.48) years, and 50 females, aged 18 to 87 years, with an average age of (55.02±19.54) years. Patients with acetabular fractures, hip dysplasia, and metal implants in the acetabulum were excluded. Import CT data into Mimics software in DICOM format to generate a three-dimensional model, and find the axialprojection of the infra-acetabular corridor in the middle of the pubis ramus in the inlet view. A virtual screw was placed in the infra-acetabular space and measure the parameters including the diameter and the length of the maximum corridor, the distance from the insertion point to the pubic symphysis, to the anterosuperior iliac spine and to the medial edge of the pelvis. Then import the pelvic model into 3- matic software, establish the pelvic model anterior pelvic plane and median sagittal plane, and measure the angle between the screw axis and the two planes. A minimum corridor diameter of at least 5 mm was defined as a cutoff for placing a 3.5 mm screw, and calculate the screw insertion rate.@*RESULTS@#In 100 cases, 49% of patients had a infra acetabular corridor with a diameter ≥5 mm, and the rate of screw placement in men was significantly higher than that in women. The average diameter of the maximum corridor of infra-acetabular screw was (4.86±1.72) mm, the average length was (94.04±8.29) mm, the average distance from the insertion point to the pubic symphysis was (60.92±4.84) mm, to the anterosuperior iliac spine was (85.15± 6.85) mm, and to the medial edge of the pelvis was (6.12±3.32) mm. The mean angle between the axis of the screw and the median sagittal plane was (-1.38±4.74)°, and the mean angle between the axis of the screw and the anterior pelvic plane was (56.77±7.93)°. There are significant differences between male and female measured parameters, except for the angle between the screw axis and the anterior pelvic plane. There was no statistically significant difference in the maximum corridor parameters of infra-acetabular screw on both sides of the pelvis.@*CONCLUSION@#This study shows that the insertion rate of infra-acetabular screws is low in local patients, and the feasibility of screw insertion should be fully evaluated before surgery.


Subject(s)
Acetabulum/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Bone Screws , Feasibility Studies , Female , Fracture Fixation, Internal , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
7.
Dental press j. orthod. (Impr.) ; 26(1): e2119155, 2021. tab, graf
Article in English | LILACS, BBO | ID: biblio-1154069

ABSTRACT

ABSTRACT Introduction: Shorter miniscrew implants (MSIs) are needed to make orthodontics more effective and efficient. Objective: To evaluate the stability, insertion torque, removal torque and pain associated with 3 mm long MSIs placed in humans by a novice clinician. Methods: 82 MSIs were placed in the buccal maxillae of 26 adults. Pairs of adjacent implants were immediately loaded with 100g. Subjects were recalled after 1, 3, 5, and 8 weeks to verify stability and complete questionnaires pertaining to MSI-related pain and discomfort. Results: The overall failure rate was 32.9%. The anterior and posterior MSIs failed 35.7% and 30.0% of the time, respectively. Excluding the 10 MSIs (12.2%) that were traumatically dislodged, the failure rates in the anterior and posterior sites were 30.1% and 15.2%, respectively; the overall primary failure rate was 23.6%. Failures were significantly (p= 0.010) greater (46.3% vs 19.5%) among the first 41 MSIs than the last 41 MSIs that were placed. Excluding the traumatically lost MSIs, the failures occurred on or before day 42. Subjects experienced very low pain (2.2% of maximum) and discomfort (5.5% of maximum) during the first week only. Conclusions: Shorter 3 mm MSIs placed by a novice operator are highly likely to fail. However, failure rates can be substantially decreased over time with the placement of more MSIs. Pain and discomfort experienced after placing 3 mm MSIs is minimal and temporary.


RESUMO Introdução: Mini-implantes (MIs) mais curtos são necessários para uma Ortodontia mais eficiente e efetiva. Objetivo: Avaliar a estabilidade, torque de inserção e de remoção e dor associada a MIs de 3mm instalados em humanos por um ortodontista principiante. Métodos: 82 MIs foram instalados na região vestibular da arcada superior de 26 adultos. Pares de mini-implantes adjacente receberam carga imediata de 100g. Após 1, 3, 5 e 8 semanas, os pacientes foram reavaliados para verificar a estabilidade e preencher um questionário sobre a dor e o desconforto relacionados aos MIs. Resultados: A taxa geral de falhas foi de 32,9%, sendo de 35,7% para os MIs anteriores e 30% para os MIs posteriores. Excluindo os 10 MIs que foram perdidos por trauma (12,2%), a taxa de falha nas regiões anterior e posterior foram de 30,1% e 15,2%, respectivamente e ocorreram no 420 dia ou antes. A taxa geral de falha primária foi de 23,6%. A taxa de falha foi significativamente maior (p=0,010) nos primeiros 41 MIs do que nos 41 últimos (46,3% vs. 19,5%). As experiências relacionadas à dor foram baixas (2,2% máximo), assim como ao desconforto (5,5% máximo) durante a primeira semana. Conclusão: MIs de 3mm instalados por um novato são mais propensos a falhas. Porém, as taxas de falha podem diminuir substancialmente com a instalação de mais MIs com o decorrer do tempo. A dor e o desconforto após a instalação desses dispositivos são mínimos e temporários.


