Revisiones_bibliográficas TyO

martes, 20 de junio de 2017

Cirugía mínimamente invasiva de la columna vertebral en la espondilodiscitis lumbar: un análisis retrospectivo de un solo centro de 67 casos

http://www.cirugiavertebral.com.mx/academia/cirugia-minimamente-invasiva-de-la-columna-vertebral-en-la-espondilodiscitis-lumbar-un-analisis-retrospectivo-de-un-solo-centro-de-67-casos/

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases.

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28608178

https://link.springer.com/article/10.1007%2Fs00586-017-5180-x

De:

Tschugg A1,Hartmann S2,Lener S2,Rietzler A3,Sabrina N4,Thomé C2.

Eur Spine J.

2017 Jun 12. doi: 10.1007/s00586-017-5180-x. [Epub ahead of print]

Copyright information

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Abstract

BACKGROUND:

Minimally invasive surgical techniques have been developed to minimize tissue damage, reduce narcotic requirements, decrease blood loss, and, therefore, potentially avoid prolonged immobilization. Thus, the purpose of the present retrospective study was to assess the safety and efficacy of a minimally invasive posterior approach with transforaminal lumbar interbody debridement and fusion plus pedicle screw fixation in lumbar spondylodiscitis in comparison to an open surgical approach. Furthermore, treatment decisions based on the patient´s preoperative condition were analyzed.

CONCLUSION:

The open technique is effective in all varieties of spondylodiscitis inclusive in epidural abscess formation. MIS can be applied safely and effectively as well in selected cases, even with epidural abscess.

KEYWORDS:

Epidural abscess; Minimally invasive spine surgery; Spinal infection; Spondylodiscitis; Transforaminal lumbar interbody fusion

Resumen

ANTECEDENTES:

Se han desarrollado técnicas quirúrgicas mínimamente invasivas para minimizar el daño tisular, reducir los requerimientos de narcóticos, disminuir la pérdida de sangre y, por tanto, evitar potencialmente la inmovilización prolongada. El propósito del presente estudio retrospectivo fue evaluar la seguridad y la eficacia de un abordaje posterior mínimamente invasivo con desbridamiento y fusión intersomatica lumbar transforaminal más fijación de tornillo pedícular en espondilodiscitis lumbar en comparación con un abordaje quirúrgico abierto. Además, se analizaron las decisiones de tratamiento basadas en la condición preoperatoria del paciente.

CONCLUSIÓN:

La técnica abierta es eficaz en todas las variedades de espondilodiscitis inclusive en la formación de abscesos epidurales. El MIS se puede aplicar con seguridad y efectividad también en casos seleccionados, incluso con absceso epidural.

PALABRAS CLAVE:
Absceso epidural; Cirugía de columna mínimamente invasiva; Infección espinal; Espondilodiscitis; Fusión intersomática lumbar transforaminal

PMID: 28608178 DOI:

10.1007/s00586-017-5180-x

#cirugía mínimamente invasiva #columna vertebral #espondilodiscitis lumbar

lunes, 19 de junio de 2017

Fracturas Periprotésicas en Megaprosthesis: Abordaje Algorítmico para el Tratamiento.

http://www.reemplazoprotesico.com.mx/academia/fracturas-periprotesicas-en-megaprosthesis-abordaje-algoritmico-para-el-tratamiento/

Periprosthetic Fractures in Megaprostheses: Algorithmic Approach to Treatment.

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28112789

https://www.healio.com/orthopedics/journals/ortho/2017-5-40-3/%7Bd4eb9a92-28d7-4990-a1ce-a7eca2cc3921%7D/periprosthetic-fractures-in-megaprostheses-algorithmic-approach-to-treatment

De:

Savvidou OD,Sakellariou VI,Megalooikonomou P,Mavrogenis AF,

Papagelopoulos PJ.

Orthopedics.

2017 May 1;40(3):e387-e394. doi: 10.3928/01477447-20170117-07. Epub 2017 Jan 23.

Copyright 2017, SLACK Incorporated.

Abstract

With increases in both life expectancy and the number of patients with endoprosthetic replacements, more periprosthetic fractures are expected to occur. Periprosthetic fractures related to megaprostheses present a treatment challenge, with a high incidence (one-third of affected patients) of secondary revision as a result of prosthetic loosening, infection, nonunion, refracture, or even amputation. Efforts to improve endoprosthetic reconstruction should focus on preventing postoperative complications. Understanding the causes of complications and strategies to avoid them could lead to significant improvements in implant survival, limb function, and patient outcomes. This article presents a concise review of the current literature and an algorithmic approach to reconstruction of these complex injuries. [Orthopedics. 2017; 40(3):e387-e394.].

