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

ABSTRACT

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


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


Subject(s)
Humans , Female , Aged , Tibia , Dentigerous Cyst/surgery , Bone Transplantation , Reconstructive Surgical Procedures , Osteotomy , Surgical Flaps , Tooth Extraction , Dentigerous Cyst/diagnostic imaging , Mandible
2.
Rev. bras. ortop ; 56(6): 813-818, Nov.-Dec. 2021. graf
Article in English | LILACS | ID: biblio-1357147

ABSTRACT

Abstract Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. The relative energy deficiency in sport syndrome, along with an eating disorder, training overload, and osteopenia, was identified as a risk factor. Although rare, multiple stress fractures can occur in female triathletes. These patients must be screened for risk factors associated with biomechanics, nutrition, and training to develop an effective prevention and treatment program.


Resumo Fraturas por estresse recorrentes num mesmo atleta são raras. Apresentamos o caso de uma triatleta que sofreu múltiplas fraturas por estresse na tíbia bilateral, na fíbula direita e no colo femoral esquerdo. O tratamento conservador foi instituído em todos os episódios, com repouso, redução da carga de treino e reabilitação fisioterápica. Foi identificada como fator de risco a síndrome da deficiência energética relativa no esporte, com distúrbio alimentar, sobrecarga de treino e osteopenia. Mesmo que seja raro, múltiplas fraturas por estresse podem ocorrer em mulheres triatletas, nas quais é importante avaliar os fatores de risco associados à biomecânica, nutrição e ao treinamento para arquitetar um programa de prevenção e tratamento efetivos.


Subject(s)
Humans , Female , Adult , Tibia/injuries , Fractures, Stress , Risk Factors , Physical Therapy Modalities , Lower Extremity , Female Athlete Triad Syndrome , Athletes
3.
Rev. bras. ortop ; 56(3): 313-319, May-June 2021. tab
Article in English | LILACS | ID: biblio-1288667

ABSTRACT

Abstract Objective The present paper evaluates the resuming of physical activities by young, active patients who practiced some sport modality and underwent a high tibial osteotomy (HTO) using the opening wedge technique. Methods A total of 12 patients submitted to HTO using the opening wedge technique were prospectively analyzed. All patients were not playing sports at that time. Pre- and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores, visual analog scale for pain and performance level were compared. The average follow-up time was of 12 months. Results One patient resumed sporting activities at a performance level significantly lower compared to the preoperative level, while eight patients returned at a slightly below level, two returned at the same level and one patient returned at a higher level in comparison with the preoperative period. Conclusion For isolated medial osteoarthrosis treatment, HTO using the opening wedge technique has favorable clinical and functional results, allowing patients to resume their sporting activities.


Resumo Objetivo Avaliar o retorno ao esporte em pacientes jovens e ativos praticantes de alguma modalidade esportiva submetidos a osteotomia tibial alta (OTA) com o método de cunha de abertura. Métodos Foram analisados prospectivamente 12 pacientes submetidos ao procedimento de OTA utilizando-se método de cunha de abertura. Todos os pacientes estavam afastados do esporte. Foram utilizados os escores Lysholm, questionário International Knee Documentation Committee (IKDC, na sigla em inglês), escala analógica de dor e nível de retorno em comparação ao período pré-operatório. O tempo médio de seguimento foi de 12 meses. Resultados Um paciente retornou ao esporte em nível muito abaixo do pré-operatório, oito pacientes retornaram em nível pouco abaixo, dois pacientes retornaram no mesmo nível e um paciente retornou em nível acima. Conclusão A OTA com uso do método de cunha de adição como forma de tratamento para osteoartrose medial isolada demonstra resultados clínicos e funcionais favoráveis e permite o retorno ao esporte.


Subject(s)
Humans , Male , Female , Adult , Osteoarthritis , Osteotomy , Sports , Tibia , Exercise , Surveys and Questionnaires , Return to Sport
4.
Arq. bras. med. vet. zootec. (Online) ; 73(2): 411-416, Mar.-Apr. 2021. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1248919

ABSTRACT

Tibial plateau leveling osteotomy (TPLO) associated to cranial wedge closing ostectomy (CCWO) has been one of the best options to manage cranial cruciate ligament (CCL) disease and excessive tibial plateau angle (TPA) in large dogs, however, the complication rate is potentially high. It is believed that a more robust fixation is necessary to stabilize them and decrease the risk of implant failure. A 6-year-old male American Pit Bull, weighing 36kg, with 90-day history of right hind limb lameness, was diagnosed with CCL disease. Due to the excessive tibial plateau angle (42°), TPLO was associated with a modified CCWO using a double plating technique. A final TPA of 12° was accomplished, and a restricted level of exercises and physiotherapy were recommended. The patient was followed monthly until the fifth month postoperatively, when radiographic bone consolidation and no lameness were observed. By the date of this submission, 3 years after the procedure, the owner has reported no complications. The double plating technique for fixing TPLO and modified CCWO proved to be effective for the treatment of CrCL deficiency in a large dog with an excessive TPA.(AU)