Subject(s)
Humans , Adult , Bone Screws , Dental Implants , Orthodontic Anchorage Procedures , Dental Implants/adverse effects , Feasibility Studies , Dental Prosthesis, Implant-Supported , Torque , Dental Implantation, Endosseous , Maxilla/surgery
8.
Braz. dent. sci ; 24(1): 1-8, 2021. tab, ilus
Article in English | LILACS, BBO | ID: biblio-1145466

ABSTRACT

Objectives: With regard to the prevalence of abutment screw loosening (SL) and bone height reduction, particularly in the posterior regions of the jaws, as well as the contradictory issue of applying short implants instead of surgeries, along with all preparations associated with longer implants, the present study aimed to compare the amount of torque loss in short implants with increased vertical cantilever abutments and standard ones. Material and Methods: In this experimental study, a total number of 20 implants (MegaGen Implant Co., Ltd, South Korea) with 4.5 mm diameter including 10 short implants (7 mm) and 10 standard ones (10 mm) were utilized. Using a surveyor, fixtures were perpendicularly mounted in 13×34 mm resin for short implants and 19×34 mm resin for standard ones. The abutments of the same height but different cuff heights (2.5 mm for the standard implants and 5.5 mm for the short ones) were then tightened with 30 N.cm, via a digital torque meter. To compensate the settling effect, the abutment screw was re-tightened with 30 N.cm after 10 min. Upon applying 500,000 cycles at 75 N.cm and 1 Hz along the longitudinal axis on each sample, blind reverse torque value (RTV) was measured with a digital torque meter. The data were finally analyzed using Student's t-test. Results:Both groups experienced torque loss, but there was no statistically significant difference between the case and control groups in terms of abutment SL (p = 0451). Conclusion: Short implants seem to be a good mechanical alternative in emergencies with respect to torque loss and abutment SL. (AU)


Objetivos: Considerando a prevalência de afrouxamento de parafuso dos pilares, redução da altura óssea especialmente nas regiões posteriores, a questão contraditória da aplicação de implantes curtos em vez de cirurgias e todos os preparos associados a implantes mais longos, este estudo buscou comparar implantes curtos com pilares cantilever verticais aumentados e implantes padrão na quantidade de perda de torque. Material e métodos: Neste estudo experimental, foram utilizados 20 implantes (Megagen, Coreia do Sul) com diâmetro de 4,5 mm, incluindo 10 implantes curtos (7 mm) e 10 implantes padrão (10 mm). A fixação foi realizada perpendicularmente em uma resina 13 × 34 mm para implantes curtos e uma resina 19 × 34 mm para implantes padrão, usando um topógrafo. Os pilares da mesma altura, mas com diferentes comprimentos de manguito (2,5 mm para os implantes padrão e 5,5 mm para os implantes curtos) foram apertados com 30 N, utilizando um torquímetro digital. Para compensar o efeito de sedimentação, o parafuso do pilar foi reapertado com 30 N após 10 min. Depois de aplicar 500.000 ciclos a 75 N e 1 Hz ao longo do eixo longitudinal em cada amostra, o valor de torque reverso cego foi medido com um medidor de torque digital. Os dados foram analisados pelo teste t de Student. Resultados: Todos os grupos tiveram perda de torque, mas não houve diferença estatisticamente significativa entre os grupos caso e controle em termos de afrouxamento do parafuso do pilar (p = 0451). Conclusão: Os implantes curtos parecem ser uma boa alternativa mecânica em emergências em termos de perda de torque e afrouxamento do parafuso do pilar. (AU)


Subject(s)
Bone Screws , Torque , Dental Implantation
9.
Article in Chinese | WPRIM | ID: wpr-879394

ABSTRACT

OBJECTIVE@#To compare clinical effect of cannulated screw and bone plate for the treatment of humeral fracture of greater tuberosity.@*METHODS@#From January 2010 to January 2020, clinical trial literatures on the treatment of humeral tuberosity fractures with cannulated screw and bone plate were searched by PubMed, EMbase, Cochrane Library, Wanfang, CNKI, CBM Database, VIP Database and other databases. Independent literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Revman5.2 software was used to perform Meta analysis.@*RESULTS@#Totally 5 clinical randomized controlled trials and 12 cohort studies were selected, including 1 068 patientsin which 559 patients were treated by cannulated screw internal fixation and 509 patients treated by bone plate internal fixation. Meta analysis resluts showed that there were satistical differences in operation time[MD=-23.03, 95% CI(-29.69, -16.36), @*CONCLUSION@#Compared with bone plate, cannulated screw for the treatment of humeral fracture of greater tuberosity has advantages of shorter opertaion time, less blood loss, shorter hospital stay, lower incidence rate of postopertaive infection, and more benefit for fracture healing.


Subject(s)
Bone Plates , Bone Screws , Fracture Fixation, Internal , Humans , Humeral Fractures/surgery , Humerus , Randomized Controlled Trials as Topic , Treatment Outcome
10.
Article in Chinese | WPRIM | ID: wpr-879385

ABSTRACT

OBJECTIVE@#To explore biomechanical characteristics of minimally invasive different screw fixations in treating Sanders typeⅡcalcaneal fractures.@*METHODS@#Dicom data of calcaneus by CT scan were input into Mimics 21.0 software and Ansys15.0 software to construct three-dimensional finite element digital model of calcaneus;this model was input into UG NX 10.0 software, and calcaneus was cut according to Sanders classification to establish Sanders typeⅡ calcaneus model with posterior articular surface collapse;then simulated minimally invasive screw internal fixation after calcaneal fracture:a screw from posterior articular surface was used to outside-in fix sustentaculum tali, other 4 screws were used to fix calcaneus by different methods through calcaneal tuberosity, and 4 different calcaneal models were obtained. Under the same conditions, 4 types of internal fixation models were loaded respectively, and nonlinear finite element analysis was performed to calculate the stress distribution of different internal fixation models.@*RESULTS@#Under the same condition of loading, the model 3 had smaller displacement value, maximum calcaneus displacement value and maximum equivalent stress value of the screw than other three internal fixation models, and the stress was more dispersed.@*CONCLUSION@#In minimally invasive screw internal fixation of calcaneus fracture, after 1 sustentaculum tali screw fixation, 2 screws crossed fix posterior articular surface from calcaneal tuberosity, 2 screws fix parallelly calcaneocuboid joint from calcaneal tuberosity are more suitable for biomechanical requirements, and could provide basic theory for clinical treatment.


