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1.
Rev. colomb. cir ; 39(3): 407-420, 2024-04-24. fig, tab
Article in Spanish | LILACS | ID: biblio-1553805

ABSTRACT

Introducción. El cáncer gástrico en Colombia es la segunda neoplasia más común en hombres y la cuarta en mujeres. En los últimos años se han descrito ampliamente los beneficios del abordaje laparoscópico en el cáncer gástrico frente a sangrado, recuperación postoperatoria y complicaciones, sin afectar los resultados oncológicos. Métodos. Estudio observacional retrospectivo de pacientes llevados a gastrectomía laparoscópica en la Clínica Universitaria Colombia durante un período de diez años, entre 2013 y 2023. Se describieron los resultados perioperatorios en cuanto a estancia hospitalaria, sangrado operatorio, duración del procedimiento, complicaciones, causas de reintervención y mortalidad en los primeros 30 días. Resultados. Se incluyeron 418 pacientes, 58,9 % hombres, con una edad promedio de 60,8 años. Se documentó un tiempo quirúrgico promedio de 228,7 minutos, con un sangrado de 150 ml. La media de ganglios linfáticos resecados fue de 26,1 ± 11,4. La estancia hospitalaria en promedio fue de 4 ± 4 días, y se registraron complicaciones en 104 sujetos, con una tasa promedio de 24 %, de las cuales 29 (27,4 %) obtuvieron una clasificación Clavien-Dindo IIIB. Conclusiones. La gastrectomía por laparoscopia en un centro de alto volumen y con cirujanos experimentados en Colombia, tiene resultados perioperatorios similares a lo reportado en la literatura mundial. Aún se requiere de estudios de mayor fuerza de asociación para establecer recomendaciones sobre el uso rutinario de este abordaje en patología maligna avanzada.


Introduction. Gastric cancer in Colombia is the second most common neoplasm in men and the fourth in women. In recent years, the benefits of the laparoscopic approach in gastric cancer against bleeding, postoperative recovery com and complications have been widely described, without affecting oncological results. Methods. Retrospective observational study of patients undergoing laparoscopic gastrectomy at the Clínica Universitaria Colombia over a period of ten years, between 2013 and 2023. Perioperative results were described in terms of hospital stay, operative bleeding, duration of the procedure, complications, causes of reintervention, and mortality in the first 30 days. Results. 418 patients were included, 58.9% men, with an average age of 60.88 years. An average surgical time of 228.7 minutes was documented, with a blood loss of 150 ml. The mean number of lymph nodes resected was 26.1 ± 11.4. The average hospital stay was 4 ± 4 days, and complications were recorded in 104 subjects, with an average rate of 24%, of which 29 (27.4%) obtained a Clavien-Dindo IIIB classification. Conclusions. Laparoscopic gastrectomy in a high-volume center and with experienced surgeons in Colombia has perioperative results similar to those reported in the world literature. Studies with greater strength of association are still required to establish recommendations on the routine use of this approach in advanced malignant pathology.


Subject(s)
Humans , Postoperative Complications , Laparoscopy , Gastrectomy , Stomach Neoplasms , Mortality , Minimally Invasive Surgical Procedures
2.
Rev. colomb. cir ; 39(3): 421-429, 2024-04-24. tab, fig
Article in Spanish | LILACS | ID: biblio-1554113

ABSTRACT

Introducción. El objetivo de este estudio fue comparar los desenlaces a corto plazo de la gastrectomía laparoscópica en adultos vs. adultos mayores con cáncer gástrico localmente avanzado en una cohorte de un país occidental. Métodos. Estudio de cohorte prospectivo en pacientes sometidos a gastrectomía laparoscópica por cáncer gástrico localmente avanzado, en el Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, entre noviembre de 2014 y diciembre de 2018. Se realizó análisis descriptivo, de comparación de grupos y bivariado. Resultados. De un total de 116 pacientes, 51 pacientes (44 %) tenían 65 años o más y 63 pacientes (54 %) eran hombres. No se encontró diferencia estadísticamente significativa al comparar los pacientes menores de 65 años con los de 65 años o más. La mediana del tiempo operatorio fue de 240 minutos en ambos grupos (p>0,05), la mediana de los márgenes de resección macroscópica fue 6 cm vs. 5 cm (p>0,05), la mediana de los ganglios linfáticos disecados fue 25 vs. 19 (p>0,05), la mediana de ganglios linfáticos positivos fue 4 vs. 3 (p>0,05), la mediana de estancia fue de 7 días en ambos grupos (p>0,05). La tasa general de complicaciones posoperatorias no difirió significativamente entre adultos (7%) y adultos mayores (11 %) (p>0,05) y no se observaron diferencias significativas en las tasas de complicaciones menores (Clavien-Dindo grado II; 3-5 % vs. 6-12 %; p>0,05) y graves (Clavien-Dindo ≥ IIIa; 3-5 % vs. 4-8 %; p>0,05). Conclusiones. No se encontraron diferencias estadísticamente significativas en los resultados a corto plazo entre los pacientes adultos y adultos mayores con cáncer gástrico localmente avanzado tratados con gastrectomía laparoscópica. Esta técnica es segura en ancianos.


Introduction. The objective of this study was to compare the short-term outcomes of laparoscopic gastrectomy in adults vs. older patients with locally advanced gastric cancer from a Western country cohort. Methods. Prospective cohort study in patients undergoing laparoscopic gastrectomy for locally advanced gastric cancer at the Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, between November 2014 and December 2018. Descriptive, group comparison and bivariate analysis was performed. Results. Of a total of 116 patients, 51 patients (44%) were 65 years or older and 63 patients (54%) were men. No statistically significant difference was found when comparing patients under 65 years of age with those 65 years of age or older. The median operating time was 240 minutes in both groups (p>0.05), the median macroscopic resection margins were 6 cm vs. 5 cm (p>0.05), the median number of lymph nodes dissected was 25 vs. 19 (p>0.05), the median number of positive lymph nodes was 4 vs. 3 (p>0.05), the median stay was 7 days in both groups (p>0.05). The overall rate of postoperative complications did not differ significantly between adults (7%) and older adults (11%) (p>0.05) and no significant differences were observed in the rates of minor (Clavien-Dindo grade II; 3-5% vs. 6-12%; p>0.05) and severe complications (Clavien-Dindo ≥ IIIa; 3-5% vs. 4-8%; p>0.05). Conclusions. No statistically differences were found in short-term outcomes between adult and older patients with locally advanced gastric cancer treated with laparoscopic gastrectomy. This technique is safe in the elderly.


