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1.
Orthop J Sports Med ; 10(10): 23259671221126693, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36250031

RESUMO

Background: Roughly 30% of patients with chronic lateral ankle instability (CLAI) have long-lasting painful instability requiring surgical intervention. Ligament reconstruction with the traditional open method and using tendon allografts can provide sufficient mechanical stability for severe CLAI. Arthroscopic ligament reconstruction with tendon allograft has recently been introduced to treat CLAI. Purpose: In this study, we describe an arthroscopic ligament reconstruction procedure involving the use of the tendon allograft for patients with CLAI, and we compare the efficacy of this procedure with open ligament reconstruction with tendon allograft. Study Design: Cohort study; Level of evidence, 3. Methods: We enrolled 10 patients (4 men and 6 women) with CLAI (mean age, 37.3 years; range, 16-57 years) who underwent arthroscopic ligament reconstruction with tendon allografting between November 2017 and June 2019. The control group consisted of 10 patients who received open tendon allograft reconstruction. Preoperative and 2-year postoperative functional outcomes were evaluated using the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale (AOFAS), Karlsson Ankle Functional Score (KAFS), pain visual analog scale (VAS), 12-Item Short Form Health Survey (SF-12), and Tegner activity score (TAS). Results: The mean operative time was 118 and 110 minutes in the arthroscopic and open groups, respectively. At 2-year follow-up, scores on the AOFAS improved significantly compared with preoperatively, from 71.3 to 96.4 (P = .006) in the arthroscopic group, and from 68.6 to 96.7 (P = .005) in the open group. The postoperative AOFAS, VAS, KAFS, and SF-12 scores did not differ significantly between the 2 groups; however, the TAS score was significantly higher in the arthroscopic reconstruction group compared with in the open group (7 vs 6.1, respectively; P = .01). Conclusion: Arthroscopic ligament reconstruction with tendon allografting resulted in sufficient ankle stability and no donor-site morbidity. This procedure can yield similar functional outcomes to open reconstruction technique and may be an option for the management of CLAI.

2.
J Clin Med ; 11(14)2022 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-35887727

RESUMO

Background: The purpose of this study is to investigate the clinical and radiological results of a sliding oblique metatarsal osteotomy (SOMO) to correct bunionette deformity. Methods: We retrospectively reviewed 44 patients (51 feet, left/right: 29/22) from December 2010 to December 2018 who underwent SOMO and compared radiographic measurements and clinical outcome scores preoperatively and postoperatively. Radiographic measurements included 4th and 5th intermetatarsal angle (IMA), metatarsophalangeal angle (MTPA), and lateral deviation angle (LDA). Clinical outcome measurements included The American Orthopedic Foot and Ankle Society (AOFAS) score for lesser metatarsophalangeal procedures and visual analog scale (VAS) pain score. The mean follow-up period was 26.6 months (minimum 18 months). Based on Coughlin and Fallat classification, all cases were separated into four subtypes: 6 type I, 10 type II, 12 type III, 23 type IV cases included.) Results: All radiographic parameters significantly improved after SOMO procedure (IMA/MTPA/LDA, p value < 0.001). Clinical scores also showed a significant improvement in AOFAS and VAS scores (p value < 0.001). In terms of subgroup based on each type, both radiographic measurements and clinical scores revealed significant improvements in each subgroup (p value < 0.05), except LDA of type I subgroup (p value = 0.09). Three cases reported pin-tract infection but recovered with good healing after removal of the K-wire and a prescription of oral antibiotic. Conclusion: The SOMO procedure may be considered as a reliable and simple treatment for most types of bunionette deformity with satisfactory outcomes and no severe complications. Level of Evidence: Level IV, case series.

3.
BMC Musculoskelet Disord ; 23(1): 11, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980055

RESUMO

BACKGROUND: The plantar plate is an important static stabilizer of the lesser metatarsophalangeal joints, and disruptions of the plantar plate can lead to significant instability and lesser toe deformities. In recent years, direct plantar plate repair has been proposed. Although direct repair via a dorsal approach is attractive, a torn plantar plate is small and difficult to access using regular instruments in a restricted operative field. METHODS: In this report, a unique method for plantar plate repairs was used to repair various configurations of plantar plate tears with standard operative instruments that are available in most operating rooms. RESULTS: Using this method, 10 patients underwent plantar plate repairs, and the mean follow-up period was 24 (range, 14-38) months. The mean visual analog scale score for pain preoperatively was 4.1 (range, 0-6) and decreased to 0.6 (range, 0-3) at last follow-up. Postoperatively, the mean visual analog scale score for satisfaction was 9.6 (range, 8-10) and the mean American Orthopedic Foot and Ankle Society forefoot score was 88.8 (range, 75-100). CONCLUSIONS: Our study proposes an inexpensive and versatile method for plantar plate repair via a dorsal approach that uses standard operative instruments. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04949685 . July 2, 2021 - Retrospectively registered, LEVEL OF CLINICAL EVIDENCE: 4.


