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Importancia de la Relación Anatómica entre el nervio Isquiático y el Margen Posterior del Acetábulo en la Luxación Posterior de la Cadera
da Rocha,A. C; Monte Bispo,R. F; da Cruz,R. D; dos Santos,F. T. A; dos Santos,T. F. A; Olave,E; Sousa-Rodrigues,C. F;
International Journal of Morphology , 2012, DOI: 10.4067/S0717-95022012000300013
Abstract: the posterior dislocation of the hip joint is a trauma that can undergo a large part of the population, which may compromise the sciatic nerve, causing serious problems in the life of the affected individual. knowledge of the anatomical relationship between the sciatic nerve and the posterior margin of the acetabulum will facilitate accurate diagnosis and early um this injury. in order to study the topographical relationship of the sciatic nerve with the posterior margin of the acetabulum and provide background for orthopedic anatomical in posterior dislocations of the hip were studied 40 lower limbs formolized human cadavers, adults of both sexes , located in the topographical anatomy laboratories of the universidade estadual de ciencias da saude, alagoas, brasil. in 19 limbs (47.7%) sciatic nerve passed directly over the posterior margin of the acetabulum and the remaining 21 (53.3%), the nerve passed distal to the acetabular margin, distance ranging from 6-49 mm. the results show the close relationship between the sciatic nerve and the acetabular margin, which increases the possibility of nerve injury in posterior dislocation of the hip.
Selective Posterior Epiphysiodesis of the Triradiate Cartilage of the Acetabulum: Preliminary Results of an Experimental Study in Rabbits  [PDF]
Bibiana Dello Russo
Open Journal of Orthopedics (OJO) , 2016, DOI: 10.4236/ojo.2016.68032
Abstract: Background: Residual acetabular dysplasia is one of the main complications of developmental dysplasia of the hip (DDH). Without treatment, over time degenerative osteoarthritis of the joint will develop, inexorably leading to the need for joint replacement. Acetabular and/or femoral osteotomies do not avoid the appearance of osteoarthritis in a significant number of patients. The purpose of this study was to assess the possibility of provoking changes in the morphology of the acetabulum through selective epiphysiodesis of the extra-articular portion of the ilioischial arm of the triradiate cartilage, using a percutaneous cannulated screw with the guidance of an imaging intensifier in an experimental model in rabbits. Methods: In a pilot study, 3-week-old New Zealand rabbits (n = 20) were submitted to unilateral surgery of the hip while the contralateral hip of the same group was used as a control. Posterior epiphysiodesis to the triradiate cartilage of the acetabulum was performed by placement of a cannulated screw. The rabbits were followed-up until 18 weeks of life. Radiographic measurements of the hips were performed immediately postoperatively and at 12 weeks of life and before the rabbits were sacrificed at week 18. Three-dimensional computed tomography (3D-CT) scans were performed. Non-parametric tests for paired samples and the Wilcoxon test were used to compare the differences between group 1 and group 2. A p < 0.05 was considered significant. Results: The non-intervened hips showed that, when the rabbit matured, the acetabulum lost concavity and depth. When comparing the median differences of the angles evaluated at 12 weeks between groups, a statistically significant difference was found in all radiographic measurements: an increase in Wiberg’s angle but a decrease in acetabular index, acetabular angle of Sharp, acetabular depth index, and acetabular anteversion. Evaluating the operated hips at 12 and 18 weeks (three months after having removed the screw) using 3D-CT, we observed a rebound effect in the correction confirming that the effect obtained through selective epiphysiodesis did not cause the definitive closure of the cartilage. Conclusions: Selective growth arrest of the ilioischial arm of the triradiate cartilage (posterior epiphysiodesis) can alter growth and change the shape of the acetabulum in rabbits. A rebound effect was observed when the screw was removed, confirming that the technique did not provoke definitive closure of the physis. Level of evidence: Level-2, therapeutic study.