Subject(s)
Humans , Stomach Neoplasms , Aged , Gastrectomy , Postoperative Complications , Laparoscopy , Minimally Invasive Surgical Procedures
3.
Rev. colomb. cir ; 39(2): 218-230, 20240220. fig, tab
Article in Spanish | LILACS | ID: biblio-1532578

ABSTRACT

Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.


Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.


Subject(s)
Humans , Colorectal Neoplasms , Enhanced Recovery After Surgery , Length of Stay , Laparoscopy , Colorectal Surgery , Minimally Invasive Surgical Procedures
4.
Article in Spanish | LILACS, BINACIS | ID: biblio-1531280

ABSTRACT

Introducción: La cirugía mínimamente invasiva de columna se ha vuelto cada vez más popular en los últimos años. Se han desarrollado técnicas nuevas y menos invasivas que se han convertido en procedimientos de elección para determinadas enfermedades. El tamaño del corredor aorto-psoas es un factor determinante al elegir la técnica oblicua de fusión intersomática. Objetivos: Describir las modificaciones en el tamaño del corredor aorto-psoas en decúbito lateral derecho y decúbito supino mediante resonancia magnética y su asociación con el índice de masa corporal. materiales y métodos: Se realizó una resonancia magnética de los espacios discales de L1-L2 a L4-L5 a 13 voluntarios en decúbito supino y decúbito lateral derecho. Se midió el corredor y se comparó el tamaño en cada nivel. Resultados: El tamaño del corredor aorto-psoas y de la distancia arteria-disco tuvo un aumento estadísticamente significativo al posicionar al paciente en decúbito lateral derecho. Conclusiones: La resonancia magnética es de suma importancia en la planificación prequirúrgica, pues deja en evidencia la movilidad de las estructuras abdominales. Se producen cambios significativos en el corredor aorto-psoas y la distancia arteria-disco al ubicar al paciente en decúbito lateral derecho. Sin embargo, estos cambios no tienen una relación significativa con el índice de masa corporal. Nivel de Evidencia: IV


Introduction: Minimally invasive spine surgery (MISS) has gained popularity in recent years. New and less invasive techniques have emerged as the preferred procedures for certain pathologies. The size of the aorta-psoas corridor is decisive when choosing the oblique interbody fusion technique. Objectives: To describe the changes in the size of the aorta-psoas corridor in the right lateral decubitus and supine decubitus positions by magnetic resonance imaging and their association with body mass index. materials and methods: 13 volunteers underwent MRI of the disc spaces from L1-L2 to L4-L5 in the supine and right lateral decubitus positions. The corridor was measured, and the sizes at each level were compared. Results: A statistically significant increase in the size of the aorta-psoas corridor and the artery-disc distance was obtained when positioning the patient in the right lateral decubitus position. However, these have no significant relationship with BMI. Conclusions: The use of MRI in pre-surgical planning is extremely important. This study reveals the mobility of the abdominal structures. We can conclude that, as stated in the objective of the study, significant changes occur in the aorta-psoas corridor and the artery-disc distance when the patient is positioned in the right lateral decubitus position. Level of Evidence: IV


Subject(s)
Adult , Spinal Diseases , Spinal Fusion , Magnetic Resonance Imaging , Minimally Invasive Surgical Procedures , Lumbar Vertebrae
5.
Chinese Journal of Reparative and Reconstructive Surgery ; (12): 40-45, 2024.
Article in Chinese | WPRIM | ID: wpr-1009106

ABSTRACT

OBJECTIVE@#To compare the accuracy and effectiveness of orthopaedic robot-assisted minimally invasive surgery versus open surgery for limb osteoid osteoma.@*METHODS@#A clinical data of 36 patients with limb osteoid osteomas admitted between June 2016 and June 2023 was retrospectively analyzed. Among them, 16 patients underwent orthopaedic robot-assisted minimally invasive surgery (robot-assisted surgery group), and 20 patients underwent tumor resection after lotcated by C-arm X-ray fluoroscopy (open surgery group). There was no significant difference between the two groups in the gender, age, lesion site, tumor nidus diameter, and preoperative pain visual analogue scale (VAS) scores ( P>0.05). The operation time, lesion resection time, intraoperative blood loss, intraoperative fluoroscopy frequency, lesion resection accuracy, and postoperative analgesic use frequency were recorded and compared between the two groups. The VAS scores for pain severity were compared preoperatively and at 3 days and 3 months postoperatively.@*RESULTS@#Compared with the open surgery group, the robot-assisted surgery group had a longer operation time, less intraoperative blood loss, less fluoroscopy frequency, less postoperative analgesic use frequency, and higher lesion resection accuracy ( P<0.05). There was no significant difference in lesion resection time ( P>0.05). All patients were followed up after surgery, with a follow-up period of 3-24 months (median, 12 months) in the two groups. No postoperative complication such as wound infection or fracture occurred in either group during follow-up. No tumor recurrence was observed during follow-up. The VAS scores significantly improved in both groups at 3 days and 3 months after surgery when compared with preoperative value ( P<0.05). The VAS score at 3 days after surgery was significantly lower in robot-assisted surgery group than that in open surgery group ( P<0.05). However, there was no significant difference in VAS scores at 3 months between the two groups ( P>0.05).@*CONCLUSION@#Compared with open surgery, robot-assisted resection of limb osteoid osteomas has longer operation time, but the accuracy of lesion resection improve, intraoperative blood loss reduce, and early postoperative pain is lighter. It has the advantages of precision and minimally invasive surgery.


