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1.
Rev. Círc. Argent. Odontol ; 79(230): 24-28, dic. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1358462

ABSTRACT

Objetivos: Demostrar la utilidad y la facilidad técnica del injerto tibial en defectos óseos orales y maxilofaciales, para tenerlo como un recurso alternativo en la práctica general del cirujano oral y maxilofacial. Caso clínico: Se presenta un caso clínico con el uso de injerto óseo autólogo de tibia para el relleno de un defecto óseo a raíz de una lesión quística. Se realizó la exéresis de la patología quística por medio de un abordaje oral y posteriormente se recolectó hueso medular tibial a través de un abordaje medio al tubérculo anterior de la tibia, para poder colocarlo en el defecto óseo. Conclusión: El injerto de hueso medular de epífisis tibial representa un sitio de recolección de fácil acceso, del que se puede obtener una cantidad de hueso ideal para defectos de pequeño y mediano tamaño de la región maxilofacial, de baja morbilidad y con muy pocas complicaciones post-operatorias, lo que lo convierte en una alternativa para rellenos de cavidades óseas de gran utilidad (AU)


Objective: To demonstrate the utility and technical ease of the tibial graft in oral and maxillofacial bone defects so as to have it as an alternative resource in the general practice of the oral and maxillofacial surgeon. Case report: A clinical case is shown with the use of an autologous tibial bone graft to fill a bone defect as a result of a cystic lesion. The cyst was excised by an oral approach and the medial tibial bone was collected through a middle approach to the anterior tubercle of the tibia, to place it in the bone defect. Conclusion: The tibial epiphysis medullary bone graft represents an easily accessible collection site, from which an ideal amount of bone can be obtained for small and mediumsized defects of the maxillofacial region, with low morbidity and very few post-operative complications, which makes it a useful option for bone cavity filling (AU)


Subject(s)
Humans , Female , Aged , Tibia , Dentigerous Cyst/surgery , Bone Transplantation , Reconstructive Surgical Procedures , Osteotomy , Surgical Flaps , Tooth Extraction , Dentigerous Cyst/diagnostic imaging , Mandible
2.
Arq. bras. med. vet. zootec. (Online) ; 73(5): 1067-1075, Sept.-Oct. 2021. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1345266

ABSTRACT

The aim of this study was to evaluate neovascularization of bovine xenografts implanted in intracorporeal sites of rabbits (bioreactors). 30 rabbits were used, divided into 6 groups, according to the evaluation time (7, 15, 30, 45, and 60 days); each animal received xenogenic implants in 3 different intracorporeal sites (A1 - omentum bag; A2 - intermuscular space of quadriceps femoris; A3 - subperiosteal of ilium bone). Histological assessments graded the presence of angiogenesis, the number of inflammatory cells, newly formed bone tissue, and the presence of giant cells. Histological analyses showed intense angiogenesis in all implanted xenografts. Presence of inflammatory infiltrate and giant cells at the A1 implant site and presence of bone neoformation at the A3 implant site were noted. Degeneration of implants and formation of a fibrous capsule were noted. When comparing the interaction of the site with the days of evaluation, statistical analysis showed a significant difference (p≤0.05) in any time of neovascularization analysis. The vascular endothelial growth factor (VEGF) and inflammatory cells of the omentum in its structure, may have contributed to the greater presence of neovessels and inflammatory cells, a fact that may indicate functionality as a possible bone substitute.(AU)


O objetivo deste estudo foi avaliar a neovascularização de xenoenxertos bovinos implantados em sítios intracorpóreos de coelhos (biorreatores). Foram utilizados 30 coelhos, os quais foram divididos em seis grupos, de acordo com o tempo de avaliação (sete, 15, 30, 45 e 60 dias); cada animal recebeu implantes xenogênicos em três diferentes sítios intracorpóreos (A1 - bolsa de omento; A2 - espaço intermuscular do quadríceps femoral; A3 - subperiosteal do osso ílio). Avaliações histológicas classificaram a presença de angiogênese, o número de células inflamatórias, de tecido ósseo neoformado e a presença de células gigantes. As análises histológicas mostraram intensa angiogênese em todos os xenoenxertos implantados. Observou-se presença de infiltrado inflamatório e células gigantes no local do implante A1 e presença de neoformação óssea no local do implante A3. Ao mesmo tempo, a degeneração dos implantes e a formação de uma cápsula fibrosa foram observadas. Ao comparar a interação do local com os dias de avaliação, a análise estatística mostrou diferença significativa (P≤0,05) em qualquer momento da análise de neovascularização. O fator de crescimento endotelial vascular (VEGF) e as células inflamatórias do omento em sua estrutura podem ter contribuído para a maior presença de neovasos e células inflamatórias, fato que pode indicar funcionalidade como possível substituto ósseo.(AU)


Subject(s)
Animals , Cattle , Rabbits , Bone Transplantation/veterinary , Bioreactors/veterinary , Heterografts/blood supply , Models, Animal
3.
Int. j. med. surg. sci. (Print) ; 8(3): 1-9, sept. 2021. ilus
Article in English | LILACS | ID: biblio-1292570

ABSTRACT

Ossifying Fibroma is a gingival mass in which calcified foci are found. It is a nodular lesion that involves the inserted and interdental gum. There is a predilection for the female sex and for the anterior region of the maxilla. This work aims to report the surgical management of a Ossifying Fibroma in the maxilla and the immediate reconstructive with autogenous graft. Female patient, in the third decade of life, presenting Ossifying Fibroma in the region between maxillary incisors and premolars. She was treated surgically by means of marginal resection of the lesion under general anesthesia and immediate reconstruction with autologous iliac crest graft. Followed up for 12 months with no signs of recurrence.