A osteotomia de nivelamento do platô tibial (TPLO) associada à ostectomia modificada em cunha de fechamento cranial da tíbia (CCWO) tem sido uma das melhores opções para tratamento de cães grandes com doença do ligamento cruzado cranial (DLCCr) e ângulo excessivo do platô tibial, mas o índice de complicações é alto. Acredita-se haver necessidade de fixação mais robusta para reduzir as chances de falha nos implantes. Um cão macho, seis anos, da raça American Pit Bull, 36kg, com histórico de claudicação em membro pélvico direito há 90 dias, foi diagnosticado com DLCCr. Devido ao ângulo excessivo do platô tibial (42°), a osteotomia de nivelamento do platô tibial foi associada à ostectomia modificada em cunha de fechamento cranial da tíbia (CCWO) por meio da técnica de placa dupla. No pós-operatório imediato, identificou-se TPA de 12°; exercícios controlados e fisioterapia foram recomendados e a evolução do quadro foi analisada mensalmente até o quinto mês pós-cirurgia. Com 150 dias de evolução, não houve alterações de locomoção e havia ocorrido completa consolidação radiográfica das osteotomias. Até o momento da submissão deste artigo, três anos pós-procedimento, o tutor relata ausência de complicações, via contato telefônico. Portanto, a técnica modificada mostrou-se eficaz no tratamento da DLCCr.(AU)


Subject(s)
Animals , Dogs , Tibia/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Injuries/veterinary , Osteotomy/veterinary , Fracture Fixation, Internal/veterinary
5.
Rev. bras. ortop ; 56(1): 47-52, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288647

ABSTRACT

Abstract Objective The objective of the present study was to evaluate the relationship between patients with anterior cruciate ligament (ACL) injury by indirect trauma and increased posterior tibial inclination. Methods Retrospective study, performed by analysis of medical records and digital radiographs of patients, present in a database of a tertiary orthopedic hospital. The sample consisted of two groups, the first group consisting of patients diagnosed with ACL injury by indirect trauma, and a control group matched by age. Results Each group consisted of 275 patients, whose measurements of posterior tibial inclination were measured by three specialists. It was observed that the group of patients with ACL lesion presented a significantly higher tibial slope (in degrees) than the control group in the total sample and in the subsamples stratified by gender. The best cutoff point for the first group was identified as a posterior tibial inclination ≥ 8º, achieving a sensitivity of 63.3% and a specificity of 62.5%. The first group also had a tibial slope ratio ≥ 8º (63.3%), significantly higher than the control group (37.5%), with an odds ratio of 2.8. Conclusion It was concluded that the increase of the posterior tibial inclination is associated with an increased risk for injury of the ACL by indirect trauma, mainly for values ≥ 8º.


Resumo Objetivo O objetivo do presente estudo foi avaliar a relação entre pacientes com lesão do ligamento cruzado anterior (LCA) por trauma indireto e o aumento da inclinação posterior da tíbia. Métodos Estudo retrospectivo, realizado por análise de prontuários e radiografias digitais de pacientes, presentes em banco de dados de um hospital terciário de ortopedia e traumatologia. A amostra foi composta por dois grupos, sendo o primeiro formado por pacientes com diagnóstico de lesão do LCA, por trauma indireto, e um grupo controle pareado por idade. Resultados Cada grupo foi formado por 275 pacientes, cujas medidas de inclinação tibial posterior foram aferidas por 3 especialistas. Observou-se que o grupo dos pacientes com lesão do LCA apresentou slope tibial (em graus) significativamente maior que o grupo controle na amostra total e nas subamostras estratificadas por gênero. Identificou-se como o melhor ponto de corte (cutoff) para o primeiro grupo uma inclinação tibial posterior ≥ 8º, atingindo uma sensibilidade de 63,3% e uma especificidade de 62,5%. O primeiro grupo também apresentou proporção de slope tibial ≥ 8º (63,3%), significativamente maior que o grupo controle (37,5%), com razão de chances de 2,8. Conclusão Concluiu-se que o aumento da inclinação tibial posterior está associado com um maior risco para lesão do LCA por trauma indireto, principalmente para valores ≥ 8º,