Subject(s)
Humans , Robotics , Osteoma, Osteoid/surgery , Orthopedics , Blood Loss, Surgical , Retrospective Studies , Neoplasm Recurrence, Local , Minimally Invasive Surgical Procedures , Bone Neoplasms/surgery , Analgesics , Treatment Outcome
7.
Educ. med. super ; 37(3)sept. 2023.
Article in Spanish | LILACS, CUMED | ID: biblio-1528553

ABSTRACT

Introducción: La interdisciplinariedad es el resultado de la puesta en práctica de varias disciplinas, que permite afrontar el objeto de estudio de modo integral y promover el desarrollo de nuevas intervenciones para la solución de problemas. En el campo de la medicina involucra la contribución de diversas disciplinas y la participación de especialistas de diversas áreas que integra el pensamiento de diferentes profesiones o tecnologías para lograr un resultado común. Objetivos: Exponer una visión integral acerca de cómo la interdisciplinariedad ha permitido el desarrollado de la cirugía mínimamente invasiva en la especialidad de urología. Métodos: Se realizó una revisión sistemática y crítica de artículos reportados sobre la interdisciplinariedad en el campo de la cirugía mínimo invasiva, en idioma español e inglés, desde 2005 hasta 2022, en sitios Web (PubMed, SciELO, MedLine, Lilacs y Science Direct. Se referenciaron 22 artículos de los consultados. Conclusiones: Las evidencias reportadas y consultadas ofrecen una visión integral de las diversas intervenciones que certifican la interdisciplinariedad en el campo de la cirugía urológica mínimamente invasiva, que fortalece el marco curricular de la especialidad y permite alcanzar un nivel de profesionalidad significativo, evidenciado en un excelente desempeño profesional(AU)


Introduction: Interdisciplinarity results from implementing several disciplines, allowing to address the object of study comprehensively, as well as promote the development of new interventions to solve problems. In the field of medicine, it involves the contribution of various disciplines and the participation of specialists from different areas, integrating the thinking from different professions or technologies to achieve a common result. Objectives: To present a comprehensive perspective of how interdisciplinarity has allowed the development of minimally invasive surgery in the specialty of urology. Methods: A systematic and critical review was carried out with reported articles on interdisciplinarity in the field of minimally invasive surgery, in Spanish and English, from 2005 to 2022, in Web sites (PubMed, SciELO, MedLine, Lilacs and Science Direct). Twenty-two of the consulted articles were referenced. Conclusions: The reported and consulted evidence offers a comprehensive perspective of the various interventions certifying interdisciplinarity in the field of minimally invasive urologic surgery, which strengthens the curricular framework of the specialty and allows to achieve a significant level of professionalism, evidenced through excellent professional performance(AU)


Subject(s)
Humans , Technology/methods , Urology/education , Minimally Invasive Surgical Procedures/methods , Knowledge , Education, Medical
8.
Rev. bras. ortop ; 58(3): 449-456, May-June 2023. tab, graf
Article in English | LILACS | ID: biblio-1449834

ABSTRACT

Abstract Objective The endoscopic release of the ulnar nerve reproduces a simple (in situ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.


Resumo Objetivo A liberação endoscópica do nervo ulnar permite reproduzir uma liberação simples (in situ), mas através de incisões menores e com menor lesão de partes moles e uma maior preservação da vascularização do nervo. A visualização clara através da endoscopia permite observar todo o trajeto do nervo e das estruturas nobres circundantes, mostrando os sinais de compressão, possibilitando realizar a liberação de forma segura em um trajeto de 10 cm nos sentidos distal e proximal ao epicôndilo medial. Método Foram encontrados, de forma retrospectiva, no período entre janeiro de 2016 e janeiro de 2020, 15 pacientes (sendo 1 com lesão bilateral) submetidos a liberação da compressão do nervo ulnar no cotovelo pela técnica endoscópica com equipamento de Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA). Resultados Todos os pacientes tiveram melhora dos sintomas de compressão do nervo ulnar e o período de retorno ao trabalho foi de em média 26,5 dias. Não houve recidivas e não houve a necessidade de outro procedimento. Também não houve complicações graves decorrentes do procedimento, como infecção, lesão nervosa ou vascular. Em um paciente, houve parestesia transitória dos ramos sensitivos para o antebraço, com retorno completo da função em 8 semanas. Conclusão Os resultados mostram que a liberação endoscópica do nervo ulnar no cotovelo comoequipamentodeAgeeéuma técnica segura, confiável e com bons resultados.


Subject(s)
Humans , Paresthesia , Minimally Invasive Surgical Procedures , Cubital Tunnel Syndrome/therapy , Elbow/surgery , Nerve Compression Syndromes
9.
Femina ; 51(3): 147-150, 20230331. Ilus
Article in Portuguese | LILACS | ID: biblio-1428721

ABSTRACT

A evolução contínua das áreas cirúrgicas se deve a estudos e pesquisas, avanços tecnológicos e desenvolvimento de equipamentos mais avançados. A cirurgia minimamente invasiva, incluindo a videolaparoscopia, histeroscopia e cirurgia robótica, tem sido impactada significativamente pelos avanços cirúrgicos. As técnicas minimamente invasivas têm se tornado padrão-ouro no diagnóstico e tratamento de doenças ginecológicas, proporcionando benefícios como redução do tempo cirúrgico, menor dor no pós-operatório e melhoria na qualidade de vida. O treinamento adequado do cirurgião e da equipe é fundamental para o sucesso do tratamento cirúrgico, e o desenvolvimento tecnológico e aprimoramento dos equipamentos impulsionam a cirurgia minimamente invasiva como uma área específica da Ginecologia. Métodos seguros de treinamento, como laboratórios de simulação, permitem o aprimoramento gradual das habilidades dos cirurgiões em formação, preparando-os para uma prática segura e eficaz. A literatura fornece ferramentas e conceitos para o treinamento em cirurgia minimamente invasiva, visando formar residentes e novos cirurgiões.


Subject(s)
Minimally Invasive Surgical Procedures/methods , Pain, Postoperative , Patient Care Team , Quality of Life , Gynecologic Surgical Procedures/history , Teaching/education , Technological Development , Surgical Oncology/trends , Medical Staff, Hospital/education
11.
Article in Spanish | LILACS, BINACIS | ID: biblio-1415760

ABSTRACT

Introducción: La lesión del ligamento calcaneonavicular ha sido descrita como una de las causas de la deformidad en el pie plano del adulto. El objetivo de este artículo es describir portales modificados para el diagnóstico y la reparación endoscópica de las lesiones del fascículo superomedial del ligamento calcaneonavicular y evaluar la seguridad de los portales utilizados. Materiales y Métodos:Se llevó a cabo un estudio cadavérico con seis preparados reproduciendo una lesión del fascículo superomedial del ligamento calcaneonavicular con una punta de corte de radiofrecuencia y la posterior reparación endoscópica. Se crearon dos portales modificados para el abordaje. Luego se procedió a la disección anatómica para evaluar la seguridad de los portales en relación con las estructuras anatómicas. El primer portal se realiza inmediatamente proximal a una línea trazada desde la punta del maléolo medial dirigida al centro del talón, el segundo portal se emplaza 0,5 cm proximal a la inserción del tendón tibial posterior en el escafoides por transiluminación. Si es necesario, se coloca un portal accesorio inmediatamente dorsal al tendón tibial posterior a mitad de camino entre los dos portales antes descritos. Resultados:En todos los casos, fue posible la reparación del ligamento con el procedimiento endoscópico. En la disección anatómica de los portales, se observó una distancia promedio a las estructuras vasculonerviosas de 11,83 mm del portal proximal y de 9,66 mm del portal distal. Conclusión: Los portales modificados son seguros y permiten la visualización directa del haz superomedial del ligamento calcaneonavicular y su reparación endoscópica. Nivel de Evidencia: IV