Subject(s)
Bone Screws , Calcaneus/surgery , Finite Element Analysis , Fracture Fixation, Internal , Fractures, Bone/surgery , Humans , Treatment Outcome
11.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(4): 325-334, dic. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1351408

ABSTRACT

Introducción: Los métodos más utilizados para la artrodesis de la articulación interfalángica proximal y metacarpofalángica son la banda de tensión y el tornillo compresivo. El objetivo de este estudio fue comparar los resultados entre pacientes tratados con estas técnicas. Materiales y Métodos: Estudio comparativo retrospectivo de 10 años. Se incluyeron pacientes esqueléticamente maduros tratados por artrosis y artritis. Se analizaron la tasa de consolidación ósea, el tiempo hasta la consolidación, la incidencia de complicaciones y la tasa de reoperaciones. En un análisis secundario, se compararon los pacientes reumáticos y no reumáticos. Resultados: Se evaluaron 56 casos en 44 pacientes (edad promedio 53 años). Grupo 1: 35 casos tratados con banda de tensión y grupo 2: 21 tratados con tornillo compresivo. Había 32 casos reumáticos y 24 no reumáticos. El seguimiento promedio fue de 24 meses. La tasa promedio de consolidación fue del 94,2% en el grupo 1 y del 85,7% en el grupo 2. La incidencia de complicaciones fue del 11,4% en el primer grupo y 23,8% en el segundo, y la tasa de reoperaciones, del 17,1% y del 0%, respectivamente. Conclusiones: Ambos métodos permiten lograr tasas altas de consolidación, pero la incidencia de seudoartrosis fue casi tres veces superior con el tornillo compresivo que con la banda de tensión. La tasa más alta de reoperaciones en el grupo con banda de tensión fue por extracción del material. El tiempo de consolidación fue más corto en los pacientes no reumáticos, independientemente de la técnica. Nivel de Evidencia: III


Introduction: Tension band wiring (TBW) and compression screw fixation are the most common methods used for proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint arthrodesis. The aim of this study was to compare outcomes between patients treated with those methods. Materials and Methods: A 10-year retrospective comparative study. The study population included skeletally mature patients treated for osteoarthritis or arthritis. Union rates, healing times, complications, and reoperation rates were compared between TBW and compression screw fixation methods. Outcomes were also studied in terms of rheumatic and nonrheumatic patients. Results: The study sample consisted of 56 cases and 44 patients (average age, 53 years). Group 1: 35 patients treated with TBW. Group 2: 21 patients treated with compression screw fixation. There were 32 rheumatic cases and 24 nonrheumatic cases. The average follow-up was 24 months. Union rates were 94.2% (Group 1) and 85.7% (Group 2). Complication rates were 11.4% (Group 1) and 23.8% (Group 2). Reoperation rates were 17.1% (Group 1) and 0% (Group 2). Conclusions: Both methods have high union rates; however, the nonunion incidence in the compression screw group was almost three times higher than in the TBW group. The reoperation rate was higher in the TBW group, mostly due to hardware removal. Healing time was shorter in non-rheumatic patients regardless of the method. Level of Evidence; III


Subject(s)
Adult , Middle Aged , Arthrodesis , Bone Screws , Treatment Outcome , Finger Joint/surgery , Metacarpophalangeal Joint/surgery
12.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1142103

ABSTRACT

Introducción: Las fracturas ipsilaterales proximales de fémur ocurren en el 1 al 9% de las fracturas diafisarias. Existen múltiples tratamientos propuestos para dicha asociación lesional. El objetivo de este trabajo es revisar los diferentes métodos de tratamiento propuestos, y comparar sus resultados funcionales y principales complicaciones. Materiales y Métodos: Se utilizaron los buscadores electrónicos: PubMed, Lilacs, Cochrane y Ovid SP. La búsqueda llegó a un total de 1829 trabajos, de los cuales se seleccionaron 21 según criterios de inclusión y exclusión. Discusión: No existe un consenso acerca de cuál es el mejor método de fijación para esta asociación lesional. Esta ocurre en pacientes jóvenes por un mecanismo axial de alta energía cinética y la opción elegida debe buscar la reducción anatómica de la fracturas proximales de fémur. Las complicaciones como la pseudoartrosis de cuello femoral y la necrosis avascular son de difícil manejo en este grupo etario. Conclusión: Las fracturas ipsilaterales proximales y diafisarias de fémur son lesiones que presentan un problema diagnóstico y terapéutico. Hay un subdiagnóstico de las mismas y no existe un implante ideal, ni un consenso de cual es el mejor método de fijación.


Introduction: Ipsilateral proximal femoral fractures ocurred in 1 to 9% of femoral shaft fractures. There are multiple treatments proposed for these injuries. The objetive of the present work is revise the different treatment options and compare their functional results and main complications Materials and methods: A comprehensive literature search was carried out using: Pubmed, Lilacs, Cochrane and OVID SP. Initially there were identified a total of 1829 studies. Only 21 studies remained after inclusion and exclusion were applied. Discussion: There is no consensus about which is the best fixation option for these injuries. These occurred in young patients as a result of a high energy axial trauma, and the selected treatment must achieve anatomic reduction of the proximal femoral fracture. Complications such as femoral neck no-union and avascular necrosis are difficult to manage at this age. Conclusion: Ipsilateral proximal and shaft femoral fractures present diagnostic and therapeutic problems. There is an underdiagnosis of these injuries, and there is no ideal implant or consensus on which is the best fixation method.


