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1.
China Journal of Orthopaedics and Traumatology ; (12): 51-56, 2024.
Article in Chinese | WPRIM | ID: wpr-1009222

ABSTRACT

OBJECTIVE@#To observe the clinical efficacy of lesion removal, bone grafting, fusion, and external fixation in the treatment of late-stage wrist tuberculosis.@*METHODS@#From October 2015 to May 2019, 25 patients with late-stage wrist tuberculosis were treated using lesion removal, bone grafting, fusion, and external fixation. Among these patients, there were 14 males and 11 females, aged from 40 to 74 years old, with an average age of (60.72±8.45) years old. The duration of the disease ranged from 5 to 24 months, with an average of (11.52±7.61) months. There were 11 cases of left wrist tuberculosis and 14 cases of right wrist tuberculosis, with 5 cases accompanied by sinus formation. Postoperative regular anti-tuberculosis treatment was continued. Visual analogue score (VAS), inflammatory indicators, Gartland-Werley wrist function score, and upper limb function score were observed before and after treatment.@*RESULTS@#All 25 patients were followed up for ranging from 12 to 36 months with an average of (19.7±6.3) months. At the latest follow-up, all wounds were healed satisfactorily, and there was no recurrence of tuberculosis or infection. VAS at one week before operation and three months after operation were (5.16±1.14) score and (1.68±0.80) score respectively. One week before operation and three months after operation, erythrocyte sedimentation rate (ESR) was (44.20±20.56) mm·h-1 and (14.44±1.14) mm·h-1, and C-reactive protein (CRP) was (12.37±7.95) mg·L-1 and (4.3±3.37) mg·L-1. The differences in all three data sets were statistically significant (P<0.01). According to Gartland-Werley wrist function scoring, the scores at one week before operation and one year after operation were (21.32±3.44) and (14.96±1.37) respectively, showed a statistically significant difference (P<0.01). According to the upper limb function score (disabilities of the arm, shoulder, and hand, DASH), the score was (70.52±7.95) at one week before operation and(28.84±2.30) at one year after operation. The difference was statistically significant (P<0.01). At the latest follow-up, no patient had a recurrence of tuberculosis.@*CONCLUSION@#The short-term clinical efficacy of treating wrist tuberculosis with lesion removal, bone grafting, fusion, and external fixation is satisfactory.


Subject(s)
Male , Female , Humans , Middle Aged , Aged , Adult , Tuberculosis, Spinal/surgery , Wrist/surgery , Bone Transplantation , Thoracic Vertebrae/surgery , Lumbar Vertebrae , Spinal Fusion , Treatment Outcome , Upper Extremity , Retrospective Studies
2.
Braz. j. oral sci ; 23: e244481, 2024. ilus
Article in English | LILACS, BBO | ID: biblio-1537088

ABSTRACT

Aims: This study aimed to examine the biological response of synthetic nanocomposite material on canine mandibular bone. Methods: Nine healthy adult male local breed dogs aged 12 to 18 months and weighing 10.2 to 15.2 kg were used in the study. Based on healing intervals of 1 and 2 months, the dogs were divided into 2 groups. Each group had 3 subgroups with 3 dogs each. The division was based on the grafting material used to fill the created defect: an empty defect (Control-ve), Beta-Tricalcium Phosphate, and nanocomposite (Beta-Tricalcium Phosphate and nanosilver 1%) . Surgery started after the dogs were anaesthetized. The surgical procedure began with a 5 cm parallel incision along the mandible's lower posterior border. After exposing the periosteum, a three 5mm-diameter, 5-mmdeep critical-size holes were made, 5mm between each one. Each group's grafting material had independent 3 holes. The defects were covered with resorbable collagen membranes followed by suturing of the mucoperiosteal flap. Results: Total densitometric analysis showed no significant differences between groups at 1-month intervals, with the nanocomposite group having a higher mean rank (165.66± 31.21) in comparison to other groups while at 2 months intervals that there was a highly significant difference between three groups as the P-value was (0.000) with the nanocomposite group having a higher mean rank (460.66± 26.40). Conclusions: In the current study, the use of nanocomposites improved osteoconductivity by accelerating new bone formation. Moreover, the encorporation of nanosilver enhanced growth factor activity. These attributes make nanocomposites a promising material for enhancing the bone healing process


Subject(s)
Animals , Dogs , Regeneration , Calcium Phosphates , Bone Transplantation , Bone Substitutes , Nanocomposites , Cone-Beam Computed Tomography , Anti-Bacterial Agents
3.
São Paulo; s.n; 20231211. 81 p.
Thesis in Portuguese | LILACS, BBO | ID: biblio-1519331