Introduction: Calcaneonavicular ligament injury has been described as a cause of adult flat foot deformity. The objective of this study is to describe modified portals for the diagnosis and treatment of injuries to the superomedial bundle of the calcaneonavicular ligament and to evaluate the safety of the portals used. Materials and Methods: We performed a cadaveric specimen study on 6 feet, where we reproduced a lesion of the superomedial bundle of the calcaneonavicular ligament with a radiofrequency ablation device and repaired it endoscopically. Two modified portals were created for the approach and an anatomical dissection was performed to assess the safety of the portals in relation to the anatomical structures. The first portal was placed immediately proximal to a line drawn from the tip of the medial malleolus toward the center of the heel; the second portal was placed 0.5 cm proximal to the posterior tibial tendon insertion into the navicular bone, guided by transillumination. If needed, an accessory portal was placed halfway between the two previously described portals immediately dorsal to the posterior tibial tendon. Results:In all cases, ligament repair was achieved with the endoscopic procedure. In the anatomical dissection of the portals, we observed an average distance of 11.83 mm from the proximal portal and 9.66 mm from the distal portal to neurovascular structures. Conclusion:Modified portals are safe and allow direct visualization of the superomedial bundle of the calcaneonavicular ligament to perform endoscopic repair. Level of Evidence: IV


Subject(s)
Adult , Flatfoot , Minimally Invasive Surgical Procedures , Foot Joints , Endoscopy/methods , Ligaments, Articular/surgery
12.
Artrosc. (B. Aires) ; 30(3): 115-120, 2023.
Article in Spanish | LILACS, BINACIS | ID: biblio-1519430

ABSTRACT

Introducción: Los meniscos juegan un papel crucial para la correcta biomecánica y función adecuada de la rodilla. Las lesiones, según sean traumáticas o degenerativas, tienen orígenes, algoritmos diagnósticos y tratamientos distintos. En el pasado, la meniscectomía era el tratamiento de elección; a medida que se fue comprendiendo la importancia de estas estructuras anatómicas estos fueron migrando hacia opciones de preservación, intentando resguardar la mayor cantidad de tejido meniscal, fomentar su reparación y así disminuir el riesgo de osteoartritis de manera temprana.El objetivo de este trabajo es mostrar los resultados de las reparaciones meniscales efectuadas entre 2012 y 2018, y complementar con una revisión de las técnicas quirúrgicas que hemos realizado en el trascurso de estos años, y las causas de fallas en nuestra serie de pacientes.Materiales y métodos: evaluamos doscientas treinta y cuatro reparaciones meniscales realizadas entre el 2012 y el 2018. El promedio de edad fue de veintiocho años. Un 72% se asoció a lesión y reconstrucción del ligamento cruzado anterior. Incluimos las reparaciones meniscales aisladas, como también asociadas a plástica de LCA, de ambos sexos, con técnicas dentro-fuera, fuera-dentro, todo-adentro y la asociación de estas técnicas. Por otra parte, excluimos pacientes con datos incompletos en la historia clínica, revisiones de suturas realizadas por otro equipo quirúrgico y por falta de seguimiento. La evaluación se basó en el examen físico, la escala visual análoga (EVA) para el dolor y la funcionalidad mediante los scores de IKDC, Lysholm y Tegner.Resultados: la reparación meniscal artroscópica estuvo asociada a la reconstrucción ligamentaria del LCA en un 72% (169 casos) y en un 28% (65 casos) la sutura meniscal como único procedimiento. Se repararon ciento setenta y un meniscos internos y sesenta y tres externos. Con respecto a la técnica utilizada, la distribución fue la siguiente: 151 fueron fuera-dentro; 31, todo-adentro y 52, híbrida (mixta). El promedio de puntos de sutura fue de 3.11 (rango 2 ­ 10). El seguimiento promedio fue de sesenta meses (rango 48 ­ 72). El score de Lysholm postoperatorio fue de 94 (rango 87 ­ 96), el IKDC postoperatorio de 88 (rango 84 ­ 92) y la escala EVA fue de 1/10. Se registraron veintitrés fallas de reparación meniscal (9.8% del total), trece asociadas a plástica de ligamento cruzado anterior (LCA) (56% de las fallas y el promedio de edad de esta población fue el mismo que el de la serie general, veintiocho años). Las fallas fueron consideradas con los criterios de Barret y se confirmaron en el intraoperatorio con visualización artroscópica.Conclusión: comprendiendo la biomecánica articular y la importancia de las estructuras meniscales en la prevención de lesiones degenerativas de la rodilla, debemos intentar la reparación meniscal en todos los casos que sean posibles. En nuestra serie utilizamos técnicas reproducibles con bajo índice de complicaciones, con un índice de falla del 9.8%. Es por eso que pregonamos la importancia de "salvar el menisco". Nivel de Evidencia: IV