Introdução: As fraturas proximais ipsilaterais do fêmur ocorrem em 1 a 9% das fraturas diafisárias. Existem vários tratamentos propostos para essa associação lesional. O objetivo deste trabalho é rever os diferentes métodos de tratamento propostos, e comparar os seus resultados funcionais e principais complicações. Materiais e Métodos: Foram utilizados os buscadores eletrônicos: Pubmed, Lilacs, Cochrane e Ovid SP. A busca chegou a um total de 1829 trabalhos, dos quais foram selecionados 21 segundo critérios de inclusão e exclusão. Discussão: Não há consenso sobre qual é o melhor método de fixação para esta associação lesional. Esta ocorre em pacientes jovens por um mecanismo axial de alta energia cinética e a opção escolhida deve procurar a redução anatômica da fratura proximal do fêmur. Complicações como a pseudoartrose do pescoço femoral e a necrose avascular são de difícil manejo neste grupo etário. Conclusão: As fraturas ...(SUPRIMIR LO PRECEDENTE)Conclusão: As fracturas ipsilaterais proximais e diafisárias do fémur são lesões que apresentam um problema diagnóstico e terapêutico. Há um subdiagnóstico das mesmas e não existe um implante ideal, nem um consenso de qual é o melhor método de fixação.


Subject(s)
Humans , Bone Nails/adverse effects , Bone Plates/adverse effects , Bone Screws/adverse effects , Femoral Neck Fractures/surgery , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Treatment Outcome , Fracture Fixation, Internal/adverse effects
13.
Rev. bras. ortop ; 55(6): 695-701, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156194

ABSTRACT

Abstract Objective Compare by mechanical tests the pullout resistance and the insertion torque of rough and smooth pedicle screws. Methods Pedicle screws with rough surface and smooth surface, with diameters of 4.8; 5.5 and 6.5 mm, were inserted in polyurethane blocks with density of 10 PCF (0.16 g/cm3). Insertion torque and pullout strength were assessed. Results The pullout strength of the rough surface and smooth surface screws did not differ, except in the group of 4.8 mm diameter screws. In this group, the rough surface screws showed greater resistance to pullout. Conclusion Pedicle screws with a rough surface did not show increased pullout resistance in the acute phase of their insertion in polyurethane blocks compared to smooth surface screws. The rough surface screws had a higher insertion torque than the smooth surface screws, depending on the diameter of the screw and the preparation of the pilot hole.


Resumo Objetivo Comparar por testes mecânicos a resistência ao arrancamento e o torque de inserção do parafuso pedicularjateado e liso. Métodos Parafusos pediculares de superfície áspera e de superfície lisa com diâmetros de 4,8; 5,5 e 6,5 mm foram inseridos em blocos de poliuretano com densidade de 10 PCF (0,16 g/cm3). O torque de inserção e a força de arrancamento foram avaliados. Resultados A força de arrancamento dos parafusos de superfície áspera e de superfície lisa não diferiu, exceto no grupo de parafusos com 4,8 mm de diâmetro. Nesse grupo, os parafusos de superfície áspera apresentaram maior resistência ao arrancamento. Conclusão Os parafusos pediculares de superfície áspera não apresentaram aumento da resistência ao arrancamento na fase aguda de sua inserção em blocos de poliuretano em relação aos parafusos de superfície lisa. Os parafusos de superfície áspera apresentaram maior torque de inserção que os parafusos de superfície lisa, dependendo do diâmetro do parafuso e da preparação do furo piloto.


Subject(s)
Polyurethanes , Spine , Biomechanical Phenomena , Bone Screws , Pedicle Screws , Pilots
14.
Rev. bras. ortop ; 55(5): 605-611, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1144212

ABSTRACT

Abstract Objective The present paper aims to present results from radiographic evaluations of patients with extra-articular distal radius fractures submitted to percutaneous fixation with a 3.5 mm solid screw. Methods Analytical, descriptive and retrospective case series of 16 patients with evaluation of the radiographic parameters. Results The average age of the study population was 46.5 years old (25-60 years old); 81.25% of the sample was female. The average time until surgery was 8.8 days (4-14 days). The mean preprocedural volar tilt was - 7.41° (−23.48°-5.29°, standard deviation [SD] ± 6.59°). The mean volar tilt immediately after surgery was 5.93° (SD ± 6.23°, p< 0.001). There was no statistical difference in volar tilt values after 6 months of follow-up. The mean preprocedural radial height was 4.13 mm (−7.8 mm-9.5 mm, SD ± 5.06 mm). There was a statistically significant increase at the immediate postoperative period to 10.04 mm (p= 0.002), and a significant reduction at 6 months to 9.55 mm (p= 0.012). The consolidation rate was 100% with the technique used, with a minimal complication rate. No patient had infection or required a reoperation. Conclusion The technique was effective for the treatment of distal radial extra-articular fractures at 6 months, with a low complication rate; radiographic parameters values were acceptable and close to the anatomical ones.


Resumo Objetivo Apresentar o resultado das avaliações radiográficas dos pacientes com fraturas extra-articulares do rádio distal submetidos a fixação percutânea com parafuso maciço de 3.5mm. Métodos Série de casos, analítica, descritiva e retrospectiva de 16 pacientes com avaliação dos parâmetros radiográficos da técnica utilizada. Resultados A média de idade da população estudada foi de 46,5 anos (25-60 anos), sendo 81,25% do sexo feminino. O tempo de espera até a cirurgia foi de 8,8 dias (4-14 dias). O tilt volar médio pré-procedimento foi - 7,41° (−23,48°-5,29°, desvio padrão [DP] ± 6,59°). O tilt volar imediatamente após o procedimento cirúrgico foi de 5,93° (DP ± 6,23°, p< 0,001). Sem diferença estatística nos valores de tilt volar ao final de 6 meses de evolução. A altura radial pré-procedimento foi de 4,13 mm (−7,8°-9,5°, DP ± 5,06°). Aumento estatisticamente significativo no pós-operatório imediato para 10,04 mm (p= 0,002). Redução significativa ao final de 6 meses para 9,55 mm (p= 0,012). Atingimos 100% de consolidação com a técnica utilizada, com índice mínimo de complicações. Nenhum paciente apresentou infecção ou precisou ser reoperado. Conclusão A técnica mostrou-se eficaz para o tratamento de fraturas extra-articulares da extremidade distal do rádio ao final de 6 meses, com baixo índice de complicações e parâmetros radiográficos aceitáveis e próximos dos valores anatômicos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Radius Fractures/surgery , Radius Fractures/diagnostic imaging , Bone Screws , Fracture Fixation, Internal/methods , Radius/anatomy & histology , Retrospective Studies , Range of Motion, Articular , Minimally Invasive Surgical Procedures
15.
Braz. dent. j ; 31(4): 374-379, July-Aug. 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1132322

