EVALUATION OF TENOTOMY IN THE HIP SUBLUXATION TREATMENT OF CHILDREN WITH ZIKA SYNDROME

ABSTRACT Objectives: Evaluate the efficacy and effects of releasing the muscles of subluxated hips of patients with SCZ. Methods: This is a retrospective study with 29 patients with subluxation of the hip, corresponding to 55 hips operated in a public hospital in Recife, Brazil. Preoperative femoral head migration (PM) percentages were evaluated and compared with 6- and 12-month postoperative results. Results: Twenty-nine patients were eligible, representing 55 hips evaluated. 19 were female (65.5%), with a mean age of 31.45 months (ranging from 23 to 42 years). 19 patients were GMFCS level V (65.5%), 34.5% were level IV, and 20 of the 29 patients (69%) had no complications. The PM had an absolute reduction of 11.6% (GMFCS IV) and 13.31% (GMFCS V) in the first six months. After 12 months, there was a regression of MP of 7.14% (GMFCS V) and 11.25% (GMFCS IV) compared to preoperative values, with no significant statistical difference among MP values presented between 6 and 12 months after surgery. Conclusions: The surgery was effective in PM regression during the analyzed period and presented a low complication rate. Level of Evidence III; Comparative retrospective study

Tratamento da luxação e subluxação crônica dolorosa do quadril em pacientes com paralisia cerebral pela técnica de McHale

Foram avaliados 20 pacientes portadores de paralisia cerebral submetidos ao procedimento de McHale, ressecção artroplástica do quadril com osteotomia valgizante subtrocantérica. Em relação ao gênero, 11 eram do feminino e nove do masculino. A idade variou de sete a 23 anos, com média de 12,2 anos. Todos os pacientes eram não deambuladores, sendo 17 tetraparéticos espásticos, dois diparéticos espásticos e um tetraparético espástico com componente atetóide. O tempo de seguimento variou de 0,25 anos (três meses) a 7,5 anos (90 meses), com média de cinco anos (60 meses). A técnica cirúrgica de McHale et al. foi utilizada em 31 quadris que encontravam-se luxados ou subluxados, e que, caracteristicamente, apresentavam-se dolorosos. Houve remissão completa da dor em 24 (77,4%) quadris; em seis (19,35%), a dor, à manipulação do quadril, permaneceu, porém, de menor intensidade; e em um quadril (3,2%) a dor permaneceu a mesma que antes da cirurgia. Observou-se melhora na realização da higiene pessoal e na capacidade de sentar em 95% dos casos. Os quadris mantiveram-se móveis, e não foi observada migração proximal relevante do fêmur, complicação esta, comum em outros procedimentos. A cirurgia de McHale possibilitou uma melhora na mecânica do quadril, e os resultados permitiram concluir, que este procedimento de salvamento, é uma alternativa viável em pacientes adequadamente selecionado

SIMPLIFIED CALCULATION FOR CORRECTIVE OSTEOTOMIES OF LONG BONES

ABSTRACT Objectives: To present a simplified calculation for the measurement of osteotomy wedges used for the correction of angular uniplanar deformities of long bones and to compare the simplified calculation proposed (circumferential calculation) with the classical trigonometric calculations, as well as with the exact calculation performed by computer software AutoCADtm. Methods: The software AutoCADtm was used to calculate the bone wedges, for mathematical comparison of the three main groups, each one of them containing 18 hypothetical bone deformities which angles ranging from 5 to 90 degrees, with 5 degrees intervals between them. Results: In the analysis of 18 deformities, the hypothetical angular bone, the average lengths of the corrective wedges obtained by the trigonometric, circumferential and the exact metods were, respectively, 32.21 ± 16.81 mm, 33.16 ± 18.63 mm and 35.22 ± 23.52 mm. There was no statistically significant difference between the three calculation methods (p>0.05). Conclusion: The circumferential calculation proposed in this study is useful for being accurate and simple, not requiring any trigonometric knowledge. Level of Evidence II, Experimental Study