Resumen

Con aumentos en la esperanza de vida y el número de pacientes con reemplazos endoprotésicos, se esperan más fracturas periprotésicas. Las fracturas periprotésicas relacionadas con las megaprotesis presentan un reto de tratamiento, con una alta incidencia (un tercio de los pacientes afectados) de revisión secundaria como resultado del aflojamiento protésico, infección, no unión, refracción o incluso amputación. Los esfuerzos para mejorar la reconstrucción endoprótesis deben centrarse en la prevención de complicaciones postoperatorias. Entender las causas de las complicaciones y las estrategias para evitarlas podría conducir a mejoras significativas en la supervivencia del implante, la función de la extremidad y los resultados del paciente. Este artículo presenta una revisión concisa de la literatura actual y un abordaje algorítmico para la reconstrucción de estas lesiones complejas. [Ortopedía. 2017; 40 (3): e387 – e394.].

PMID: 28112789 DOI:

10.3928/01477447-20170117-07

#reemplazos endoprotésicos #fracturas periprotésicas #megaprotesis #abordaje algorítmico

Clasificación de la fractura del cuello femoral

http://www.ortopedistaseguro.com.mx/academia/clasificacion-de-la-fractura-del-cuello-femoral/

Femoral Neck fracture classification

Fuente
Este artículo es originalmente publicado en:

https://youtu.be/U4xqHvIkDUI

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Publicado el 5 may. 2017

Dr. Ebraheim’s educational animated video describes classifications of femoral neck fractures.

Femoral neck fractures can occur as a result of low energy trauma in the elderly. In this case you will need to get a medical consultation! Femoral neck fractures can also occur due to high energy trauma, such as with falls or motor vehicle accidents. Femoral neck fractures can occur in older as well as younger patients, and in these cases you need to apply the ATLS protocol. Femoral neck fractures can also occur due to insufficiency fractures. This occurs due to weak bones, because of osteoporosis or osteopenia. The patient will have groin pain, pain with axial compression and the x-ray may be normal (helpful in diagnosing insufficiency fracture). There may also be a stress fracture due to overuse and more loading on the hips. Stress fractures may occur in athletes, ballet dancers, or military recruits.
Anatomic classification
1. Subcapital – common
2. Transcervical
3. Basicervical
The subcapital fracture has two classifications: the garden classification and Pauwel’s classification. The garden classification system classifies the fracture according to the amount or degree of displacement. It relates the amount of displacement to the risk of vascular disruption. This classification applies to the geriatric and insufficiency fractures. It can then be classified into two groups: the nondisplaced and the displaced. Types I and II are nondisplaced, while types III and IV are displaced. Type I is incomplete and impacted in valgus. Type II is a complete fracture and nondisplaced on at least two planes (anteroposterior & lateral). Type III is a complete fracture and partially displaced. The trabecular pattern of the femoral head does not line up with the acetabular trabecular pattern. A type IV fracture is completely displaced with no continuity between the proximal and distal fragments. The trabecular pattern of the femoral head remains parallel with the acetabulum trabecular pattern.
The Pauwel’s Classification is classified into three fracture types. It classifies the fracture according to the orientation and direction of the fracture line across the femoral line. It related to the biomechanical stability. The more vertical the fracture, the more sheer forces and the more the complication rate. Type I is stable and has an obliquity ranging from 0-30 degrees. Type II is less stable and have an obliquity ranging from 30-50 degrees. Lastly, type III is unstable and has an obliquity between 50-70 degrees or more. As the fracture progresses from Type I – Type III, the obliquity of the fracture line increases. As the fracture line becomes more vertical, the sheer forces increase and the instability increases. A horizontal fracture is good and stable while a vertical fracture is bad and unstable. The more displaced the fracture, the more disruption of the blood supply and the chance of avascular necrosis and nonunion (can occur in about 25% of displaced fractures). In nonunion occurs in a younger patient, you may help the patient by doing a subtrochanteric osteotomy to reorient the fracture line from vertical to horizontal (will help the fracture healing).
Femoral Neck Fractures Associated with Femoral Shaft Fractures
The typical neck fracture is vertical and nondisplaced. It may require internal rotation view x-rays to see this hip fracture (fracture could be missed). Treatment of this fracture is to fix the femoral neck fracture first, followed by the femoral shaft fracture. The usual combination is parallel screws in the femoral neck and a retrograde femoral rod for the fractured femur.
Stress fractures are more common in females due to the female athletic triad. It can be a tension fracture. The fracture or callus is present on the superior aspect of the femoral neck. Adult bone is weak in tension, so stress fracture of the femoral neck needs to be fixed! This should be an emergency operation before the fracture displaces. With compression fractures, the compression or callus is present on the inferior aspect of the femoral neck. It is believed that if the compression fracture is less than 50% across the neck, then the fracture could be stable and you can do protected crutch ambulation. If the fracture is more than 50% across the neck, then the fracture is unstable and you will do an ORIF. Some surgeons fix all stress fractures of the femoral neck. A female runner with groin pain can indicated a stress fracture. Get an MRI, the fracture will probably need to be fixed.

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