ABSTRACT

Abstract The aim of this study was to verify the effect of the implant volume loss, vertical misfit between abutment and prosthetic platform, prosthetic screw loosening torque, and screw stress distribution in titanium and zirconia abutments. Ten CAD/CAM system custom abutments of each material were milled and attached to the titanium implants. The implant volume loss was evaluated by microtomography, the vertical misfit with optical microscopy, and digital torque wrench measured the prosthetic screw loosening. All experimental analyses were performed before and after mechanical cycle (1,000,000 cycles, 100 N/2 Hz). Virtual models of the structures were created for finite element analysis, and the stress on the screw obtained with von Mises procedure. Data were analyzed using an independent t-test, two-way ANOVA for repeated measures, and Tukey's HSD test (a=0.05). There was no significant difference in the implant volume loss for the two abutment materials (p=0.662). Titanium abutments provided higher loosening torque values after mechanical cycling (p<0.001). Lesser marginal misfit was obtained with titanium abutments before and after mechanical cycling (p<0.001). The stress distribution on the screw was similar between abutment materials. In conclusion, CAD/CAM custom titanium abutment reduced the marginal misfit and increased the torque maintenance of prosthetic screws when compared to CAD/CAM custom zirconia abutment.


Resumo O objetivo neste estudo foi verificar o efeito da diminuição de volume do implante, desajuste vertical entre o pilar e plataforma protética, torque de afrouxamento do parafuso protético e distribuição da tensão no parafuso em pilares de titânio e zircônia. Dez pilares personalizados de cada material foram fresados e conectados aos implantes de titânio. A diminuição de volume do implante foi avaliada com microtomografia, o desajuste vertical com microscopia óptica e o torque de afrouxamento do parafuso protético com chave de torque digital. Todas as análises experimentais foram realizadas antes e após aplicação do ciclo mecânico (1.000.000 ciclos, 100 N/2 Hz). Modelos virtuais das estruturas foram criados para análise por elementos finitos e a tensão no parafuso obtida com valores de von Mises. Os dados foram analisados usando teste t independente, análise de varância dois fatores para medidas repetidas e teste de Tukey HSD (a=0,05). Não houve diferença significativa na diminuição de volume do implante para os dois materiais do pilar (p= 0,662). Os pilares de titânio proporcionaram maiores valores de torque de afrouxamento após o ciclo mecânico (p<0,001). O menor desajuste marginal foi obtido com os pilares de titânio antes e após o ciclo mecânico (p<0,001). A distribuição da tensão no parafuso foi similar entre os materiais. Em conclusão, os pilares personalizados de titânio reduziram o desajuste marginal e aumentaram a manutenção do torque dos parafusos protéticos quando comparados aos pilares de zircônia.


Subject(s)
Titanium , Dental Abutments , Zirconium , Bone Screws
16.
Rev. méd. panacea ; 9(2): 135-140, mayo-ago. 2020.
Article in Spanish | LILACS, LIPECS | ID: biblio-1121237

ABSTRACT

Introducción: El tratamiento quirúrgico de las fracturas intertrocantericas presenta complicaciones postquirúrgicas múltiples debido a varios factores, el índice punta-ápex o "TAD" es uno de los principales predictores del desanclaje del tornillo femoral o "cut out". Objetivo: Realizar una revisión bibliográfica del "TAD" en los estudios científicos más actuales. Materiales y métodos: Estudio descriptivo de búsqueda bibliografíca en páginas científicas como Scielo, Elsevier, Pubmed, Medline y bibliotecas virtuales nacionales e internacionales. Resultados: Las fracturas intertrocantericas representan el 50% de todas las fracturas del fémur proximal, mayor incidencia en mujeres (2:1 hasta 8:1) y personas mayores de 65 años, las complicaciones postquirúrgicas representan el 17%, el desanclaje de tornillo o "cut out" se describe como la complicación más común. El "TAD" es usado desde 1995; la migración del tornillo deslizante en la cabeza femoral se observa inclusive en pacientes con TAD menor de 25 mm, debido a la implicancia de factores (asociados al implante, mal posicionamiento del tornillo deslizante y mala calidad ósea), dando un umbral óptimo del TAD más bajo (<20 mm) que el corte tradicional(<25 mm); por cada milímetro que aumenta el TAD, el riesgo de corte aumenta aproximadamente 1.1. El TAD presenta una especificidad significativamente mayor que el CalTAD y TAD + CalTAD (59.1 vs 49.2%, p <0.001; 59.1 vs 54.1%, p <0,001). Conclusiones: El "TAD", sigue siendo el mayor predictor de "cut out" en la actualidad inclusive por encima de los nuevos predictores. (AU)