Assuntos
Deformidades do Pé , Instabilidade Articular , Articulação Metatarsofalângica , Placa Plantar , Humanos , Osteotomia , Placa Plantar/cirurgia
4.
Artigo em Inglês | MEDLINE | ID: mdl-34360410

RESUMO

BACKGROUND: People with dementia are a high-risk group for hip fractures. Although the increased risk of hip fractures associated with antipsychotic drugs (APD) is found in older populations, little is known about the risk for people with dementia living in Asia. We aimed to investigate the association between hip fractures and the characteristics of APD use in patients with dementia. METHODS: A nested case-control analysis was conducted on a nationwide cohort in Taiwan. People with diagnoses of dementia during 2003-2012 were identified. Conditional logistic regression analysis was performed, and adjusted odds ratios (aORs) were calculated with a 95% confidence interval (CI) to estimate the risk of hip fractures. RESULTS: APD use was associated with an increased risk of hip fractures in patients with dementia; current use or combined use of first and second generations of APDs had even higher risks. Regarding the duration of APD use, a U-shape curve of hip fracture risk was noted, and the risk peaked during 0-15 days and >215 days of exposure (aOR = 1.46, 95% CI 1.37-1.57; aOR = 1.47, 95% CI 1.37-1.58; respectively). Considering the doses of APDs, the hip fracture risk was significantly increased with all four levels of the cumulative doses and average daily doses and peaked in the group with the highest average daily dose. CONCLUSIONS: The findings suggest that caution must be taken when initiating APD use in patients with dementia, even in a small dose, and mixed types of APD prescriptions should be administered with care. Furthermore, frequent evaluation of the possibility of tapering or withdrawal of the medication is necessary, as the risk does not attenuate after long-term use.


Assuntos
Demência , Fraturas do Quadril , Preparações Farmacêuticas , Idoso , Estudos de Casos e Controles , Demência/induzido quimicamente , Demência/epidemiologia , Fraturas do Quadril/induzido quimicamente , Fraturas do Quadril/epidemiologia , Humanos , Fatores de Risco
5.
J Foot Ankle Surg ; 58(1): 187-191, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30448372

RESUMO

Tarsal navicular osteonecrosis in adults is a rare condition with unclear etiology, and the optimal treatment has not been established. Here we report a case of tarsal navicular osteonecrosis with a complete course of treatment and comprehensive imaging studies starting at an early stage. A 37-year-old female diagnosed with tarsal navicular osteonecrosis was first treated with percutaneous decompression, but her symptoms persisted postoperatively. The tarsal navicular showed no further collapse, but follow-up magnetic resonance imaging (MRI) at 6 months postoperatively revealed persistent osteonecrotic changes. Debridement of the necrotic bone with preservation of the cortical shell and bone substitute packing for the defect (light bulb procedure) were performed. The symptoms resolved by 3 months postoperatively, and the patient could return to work. At a 6-year follow-up visit, the patient was free of symptoms, and MRI showed remodeling of the tarsal navicular without further collapse.


Assuntos
Substitutos Ósseos/uso terapêutico , Desbridamento , Osteonecrose/cirurgia , Ossos do Tarso , Adulto , Descompressão Cirúrgica , Feminino , Humanos , Imageamento por Ressonância Magnética , Osteonecrose/diagnóstico por imagem , Osteonecrose/patologia
6.
J Bone Joint Surg Am ; 93 Suppl 1: 92-9, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21411690