ABSTRACT

A regeneração óssea é um processo importante para oferecer tratamentos reconstrutivos mais rápidos e eficientes, no entanto, limitações técnicas continuam sendo um desafio, assim como a velocidade de formação e maturação óssea. Portanto, as pesquisas têm se voltado para técnicas alternativas na regeneração óssea e atualmente, a engenharia tecidual tem estudado o uso de células tronco para tratamento de perdas ósseas. A eficácia e a taxa de sucesso das diferentes técnicas e scaffolds foram avaliadas. Porém, há pouca informação sobre a eficácia combinada de carreadores xenógenos, células tronco de dentes decíduos esfoliados humano (SHEDs) e a terapia de fotobiomodulação (PBMT) na regeneração de defeitos ósseos. Baseado em estudos prévios, a proposta deste estudo foi avaliar, in vitro, a ação da PBMT, uma técnica com propriedades imunomodulatórias, angiogênicas e com capacidade de aumentar a adesão, proliferação e migração celular ao biomaterial tridimensional de osso bovino mineralizado desproteinizado com colágeno suíno a 10% (OBMDC), semeado com SHEDs, para acelerar e aumentar a taxa de formação óssea. Foi utilizado o laser de diodo, com comprimento de onda de 660nm; 40mW de potência; 3J/cm2 de densidade de energia e 2 segundos de tempo de aplicação após 24h e 72h do plaqueamento. Para avaliar a proliferação, as SHEDs foram descongeladas cultivadas, plaqueadas, semeadas no scaffold de OBMDC e divididas em 8 grupos: 1) Controle 15%; 2) Controle 5%; 3) OBMDC 15%; 4) OBMDC 5%; 5) Laser 15%; 6) Laser 5%; 7) OBMDC-L 15%; 8) OBMDC-L 5% e a análise de proliferação foi realizada por MTT. Para avaliar diferenciação celular, as amostras foram divididas em quatro grupos: 1) Grupo Controle clonogênico: SHEDs cultivadas em meio clonogênico; 2) Grupo Controle mineralizante: SHEDs cultivadas em meio mineralizante; 3) Grupo laser clonogênico: SHEDs cultivadas em meio clonogênico com aplicação de laser; 4) Grupo laser mineralizante: SHEDs cultivada em meio mineralizante com aplicação de laser. Para o grupo laser, as células foram irradiadas no período de 24h e 72h após o plaqueamento e todas as amostras fixadas para análise da formação dos depósitos de cálcio, através do ensaio de vermelho de alizarina após 23 dias de cultivo celular e os dados foram tratados estatisticamente (p0,05). Para avaliar a morfologia celular das SHEDs em todos os grupos, utilizou-se o microscópio invertido de fase em 24h e 72h após o plaqueamento. O grupo OBMDC-L 5% SFB em 72h, demonstrou maior proliferação celular que o grupo Controle (p=0.0286). O grupo laser no meio mineralizante apresentou maior formação de depósito de matriz mineralizada em comparação ao grupo controle em meio clonogênico, controle em meio mineralizante e laser em meio clonogênico (p<0,0001). Considerando as condições experimentais deste estudo, concluiu-se que, in vitro, as SHEDs, semeadas em scaffold OBMDC, proliferaram mais após 2 aplicações de PBMT e houve diferenciação osteogênica das células após 23 dias em meio mineralizante.


Subject(s)
Bone Regeneration , Bone Transplantation , Low-Level Light Therapy , Mesenchymal Stem Cells
4.
Salud mil ; 42(2): e501, 20230929. ilus
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1531720

ABSTRACT

En la actualidad es cada vez más frecuente la consulta de pacientes que siendo sometidos en edades tempranas a cirugías de extirpación tumoral y posterior reconstrucción con injertos presentan problemas tanto funcionales como estéticos, el uso de prótesis implantosoportadas mejora la calidad de vida, pero al mismo tiempo representan un desafío por la baja disponibilidad ósea. Se presenta un caso clínico de rehabilitación protésica implantosoportada en una paciente con gran déficit óseo mandibular como consecuencia de le extirpación de una neoplasia y posterior injerto de costilla. Se colocaron 2 implantes osteointegrados en hueso remanente y rehabilitación con prótesis removible sostenida a una barra colada. Por ser un tratamiento poco invasivo y conservador fue aceptado fácilmente por la paciente y la mejora tanto en la estética como en la función fue notoria.


Nowadays, it is becoming more and more frequent to see patients who underwent surgery for tumor removal and subsequent reconstruction with grafts at an early age, presenting both functional and esthetic problems. The use of implant-supported prostheses improves the quality of life, but at the same time represents a challenge due to the low availability of bone. A clinical case of implant-supported prosthetic rehabilitation is presented in a patient with a great mandibular bone deficit as a consequence of the removal of a neoplasm and subsequent rib graft. Two osseointegrated implants were placed in the remaining bone and rehabilitation with a removable prosthesis supported by a cast bar. Being a minimally invasive and conservative treatment, it was easily accepted by the patient and the improvement in both esthetics and function was notorious.


Atualmente, são cada vez mais frequentes os pacientes submetidos à cirurgia de remoção de tumores e posterior reconstrução com enxertos em idade precoce que apresentam problemas funcionais e estéticos. O uso de próteses implanto-suportadas melhora a qualidade de vida, mas, ao mesmo tempo, representa um desafio devido à baixa disponibilidade de osso. Apresentamos um caso clínico de reabilitação protética implanto-suportada em um paciente com grande déficit ósseo mandibular em consequência da remoção de uma neoplasia e posterior enxerto de costela. Dois implantes osseointegrados foram colocados no osso remanescente e a reabilitação foi feita com uma prótese removível suportada por uma barra de gesso. Por se tratar de um tratamento minimamente invasivo e conservador, foi facilmente aceito pelo paciente e a melhora na estética e na função foi perceptível.


Subject(s)
Humans , Female , Middle Aged , Ribs , Transplantation, Autologous , Bone Transplantation , Dental Implantation, Endosseous/methods , Denture, Partial, Removable , Oral Surgical Procedures/adverse effects , Mandibular Reconstruction/rehabilitation
5.
Rev. cir. traumatol. buco-maxilo-fac ; 23(1): 12-17, jan.-mar. 2023. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1443450

ABSTRACT

Introdução: O uso de membranas de barreira de exclusão de epitélio para regeneração óssea guiada tem sido apresentado na literatura como abordagem de tratamento bem sucedida, essas barreiras irão impedir a incorporação de células de tecidos moles no enxerto ósseo ou no es paço criado pelo defeito e permitir que apenas as células osteogênicas estejam presentes. Relato de caso: Trata-se de um caso clinico de um paciente que evoluiu com perda óssea significativa por lesão Endo-periodontal levando a perda dentaria, para a reabilitação com implantes se fez necessário uma reconstrução de um defeito crítico com a utilização de tela de titânio para arcabouço ósseo de mistura de enxerto autógeno e biomaterial e recobrimento com membrana de colágeno, o enxerto autógeno foi removido de área doadora na mandíbula e utilizado de forma particulada. Conclusão: As telas de titânio apresentam viabilidade e previsibilidade no aumento ósseo vertical, horizontal e tridimensional em decorrência da sua ampla aplicabilidade, elasticidade, plasticidade adequadas e boas propriedades mecânicas. Avanços na diminuição de suas taxas de exposição e risco de complicações no período de cicatrização melhoram a cada dia a previsibilidade da técnica, bem como a associação com outros materiais como os hemoderivados... (AU)