Subject(s)
Humans , Tibia , Anterior Cruciate Ligament , Knee Injuries , Ligaments
6.
J. appl. oral sci ; 29: e20200647, 2021. graf
Article in English | LILACS | ID: biblio-1286912

ABSTRACT

Abstract Objective To evaluate the effect of different protocols of low-level intensity laser therapy (LLLT) irradiation on the osseointegration of implants placed in grafted areas. Methodology 84 rats were randomly allocated into six groups: DBB: defect filled with deproteinized bovine bone; HA/TCP: defect filled with biphasic ceramic of hydroxyapatite/β-tricalcium phosphate ; DBB-LI: defect filled with DBB and treated with LLLT after implant placement; HA/TCP-LI: defect filled with HA/TCP and treated with LLLT after implant placement; DBB-LIB: defect filled with DBB and treated with LLLT after graft procedure and implant placement; and HA/TCP-LIB: defect filled HA/TCP and treated with LLLT after graft procedure and implant placement. The bone defects were made in the tibia and they were grafted. After 60 days, the implants were placed. The rats were subsequently subjected to euthanasia 15 and 45 days after implant placement. The pattern of osseointegration and bone repair in the grafted area was evaluated by biomechanical, microtomographic, and histometric analyses. Furthermore, the expression of bone biomarker proteins was assessed. Results The LLLT groups presented higher removal torque, mineralized tissue volume, and a greater degree of osseointegration, especially when LLLT was performed only after implant placement, and these findings were associated with higher expression of BMP2 and alkaline phosphatase. Conclusion LLLT performed on implants placed in grafted areas enhances the osseointegration process.


Subject(s)
Animals , Cattle , Rats , Dental Implants , Osseointegration , Low-Level Light Therapy , Tibia/surgery , Ceramics
7.
Artrosc. (B. Aires) ; 28(2): 171-174, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1282684

ABSTRACT

La inestabilidad de la articulación tibioperonea proximal puede presentarse con una luxación, con escasos síntomas laterales de la rodilla, dolor, malestar e incomodidad durante distintas actividades o síntomas relacionados con la irritación del nervio peroneo común. Un preciso diagnóstico prequirúrgico es imperativo, así como el tratamiento conservador con inmovilización y kinesiología por cuatro a seis semanas. En la población adolescente, el planeamiento prequirúrgico puede ser dificultoso por la presencia de los cartílagos abiertos, por lo tanto, se debe tomar precaución en la realización de los túneles y en la colocación de implantes en relación con la fisis abierta. El objetivo del siguiente trabajo es presentar el caso de un niño de once años con inestabilidad tibioperonea proximal recurrente, además mostrar detalles de la técnica quirúrgica, protocolo postoperatorio y sus excelentes resultados


Instability of the proximal tibiofibular joint (PTFJ) can present as dislocations, vague symptoms of lateral knee pain, discomfort during activity, or symptoms related to irritation of the common peroneal nerve. An accurate preoperative diagnosis is imperative and should include a trial of taping of the PTFJ for a 4- to 6-week time frame before surgical reconstruction is indicated. In the adolescent population, surgical planning can be complicated by the presence of open physes; therefore, caution must be taken to avoid drilling through or placing screw fixation across the physes. Potential complications include growth arrest and limb length discrepancy. Therefore, the purpose of this case report is to describe the surgical technique for addressing PTFJ instability in adolescent patients. The aim of this case report is to present a case of instability of the proximal tibiofibular joint (PTFJ) treated surgically in an eleven-year-old male soccer player, focused on technical tips, strict rehab protocol with excellent results


Subject(s)
Child , Tibia/surgery , Fibula/surgery , Growth Plate/surgery , Joint Instability , Knee Joint/surgery
8.
Braz. oral res. (Online) ; 35: e001, 2021. tab, graf
Article in English | LILACS, BBO | ID: biblio-1132750

ABSTRACT

Abstract: Three-point bending test is the most common mechanical test used for quantifying the biomechanical quality of bone tissue and bone healing in small animals. However, there is a lack of standardization for evaluation of bone repair by cortical perforation. The aim of this study was to determine the influence of bone defect position in the proximal metaphysis of rat tibias during load application and different span configuration on the three-point bending test outcomes. Cortical defects with 1.6 mm diameter were created at a standardized location on the medial surface of 60 tibias of male Wistar rats. The animals were euthanized 7 days after surgery. Five specimens were used to create 3D models for finite element analysis using high-resolution micro-CT images. Two spans (6 and 10mm) and three positions of the bone defect in relation to the load application (upward, frontal and downward) were evaluated experimentally (n = 10) and in finite element analysis (n = 5). Maximum load (N) and stiffness (N/mm) were statistically analyzed with 2-way ANOVA and Tukey test (α = 0.05). The results demonstrated that span and orientation of the bone defect significantly influenced the fracture pattern, stress distribution and force versus displacement relation. Therefore, reliable outcome can be achieved creating the bone defect at 8 mm from the extremity of the proximal epiphysis; placing a 10 mm distance span and downward facing defect position to allow a better distribution of stress and more fracture patterns that reached the bone defect target area with less intra-group variability.