El Fibroma osificante es una masa gingival en la que se encuentran focos calcificados. Es una lesión nodular que involucra la encía adherida e interdentaria. Hay una predilección por el sexo femenino y por la región anterior del maxilar. Este trabajo tiene como objetivo informar sobre el manejo quirúrgico de un fibroma osificante periférico en el maxilar y su reconstrucción inmediata con injerto autógeno. Paciente de sexo femenino, en la tercera década de vida, presenta un Fibroma osificante en la región entre incisivos maxilares y premolares. Fue tratada quirúrgicamente por medio de una resección marginal de la lesión bajo anestesia general y reconstrucción inmediata con injerto de cresta ilíaca autóloga. Seguimiento durante 12 meses sin signos de recurrencia.


Subject(s)
Humans , Adult , Cementoma/surgery , Radiography, Panoramic , Cementoma/diagnostic imaging , Bone Transplantation/methods , Cone-Beam Computed Tomography
4.
Rev. habanera cienc. méd ; 20(4): e3211, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289629

ABSTRACT

Introducción: El tratamiento inicial de la cervicalgia por degeneración de los discos intervertebrales es conservador, pero en caso de fallo la discectomía es la opción quirúrgica habitual, sustituyendo el disco por un injerto óseo u otra estructura que cumpla total o parcialmente las funciones del primero. El Servicio de Neurocirugía del Hospital General Camilo Cienfuegos de Cuba ha diseñado un nuevo modelo de prótesis de disco intervertebral cervical para tratar esta enfermedad. Objetivo: Evaluar el desempeño mecánico de la prótesis diseñada a través del método de los elementos finitos bajo las cargas habituales de la columna cervical. Material y Métodos: Se realizó un estudio experimental mediante la simulación numérica, según el método de los elementos finitos, sometiendo la prótesis a las cargas axiales recomendadas por las normas ASTM F2423-11e ISO 18192-1.2011 mediante el software Free CAD 0.18. Resultados: Los mayores esfuerzos soportados por la prótesis en la posición neutral, flexión anterior y flexión lateral fueron de 28.79 MPa, 52.29 MPa y 55.59 MPa respectivamente. La prótesis no sufrió ninguna fractura al no sobrepasar los valores anteriores al límite elástico del material que la constituye. La mayor deformación descrita fue de 1 m. Conclusiones: La mayor concentración de esfuerzos en la prótesis se ubicó en el punto de contacto de la cavidad prismática de la pieza superior al hacer contacto con el prisma de la pieza inferior. El dispositivo diseñado no sufrió ninguna deformación significativa ni se fracturó ante las cargas aplicadas(AU)


Introduction: The initial treatment of cervicalgia due to degeneration of the intervertebral discs is conservative, but in case of failure, discectomy is the usual surgical option, replacing the disc with a bone graft or another structure that fully or partially fulfills the functions of the former. The Neurosurgery Service of the Camilo Cienfuegos General Hospital in Cuba has designed a new cervical intervertebral disc prosthesis model to treat this disease. Objective: To evaluate the mechanical performance of the prosthesis designed through the finite element method under the usual loads of the cervical spine. Material and Methods: An experimental study was carried out using numerical simulation according to the finite element method, subjecting the prosthesis to the axial loads recommended by ASTM F2423-11e ISO 18192-1.2011 standards using Free CAD 0.18 software. Results: The greatest efforts supported by the prosthesis in the neutral position, anterior flexion and lateral flexion were 28.79 MPa, 52.29 MPa and 55.59 MPa, respectively. The prosthesis did not suffer any fracture as it did not exceed the values ​prior to the elastic limit of the material that constitutes it. The greatest deformation described was 1 956;m. Conclusions: The highest concentration of efforts in the prosthesis was located at the point of contact of the prismatic cavity of the upper part when making contact with the prism of the lower part. The designed device did not undergo any significant deformation or fracture at the applied loads(AU)


Subject(s)
Software , Bone Transplantation , Hospitals, General
5.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 52-55, maio-ago. 2021. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1283891

ABSTRACT

Pacientes com históricos de defeitos ósseos provocados por infecções, malformação congênita, neoplasias, deformação por iatrogenia, radioterapia e trauma buscam contornos faciais mais harmônicos através da reabilitação cirúrgica. Para facilitar a reconstrução maxilofacial dois grupos de materiais podem ser utilizados, os enxertos ósseos e os materiais aloplásticos. O objetivo é relatar um caso incomum de infecção e exposição de material utilizado para enxertia a base de polimetilmetacrilato, bem como a sua posterior reabordagem cirúrgica. Embora o Polimetilmetacrilato aparente ser seguro, ele exibe complicações diversas em função da imunologia do hospedeiro, que poderá reagir de diferentes formas. Desse modo, faz-se necessário ressaltar a importância da prevenção e proservação de cada caso de forma individualizada(AU)


Patients with a history of bone defects caused by infections, congenital malformation, neoplasms, iatrogenic deformation, radiotherapy and trauma seek more harmonious facial contours through surgical rehabilitation. To facilitate maxillofacial reconstruction, two groups of materials can be used, bone grafts and alloplastic materials. The objective is to report an unusual case of infection and exposure of material used for grafting with polymethylmethacrylate, as well as its subsequent surgical approach. Although Polymethylmethacrylate appears to be safe, it exhibits different complications depending on the host's immunology, which may react in different ways. Thus, it is necessary to emphasize the importance of preventing and preserving each case individually(AU)


