Osteocondroma solitario de la escápula: localización poco habitual para un tumor frecuente / A solitary osteochondroma of the scapula: Uncommon location for a common tumor

El osteocondroma es un tumor óseo benigno que afecta, en general, a niños y adultos jóvenes. Se localiza habitualmente en las metáfisis de los huesos largos alrededor de la rodilla, aunque también puede afectar a huesos planos como la escápula.Se presenta el caso clínico de un niño de 11 años con tumoración dolorosa en la superficie dorsal de la escápula de un año de evolución. Se diagnostica un osteocondroma escapular, localización poco frecuente para este tumor. Debido a la persistencia de la sintomatología, se realizó exéresis quirúrgica

Osteochondroma is a benign bone tumor that usually affects children and young adults. It is typically located in the metaphysis of long bones around the knee, although it could also affect flat bones like scapula. We report the case of a 11-year-old child with one year of evolution painful tumor at the dorsal surface of the scapula. He was diagnosed with osteochondroma of the scapula, uncommon location for this tumor. Due to the persistence of the symptomatology surgical excision was performed.

Trombosis venosa profunda secundaria a aneurisma de la arteria poplítea: caso clínico-radiológico y revisión de la literatura / Deep vein thrombosis secondary to popliteal artery aneurysm: literature review and presentation of case

Popliteal artery aneurysms is the most frequent peripheral aneurysm, predominantly affects men over 60 years of age and has a high morbidity associated to his complications, among which are ischemic complication, which can often end in amputation of the limb. Less frequent complications such as neuropathic and venous complications, particularly deep vein thrombosis, are equally relevant. Case presentation: Patient with an aneurysm of the popliteal artery complicated by thrombosis of the adjacent popliteal vein. Color Doppler ultrasound plays a fundamental role in the diagnosis.

¿Qué debe saber el neurocirujano sobre condrosarcoma espinal primario? Condrosarcoma espinal primario / What should the neurosurgeon know about primary spinal chondrosarcoma? Primary spinal chondrosarcoma

El condrosarcoma ocupa el tercer puesto dentro de las neoplasias óseas primarias, siendo la columna vertebral una localización inusual. Según su etiología se clasifican en condrosarcoma primario o secundario a lesiones subyacentes de tipo cartilaginosa como el encondroma u osteocondroma; siendo entre el 80-90% de bajo grado. Pueden presentarse en cualquier nivel de la columna vertebral, siendo más frecuente en la región torácica y cervical, comprometiendo los elementos posteriores de la vértebra, los cuerpos vertebrales o ambos, en un 40%, 15% y 45% respectivamente. El síntoma más común es el dolor localizado asociado a manifestaciones neurológicas. El método diagnóstico de elección es la biopsia por punción y el tratamiento se basa fundamentalmente en la resección quirúrgica

Chondrosarcoma occupies the third position within the primary bony neoplasia's, with an unusual location at the level of the spine. According to their etiology, they are classified as primary chondrosarcoma or secondary to underlying cartilaginous lesions such as the enchondroma or osteochondroma, being between 80-90% of low grade. They can occur at any level of the spine, being more frequent in the thoracic and cervical region, compromising the posterior elements of the vertebra, the vertebral body or both, by 40%, 15% and 45% respectively. The most common symptom is localized pain associated with neurological manifestations. The diagnostic method of choice is biopsy and treatment is based primarily on surgical resection.

Osteochondroma of mandibular ramus and condylar neck: simultaneous resection and reconstruccion with personalized alloplastic joint prosthesis / Osteocondroma de la rama mandibular y cuello del cóndilo: resección y reconstrucción simultánea con prótesis articular personalizada aloplástica

Osteochondromas are benign osteogenic tumors that can attain great size, which may require resection and additional treatment to restore the jaw's shape and function. In this report, an osteochondroma located on the mandibular ramus and neck of the condyle was resected and reconstructed simultaneously through a total joint replacement. After the surgery, the patient remains asymptomatic and recovers opening and closing ranges, phonation and the masticatory function. The immediate reconstruction after resection is a good alternative to avoid a second operation and the presurgical virtual planning ensures the complete removal of the lesion using cutting guides and covering the entire defect with a customized alloplastic joint prosthesis.