Introduction: The use of epithelial exclusion barrier membranes for guided bone regeneration has been presented in the literature as a successful treatment approach, these barriers will prevent the incorporation of soft tissue cells into the bone graft or the space created by the defect and allow that only osteogenic cells are present. Case report: This is a clinical case of a patient who evolved with significant bone loss due to an endo-periodontal lesion leading to tooth loss, for rehabilitation with implants it was necessary to reconstruct a critical defect using mesh titanium for bone framework of mixture of autogenous graft and biomaterial and covering with collagen membrane, the autogenous graft was removed from the donor area in the mandible and used in a particulate form. Conclusion: Titanium meshes are viable and predictable in vertical, horizontal and three-dimensional bone augmentation due to their wide applicability, adequate elasticity and plasticity, good mechanical properties. Advances in reducing their exposure rates and risk of complications during the healing period improve the predictability of the technique every day, as well as the association with other materials such as blood products... (AU)


Introducción: El uso de membranas de barrera de exclusión epitelial para la regeneración ósea guiada se ha presentado en la literatura como un enfoque de tratamiento exitoso, estas barreras evitarán la incorporación de células de tejido blando al injerto óseo o el espacio creado por el defecto y permitirán que solo presencia de células osteogénicas. Reporte de caso: Este es un caso clínico de un paciente que evolucionó con una pérdida ósea importante debido a una lesión endo-periodontal que lo llevó a la pérdida de un diente, para rehabilitación con implantes fue necesario reconstruir un defecto crítico utilizando malla de titanio para armazón óseo de mezcla de injerto autógeno y biomaterial y cubriendo con membrana de colágeno, el injerto autógeno se extrajo del área donante en la mandíbula y se usó en forma de partículas. Conclusión: Las mallas de titanio son viables y predecibles en el aumento óseo vertical, horizontal y tridimensional debido a su amplia aplicabilidad, adecuada elasticidad y plasticidad, buenas propiedades mecánicas. Los avances en la reducción de sus tasas de exposición y riesgo de complicaciones durante el periodo de cicatrización mejoran día a día la predictibilidad de la técnica, así como la asociación con otros materiales como los hemoderivados... (AU)


Subject(s)
Humans , Male , Middle Aged , Biocompatible Materials , Dental Implants , Bone Transplantation , Mandibular Reconstruction
6.
Rev. bras. ortop ; 58(3): 523-531, May-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1449816

ABSTRACT

Abstract Objective To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting. Methods A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve. Results Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration. Conclusion We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.


Resumo Objetivo Avaliarosresultadosclínicos, radiográficos e a sobrevida da cirurgia de revisão acetabular de artroplastia total de quadril com implante cimentado sem uso de anel de reforço, associado à enxertia óssea homóloga estrutural. Métodos Um total de 40 pacientes (44 quadris) operados de 1995 a 2015 foram analisados retrospectivamente. As radiografias foram avaliadas de acordo com a classificação do defeito ósseo acetabular, o formato do enxerto e à presença de osteointegração. Foram considerados casos de insucesso a migração do implante > 5 mm em qualquer direção e/ou a progressão de linhas de radioluscência em torno do componente acetabular > 2mm. Verificamos a associação dos achados radiográficos com os casos de falha utilizando testes estatísticos e analisamos a sobrevida utilizando a curva de Kaplan-Meier. Resultados Dos 44 quadris, 45,5% dos defeitos acetabulares eram Paprosky tipo 3A e 50%, 3B. Em 65% dos quadris, a configuração do enxerto foi classificada como tipo 1 de Prieto e em 31% como tipo 2. Não foi observada evidência radiográfica de osteointe-gração em 13,6% dos casos. Observamos 9 (20,5%) falhas de reconstrução. Foi observada correlação entre falha da reconstrução com a ausência de sinais radiográficos de osteointegração do enxerto. Conclusão Observamos bons resultados clínicos e radiográficos, com sobrevida de 79,54% em seguimento médio de 9,65 anos. Também houve associação entre ausência de sinais radiográficos de osteointegração do enxerto estrutural e falha nesta série de pacientes com grandes defeitos ósseos. As falhas não se correlacionaram com a severidade do defeito ósseo acetabular, espessura ou configuraçãodoenxerto.


Subject(s)
Humans , Reoperation , Transplantation, Homologous , Cross-Sectional Studies , Osseointegration , Bone Transplantation , Arthroplasty, Replacement, Hip
7.
Rev. bras. ortop ; 58(2): 326-330, Mar.-Apr. 2023. tab
Article in English | LILACS | ID: biblio-1449798

ABSTRACT

Abstract Objective Medial open wedge high tibial osteotomy (MOWHTO) significantly relieves pain in the medial joint line in medial compartment osteoarthritis of the knee. But some patients complain of pain over the pes anserinus even 1 year after the osteotomy, which may require implant removal for relief. This study aims to define the implant removal rate after MOWHTO due to pain over the pes anserinus. Methods One hundred and three knees of 72 patients who underwent MOWHTO for medial compartment osteoarthritis between 2010 and 2018 were enrolled in the study. Knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), and visual analogue score (VAS) were assessed for pain in the medial knee joint line (VAS-MJ) preoperatively, 12 months postoperatively, and yearly thereafter; adding VAS for pain over the pes anserinus (VAS-PA). Patients with VAS-PA ≥ 40 and adequate bony consolidation after 12 months were recommended implant removal. Results Thirty-three (45.8%) of the patients were male and 39 (54.2%) were female. The mean age was 49.4 ± 8.0 and the mean body mass index was 27.0 ± 2.9. The Tomofix medial tibial plate-screw system (DePuy Synthes, Raynham, MA, USA) was used in all cases. Three (2.8%) cases with delayed union requiring revision were excluded. The KOOS, OKS, and VAS-MJ significantly improved 12 months after MOWHTO. The mean VAS-PA was 38.3 ± 23.9. Implant removal for pain relief was needed in 65 (63.1%) of the103 knees. The mean VAS-PA decreased to 4.5 ± 5.6 3 months after implant removal (p < 0.0001). Conclusion Over 60% of the patients may need implant removal to relieve pain over the pes anserinus after MOWHTO. Candidates for MOWHTO should be informed about this complication and its solution.