Subject(s)
Animals , Male , Rats , Tibia , Mechanical Phenomena , Bone and Bones , Rats, Wistar , Finite Element Analysis
9.
Autops. Case Rep ; 11: e2021276, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249019

ABSTRACT

Adamantinoma of the long bones is an exceedingly rare and slow-growing tumor that affects the diaphysis of long bones, particularly the tibia. Based on the pattern of the epithelial cell component and the presence or absence of the osteofibrous dysplasia-like element, several histological variants have been described, such as (i) tubular (the most frequent), (ii) basaloid, (iii) squamous, (iv) spindle variant, (v) osteofibrous dysplasia -like variant, and (vi) Ewing's sarcoma - like adamantinoma (the least frequent). The diagnosis may be challenging since this tumor may be mistakenly interpreted as carcinoma, myoepithelial tumor, osteofibrous dysplasia, and vascular tumor. We report the case of a 41-year-old male who presented with swelling over the right leg associated with pain. The X-ray showed a lytic lesion of the right-sided tibia. The diagnosis of adamantinoma was made based on the clinico-radiological, histomorphology, and immunohistochemical findings. Histologically, classic adamantinoma is a biphasic tumor characterized by epithelial and osteofibrous components in varying proportions and differentiating patterns. The diagnosis can be confirmed by immunohistochemistry for demonstrating sparse epithelial cell nests when the radiological features are strongly consistent with adamantinoma. This case is highlighted because the epithelial component can lead to a misdiagnosis, particularly when the clinico-radiological features are overlooked. Adamantinoma of long bones has the potential for local recurrence and may metastasize to the lungs, lymph nodes, or other bones. The prognosis is good if early intervention is taken.


Subject(s)
Humans , Male , Adult , Tibia/pathology , Adamantinoma/pathology , Diaphyses
10.
Article in Chinese | WPRIM | ID: wpr-921936

ABSTRACT

OBJECTIVE@#To compare the femoral and tibial tunnel positions of anterior cruciate ligament reconstruction using the modified transtibial (MTT) technique and anteromedial (AM) portal technique.@*METHODS@#Between January 2017 and September 2020, 78 patients with anterior cruciate ligament rupture underwent single-bundle reconstruction with the modified transtibial technique in 39 cases (group MTT) and through anteromedial approach in 39 cases (group AM). There were 25 males and 14 females in group MTT, with an average age of (37.0±2.3) years old; 27 males and 12 females in group AM, with an average age of (37.5±2.2) years old. CT scan of the affected knee was conducted one week after the surgery to measure and compare the femoral tunnels positioning (Fx, Fy), tibial tunnels positioning in the frontal plane(Tx1), tibial tunnels positioning in the sagittal plane (Ty1), and tibial tunnels positioning in the axial plane (Tx2, Ty2) in patients undergoing anterior cruciate ligament reconstruction through Mimics software.@*RESULTS@#Three-dimensional CT reconstruction after the surgery showed that the average Fx and Fy were(25.2±2.1)% and (34.9±3.0)% respectively and the Tx1 and Ty1 were (45.5±3.3)% and (44.7± 3.0)% respectively, while the Tx2 and Ty2 were (47.0±3.0)% and (39.9±4.2)% respectively in group MTT. In group AM, the average Fx and Fy were (26.0±2.0)% and (36.1±3.9)% respectively and the Tx1 and Ty1 were (46.5±3.1)% and (45.6± 3.1)% respectively, while the Tx2 and Ty2 were (47.4±2.5)% and (39.6±3.9)% respectively. There were no statistically significant differences in the femoral and tibial tunnels between the two groups (@*CONCLUSION@#Both the MTT and AM technique can achieve good anatomical positioning of the femoral and tibial tunnels, without significant differences in the positioning of the bone tunnels.


