Revistas
Revista:
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
ISSN:
0002-8614
Año:
2024
Vol.:
72
N°:
1
Págs.:
268 - 279
Background: Vitamin D deficiency has been linked to numerous health issues, including an increased risk of hip fractures. This meta-analysis aimed to investigate the relationship between vitamin D deficiency and mortality in patients with hip fracture. To assess the impact of different levels of vitamin D deficiency on mortality in patients with hip fractures and examine the influence of potential confounding factors.Methods: A systematic search of PubMed, EMBASE, Scopus, and Cochrane Collaboration Library was conducted, resulting in nine eligible cohort studies (n = 4409). Patients with hip fractures were categorized based on their vitamin D levels as severe, moderate, or insufficient. Mortality was the primary outcome measure in this study. Subgroup analyses were performed according to the follow-up time. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model in Review Manager 5.4.Results: Nine studies, with a pool of 4409 patients, were included. Vitamin D insufficiency was significantly associated with increased mortality (OR 1.24, 95% CI 1.05-1.46; I-2 = 4%). Severe deficiency also led to a significant increase in mortality (OR 2.08, 95% CI 1.09-3.97; I-2 = 42%), whereas moderate deficiency did not show a significant effect (OR 1.06, 95% CI 0.79-1.44; I-2 = 0%). Subgroup analysis revealed significant associations between vitamin D insufficiency and increased mortality at 1-year (OR 1.37, 95% CI 1.06-1.77) and 2-year follow-ups (OR 1.78, 95% CI 1.01-3.15). After adjusting for potential confounders, no significant increase in the mortality rate was observed.Conclusions: This meta-analysis suggests that vitamin D insufficiency and severe deficiency are associated with increased mortality in patients with hip fracture. However, after adjusting for confounding factors, this association was not statistically significant. Further research is necessary to understand the role of vitamin D deficiency in this population.
Revista:
REVISTA ESPAÑOLA DE CIRUGIA ORTOPEDICA Y TRAUMATOLOGIA
ISSN:
1888-4415
Año:
2023
Vol.:
67
N°:
6
Págs.:
480 - 486
Revista:
GLOBAL SPINE JOURNAL
ISSN:
2192-5682
Año:
2023
Vol.:
13
N°:
1
Págs.:
156 - 163
Study Design: Animal experimental model. Objective: To study the clinical behavior and histological changes in the spinal cord, nerve roots and perivertebral muscles of the spine after induced leakage of polymethylmethacrylate (PMMA) loaded with antiblastic drugs during vertebroplasty in an animal model of pigs. Methods: We performed vertebroplasty on 25 pigs. The animals were divided into 3 groups: vertebroplasty with PMMA alone (control group), vertebroplasty with PMMA loaded with methotrexate (MTX) and vertebroplasty with PMMA loaded with cisplatin (CYS). At 2 vertebral levels, epidural and prevertebral, massive cement leaks were induced. Animals were evaluated daily. Two weeks later, the pigs were sacrificed, and the tissues that came in contact with the cement were analyzed. Results: The clinical results for each of the groups were reported. The control group had no clinical alterations. In the MTX group, 2 pigs died before 1 week due to pneumonitis. In the CYS group, 4 animals had motor impairment, and 3 of the 4 had paraplegia. The histological results were as follows: the control and MTX groups showed synovial metaplasia, inflammatory reaction, crystal deposits, and giant cell reaction in the dura mater and muscle and all the animals in the CYS group had spinal cord and muscular necrosis. Conclusions: Massive cement leak after vertebroplasty with PMMA loaded with cisplatin is extremely toxic to the spinal cord and muscles around the spine. Therefore, its use cannot be recommended for the treatment of vertebral metastases. Using PMMA loaded with methotrexate seems to be a safe procedure, but further research is needed.
Autores:
Gil-Melgosa, L.; Grasa, J.; Urbiola, A.; et al.