Introduction: Menisci play a crucial role in the proper biomechanics and adequate function of the knee. Traumatic and degenerative injuries have different origins, diagnostic algorithms, and treatments. In the past, meniscectomy was the treatment of choice. As we understood the importance of these anatomical structures, treatments shifted towards more reparative options, aiming to preserve the maximum amount of meniscal tissue, promoting its repair, and reducing the risk of early osteoarthritis.Our objective is to present the results of meniscal repairs performed between 2012 and 2018, complemented by a review of the surgical techniques we have performed over the course of these years and the causes of failures in our patient series.Materials and methods: we evaluated 234 meniscal repairs performed between 2012 and 2018. The average age was twenty-eight years. 72% were associated with anterior cruciate ligament (ACL) injury and reconstruction. We included both isolated meniscal repairs and those associated with ACL reconstruction, performed in both genders, using inside-out, outside-in, and all-inside techniques, as well as the combination of these techniques. Patients with incomplete medical records, suture revisions performed by another surgical team, and lack of follow-up were excluded. Evaluation was based on physical examination, pain assessment using the visual analog scale (VAS), and functionality using the IKDC, Lysholm and Tegner scores.Results: arthroscopic meniscal repair was associated with ACL reconstruction in 72% (169 cases) and meniscal repair as the only procedure in 28% (65 cases), which 171 were medial menisci and 63 lateral menisci. Regarding the technique used, the distribution was as follows: 151 outside-in, 31 all-inside, and 52 hybrids (mixed). The average number of sutures was 3.11, (range 2 ­ 10). The average follow-up was sixty months (range 48 ­ 72 months). The postoperative Lysholm score was 94 (range 87 ­ 96), postoperative IKDC was 88 (range 84 ­ 92), and the VAS score was 1/10. A total of 23 failures were recorded (9.8% of the total), 13 were associated with ACL reconstruction (56% of the failures), and the average age of this population was the same as the overall series (28 years old). Failures were assessed according to Barrett's criteria and confirmed intraoperatively with arthroscopic visualization.Conclusion: understanding joint biomechanics and the importance of meniscal structures in preventing degenerative knee injuries, we should attempt meniscal repair in all possible cases. In our series, we used reproducible techniques with a low complication rate, resulting in a failure rate of 9.8%. Therefore, we emphasize the importance of "save the meniscus". Level of Evidence: IV


Subject(s)
Adult , Menisci, Tibial/surgery , Minimally Invasive Surgical Procedures , Knee Joint , Follow-Up Studies
13.
Coluna/Columna ; 22(3): e250452, 2023. tab, graf, il. color
Article in English | LILACS | ID: biblio-1520788

ABSTRACT

ABSTRACT: Objective: To evaluate the epidemiological, clinical, and radiological data of patients treated with XLIF, including the impact on quality of life, pain parameters, and improvement of lumbar lordosis. Methods: Retrospective longitudinal study, in which medical records of patients who underwent XLIF between 2017 and 2020 at Hospital do Trabalhador/UFPR were reviewed. Demographic characteristics and radiological aspects, such as the Cobb angle, were recorded. Clinical characteristics using parameters such as pain by VAS and the disability index by ODI were evaluated before surgery and 12 months after. Results: Female patients predominated (66.7%), with a mean age of 59.1 years (35-82 years). The length of stay, in the median, was three days, and the time to return to daily activities was three months. Only four patients (8.9%) had complications. The questionnaire analysis showed a significant difference between all scales' pre and postoperative scores. The ODI showed an average reduction of 39.2%, and the median score of VAS in the postoperative period was half the preoperative period (reduction of 50%; p <0.001). The lordosis angle increased by 26.3% in the postoperative period (p <0.001). Conclusion: XLIF presents low complication rates, improves lumbar lordosis, and allows recovery from daily activities in a short period, in addition to performing a statistically significant improvement in quality of life and pain according to the VAS and ODI scales, being, therefore, a viable and effective treatment technique. Level of Evidence II; Retrospective Study.


RESUMO: Objetivo: Avaliar o perfil epidemiológico dos pacientes tratados com a XLIF, dados clínicos e radiológicos, incluindo o impacto na qualidade de vida, parâmetros de dor e melhora da lordose lombar. Métodos: Estudo longitudinal retrospectivo, em que foram revisados prontuários de pacientes submetidos à XLIF entre 2017 e 2020 no Hospital do Trabalhador/UFPR. Foram registrados os aspectos demográficos, características clínicas através de parâmetros como dor pela EVA e o índice de incapacidade pelo ODI, aspectos radiológicos incluindo o ângulo de Cobb antes da cirurgia e 12 meses após. Resultados: Predominou o sexo feminino (66,7%), com média de idade de 59,1 anos (35-82 anos). O tempo de internação, em mediana, foi de 3 dias e o tempo de retorno às atividades diárias foi de 3 meses. Apenas quatro pacientes (8,9%) apresentaram complicações. A análise através de questionários demonstrou diferença significativa entre as pontuações pré e pós-operatórias em todas as escalas. No ODI, houve redução média na pontuação de 39,2% e na EVA, a pontuação mediana no pós operatório foi a metade da pontuação no pré-operatório (redução de 50%; p<0,001). O ângulo da lordose teve aumento de 26,3% no pós-operatório em relação ao valor basal (p<0,001). Conclusão: A XLIF apresenta baixos índices de complicação, melhora da lordose lombar e permite a recuperação às atividades diárias em curto período de tempo, além de desempenhar melhora estatisticamente significativa na qualidade de vida e no quadro álgico segundo as escalas EVA e ODI, sendo, portanto, uma técnica viável e eficaz de tratamento. Nível de Evidência II; Estudo Retrospectivo.


RESUMEN: Objetivo: Evaluar los datos epidemiológicos, clínicos y radiológicos de los pacientes tratados con XLIF, incluyendo el impacto en la calidad de vida, los parámetros de dolor y la mejoría de la lordosis lumbar. Métodos: Estudio longitudinal retrospectivo, revisando las historias clínicas de los pacientes que se sometieron a XLIF entre 2017 y 2020 en el Hospital do Trabalhador/UFPR. Se registraron características demográficas y radiológicas, como el ángulo de Cobb. Se evaluaron las características clínicas mediante parámetros como el dolor por EVA y el índice de discapacidad por ODI antes de la cirugía y 12 meses después. Resultados: Predominó el sexo femenino (66,7%), con una edad media de 59,1 años (35-82 años). La duración de la estancia, en promedio, fue de 3 días y el tiempo para volver a las actividades diarias fue de 3 meses. Solo cuatro pacientes (8,9%) presentaron complicaciones. Los cuestionarios mostraron una diferencia significativa entre las puntuaciones pre y postoperatorias. El ODI mostró una reducción media del 39,2% y la puntuación media de la EVA en el postoperatorio fue la mitad de la puntuación en el preoperatorio (p <0,001). El ángulo de lordosis aumentó un 26,3% en el postoperatorio (p <0,001). Conclusiones: XLIF presenta bajas tasas de complicaciones, mejora la lordosis lumbar y permite la recuperación de las actividades diarias en un corto período de tiempo, con una mejora estadísticamente significativa en la calidad de vida y el dolor según EVA y ODI, siendo una técnica de tratamiento viable y eficaz. Nivel de evidencia IV; Estudio Retrospectivo.