PROSPECTIVE STUDY OF ASPIRIN FOR THROMBOEMBOLISM PROPHYLAXIS IN TOTAL HIP ARTHROPLASTY

<div><p>ABSTRACT Objectives: To evaluate the effectiveness of aspirin as prophylaxis for deep venous thrombosis (DVT) in patients undergoing total hip arthroplasty (THA), and to analyze the incidence of bleeding during the post-operative period. Methods: This prospective study carried out in 2017 consisted of 37 patients indicated for THA with high risk for DVT. Immediately after the procedure, aspirin, elastic compression socks and early deambulation were initiated. Doppler ultrasound was performed in the legs 6 days and 6 weeks post-procedure to rule out venous thromboembolism. Hematometric variables and clinical criteria were used to detect bleeding. Results: The incidence of VTE (venous thromboembolism) 6 days post-procedure was 21.6%. By 6 weeks post-procedure, it dropped to 8.1%, (p = 0.102). Only 2.7% were diagnosed with VTE, 6 days and also 6 weeks post-procedure. Within the immediate postoperative period, hemoglobin was lower (p < 0.001), in contrast to 6 weeks after surgery, when it returned to baseline levels. Conclusion: Aspirin was an effective chemical prophylaxis for venous thromboembolism in high-risk patients who underwent THA. There was no clinical record of postoperative bleeding and hematometric levels suggested that there was no chronic bleeding. Level of Evidence II; Prospective study.</p></div

Perfil epidemiológico dos pacientes amputados acompanhados em um grande centro referência em reabilitação de Pernambuco

The amputation of a limb is more dramatic and sensorimotor limitations in young patients, as well as in the adult or elderly population with comorbidities. Objective: This study outlined the demographic and epidemiological profile of patients treated at a large referral rehabilitation center in Pernambuco. Methods: A cross-sectional study was carried out with a review of active medical records. The results were processed by Microsoft Excel® and the program used for the statistical calculations was the IBM® SPSS® version 23. Results: It was observed a mean age of 48.36 years, male gender (76.6%), married (47.7%), elementary education (64.8%) and from all regions of the state. As for amputation, with no predilection for the side, more frequent in the lower limbs transfemoral (55.1%), variable length stumps and more frequent vascular and traumatic causes. On physical examination, stumps in rehabilitation conditions, use of community or home addition in the first consultation and no previous use of prosthesis. In 83.6% of the cases, the patients used their prosthesis more than 7h/day and 58.6% had independent walking in the community, with prosthesis durability of up to 36 months (75.8%). Conclusion: Amputation occurs at a young age, with men being more affected, vascular diseases and accidents involving motor vehicles are the main causes, surgeries occur more in bone diaphyses. The therapy time was effective. Public policies are needed to speed up patient access to specialized centers and from them to rehabilitation centers and to improve the materials and components that make up the prostheses offered by the SUS.A amputação de um membro se reveste de maior dramaticidade e limitações sensório-motoras em pacientes jovens, assim como, na população adulta ou idosa com comorbidades. Objetivo: Traçar o perfil demográfico e epidemiológico dos pacientes atendidos em um grande centro de referência em reabilitação em Pernambuco. Métodos: Realizou-se um estudo de corte transversal com revisão de prontuários ativos. Os resultados foram tratados pelo Microsoft Excel® e o programa utilizado para os cálculos estatísticos foi o IBM® SPSS® na versão 23. Resultados: Observou-se idade média de 48,36 anos, gênero masculino (76,6%), casados (47,7%), ensino fundamental (64,8%) e oriundos de todas as regiões do estado. Quanto à amputação, sem predileção por lado, mais frequente nos membros inferiores transfemoral (55,1%), cotos de comprimento variável e causas vasculares e traumáticas mais frequentes. No exame físico, cotos em condições de reabilitação, utilização de aditamento comunitário ou domiciliar na primeira consulta e sem uso prévio de prótese. Em 83,6% dos casos, os pacientes usavam sua prótese mais de 7h/dia e 58,6% possuíam marcha independente na comunidade, com durabilidade da prótese em até 36 meses (75,8%). Conclusão: A amputação ocorre em idade jovem, sendo os homens mais acometidos, as doenças vasculares e acidentes envolvendo veículos motorizados são as principais causas, as cirurgias ocorrem mais nas diáfises ósseas. O tempo de terapias foi efetivo. Fazem-se necessárias políticas públicas que agilizem o acesso do paciente a centros especializados e desses aos centros de reabilitação e para melhoria dos materiais e componentes que compõem as próteses oferecidas pelo SUS