Subject(s)
Adult , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Female , Femur/surgery , Humans , Knee Joint/surgery , Male , Software , Tibia/surgery , Tomography, X-Ray Computed
11.
Article in Chinese | WPRIM | ID: wpr-921927

ABSTRACT

OBJECTIVE@#To evaluate the effect of one-stage treatment of bone morphogenetic protein 2 combined with Jifusheng in the experimental model of osteomyelitis in rabbits.@*METHODS@#The model of chronic osteomyelitis of tibia was established in 30 3-month-old male New Zealand white rabbits with a body weight of (2.0±0.5) kg, and the model was verified 4 weeks after operation. Thirty rabbits with osteomyelitis were randomly divided into 3 groups with 10 rabbits in each group (@*RESULTS@#At 4 weeks after operation, 30 rabbits with osteomyelitis were successfully validated. The results of serological examination showed that the hypersensitive C-reactive protein (CRP) and white blood cell count(WBC)in the model group were significantly higher than those in the blank group at 2 and 4 weeks after operation. Eight weeks after treatment, the detection of blood indexes showed that the white blood cell count (WBC)and hypersensitive C reactive protein (CRP)in treatment group A and treatment group B were significantly lower than those in the model group (@*CONCLUSION@#The combined application of apolipoprotein 2-Jifusheng can promote bone repair and reduce the inflammation of the focus. it can treat rabbits with osteomyelitis in one stage, provide objective basis for the formulation of clinical treatment strategy of osteomyelitis and further promote clinical research.


Subject(s)
Animals , Apolipoproteins , Bone Density , Bone and Bones , Male , Osteomyelitis/drug therapy , Rabbits , Tibia
12.
Article in Chinese | WPRIM | ID: wpr-921900

ABSTRACT

OBJECTIVE@#To explore effect and significance of lateral closed high tibial osteotomy on recovery of activity of knee joint.@*METHODS@#From February to December 2018, 78 patients with knee osteoarthritis who were treated by high tibial osteotomy for the first time were selected as the observation group, including 46 males and 32 females, aged from 55 to 73 years old with an average age of (61.78±6.39) years old, the course of disease ranged from 6 to 24 months with an average of (16.52±4.25) months;according to Kellgren-Lawrence (K-L) grading, 36 patients were gradeⅡand 42 patients were grade Ⅲ. Another 20 healthy people were selected as healthy group, including 13 males and 7 females, aged from 56 to 73 years old with an average of (60.89±7.12) years old. The expression of miR-146 in peripheral blood was compared between observation group and healthy group. At the same time, patients in observation group were followed up for 6 months. The patients whose knee joint function returned to normal or improved significantly during the follow-up period were admitted as the effective group, while the patients whose knee joint function did not improve significantly or tended to aggravate were admitted as the ineffective group. The clinical data and the relative expression of serum miR-146 between effective group and ineffective group were analyzed.@*RESULTS@#The relative expression of serum miR-146 in observation group after operation was significantly higher than that in healthy group (@*CONCLUSION@#The expression level of serum miR-146 showed upward trend, which could regulate the differentiation of chondrocyte. The monitoring of miR-146 after operation has reference value for predicting the recovery of bone and joint function after operation.


Subject(s)
Aged , Female , Humans , Knee Joint , Male , MicroRNAs/genetics , Middle Aged , Osteoarthritis, Knee/surgery , Osteotomy , Tibia/surgery , Treatment Outcome
13.
Chinese Medical Journal ; (24): 2316-2321, 2021.
Article in English | WPRIM | ID: wpr-921157

ABSTRACT

BACKGROUND@#Multiple techniques are commonly used for posterior cruciate ligament (PCL) reconstruction. However, the optimum method regarding the fixation of PCL reconstruction after PCL tears remains debatable. The purpose of this study was to compare the biomechanical properties among three different tibial fixation procedures for transtibial single-bundle PCL reconstruction.@*METHODS@#Thirty-six porcine tibias and porcine extensor tendons were randomized into three fixation study groups: the interference screw fixation (IS) group, the transtibial tubercle fixation (TTF) group, and TTF + IS group (n = 12 in each group). The structural properties of the three fixation groups were tested under cyclic loading and load-to-failure. The slippage after the cyclic loading test and the stiffness and ultimate failure load after load-to-failure testing were recorded.@*RESULTS@#After 1000 cycles of cyclic testing, no significant difference was observed in graft slippage among the three groups. For load-to-failure testing, the TTF + IS group showed a higher ultimate failure load than the TTF group and the IS group (876.34 ± 58.78 N vs. 660.92 ± 77.74 N [P < 0.001] vs. 556.49 ± 65.33 N [P < 0.001]). The stiffness in the TTF group was significantly lower than that in the IS group and the TTF + IS group (92.77 ± 20.16 N/mm in the TTF group vs. 120.27 ± 15.66 N/m in the IS group [P = 0.001] and 131.79 ± 17.95 N/mm in the TTF + IS group [P < 0.001]). No significant difference in the mean stiffness was found between the IS group and the TTF + IS group (P = 0.127).@*CONCLUSIONS@#In this biomechanical study, supplementary fixation with transtibial tubercle sutures increased the ultimate failure load during load-to-failure testing for PCL reconstruction.


