Iliac crest is common site for harvesting bone grafts. Morphometry of iliac crest is of vital importance in orthopedic surgery. Measurements were done on male (n=85) and female (n=85) hip bones. Length of iliac crest, thickness of iliac crest and ilium were measured. Thickness was measured at pre-defined points on crest and ilium 2 cm apart starting from anterior superior iliac spine (ASIS). Ilium was measured at a depth of 2.5 cm from crest. Statistical analysis was done. Iliac crests were longer in male bones. Ventral iliac crest was thickest at 6 cm from ASIS in both sexes. While iliac crest bore minimum thickness at 12 cm and 10 cm from ASIS in male and female bones respectively, however at 2.5 cm below iliac crest surface ilium was thickest at 4 cm from ASIS and at ASIS in male and female bones respectively. In case of male bones, dorsal part of iliac crest was thickest at 2.15 ± 1.29 cm from posterior superior iliac spine (PSIS) while in females it was at 1.78 ± 1.31 cm from PSIS. In dorsal part of ilium, it was observed at 2.31 ± 1.47 cm and 1.9 ± 1.79 cm from PSIS for male and female bones respectively. This study provided detailed variable morphometry and significant sexual dimorphism observed in iliac crest and ilium. Thickest safe zones in both sexes are a useful guide for harvesting appropriate bone grafts.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- odběr tkání a orgánů metody MeSH
- os ilium * anatomie a histologie MeSH
- senioři MeSH
- transplantace kostí * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The medial approach for minimally invasive harvesting of a deep circumflex iliac artery (DCIA) flap is described for reconstruction of the jaw. The associated preservation of the crest of the ilium prevents the raising of the abdominal internal oblique muscle (IO) in a standard fashion. However, reconstructive surgery of composite mandibular defects includes bone and soft tissue. To achieve this goal, we combined this technique with a new perforator-based raising of the IO for reconstruction of intraoral soft tissue. METHODS: In this study, we present eight cases of patients with composite mandibular defects who underwent the myo-osseous DCIA flap procedure with an IO perforator. Virtual surgical planning was employed to preplan the size and configuration of the graft. Cutting guides were made using CAD/CAM technology. The surgical procedure followed the described medial approach for minimally invasive harvesting, leaving the iliac crest, spine, and skin intact. In addition, we completely cut and isolated the IO with its sole attachment being the ascending branch of the DCIA. We used either a surgical guide with a slot to lead through both the transverse branch of the bone and the ascending branch of the IO or a surgical guide consisting of 2 parts. RESULTS: In all instances, the flap successfully survived with a 100% success rate. There were no signs of infection, wound opening, or bleeding in either patient. Furthermore, the patients did not exhibit permanent complications related to the donor site. The internal oblique perforator flap exhibited remarkable integration in all patients and underwent rapid transformation. Notably, the flap developed keratinized mucosa (KM) that closely resembled the attached gingiva. CONCLUSION: Our study demonstrated the effectiveness of a medial approach for harvesting a newly designed more flexible chimeric myo-osseous deep circumflex iliac artery flap. By incorporating virtual surgical planning and custom-made cutting guides for obtaining deep circumflex iliac artery flaps through the medial route along with an internal oblique perforator flap, we have established a highly promising method for the rehabilitation of patients with composite mandibular defects. This approach not only improves functional outcomes, but also enhances aesthetic results to maintain patients' quality of life.
- MeSH
- arteria iliaca chirurgie MeSH
- chirurgické laloky MeSH
- design s pomocí počítače MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mandibula chirurgie MeSH
- miniinvazivní chirurgické výkony metody MeSH
- os ilium chirurgie MeSH
- senioři MeSH
- zákroky plastické chirurgie * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Most humeral nonunions can be successfully treated with a single procedure, but some are more difficult to heal. Humeral nonunions which have two or more surgical procedures were defined as refractory humeral nonunions, and this condition is a very challenging condition. The aim of the study is to show the results of atrophic refractory humeral nonunion treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty. MATERIAL AND METHODS Refractory humeral nonunions treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty from January 2010 to March 2019 were included this study retrospectively. Patient baseline information, number of previous surgeries, comorbidities, follow-up time, fracture union time, and complications were recorded. The functional outcome was evaluated with the Constant scores and Mayo scores at the end of the first year. The primary outcome variable was mentioned as bony union. RESULTS A total of 13 refractory humeral nonunions included this study. The average age of the patients was 50.92±15.55 years (range, 26-78 years), and 8 of them were female. Preoperative and postoperative mean Mayo scores were; 56.54±17.84, and 85.38±7.49 respectively (p<0.001). Preoperative and postoperative mean Constant scores were; 45±11.71, and 80.62±5.38 respectively (p<0.001). DISCUSSION The strict application of basic nonunion principles can result in successful salvage of refractory humeral nonunions. But this concept may not provide sufficient solution for each situation. On the other hand, we also applied the basic nonunion principles. Compression plating and autogenous bone grafting and spongioplasty have been considered as the gold standard in the management of humeral shaft nonunion. CONCLUSIONS Open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty should be considered as an alternative for the treatment of refractory atrophic humeral nonunions, whose treatment is a very challenging condition for surgeons. Key words: block graft, bone grafting, nonunion, refractory humeral nonunion, spongioplasty.