Subject(s)
Humans , Female , Middle Aged , Bone Transplantation , Polymethyl Methacrylate , Maxillofacial Injuries , Orbit , Surgery, Oral , Zygoma , Biocompatible Materials , Iatrogenic Disease , Maxilla
6.
Rev. venez. cir. ortop. traumatol ; 53(1): 10-19, jun. 2021. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1252872

ABSTRACT

El manejo de pseudoartrosis infectadas, osteomielitis y defectos óseos representa un reto enorme para el cirujano ortopedista. Hace diez años, Masquelet presentó la técnica de inducción de membrana como alternativa al manejo de las complicaciones mencionadas arriba con excelentes tasas de consolidación y erradicación del proceso infeccioso. Estudiamos una de serie de 14 casos, prospectiva, con seguimiento clínico y radiológico mínimo de 2 años (enero 2015-diciembre 2018), donde evaluamos múltiples variables en pacientes a quienes se les realizó el protocolo de Masquelet. Obtuvimos una tasa de consolidación de 85,7% (12/14). Con un tiempo promedio para alcanzarla de 6,1 meses (3-9m). Todos los pacientes que lograron la consolidación se encontraban libres de infección al final del seguimiento. Por su reproducibilidad y alta tasa de consolidación, consideramos la técnica de inducción de membrana, como una excelente opción en el manejo de pseudoartrosis infectadas complejas(AU)


The management of infected nonunions, osteomyelitis, and bone defects represents an enormous challenge for the orthopedic surgeon. Ten years ago, Masquelet presented the membrane induction technique as an alternative to the management of the complications afore mentioned with excellent rates of consolidation and eradication of the infectious process. We prospectively studied a series of 14 cases, with a clinical and radiological follow-up of at least 2 years (january 2015-december 2018). Where we evaluated multiple variables in patients who underwent the Masquelet protocol. We obtained a consolidation rate of 85.7% (12/14). With an average time to reach it of 6.1 months (3-9m). All patients who achieved union were free of infection at the end of follow-up. Due to its reproducibility and high consolidation rate, we consider the membrane induction technique an excellent option in the management of complex infected nonunions(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Osteomyelitis/complications , Pseudarthrosis/complications , Bone Transplantation , Orthopedic Procedures , Bone Diseases , Traumatology
7.
Rev. bras. ortop ; 56(2): 138-146, Apr.-June 2021. graf
Article in English | LILACS | ID: biblio-1251348

ABSTRACT

Abstract The increase in the number of revision total knee arthroplasty surgeries has been observed in recent years, worldwide, for several causes. In the United States, a 601% increase in the number of total knee arthroplasties, between 2005 and 2030, is estimated. Among the enormous challenges of this complex surgery, the adequate treatment of bone defects is essential to obtain satisfactory and lasting results. The adequate treatment of bone defects aims to build a stable and lasting support platform for the implantation of the definitive prosthetic components and, if possible, with the reconstruction of bone stock. Concomitantly, it allows the correct alignment of the prosthetic and limb components, as well as restoring the height of the joint interline and, thus, restoring the tension of soft parts and load distribution to the host bone, generating a joint reconstruction with good function, stable, and painless. There are several options for the management of these bone defects, among them: bone cement with or without reinforcement with screws, modular metallic augmentations, impacted bone graft, structural homologous graft and, more recently, metal metaphyseal cones, and metaphyseal sleeves. The objective of the present article was to gather classic information and innovations about the main aspects related to the treatment of bone defects during revision surgeries for total knee arthroplasty.


Resumo O aumento do número de cirurgias de revisão de artroplastia total do joelho tem sido observado nos últimos anos, em todo o mundo, por diversas causas. Nos Estados Unidos, é estimado um aumento de 601% no número de artroplastias totais do joelho entre 2005 e 2030. Dentre os enormes desafios dessa cirurgia complexa, o adequado tratamento dos defeitos ósseos é essencial para a obtenção de resultados satisfatórios e duradouros. O adequado tratamento dos defeitos ósseos objetiva construir uma plataforma de suporte estável e duradoura para a implantação dos componentes protéticos definitivos e, se possível, com recomposição do estoque ósseo. Concomitantemente, possibilita o correto alinhamento dos componentes protéticos e do membro, assim como permite restabelecer a altura da interlinha articular e, dessa forma, restaurar a tensão de partes moles e distribuição de carga ao osso hospedeiro, gerando uma reconstrução articular com boa função, estável e indolor. Diversas são as opções para manejo dessas falhas ósseas, entre elas: cimento ósseo com ou sem reforço com parafusos, aumentos metálicos modulares, enxerto ósseo impactado, enxerto estrutural homólogo e, mais recentemente, cones metafisários de metal trabecular e sleeve metafisário. O objetivo do presente artigo foi reunir informações clássicas e inovações dos principais aspectos relativos ao tratamento das falhas ósseas durante as cirurgias de revisão de artroplastia total do joelho.


