Estudo das malformações da coluna cervical no mongolismo

BV UNIFESP: Teses e dissertaçõe

Tratamento cirúrgico das fraturas da coluna torácica e lombar pelas técnicas de Luque e Harrington associada com as amarrias de Luque: estudo comparativo

BV UNIFESP: Teses e dissertaçõe

Tratamento cirúrgico das hérnias discais foraminais pela microdiscectomia artroscópica

A hérnia discal lombar foraminal é extremamente incapacitante em relação à sintomatologia clínica. Nos últimos quarenta anos muitas alternativas foram propostas no tratamento dessa patologia. Vinte pacientes com essa síndrome radicular foram operados, via póstero-lateral, pela técnica da microdiscectomia artroscópica. O acompanhamento foi realizado com questionários de auto-avaliação pré-operatória e pós-operatória sendo obedecidos rigorosamente os critérios de inclusão e exclusão para a indicação cirúrgica. A idade média dos pacientes foi de 43 anos, com variação de 23 a 58 anos. Houve predomínio do sexo feminino (13 pacientes e freqüência percentual de 65%) em relação ao masculino (7 pacientes e freqüência percentual de 35%). Todos os pacientes foram operados de hérnia discal lombar foraminal no nível entre as 4ª e 5ª vértebras lombares. Os resultados clínicos apresentaram um percentual de 75% de sucesso. Não ocorreram nesse estudo complicações, tais como: lesão nervosa motora, vascular ou discite bacteriana

Efficacy of the use of templating in total hip arthroplasty

OBJECTIVE: The aim was to evaluate the effectiveness of traditional preoperative planning with the use of templating. METHOD: Forty-three anteroposterior X-rays were analyzed by three experienced surgeons (A, B, C) and compared. Cohen's Kappa concordance test and weighted Kappa indexes using quadratic weighting were used for statistical analysis with a confidence interval of 95%. RESULTS: The preoperative evaluations were divided into the analysis of the sizes of the acetabular cup, stem and plug of the distal femoral canal. Surgeon A obtained a moderate agreement in relation to the acetabular component and substantial agreements in relation to the stem and plug. Surgeon B had moderate agreement in relation to both the acetabulum and the stem and substantial agreement in relation to the plug. Surgeon C obtained moderate agreement in relation to the analysis of the acetabulum and the plug and substantial agreement for the stem. The intraobserver agreement test demonstrated a prevalence of slight agreement in relation to the acetabulum and substantial agreement in relation to the stem and to the plug. CONCLUSION: Templating used in preoperative planning proved effective; however, there was a prevalence of slight and moderate agreement in relation to the size of the acetabular component

Avaliação tomográfica dos pedículos vertebrais no tratamento cirúrgico dos pacientes com escoliose idiopática do adolescente

OBJETIVO: Determinar através de cortes tomográficos e reconstrução tridimensional a incidência de mal posicionamento de parafusos em pacientes submetidos ao tratamento cirúrgico da Escoliose idiopática do adolescente. MÉTODOS: Foram analisados exames tomográficos de 8 pacientes, tratados cirurgicamente no Hospital de Base de São José do Rio Preto-SP, realizada instrumentação posterior partindo de T2 /T4 a L4/L5 totalizando 164 parafusos. RESULTADOS: 32,9% (n=54) apresentavam posicionamento com risco potencial,ou seja desvio acima de 2 milímetros, sendo 20,1% (n=33) com invasão lateral, 9,1% (n=15) com invasão medial, 3,6 %(n=6) com invasão anterior. Dos parafusos que ofereciam risco potencial a relação com aspecto da curva foi de 46% (n=25) na concavidade, 35% (n=19) na convexidade e 19% (n=10) em vértebras adjacentes a curva. CONCLUSÃO: Os limites de penetração aceitáveis, assim como os métodos de mensuração ainda não foram padronizados, a técnica free hand' mostrou-se segura, apesar da violação dos pedículos. A tomografia computadorizada pré-operatória, auxilia no planejamento cirúrgico e na redução das complicações.OBJETIVO: Evaluar mediante tomografía computarizada tridimensional de reconstrucción, una mala posición de los tornillos de pedículo en pacientes con escoliosis idiopática del adolescente. MÉTODOS: Se analizó cortes de tomografía computarizada de 8 pacientes sometidos a tratamiento quirúrgico en el Hospital de Base de São José do Rio Preto-SP, que se llevaron a cabo la fusión vertebral posterior de T2/T4 a L4/L5, 164 tornillos se insertaron. RESULTADOS: 32,9% (n = 54) fueron mal colocados que ofrecen riesgo potencial, que se consideraba una desviación de 2 mm, 20,1% (n = 33), la invasión lateral, el 9,1% (n = 15) invasión medial, 3,6 % (n = 6) la invasión anterior. de los tornillos mal colocados el 46% (n = 25) fueron en la concavidad, el 35% (n = 19) en la convexidad y el 19% (n = 10) se curva cerca. CONCLUSIÓN: Los límites aceptables invasión no se determinaron también, y también los métodos de medición no están estandarizados. La técnica free hand resultó segura, además de violación pedículo. Pre-Op CT Scan mostró útil en la cirugía de la planificación y evitar complicaciones.OBJECTIVE: To Evaluate by CT scan tridimensional reconstruction, malpositioning of pedicle screws in adolescent idiopathic scoliosis patients. METHODS: It was analyzed CT scan cuts of 8 patients submitted to surgical treatment in Hospital de Base de São José do Rio Preto- SP, which were performed posterior spinal fusion from T2/T4 to L4/L5, 164 screws were inserted. RESULTS: 32,9% (n=54) were malpositioned offering potential risk, which was considered 2mm deviation, 20,1% (n=33) lateral invasion, 9,1% (n=15) medial invasion, 3,6% (n= 6) anterior invasion. From those malpositioned screws 46% (n=25) were in concavity, 35% (n=19) in convexity and 19% (n=10) were nearby curve. CONCLUSION: Acceptable invasion boundaries were not well determined, and also measurements methods are not standardized. The free hand technique proved safe, besides pedicle violation. Pre-Op CT Scan showed helpful in surgery planning and avoiding complications

Analysis of joint mobility patterns among preschool children

CONTEXT AND OBJECTIVE: Standardization of normal joint mobility criteria is complex, especially for preschool children, for whom differentiation from hypermobility (JH) is even more difficult. This study aimed to investigate joint mobility of the fifth finger, wrist, elbow, knee and trunk among preschool children, estimate the incidence of JH and evaluate the effect of gender and age and the applicability of standard criteria for identifying JH among preschool children. DESIGN AND SETTING: Cross-sectional descriptive and quantitative study, at São José do Rio Preto medical school. METHODS: 1,120 healthy children (534 boys, 47.7%; 586 girls, 52.3%; age range: 4-7 years) were evaluated using Beighton scores. Passive extension of fifth finger (> 90º), passive apposition of thumb to forearm, active extension of elbow and knee (> 10º) and anterior trunk flexion placing flat hand on ground were assessed. One point was scored for each positive result (maximum: 9). Scores > 4 were considered to be JH. Student’s t test and variance analysis were used for statistical analysis. RESULTS: JH was observed in 80% of wrists, 53.3% of fifth fingers, 36.6% of elbows, 14% of trunks and 12.5% of knees. Scores > 4 were found for 64.6% of the children. Females had higher angular values. Lower scores were associated with greater age. CONCLUSIONS: JH is a common condition among preschool children and currently available methods are inadequate. New parameters and criteria should be developed for identifying JH among these children