Resumo Objetivo A osteotomia tibial alta com cunha de abertura medial (MOWHTO, do inglês medial open wedge high tibial osteotomy) alivia de forma significativa a dor na linha articular medial em casos de osteoartrite do compartimento medial do joelho. Alguns pacientes, porém, se queixam de dor nos tendões dos músculos sartório, grácil e semitendinoso (pata de ganso) mesmo 1 ano após a osteotomia, o que pode exigir a remoção do implante. Este estudo define a taxa de remoção do implante após a MOWHTO devido à dor nos tendões dos músculos sartório, grácil e semitendinoso. Métodos Cento e três joelhos de 72 pacientes submetidos à MOWHTO para tratamento da osteoartrite do compartimento medial entre 2010 e 2018 foram incluídos no estudo. A pontuação de desfecho de lesão no joelho e osteoartrite (KOOS, do inglês Knee Injury and Osteoarthritis Outcome Score), a pontuação dejoelho de Oxford (OKS, do inglês Oxford Knee Score) e a escala visual analógica (EVA) de dor na linha articular medial do joelho (EVA-MJ) foram avaliados antes da cirurgia. A EVA nos tendões dos músculos sartório, grácil e semitendinoso (EVA-PA) foi adicionada a essas avaliações, também realizadas 12 meses após o procedimento e, a seguir, anualmente. A remoção do implante foi recomendada em pacientes com EVA-PA ≥ 40 e consolidação óssea adequada em 12 meses. Resultados Trinta e três (45,8%) pacientes eram homens e 39 (54,2%), mulheres. A média de idade foi de 49,4 ±8,0, e o índice de massa corpórea (IMC) médio foi de 27,0 ± 2,9. O sistema placa-parafuso tibial medial Tomofix (DePuy Synthes, Raynham, MA, EUA) foi utilizado em todos os casos. Três (2,8%) casos foram excluídos devido ao retardo de consolidação e à necessidade de revisão. Os resultados nas escalas KOOS, OKS e EVA-MJ melhoraram significativamente 12 meses após a MOWHTO. A EVA-PA média foi de 38,3 ± 23,9. A remoção do implante para alívio da dor foi necessária em 65 (63,1%) dos 103 joelhos. Três meses após a remoção do implante, a EVA-PA média diminuiu para 4,5 ± 5,6 (p < 0,0001). Conclusão A remoção do implante pode ser necessária em mais de 60% dos pacientes para alívio da dor nos tendões dos músculos sartório, grácil e semitendinoso após a MOWHTO. Os candidatos à MOWHTO devem ser informados sobre esta complicação e sua resolução.


Subject(s)
Humans , Osteotomy , Surgical Wound Infection , Tibia/surgery , Bone Plates , Bone Transplantation , Device Removal
8.
J. oral res. (Impresa) ; 12(1): 127-138, abr. 4, 2023. tab
Article in English | LILACS | ID: biblio-1516450

ABSTRACT

Introduction: The use of enamel matrix-derived proteins (EMD) has increased in recent years due to their tissue-inducing properties that support periodontal regeneration. This study is an overview of systematic reviews with FRISBEE methodology on the use of EMD alone or combined with autologous bone graft materials (BGM) in the treatment of intrabony defects. Materials and Methods: A systematic search in the Epistemonikos database was performed. RevMan 5.3 and GRADEpro were used for data analysis and presentation Results: Four systematic reviews and two clinical trials were identified. All studies analysed change in probing depth, clinical attachment level, gingival margin level and bone defect depth (all changes in favour of EMD+BGM groups: mean difference (MD): 0.37 mm more, MD: 0.7 mm more, MD: 0.3 mm less, MD: 0.75 more, respectively). Conclusions: Adding autologous bone graft to EMD to treat intrabony defects showed better results, but not a relevant clinical difference compared to the use of EMD alone.


Introducción: El uso de proteínas derivadas de la matriz del esmalte (EMD) ha aumentado en los últimos años debido a sus propiedades inductoras de tejidos que apoyan la regeneración periodontal. Este estudio es una revisión sistemática de revisiones sistemáticas utilizando metodología FRISBEE sobre el uso de EMD solo o combinado con materiales injerto óseo autólogo (BGM) en el tratamiento de defectos intraóseos. Materiales y Métodos: Se realizó una búsqueda sistemática en la base de datos Epistemonikos. Se utilizaron RevMan 5.3 y GRADEpro para el análisis y la presentación de los datos. Resultados: Se identificaron cuatro revisiones sistemáticas y dos ensayos clínicos. Todos los estudios analizaron el cambio en la profundidad de sondaje, el nivel de inserción clínica, el nivel del margen gingival y la profundidad del defecto óseo (todos los cambios a favor de los grupos EMD+BGM: MD: 0,37 mm más, media de diferencia (MD): 0,7 mm más, MD: 0,3 mm menos, MD: 0,75 más, respectivamente). Conclusión: La adición de injerto óseo autólogo a la EMD para tratar defectos intraóseos mostró mejores resultados, pero no una diferencia clínica relevante en comparación con el uso de la EMD sola.


Subject(s)
Humans , Alveolar Bone Loss/rehabilitation , Bone Transplantation/methods , Dental Enamel Proteins/therapeutic use , Periodontal Diseases , Transplantation, Autologous , Bone Regeneration
9.
J. oral res. (Impresa) ; 12(1): 152-167, abr. 4, 2023. tab, ilus
Article in English | LILACS | ID: biblio-1516525

ABSTRACT

Objective: The objective of the present systematic review and meta-analysis was to compare treatment with membrane associated with bone grafting and treatment exclusively with membrane in the approach of Class II furcation defects in mandibular molars. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were conducted in five databases (PubMed, Web of Science, Scopus, Ovid, and Lilacs), in Septem-ber 2021, without restriction regarding publication year or language. Studies comparing membranes associated with bone grafting and membranes exclusively in the treatment of Class II furcation lesions were included. Cross-sectional, case-control studies, and reviews were excluded. Study selection, data extraction, and risk of bias assessment (MINORS) were performed by two review authors. The certainty of the evidence (GRADE) was evaluated and meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. Results: Four hundred eighty-six references were iden-tified and four studies were included. Greater reduction in probing depth [MD = 0.32 (CI = 0.09, 0.56)] and greater clinical attachment level gain [MD = 0.41 (CI = 0.24, 0.57)] were observed when membrane and bone grafting were used. The risk of bias of included studies was low. Conclusions: This present systematic review and meta-analysis demonstrated that treatment of Class II furcation defects in mandibular molars using membrane and bone grafing is significantly more efficacious than treatment with the exclusive use of membrane.