Subject(s)
Bone and Bones/abnormalities , Bone Transplantation , Arthroplasty, Replacement, Knee
8.
J. appl. oral sci ; 29: e20200568, 2021. tab, graf
Article in English | LILACS, BBO | ID: biblio-1143153

ABSTRACT

Abstract Objective The aim of this study is to evaluate the new bone and connective tissue formation and the biomaterial remaining after maxillary sinus bone augmentation using 5 different bone substitutes. The osteocalcin immunolabeling was performed to demonstrate their calcification and the possibility of receiving dental implants. Methodology 40 patients underwent maxillary sinus bone augmentation and were divided in 5 groups: Group 1 with 8 maxillary sinuses were grafted with autogenous bone graft (AB); Group 2 with 8 maxillary sinuses grafted with bioactive glass (BG); Group 3 with 8 maxillary sinuses grafted with bioactive glass added to autogenous bone graft (BG + AB) 1:1; Group 4 with 8 maxillary sinuses grafted with Bio-Oss (BO) and Group 5 with 8 maxillary sinuses grafted with Bio-Oss added to autogenous bone graft (BO + AB) 1:1. Results In group AB, 37.8% of bone was formed in the pristine bone region, 38.1% in the intermediate and 44.5% in the apical region. In group BG, 43.6% was formed in the pristine bone, 37% in the intermediate and 49.3% in the apical region. In group BG + AB 1:1, 39.0% was formed in the pristine bone region, 34.8% in the intermediate and 36.8% in apical region. In group BO, 33.4% was formed in the pristine bone, 32.5% in the intermediate and 34.3% in the apical region. In group BO + AB 1:1, 32.8% was formed in the pristine bone, 36.1% in intermediate and 27.8% in the apical regions. The immunolabeling for osteocalcin showed an intensive staining for all groups, which could demonstrate the calcification of the bone formed. Conclusion This study showed that the groups evaluated formed a suitable lamellar bone in the maxillary sinus reconstruction after six months of bone healing, thus being indicated to receive dental implants.


Subject(s)
Humans , Osteogenesis , Dental Implants , Bone Transplantation , Bone Substitutes , Sinus Floor Augmentation , Dental Implantation, Endosseous , Maxillary Sinus/surgery , Maxillary Sinus/diagnostic imaging
9.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 651-658, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353972

ABSTRACT

Se presenta el caso de un hombre de 27 años con una lesión grave articular interfalángica proximal en el dedo anular de la mano derecha, provocada por un proyectil de arma de fuego, que fue tratada con doble injerto osteocondral de costilla. Tenía una fractura expuesta y déficit de stock óseo y cartilaginoso tanto en la primera como en la segunda falange. Luego de la limpieza inicial, a las 3 semanas, se realizó una artroplastia interfalángica proximal con doble injerto osteocondral de costilla y fijador externo distractor de Suzuki. Se describe con detalle la técnica quirúrgica.A las 10 semanas posoperatorias, la flexión activa interfalángica era de 75° y la extensión activa, de -15°, con articulación estable. Alta laboral a los 3 meses de la cirugía, sin dolor y un puntaje DASH de 14,2. Las radiografías mostraron la incorporación de los injertos, sin reabsorción y con una articulación congruente.Se valora la ventaja de esta técnica en cuanto a la escasa morbilidad para la zona dadora y la versatilidad para las reconstrucciones con defectos articulares. El resultado funcional temprano subjetivo y objetivo fue satisfactorio. No se pueden descartar complicaciones futuras. Nivel de Evidencia; IV


We present the case of a 27-year-old male patient with a gunshot wound and severe proximal interphalangeal joint injury in the ring finger of the right hand, treated with a double osteochondral rib graft. He had an exposed fracture and a lack of bone and cartilage stock in both the first and second phalanx. After the initial toilette, at 3 weeks, a proximal interphalangeal arthroplasty was performed with a double osteochondral rib graft protected by a Suzuki external distractor. The surgical technique is described in detail. At 10 weeks after surgery, an active interphalangeal joint flexion of 75° and active extension of -15° were verified, without articular instability. The patient returned to work at 3 months after surgery, with no residual pain (0 VAS score) and a DASH score of 14.2. Radiographs showed incorporated grafts without resorption and a congruent joint. This technique is valued for its low morbidity on the donor site and versatility for joint defect reconstructions. The limitations of our study are mentioned. The clinical case presented obtained a satisfactory subjective and objective early functional outcome. Further complications cannot be ruled out. Level of Evidence: IV


Subject(s)
Adult , Bone Transplantation , Arthroplasty, Replacement, Finger/methods , Finger Joint/surgery , Fingers/surgery , Fractures, Open
10.
Artrosc. (B. Aires) ; 28(1): 62-68, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1252448

ABSTRACT

Introducción: El objetivo de nuestro trabajo es evaluar la evolución clínica, la condroprotección y la reacción inmunológica del trasplante de menisco (TM) con aloinjerto gama irradiado (GI) versus fresco congelado (FC) a veinticuatro meses. Materiales y métodos: veinte TM mediales en veinte pacientes, se evaluaron escalas de rodilla, Mapeo-T2 y segunda vista artroscópica, así como identificación de reacciones inmunológicas con la medición de citocinas inflamatorias por PCR en sangre y líquido sinovial. Trece trasplantes con injerto FC y siete GI, edad promedio de treinta y dos años. Resultados: mejoría significativa en escalas a veinticuatro meses: KOOS (dolor 67.80/79.30; síntomas 60.80/82.10; AVD 8.05/92.40; deportes 37/63.35; CV 28.90/71.30), Lysholm (62.20/85.80), IKDCs (50.17/72.12), EVA (3.35/0.4). El cartílago del compartimento trasplantado se mantuvo dentro de valores normales, sin diferencia a los veinticuatro meses (fémur: 33.43 versus 33.50 ms, p = 0.16) (tibia: 33.57 versus 34.35 ms, p = 0.21). Todos los pacientes mostraron integridad del injerto a los doce meses en la segunda vista artroscópica. Solo se observó aumento en las citoquinas plasmáticas IL-6 e IL-17 en un paciente del grupo GI, sin repercusión clínica. Conclusiones: mejoría clínica, adecuada integración y condroprotección significativa a veinticuatro meses en ambos tipos de injertos


