RESUMO
During the last 2 decades, there was an increasing interest in mini-invasive procedures for hallux valgus correction. In this scenario the Bösch technique appears to be a reproducible distal metatarsal osteotomy (DMO) to achieve a proper correction. Our DMO variant, called BC, was planned to combine the stability and predictability of the chevron osteotomy, with the power of correction, low surgical time and mini-invasive approach of the Bösch-SERI technique. The purpose of this investigation is to describe the surgical technique and report the results of this modified procedure at a minimum 2-year follow-up. Sixty-three patients who underwent the BC technique for mild and moderate hallux valgus were prospectively evaluated. Mean follow-up was 36.5 (range 23.4-59.8) months, the mean American Orthopedic Foot and Ankle Society score improved from a median of 47.4 points preoperatively to a median of 88 points postoperatively (p < .05). First MTPJ ROM did not change from preoperative period (mean 32.5°) to the postoperative period (mean 31.8°) (p > .65). All osteotomies went on to bony healing in the 6-week follow-up visit. Fifty-two (82%) of patients were either very satisfied or satisfied with the procedure (p < .05). With our numbers, BC osteotomy is shown to be a technique that can treat both mild and moderate deformities, achieving correction that is maintained over the follow-up evaluated, with a 24 relatively simple procedure and short operative time.
Assuntos
Joanete , Hallux Valgus , Ossos do Metatarso , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Osteotomia/métodos , Resultado do TratamentoRESUMO
Abstract Introduction: Lateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other. Objective: The aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model. Methods: Eight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n = 4), and percutaneous osteotomy (8 bones) in Group 2 (n = 4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively. Results: In the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed. Conclusion: Percutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique.
Resumo Introdução: Nas rinoplastias, a osteotomia lateral é realizada principalmente por via endonasal ou percutânea para correção de deformidades nasais. Ambas as técnicas apresentam vantagens e desvantagens. Objetivo: Comparar os efeitos histopatológicos sobre a cicatrização óssea e estabilidade nasal entre as técnicas de osteotomia endonasal e percutânea em rinoplastia em um modelo animal experimental. Método: Foram incluídos oito coelhos brancos da Nova Zelândia de um ano de idade. Hidrocloreto de xilazina e cetamina intramuscular foram administrados aos coelhos como agentes anestésicos. Osteotomia endonasal (8 ossos) foi realizada no Grupo 1 (n = 4) e osteotomia percutânea (8 ossos) no Grupo 2 (n = 4). Um mês depois, os coelhos foram sacrificados. A cicatrização óssea dos coelhos foi avaliada de acordo com o escore de cicatrização óssea de Huddleston et al. Em ambos os grupos, a integridade do osso nasal foi avaliada subjetivamente. Resultados: No grupo da osteotomia percutânea, observou-se cicatrização óssea de grau 1 em duas amostras (25%), cicatrização óssea de grau 2 em duas amostras (25%), e cicatrização óssea de grau 3 em quatro amostras (50%). No grupo da osteotomia endonasal, observou-se cicatrização óssea de grau 1 em 6 amostras (75%) e a cicatrização óssea de grau 2 foi observada em 2 amostras (25%). No grupo percutâneo, o tecido fibroso foi observado em 2 amostras, enquanto tecido predominantemente fibroso e uma menor quantidade de cartilagem foi observada em 2 e uma quantidade igual de tecido fibroso e cartilagem foi observada em 4 amostras. No grupo endonasal, observou-se tecido fibroso em 6 amostras e tecido predominantemente fibroso com uma menor quantidade de cartilagem em 2 amostras. Em ambos os grupos, quando força manual foi aplicada aos ossos nasais, a mesma resistência foi observada subjetivamente. Conclusão: A técnica de osteotomia lateral percutânea resultou em menor traumatismo ósseo e periosteal e melhor cicatrização óssea em comparação com a técnica de osteotomia endonasal.