Introduction: Surgical treatment of intertrochanteric fractures involves multiple post-surgical complications due to several factors. The tip-apex distance or "TAD" is one of the main predictors of femoral screw displacement or "cutout". Objective: perform a bibliographic review of the "TAD" in the most current scientific studies. Materials and methods: Descriptive study of bibliographic searches in scientific sites such as Scielo, Elsevier, Pubmed, Medline and national and international virtual libraries. Results: Intertrochanteric fractures account for 50% of all fractures of the proximal femur, higher incidence in women (2:1 to 8:1) and people over 65 years, post-surgical complications account for 17%, screw displacement or "cutout" is described as the most common complication. The TAD has been used since 1995; migration of the sliding screw in the femoral head is observed even in patients with a cut out of less than 25 mm, due to the implication of factors (associated with the implant, poor positioning of the sliding screw and poor bone quality), giving an optimal threshold of cut out lower (<20 mm) than the traditional cut out (<25 mm); for every millimeter that the cut out increases, the risk of cut out increases approximately 1.1. TAD has a significantly higher specificity than CalTAD y TAD + CalTAD (59.1 vs 49.2%, p <0.001; 59.1 vs 54.1%, p <0,001). Conclusions: The "TAD", is still the biggest predictor of "cut out" at present even above the new predictors. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Bone Screws , Hip Fractures/surgery , Hip Fractures/therapy , Epidemiology, Descriptive
17.
Coluna/Columna ; 19(3): 197-200, July-Sept. 2020. tab, graf
Article in English | LILACS | ID: biblio-1133579

ABSTRACT

ABSTRACT Objectives To observe the influence of the congruence of the tapping of the pilot hole on the anchorage of the pedicle screws. Methods 5.5 and 6.5 mm screws from two vertebral fixation systems (Pedicol and Safe) were inserted into polyurethane blocks. Experimental groups were formed according to the pilot hole preparation: A- drilling with a 2.7 mm drill bit, B- Tapping of the pilot hole with a tap of lesser diameter than the diameter of the screw with a congruent thread design, C- Tapping of the pilot hole with a tap of lesser diameter than the diameter of the screw and an incongruous thread design. The polyurethane blocks with the screws were subjected to a tensile strength test to evaluate the pullout resistance of the screws. Results Using congruent pilot hole tapping of a lesser diameter and congruent thread design increased the pullout resistance of the rough-surface screws (Safe). The screws with a smooth surface (Pedicol) presented greater pullout resistance with tapping of a lesser diameter and incongruous thread design. Conclusions The congruence of the tap used to prepare the pilot hole increased the pullout resistance of the rough-surfaced screws. Level of Evidence III; Therapeutic Study.


RESUMO Objetivos Observar a influência da congruência do macheamento do orifício piloto na ancoragem dos parafusos pediculares. Métodos Parafusos de 5,5 e 6,5 mm, pertencentes a dois sistemas de fixação vertebral (Pedicol e Safe), foram introduzidos em blocos de poliuretano. Os grupos experimentais foram formados de acordo com o preparo do orifício piloto: A - perfuração com broca de 2,7 mm, B - macheamento do orifício piloto com macho de diâmetro inferior ao diâmetro do parafuso e desenho de rosca congruente, C - macheamento do orifício piloto com macho de diâmetro inferior ao diâmetro do parafuso e desenho de rosca incongruente. Os blocos de poliuretano com os parafusos foram submetidos a ensaio de resistência à tração para avaliar a resistência dos parafusos ao arrancamento. Resultados A utilização do macheamento do orifício piloto de menor tamanho e congruente aumentou a resistência ao arrancamento dos parafusos de superfície rugosa (Safe). Os parafusos de superfície lisa (Pedicol) apresentaram maior resistência ao arrancamento com a utilização do macheamento com menor diâmetro e incongruente. Conclusões A congruência do macho utilizado para o preparo do orifício piloto aumentou a resistência ao arrancamento nos parafusos de superfície rugosa. Nível de Evidência III; Estudo terapêutico.


RESUMEN Objetivos Observar la influencia de la congruencia del taladramiento del orificio piloto en el anclaje de los tornillos pediculares. Métodos Fueron introducidos tornillos de 5,5 y 6,5 mm, pertenecientes a dos sistemas de fijación vertebral (Pedicol y Safe) en bloques de poliuretano. Los grupos experimentales fueron formados de acuerdo con la preparación del orificio piloto: A- perforación con broca de 2,7 mm, B- taladramiento del orificio piloto con mecha de diámetro inferior al diámetro del tornillo y diseño de rosca congruente, C- taladramiento del orificio piloto con mecha de diámetro inferior al diámetro del tornillo y diseño de rosca incongruente. Los bloques de poliuretano con los tornillos fueron sometidos a ensayo de resistencia a la tracción para evaluar la resistencia de los tornillos al arrancamiento. Resultados El uso del taladramiento del orificio piloto de menor tamaño y congruente aumentó la resistencia al arrancamiento de los tornillos de superficie rugosa (Safe). Los tornillos de superficie lisa (Pedicol) presentaron mayor resistencia al arrancamiento con el uso del taladramiento con menor diámetro e incongruente. Conclusiones La congruencia de la mecha utilizada para la preparación del orificio piloto aumentó la resistencia al arrancamiento en los tornillos de superficie rugosa. Nivel de Evidencia III; Estudio terapéutico.


