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- ItemAcesso aberto (Open Access)Comparação entre os resultados obtidos na reconstrução do ligamento cruzado anterior do joelho utilizando dois tipos de enxertos autólogos: tendão patelar versus semitendíneo e grácil(Sociedade Brasileira de Ortopedia e Traumatologia, 2009-06-01) Abdalla, Rene Jorge [UNIFESP]; Monteiro, Diego Antico; Dias, Leonardo; Correia, Dárcio Maurício; Cohen, Moises [UNIFESP]; Forgas, Andrea; Universidade Federal de São Paulo (UNIFESP); Centro de Ortopedia e Reabilitação no Esporte Centro de Estudos; Universidade de São Paulo (USP)OBJECTIVE: this study aims to compare the arthrometric and isokinetic examination results from two types of autologous grafts: the central third of the patellar ligament and a graft formed by the tendons of the semitendinosus and gracilis muscles, within the same rehabilitation protocol, six months after the surgery. METHODS: the results from examinations carried out on 63 patients were analyzed. These patients were divided in two groups: one group of 30 patients who received a patellar tendon graft and another group of 33 patients who received a graft from the tendons of the semitendinosus and gracilis muscles. Both the grafts were attached in the same way, with EndobuttonTM for suspensory fixation to the femur and a bioabsorbable interference screw for fixation in the tibial tunnel. RESULTS: arthrometry 30 did not present any statistical difference between the two study groups. On the other hand, the isokinetic evaluation showed that the patellar tendon group had a larger mean peak torque of flexion and greater extension deficit, while the semitendinosus/gracilis group had a better mean flexion/extension ratio and greater percentage of flexion deficit. There was no statistically significant difference between the groups when measuring peak torque extension. CONCLUSION: therefore, when the patellar tendon was used, there was greater extensor deficit and, when the semitendinosus/gracilis tendons were used, there was greater flexor deficit.
- ItemAcesso aberto (Open Access)Lesão do ligamento cruzado anterior: tratamento e reabilitação. Perspectivas e tendências atuais(Sociedade Brasileira de Ortopedia e Traumatologia, 2012-04-01) Arliani, Gustavo Gonçalves [UNIFESP]; Astur, Diego Da Costa [UNIFESP]; Kanas, Michel [UNIFESP]; Kaleka, Camila Cohen; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Faculdade de Ciências Médicas Grupo do JoelhoOBJECTIVE: The aim of this study was to evaluate the procedures used by knee surgeons in Brazil for treating and rehabilitating anterior cruciate ligament injuries. METHODS: A questionnaire consisting of 21 closed questions was developed, addressing topics relating to treatment and rehabilitation after anterior cruciate ligament reconstruction. The questionnaire was applied to Brazilian knee surgeons during the three days of the 42nd Brazilian Congress of Orthopedics and Traumatology in 2010. RESULTS: A total of 226 surgeons filled out the questionnaire completely. The most commonly used types of graft were hamstrings tendons and the central third of the ipsilateral patellar tendon, which were used by 82.3% and 53.5% of the sample, respectively. The technique of reconstruction with a single transtibial band was the first preference and was used by 66.4% of the participants. A period of 1 to 4 weeks between injury and surgical procedure was considered ideal by most participants (52.65%). Complaints from patients that the knee was 'giving way' or unstable and presence of a positive pivot shift maneuver were the most decisive factors considered in making the decision to operate the patient. Patient satisfaction and absence of complaints of instability during the postoperative period were the criteria deemed to be most important for the surgery to be considered a success. CONCLUSIONS: There are clearly evolving trends in treating and rehabilitating the anterior cruciate ligament in Brazil. However, more prospective controlled studies are needed in order to evaluate the clinical and scientific benefits of these trends.