Introduction: Our objective is to evaluate the clinical course, chondroprotection and immunological reaction of meniscus transplantation (TM) with gamma irradiated (GI) versus fresh frozen (FC) allograft at twenty-four months. Materials and methods: twenty medial TMs in twenty patients, knee scales, T2-mapping and second arthroscopic view were evaluated, as well as identification of immunological reactions with the measurement of inflammatory cytokines by PCR in blood and synovial fluid. Thirteen transplants with FC graft and seven GI grafts, average age of thirty-two years. Results: significant improvement on scales at twenty-four months: KOOS (pain 67.80 / 79.30; symptoms 60.80 / 82.10; AVD 8.05 / 92.40; sports 37 / 63.35; CV 28.90 / 71.30), Lysholm (62.20 / 85.80), IKDCs (50.17 / 72.12), EVA (3.35 / 0.4). The cartilage of the transplanted compartment remained within normal values, with no difference at twenty-four months (femur: 33.43 versus 33.50 ms, p = 0.16) (tibia: 33.57 versus 34.35 ms, p = 0.21). Conclusions: all patients showed integrity of the graft at twelve months in the second arthroscopic view. An increase in plasma cytokines IL-6 and IL-17 was only observed in one patient in the GI group, without clinical repercussion. Clinical improvement, adequate integration and significant chondroprotection at twenty-four months in both types of grafts


Subject(s)
Adult , Cartilage, Articular , Bone Transplantation/methods , Allografts , Tibial Meniscus Injuries/surgery , Knee Joint/surgery
11.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353984

ABSTRACT

Objetivos: El tratamiento de elección para las fracturas femorales periprotésicas Vancouver B3 aún no está definido. Por este motivo, nos propusimos analizar la tasa de complicaciones de la técnica de injerto óseo impactado con un vástago cementado cuando se utiliza para tratar estas fracturas. Materiales y métodos: Estudiamos retrospectivamente 33 fracturas femorales periprotésicas B3 tratadas con la técnica de injerto óseo impactado operados entre 2000 y 2016, analizando la tasa de complicaciones. La mediana de seguimiento fue de 75 meses (RIC 36-111). La mediana de edad fue de 78 años (RIC 74-83). La mediana del defecto óseo femoral fue 3 (RIC 3-3) según la clasificación de la Endo-Klinik. Se realizó un análisis de regresión múltiple para determinar los factores de riesgo asociados a complicaciones, las variables incluidas fueron: cantidad de cirugías previas, diámetro de la nueva cabeza femoral y defecto óseo femoral. Resultados: Se realizó una cirugía de revisión en dos etapas en cuatro pacientes. Se registraron cinco fallas asépticas del implante y dos luxaciones en toda la serie. El análisis de regresión lineal multivariable mostró una asociación significativa entre el grado del defecto óseo femoral Endo-Klinik y la tasa de complicaciones (p = 0,04). Conclusión: La reconstrucción femoral con la técnica de injerto óseo impactado para tratar fracturas periprotésicas Vancouver B3 provocó una alta tasa de complicaciones. Nivel de Evidencia: IV


Aims: Because the gold standard for the treatment of Vancouver type B3 periprosthetic femoral fractures (PFFs) is yet to be defined, we sought to analyze the complication rate of the impaction bone grafting (IBG) technique with a cemented stem for the treatment of this fractures. Materials and methods: We retrospectively studied 33 B3 PFFs treated with the IBG technique oper-ated between 2000 and 2016, analyzing the complication rate. The median follow-up was 75 months (interquartile range [IQR], 36-111). The median age was 78 years (IQR, 74-83). The median grade of EndoKlinik femoral bone defect was 3 (IQR, 3-3). Weperformed a multiple regression analysis to determine risk factors for complications, including the following variables: number ofprevious surgeries, femoral head diameter, and femoral bone defect. Results: As for infection outcomes, 2-stage revision surgerywas performed in 4 patients. We registered 5 implant failures and 2 dislocations in the whole series. Multiple regression analysisshowed a significant association between the grade of EndoKlinik femoral bone defect and complication rate (P=0.04). Conclu-sion: Femoral reconstruction with the IBG technique evidenced a high complication rate for the treatment of B3 PFF. Level of Evidence: IV


Subject(s)
Postoperative Complications , Reoperation , Bone Transplantation , Treatment Outcome , Arthroplasty, Replacement, Hip , Periprosthetic Fractures/surgery , Hip Fractures/surgery
12.
Article in Chinese | WPRIM | ID: wpr-921911

ABSTRACT

Recurrent anterior dislocation of shoulder with bone defect is one of the common diseases of shoulder joint. How to effectively repair glenoid bone defect and reduce recurrence rate of shoulder dislocation is a problem that clinicians focus on. Bone grafting could stimulate bone, promote bone regeneration and bone remodeling, and restore the normal anatomical structure of glenoid. Among them, Bristow-Latarjet procedure is a classic operation for recurrent shoulder dislocation. Latarjet procedure could repair larger glenoid bone defects, but with higher surgical skills for surgeons;autogenous iliac grafting is the first choice for revision once Latarjet procedure failed;osteochondral grafting (autogenous and allogenous) has certain advantages in reconstructing original articular surface and preventing joint degeneration, but autologous osteochondral grafting may cause secondary injury, while immune rejection is difficult to avoid for allogenous osteochondral grafting. With the improvement of composite materials, and the mechanism of bone regeneration and remodeling, as well as the advantages and disadvantages of bone grafting, tissue engineering technology may become an effective method for the treatment of glenoid bone defect in the future.