Los osteocondromas son tumores osteogénicos benignos que pueden alcanzar grandes tamaños, los cuales requieren de resección quirúrgica y generalmente de algún tratamiento adicional para restaurar la forma y la función mandibular. En este caso, un osteocondroma localizado en la rama mandibular y el cuello del cóndilo fue reseccionado y reconstruido simultáneamente a través de un reemplazo articular total. Después de la cirugía, el paciente permanece asintomático y recupera los intervalos de apertura y cierre, la fonación y la función masticatoria. La reconstrucción inmediata después de la resección es una buena alternativa para evitar una segunda operación, y la planificación virtual prequirúrgica garantiza la eliminación completa de la lesión utilizando guías de corte y cubriendo todo el defecto con una prótesis articular aloplástica personalizada.

Osteocondroma de patela. Reporte de caso / Patellar osteochondroma. Case report

Los osteocondromas son tumores benignos frecuentes en la niñez, usualmente localizados en la metáfisis de los huesos y se van alejando de la fisis a medida que se da el crecimiento. Los osteocondromas de patela son poco comunes, refiriéndonos a su ubicación. El objetivo es informar un raro caso de un paciente escolar quien presento este tumor en su rótula derecha.

Osteochondromas are frequent benign tumors in childhood, usually located in bone metaphysis from where they recede from the physis as growth occurs. Osteochondromas of the patella are rare as this location is unfrequent. The objective is to report a rare case of a school patient who presented this tumor in his right patella.

Osteocondroma escapular / Scapular osteochondroma

El osteocondroma es una lesión compuesta de hueso medular y cortical recubierta de una capa de cartílago hialino. La localización en la escápula es infrecuente. Se presentan 2 casos clínicos. Puede manifestarse con dolor o con síntomas por compresión de estructuras vecinas. La resección quirúrgica es el tratamiento de elección para el osteocondroma sintomático.

Osteochondromas are tumors composed of medullary and cortical bone with hyaline cartilage caps. Involvement of the scapula is uncommon. We report two cases. Patients may present with pain or symptoms due to compression of the adjacent structures. Surgery is the treatment of choice of symp­tomatic osteochondromas.

Snapping Knee due to a Femoral Osteochondroma after Total Knee Arthroplasty

A female patient who underwent total knee arthroplasty presented with a snapping sensation over the left knee at 10 years postoperatively. Initially, the bony mass was visible on the medial femoral condyle radiographically at 5 years postoperatively. The mass had enlarged over time and her symptoms were progressive. The mass was excised at postoperative 18 years and confirmed as an osteochondroma histopathologically. The patient’s symptoms have been completely resolved for 3-year follow-up after excision. LEVEL OF EVIDENCE: V

Accuracy analysis of computer assisted navigation for condylectomy via intraoral approach / 北京大学学报(医学版)

OBJECTIVE@#To explore the application accuracy of virtual preoperative plan after the condylectomy via intraoral approach under computer assisted surgical navigation, and to analyze the location and cause of the surgical deviation to provide reference for the surgical procedure improvement in the future.@*METHODS@#In the study, 23 cases with condylar hypertrophy (11 with condylar osteochondroma and 12 with condylar benign hypertrophy) in Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Atomatology from December 2012 to December 2016 were treated by condylectomy via intraoral approach under computer assisted surgical navigation. The patient's spiral CT data were imported into ProPlan software before operation, and the affected mandibular ramus was reconstructed three-dimensionally. The condylar osteotomy line was designed according to the lesion range, and the preoperative design model was generated and introduced into the BrainLab navigation system. Under the guidance of computer navigation, the intraoral approach was used to complete the condylar resection according to the preoperative design of the osteotomy line. Cranial spiral CT of the craniofacial region was taken within one week after operation. three-dimensional reconstruction of the mandibular ramus at the condylectomy side was performed, and the condylar section was divided into six segments (anterolateral, anterior, anteromedial, posteromedial, posterior, and posterolateral) and the corresponding regional measurement points P1 to P6 were defined. Then the preoperative virtual model and the postoperative actual model were matched by Geomagic studio 12.0 to compare the differences and to analyze the accuracy of the operation.@*RESULTS@#All the patients had successfully accomplished the operation and obtained satisfactory results. Postoperative CT showed that the condyle lesion was completely resected, and the condylar osteotomy line was basically consistent with the surgical design. No tumor recurrence or temporomandibular joint ankylosis during the follow-up period. The postoperative accuracy analysis of the condylar resection showed that the confidence intervals measured by the six groups of P1 to P6 were (-2.26 mm, -1.89 mm), (-2.30 mm, -1.45 mm), (-3.37 mm, -2.91 mm), (-2.83 mm, -1.75 mm), (-1.13 mm, 0.99 mm), and(-1.17 mm, 0.17 mm), where P3 group was different from the other 5 groups. There was no significant difference between the P5 and P6 groups and the difference between the other four groups was statistically significant.@*CONCLUSION@#Under the guidance of computer navigation, the intraoral approach can be performed more accurately. The surgical deviation of each part of the osteotomy surface is mainly due to excessive resection. The anterior medial area of the anterior medial condyle represents the most excessive resection. The posterior and posterior lateral measurement points represent the posterior condylar area. The average deviation is not large, but the fluctuation of the deviation value is larger than that of the other four groups. The accuracy of computer-assisted subtotal resection has yet to be improved.