- ItemAcesso aberto (Open Access)Método de segmentação de Esclerose Múltipla em imagem de ressonância magnética usando Fuzzy Connectedness, binarização, morfologia matemática e reconstrução 3D(Universidade Federal de São Paulo (UNIFESP), 2020-09-23) Arruda, Andre Luiz Costa De [UNIFESP]; Moraes, Matheus Cardoso [UNIFESP]; Universidade Federal de São PauloMagnetic resonance imaging (MRI) is the most used medical modality for diagnosis and monitoring of Multiple Sclerosis (MS). A segmentation process is an important task to quantify lesion and its progression. However, manual segmentation of 3D images is tedious, time consuming and often not reproducible. The state of the art presents results with room for improvements. Consequently, a semiautomatic segmentation process is proposed and described in this study. The method consists on a 3D segmentation semiautomatic process for MS lesions in MRI. It initiates by firstly carried out a preprocessing stage; thus, contrast adjustment is applied to enhance sclerosis regions from other brain information. Secondly, a feature extraction block based on Fuzzy Connectedness is performed so as to isolate sclerosis lesions from other brain regions. Finally, 3D brain reconstruction is executed along with sclerosis to provide a useful 3D information. The robustness of this approach is demonstrated by high correlation between the results and their corresponding Gold Standard. The results were also obtained by computing parameters of accuracy of image segmentation, as well as Overlap Dice. The proposed method reached True Positive of 75.61%, False Positive of 16.37% and Dice of 78.23%. The method is corroborated by its high correlation between specialist and proposed approach outcome; additionally, with the 3D reconstruction of the lesion, a better monitoring of the disease is provided, the specialist can understand the patient's symptoms, thereby increasing the patient's quality of life.
- ItemAcesso aberto (Open Access)Muscular subunits transplantation for facial reanimation(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-04-01) Hazan, André Salo Buslik; Nahas, Fabio Xerfan [UNIFESP]; Faria, Rodrigo Tiago; Sinder, Ramil; Ferreira, Lydia Masako [UNIFESP]; Souza Aguiar City Hospital; Universidade Federal de São Paulo (UNIFESP); Souza Aguiar City Hospital Reconstructive Microsurgery Division; Fluminense Federal University Plastic Surgery DivisionPURPOSE: To present an alternative technique for reconstruction of musculocutaneous damages in the face transferring innervated subsegments(subunits) of the latissimus dorsi flap for replacement of various facial mimetic muscles. METHODS: One clinical case of trauma with skin and mimetic muscles damage is described as an example of the technique. The treatment was performed with microsurgical transfer of latissimus dorsi muscle subunits. Each subunit present shape and dimensions of the respective mimetic muscles replaced. The origin, insertions and force vectors for the mimicmuscle lost were considered. Each subsegment has its own arterial and venous supply with a motor nerve component for the muscular unit. RESULTS: Pre and one year postoperative photos registration of static and dynamic mimic aspects, as well as digital electromyography digital data of the patients were compared. The transplanted muscular units presented myoeletric activity, fulfilling both the functional and cosmetic aspect. CONCLUSION: This technique seems to be a promising way to deal with the complex musculocutaneous losses of the face as well as facial palsy.
- ItemSomente MetadadadosOne-stage complex primary hypospadia repair combining buccal mucosa graft, preputial flap and tunical vaginalis flap (the three-in-one technique)(Elsevier B.V., 2011-02-01) Macedo, Antonio [UNIFESP]; Liguori, Riberto [UNIFESP]; Garrone, Gilmar [UNIFESP]; Ottoni, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Complex hypospadia repair can be performed according to different strategies, mostly in one or two stages. We present a detailed video of one patient operated according to the three-in-one technique, which combines dorsal buccal mucosa grafting for reconstruction of the incised urethral plate and a preputial flap onlay urethroplasty covered by a tunica vaginalis graft.Method: After sectioning of the urethral plate to correct ventral curvature, the original plate is anchored to the proximal penile shaft. Buccal mucosa is harvested from the lower lip and sutured to the ventral penile shaft area. A transverse preputial flap is obtained and anastomosed 'onlay' to the reconstructed neouretha. the scrotal fascia is opened at the site opposite to the placement of the pedicle of the preputial flap and a careful dissection of the tunica vaginalis and cremasteric tissue is performed. This second flap is used to cover the neourethra and is fixed to the corpora by angular interrupted 6-0 PDS sutures.Results: Our series of 35 patients resulted in 68.5% success after a single operation, whereas 31.5% needed a second repair.Conclusion: the technique gives excellent results and can be considered an alternative to one-stage repair in primary cases. (C) 2010 Journal of Pediatric Urology Company. Published by Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Reconstruction of the medial patellofemoral ligament in cases of acute traumatic dislocation of the patella: current perspectives and trends in Brazil(Sociedade Brasileira de Ortopedia e Traumatologia, 2014-10-01) Arliani, Gustavo Gonçalves; Silva, Adriano Vaso Rodrigues Da; Ueda, Léo Renato Shigueru; Astur, Diego Da Costa; Yazigi Júnior, João Alberto; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate the approaches and procedures used by knee surgeons in Brazil for treating medial patellofemoral lesions (MPFL) of the knee in cases of acute traumatic dislocation of the patella. Materials and methods: A questionnaire comprising 15 closed questions on topics relating to treating MPFL of the knee following acute dislocation of the patella was used. It was applied to Brazilian knee surgeons during the three days of the 44th Brazilian Congress of Orthopedics and Traumatology, in 2012. Results: 106 knee surgeons completely filled out the questionnaire and formed part of the sample analyzed. Most of them were from the southeastern region of Brazil. The majority (57%) reported that they perform fewer than five MPFL reconstruction procedures per year. Indication of non-surgical treatment after a first episode of acute dislocation of the patella was preferred and done by 93.4% of the sample. Only 9.1% of the participants reported that they had never observed postoperative complications. Intraoperative radioscopy was used routinely by 48%. The professionals who did not use this tool to determine the point of ligament fixation in the femur did not have a statistically greater number of postoperative complications than those who used it (p > 0.05). Conclusions: There are clear evolutionary trends in treatments and rehabilitation for acute dislocation of the patella due to MPFL, in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefit of these trends.