Subject(s)
Bone Transplantation , Humans , Joint Instability , Recurrence , Shoulder , Shoulder Dislocation/surgery , Shoulder Joint
13.
Article in Chinese | WPRIM | ID: wpr-888310

ABSTRACT

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


Subject(s)
Adolescent , Adult , Allografts , Bone Transplantation , Decompression , Femur Head , Femur Head Necrosis , Fibula , Follow-Up Studies , Humans , Middle Aged , Treatment Outcome , Young Adult
14.
Article in Chinese | WPRIM | ID: wpr-879463

ABSTRACT

OBJECTIVE@#To explore clinical effect of modified transverse tibial bone transfer microcirculation reconstruction in treating end-stage diabetic foot.@*METHODS@#From August 2016 to June 2018, 87 patients with diabetic foot treated with modified tibial transverse bone removal and microcirculation reconstruction, inclduing 54 males and 33 females;aged from 39 to 95 years old with an average of (68.9±11.3) years old;2 patients were grade 2, 37 patients were grade 3 and 50 patients were grade 4 according to Wagner's classification;the courses of diabetic were for 10 to 16 years with an average of (13.0±2.2) years;the courses of diabetic feet were for 21 to 48 days with an avergae of (34.2±8.6) days. Postoperative comlications were observed. Skin temperature, visual analogue scale(VAS) and ankle brachial index(ABI) and wound healing were recorded before and 3 months after operation.@*RESULTS@#All patients were followed up for 4 to 19 months with an average of (12.6±2.8) months. Two patients occurred subcutaneous tissue liquefaction and seepage under needle passage during bone transfer, and scabed without special treatment. One patient was performed amputation above 5 cm of ankle joint because of severe infection, and 1 patient occurred re-ulceration at 1 year after wound healing, bone transfer was performed again at the same site, and was completely healed at 8 weeks after operation. The healing time of wound ranged from 3 to 24 weeks with an average of (11.9± 3.8) weeks. Foot skin temperature before operation was (28.9±0.91) ℃, and increased to (31.70±0.32)℃ at 3 months after operation(@*CONCLUSION@#Modified lateral tibial bone transfer could effectively reconstruct microvascular network under lower leg, promote recovery of peripheral blood vessels, and promote wound healing of foot, reduce or avoid amputation. At the same time, the improved osteotomy is one of the effective methods for the treatment of diabetic foot which has advantags of less trauma, simple opertaion.


Subject(s)
Adult , Aged , Aged, 80 and over , Bone Transplantation , Diabetes Mellitus , Diabetic Foot/surgery , Female , Humans , Male , Microcirculation , Middle Aged , Tibia , Treatment Outcome
15.
Article in Chinese | WPRIM | ID: wpr-879431

ABSTRACT

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


Subject(s)
Adult , Bone Nails , Bone Plates , Bone Transplantation , Female , Femoral Fractures/surgery , Femur , Fracture Fixation, Intramedullary , Fracture Healing , Fractures, Ununited/surgery , Humans , Male , Middle Aged , Quality of Life , Treatment Outcome
16.
Article in Chinese | WPRIM | ID: wpr-879420

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis.@*METHODS@#From June 2013 to August 2016, the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed, including 55 males and 28 females, aged from 27 to 72 (49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods, 35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation, regular quadruple antituberculosis drugs were continued for 18 months. The operation time, intraoperative blood loss, hospital stay, bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain, Oswestry Disability Index (ODI), sagittal Cobb angle, erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed.@*RESULTS@#The operation was successfully completed in both groups, and the operation mode was not changed during operation. The operation time, intraoperative blood loss and hospital stay were (149.4±13.3) min, (354.3±69.0) ml, (9.4±1.6) d in group A and(116.8±10.0) min, (721.9±172.3) ml, (11.8±1.7) d in group B, respectively, with significant difference between the two groups (@*CONCLUSION@#The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay, which is conducive to early rehabilitation of patients.


Subject(s)
Aged , Bone Transplantation , Debridement , Female , Humans , Lumbar Vertebrae/surgery , Male , Pedicle Screws , Retrospective Studies , Spinal Fusion , Thoracic Vertebrae , Treatment Outcome , Tuberculosis, Spinal/surgery
17.
Article in Chinese | WPRIM | ID: wpr-879409

ABSTRACT

OBJECTIVE@#To compare the clinical effects of three different methods of binding multi-fold rib graft, iliac bone graft and titanium mesh graft in tuberculosis of thoracic vertebra by approach of transverse rib process.@*METHODS@#A hundred and seven patients with tuberculosis of thoracic vertebra received surgical treatment from January 2010 to December 2016 were retrospectively analyzed. The patients were divided into three groups according different methods of bone graft. The surgical approach of the transverse rib process was used in all 107 patients, after thoroughly remove the necrotic tissue of tuberculosis, three different bone grafts were used respectively including iliac bone graft (36 cases, group A), binding multi-fold rib graft (35 cases, group B), titanium mesh bone graft (36 cases, group C). Perioperative indexes, the time required for bone graft during operation, intraoperation blood loss, the loss rate of the anterior edge of the lesion, Cobb angle, postoperative bone graft fusion time, spinal nerve recovery and Oswestry Disability Index were compared among three groups.@*RESULTS@#All the patients were followed up for 13 to 24 months, and the operation time required for bone graft was (23.2±4.1) min in group A, (23.8± 4.4)min in group B, and (25.5±4.2) min in group C, with no statistically significant difference among three groups (@*CONCLUSION@#The approach of transverse rib process for debridement of lesions can effectively treat tuberculosis of thoracic vertebra by binding multi-fold rib graft, iliac bone graft and titanium mesh graft, but binding multi-fold rib graft can effectively avoid iliac bone donor complications, and is an effective alternative to iliac bone graft, which is worth popularizing.