Revista:
BIOMEDICINES
ISSN:
2227-9059
Año:
2022
Vol.:
10
N°:
1
Págs.:
19
Achilles tendon rupture is a frequent injury with an increasing incidence. After clinical surgical repair, aimed at suturing the tendon stumps back into their original position, the repaired Achilles tendon is often plastically deformed and mechanically less strong than the pre-injured tissue, with muscle fatty degeneration contributing to function loss. Despite clinical outcomes, pre-clinical research has mainly focused on tendon structural repair, with a lack of knowledge regarding injury progression from tendon to muscle and its consequences on muscle degenerative/regenerative processes and function. Here, we characterize the morphological changes in the tendon, the myotendinous junction and muscle belly in a mouse model of Achilles tendon complete rupture, finding cellular and fatty infiltration, fibrotic tissue accumulation, muscle stem cell decline and collagen fiber disorganization. We use novel imaging technologies to accurately relate structural alterations in tendon fibers to pathological changes, which further explain the loss of muscle mechanical function after tendon rupture. The treatment of tendon injuries remains a challenge for orthopedics. Thus, the main goal of this study is to bridge the gap between clinicians' knowledge and research to address the underlying pathophysiology of ruptured Achilles tendon and its consequences in the gastrocnemius. Such studies are necessary if current practices in regenerative medicine for Achilles tendon ruptures are to be improved.
Revista:
GERIATRICS
ISSN:
2308-3417
Año:
2022
Vol.:
7
N°:
6
Págs.:
142
Changes in vertebral body height depend on various factors which were analyzed in isolation and not as a whole. The aim of this study is to analyze what factors might influence the restoration of the vertebral body height after vertebral augmentation. We analyzed 48 patients (108 vertebrae) with osteoporotic vertebral fractures who underwent vertebral augmentation when a conservative treatment proved to be unsatisfactory. The analyses were carried out at the time of the fracture, during surgery (pre-cementation and post-cementation), at the first medical check-up (6 weeks post-surgery) and at the last medical check-up. The average vertebral height was measured, and the differences from the preoperative values were calculated at each timepoint. A Pearson correlation coefficient and a linear multivariable regression were carried out at different timepoints. The time since the vertebral fracture was 60.4 +/- 41.7 days. The patients' average age was 73.8 +/- 7 years. The total follow-up period was 1.43 +/- 1 year. After vertebral cementation, there was an increase in the vertebral body height of +0.3 cm (13.6%). During the post-operative follow-up, there was a progressive collapse of the vertebral body, and the pre-surgical height was reached. The factors that most influenced the vertebral height restoration were: a grade III collapse, an intervertebral-vacuum-cleft (IVVC) and the use of a flexible trocar before cement augmentation. The factor that negatively influenced the vertebral body height restoration was the location of the thoracolumbar spine.
Revista:
FOOT AND ANKLE SURGERY
ISSN:
1268-7731
Año:
2021
Vol.:
27
N°:
2
Págs.:
143 - 149
Background: The literature published about osteoid osteoma (OO) in the ankle-foot consists mainly on case reports.
Methods: We performed a retrospective study in which we analyzed demographic parameters, pain characteristics, treatment options and functional outcomes measured using the AOFAS and the SEFAS scales.
Results: We treated 17 patients with OO around the ankle-foot. Eighty-eight percent of patients had night pain that was relieved with NSAIDs. The bones most often affected were the talus and calcaneus. OO was diagnosed 21 months after the onset of symptoms. Mean follow-up was 17.3 years. The surgical techniques most used were curettage and curettage and bone grafting. There was a significant increase in AOFAS and SEFAS scores after surgery.
Conclusions: Suspicion is the base of a prompt and a correct diagnosis of OO. The OO should be especially suspected in patients who present night pain that can be relieved with NSAIDs.