Assuntos
Animais , Coelhos , Osteotomia/métodos , Rinoplastia/métodos , Cicatrização , Osso Nasal/cirurgia , Modelos Animais de Doenças , Osso Nasal/anatomia & histologiaRESUMO
INTRODUCTION: Lateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other. OBJECTIVE: The aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model. METHODS: Eight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n=4), and percutaneous osteotomy (8 bones) in Group 2 (n=4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively. RESULTS: In the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed. CONCLUSION: Percutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique.
Assuntos
Osso Nasal/cirurgia , Osteotomia/métodos , Rinoplastia/métodos , Cicatrização , Animais , Modelos Animais de Doenças , Osso Nasal/anatomia & histologia , CoelhosRESUMO
BACKGROUND: The purpose of this paper is to assess pain, function and complications after decompression of Mortons neuroma using a minimally invasive dorsal approach. METHOD AND RESULTS: 16 patients who underwent 19 decompressions were followed-up for 18 months. Pain was assessed with the visual analog scale (VAS), and function was assessed with the American Orthopedic Foot and Ankle Society (AOFAS) scale. Data was analyzed with the Student t test for related samples, which yielded a p value 0.05. The possible postoperative complications assessed were: skin problems, infections, wound dehiscence, delayed bone healing and recurrence. CONCLUSION: Minimally invasive decompression of Mortons neuroma is a procedure that provides pain relief and improvement in function, with a low complication rate.
ANTECEDENTES: El objetivo de este trabajo es evaluar el dolor, la función y las complicaciones posteriores a la descompresión del neuroma de Morton con abordaje dorsal por mínima invasión. MÉTODO Y RESULTADOS: Se estudiaron 19 descompresiones en 16 pacientes, en quienes se llevó a cabo un seguimiento de 18 meses. Se evaluó el dolor con la escala visual análoga (EVA) y la función con la escala de la American Orthopaedic Foot and Ankle Society (AOFAS). Los datos fueron aplicados a la prueba de T de Student para muestras relacionadas, con la cual se identificó un valor p 0.05. Se valoraron como posibles complicaciones postquirúrgicas lesiones dérmicas, infecciones, dehiscencia, retardo en la consolidación y recurrencia. CONCLUSIÓN: La descompresión por mínima invasión del neuroma de Morton es un procedimiento que aporta alivio del dolor y mejoría de la función con un porcentaje bajo de complicaciones.
Assuntos
Descompressão Cirúrgica , Neuroma Intermetatársico , Humanos , Neuroma Intermetatársico/complicações , Neuroma Intermetatársico/cirurgia , Dor , Medição da Dor , Resultado do TratamentoRESUMO
Resumen: Antecedentes: El objetivo de este trabajo es evaluar el dolor, la función y las complicaciones posteriores a la descompresión del neuroma de Morton con abordaje dorsal por mínima invasión. Método y resultados: Se estudiaron 19 descompresiones en 16 pacientes, en quienes se llevó a cabo un seguimiento de 18 meses. Se evaluó el dolor con la escala visual análoga (EVA) y la función con la escala de la American Orthopaedic Foot and Ankle Society (AOFAS). Los datos fueron aplicados a la prueba de T de Student para muestras relacionadas, con la cual se identificó un valor p < 0.05. Se valoraron como posibles complicaciones postquirúrgicas lesiones dérmicas, infecciones, dehiscencia, retardo en la consolidación y recurrencia. Conclusión: La descompresión por mínima invasión del neuroma de Morton es un procedimiento que aporta alivio del dolor y mejoría de la función con un porcentaje bajo de complicaciones.
Abstract: Background: The purpose of this paper is to assess pain, function and complications after decompression of Morton's neuroma using a minimally invasive dorsal approach. Method and results: 16 patients who underwent 19 decompressions were followed-up for 18 months. Pain was assessed with the visual analog scale (VAS), and function was assessed with the American Orthopedic Foot and Ankle Society (AOFAS) scale. Data was analyzed with the Student t test for related samples, which yielded a p value < 0.05. The possible postoperative complications assessed were: skin problems, infections, wound dehiscence, delayed bone healing and recurrence. Conclusion: Minimally invasive decompression of Morton's neuroma is a procedure that provides pain relief and improvement in function, with a low complication rate.