Subject(s)
Bone Transplantation , Humans , Lumbar Vertebrae , Retrospective Studies , Ribs/surgery , Spinal Fusion , Surgical Mesh , Thoracic Vertebrae/surgery , Titanium , Treatment Outcome , Tuberculosis, Spinal/surgery
18.
Int. j. odontostomatol. (Print) ; 14(4): 678-684, dic. 2020. graf
Article in English | LILACS | ID: biblio-1134557

ABSTRACT

ABSTRACT: The present study aims to describe, through a case report, the functioning of bone grafts, where they are obtained including bone banks and the different dental areas in which it is used. A 50-year.old female patient HMR, sought the postgraduate college of dentistry CECAPE for oral rehabilitation. The initial clinical examination revealed the absence of several dental elements in both the maxilla and mandi ble, bone resorption in the entire maxillary extension where there was an absence of elements in the anterior region and the presence of a torus in the palatal region. Initial tomographic examinations of the maxilla and mandible were performed, looking for the best conduct regarding the diagnosis and planning of the case. After the clinical and radiographic examinations was performed, and the diagnosis was reached, it was determined as a treatment for oral rehabilitation of the maxilla, bone grafting and an Implant-supported Removable Partial Prosthesis and for the mandible a Dento-muco-supported Removable Partial Prosthesis. Dental treatments and oral rehabilitation from the use of bone tissues and bone grafting have become commonly used. Procedures that would normally lead to failure started to increase the percentage of successes due to the use of these biomaterials. The use of bone grafts in dentistry has been shown to be a very effective and useful resource, considering its great applicability in bone reconstructions in different areas of dentistry.


RESUMEN: El presente estudio tiene como objetivo describir a través de un informe de caso, el funcionamiento de los injertos óseos, donde se obtienen, incluidos los bancos de huesos y las diferentes áreas dentales en las que se emplea. Una paciente HMR, de 50 años de edad, asistió el centro universitario de posgrado CECAPE para rehabilitación oral. El examen clínico inicial reveló la ausencia de varios dientes tanto en el maxilar como en la mandíbula, la resorción ósea en toda la extensión maxilar donde había ausencia de dientes en la región anterior y la presencia de un torus en la región palatina. Se realizaron exámenes tomográficos iniciales del maxilar y mandíbula, buscando la mejor conducta con respecto al diagnóstico y la planificación del caso. Después de los exámenes clínicos y radiográficos realizados y el diagnóstico listo, se determinó como un tratamiento para la rehabilitación oral del maxilar, el injerto óseo y una prótesis removible implantosoportada y para la mandíbula una prótesis parcial removible dento-muco-soportada. Los tratamientos dentales y la rehabilitación oral a partir del uso de tejidos óseos y el injerto óseo se han utilizado comúnmente. Los procedimientos que normalmente conducirían al fracaso comenzaron a aumentar el porcentaje de éxitos debido al uso de estos biomateriales. Se ha demostrado que el uso de injertos óseos en odontología es un recurso muy eficaz y útil, considerando su gran aplicabilidad en las reconstrucciones óseas en diferentes áreas de la odontología.


Subject(s)
Humans , Female , Middle Aged , Bone Transplantation/methods , Dental Implantation, Endosseous/methods , Bone-Implant Interface/diagnostic imaging , Tomography, X-Ray Computed , Mandible/diagnostic imaging , Mouth Rehabilitation
19.
Rev. cuba. ortop. traumatol ; 34(2): e295, jul.-dic. 2020. tab, ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1156591

ABSTRACT

RESUMEN Introducción: Las pseudoartrosis diafisarias de cúbito y radio constituyen un desafío terapéutico para el cirujano ortopédico, a causa de la dificultad para lograr y mantener la reducción de dos huesos paralelos en presencia de músculos pronadores y supinadores que ejercen influencias angulares y rotacionales. Objetivo: Evaluar la eficacia de la aplicación del minifijador externo combinado con el injerto óseo homólogo en esta afección. Métodos: Se realizó un estudio longitudinal, retrospectivo de corte transversal en 74 pacientes operados de pseudoartrosis diafisaria de cúbito y radio desde enero de 2000 hasta diciembre de 2014, en el Complejo Científico Ortopédico Internacional Frank País, en los que se utilizó el modelo de minifijación externa RALCA® e injerto óseo homólogo del Banco de Tejidos ORTOP. Resultados: La pseudoartrosis fue más frecuente en hombres (73 por ciento) y en las edades comprendidas entre 30 y 39 años. La localización más frecuente fue en el cúbito, en su tercio superior (52 por ciento). La mayoría de los pacientes presentaron una pseudoartrosis no viable (56 por ciento). Se consolidó en 66 por ciento de los pacientes antes de las 18 semanas y en solo uno no se obtuvo la consolidación. El hueso que menos tiempo requirió para consolidar fue el radio. En la evaluación de la eficacia de la técnica quirúrgica se obtuvo 62 por ciento de resultados buenos, 33 por ciento regulares y 5 por ciento malos. Conclusiones: La asociación de la minifijación externa modelo RALCA® e injerto óseo homólogo de banco mostró buenos resultados en el tratamiento de la pseudoartrosis de cúbito y radio(AU)