Objetivo: El objetivo de la presente revisión sistemática y metanálisis fue comparar el tratamiento con membrana asociado a injerto óseo y el tratamiento exclusivamente con membrana en el abordaje de lesiones de furca grado II en molares mandibulares. Materiales y Métodos: Se siguió la declaración de elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Las búsquedas se realizaron en cinco bases de datos (PubMed, Web of Science, Scopus, Ovid y Lilacs), en septiembre de 2021, sin restricción de año de publicación o idioma. Se incluyeron estudios que compararon membranas asociadas con injertos óseos y membranas exclusivamente en el tratamiento de lesiones de furca de grado II. Se excluyeron los estudios transversales, de casos y controles y las revisiones. Dos revisores realizaron la selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo (MINORS). Se evaluó la certeza de la evidencia (GRADE) y se realizó un metanálisis. Se proporcionaron la diferencia de medias (DM) y el intervalo de confianza (IC) del 95%. Resultados: Se identificaron 486 referencias y se incluyeron cuatro estudios. Se observó una mayor reducción en la profundidad de sondaje [DM = 0,32 (IC = 0,09, 0,56)] y una mayor ganancia en el nivel de inserción clínica [DM = 0,41 (IC= 0,24, 0,57)] cuando se utilizaron injertos de membrana y hueso. El riesgo de sesgo de los estudios incluidos fue bajo. Conclusión: La presente revisión sistemática y metanálisis demostró que el tratamiento de los defectos de furca de grado II en molares mandibulares utilizando membrana e injertos de hueso es significativamente más eficaz que el tratamiento con el uso exclusivo de membrana.


Subject(s)
Humans , Bone Transplantation/methods , Furcation Defects/therapy , Periodontitis , Guided Tissue Regeneration , Membranes, Artificial
10.
Rev. bras. ortop ; 58(1): 141-148, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1441343

ABSTRACT

Abstract Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p= 0.178), in the knee society score (78.67 versus 81.46; p= 0.33), recurrence (0 versus 0%; p= 1), and complications (25 versus 7.69%; p= 0.21). Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft.


Resumo Objetivo Este é o primeiro estudo a estabelecer a utilidade da curetagem estendida com ou sem enxerto ósseo em tumores de células gigantes (TCGs) de grau II na articulação do joelho com o objetivo de explorar os resultados funcionais pós-operatórios. Métodos Revisamos retrospectivamente 25 casos de TCGs de grau II de Campanacci submetidos a curetagem estendida entre janeiro de 2014 e dezembro de 2019. Os participantes foram divididos em 2 grupos: um grupo de 12 pacientes foi submetido a curetagem estendida com aloenxerto ósseo e cimento ósseo, enquanto o outro grupo, com 13 pacientes, foi submetido a curetagem estendida apenas com cimento ósseo. A qualidade de vida foi avaliada pela Pontuação Revista da Musculoskeletal Tumor Society (MTS, na sigla em inglês) e pela Pontuação da Knee Society (KS, na sigla em inglês), enquanto as taxas de recidiva e complicações foram avaliadas em cada coorte na última consulta de acompanhamento. O teste de Fisher e os testes t de duas amostras foram usados para comparação de resultados categóricos e contínuos, respectivamente Resultados A média de idade dos pacientes foi de 28,09 (7,44) anos; 10 (40%) pacientes eram do sexo masculino e 15 (60%) pacientes eram do sexo feminino. O fêmur distal e a tíbia proximal foram acometidos em 13 (52%) e 12 (48%) dos pacientes, respectivamente. Não houve diferença significativa na pontuação revista da MTS (25,75 versus 27,41; p= 0,178), na pontuação da KS (78,67 versus 81,46; p= 0,33) e nas taxas de recidiva (0 versus 0%; p= 1) e complicações (25 versus 7,69%; p= 0,21). Conclusões A curetagem estendida com ou sem aloenxerto ósseo tem resultados funcionais semelhantes em pacientes com TCGs de grau II no joelho, sem qualquer diferença importante na incidência de recidivas e complicações. No entanto, a conveniência cirúrgica e o custo-benefício podem favorecer a utilização apenas de cimento ósseo, enquanto a prevenção da osteoartrite em longo prazo precisa ser investigada para favorecer o enxerto ósseo.


Subject(s)
Humans , Bone Cements , Bone Transplantation , Curettage , Giant Cell Tumors , Knee/surgery
11.
Rev. ADM ; 80(1): 36-40, ene.-feb. 2023. ilus, tab
Article in Spanish | LILACS | ID: biblio-1511548

ABSTRACT

Introducción: la vitamina D es una hormona que se sintetiza por células de la piel mediante la luz ultravioleta (UV) y se obtiene a través de la dieta. La relación que se establece entre la deficiencia de vitamina D y el fracaso en injertos óseos o implantes se basa en las alteraciones inmunológicas e inflamatorias debido al vínculo que existe con la inmunidad innata y adaptativa. Objetivo: identificar los factores que se presentan en el periodonto cuando existen niveles bajos de vitamina D y se realizan tratamientos periodontales como injertos óseos e implantes. Material y métodos: se realizó la búsqueda primaria de artículos en bases de datos PubMed y Google Académico (en español e inglés), de acuerdo con las palabras claves: deficiencia, vitamina D, implantología y oseointegración. Resultados: la vitamina D afecta y predispone al rechazo de injertos, ausencia de oseointegración en implantes debido a la inmunomodulación. Conclusión: el éxito del tratamiento se vuelve predecible cuando se encuentran niveles óptimos de vitamina D en conjunto con técnicas de abordaje quirúrgico correctas que permitan generar una integración ideal de los tejidos periodontales (AU)