Biomechanical Comparison of Different Stabilization Constructs for Unstable Posterior Wall Fractures of Acetabulum. A Cadaveric Study  [PDF]
Yuntong Zhang, Yang Tang, Panfeng Wang, Xue Zhao, Shuogui Xu, Chuncai Zhang
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082993
Abstract: Purpose Operative treatment of unstable posterior wall fractures of acetabulum has been widely recommended. This laboratory study was undertaken to evaluate static fixation strength of three common fixation constructs: interfragmentary screws alone, in combination with conventional reconstruction plate, or locking reconstruction plate. Methods Six formalin-preserved cadaveric pelvises were used for this investigation. A posterior wall fracture was created along an arc of 40–90 degree about the acetabular rim. Three groups of different fixation constructs (two interfragmentary screws alone; two interfragmentary screws and a conventional reconstruction plate; two interfragmentary screws and a locking reconstruction) were compared. Pelvises were axial loaded with six cycles of 1500 N. Dislocation of superior and inferior fracture site was analysed with a multidirectional ultrasonic measuring system. Results: No statistically significant difference was found at each of the superior and inferior fracture sites between the three types of fixation. In each group, the vector dislocation at superior fracture site was significantly larger than inferior one. Conclusions All those three described fixation constructs can provide sufficient stability for posterior acetabular fractures and allow early mobilization under experimental conditions. Higher posterior acetabular fracture line, transecting the weight-bearing surface, may indicate a substantial increase in instability, and need more stable pattern of fixation.
Comparative Study of W-Shaped Angular Plate and Reconstruction Plate in Treating Posterior Wall Fractures of the Acetabulum  [PDF]
Qi Zhang, Wei Chen, Xiaobo Wu, Yanling Su, Zhiyong Hou, Yingze Zhang
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0092210
Abstract: Objective This study aims to assess the medium-term results of the reconstruction of posterior wall fractures using a W-shaped acetabular angular plate (WAAP) compared to those fixed using a reconstruction plate. Methods Between July 2006 and March 2009, we performed a retrospective study, which collected data for any patient treated for a posterior acetabular wall fracture. At the time of treatment, patients were either treated using a WAAP or a pelvic reconstruction plate. The intraoperative fluoroscopic images for both groups were compared. The quality of reduction and radiological grading were assessed according to the criteria developed by Matta. The clinical assessment was based on a modified Merle d’Aubigne and Postel scoring. Results 53 patients met the inclusion criteria and were followed up for an average of 38 months. 25 patients were treated with a WAAP (study group), and 28 patients were treated with a pelvic reconstruction plate (control group). The intraoperative fluoroscopic images of the study group confirmed extra-articular screw placement in all cases. In the control group, intra-articular screw placement was observed intraoperatively in 5 patients (17.86%), and the definitive location of the periarticular hardware could not be determined in 4 patients (14.29%) during the operation. The differences between the two groups were statistically significant (p = 0.002). In contrast, the quality of fracture reduction, clinical outcomes, and radiological grading in the study group were not significantly different from those of the control group (p>0.05). The radiographic grade was strongly associated with the clinical outcomes in both the study and control groups (p<0.05). Conclusion Reconstruction of posterior wall fractures of the acetabulum using a WAAP can help avoid screw penetration of the hip joint, provide a stable fixation of the posterior wall, and ensure good clinical outcomes.
Abordaje posterior mínimamente invasivo en artroplastia total de cadera: Estudio prospectivo y aleatorizado. Un a o de seguimiento Minimally invasive posterior approach in total hip arthroplasty: Prospective randomised trial  [cached]
J. R. Varela-Egocheaga,M.A. Suárez-Suárez,M. Fernández-Villán,V. González-Sastre
Anales del Sistema Sanitario de Navarra , 2010,
Abstract: Fundamento. La hipótesis de trabajo fue que la cirugía mínimamente invasiva era superior a la convencional para el proceso de artroplastia total de cadera. Para ello se compararon los resultados de la cirugía mínimamente invasiva con los de la cirugía convencional en artroplastia total de cadera. Material y métodos. Ensayo clínico prospectivo y aleatorizado. Se seleccionaron 50 pacientes, los cuales fueron divididos en dos grupos en función del abordaje quirúrgico: posterior mínimamente invasivo o posterior directo convencional. Se evaluaron el sangrado perioperatorio, el dolor postoperatorio, el tiempo de recuperación, la orientación y ajuste de los componentes, la tasa de complicaciones y el resultado funcional y se han seguido a los pacientes un a o mínimo. Resultados. No