ABSTRACT
Objectives: Severe pelvic deficiency presents a difficult problem in hip arthroplasty. Specifically, the goals are to restore the pelvic bone stock, place the acetabular component in the correct anatomical position, and optimize joint stability. Currently, many surgical techniques have been developed for prosthetic revision surgery for acetabular complex defects, but no consensus has been reached on the best treatment. The objective of this study was to review mid-term cases of severe bone defect (Paprosky type III) treated with a bone allograft and ring Bursch-Schneider anti-protrusion cage (BSAC). Methods: A retrospective consecutive series review of the first 23 complex acetabular reconstructions performed between 2006 and 2011 was conducted. The series included the learning curve of the procedure and a minimum 5-year follow-up. Conclusion: Our study confirmed the efficacy of using a frozen morselized allograft combined with a metal ring-type BSAC for acetabular reconstruction. The anatomical location of the center of rotation of the hip must be recovered for long-term success. In massive loosening cases, the anatomical center of rotation can only be restored by bone density reconstruction using a graft protected by a ring to improve the centering of the head. Level of Evidence IV, Case Series.
Objetivos: A deficiência pélvica severa apresenta um problema difícil na artroplastia do quadril. Especificamente, os objetivos são restaurar o estoque ósseo pélvico, colocar o componente acetabular na posição anatômica correta e otimizar a estabilidade da articulação. Atualmente, existem muitas técnicas cirúrgicas para a cirurgia de revisão protética em defeitos do complexo acetabular, mas não há consenso sobre o melhor tratamento. Os objetivos deste trabalho são revisar casos de médio prazo operados por apresentar defeito ósseo grave (Paprosky tipo III) tratado com aloenxerto ósseo e gaiola anelar Bursch - Schneider anti protusio (BSAC). Métodos: Foi realizada uma revisão retrospectiva consecutiva das primeiras 23 reconstruções acetabulares complexas realizadas entre 2006 e 2011. Esta série inclui a curva de aprendizado do procedimento e tem um acompanhamento mínimo de 5 anos. Conclusão: Em conclusão, nosso estudo confirma a eficácia do uso de aloenxerto morselado congelado combinado com um anel de metal tipo BSAC durante a reconstrução acetabular. É necessário recuperar o centro de rotação do quadril em sua localização anatômica para o sucesso a longo prazo. Em casos de soltura maciça, o centro anatómico de rotação só pode ser restaurado pela reconstrução da densidade óssea usando um enxerto protegido por um anel que melhora a centralização da cabeça. Nível de Evidência tipo IV, Série de Casos.
ABSTRACT
OBJECTIVE: To identify the variability in the surgical dressing practices and to assess the factors of their use. METHOD: A prospective study on surgical dressings was carried out. Data was collected on some post surgery patients who, once outside the operating room in a general hospital, they were still wearing a surgical dressing. A non-random sample was included. Socio demographic data, pre operative and intra operative data inside the operating room were collected as well as post surgical tests in the surgical inpatient wards. Tests chi2 were carried out for the category variables, tau Student for the continuous ones and the variant analysis. RESULTS: 315 patients were put into groups of 5 according to the surgical proceedings. All dressings were realized with non-woven gauze dressings (more absorbent) and mostly removed every 24 to 48 hours. Two groups showed more exuded dressings. The highest percentage of lesions appeared when dressings were removed between 24 and 48 hours. 50% of the removed ones before the first 24 hours had been over dressed and the chance of having skin lesion was increased 7 times with the reinforcement. Patients showed a medium average of comfort of 6,09 (EVA 0-10) to the dressings. CONCLUSIONS: The use of the traditional dry dressings to cover surgical wounds and the technique to apply a dressing over the existing one are here confirmed. A direct relation is observed between the reapplication of dressings to the same wound and the skin lesions.
Subject(s)
Bandages/statistics & numerical data , Adult , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Objetivo: identificar la variabilidad en la práctica de los apósitos quirúrgicos y los factores asociados con su uso. Método: se realizó un estudio transversal sobre los apósitos quirúrgicos. Se estudió una población de pacientes quirúrgicos de un hospital general que al salir del quirófano eran portadores de dicho apósito. Se incluyó una muestra no aleatoria. Se recogieron datos sociodemográficos y clínicos preoperatorios e intraoperatorios en el quirófano y postoperatorios en las plantas de hospitalización quirúrgica. Se efectuaron pruebas de alpha2 para las variables categóricas y para las continuas la ? de Student y el análisis de la varianza. Resultados: 315 pacientes se agruparon en cinco grupos, según el procedimiento quirúrgico. Todos los apósitos se realizaron con gasas hidrófilas de algodón, fijados con apósito de tejido sin tejer y la mayoría cambiados entre las 24-48 horas. Dos grupos presentaron más apósitos manchados. El mayor porcentaje de lesiones aparecía cuando se cambiaban entre las 24 y las 48 horas. El 50% de los cambiados antes de las 24 horas había sido reforzado y la probabilidad de que se lesionara la piel se multiplicaba por siete con el refuerzo. Los pacientes manifestaron un confort medio de 6,09 (EVA 0- 10) respecto al apósito. Conclusiones: se constata el uso del apósito tradicional de gasa seca para cubrir las heridas operatorias y la técnica de refuerzo de los apósitos. Se observa una relación directa entre el refuerzo y las lesiones en la piel(AU)
Objective: To identify the variability in the surgical dressing practices and to assess the factors of their use. Method: A prospective study on surgical dressings was carried out. Data was collected on some post surgery patients who, once outside the operating room in a general hospital, they were still wearing a surgical dressing. A non-random sample was included. Socio demographic data, pre operative and intra operative data inside the operating room were collected as well as post surgical tests in the surgical inpatient wards. Tests alpha2 were carried out for the category variables, ? Student for the continuous ones and the variant analysis. Results: 315 patients were put into groups of 5 according to the surgical proceedings. All dressings were realized with non-woven gauze dressings (more absorbent) and mostly removed every 24 to 48 hours. Two groups showed more exuded dressings. The highest percentage of lesions appeared when dressings were removed between 24 and 48 hours. 50% of the removed ones before the first 24 hours had been over dressed and the chance of having skin lesion was increased 7 times with the reinforcement. Patients showed a medium average of comfort of 6,09 (EVA 0-10) to the dressings. Conclusions: The use of the traditional dry dressings to cover surgical wounds and the technique to apply a dressing over the existing one are here confirmed. A direct relation is observed between the reapplication of dressings to the same wound and the skin lesions(AU)