Subject(s)
Humans , Adult , Middle Aged , Aged , Minimally Invasive Surgical Procedures , Orthopedics , Spine , Pain Measurement
14.
Rev. venez. cir ; 76(1): 4-9, 2023. ilus, tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1552928

ABSTRACT

La duodenopancreatectomía cefálica es la única opción con criterio curativo de los tumores periampulares y cabeza de páncreas. El abordaje mínimamente invasivo ha mostrado sus beneficios en la duodenopancreatectomía cefálica lo cual ha llevado a un mayor interés a nivel mundial por esta técnica. El objetivo es describir la técnica utilizada y analizar la evolución que presentaron los primeros casos realizados en Venezuela de duodenopancreatectomía laparoscópica y así dar a conocer nuestra experiencia, es un estudio retrospectivo, descriptivo, de corte transversal; se revisaron 106 historias clínicas, obteniendo 8 casos para este estudio: 5 femeninos y 3 masculinos, los promedios de edad y tiempo de evolución de la enfermedad fueron de 54,15 años y de 7 meses respectivamente, la indicación fue 4 tumores de cabeza de páncreas y 4 periampulares, el índice de masa corporal promedio fue de 23,44 kg/mt2, el tiempo quirúrgico osciló entre 315 ­ 475 min, la estancia hospitalaria de 4 ­ 24 días, las perdidas hemáticas fueron de 200cc ± 20cc, tres pacientes presentaron complicaciones post operatorias mediatas. En conclusión, los resultados que hemos observado en nuestro reporte inicial de casos de duodenopancreatectomía laparoscópica reúnen las características de otras publicaciones similares y se ratifica los beneficios de este abordaje, la clave para la duodenopancreatectomía laparoscópica de rutina es que sea realizada en centros especializados, con protocolos estandarizados, ejecutado por cirujanos hepatobiliar y pancreática con experiencia en laparoscopia avanzada(AU)


Duodenopancreatectomy is the only option with curative criteria of the periampullary tumors and pancreatic head. The minimally invasive approach has shown its benefits in cephalic duodenopancreatectomy which has led to greater interest worldwide in this technique. The objective is to describe the technique used and analyze the evolution presented by the first cases of laparoscopic duodenopancreatectomy and thus publicize our experience, it is a retrospective, descriptive, cross-sectional study; 106 medical records were reviewed, obtaining 8 cases for this study: 5 women and 3 men, the average age and the time of evolution of the disease were 54.15 years and 7 months, the indication was 4 pancreas head and 4 periampullary tumors, the average body mass index was 23, 44 kg/mt2, assisted surgery was performed in 4 patients and 4 totally laparoscopic, the surgical time ranged between 315 - 475 min, and the hospital stay was 4 - 24 days, the blood loss was 200cc ± 20cc, three patients presented mediated postoperative complications. In conclusion, the results we have observed in our initial case report of laparoscopic duodenopancreatectomy meet the characteristics of other similar publications and the benefits of this approach are ratified, the key to routine laparoscopic duodenopancreatectomy is that it is performed in specialized centers, with standardized protocols, executed by surgeons with experience in advanced laparoscopy in addition to hepatobiliary and pancreatic surgery(AU)


Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Pancreatic Neoplasms , Pancreaticoduodenectomy , Laparoscopy , Colonic Neoplasms , Minimally Invasive Surgical Procedures
15.
Rev. venez. cir ; 76(1): 34-39, 2023. ilus, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1552947

ABSTRACT

Introducción: En la búsqueda de nuevas y mejores alternativas quirúrgicas que permitan disminuir el trauma a la pared abdominal, ha surgido la cirugía por puerto único (PU), un procedimiento que consiste en la realización de la cirugía laparoscópica a través de una incisión única, generalmente en la cicatriz umbilical. Los resultados han sido alentadores y nuevas investigaciones al respecto son necesarias. Objetivo: Comparar la técnica quirúrgica de la apendicectomía laparoscópica por puerto único (PU) versus técnica estándar de 03 puertos (AL3P) en el tratamiento de pacientes con apendicitis aguda. Metodología: Estudio prospectivo, aleatorizado, incluyó 158 pacientes distribuidos en 2 grupos (71 PU, 89 AL3P), desde junio de 2013 a junio de 2016, comparándose variables demográficas, tiempo quirúrgico, complicaciones trans y postoperatorias, conversión, dolor postoperatorio, beneficios estéticos y satisfacción. Resultados: La edad, sexo, IMC, evolución, medicación previa, recuento leucocitario y fase de la enfermedad fue similar en ambos grupos. El tiempo operatorio promedio en PU fue de 48 min, menor que en AL3P (p˂0,001), y se evidenció disminución del mismo posterior a la curva de aprendizaje de 30 casos. No hubo conversión en PU a cirugía abierta. La tasa de complicaciones intra Y postoperatorias fue similar en ambos grupos (p=0,486 y p=0,887). La estancia hospitalaria fue menor en los pacientes de PU (p˂0,001) con mejor resultado estético (p=0,036) y mayor grado de satisfacción (p=0,047). Conclusión: La apendicectomía por PU demostró ser una técnica factible, segura y reproducible en nuestro medio(AU)


Introduction: In the search for new and better surgical alternatives to reduce the trauma to the abdominal wall, it has emerged single port surgery (SP), a procedure that involves performing laparoscopic surgery through a single incision, usually in the umbilicus. The results have been encouraging and further investigations are needed in this regard. Objective: To compare laparoscopic single port appendectomy (SP) versus standard 03 ports laparoscopic technique (AL3P) in the treatment of patients with acute appendicitis. Materials and Methods: Prospective, randomized study, included 158 patients divided into 2 groups (71 SP, 89 AL3P), from June 2013 to June 2016, comparing demographic variables, surgical time, trans and postoperative complications, conversion, postoperative pain, aesthetic benefits and satisfaction. Results: Age, sex, BMI, evolution, premedication, white blood cell count and stage of the disease was similar in both groups. Mean operative time was 48 min on the SP, lower than in AL3P (p˂0,001), and decreased following the learning curve of 30 cases. There was no conversion of SP to open surgery. The rate of intraoperative and postoperative complications was similar in both groups (p = 0.486 and p = 0.887). The hospital stay was lower in patients SP (p˂0,001), with better cosmetic outcome (p = 0.036) and greater satisfaction (p=0.047). Conclusion: SP appendectomy proved to be a feasible, safe and reproducible technique in our environment(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Appendectomy , Laparoscopy , Minimally Invasive Surgical Procedures , Appendicitis , General Surgery , Surgical Procedures, Operative , Abdominal Wall
16.
Chinese Journal of Medical Instrumentation ; (6): 591-597, 2023.
Article in Chinese | WPRIM | ID: wpr-1010245