Revista:
FOOT AND ANKLE SURGERY
ISSN:
1268-7731
Año:
2021
Vol.:
27
N°:
5
Págs.:
592
Revista:
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
ISSN:
0936-8051
Año:
2019
Vol.:
139
N°:
12
Págs.:
1681 - 1690
Introduction A multitude of procedures has been described in the literature for the treatment of lesser toe deformities and there is currently no general consensus on the optimal method of fixation. The aim of this study is to assess the clinical and radiological outcomes of an intramedullary nitinol implant for the correction of lesser toe deformities, and to determine if the distal interphalangeal (DIP) joint and metatarsophalangeal (MTP) joint are modified during patient follow-up after correction of the PIP joint. Materials and methods A prospective analysis of 36 patients with claw toe or hammertoe who were treated with an intramedullary nitinol implant. Clinical manifestations and angulation of the metatarsophalangeal, proximal and distal interphalangeal (MTP, PIP, DIP) joints were evaluated in radiographic studies preoperatively, at first medical revision post-surgery, and after a minimum of 1 year of follow-up. Complications such as non-union rate, implant rupture, and implant infection were also evaluated during follow-up. Results All patients were women with an average age of 65.5 (range 47-82) years. The average follow-up time was 2.4 (range 1-5.7) years. Fifty intramedullary nitinol implants were used. The MTP joint extension and PIP joint flexion decreased by 15.9 degrees (95% CI - 19.11 to - 12.63) and 49.4 degrees (95% CI - 55.29 to - 43.52), respectively, at the end of follow-up. Moreover, the DIP joint flexion increased progressively during follow-up (13.7 degrees pre-surgery versus 35.6 in last medical check-up, 95% CI 13.24-30.57). There were four (8%) asymptomatic implant ruptures. The rate of fusion was 98%. Conclusion The reduction of the PIP joint using an intramedullary nitinol implant is a good option in lesser toe deformities, with few complications and a high rate of arthrodesis. Moreover, the PIP joint reduction affects both the MTP and DIP joints.
Revista:
EUROPEAN SPINE JOURNAL
ISSN:
0940-6719
Año:
2017
Vol.:
26
N°:
12
Págs.:
3216 - 3224
PURPOSE:
To determine the efficacy of cisplatin- or methotrexate-containing acrylic cement for local and systemic antineoplastic drug diffusion. Among the uses of acrylic cement or Polymethylmethacrylate (PMMA), there is the possibility to employ it as vehicle for drug diffusion. This capability is of interest in the treatment of pathological fractures: The curative effects of the cement (cytotoxicity of the monomer and increased temperature) are added to the antineoplastic effect of the drugs.
METHODS:
In the experimental study, two groups of ten pigs underwent vertebroplasty using cement mixed with 500 mg of powder cisplatin or 1000 mg of powder methotrexate. Vertebroplasty was performed in two non-consecutive lumbar vertebrae with bipedicular cement injection. Transpedicular bone biopsy was performed weekly to measure levels of antineoplastic agent in bone tissue and blood plasma. Cisplatin was studied by atomic absorption spectrometry and methotrexate by fluorescence polarization immunoassay. Renal and hepatic function and blood analysis were performed weekly.
RESULTS:
Cisplatin and methotrexate levels were found in bone tissue at more than 5 weeks following surgery. The cisplatin peak occurred at week 3 (mean 1269 ¿g/g bone) and the methotrexate peak at week 1 (mean 862.76 ¿g/g bone). Plasma drug levels were found 72 h after surgery, with a peak at 24 h for cisplatin (mean 0.23 ¿mol/L) and at 30 min for methotrexate (mean 0.92 ¿mol/L). None of the animals died during the study. Animals with intracanal cement leaks showed no neurological involvement. Renal, hepatic and hemogram studies remained within normal limits.
CONCLUSIONS:
There is local diffusion of antineoplastic agents from the cement to bone and plasma. We found methotrexate and cisplatin levels in bone at up to 5 weeks, comparable to previous in vitro reports. At the doses administered, there were no cases of myelosuppression, hepatotoxicity, or nephrotoxicity.