RESUMO

BACKGROUND: There is a variety of treatment modalities for unicameral bone cysts, with variable outcomes reported in the literature. Although good initial outcomes have been reported, the success rate has often changed with longer-term follow-up. We introduce a novel, minimally invasive treatment method and compare its clinical outcomes with those of other methods of treatment of this lesion. METHODS: From February 1994 to April 2008, forty patients with a unicameral bone cyst were treated with one of four techniques: serial percutaneous steroid and autogenous bone-marrow injection (Group 1, nine patients); open curettage and grafting with a calcium sulfate bone substitute either without instrumentation (Group 2, twelve patients) or with internal instrumentation (Group 3, seven patients); or minimally invasive curettage, ethanol cauterization, disruption of the cystic boundary, insertion of a synthetic calcium sulfate bone-graft substitute, and placement of a cannulated screw to provide drainage (Group 4, twelve patients). Success was defined as radiographic evidence of a healed cyst or of a healed cyst with some defect according to the modified Neer classification, and failure was defined as a persistent or recurrent cyst that needed additional treatment. Patients who sustained a fracture during treatment were also considered to have had a failure. The outcome parameters included the radiographically determined healing rate, the time to solid union, and the total number of procedures needed. RESULTS: The follow-up time ranged from eighteen to eighty-four months. Group-4 patients had the highest radiographically determined healing rate. Healing was seen in eleven of the twelve patients in that group compared with three of the nine in Group 1, eight of the twelve in Group 2, and six of the seven in Group 3. Group-4 patients also had the shortest mean time to union: 3.7 ± 2.3 months compared with 23.4 ± 14.9, 12.2 ± 8.5, and 6.6 ± 4.3 months in Groups 1, 2, and 3, respectively. CONCLUSIONS: This new minimally invasive method achieved a favorable outcome, with a higher radiographically determined healing rate and a shorter time to union. Thus, it can be considered an option for initial treatment of unicameral bone cysts.


Assuntos
Cistos Ósseos/cirurgia , Transplante de Medula Óssea , Curetagem , Úmero , Procedimentos Cirúrgicos Minimamente Invasivos , Cistos Ósseos/patologia , Parafusos Ósseos , Substitutos Ósseos/administração & dosagem , Sulfato de Cálcio/administração & dosagem , Etanol/administração & dosagem , Seguimentos , Humanos , Estudos Retrospectivos , Solventes/administração & dosagem , Resultado do Tratamento
7.
J Bone Joint Surg Am ; 92(4): 855-62, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20360508

RESUMO

BACKGROUND: There is a variety of treatment modalities for unicameral bone cysts, with variable outcomes reported in the literature. Although good initial outcomes have been reported, the success rate has often changed with longer-term follow-up. We introduce a novel, minimally invasive treatment method and compare its clinical outcomes with those of other methods of treatment of this lesion. METHODS: From February 1994 to April 2008, forty patients with a unicameral bone cyst were treated with one of four techniques: serial percutaneous steroid and autogenous bone-marrow injection (Group 1, nine patients); open curettage and grafting with a calcium sulfate bone substitute either without instrumentation (Group 2, twelve patients) or with internal instrumentation (Group 3, seven patients); or minimally invasive curettage, ethanol cauterization, disruption of the cystic boundary, insertion of a synthetic calcium sulfate bone-graft substitute, and placement of a cannulated screw to provide drainage (Group 4, twelve patients). Success was defined as radiographic evidence of a healed cyst or of a healed cyst with some defect according to the modified Neer classification, and failure was defined as a persistent or recurrent cyst that needed additional treatment. Patients who sustained a fracture during treatment were also considered to have had a failure. The outcome parameters included the radiographically determined healing rate, the time to solid union, and the total number of procedures needed. RESULTS: The follow-up time ranged from eighteen to eighty-four months. Group-4 patients had the highest radiographically determined healing rate. Healing was seen in eleven of the twelve patients in that group compared with three of the nine in Group 1, eight of the twelve in Group 2, and six of the seven in Group 3. Group-4 patients also had the shortest mean time to union: 3.7 +/- 2.3 months compared with 23.4 +/- 14.9, 12.2 +/- 8.5, and 6.6 +/- 4.3 months in Groups 1, 2, and 3, respectively. CONCLUSIONS: This new minimally invasive method achieved a favorable outcome, with a higher radiographically determined healing rate and a shorter time to union. Thus, it can be considered an option for initial treatment of unicameral bone cysts.


Assuntos
Cistos Ósseos/terapia , Adolescente , Adulto , Cistos Ósseos/diagnóstico por imagem , Transplante de Medula Óssea , Parafusos Ósseos , Substitutos Ósseos/uso terapêutico , Criança , Pré-Escolar , Curetagem , Etanol/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intralesionais , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Radiografia , Adulto Jovem
8.
J Biomed Sci ; 17: 2, 2010 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-20064257

RESUMO

BACKGROUND: Schizophrenia is a complex disorder with involvement of multiple genes. METHODS: In this study, genome-wide screening for DNA copy-number variations (CNVs) was conducted for ten pairs, a total of 20 cases, of affected siblings using oligonucleotide array-based CGH. RESULTS: We found negative symptoms were significantly more severe (p < 0.05) in the subgroup that harbored more genetic imbalance (n >== 13, n = number of CNV-disrupted genes) as compared with the subgroup with fewer CNVs (n <== 6), indicating that the degree of genetic imbalance may influence the severity of the negative symptoms of schizophrenia. Four central nervous system (CNS) related genes including CCAAT/enhancer binding protein, delta (CEBPD, 8q11.21), retinoid x receptor, alpha (RXRA, 9q34.2), LIM homeobox protein 5 (LHX5, 12q24.13) and serine/threonine kinase 11 (STK11, 19p13.3) are recurrently (incidence >== 16.7%) disrupted by CNVs. Two genes, PVR (poliovirus receptor) and BU678720, are concordantly deleted in one and two, respectively, pairs of co-affected siblings. However, we did not find a significant association of this BU678720 deletion and schizophrenia in a large case-control sample. CONCLUSIONS: We conclude that the high genetic loading of CNVs may be the underlying cause of negative symptoms of schizophrenia, and the CNS-related genes revealed by this study warrant further investigation.