ABSTRACT

Robotic puncture system has been widely used in modern minimally invasive surgery, which usually uses hand-eye calibration to calculate the spatial relationship between the robot and the optical tracking system. However, the hand-eye calibration process is time-consuming and sensitive to environmental changes, which makes it difficult to guarantee the puncture accuracy of the robot. This study proposes an uncalibrated positioning method for puncture robot based on optical navigation. The method divides the target path positioning into two stages, angle positioning and position positioning, and designs angle image features and position image features respectively. The corresponding image Jacobian matrix is constructed based on the image features and updated by online estimation with a cubature Kalman filter to drive the robot to perform target path localization. The target path positioning results show that the method is more accurate than the traditional hand-eye calibration method and saves significant preoperative preparation time by eliminating the need for calibration.


Subject(s)
Robotics , Robotic Surgical Procedures , Calibration , Minimally Invasive Surgical Procedures , Optical Devices
17.
Acta Academiae Medicinae Sinicae ; (6): 853-858, 2023.
Article in Chinese | WPRIM | ID: wpr-1008140

ABSTRACT

With the continuous advances in modern medical technology and equipment,minimally invasive surgery (MIS) is widely applied in clinical practice.Ultrasound (US) as a real-time,portable,and radiation-free medical imaging method can be used for the intraoperative guidance in MIS to ensure safe and effective surgery.However,the physical characteristics of conventional US fail to display some tissue structures of the human body due to the existence of gas and bone.US-based navigation can make up for the deficiencies by advanced imaging technologies including spatial orientation,image reconstruction,and multi-modality image fusion,being real-time,accurate,and radiation-free.Therefore,US-guided robots can achieve safe,effective,and minimally invasive operation in MIS.This paper reviews the studies of US-guided robots in MIS and prospects the development of this field.


Subject(s)
Humans , Robotics/methods , Minimally Invasive Surgical Procedures/methods , Ultrasonography , Spinal Fusion/methods , Ultrasonography, Interventional/methods
18.
Artrosc. (B. Aires) ; 30(2): 71-76, 2023.
Article in Spanish | LILACS, BINACIS | ID: biblio-1451223

ABSTRACT

Introducción: Existe poca evidencia respecto de la concordancia entre el plan preoperatorio mediante artroplastia total de rodilla asistida por robot y el plan posterior al balance protésico realizado por el cirujano. El objetivo de este trabajo es evaluar el grado de concordancia entre la planificación preoperatoria de la artroplastia total de rodilla con asistencia robótica semiactiva (Mako) y la planificación efectuada por el traumatólogo durante la cirugía. Materiales y métodos: estudio retrospectivo y descriptivo de prótesis primarias instaladas entre octubre de 2018 y junio de 2019 con planificación preoperatoria realizada por el software MAKOplasty®. Se excluyeron las prótesis no colocadas por el sistema robótico o con información clínica incompleta. Esto se comparó con la planificación intraoperatoria del traumatólogo. Variables analizadas: alineación coronal y sagital, rotación y tamaño de los componentes e inserto. Los datos se analizaron con el softwareSTATA v.16.0. Se realizó un análisis descriptivo univariante cualitativo, con un intervalo de confianza del 95%. Resultados: se incluyeron cincuenta y una rodillas operadas de cuarenta y nueve pacientes, el 69% fueron mujeres. El nivel de concordancia para el componente femoral fue: axial 86.3% (IC = 73.7 - 94.2), coronal 88.2% (IC = 76.1 - 95.5), sagital 88.2% (IC = 76.1 - 95.5). Componente tibial: axial 98% (IC = 89.5 ­ 99.9), coronal 96.1% (IC = 86.5 ­ 99.5), sagital 96.1% (IC = 86.5 ­ 99.5). Tamaño del componente: fémur 94.1% (IC = 83.7 ­ 98.7), tibia 84.3% (IC = 71.4 ­ 92.9), inserto 27.4% (IC = 15.8 ­ 41.7). Conclusión: la planificación preoperatoria mediante el uso de la asistencia robótica semiactiva de Mako presenta un buen nivel de concordancia con la planificada intraoperatoriamente, a excepción del tamaño del inserto. El traumatólogo es determinante en la modificación del plan preoperatorio. Nivel de Evidencia: III


Introduction: There is little evidence regarding the concordance between the preoperative plan using robotic-assisted total knee arthroplasty and that after the prosthetic balance by the surgeon. Our aim is to evaluate the level of agreement between the preoperative planning of total knee arthroplasty with semiactive robotic assistance (Mako) and the planning made by the orthopedic surgeon during the surgery. Materials and methods: descriptive study of prostheses installed between October 2018 and June 2019 with preoperative planning performed by the MAKOplasty® software. This was compared with intraoperative planning by the Orthopedic Surgeon. Variables analyzed: coronal and sagittal alignment, rotation and size of the components and insert. The data was analyzed with the STATA v.16.0 software. A qualitative univariate descriptive analysis was performed, with a 95% confidence interval. Results: fifty-one operated knees from forty-nine patients were included, 69% were women. The level of agreement was: Femoral component: axial 86.3% [CI = 73.7 - 94.2], coronal 88.2% [CI = 76.1 - 95.5], sagittal 88.2% [CI = 76.1 - 95.5]. Tibial component: axial 98% [CI = 89.5 - 99.9], coronal 96.1% [CI = 86.5 - 99.5], sagittal 96.1% [CI = 86.5 - 99.5]. Component size: femur 94.1% [CI = 83.7 - 98.7], tibia 84.3% [CI = 71.4 - 92.9], insert 27.4% [CI = 15.8 - 41.7]. Conclusion: preoperative planning through the use of Mako semiactive robotic assistance presents a good level of agreement with that planned intraoperatively, with the exception of the insert size. The orthopedic surgeon is decisive in modifying the preoperative plan. Level of Evidence: III


Subject(s)
Minimally Invasive Surgical Procedures , Arthroplasty, Replacement, Knee , Surgery, Computer-Assisted , Preoperative Period , Intraoperative Period , Knee Joint/surgery
19.
Artrosc. (B. Aires) ; 30(2): 77-82, 2023.
Article in Spanish | LILACS, BINACIS | ID: biblio-1451224