Subject(s)
Animals , Biomechanical Phenomena , Posterior Cruciate Ligament Reconstruction , Sutures , Swine , Tendons/surgery , Tibia/surgery
14.
Article in Chinese | WPRIM | ID: wpr-879463

ABSTRACT

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


Subject(s)
Adult , Aged , Aged, 80 and over , Bone Transplantation , Diabetes Mellitus , Diabetic Foot/surgery , Female , Humans , Male , Microcirculation , Middle Aged , Tibia , Treatment Outcome
15.
Article in Chinese | WPRIM | ID: wpr-879461

ABSTRACT

OBJECTIVE@#To explore clinical effects of intramedullary nailing through suprapatellar approach with semiextended position in treating tibial fractures.@*METHODS@#From January 2018 to June 2019, 23 patients with tibia fractures were treated with suprapatellar approach intramedullary nailing on knee semiextended position, including 18 males and 5 females, aged from 26 to 67 years old with an average age of (38.5±9.6) years old. Eight patients were tibial proximal fractures, 7 patients were tibial shaft fractures, 6 patients were tibial distal fractures and 2 patients were tibial segmental fractures. Operation time, intraoperative blood loss, complications and fracture healing time were recorded. Range of motivation of knee joint between 3 days and 3 months after operation were compared, Hospital for Special Surgery (HSS) score and visual analogue scale (VAS) were used to evaluate clinical effects.@*RESULTS@#All patients were followed up from 8 to 19 months with an average of (12.3±7.6) months. Operation time was (55.3±5.1) min, intraoperative blood loss was (84.0±8.7) ml. No obvious complications occurred. All patients were achieved bony union at stageⅠ, fracture healing time ranged from 3 to 8 months with an average of (4.6±1.5) months. Flexion extension range of knee motion at 3 days after operation was (110.4±15.3)°, and increased to (123.7±16.5)° at 3 months after operation (@*CONCLUSION@#Intramedullary nailing through suprapatellar approach with semiextended position in treating tibia fractureshas advantages of simple operation, less trauma for soft tissue, less pain, rapid recovery of function and less complication. It is especially suitable for patients with tibial multi-segment fracture and multiple fractures of ipsilateral lower limb for safety and simple.


Subject(s)
Adult , Aged , Bone Nails , Diaphyses , Female , Fracture Fixation, Intramedullary , Humans , Male , Middle Aged , Tibia , Tibial Fractures/surgery , Treatment Outcome
16.
Article in Chinese | WPRIM | ID: wpr-879455

ABSTRACT

OBJECTIVE@#This study aimed to research whether anterior tibial crest is a reliable anatomical reference for rotational alignment of tibial component in TKA.@*METHODS@#The study included 122 patients who underwent computed tomography angiography (CTA) examination for unilateral lower extremity trauma with normal contralateral lower extremities, including 89 males and 33 females, with an average age of(51.4±16.4) years old(ranged 18 to 81 years old). Picture archiving and communication system (PACS) was used to mark 11 lines including the surgical epicondylar axis (SEA) connecting the most prominent points of the lateral epicondyle and the deepest point of the sulcus on the medial epicondyle of the femur, axis of medial border of patellar tendon (MEPT)connecting the middle of the posterior cruciate ligament (PCL) and medial border of the patellar tendon at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, transverse axis of tibia (TAT) at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, Akagi line connecting the projected middle of the PCL and medial border of the patellar tendon at the tibial attachment, the axis of the medial 1/3 of patellar tendon(M1/3) connecting the projected middle of PCL and the medial 1/3 of the patellar tendon at the patellar tendon attachment level, Insall line connecting the projected middle of the PCL and the medial 1/3 of tibial tubercle, the axis of medial border of tibial tubercle (MBTT) connecting the projected middle of the PCL and medial border of tibial tubercle, as well as the axis of the proximal anterior tibial crest (PATC), axis 1 of the middle anterior tibial crest (MATC1), axis 2 of the middle anterior tibial crest (MATC2) and the axis of the distal anterior tibial crest (DATC) which were marked by connecting the 4 equidistant points on the sharp anterior tibial crest and the projected middle of the PCL. The angles between TAT and SEA as well as the angles between other axes and the perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined using One-Way ANOVA and paired @*RESULTS@#The angles between the axes of MEPT, Akagi line, M1/3, Insall line, MBTT, PATC, MATC1, MATC2, DATC and the perpendicular to SEA were (-1.6 ±4.5)° , (1.4 ±5.0)° , (10.2±5.1)°, (11.9±5.4)°, (3.6±4.8)°, (12.0±6.9)°, (7.2±8.6)°, (7.1±10.4)°, (6.6±13.5)°, respectively. The angle between TAT and SEA was (4.1±5.3)°. MEPT was external rotation compared to SEA. M1/3, Insall line and PATC were significantly greater than Akagi line, MBTT, TAT (@*CONCLUSION@#The middle tibial anterior crest can be used as a reference for rotational alignment of tibial component in TKA, and its reliability is better than Insall line, but worse than Akagi line, TAT and MBTT.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee , Female , Humans , Knee Joint/surgery , Male , Middle Aged , Posterior Cruciate Ligament/surgery , Reproducibility of Results , Rotation , Tibia/surgery , Young Adult
17.
Article in Chinese | WPRIM | ID: wpr-879452