se han encontrado diferencias significativas entre los grupos en cuanto a sangrado perioperatorio. El dolor postoperatorio fue menor con la cirugía mínimamente invasiva, la velocidad de recuperación fue significativamente mayor con el abordaje posterior mínimamente invasivo al detectarse una menor estancia hospitalaria y un inicio más precoz de la deambulación. No se encontraron diferencias en cuanto a tiempo quirúrgico, orientación y ajuste de los componentes, tasa de complicaciones ni resultado funcional. Impacto económico favorable a la cirugía mínimamente invasiva con un ahorro del 5% del total de coste del proceso. Conclusiones. El abordaje posterior mínimamente invasivo disminuye el dolor y acelera la recuperación con un impacto económico favorable, sin mostrar diferencias en ninguna de los demás aspectos estudiados. Backgrond. Our working hypothesis was that minimally invasive surgery was superior to conventional surgery for total hip arthroplasty procedure. We compared THR results in the minimally invasive posterior approach with THR results in the conventional posterior approach. Methods. Prospective, randomised trial. Fifty patients were selected and then divided into two groups based on treatment (minimally invasive posterior approach or conventional posterior approach). Data collected: Perioperative bleeding, postoperative pain, time of recovery, component orientation, complications and functional results. One year follow-up. Results. No differences were found in blood loss, surgical time, component orientation, rate of complications or functional result. The minimally invasive lateral approach produced less postoperative pain and a faster recovery, with a shorter hospital stay and earlier walking-start, and a positive economic impact with 5% of the total process cost sa
Paolo Ricci A,Odette Freundlich K,Vicente Solà D,Jack Pardo S
Revista Chilena de Obstetricia y Ginecología , 2008,
Abstract: Objetivo: Demostrar la efectividad de la neuromodulación con el sistema de estimulación transcutánea del nervio tibial posterior, en la inhibición de las contracciones no inhibidas del detrusor, en paciente con urgeincontinencia refractaria a tratamiento. Paciente: Se presenta un caso de incontinencia de orina mixta, con solución al componente de esfuerzo mediante TVT-Secur. El componente de urgencia, dado por vejiga hiperactiva, se trata mediante neuromodulación transcutánea del nervio tibial posterior, refractario al tratamiento medicamentoso y fisioterapia. Se demuestra objetivamente la acción de la neuromodulación, mediante la realización de una cistometría (urodinamia monocanal) durante la estimulación de nervio tibial (estímulos en modo continuo a 20 Hz y 200 milisegundos), comparada con la realizada sin estimulación. Resultados: Las contracciones no inhibidas del detrusor se inhibieron al realizar la neuromodulación con el sistema de estimulación transcutáneo del nervio tibial posterior, demostrado objetivamente por la desaparición de las contracciones durante la fase de llenado vesical. La capacidad cistométrica máxima, aumentó durante la neuromodulación y la sensación urgencia miccional disminuyó. Conclusión: La neuromodulación con el sistema de estimulación transcutánea del nervio tibial posterior, es efectiva en el tratamiento de la vejiga hiperactiva, lo que es posible de objetivar mediante la realización de una cistometría con urodinamia monocanal. Esta terapia ofrece una alternativa de tratamiento, con todas las características de mínima invasión. Objective: To demonstrate objectively the efficiency of the neuromodulation with the transcuteneous posterior tibial nerve stimulation in overactive bladder, in a patient with urge incontinence, refractory to traditional treatments. Patient: A case of urinary mixed incontinence is presented. The TVT-Secur was used for the stress urinary incontinence. The urge-incontinence due to overactive bladder was treated by transcutaneous tibial nerve neuromodulation when refractory appearing to the treatment with medicines and physiotherapy by thirty days. The action of the neuromodulation is demonstrated objectively by cystometry. Monochannel urodynamic equipment was used. The Biomed 2000 equipment was used for the transcutaneous neuromodulation, with stimuli in continuos way to 20 Hertz and 200 milliseconds. Results: The transcutaneous tibial nerve neuromodulation is able to inhibit the contraction of the detrusor, in a patient with urge-incontinence refractory to medical treatment. This is demonstrated o
Fractura de Cadera en los hospitales públicos de la Argentina Hip Fracture in Public Hospitals of Argentina  [cached]
Mánica A Ercolano,Mánica L Drnovsek,Alicia Gauna
Revista Argentina de Endocrinología y Metabolismo , 2012,