Subject(s)
Humans , Spine , Biomechanical Phenomena , Bone Screws
18.
Coluna/Columna ; 19(3): 189-193, July-Sept. 2020. tab, graf
Article in English | LILACS | ID: biblio-1133571

ABSTRACT

ABSTRACT Objective To compare the use of a dynamic surgical guide (PediGuard®) and pilot hole preparation, with the use of a probe and the aid of fluoroscopy in osteoporotic or osteopenic patients undergoing pedicular fixation of the thoracic or lumbar spine. Methods One hundred and eight patients were randomized. A pilot hole was prepared with the dynamic surgical guide (PediGuard®), or with a probe with the aid of fluoroscopy. A total of 657 vertebral pedicles (120 thoracic and 180 lumbar) were included in the study. The parameters used for the comparison were: accuracy of the pedicular screw, number of fluoroscopic shots, and change in intraoperative trajectory of the perforation after detecting pedicle wall rupture. Results In the group with use of the dynamic surgical guide, malpositioning of the pedicle screws was observed in 8 (2.6%) patients and intraoperative change of perforation trajectory in 12 (4%) patients, and there were 52 fluoroscopic shots. In the group without use of the dynamic surgical guide (PediGuard®), misplacement of the pedicle screws was observed in 33 (11%) patients and intraoperative change of perforation trajectory in 47 (13.2%) patients, and there were 136 fluoroscopic shots. Conclusion The use of the dynamic surgical guide (PediGuard®) in patients with osteoporosis or osteopenia enabled more accurate placement of pedicular screws, with less change in the intraoperative course of the perforation and less intraoperative radiation. Level of Evidence II; Randomized clinical trial of lesser quality.


RESUMO Objetivo Comparar o uso de um guia cirúrgico dinâmico (PediGuard®) e o preparo de orifício piloto com uma sonda e o auxílio de fluoroscopia em pacientes com osteopenia ou osteoporose submetidos à fixação pedicular da coluna torácica ou lombar. Métodos Cento e oito pacientes foram randomizados. Um orifício piloto foi preparado com o guia cirúrgico dinâmico (PediGuard®) ou com uma sonda com auxílio de fluoroscopia. Foram incluídos no estudo 657 pedículos vertebrais (120 torácicos e 180 lombares). Os parâmetros usados para a comparação foram: acurácia da colocação do parafuso pedicular, número de disparos fluoroscópicos e mudança da trajetória intraoperatória da perfuração depois da detecção de ruptura da parede do pedículo. Resultados No grupo de pacientes em que se usou o guia cirúrgico dinâmico, observou-se mau posicionamento dos parafusos pediculares em oito (2,6%) pacientes e alteração da trajetória intraoperatória da perfuração em 12 (4%) pacientes, com 52 disparos fluoroscópicos. No grupo de pacientes em que o guia cirúrgico dinâmico (PediGuard®) não foi usado o mau posicionamento dos parafusos pediculares foi observado em 33 (11%) pacientes, a mudança intraoperatória da trajetória da perfuração foi vista em 47 (13,2%) pacientes, com 136 disparos fluoroscópicos. Conclusão O uso do guia cirúrgico dinâmico (PediGuard®) em pacientes com osteoporose ou osteopenia permitiu a colocação de parafusos pediculares com maior acurácia, com menor alteração da trajetória intraoperatória da perfuração e menor dose de radiação intraoperatória. Nível de Evidência II; Estudo clínico randomizado de menor qualidade.


RESUMEN Objetivo Comparar el uso de una guía quirúrgica dinámica (PediGuard®) y la preparación del orificio piloto con una sonda y la ayuda de fluoroscopia en pacientes con osteopenia u osteoporosis sometidos a fijación pedicular de la columna torácica o lumbar. Métodos Ciento ocho pacientes fueron asignados aleatoriamente. Se preparó un orificio piloto preparado con la guía quirúrgica dinámica (PediGuard®) o con una sonda con ayuda de fluoroscopia. Se incluyeron en el estudio 657 pedículos vertebrales (120 torácicos y 180 lumbares). Los parámetros utilizados para la comparación fueron: precisión de la colocación del tornillo pedicular, número de disparos del dispositivo de fluoroscopia y cambio en la trayectoria intraoperatoria de la perforación después de la detección de ruptura de la pared del pedículo. Resultados En el grupo de pacientes en el que se utilizó la guía quirúrgica dinámica, se observó mal posicionamiento de los tornillos pediculares en 8 (2,6%) pacientes y cambios de la trayectoria intraoperatoria de la perforación en 12 (4%) pacientes, con 52 disparos del aparato de fluoroscopia. En el grupo de pacientes en los que no se utilizó la guía quirúrgica dinámica (PediGuard®), se observó un mal posicionamiento de los tornillos pediculares en 33 (11%) pacientes, el cambio intraoperatorio de la trayectoria de perforación se observó en 47 (13,2%) pacientes, con 136 disparos fluoroscópicos. Conclusión El uso de la guía quirúrgica dinámica (PediGuard®) en pacientes con osteoporosis u osteopenia permitió la colocación de tornillos pediculares con mayor precisión, menos cambios en la trayectoria intraoperatoria de la perforación y dosis más baja de radiación intraoperatoria. Nivel de Evidencia II; Ensayo clínico aleatorizado de menor calidad.


Subject(s)
Humans , Orifice Valves , Bone Diseases, Metabolic , Bone Screws , Fluoroscopy
19.
Rev. cir. traumatol. buco-maxilo-fac ; 20(4): 31-34, out.-dez. 2020. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1252709

ABSTRACT

Introdução: As fraturas faciais pediátricas são geralmente decorrentes de traumas de alta energia e o seu tratamento está relacionado à fase do crescimento facial e do padrão do trauma ocorrido. A literatura atual descreve, com sucesso, a fixação de fraturas de zigoma com pouco deslocamento, utilizando apenas um ponto, seja ele na sutura frontozigomática ou no pilar zigomaticomaxilar, podendo ser associado ao uso de placas do sistema de fixação absorvível, principalmente, em pacientes em fase de crescimento. Este trabalho tem por objetivo relatar um caso de fratura de zigoma em paciente pediátrico tratado com placa e parafusos absorvíveis, utilizando o princípio de fixação em um único ponto. Relato de caso: Paciente de 06 anos de idade foi atendido em serviço de Cirurgia Bucomaxilofacial, cursando com ferimento cortocontuso em margem supraorbitária direita associada à presença de degrau palpável em região de sutura frontozigomática direita, o qual foi confirmado pela tomografia computadorizada, demonstrando leve deslocamento medial. O paciente foi submetido à redução aberta e fixação da fratura com material reabsorvível. Considerações finais: A utilização de fixação com placas reabsorvíveis em um único ponto tem sido um excelente aliado, porém não é indicado para fraturas com deslocamento significativo, instáveis e panfaciais... (AU)