Introduction: vitamin D is a hormone that is synthesized by skin cells using UV light and consumed through the diet. The relationship established between vitamin D deficiency and the failure of bone grafts or implants is based on immunological and inflammatory alterations due to the intimate link with innate and adaptive immunity. Objective: to identify the factors that occur in the periodontium when there are low levels of vitamin D and periodontal treatments such as bone grafts and implants are performed. Material and methods: a search for articles was carried out in PubMed and Google Scholar (Spanish and English). Results: vitamin D affects and predisposes to graft rejection, absence of osseointegration in implants due to immunomodulation. Conclusion: the success of the treatment becomes predictable when optimal levels of vitamin D are found together with the correct surgical approach techniques that allow the generation of an ideal integration of the periodontal tissues.(AU)


Subject(s)
Vitamin D Deficiency/complications , Osseointegration/physiology , Dental Implantation, Endosseous/adverse effects , Vitamin D/metabolism , Bone Transplantation/adverse effects
12.
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1439186

ABSTRACT

Braquimetatarsia es el acortamiento anormal de uno o más metatarsianos. Tiene una incidencia de 0.02%-0.05% predominando en mujeres de 25 a 1. En un 72% puede ser bilateral. La etiología no es clara pero se plantea el cierre prematuro de la fisis dando un retardo en el crecimiento. La mayoría de las veces presenta síntomas causados por alteración en la mecánica de la parábola metatarsal como dolor e hiperqueratosis. Puede existir metatarsalgia y agregar en la evolución desviaciones digitales adicionales. El principal motivo de consulta es estético. El objetivo del reporte es mostrar dos técnicas quirúrgicas y los resultados clínicos correspondientes usando el score AOFAS, además de los resultados imágenológicos con hasta 5 años de seguimiento. Se describen dos pacientes y se analizan dos técnicas quirúrgicas diferentes para alargar los metatarsianos. Se trata de alargamientos agudos con interposición de injerto intercalar, en un caso mediante el procedimiento de Sandro Gianini con injerto de cresta ilíaca y en el otro con injerto de metatarsiano adyacente con modificación de la longitud del segundo y tercer metatarsiano restituyendo en ambos casos la parábola metatarsal. Obtuvimos buenos resultados al igual que series numerosas pudiendo recomendarse en casos similares.


Brachymetarsal is the abnormal shortening of one or more metatarsals. It has an incidence of 0.02%-0.05%, predominantly in women from 25 to 1. In 72% it can be bilateral. The etiology is not clear, but premature closure of the physis is suggested, giving growth retardation. Most of the time it presents symptoms caused by an alteration in the mechanics of the metatarsal parabola, such as pain and hyperkeratosis. There may be metatarsalgia and add additional digital deviations in the evolution. The main reason for consultation is aesthetic. The objective of the work is to show the surgical technique and the clinical results using the AOFAS score, in addition to the imaging results with up to 5 years of follow-up. Two patients are described and two different surgical techniques to lengthen the metatarsals are analyzed. These are acute lengthenings with intercalary graft interposition, in one case using the S.Gianini procedure with an iliac crest graft and in the other with an adjacent metatarsal graft with modification of the length of the second and third metatarsals, restoring in both cases the metatarsal parabola. We obtained good results. results as well as numerous series and can be recommended in similar cases.


Braquimetatarsal é o encurtamento anormal de um ou mais metatarsos. Tem incidência de 0,02%-0,05%, predominantemente em mulheres de 25 a 1 ano. Em 72% pode ser bilateral. A etiologia não é clara, mas sugere-se o fechamento prematuro da fise, causando retardo de crescimento. Na maioria das vezes apresenta sintomas decorrentes de uma alteração na mecânica da parábola metatarsal, como dor e hiperqueratose. Pode haver metatarsalgia e adicionar desvios digitais adicionais na evolução. O principal motivo da consulta é a estética. O objetivo do trabalho é mostrar a técnica cirúrgica e os resultados clínicos utilizando o escore AOFAS, além dos resultados de imagem com até 5 anos de seguimento. Materiais e métodos: São incluídos dois pacientes e analisadas duas técnicas cirúrgicas diferentes para alongar os metatarsos. São alongamentos agudos com interposição de enxerto intercalar, em um caso utilizando a técnica de S. Gianini com enxerto de crista ilíaca e no outro com enxerto de metatarso adjacente com modificação do comprimento do segundo e terceiro metatarsos, restaurando em ambos os casos o metatarso parábola. Obtivemos bons resultados, bem como inúmeras séries, podendo ser recomendados em casos semelhantes.


Subject(s)
Humans , Female , Adult , Middle Aged , Young Adult , Bone Lengthening/methods , Foot Deformities, Congenital/surgery , Metatarsal Bones/surgery , Bone Transplantation/methods , Osteotomy , Metatarsal Bones/abnormalities , Treatment Outcome
13.
West China Journal of Stomatology ; (6): 284-289, 2023.
Article in English | WPRIM | ID: wpr-981125

ABSTRACT

OBJECTIVES@#To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it.@*METHODS@#A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated.@*RESULTS@#Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036).@*CONCLUSIONS@#The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.


Subject(s)
Humans , Child , Adolescent , Cleft Palate/surgery , Cleft Lip/surgery , Retrospective Studies , Cancellous Bone , Treatment Outcome , Alveolar Bone Grafting/methods , Bone Transplantation/methods
14.
West China Journal of Stomatology ; (6): 129-133, 2023.
Article in English | WPRIM | ID: wpr-981103

ABSTRACT

Alveolar cleft is one of the key links of cleft lip and palate reconstruction due to its close relationship with tooth and jaw coordination and nasolabial deformity. The alveolar bone graft repairs the hole in the gum ridge and stabilizes the bone arch, providing better support for the base of the nose and new bone for the roots of the developing teeth to grow into. Unfortunately, bone graft failure in the traditional way, even among minor clefts, bony hypoplasia, or absence that affects the nasal base and piriform rim, is common. Two-stage alveolar bone grafting, which has advantages in addressing the underlying skeleton and deficiency, could be an optional surgical procedure for nasal floor reconstruction in adult patients with a broad alveolar cleft.