ABSTRACT

OBJECTIVE@#To compare clinical effect of intramedullary nailing through suprapatellar, infrapatellar and paracpatellar approach in treating tibial shaft fracture.@*METHODS@#From June 2012 to June 2018, 36 patients with tibial shaft fracture were treated with intramedullary nails, and were divided into three groups according to surgical approach. Twleve patients were through suprapatellar approach, including 7 males and 5 females aged from 25 to 53 years old with an average of (37.8±11.4) years old;and 4 patients were type A, 4 patients were type B, and 4 patients were type C according to AO classification. Ten patients were through infrapatellar approach, including 6 males and 4 females aged from 19 to 56 years old with an average of (35.6±10.0) years old;and 3 patients were type A, 4 patients were type B, and 3 patients were type C according to AO classification. Forteen patients were through paracpatellar approach, including 8 males and 6 females aged from 21 to 58 years old with an average of (36.6±10.0) years old;and 4 patients were type A, 6 patients were type B, and 4 patients were type C according to AO classification. Operation time, intraoperative blood loss, fluoroscopy times, fracture healing time and complications among three groups were observed, and knee joint functions were evaluated by Lysholm score.@*RESULTS@#All patients were followed up from 12 to 18 months with an average of (15.0±3.0) months. There were no difference in intraoperative blood loss and fracture healing time among three groups (@*CONCLUSION@#intramedullary nailing through suprapatellar for the treatment of tibial shaft fracture is benefit for fracture healing and recovery of knee joint function, while infrapatellar and paracpatellar approach have advantages in exposure of insertion point. We should select approach reasonably according to our experience.


Subject(s)
Adult , Bone Nails , Diaphyses , Female , Fracture Fixation, Intramedullary , Humans , Male , Middle Aged , Tibia , Tibial Fractures/surgery , Treatment Outcome , Young Adult
18.
Article in Chinese | WPRIM | ID: wpr-879406

ABSTRACT

OBJECTIVE@#To investigate the clinical effect of high tibial osteotomy combined with arthroscopic lateral retinacular release in the treatment of knee varus osteoarthritis.@*METHODS@#From October 2017 to April 2019, a retrospective analysis was performed on 43 patients with knee varus osteoarthritis and lateral patellar compression syndrome treated by high tibial osteotomy combined with arthroscopic lateral retinacular release. There were 15 males and 28 females, aged 53 to 72(62.05±5.17) years. The visual analogue scale(VAS), Lysholm, and the knee range of motion were used to evaluate knee pain and functional recovery before operation, 2 weeks, 3 months and 12 months after operation. And the congruence angle (CA), patellar tilt angle (PTA), and femala-tibial angle (FTA) were measured respectively before and 12 months after operation to evaluate the congruence of patellar joint, and the improvement of line of gravity of lower limb.@*RESULTS@#All 43 patients were followed up for more than 12 months, with a follow-up time of 14 to 28 (19.60±4.50) months. The VAS scores decreased from 6.65±0.65 before operation to 2.16±0.95, 0.51±0.77 and 0.33±0.64 at 2 weeks, 3 months and 12 months after operation, and the difference was statistically significant (@*CONCLUSION@#High tibial osteotomy combined with arthroscopic lateral retinacular release can relieve weight-bearing pain in frontal axis and improve the function of knee in sagittal axis.


