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- ItemAcesso aberto (Open Access)Comparação das alterações do potencial evocado somatosensorial no tratamento cirúrgico da escoliose idiopática entre técnicas com e sem amarrilha sublaminar(Sociedade Brasileira de Coluna, 2010-09-01) Ueta, Renato Hiroshi Salvioni [UNIFESP]; Del Curto, David [UNIFESP]; Wajchenberg, Marcelo [UNIFESP]; Martins Filho, Délio Eulálio [UNIFESP]; Ferreira, Ricardo [UNIFESP]; Puertas, Eduardo Barros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: to compare the number of events with alteration in the somatosensory evoked potentials (SSEP) and its repercussion between different techniques of surgical treatment for idiopathic scoliosis, with and without sublaminar wiring. METHODS: twenty-five surgical procedures with flexible curves for treatment of idiopathic scoliosis were reviewed in the period of November 1996 to September 1999. They were divided into two groups: without sublaminar wiring (Cotrel-Dubousset's system) (Group I); and with sublaminar wiring (Harrington-Luque's system and rectangle of Hartshill) (Group II). In all surgeries, the intraoperative neurophysiologic monitoring with Somatosensory Evoked Potentials (SSEPs) was used. RESULTS: according to the findings, a bigger frequency of monitoring changes was observed during and at the end of the surgery in Group II. A high incidence of false-negative changes was also verified. No patient with neurological damages was observed. CONCLUSION: There are still doubts about the safest method for the surgical treatment of idiopathic scoliosis. The results presented in this study suggest a smaller incidence of SSEPs changes in the patients treated with Cotrel-Dubousset's system.
- ItemAcesso aberto (Open Access)Influência do trauma cirúrgico no comportamento dos níveis séricos de albumina após cirurgia da coluna vertebral(Sociedade Brasileira de Coluna, 2010-12-01) Luciano, Rafael Paiva [UNIFESP]; Leite, Marcio Squassoni [UNIFESP]; Martins, Délio Eulálio [UNIFESP]; Wajchenberg, Marcelo [UNIFESP]; Puertas, Eduardo Barros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: to evaluate the variation of serum albumin concentration in surgery of the spine and its relation to clinical effects in the postoperative. METHODS: prospective observational study on the values of serum albumin of 55 patients undergoing spine surgery.Blood samples were collected one day before and 24 hours after the procedure. The paired t test was performed to evaluate the change parameters albumin, hemoglobin and hematocrit. The presence of association between the degree of variation in levels of albumin (<1 g/dL or >1 g/dL) and the variables of interest: complications, transfusions, procedures performed, patients' age and sex and diagnosis were assessed by χ2 test or the χ2 likelihood ratio when appropriate. RESULTS: the average reduction of this protein was of 0.58 g/dL, ranging from 0 to 1.8 g/dL. Of the patients, 78.2% showed albumin values in the postoperative period below the normal range. Only two patients presented with complications during the 30 days of follow-up. The group with the correction of deformities showed 100% of patients with variation of >1 g/dL. CONCLUSION: there was an influence of the surgical trauma in reducing serum albumin, on average, 0.58 g/dL in surgery of the spine. It was not possible to associate this decrease to complications in the postoperative period after 30 days of follow-up of these patients.