Pinzamiento femoroacetabular secundario a osteocondroma ilíaco solitario / Femoroacetabular impingement secondary to solitary iliac osteochondroma

El pinzamiento femoroacetabular provoca dolor agudo en la ingle anterior y limita la movilidad de la cadera. Es un síndrome clínico propiciado por una alteración en la anatomía ósea. Los osteocondromas son los principales tipos de tumores benignos, alteran la anatomía ósea y, según su localización, pueden generar dolor y pinzamiento. Este reporte de caso tuvo como objetivo el describir el tratamiento dado y la evolución clínica de un paciente con pinzamiento secundario a un osteocondroma ilíaco solitario. Se presenta un paciente masculino de 20 años con agudización de un dolor punzante y disminución en los arcos de movilidad en la articulación de la cadera derecha, sin mejoría con tratamiento sintomático. Mediante estudios de imagen se identificó una masa tumoral en la región afectada. Se realizó resección quirúrgica total mediante un abordaje lateral directo extendido de Hardinge. Dada la naturaleza benigna del tumor y su total resección, el paciente evolucionó satisfactoriamente y se pudo incorporar a sus actividades cotidianas. Se concluye que los osteocondromas no son exclusivos de las metáfisis o epífisis de huesos largos. Deben sospecharse las presentaciones atípicas cuando el cuadro clínico es sugestivo, aun después de la adolescencia(AU)

Femoroacetabular impingement generates acute pain in the anterior groin and limitation of hip mobility. It is a clinical syndrome caused by an alteration in bone anatomy. Osteochondromas are the main types of benign tumors, they alter the bone anatomy and depending on their location, they can generate pain and impingement. This case report aims to serve as a reference for specialized care in communicating the diagnostic challenges and approach in a patient with secondary clamping to osteochondroma of atypical presentation. The present case report aims to describe the given treatment and clinical evolution of a patients presenting femoroacetabular impingement secondary to a solitary osteochondroma. We report a 20-year-old male patient with exacerbation of a shooting pain and decrease in the mobility arches in his right hip joint, with no improvement with symptomatic treatment. Through imaging studies, a tumor mass was identified in the affected region. Total surgical resection was performed through an extended direct lateral approach of Hardinge. Given the benign nature of the tumor and its total resection, the patient evolved satisfactorily. The prognosis is favorable. He was able to return to his daily activities. We concluded that osteochondromas are not exclusive to the metaphysis or epiphyses of long bones. Atypical presentations should be suspected when clinical manifestations suggest so, even after adolescence(AU)

Le pincement fémoro-acétabulaire provoque une douleur aigue au niveau du bassin antérieur et empêche la mobilité de la hanche. Il s'agit d'un syndrome clinique poussé par une altération de l'anatomie osseuse. Les ostéochondromes sont des tumeurs bénignes, altérant l'anatomie osseuse et, selon leur localisation, pouvant même déclencher la douleur et le pincement. Ce rapport de cas a le but de décrire le traitement proposé et l'évolution clinique d'un patient atteint de pincement secondaire à un ostéochondrome iliaque solitaire. Un patient âgé de 20 ans souffrant la recrudescence d'une douleur aigue et la diminution des arcs de mobilité de l'articulation de la hanche droite, sans soulagement, même sous traitement symptomatique, est présenté. Une masse tumorale a été identifiée par imagerie dans la région affectée. On a effectué une résection chirurgicale totale par la voie d'abord latérale directe et étendue de Hardinge. Étant données la nature bénigne de la tumeur et sa totale résection, le patient a eu une évolution satisfaisante, et a pu s'incorporer aux activités de la vie quotidienne. On peut conclure que les ostéochondromes ne sont pas exclusifs de la métaphyse ou de l'épiphyse des os longs. On doit suspecter des présentations atypiques lorsque le tableau clinique est suggestif, même après l'adolescence(AU)