- ItemAcesso aberto (Open Access)Resultados clínicos e funcionais de pacientes submetidos à reconstrução cirúrgica minimamente invasiva para o tratamento das rupturas crônicas do tendão calcâneo.(Universidade Federal de São Paulo (UNIFESP), 2019-03-29) Silveira, Juliana Doering Xavier Da [UNIFESP]; Pochini, Alberto De Castro [UNIFESP]; Mansur, Nacime Salomão Barbachan; http://lattes.cnpq.br/2476659894036430; http://lattes.cnpq.br/5286610387997973; http://lattes.cnpq.br/2476659894036430; http://lattes.cnpq.br/9862279413112623; Universidade Federal de São Paulo (UNIFESP)Introduction: Achilles tendon chronic ruptures most often need surgical treatment to achieve the best possible functional outcomes. The minimally invasive approach described in this study aims at establishing a reliable and robust construction with minimal skin and wound complication rates. Objective: the present primary transversal study aims to assess the functional and clinical results after undergoing minimally invasive surgical approach as measured by the Single Heel Rise Test, anthropometric measures and two validated scores. Method: thirteen patients who had undergone the described surgical treatment during the period encompassed between 2013 and 2017 were evaluated after a minimal 12-month post-operative period. All patients performed the Single Heel Rise Test to assess muscle endurance. Their calf circumference and weight-bearing ankle dorsiflexion angle were measured for this very purpose. The patients were additionally assessed with the Achilles Tendon Total Rupture Score and Visual Analogic Scale to determine subjective clinical results. Results: a complication rate of 15.4% (2 patients) was established. A difference between both legs for the dorsiflexion angle (p<0.05) and calf circumference measurement (p<0.05) was found. A variation of 36% of muscle endurance for the functional heel rise test (p<0.05) was also observed. ATRS score (mean 82.8) was high despite the muscle endurance measures. Conclusion: the limbs operated according to the purposed technique showed less resistance strength when compared to the non-operated side. No correlation was established between this finding and the test scores obtained from the assessment of the subjective functional results. As such the minimally invasive approach performed in the patients in this study has robustly demonstrated to provide both satisfaction and good functional results.
- ItemSomente MetadadadosSkull reconstruction after resection of bone tumors in a single surgical time by the association of the techniques of rapid prototyping and surgical navigation(Springer Heidelberg, 2016) Anchieta, M. V. M.; Salles, F. A.; Cassaro, B. D.; Quaresma, M. M.; Santos, Bruno Fernandes de Oliveira [UNIFESP]Presentation of a new cranioplasty technique employing a combination of two technologies: rapid prototyping and surgical navigation. This technique allows the reconstruction of the skull cap after the resection of a bone tumor in a single surgical time. The neurosurgeon plans the craniotomy previously on the EximiusMed software, compatible with the Eximius Surgical Navigator, both from the company Artis Tecnologia (Brazil). The navigator imports the planning and guides the surgeon during the craniotomy. The simulation of the bone fault allows the virtual reconstruction of the skull cap and the production of a personalized modelling mold using the Magics-Materialise (Belgium)-software. The mold and a replica of the bone fault are made by rapid prototyping by the company Artis Tecnologia (Brazil) and shipped under sterile conditions to the surgical center. The PMMA prosthesis is produced during the surgical act with the help of a hand press. The total time necessary for the planning and production of the modelling mold is four days. The precision of the mold is submillimetric and accurately reproduces the virtual reconstruction of the prosthesis. The production of the prosthesis during surgery takes until twenty minutes depending on the type of PMMA used. The modelling mold avoids contraction and dissipates the heat generated by the material's exothermic reaction in the polymerization phase. The craniectomy is performed with precision over the drawing made with the help of the Eximius Surgical Navigator, according to the planned measurements. The replica of the bone fault serves to evaluate the adaptation of the prosthesis as a support for the perforations and the placement of screws and fixation plates, as per the surgeon's discretion. This technique allows the adequate oncologic treatment associated with a satisfactory aesthetic result, with precision, in a single surgical time, reducing time and costs.