- ItemAcesso aberto (Open Access)Intervenções cirurgicas (microfratura, perfuração, transplante osteocondral autologo e homologo) para o tratamento de lesões (osteo) condrais no joelho de adultos: revisão sistematica(Universidade Federal de São Paulo (UNIFESP), 2016-12-30) Gracitelli, Guilherme Conforto [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; http://lattes.cnpq.br/0981211406387862; http://lattes.cnpq.br/2455436508318062; Universidade Federal de São Paulo (UNIFESP)Introduction: Cartilage defects of the knee are often debilitating and predispose to osteoarthritis. Microfracture, drilling, mosaicplasty and allograft transplantation are four surgical treatment options that are increasingly performed worldwide. We set out to examine the relative effectiveness of these four different methods. Objective: To assess the effects (benefits and harms) of different surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults. Methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, SPORTDiscus, LILACS, trial registers and conference proceedings. Date of search: February 2016.Any randomised or quasi-randomised trials that evaluated surgical interventions (microfracture, drilling, mosaicplasty and allograft transplantation) for treating isolated cartilage defects of the knee in adults.At least two review authors independently selected studies, assessed risk of bias and extracted data. Intervention effects were assessed using risk ratios for dichotomous data and mean differences (MD) for continuous data, with 95% confidence intervals. Data were pooled using the fixed-effect model, where possible. Results: Three randomised controlled trials comparing mosaicplasty versus microfracture were included. These reported results for a total of 133 participants, of whom 79 (59%) were male. Mean ages in the three trials ranged between 24.4 and 32.3 years. All studies included cartilage lesion grade 3 or 4 (ICRS classification). The Defect area ranged from 1.0 to 6.0cm2. No trials of allograft transplantation or drilling were identified. All trials were judged as being at high or unclear risk for performance and reporting bias. Trials presented small sample size, with two studies in a single centre. Reflecting the imprecision of the results, the evidence was deemed to be of very low quality for all primary and secondary outcomes; which means that our level of uncertainty about the estimates is high. Data that assessed function were presented in all reports. Only one study (57 participants) found a clinically important difference in favour of mosaicplasty at one year (MD 10.29, 95% CI 7.87 to 12.71). This difference also continued at three years (mean 89 versus 75; reported P < 0.001) and at 10 years (MD 13.97, 95% CI 13.25 to 14.69). In the long-term (5 years and above), two trials pooled (72 participants) showed no clinically important difference between the two groups (MD -1.10, 95% CI -4.54 to 2.33). No trial found statistical or clinical difference of better long-term quality of life and pain symptoms. Pooled results for treatment failure reported at long-term follow-up in the three trials showed recurrence and re-operations were significantly fewer in the mosaicplasty group (10/64 versus 20/65; RR 0.47, 95% CI 0.24 to 0.90). The majority of failures were mainly due symptom recurrence. All trials reported activity score but due to clear statistical and clinical heterogeneity, we did not pool the long term Tegner score results. One study (57 participants) reported slightly higher Tegner score in intermediate-term (MD 0.48, 95% CI 0.21 to 0.75) and long-term (MD 0.72, 95% CI 0.46 to 0.98) in the mosaicplasty group, however between group difference may not be clinically important. Other two trials found no difference between the two groups for activity scores. Only one study reported and found a greater return to pre-injury level of sports activities in the higher mosaicplasty group (26/28 versus 15/29; RR 1.90, 95% CI 1.34 to 2.70); The same trial reported greater sports continuation in the mosaicplasty group at three years (25/28 versus 8/29; RR 3.24, 95% CI 1.77 to 5.92). Pooled data from two trials of participants with radiographically- defined osteoarthritis showed a significant difference in favour of mosaicplasty (9/40 versus 19/40; RR 0.48, 95% CI 0.25 to 0.92). Conclusion: Overall, there is a total lack of evidence about allograft transplantation or drilling and there is insufficient evidence to draw conclusions on the use of microfracture and mosaicplasty for treating isolated cartilage defects of the knee in adults in regards to function, quality of life, and activity. However, the "failure of treatment and adverse effects" and "quality of cartilage" was favorable for the mosaicplasty intervention. Due to the low evidence, further research is needed to define the best surgical option for treating isolated cartilage defects of the knee in adults.
- ItemSomente MetadadadosTendências do tratamento das lesões do ligamento cruzado anterior do joelho nos sistemas de saúde pública e suplementar do Brasil(Universidade Federal de São Paulo (UNIFESP), 2014-02-26) Batista, Rodrigo Martins Borges Ferreira [UNIFESP]; Cohen, Moises [UNIFESP]; http://lattes.cnpq.br/6174355233304675; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Orthopedic surgery implies high costs for both public and private healthcare. The aim of this study was to better understand the differences between the public and private sectors regarding the treatment of a damaged anterior cruciate ligament (ACL), which is a common knee injury. DESIGN AND SETTING: Descriptive cross-sectional study conducted during the Brazilian Orthopedics Congress in Brasília. METHODS: We applied questionnaires during the 2010 Brazilian Orthopedics Congress, with participation by 241 knee surgeons from 24 Brazilian states. This was followed by statistical analysis on the data that were obtained. RESULTS: The orthopedic surgeons who were evaluated used different approaches and treatment options in different Brazilian states, comparing between the public and private systems. DISCUSSION: Patients with ACL injuries are sometimes dealt with differently in the public and private systems in Brazil. In some situations, the results are not so disparate, but in others, the harm done both to patients and to surgeons themselves may become irreparable. This may be due either to the restrictions of healthcare operators or to the limited or poorly distributed budget of the Brazilian National Health System (Sistema Único de Saúde, SUS). In fact, what is done in practice does not always follow what the literature suggests as the most appropriate treatment. CONCLUSIONS: Both in the public and in the private systems in Brazil, because of nonmedical issues surrounding the treatment, the best medical decision is not always made. This may be harmful both to patients and to physicians.