Manejo expectante de osteocondroma solitario interóseo de la tibia distal: reporte de un caso y revisión de la literatura / Non-surgical management of an interosseous solitary osteochondroma of the distal tibia: a case report and review of the literature

La localización del osteocondroma en la tibia distal es poco frecuente y su crecimiento con compromiso y deformidad del peroné distal es aún más raro, haciéndolo una condición más sintomática que en otras ubicaciones. Factores como la severidad de los síntomas, deformidad progresiva del tobillo, complicaciones sindesmóticas, riesgo de fractura patológica o transformación maligna, junto con nuevas y mejores técnicas quirúrgicas, han llevado a que el manejo expectante de esas lesiones sea excepcional y escasamente reportado. Presentamos el caso de un joven de 17 años con osteocondroma solitario interóseo tibio distal sintomático y compromiso fibular, que fue exitosamente manejado en forma expectante. A los 5 años de seguimiento clínico-radiológico no presenta complicaciones y la lesión se mantiene estable.

Osteochondromas located in the distal tibia are a rare condition, and the involvement of the distal fibula with deformity is even more uncommon. Factors such as the severity of symptoms, progressive deformity of the ankle, syndesmotic complications, the risk of pathological fracture or malignant transformation, together with new and safer surgical techniques, have led to scarce reports of non-surgical management. We present a case report of a 17-year-old male with a symptomatic interosseous solitary osteochondroma in the distal tibia with fibular involvement, which was successfully managed non surgically. After 5 years of clinical and radiological follow-up, he has no complications, and the lesion remains stable.

Osteocondroma como hallazgo Incidental en Úlcera Varicosa Sobreinfectada en miembro inferior / Osteochondroma as an incidental finding in Superinfected Varicose Ulcer in the lower limb

El osteocondroma es la lesión tumoral más frecuente del hueso. Éste presenta características radiológicas patognomónicas con continuidad cortical y medular, con lesión exofítica iniciada en metáfisis, protruyendo hasta la diáfisis de huesos largos, con predominio en la porción distal del fémur, fíbula y tibia proximal. Para el diagnóstico de esta patología, por lo general sólo se necesita una imagen radiológica simple en dos planos, en casos ocasionales necesitando tomografía computarizada para verificarlo. En la mayoría de los casos el diagnóstico ocurre de forma incidental, en pacientes asintomáticos, en contados casos, se observa impotencia funcional, bursitis, parestesias o fracturas en hueso patológico. El riesgo de transformación es menor al 1 %, siendo el tumor maligno más frecuente el condrosarcoma. Se describe el reporte de un hallazgo imagenológico incidental de un tumor óseo en un paciente de 65 años con úlcera varicosa sobreinfectada en conjunto con la discusión sobre la importancia de la imagenología para estos diagnósticos.

Osteochondroma is the most frequent tumor lesion in bone. This presents pathognomonic radiological features with cortical and medullary continuity, with exophytic lesion initiated in metaphysis, protruding to the diaphysis of long bones, predominating in the distal portion of the femur, fibula and proximal tibia. For the diagnosis of this pathology, usually only a simple radiological image is needed in two planes, in occasional cases needing computed tomography to verify it. In most cases the diagnosis occurs incidentally, in asymptomatic patients, in few cases, functional impotence, bursitis, paresthesias or fractures in pathological bone are observed. The risk of transformation is less than 1 %, with the malignant tumor being more frequent chondrosarcoma. Following the report of an incidental imaging finding of a bone tumor on 65 years old patient with varicose ulcer infected in conjunction with the discussion of the importance of these diagnostic imaging to be described.

Osteochondroma of the Distal Clavicle: A Rare Cause of Impingement and Biceps Tear of the Shoulder

Hereditary multiple exostosis (HME) is an autosomal dominant disorder manifested by the presence of multiple osteochondromas. Although the lesions are benign in nature, exostoses are often associated with characteristic progressive skeletal deformity and displaying clinical symptoms such as mechanical irritation or impingement. We present the successful arthroscopic resection in a 24-year-old HME male with impingement syndrome and long head tendon tear of the biceps caused by osteochondroma arising from the distal clavicle.