Abstract: La fractura de cadera en población a osa constituye un problema creciente para los sistemas de salud a nivel mundial debido a su elevado impacto econámico y social. Objetivos: Evaluar los egresos por fractura de cadera en adultos mayores de 55 a os informados al Ministerio de Salud de la Nación durante los a os 2000, 2006, 2007 y 2008. Analizar el efecto de la edad y sexo sobre la incidencia de fracturas de cadera, los tipos de fractura y su variabilidad en el tiempo. Materiales y Métodos: Se obtuvieron los datos de egresos por fracturas de cadera en pacientes mayores de 55 a os registrados en el Ministerio de Salud de la Nación. Se calculá la Tasa de Egresos (TE) por fracturas de cadera, la TE estratificada por sexo (♀: mujer, ♂: varán) y edad; Tasa de Crecimiento Interanual (TCI). Estadística: test de Chi cuadrado y test T de Student para datos no apareados. Resultados y Conclusiones: La fractura de cadera en los hospitales públicos de la Argentina durante los a os evaluados, alcanzá un promedio de 5700 egresos/a o, con una TE 280/100000. La relación ♀/♂ fue de 2,3. La edad de egreso promedio fue de 78,7 a os siendo significativamente menor en los hombres en relación a las mujeres. La relación ♀/♂ aumentá tres veces con la edad. La edad fue un fuerte determinante de las fracturas, siendo la TE de 2800/100000 en los individuos mayores de 75 a os. La TCI fue de 1,4 %. La fractura cervical de fémur fue la más frecuente, y fue aumentando progresivamente con la edad; la fractura de trocánter se mantuvo estable en los grupos de menor edad y solo aumentá en los mayores de 75 a os. Ambos tipos de fractura predominaron en las mujeres. Este es el primer trabajo que establece datos sobre fractura de cadera en la Argentina. Con el envejecimiento de la población, la fractura de cadera se convertirá en una carga progresivamente mayor para los sistemas de salud. Hip fracture in the aged population constitutes a growing problem for health systems at a global level because of its economic and social impact. Objectives: to assess discharges for hip fracture in adults over the age of 55 reported to the Ministry of Health of Argentina during the years 2000, 2006, 2007 and 2008; analyze the effect of age and sex on the incidence of hip fractures and its variability over time. Materials and Methods: The discharge data for hip fractures in patients over 55 years were obtained from registers of the Ministry of Health of Argentina. We calculated the Discharge Rate (DR) by hip fractures, DR of fractures stratified by sex (♀: female, ♂: male) and age; the Annual Growth Rate (AG
Distribución topográfica de la respuesta cortical del potencial evocado somatosensorial del nervio tibial posterior Topographical distribution of the cortical response of the somatosensorial evoked potencial of the posterior tibial nerve  [cached]
Ernesto Cruz Menor,Yunit Hernández Rodríguez,Marlén Cruz Menor,Juan M Riol Lozano
Revista de Ciencias M??dicas de Pinar del R?-o , 2006,
Abstract: La respuesta cortical del Potencial Evocado Somatosensorial del nervio tibial posterior ha mostrado en diferentes investigaciones una gran variabilidad en cuanto a los resultados obtenidos por diferentes autores. Los objetivos de este trabajo fueron evaluar en una muestra de sujetos adultos sanos la distribución topográfica de la respuesta cortical del potencial evocado somatosensorial del nervio tibial posterior empleando un protocolo de registro con 19 derivaciones del Sistema Internacional 10/20 en el equipo MEDICID-4. Se estudiaron 18 sujetos adultos sanos. En todos los sujetos se obtuvo la respuesta cortical P40, manteniéndose los 19 canales de registro, modificándose los filtros a valores entre 0.5 y 300 Hz, y la frecuencia de muestreo se modificó a 1000 Hz. Los resultados muestran una máxima amplitud de la P 40 en línea media. Además, simultáneamente se obtiene dicha respuesta en la propia región centro-parietal ipsilateral, sin existir gran variabilidad intra e interindividuos. De esto se concluye que la estimulación del nervio tibial el pico P40 mostró una distribución cortical centro-parietal tanto en línea media como ipsilateral, con máxima amplitud en esta última, es decir, la P40 se obtuvo paradójicamente con mayor amplitud hacia la misma región del lado estimulado. The cortical response of the somatosensorial evoked potential of the posterior tibial nerve has shown, in different research works, a great variability in terms of the results obtained by different authors. The aims of this paper were to evaluate in a sample of healthy adult individuals the topographical distribution of the cortical response of the somatosensorial evoked potential of the posterior tibial nerve by using a protocol registration with 19 derivations from the International System 10/20 in the MEDICID-4 team. Eighteen adult individuals were studied. In each individual the cortical response was P40, remaining the 19 registration canals, modifying the filter between 0.5 and 300 Hz, and the sampling frequency was modified to 1000 Hz. Results show a maximum amplitude of the P40 in the middle line. In addition, simultaneously, such response is registered in the central parietal ipsilateral region, with no great intraindividual and interindividual variability. As a conclusion, the stimulation of the tibial nerve and peak P40 showed a cortical central parietal distribution in the middle line, as well as ipsilaterally, with maximum amplitude in the latter. P40 was obtained paradoxically with a greater amplitude towards the same region of the stimulated site.