- ItemSomente MetadadadosTransphyseal Anterior Cruciate Ligament Reconstruction in Patients With Open Physes(Elsevier B.V., 2009-08-01) Cohen, Moises [UNIFESP]; Ferretti, Mario [UNIFESP]; Quarteiro, Marcelo [UNIFESP]; Marcondes, Frank B. [UNIFESP]; Hollanda, Joao P. B. de [UNIFESP]; Amaro, Joicemar T. [UNIFESP]; Abdalla, Rene Jorge [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: the Purpose of this study was to evaluate the clinical Outcomes of transphyseal anterior cruciate ligament (ACL) reconstruction in patients with open physes. Methods: Transphyseal ACL reconstruction was performed in 26 patients with open tibial and femoral physes (physis > 2 mm) by use of autogenous quadrupled hamstrings as grafts. Meniscal tearing was found in 65.3% of the patients. Partial chondral defect injury on the medial femoral condyle was found 6 months after injury in only 2 patients (7.69% of all patients). the mean follow-up period was 45 +/- 18.3 months. Clinical Outcomes were evaluated by use of the International Knee Documentation Committee score and Lysholm Knee Scoring Scale, and the anteroposterior stability was objectively measured by use of KT-1000 arthrometer (MEDmetric, San Diego, CA). Possible length and angular discrepancies were observed by conventional radiography in a long film and scanograms of the lower limbs. Results: the mean length discrepancy between the operated lower limb and the contralateral limb was 1.2 +/- 3.2 mm (range, -7 to 7 mm). the mean angular deviation difference between the lower limbs was 0.46 degrees +/- 1.1 degrees. New traumatic injuries developed in 3 patients, in whom surgical revision was performed; 1 patient underwent a late meniscectomy. the mean difference in KT-1000 measurement was 2.0 +/- 1.0 mm. the mean subjective International Knee Documentation Committee score was 91.5 +/- 5.7, and the mean score oil the modified Lysholm scale was 93.5 +/- 4. of the patients, 3 (11.2% of all patients) could not return to the same level of physical activity as before injury. Conclusions: ACL reconstruction by use of the transphyseal technique in ail immature skeleton with a hamstring autograft, with careful attention being paid to the technique, resulted in good clinical outcomes and no growth abnormalities. Level of Evidence: Level IV, therapeutic Case series.
- ItemAcesso aberto (Open Access)Sem título(Sociedade Brasileira de Ortopedia e Traumatologia, 2014-07-01) Queiroz, Antônio Altenor Bessa de; Janovsky, César; Franciozi, Carlos Eduardo da Silveira [UNIFESP]; Ramos, Leonardo Addêo; Granata Junior, Geraldo Sérgio Mello; Luzo, Marcus Vinicius Malheiros [UNIFESP]; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To determine the reference points for the exit of the tibial guidewire in relation to the posterior cortical bone of the tibia. Methods: Sixteen knees from fresh cadavers were used for this study. Using a viewing device and a guide marked out in millimeters, three guidewires were passed through the tibia at 0, 10 and 15 mm distally in relation to the posterior crest of the tibia. Dissections were performed and the region of the center of the tibial insertion of the posterior cruciate ligament (PCL) was determined in each knee. The distances between the center of the tibial insertion of the PCL and the posterior tibial border (CB) and between the center of the tibial insertion of the PCL and wires 1, 2 and 3 (CW1, CW2 and CW3) were measured. Results: In the dissected knees, we found the center of the tibial insertion of the PCL at 1.09 ± 0.06 cm from the posterior tibial border. The distances between the wires 1, 2 and 3 and the center of the tibial insertion of the PCL were respectively 1.01 ± 0.08, 0.09 ± 0.05 and 0.5 ± 0.05 cm. Conclusion: The guidewire exit point 10 mm distal in relation to the posterior crest of the tibia was the best position for attempting to reproduce the anatomical center of the PCL.