- ItemAcesso aberto (Open Access)Tratamento do neuroma de Morton via plantar: avaliação retrospectiva dos resultados cirúrgicos(Sociedade Brasileira de Ortopedia e Traumatologia, 2007-01-01) Nery, Caio Augusto de Souza [UNIFESP]; Barroco, Rui dos Santos; Furlan, Cleber; Tardini, Carlos Henrique; Cemin, Fabio Serra; Mombach, Renan Galas; Universidade Federal de São Paulo (UNIFESP); FMABC Setor de Medicina e Cirurgia do Pé; FMABCWith the objective of assessing the effectiveness of the surgical technique involving neurectomy through plantar, cross-sectional port out of the load zone in individuals with Morton s neuroma, 217 patients were submitted to this treatment. A total of 264 feet were observed, being 32.2% right feet, 46.1% left feet, and 21.7% bilaterally. Regarding gender, 86.6% of the occurrences were seen in women, and 13.4% in men. Regarding the site, 83.5% (220 neuromas) were present at the third interdigital space, 7.5% at the second space, and 47 patients presented it bilaterally. The average follow-up time was 7.5 years, ranging from 4 to 216 months, with satisfactory and fair outcomes in 95.8% of all patients, with only 11 patients (4.2%) not satisfied with the overall treatment. The authors conclude, therefore, that neurectomy through cross-sectional plantar port is a satisfactory option, with good anatomical view of the neuroma, evolving well to healing, early return to activities and patient satisfaction with the outcome achieved.
- ItemAcesso aberto (Open Access)The WHO Surgical Safety Checklist: knowledge and use by Brazilian orthopedists(Sociedade Brasileira de Ortopedia e Traumatologia, 2013-12-01) Motta Filho, Geraldo Da Rocha [UNIFESP]; Silva, Lucia De Fatima Neves Da; Ferracini, Antonio Marcos; Bahr, Germana Lyra; Instituto Nacional de Traumatologia e Ortopedia; Universidade Federal de São Paulo (UNIFESP); Fundacao Oswaldo Cruz Escola Nacional de Saude Publica; Fundacao Getulio Vargas; Hospital San Rafael; Audencia School of Management; Universidade Federal do Rio de JaneiroObjective:The research examined Brazilian orthopedists' degree of knowledge of the World Health Organization Surgical Safety Checklist.Methods:A voluntary survey was conducted among the 3231 orthopedists taking part in the 44th Brazilian Congress of Orthopedics and Traumatology in November 2012, using a questionnaire on the use of WHO Surgical Safety Checklist. A statistical analysis was done upon receipt of 502 completed questionnaires.Results:Among the 502 orthopedists, 40.8% reported the experience of wrong site or wrong patient surgery and 25.6% of them indicated miscommunication as the main cause for the error. 35.5% of the respondents do not mark the surgical site before sending the patient to the operating room and 65.3% reported lack of knowledge of the World Health Organization (WHO) Surgical Safety Checklist, fully or partially. 72.1% of the orthopedists have never been trained to use this protocol.Discussion:Medical errors are more common in the surgical environment and represent a high risk to patient safety. Orthopedic surgery is a high volume specialty with major technical complexity and therefore with increased propensity for errors. Most errors are avoidable through the use of the WHO Surgical Safety Checklist. The study showed that 65.3% of Brazilian orthopedists are unaware of this protocol, despite the efforts of WHO for its disclosure.