Revista:
EUROPEAN SPINE JOURNAL
ISSN:
0940-6719
Año:
2014
Vol.:
23
N°:
1
Págs.:
276 - 277
Revista:
European Spine Journal
ISSN:
0940-6719
Año:
2011
Vol.:
20
N°:
2
Págs.:
338 - 339
Study Design: Prospective, experimental study in animals, approved by the local ethics committee for animal research.
Aims: To evaluate and compare the histological changes in myeloradicular structures and paravertebral tissue induced by contact with acrylic cement with and without methotrexate in vertebroplasty in pigs.
Material and Methods: Ten female pigs of the Large White¿Landrace breed, weighing 30 kg and divided into two groups: control group, containing five pigs that underwent vertebroplasty with acrylic cement, and methotrexate group, with five pigs that underwent vertebroplasty using cement combined with 1 g of methotrexate. A standard fluoroscopy-guide transpedicular vertebroplasty technique was performed with an 11-G trocar. Cement leak to the prevertebral and epidural muscle tissue was induced in two different lumbar vertebrae; 1 cc of cement was injected per vertebra. Animals were sacrificed at 3 weeks. Spines were removed, the section where tissues were in contact with cement was isolated by dissection, the surface in direct contact with cement was marked with India ink, and specimens were processed by fixation and hematoxylin eosin staining for pos-terior microscopic study.
Results: Macroscopic results: In both groups, the cement was distributed in layers surrounding the dural sac. Histological results: In the control group, leakage to the prevertebral musculature with atrophy of muscle fibers, inflammatory infiltrate in areas in contact with cement, epithelial dysplasia, and foreign body reaction in relation to cement particles. In addition, epidural leak with dural thickening and inflammatory reaction only in areas of the dura mater in contact with cement. In the methotrexate group, the same changes as in the control group were observed.
Clinical results: Neurological lesion due to cement leak was not produced any of the ten pigs.
Conclusions:The tube-like laminar distribution of the cement may explain the fact that there was an absence of paraplegia in the study animals. Contact of the muscle and dura with cement seemed to induce an inflammatory reaction, with cell death, and atrophy and thickening of membranes in some cases. Addition of methotrexate to acrylic cement did not seem to increase the local toxicity of cement alone.
Revista:
European Spine Journal
ISSN:
0940-6719
Año:
2011
Vol.:
20
N°:
11
Págs.:
2094 - 2095
To evaluate and compare the histological changes in spinal cord and nerve root structures and perivertebral tissues induced by contact with acrylic bone cement containing cisplatin, injected by vertebroplasty in pigs.
Revista:
Revista española de cirugía ortopédica y traumatología (Ed. impresa)
ISSN:
1888-4415
Año:
2011
Vol.:
55 Espec. Congreso
N°:
CC-81
Págs.:
147
Introducción y objetivos: Los osteocondromas afectan raramente a la columna cervical y la literatura refiere normalmente casos por compresión medular. El diagnóstico es difícil ya que rara vez se sospecha. El caso que presentamos plantea cuestiones en cuanto al diagnóstico, la indicación y el abordaje quirúrgico así como la necesidad de añadir o no una artrodesis.
Material y método: Mujer de 26 años, con dolor occipital/suboccipital izquierdo desde hacía 17 años. Diagnosticada previamente de osteocondroma en arco posterior de C2, se aconsejó esperar y ver por dificultad y riesgo en caso de intervención. El dolor era constante y referido al ¿Punto de Arnold¿ con irradiación a occipital, y aumentaba con los movimientos del cuello. Las radiografías simples no fueron orientativas. En TC se observó una lesión compatible con osteoma osteoide del arco posterior del atlas (en axial) una prominencia ósea que nacía del istmo del axis (cortes coronales y sagitales). Era compatible con un osteocondroma de crecimiento vertical. Los cortes sagitales y coronales mostraban una anquilosis inter-apofisaria de articulación C1C2 izquierda. La gammagrafía mostraba hipercaptación en dicha articulación, sin hipercaptación en la lesión. La intervención quirúrgica (abordaje posterior medio) consistió en resección simple de la lesión mediante osteotomía de su base, siendo fácilmente separable del arco posterior de C1. La raíz C2 izquierda estaba ¿anclada¿ por el osteocondroma en su división, siendo difícil movilizar su ramo posterior.