Solitary osteochondroma in the body of the pubic bone: a cadaveric case report / 대한해부학회지

Osteochondromas develop as cartilaginous nodules in the periosteum of bones. They are the commonest benign tumors of the skeleton, generally observed in the long bones. Rarely, they are also found in the axial skeleton, flat bones of skull and facial bones. During a regular dissection, we came across a solitary osteochondroma in posterior surface of the body of the right pubic bone. Histopathology of the bony projection confirmed the typical features of the osteochondroma. The symptomatic osteochondromas are usually evaluated during radiographic examination. Though, the observed osteochondroma is relatively smaller its unusual location is remarkable and knowledge of occurrence of such nodules is clinically important during the diagnosis and planning of treatment.

Osteocondromas: presentación del osteocondroma subungueal / Osteochondromas: introducing the subungual osteochondroma

Resumen: Introducción: Los osteocondromas subungueales son tumoraciones benignas de la región sub- o periungueal que ocasionan elevación, ulceración y deformidad a dicho nivel. Objetivos: Investigar la incidencia de osteocondroma subungueal en un segmento de población pediátrica. Material y métodos: Estudio retrospectivo, transversal, descriptivo y observacional, basado en la revisión de expedientes con resultado histopatológico de osteocondroma de 2001 a 2014. Resultados: Cuatro de los osteocondromas correspondieron a la presentación subungueal, con una distribución por sexos de 1:1 y un promedio de edad de 9.5 años, relación 3:1, derecho:izquierdo; el cuarto dedo fue el más afectado. Discusión: El osteocondroma sunbungueal presenta una incidencia de 8.5% de todos los osteocondromas.

Abstract: Introduction: Subungual osteochondromas are benign tumors of the sub- or periungual region, causing lifting, ulceration and deformity at that level. Objective: To research the incidence of subungual osteochondromas in a specific pediatric population. Material and methods: Retrospective, transversal, descriptive and observational study based on the review of records with a histopathological result of osteochondroma from 2001 to 2014. Results: The pathological assessment featured four osteochondromas that corresponded to the subungual presentation, with an equal gender distribution of 1:1, an average age of 9.5 years, right: left ratio of 3:1; the 4th finger was the most affected. Discussion: Subungual osteochondroma has an incidence of 8.5% of all osteochondromas.

Biopsia endoscópica de osteocondroma de fosa infratemporal / Endoscopic biopsy of infratemporal fossa osteochondroma

Presentamos el caso de una mujer de 13 años con un gran tumor de características óseas en la fosa infratemporal derecha, el cual fue biopsiado mediante un abordaje endoscópico transeptal transpterigoídeo. La biospia mostró un osteocondroma. Describimos el caso y discutimos sus aspectos relevantes.

We report the case of a 13-year-old woman with a large tumor with osseous appearance in her right infratemporal fossa, which was biopsied through an endoscopic transpterygoid approach. The biopsy showed an osteocondroma. We described the case and discuss its relevant aspects.

Osteocondroma, relato de un caso / Osteochondroma, a case report

El osteocondroma representa la lesión tumoral más frecuente del hueso. La característica radiológica patognomónica de este tumor es la continuidad cortical y medular de las lesiones con el hueso del que surgen. Las lesiones pueden ser solitarias o múltiples, formando esta última parte del síndrome de exostosis hereditaria múltiple. Estas lesiones también se pueden presentar con complicaciones como deformidades óseas, fracturas, compromiso neurológico o vascular, formación de bursa y más raramente transformación maligna. El diagnóstico requiere de un trípode clave: clínica, estudio histopatológico/biopsia y estudios de imagen que son necesarios para el tratamiento y planificación de exéresis quirúrgica y anestésica como es el caso que se relata a continuación.

Osteochondroma represents the most frequent tumoral lesion of the bone. The pathognomonic radiological characteristic of this tumor is the cortical and medullary continuity of the lesions with the bone from which they arise. The lesions can be solitary or multiple, forming this last part of the syndrome of multiple hereditary exostosis. These lesions can also present with complications such as bone deformities, fractures, neurological or vascular compromise, bursa formation and, more rarely, malignant transformation. The diagnosis requires a key tripod: clinical, histopathological study / biopsy and imaging studies that are necessary for the treatment and planning of surgical and anesthetic excesses, as is the case reported below.