Subject(s)
Aged , Female , Humans , Knee Joint/surgery , Male , Middle Aged , Osteoarthritis, Knee/surgery , Osteotomy , Patella , Retrospective Studies , Tibia/surgery , Treatment Outcome
19.
Article in Chinese | WPRIM | ID: wpr-879384

ABSTRACT

OBJECTIVE@#To analyze effect of accordion technique on bone mineralization of extended bone segment in treating tibial bone defect with bone transport.@*METHODS@#From May 2017 to October 2019, 22 patients with tibial bone defects were treated with Ilizarov bone-transport technique, and divided into two groups after bone-transport was completed, 11 patients in each group. In observation group, there were 9 males and 2 females aged from 20 to 60 years old with an average of (42.6± 13.3) years old;the length of bone defect ranged from 3 to 13 cm with an average of(6.4±2.6) cm;2 patients were suffered from upper tibial bone defects, 3 patients were middle and 6 patients were lower;patients were treated with accordion technique for 35 days. In control group, there were 10 males and 1 female aged from 41 to 60 years old with an average of (51.6±6.4) years old;the length of bone defect ranged from 3 to 10.7 cm with an average of (6.6±2.5) cm;1 patient was suffered from upper tibial bone defects, 3 patients were middle and 7 patients were lower;patients were treated with lock external fixator to waiting bone mineralization. The content of hydroxyapatite (HAP) extended bone segment was measured after bone-transport completed immediately, 35, 65 and 95 days after bone-transport was completed, respectively, then the mineralization time and healing time were compared between two groups, and the therapeutic effect of bone defect was evaluated by using Paley scoring criteria.@*RESULTS@#Twenty-two patients were followed up from 18 to 36 months with an average of (27.0±6.3) months. The wounds on the bone defects healed spontaneously during bone transport, and there were no wound complications such as skin infection or skin necrosis occurred. There were statisticaldifference in the content of HAP of the extended bone segments at 35, 65 and 95 days after bone-transport between two groups (@*CONCLUSION@#Accordion technique and locking external fixator mineralization in prolonging bone segment healing after bone-transport have the equal clinical effect, while the accordion technique could significantly accelerate the growth rate of HAP and shorten the mineralization time and healing time.


Subject(s)
Adult , Aged , Calcification, Physiologic , External Fixators , Female , Humans , Ilizarov Technique , Infant, Newborn , Male , Middle Aged , Tibia/surgery , Tibial Fractures , Treatment Outcome , Young Adult
20.
Arq. bras. med. vet. zootec. (Online) ; 72(6): 2259-2265, Nov.-Dec. 2020. ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1142302

ABSTRACT

A osteomielite é um desafio terapêutico em ortopedia, capaz de retardar ou mesmo impedir a consolidação óssea. O omento, há anos, tem sido empregado como alternativa em diferentes procedimentos cirúrgicos, por sua capacidade, entre outras, de angiogênese, sendo aplicado na ortopedia veterinária quando há o risco de não união óssea. Neste caso, um cão Fila Brasileiro foi submetido à realização de enxerto com retalho pediculado de omento maior, após osteomielite resistente presente em osteossíntese de fratura múltipla de tíbia aberta grau II. Durante 16 dias, manteve-se a comunicação do retalho, mas, diante do risco de peritonite, o pedículo foi seccionado. Numa sequência de intervenções cirúrgicas, após 89 dias, houve cicatrização óssea e remissão da osteomielite, mesmo na presença de bactérias multirresistentes. Neste relato, o omento foi efetivo como terapia adjuvante no tratamento da osteomielite e garantiu o retorno da função do membro.(AU)


Osteomyelitis is a therapeutic challenge in orthopedics, capable of delaying or even preventing bone healing. The omentum has been used in different surgical procedures as an alternative for its capacity, among others, of angiogenesis, being applied in veterinary orthopedics, when there is a risk of non-union of bone. In this case, a Brazilian row dog was submitted to grafting with pedicle flap of greater omentum, after resistant osteomyelitis present in open fracture osteosynthesis of open tibia grade II. For 16 days the communication of the flap was maintained, but at the risk of peritonitis, the pedicle was sectioned. In a sequence of surgical interventions, after 89 days, there was bone healing and remission of osteomyelitis, even in the presence of multi-resistant bacteria. In this report, the omentum was effective as adjuvant therapy in the treatment of osteomyelitis and guaranteed the return of limb function.(AU)


Subject(s)
Animals , Dogs , Omentum/transplantation , Osteomyelitis/therapy , Osteomyelitis/veterinary , Tibia/pathology , Pedicle Screws/veterinary
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