ABSTRACT Introduction: Diaphyseal pseudoarthroses of the ulna and radius constitute a therapeutic challenge for the orthopedic surgeon, due to the difficulty to achieve and maintain the reduction of two parallel bones in the presence of pronator and supinator muscles that exert angular and rotational influences. Objective: To evaluate the effectiveness of using external minifixator combined with homologous bone graft in the treatment of this condition. Method: A longitudinal, retrospective and cross-sectional study was carried out with 74 patients operated on, from January 2000 to December 2014, for diaphyseal pseudoarthrosis of the ulna or radius at Frank País International Orthopedic Scientific Complex, cases in which RALCA® external minifixation and homologous bone graft from the ORTOP Tissue Bank were used. Results: Pseudoarthrosis was more frequent in men (73 percent) and at ages 30-39 years. The most frequent location was the ulna, in its upper third (52 percent). Most of the patients had nonviable pseudoarthrosis (56 percent). The condition was consolidated in 66 percent of the patients within 18 weeks, and only one did not achieve consolidation. The bone that took the least time to heal was the radius. In the evaluation of the effectiveness of the surgical technique, 62% obtained good outcomes; 33 percent fair outcomes; and 5 percent, poor outcomes. Conclusions: The association of the RALCA® model miniexternal fixation and homologous bone graft from the Bank showed good outcomes in the treatment of ulna and radius pseudoarthrosis(AU)


Subject(s)
Humans , Male , Female , Pseudarthrosis/surgery , Radius Fractures/surgery , Ulna Fractures/surgery , Bone Transplantation/methods , Allografts/transplantation , Cross-Sectional Studies , Retrospective Studies , Longitudinal Studies
20.
Rev. Odontol. Araçatuba (Impr.) ; 41(3): 33-39, set./dez. 2020. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1121742

ABSTRACT

Este relato de caso clínico tem como objetivo descrever a utilização de osso alógeno na reconstrução de maxila atrófica para posterior reabilitação com prótese fixa metalocerâmica sobre implantes, fazer uma análise histológica do tecido ósseo enxertado e descrever o acompanhamento clínico e radiográfico por 8 anos. Uma paciente de 54 anos, com edentulismo parcial e atrofia moderada-a-severa na maxila, apresentou-se para tratamento demonstrando muito interesse em receber prótese sobre implantes. Após exame clínico e radiográfico, foi realizada montagem dos modelos de estudo em ASA para enceramento diagnóstico e obtenção de um guia multifuncional (tomográfico/ cirúrgico). A tomografia indicou a necessidade de reconstrução óssea maxilar. Procedeuse então à aposição de blocos de osso alógeno para aumento horizontal nas regiões anterior e posterior da maxila. Um dos blocos foi triturado e utilizado para levantamento do assoalho do seio maxilar no lado esquerdo. Dez meses depois, uma nova tomografia foi solicitada, utilizando o mesmo guia inicial, e os implantes instalados, utilizando o guia multifuncional como guia cirúrgico. Neste momento, material ósseo foi coletado na interface osso enxertado/osso nativo com uma broca trefina. Os resultados histológicos demonstraram viabilidade das células ósseas no enxerto, além da presença de vasos sanguíneos. Após o tempo necessário para osseointegração, procedeu-se com tratamento protético. Nenhuma complicação foi relatada até oito anos de controle. A sequência de tratamento proposta forneceu bons resultados estéticos e funcionais. Concluiu-se, então, que o emprego de osso alógeno é uma alternativa viável para a reconstrução de rebordos alveolares severamente reabsorvidos(AU)


This clinical case report aims to describe the use of allogeneic bone in the atrophic maxilla reconstruction for subsequent rehabilitation with a fixed metal-ceramic prosthesis on implants; to perform a histological analysis of the grafted bone tissue; and to describe the clinical and radiographic monitoring for 8 years. A 54-year-old patient, with partial edentulism and moderate-to-severe atrophy in the maxilla showed great interest in receiving implant prostheses. After c linical and radiographic examination, the ASA study models were assembled for diagnostic waxing and a multifunctional guide (tomographic / surgical) was obtained. Tomography indicated the need for maxillary bone reconstruction. Allogeneic bone blocks were then placed for horizontal enlargement in the anterior and posterior regions of the maxilla. One of the blocks was crushed and used to lift the floor of the maxillary sinus on the left side. Ten months later, a new tomography was requested, using the same initial guide, and the implants installed, using the multifunctional guide as a surgical guide. At this time, bone material was collected at the grafted bone / native bone interface with a trephine drill. Histological results demonstrated viability of bone cells in the graft, besides the presence of blood vessels. After the necessary time for osseointegration, a prosthetic treatment was performed. No complications were reported up to eight years of control. The propose treatment sequence provided good aesthetic and functional results. It was concluded, then, that the use of allogeneic bone is a viable alternative for the reconstruction of severely reabsorbed alveolar edges(AU)


Subject(s)
Bone Transplantation , Dental Prosthesis, Implant-Supported , Dental Prosthesis Design , Sinus Floor Augmentation
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