Incontinencia urinaria de esfuerzo por osteocondroma familiar múltiple tardío / Urinary incontinence due to late multiple family osteochondroma

La osteocondroma múltiple familiar hereditaria es una enfermedad benigna, que por su posibilidad de malignización y el avance de sus deformaciones requiere controles periódicos. El objetivo del trabajo fue presentar un caso con diagnóstico de un tumor después de un largo periodo de tiempo de extirpación de su última lesión. Se presenta una paciente, de 62 años de edad, con antecedentes de osteocondroma múltiple familiar hereditaria desde los 8 años de edad. Es operada en varias ocasiones durante la infancia. Acude ahora por presentar incontinencia urinaria y aumento de volumen región vaginal, que aumentó en los últimos 8 meses. Antecedentes de la enfermedad en el padre, el hijo y la nieta. Se observan cicatrices en miembros y deformidades. Al tacto vaginal y rectal se encontró un tumor pétreo que ocupa la pared anterior y lateral derecha de la vagina. En estudios radiográficos y tomografía axial computarizada de abdomen se observa tumor en rama isquiopubiana derecha. La paciente fue operada y realizó la resección del tumor. La evolución fue satisfactoria. Anatomía Patológica informó tumor de 6 x 5 cm con actividad elevada de los condrotocitos. En la paciente destaca la aparición de un tumor de la misma enfermedad en la rama isquiopubiana, localización de baja frecuencia, el cual apareció 50 años después del último extirpado. La laparotomía extraperitoneal fue excelente para lograr la exéresis del tumor(AU)

Hereditary family multiple osteochondroma is a benign disease that requires systematic control on account of its possible malignization and advance of deformations. The objective of this paper was to present a patient diagnosed with a tumor after a long period of time elapsed from the excision of her last lesion. Here is a female patient aged 62 years, with history of hereditary family multiple osteochondroma since she was 8 years-old. She had been operated on several times in her childhood. She went to the hospital because she suffered urinary incontinence and volume increase in the vaginal region for the last 8 months. Her father, son and niece had the same problem. Scars and deformities were observed in limbs. On the vaginal and rectal exam, a stony tumor was found, which occupied the right anterior and lateral wall of the vagina. The radiographic studies and the abdominal CT showed a tumor in the right ischiopubic ramus. The patient was operated on to remove the tumor and her progress was satisfactory. The pathological anatomy report confirmed a 6 x 5 cm tumor with high activity of chondrocytes. In this patient, a tumor of the same disease located in the ischiopubic ramus occurred 50 years after the last excision of another tumor. The extroperitoneal laparatomy was an excellent method to achieve tumor excision(AU)

Snapping scapula. Arthroscopic resection of osteochondroma of the subscapularis superomedial angle. Case report and literature review / Ressalto de escápula. Ressecção artroscópica de osteocondroma subescapular da região superomedial. Relato de caso e revisão da literatura

ABSTRACT Snapping scapula syndrome has several etiologies, including subscapular osteochondroma. When this tumor needs to be removed, this can be done arthroscopically, a procedure that has restricted indications. The authors present a case of a patient with superomedial subscapular osteochondroma who underwent a scapulothoracic arthroscopy for its removal.

RESUMO A escápula em ressalto é uma síndrome com diversas etiologias, entre elas o osteocondroma subescapular. Quando esse tumor necessita ser retirado, é possível fazê-lo por via artroscópica, um procedimento que apresenta indicações restritas. Os autores apresentam neste artigo o caso de uma paciente com osteocondroma da região superomedial da face ventral da escápula, submetida a procedimento cirúrgico por artroscopia escápulotorácica para sua retirada.

Regenerative potential of the cartilaginous tissue in mesenchymal stem cells: update, limitations, and challenges / Potencial regenerativo do tecido cartilaginoso por células-tronco mesenquimais: atualização, limitações e desafios