Subject(s)
Humans , Adult , Alveolar Bone Grafting/methods , Cleft Lip/surgery , Cleft Palate/surgery , Treatment Outcome , Nose/abnormalities , Bone Transplantation/methods
15.
West China Journal of Stomatology ; (6): 123-128, 2023.
Article in English | WPRIM | ID: wpr-981102

ABSTRACT

Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.


Subject(s)
Humans , Dental Implants , Plastic Surgery Procedures , Free Tissue Flaps/surgery , Quality of Life , Dental Implantation, Endosseous , Fibula/surgery , Bone Transplantation , Mandibular Reconstruction
16.
China Journal of Orthopaedics and Traumatology ; (12): 1191-1195, 2023.
Article in Chinese | WPRIM | ID: wpr-1009210

ABSTRACT

OBJECTIVE@#To explore clinical effect of attaching locking plate with bone grafting based on retaining the original intramedullary nail in treating non-union after intramedullary nail fixation of long shaft fractures of lower limbs.@*METHODS@#A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020. All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone, and were underwent open reduction plate internal fixation and bone grafting for old fractures. Among them, 14 were males and 6 were females, aged from 35 to 56 years old with an average of (42.2±9.6) years old. Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture. According to characteristics of fracture end nonunion, 6 patients were stable/atrophic, 9 patients were unstable/large, and 5 patients were unstable/atrophic. The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery. Visual analogue scale (VAS), knee range of motion, bone healing time, complications and fracture-end healing were recorded before and at the latest follow-up.@*RESULTS@#All patients were followed up for 18 to 48 months with an average of (36.3±10.5) months. The incision of all patients were healed at stageⅠwithout complications such as infection or internal fixation ruptur. Healing time of femur and tibia was (8.5±2.6) months and (9.5±2.2) months. Knee joint motion increased from preoperative (101.05±8.98) ° to postoperative (139.35±8.78) ° at the latest follow-up (t=-12.845, P<0.001). VAS decreased from preoperative (5.15±1.72) to postoperative (0.75±0.96) at the latest follow-up (t=11.186, P<0.001).@*CONCLUSION@#On the basis of retaining the original intramedullary nail, the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation, less trauma, fewer complications and high fracture healing rate. It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.


Subject(s)
Male , Female , Humans , Adult , Middle Aged , Bone Transplantation , Retrospective Studies , Bone Plates , Fracture Fixation, Intramedullary/adverse effects , Femoral Fractures/complications , Lower Extremity , Fractures, Ununited/surgery , Fracture Healing , Tibial Fractures/complications , Bone Nails , Treatment Outcome
17.
China Journal of Orthopaedics and Traumatology ; (12): 1185-1190, 2023.
Article in Chinese | WPRIM | ID: wpr-1009209

ABSTRACT

OBJECTIVE@#To analysis and determine MR signs of Harris score ARCO stages 2-4 in osteonecrosis of femoral head (ONFH).@*METHODS@#Thirty-four patients with ONFH of ARCO stages 2 to 4 who underwent routine MR, T2 mapping, 3D-SPACE sequence examination and Harris score were retrospectively collected from January 2019 to June 2020, and 3 patients were excluded, and 31 patients were finally included, including 23 males and 8 females, aged from 18 to 62 years old with an average of(40.0±10.8) years old. Among them 21 patients with bilateral femoral head necrosis, totally 52 cases, including 17 with ARCO stage 2 patients, 24 ARCO stage 3, and 11 ARCO stage 4. MR imaging signs (femoral head collapse depth, ONFH index, bone marrow edema, hyperplasia, grade and T2 value of cartilage injury, and joint effusion) were scored and measured on the picture archiving and communication system (PACS) workstation, and the cartilage quantitative parameter T2 value was calculated and measured on Siemens postprocessing workstation. Pearson correlation analysis was used to evaluate the correlation between various MR signs and Harris score, and then multiple linear regression analysis was used to examine impact of MR signs on Harris hip score.@*RESULTS@#Femoral head collapse depth(r=-0.563, P=0.000), grade of cartilage injury(r=-0.500, P=0.000), and joint effusion (r=-0.535, P=0.000) were negatively correlated with Harris score by Pearson correlation analysis. Multiple linear regression analysis showed that joint effusion(β=-6.198, P=0.001) and femoral head collapse depth(β=-4.085, P=0.014) had a significant negative impact on Harris hip score.@*CONCLUSION@#Femoral head collapse depth and joint effusion both had significant negative relationship with Harris hip score. It is recommended to routinely evaluate femoral head collapse depth and joint effusion quantitatively and gradedly, so as to efficiently and accurately assist clinical diagnosis and treatment.


Subject(s)
Male , Female , Humans , Adolescent , Young Adult , Adult , Middle Aged , Femur Head Necrosis/diagnostic imaging , Retrospective Studies , Femur Head/diagnostic imaging , Bone Transplantation/methods , Magnetic Resonance Imaging , Treatment Outcome
18.
China Journal of Orthopaedics and Traumatology ; (12): 936-942, 2023.
Article in Chinese | WPRIM | ID: wpr-1009164