Physical activity and osteoporosis hip fracture in postmenopausal women EJERCICIO Fí SICO Y RIESGO DE FRACTURA OSTEOPORóTICA DE CADERA EN MUJERES POSTMENOPAUSICAS.  [cached]
J. Ponce,A. álvarez,F. Pascual,L.P. Rodrí-guez
Motricidad : European Journal of Human Movement , 2010,
Abstract: Studies from 1968 on postmenopausal osteoporosis, osteoporotic hip fracture, and fundamentally the association betwen physical activity and hip fractures in postmenopausal women are reviewed. Physical activity has been related to enhanced bone mass and improved physical functioning and thus may reduce the risk for osteoporotic hip fracture. All the studies suggest a protectiv effect of physical activity with regard to hip fractures reducing the risk of later fracture by up to 50%. Higher levels of leisure time, sport activity, and household chores and fewer hours of sitting daily were associated with a significantly reduced relative risk for hip fracture after adjustment for age, dietary factors, falls, and functional and health status. Low-intensity activities may be the most prudent recommendation for sedentary older women. KEY WORDS: Osteoporosis, hip fracture, physical activity, postmenopausal women. Se han revisado desde 1968 estudios sobre osteoporosis postmenopáusica, fractura osteoporótica de cadera y, fundamentalmente, asociación entre actividad física y fracturas de cadera en mujeres postmenopáusicas. Se ha relacionado la actividad física con un incremento de la masa ósea y una mejora de la condición física, pudiendo por tanto reducir el riesgo de fractura osteoporótica de cadera. Todos los estudios sugieren un efecto protector de la actividad física sobre las fracturas de cadera, reduciendo el riesgo posterior de fractura hasta un 50%. Más tiempo de ocio, actividades deportivas, tareas domésticas y menos horas diarias sentado se han asociado con un riesgo relativo significativamente menor de fractura de cadera, tras ajuste considerando edad, dieta, caídas y estado funcional y de salud. Actividades de baja intensidad puede ser la recomendación más prudente para las mujeres sedentarias de edad avanzada. PALABRAS CLAVE: Osteoporosis, fractura de cadera, actividad física, mujeres postmenopáusicas.
Antecedentes, historia y pronóstico de la displasia del desarrollo de la cadera Backgrounds, history and prognosis of hip dysplasia development
Octavio Silva-Caicedo,Diego Alexander Garzón-Alvarado
Revista Cubana de Investigaciones Biom??dicas , 2011,
Abstract: La displasia de cadera es una enfermedad que se presenta en ni os menores de dos a os, pero puede tener consecuencias importantes en edad adulta, incluso, puede llevar a osteoartrosis de cadera, y por tanto, desembocar en invalidez en adultos jóvenes. La displasia de cadera es una afección ósea que puede tener su raíz en defectos congénitos, hereditarios, o degenerativos que llevan a una formación inadecuada de la articulación de la cadera (coxofemoral) que puede provocar, a mediano plazo, una deficiente formación de la articulación y cojera y a largo plazo, desgaste excesivo de la articulación e invalidez. Por tanto, se requieren estudios actualizados que relaten los avances más importantes en la comprensión, desarrollo, pronóstico y tratamiento de esta importante enfermedad que afecta de 15 a 20 por cada 1 000 ni os y tiene como principal víctima a las ni as recién nacidas. Desde este punto de vista el objetivo de este artículo es presentar el estado del arte, los antecedentes, historia y pronóstico de la displasia del desarrollo de la cadera. Por tanto, este trabajo puede ser de especial importancia para los médicos, ortopedistas y fisioterapeutas que requieran de una actualización en el tema de la displasia de la cadera. Hip dysplasia is a disease present in children under two years, but may to have significant consequences in adulthood; even it may leads to a hip osteoarthrosis and thus, to provoke disability in young adults. The his dysplasia is a bone affection that may to have its origin in congenital, hereditary or degenerative disorders that a medium term may to cause of an inappropriate formation in hip joint (coxofemoral) and claudication, and at long term, an excessive corrosion and disability. Thus, updated studies are necessary relating the more significant advances in understanding, development, prognosis and treatment of this important entity affecting 15-20 by each 1 000 children and its major victims are the newborn girls. From this point of view, the aim of present paper is to present the backgrounds, history and prognosis of hip dysplasia development. Therefore, present paper may to be very important for physicians, orthopedists, and physiotherapists updating on hip dysplasia.
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