ABSTRACT

Introducción: El tratamiento artroscópico del síndrome de fricción femoroacetabular (SFFA) en displasia de cadera es controversial. Inicialmente, algunos estudios demostraron una tasa elevada de fallas, mientras que otros más recientes describieron una mejoría clínica comparable con pacientes sin falta de cobertura acetabular. El propósito de este estudio fue comparar los resultados clínicos y funcionales de la artroscopía de cadera en dos cohortes: pacientes con displasia borderline y pacientes con ángulo centro-borde normal. Materiales y métodos: evaluamos los resultados clínicos y funcionales utilizando el Harris Hip Score (HHS), Hip Outcome Score (HOS) y l Escala Visual Análoga del Dolor (EVA) del tratamiento artroscópico del SFFA para dos grupos de pacientes: el grupo 1 conformado por aquellos que presentaban displasia borderline (DB) y el grupo 2, compuesto por pacientes con un valor del ángulo centro-borde normal (ACBN). Resultados: los valores postoperatorios de las escalas de HHS y EVA no mostraron diferencias estadísticamente significativas entre los grupos (87.0 ± 5.3 versus 85.8 ± 3.6; p = 0.200 y 1.5 ± 0.6 versus 1.3 ± 0.5; p = 0.07, respectivamente).No se observaron diferencias significativas con respecto a las actividades de la vida diaria del score de HOS (91.8 ± 6.6 versus 93.2 ± 5.9; p = 0.28), ni de deportes, (85.1 ± 7.7 ± 8.3 versus 88.3 ± 11.9; p = 0.19). Conclusión: los pacientes sometidos a una artroscopía de cadera con displasia borderline, alcanzan resultados clínicos y funcionales similares que aquellos con ACBN con una media de seguimiento de tres años. Nivel de Evidencia: III


Introduction: Arthroscopic treatment of femoral-acetabular impingement syndrome in patients with hip dysplasia is controversial. There are some reports that observed an increased failure rate in this type of patients. More recent studies described good patients clinical and functional outcomes, comparable with patients with a normal acetabular coverage. The purpose of this study was to assess functional and clinical outcomes of arthroscopic treatment of FAI in two cohorts: patients with Borderline Dysplasia and patients with a normal lateral center-edge angle. Materials and methods: we assessed patients reported outcomes of two groups of patients: group 1 that consisted in patients with Borderline Dysplasia and group 2, with patients with a normal lateral center-edge angle. The minimum follow-up required was three years. Results: there were no statistically significant differences regarding Harris Hip Score and Visual Analogue Scale of Pain respectively (87.0 ± 5.3 versus 85.8 ± 3.6; p = 0.200 y 1.5 ± 0.6 versus 1.3 ± 0.5; p = 0.07) after surgery between both groups. We didn't observe differences regarding Daily Living Activities (91.8 ± 6,6 versus 93.2 ± 5.9; p = 0.28) or Sports of Hip Outcome Score (85.1 ± 7.7 ± 8.3 versus 88.3 ± 11.9; p = 0.19).Conclusion: arthroscopic treatment of FAI syndrome in patients with borderline dysplasia, achieves good clinical and functional outcomes, comparable with patients with a normal lateral center-edge angle. Level of Evidence: III


Subject(s)
Adult , Arthroscopy/methods , Bone Diseases, Developmental , Retrospective Studies , Minimally Invasive Surgical Procedures , Femoracetabular Impingement
20.
Artrosc. (B. Aires) ; 30(2): 88-95, 2023.
Article in Spanish | LILACS, BINACIS | ID: biblio-1451226

ABSTRACT

La inestabilidad patelofemoral es uno de los problemas más frecuentes en pacientes jóvenes, y representa del 2 al 3% de todas las lesiones de rodilla. Significa una causa importante de morbilidad debido a la limitación de varias actividades de la vida diaria, y a largo plazo el surgimiento de artrosis. La inestabilidad patelofemoral es descripta como la deficiencia de la constricción pasiva que genera un desplazamiento lateral de la patela total o parcial de su posición normal con respecto a la tróclea. Los desórdenes patelofemorales son el resultado de una anatomía aberrante, están dados por una alteración en la alineación ósea y generan un desequilibrio biomecánico. Existen cuatro factores clásicos que generan inestabilidad patelar: patela alta, displasia troclear, alteración en la distancia (TT-TG) y excesiva inclinación patelar. Al generarse una luxación, el ligamento patelofemoral medial (LPFM) se ve afectado en al menos el 25% de los casos. El complemento diagnóstico se realiza a través de rayos X, tomografía computarizada y resonancia magnética. La restauración de la función por tratamiento quirúrgico ha mostrado resultados similares al conservador en primoluxaciones, sin embargo, se ha visto que la reconstrucción del ligamento patelofemoral medial presenta mejores resultados clínicos para el paciente. Hasta el momento, hemos intervenido diecinueve pacientes con la técnica descripta, para los cuales no hay reportada una reluxación de rótula y tienen una escala de Lysholm de 87 puntos que se encuentra dentro del parámetro "bueno".


Patellofemoral instability is one of the most frequent problems in young patients, and represents 2 to 3% of all knee injuries. It denotes an important cause of morbidity due to the limitation of various activities of daily living and in the long term the appearance of osteoarthritis. Patellofemoral instability is defined as the deficiency of passive constriction that generates a total or partial lateral displacement of the patella from its normal position with respect to the trochlea. Patellofemoral disorders are the result of an aberrant anatomy, they are given by an alteration in bone alignment and generates a biomechanical imbalance. There are four classic factors that generate patellar instability: high patella, trochlear dysplasia, alteration in distance (TT-TG) and excessive patellar inclination. When generating the dislocation, the medial patellofemoral ligament is affected in at least 25% of cases. The diagnostic complement is carried out through X-rays, computed tomography and nuclear magnetic resonance.Restoration of function surgical treatment has shown similar results to conservative treatment in primoluxations, however it has been seen that reconstruction of the medial patellofemoral ligament presents better clinical results for the patient.To date, nineteen patients we have been operated on with the technique described of whom there is no reported reluxation of the patella and who have a Lysholm scale of 85 points that is within a good parameter.


Subject(s)
Minimally Invasive Surgical Procedures , Patellofemoral Joint/surgery , Joint Instability , Knee Joint/surgery
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