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy of percutaneous screw fixation combined with minimally invasive transpedicular bone grafting and non-bone grafting in the treatment of thoracolumbar fractures.@*METHODS@#From Janury 2021 to June 2022, 40 patients with thoracolumbar fracture were divided into the experimental group and the control group. There were 26 patients in the experimental group, including 21 males and 5 females with an aberage age of (47.3±12.3) years old, who underwent percutaneous pedicle screw fixation combined with transpedicular autogenous bone grafting. In the control group, 14 patients received percutaneous pedicle screw fixation only. including 7 makes and 7 females with an average age of (50.2±11.2) years old. The operative time, intraoperative blood loss, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score (VAS), MacNab scores, loosening or broken of the implants. were compared and analyzed.@*RESULTS@#There was no significant difference in operation time, intraoperative blood loss, VAS and anterior height ratio of injured vertebrae between the two groups. Compared with the preoperative results, VAS and anterior height ratio of injured vertebrae were improved statistically(P<0.05). For Cobb angle of injured vertebra, there was no significant difference between the two groups before surgery (P=0.766). While at 1 week, 3 months and 12 months after surgery, there were statistically differences between the two groups (P values were 0.042, 0.007 and 0.039, respectively). The Cobb angle of injured vertebrae one year after operation was statistically decreased in both groups compared with that before surgery (P<0.001). One year after surgery, the excellent and good rate of Macnab scores was 96.15% in the experimental group and 92.86% in the control group, and there was no statistical differences between the two groups (P=0.648). There was one patient in the control group suffering superficial wound infection on the third day, which was cured by dressing change and anti-infection treatment. There were no postoperative screw loosening and broken in both groups.@*CONCLUSION@#The two surgical methods have the advantages of less trauma, less pain and quicker recovery, which can restore the height of the injured vertebra, reconstruct the spinal sequence and reduce the fracture of the vertebral body. Transpedicular autogenous bone grafting can increase the stability of the fractured vertebra and maintain the height of the vertebra better after surgery, thus reducing the possibility of complications such as kyphosis, screw loosening and broken.


Subject(s)
Male , Female , Humans , Adult , Middle Aged , Pedicle Screws , Bone Transplantation , Blood Loss, Surgical , Lumbar Vertebrae/injuries , Thoracic Vertebrae/injuries , Fracture Fixation, Internal/methods , Spinal Fractures/surgery , Treatment Outcome , Retrospective Studies
19.
Chinese Journal of Reparative and Reconstructive Surgery ; (12): 1190-1197, 2023.
Article in Chinese | WPRIM | ID: wpr-1009044

ABSTRACT

OBJECTIVE@#To investigate the long-term effectiveness of uncemented allograft-prosthesis composite (APC) for reconstruction of bone defects after proximal femur tumor resection.@*METHODS@#Between June 2007 and March 2014, 21 patients who underwent uncemented APC reconstruction of proximal femur after tumor resection were retrospectively evaluated. There were 9 males and 12 females with an average age of 33.2 years (range, 19-54 years). There were 9 cases of giant cell tumor of bone, 5 cases of osteosarcoma, 4 cases of osteoblastic osteosarcoma, 2 cases of chondrosarcoma, and 1 case of undifferentiated pleomorphic sarcoma. Thirteen cases of benign bone tumors were all classified as stage 3 by Enneking staging; and 8 cases of malignant bone tumors were classified as grade ⅡB in 7 cases and grade ⅡA in 1 case according to the American Joint Committee on Cancer (AJCC) staging system. Among them, 7 patients underwent reoperation after recurrence, and the rest were primary operations; 8 patients presented with pathological fractures. The preoperative Harris hip score (HHS) and American Musculoskeletal Tumor Society (MSTS) score was 40 (30, 49) and 9.1±3.5, respectively. The length of osteotomy was 80-154 mm, with an average of 110 mm. At 1 year after operation and last follow-up, HHS and MSTS scores were utilized to evaluate the function of hip joint; the gluteus medius strength score was used to evaluation of the hip abduction function. Image examinations were taken at 1, 3, 6, 9, and 12 months after operation and every year thereafter to assess the union of allograft-host bone interfaces. Intra- and post-operative complications were also recorded.@*RESULTS@#All patients were followed up 84-163 months (mean, 123.5 months). At 1 year after operation and last follow-up, the HHS and MSTS scores significantly improved when compared with the preoperative scores ( P<0.05). However, there was no significant difference in the HHS score, MSTS score, and gluteus medius strength score between the two time points after operation ( P>0.05). Image examination showed that all allograft-host bone interfaces achieved union after 5-10 months (mean, 7.6 months). At last follow-up, all patients had bone resorption, including 11 severe cases, 4 moderate cases, and 6 mild cases; the bone resorption sites included Gruen 1, 2, and 7 regions. Complications included 10 fractures and 1 prosthetic fracture. Local recurrence occurred in 3 patients and pulmonary metastasis in 3 patients.@*CONCLUSION@#Uncemented APC is a reliable method for the reconstruction of bone defects after proximal femur tumor resection. It has the good long-term effectiveness and possesses obvious advantages in the union at the bone-bone surface.


Subject(s)
Adult , Female , Humans , Male , Young Adult , Middle Aged , Allografts/pathology , Bone Neoplasms/surgery , Bone Resorption/pathology , Bone Transplantation/methods , Femur/surgery , Osteosarcoma/pathology , Prostheses and Implants , Retrospective Studies , Treatment Outcome
20.
China Journal of Orthopaedics and Traumatology ; (12): 579-585, 2023.
Article in Chinese | WPRIM | ID: wpr-981736

ABSTRACT

OBJECTIVE@#To provide an overview of the incidence of knee donor -site morbidity after autologous osteochondral mosaicplasty.@*METHODS@#A comprehensive search was conducted in PubMed, EMbase, Wanfang Medical Network, and CNKI databases from January 2010 to April 20, 2021. Relevant literature was selected based on predefined inclusion and exclusion criteria, and data were evaluated and extracted. The correlation between the number and size of transplanted osteochondral columns and donor-site morbidity was analyzed.@*RESULTS@#A total of 13 literatures were included, comprising a total of 661 patients. Statistical analysis revealed an incidence of knee donor-site morbidity at 8.6% (57/661), with knee pain being the most common complaint, accounting for 4.2%(28/661). There was no significant correlation between the number of osteochondral columns and postoperative donor-site incidence (P=0.424, N=10), nor between the diameter size of osteochondral columns and postoperative donor-site incidence(P=0.699, N=7).@*CONCLUSION@#Autologous osteochondral mosaicplasty is associated with a considerable incidence of knee donor-site morbidity, with knee pain being the most frequent complaint. There is no apparent correlation between donor-site incidence and the number and size of transplanted osteochondral columns. Donors should be informed about the potential risks.


Subject(s)
Humans , Incidence , Cartilage/transplantation , Knee , Knee Joint/surgery , Pain , Cartilage, Articular , Transplantation, Autologous , Bone Transplantation
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