Resultados: El dolor cedió inmediatamente permaneciendo la paciente asintomática durante todo su seguimiento. La anatomía patológica confirmó el diagnóstico de osteocondroma.
Comentarios y conclusiones: El dolor en el ¿Punto de Arnold¿ área occipital puede ser debido a causas diversas, incluyendo degeneración en C1C2. En este caso, el osteocondroma creció provocando a la paciente dolor durante 17 años y la degeneración observada en la articulación inter-apofisaria adyacente ipsilateral pudo ser reactiva, como en el caso de algunos fenómenos observados en el raquis cervical en torno al osteoma osteoide. Las dudas que planteaba la posible anquilosis C1C2 podrían crear controversia acerca de la indicación de añadir o no artrodesis C1C2 Una vez fue desestimada la fusión C1C2, podría tenerse en cuenta un abordaje posterolateral directo como opción.
Revista:
Revista española de cirugía ortopédica y traumatología (Ed. impresa)
ISSN:
1888-4415
Año:
2011
Vol.:
55 Esp. Congreso
N°:
CC-921
Págs.:
431 - 432
Revista:
REVISTA ESPAÑOLA DE CIRUGIA ORTOPEDICA Y TRAUMATOLOGIA
ISSN:
1888-4415
Año:
2011
Vol.:
55
N°:
2
Págs.:
85 - 90
Objetivo
Analizar los resultados a largo plazo del vástago no cementado de anclaje metafisario tipo CLS Spotorno (Sulzer/Zimmer).
Material y métodos
Se han revisado 166 pacientes a los que se colocó, de forma primaria y consecutiva 189 vástagos CLS (CementLess Spotorno) (Sulzer/Zimmer). El seguimiento mínimo ha sido de 13 años. Los parámetros clínicos se han valorado según la escala de Harris modificada, y los radiológicos según las zonas de Gruen. También se ha analizado la medición del hundimiento del vástago.
Resultados
El seguimiento medio ha sido de 180 meses (156-228) 12 pacientes (12 vástagos) habían fallecido y no se ha completado el seguimiento por diferentes motivos en 24 pacientes (29 vástagos). Así, el trabajo se ha realizado sobre 130 pacientes (148 vástagos) que tienen el seguimiento mínimo. La tasa de supervivencia global del vástago ha sido del 95% al final del seguimiento (intervalo de confianza 89-98). Las mediciones de la escala de Harris han pasado de 48 (9-76) puntos antes de la cirugía a 90 (63-100) puntos al final del seguimiento.
Conclusiones
El vástago femoral CLS obtiene unos excelentes resultados tanto clínicos como de supervivencia a largo plazo.
Nacionales y Regionales
Título:
Desarrollo de estructuras 3D para igeniería de tejidos
Código de expediente:
0011-1383-2019-000005 PC074
Investigador principal:
Froilán Granero Moltó
Financiador:
GOBIERNO DE NAVARRA
Convocatoria:
2019 GN Centros
Fecha de inicio:
01/02/2019
Fecha fin:
30/11/2019
Importe concedido:
45.552,13€
Otros fondos:
-
Título:
Desarrollo de estructuras 3D para ingeniería de tejidos.
Código de expediente:
0011-1383-2018-000005
Investigador principal:
Froilán Granero Moltó
Financiador:
GOBIERNO DE NAVARRA
Convocatoria:
2018 GN Centros
Fecha de inicio:
01/02/2018
Fecha fin:
30/11/2018
Importe concedido:
80.293,38€
Otros fondos:
-