Assuntos
Variações do Número de Cópias de DNA/genética , Esquizofrenia/genética , Adulto , Hibridização Genômica Comparativa , Genoma Humano , Estudo de Associação Genômica Ampla , Humanos , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Linhagem , Polimorfismo de Nucleotídeo Único , Esquizofrenia/patologia , Irmãos
9.
J Arthroplasty ; 24(7): 1024-32, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18757172

RESUMO

Our study was conducted to compare radiographic alignments and functional outcomes with 2 approaches to minimal-incision total knee arthroplasty (TKA): the minimal-incision medial parapatellar (MP) approach and the quadriceps-sparing (QS) approach with side-cutting instruments. Sixty patients (80 knees) with primary osteoarthritis were randomly assigned to receive MP or QS TKA. Postoperative alignment of the femoral component was significantly less valgus, and postoperative alignment of the tibial component was significantly more varus with the QS approach than with the MP approach. One tibial outlier and 3 femoral outliers were observed with QS TKA. The overall postoperative hip-knee-ankle axis was more varus, and surgical time was longer with QS TKA. Short-term isokinetic peak muscle torque, postoperative pain, and functional outcomes did not differ between the approaches.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Prótese do Joelho , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Músculo Quadríceps/fisiologia , Músculo Quadríceps/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/diagnóstico por imagem , Mau Alinhamento Ósseo/prevenção & controle , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Força Muscular/fisiologia , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Músculo Quadríceps/diagnóstico por imagem , Radiografia , Método Simples-Cego , Torque , Resultado do Tratamento
10.
J Oral Pathol Med ; 33(6): 327-34, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15200480

RESUMO

BACKGROUND: Buccal squamous cell carcinoma (BSCC) is the most frequently occurring oral cancer in Asians due to the popularity of areca use in this area. The aim of the present study was to evaluate the survival of areca-associated BSCC associated with multiple molecular markers. METHODS: Using immunohistochemistry, we evaluated the survival of a cohort of 55 patients with BSCC being followed long term, as correlated to the expression of variable markers. RESULTS: We found that p53, p21, Rb, cyclin D1 (CCD1), MDM2, and gamma-catenin were positive in 81, 60, 70, 31, 88, and 44% of patients, respectively. Subjects with -ve immunoreactivity for CCD1, and +ve immunoreactivity for MDM2 and gamma-catenin had significantly better survival than subjects with the opposite immunoreactive pattern. KAPLAN-meier survival curves confirmed this association. CONCLUSION: The data indicate that expression of CCD1, MDM2, and gamma-catenin might serve as potential prognostic markers for BSCC in areca-using patients.


Assuntos
Areca/efeitos adversos , Biomarcadores Tumorais/biossíntese , Carcinoma de Células Escamosas/metabolismo , Ciclina D1/biossíntese , Proteínas do Citoesqueleto/biossíntese , Neoplasias Bucais/metabolismo , Proteínas de Neoplasias/biossíntese , Proteínas Nucleares/biossíntese , Proteínas Proto-Oncogênicas/biossíntese , Adulto , Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/mortalidade , Ciclina D1/análise , Inibidor de Quinase Dependente de Ciclina p21 , Ciclinas/análise , Ciclinas/biossíntese , Proteínas do Citoesqueleto/análise , Desmoplaquinas , Histocitoquímica , Humanos , Pessoa de Meia-Idade , Neoplasias Bucais/química , Neoplasias Bucais/etiologia , Neoplasias Bucais/mortalidade , Proteínas de Neoplasias/análise , Proteínas Nucleares/análise , Prognóstico , Modelos de Riscos Proporcionais , Proteínas Proto-Oncogênicas/análise , Proteínas Proto-Oncogênicas c-mdm2 , Proteína do Retinoblastoma/análise , Proteína do Retinoblastoma/biossíntese , Análise de Sobrevida , Proteína Supressora de Tumor p53/análise , Proteína Supressora de Tumor p53/biossíntese , gama Catenina
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