Introduction: Pediatric facial fractures are usually consequence of high energy trauma and its treatment is related to the facial growth phase and the trauma itself. The current literature describes, successfully, the fixation of zygoma fracture with little displacement using the single point fixation, being on the frontozygomatic suture or on the zygomatic-maxillary buttress, which can be associated to the use of resorbable fixation system plates, especially in patients growing phase. The aim of this work is report a case of zygomatic fracture in a pediatric patient treated with plate and resorbable screws, using the principle of single-point fixation. Case Report: A 06-year-old patient, attended in the Oral and Maxillofacial Surgery Service, suffering from a cut-contusion wound on the right supraorbital margin associated with the presence of a palpable step in the region of the right frontozygomatic suture, which was confirmed by computed tomography, demonstrating slight medial displacement. The patient was underwent to open reduction and internal fixation of the fracture with resorbable material. Final considerations: The use of fixation with resorbable plates in a single-point has been an excellent approach, however it is not indicated for fractures with significant displacement, unstable and panfacial... (AU)


Subject(s)
Humans , Male , Child , Zygomatic Fractures/surgery , Bone Screws , Fracture Fixation, Internal , Zygomatic Fractures/diagnostic imaging , Tomography, X-Ray Computed
20.
Coluna/Columna ; 19(2): 127-132, Apr.-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1133557

ABSTRACT

ABSTRACT Objective Morphometric study of the positioning of the cortical trajectory pedicle screw in the lumbar spine of Brazilian patients of different sexes and ages, through the use of computed tomography images, in order to obtain more reliable data about cortical screw insertion and the variations observed, providing assistance for a safer, more effective approach with fewer complications. Methods Selection of 100 patients from a database, alternating by sex, measuring the length, diameter, cephalic angulation, and lateral angulation of the vertebrae from L1 to L5. Results Statistically significant measurements were obtained for the four different parameters in relation to sex. The mean age was 56, with a minimum of 20 and a maximum of 87 years. The L4 and L5 screws showed a reduction in relation to the other levels, while the width showed a progressive increase starting at L3. Lateral angulation was the parameter with the least variation among the levels, while there was greater variation and a reduction from L4 to L5 in cephalic angulation. Conclusion Statistically significant results were obtained for length, diameter, lateral and cephalic angulation. Sex was a significant factor in spine surgery instrumentation using the cortical trajectory pedicle screw technique. Level of evidence I; Diagnostic study (investigation of an examination for diagnosis).


RESUMO Objetivo Estudo morfométrico do posicionamento de parafuso pedicular com trajeto cortical na coluna lombar de pacientes brasileiros de diferentes sexos e idades, por meio da utilização de imagens de tomografia computadorizada, com o intuito de se obter dados mais fidedignos em relação à inserção do parafuso cortical e às variações observadas, proporcionando assim subsídios para uma abordagem mais segura, eficaz e com menos complicações. Métodos Seleção de 100 pacientes em bases de dados, com alternância de sexo, auferindo o comprimento, diâmetro, angulação cefálica e angulação lateral das vértebras de L1 à L5. Resultados Foram obtidas medições com significância estatística em relação ao sexo nos quatro diferentes parâmetros mensurados. A média de idade foi de 56 anos, com mínima de 20 e máxima de 87 anos. Os parafusos de L4 e L5 mostraram redução em relação aos outros níveis, enquanto a largura se mostrou progressiva a partir de L3. A angulação lateral foi o parâmetro que apresentou a menor variância entre eles, ao contrário da angulação cefálica com maior variação e diminuição de L4 e L5. Conclusões Foram obtidos resultados de comprimento, largura, angulação lateral e cefálica estatisticamente significativos. O sexo apresentou-se como fator significativo na instrumentação da cirurgia da coluna pela técnica do parafuso pedicular de trajeto cortical. Nível de evidência I; Estudo diagnóstico (investigação de um exame para diagnóstico).


RESUMEN Objetivo Estudio morfométrico del posicionamiento de tornillo pedicular con trayecto cortical en la columna lumbar de pacientes brasileños de diferentes sexos y edades, mediante el uso de imágenes de tomografía computarizada, con el objetivo de obtener datos más fidedignos con relación a la inserción del tornillo cortical y a las variaciones observadas, proporcionando así subsidios para un abordaje más seguro, eficaz y con menos complicaciones. Métodos Selección de 100 pacientes en bases de datos, con alternancia de sexo, midiendo la longitud, diámetro, angulación cefálica y angulación lateral de las vértebras desde L1 hacia L5. Resultados Fueron obtenidas medidas con significancia estadística con relación al sexo en los cuatro diferentes parámetros medidos. El promedio de edad fue de 56 años, con edad mínima de 20 y máxima de 87 años. Los tornillos de L4 y L5 mostraron reducción con relación a los otros niveles, mientras que el ancho se mostró progresivo a partir de L3. La angulación lateral fue el parámetro que presentó la menor variancia entre ellos, al contrario de la angulación cefálica, con mayor variación y disminución de L4 y L5. Conclusiones Fueron obtenidos parámetros de longitud, ancho, angulación lateral y cefálica estadísticamente significativos. El sexo se presentó como factor en la instrumentación de la cirugía de la columna por la técnica del tornillo pedicular de trayecto cortical. Nivel de evidencia I; Estudio Diagnóstico (investigación de un examen para diagnóstico).


Subject(s)
Humans , Spine/surgery , Spinal Fusion , Bone Screws
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