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1.
Spine (Phila Pa 1976) ; 34(4): 309-15, 2009 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-19214089

RESUMO

STUDY DESIGN: Correlation of locations of sacral insufficiency fractures is made to regions of stress depicted by finite element analysis derived from biomechanical models of patient activities. OBJECTIVE: Sacral insufficiency fractures occur at consistent locations. It was postulated that sacral anatomy and sites of stress within the sacrum with routine activities in the setting of osteoporosis are foundations for determining patterns for the majority of sacral insufficiency fractures. SUMMARY OF BACKGROUND DATA: The predominant vertical components of sacral insufficiency fractures most frequently occur bilaterally through the alar regions of the sacrum, which are the thickest and most robust appearing portions of the sacrum instead of subjacent to the central sacrum, which bears the downward force of the spine. METHODS: First, the exact locations of 108 cases of sacral insufficiency fractures were catalogued and compared to sacral anatomy. Second, different routine activities were simulated by pelvic models from CT scans of the pelvis and finite element analysis. Analyses were done to correlate sites of stress with activities within the sacrum and pelvis compared to patterns of sacral insufficiency fractures from 108 cases. RESULTS: The sites of stress depicted by the finite element analysis walking model strongly correlated with identical locations for most sacral and pelvic insufficiency fractures. Consistent patterns of sacral insufficiency fractures emerged from the 108 cases and a biomechanical classification system is introduced. Additionally, alteration of walking mechanics and asymmetric sacral stress may alter the pattern of sacral insufficiency fractures noted with hip pathology (P = 0.002). CONCLUSION: Locations of sacral insufficiency fractures are nearly congruous with stress depicted by walking biomechanical models. Knowledge of stress locations with activities, cortical bone transmission of stress, usual fracture patterns, intensity of sacral stress with different activities, and modifiers of walking mechanics may aid medical management, interventional, or surgical efforts.


Assuntos
Fraturas de Estresse/patologia , Osteoporose/patologia , Sacro/patologia , Fraturas da Coluna Vertebral/patologia , Caminhada , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Análise de Elementos Finitos , Fraturas de Estresse/fisiopatologia , Articulação do Quadril/patologia , Articulação do Quadril/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Modelos Biológicos , Osteoporose/fisiopatologia , Estudos Retrospectivos , Sacro/fisiopatologia , Fraturas da Coluna Vertebral/fisiopatologia , Estresse Mecânico , Tomografia Computadorizada por Raios X , Estados Unidos
2.
J Neurosurg ; 108(5): 926-9, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18447708

RESUMO

OBJECT: Postsurgical pneumocephalus is an unavoidable sequela of craniotomy. Sufficiently large volumes of intracranial air can cause headaches, lethargy, and neurological deficits. Supplemental O(2) to increase the rate of absorption of intracranial air is a common but unsubstantiated neurosurgical practice. To the authors' knowledge, this is the first prospective study to examine the efficacy of this therapy and its effect on the rate of pneumocephalus absorption. METHODS: Thirteen patients with postoperative pneumocephalus that was estimated to be > or = 30 ml were alternately assigned to breathe 100% O(2) using a nonrebreather mask (treatment group) or to breathe room air (control group) for 24 hours. Head computed tomography (CT) scans without contrast enhancement were obtained at the beginning and end of treatment or control therapy. A neuroradiologist blinded to the type of treatment used software to calculate the 3D volume of the pneumocephalus from the CT scans. The percentage of pneumocephalus absorption was calculated for each study participant. RESULTS: There was no statistically significant difference between the treatment and control groups regarding the mean initial pneumocephalus volume or time interval between CT scans. There was a significant difference (p = 0.009) between the mean rate of pneumocephalus volume reduction in the treatment (65%) and control groups (31%) per 24 hours. No patient suffered adverse effects related to treatment. CONCLUSIONS: Administration of postsurgical supplemental O(2) through a nonrebreather mask significantly increases the absorption rate of postcraniotomy pneumocephalus as compared with breathing room air.


Assuntos
Craniotomia , Oxigenoterapia/métodos , Pneumocefalia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Tomografia Computadorizada por Raios X
3.
AJNR Am J Neuroradiol ; 26(8): 2019-26, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16155152

RESUMO

BACKGROUND AND PURPOSE: Dissection and retraction of the sylvian fissure can cause venous insufficiency and may be an important contributor to postoperative edema or hemorrhage after clipping of a middle cerebral artery (MCA) aneurysm. The incidence of changes in the superficial middle cerebral vein (SMCV) and adjacent veins and whether such changes increase the amount of edema or hemorrhage on postoperative CT is the focus of this study. METHODS: Pre- and postoperative angiograms of 100 consecutive patients with MCA aneurysms treated by craniotomy and clipping were compared to determine the postoperative incidence of changes involving the SMCV. CTs from the normal and abnormal postoperative venous groups were compared to determine the amount of edema or presence of parenchymal hemorrhage. RESULTS: Postoperatively, 31 (31%) SMCVs were altered, 20 to a minor or moderate degree. Eleven cases were pronounced. In 9 (9%) cases, the SMCV was completely obscured or failed to fill on postoperative angiography. More edema (observer 1, P < .0002; observer 2, P < .0006) and small brain parenchymal hemorrhages (observer 1, P < .00003; observer 2, P < .00001) were found on the postoperative CT images of the group whose SMCVs were altered than those that were unchanged. CONCLUSIONS: Neurosurgeons and neuroradiologists should be attentive to changes in the SMCV and adjacent venous structures to optimize outcomes of procedures involving the sylvian fissure.


Assuntos
Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/fisiopatologia , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Tomografia Computadorizada por Raios X , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem
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