ABSTRACT Advances in the studies with adult mesenchymal stem cells (MSCs) have turned tissue regenerative therapy into a promising tool in many areas of medicine. In orthopedics, one of the main challenges has been the regeneration of cartilage tissue, mainly in diarthroses. In the induction of the MSCs, in addition to cytodifferentiation, the microenvironmental context of the tissue to be regenerated and an appropriate spatial arrangement are extremely important factors. Furthermore, it is known that MSC differentiation is fundamentally determined by mechanisms such as cell proliferation (mitosis), biochemical-molecular interactions, movement, cell adhesion, and apoptosis. Although the use of MSCs for cartilage regeneration remains at a research level, there are important questions to be resolved in order to make this therapy efficient and safe. It is known, for instance, that the expansion of chondrocytes in cultivation, needed to increase the number of cells, could end up producing fibrocartilage instead of hyaline cartilage. However, the latest results are promising. In 2014, the first stage I/II clinical trial to evaluate the efficacy and safety of the intra-articular injection of MSCs in femorotibial cartilage regeneration was published, indicating a decrease in injured areas. One issue to be explored is how many modifications in the articulate inflammatory environment could induce differentiation of MSCs already allocated in that region. Such issue arose from studies that suggested that the suppression of the inflammation may increase the efficiency of tissue regeneration. Considering the complexity of the events related to the chondrogenesis and cartilage repair, it can be concluded that the road ahead is still long, and that further studies are needed.

RESUMO Os avanços nos estudos com células-tronco mesenquimais (CTMs) adultas tornou a terapia regenerativa tecidual uma ferramenta promissora em diversas áreas da medicina. Na ortopedia, um dos principais desafios tem sido a regeneração do tecido cartilaginoso, sobretudo em diartroses. Na indução de CTMs, além da citodiferenciação, o contexto microambiental do tecido a ser regenerado, bem como uma disposição espacial adequada, são fatores de extrema importância. Além disso, sabe-se que a diferenciação das CTMs é basicamente determinada por mecanismos como proliferação celular (mitose), interações bioquímico-moleculares, movimento, adesão celular e apoptose. Apesar de o uso de CTMs para a regeneração da cartilagem estar ainda em âmbito de pesquisa, existem questões importantes a serem resolvidas para tornar essa terapêutica eficaz e segura. Sabe-se, por exemplo, que a expansão de condrócitos em cultura, necessária para aumentar o número de células, pode produzir fibrocartilagem, e não cartilagem hialina. No entanto, os últimos resultados são promissores. Em 2014, foi publicado o primeiro ensaio clínico fase I/II para avaliar a eficácia e a segurança da injeção intra-articular de CTMs na regeneração de cartilagem femorotibial e houve uma diminuição das áreas lesadas. Uma questão a ser explorada é o quanto modificações no próprio ambiente inflamatório articular poderiam induzir a diferenciação de CTMs já alocadas naquela região. Tal incógnita parte do princípio de estudos que sugerem que a supressão da inflamação articular aumentaria, potencialmente, a eficiência da regeneração tecidual. Considerando a complexidade dos eventos relacionados à condrogênese e ao reparo da cartilagem, conclui-se que o caminho ainda é longo, são necessárias pesquisas complementares.

The Optimal Surgical Approach and Complications in Resecting Osteochondroma around the Lesser Trochanter / 대한정형외과학회잡지

PURPOSE: Surgical risks associated with the resection of osteochondroma around the proximal tibia and fibula, as well as the proximal humerus have been well established; however, the clinical presentation and optimal surgical approach for osteochondroma around the lesser trochanter have not been fully addressed. MATERIALS AND METHODS: Thirteen patients with osteochondroma around the lesser trochanter underwent resection. We described the chief complaint, duration of symptom, location of the tumor, mass protrusion pattern on axial computed tomography image, tumor volume, surgical approach, iliopsoas tendon integrity after resection, and complication according to the each surgical approach. RESULTS: Pain on walking or exercise was the chief complaint in 7 patients, and numbness and radiating pain in 6 patients. The average duration of symptom was 19 months (2–72 months). The surgical approach for 5 tumors that protruded postero-laterally was postero-lateral (n=3), anterior (n=1), and medial (n=1). All 4 patients with antero-medially protruding tumor underwent the anterior approach. Two patients with both antero-medially and postero-laterally protruding tumor received the medial and anterior approach, respectively. Two patients who underwent medial approach for postero-laterally protruded tumor showed extensive cortical defect after resection. One patient who received the anterior approach to resect a large postero-laterally protruded tumor developed complete sciatic nerve palsy, which was recovered 6 months after re-exploration. CONCLUSION: For large osteochondromas with posterior protrusion, we should not underestimate the probability of sciatic nerve compression. When regarding the optimal surgical approach, the medial one is best suitable for small tumors, while the anterior approach is good for antero-medial or femur neck tumor. For postero-laterally protruded large tumors, posterior approach may minimize the risk of sciatic nerve palsy.