- MeSH
- dospělí MeSH
- fraktury humeru * diagnostické zobrazování chirurgie MeSH
- hojení fraktur MeSH
- humerus chirurgie MeSH
- kostní destičky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nezhojené fraktury * chirurgie MeSH
- os ilium MeSH
- retrospektivní studie MeSH
- senioři MeSH
- transplantace kostí metody MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Postmenopausal osteoporosis (PMOP) therapies are frequently evaluated by bone mineral density (BMD) gains against patients receiving placebo (calcium and vitamin D supplementation, a mild bone turnover-suppressing intervention), which is not equivalent to either healthy or treatment-naive PMOP. The aim of the present observational study was to assess the effects of TPTD treatment in PMOP (20 μg, once daily) at 6 (TPTD 6m; n = 28, age 65 ± 7.3 years), and 24 (TPTD 24m; n = 32, age 67.4 ± 6.15 years) months on bone quality indices at actively forming trabecular surfaces (with fluorescent double labels). Data from the TPTD-treated PMOP patients were compared with those in healthy adult premenopausal women (HC; n = 62, age 40.5 ± 10.6 years), and PMOP receiving placebo (PMOP-PLC; n = 94, age 70.6 ± 4.5 years). Iliac crest biopsies were analyzed by Raman microspectroscopy at three distinct tissue ages: mid-distance between the second label and the bone surface, mid-distance between the two labels, and 1 μm behind the first label. Mineral to matrix ratio (MM), mineral maturity/crystallinity (MMC), tissue water (TW), glycosaminoglycan (GAGs), and pyridinoline (Pyd) content were determined. Outcomes were compared by ANCOVA with subject age and tissue age as covariates, and health status as a fixed factor, followed by Sidak's post-hoc testing (significance assigned to p < 0.05). Both TPTD groups increased MM compared to PMOP-PLC. While TPTD 6m had values similar to HC, TPTD 24m had higher values compared to either HC or TPTD 6m. Both TPTD groups had lower MMC values compared to PMOP-PLC and similar to HC. TPTD 6m patients had higher TW content compared to HC, while TPTD 24m had values similar to HC and lower than either PMOP-PLC or TPTD 6m. Both TPTD groups had lower GAG content compared to HC group, while TPTD 6m had higher values compared to PMOP-PLC. Finally, TPTD 6m patients had higher Pyd content compared to HC and lower compared to PMOP-PLC, while TPTD 24m had lower values compared to PMOP-PLC and TPTD 6m, and similar to HC group. The results of the present study indicate that effects of TPTD on forming trabecular bone quality indices depend on treatment duration. At the recommended length of 24 m, TPTD restores bone mineral and organic matrix quality indices (MMC, TW, Pyd content) to premenopausal healthy (HC) levels.
- MeSH
- dospělí MeSH
- inhibitory kostní resorpce * farmakologie terapeutické užití MeSH
- kostní denzita MeSH
- lidé středního věku MeSH
- lidé MeSH
- os ilium patologie MeSH
- postmenopauzální osteoporóza * farmakoterapie patologie MeSH
- senioři MeSH
- teriparatid farmakologie terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
PURPOSE OF THE STUDY This retrospective study presents our experience in treatment of polytrauma patients with acetabular fractures treated with only modified Stoppa approach or in combination with iliac wing approach. The purpose of this study was to evaluate the outcome of polytrauma patients with acetabular fractures operated with only modified Stoppa approach or in combination with iliac wing approach. MATERIAL AND METHODS Polytrauma patients who suffered from acetabular fractures treated in our hospital during 2008-2018, operated by using only modified Stoppa or in combination with iliac wing approach, were included in the study. The patients were evaluated using Majeed score. Cases with hip replacement due to post-traumatic osteoarthritis (PTOA) were summarized. The study group was compared with control group, which was operated through ilioinguinal approach. RESULTS We examined 42 patients (12 women and 30 men; mean age 44 years). Anatomical or satisfactory fracture healing was achieved in 92% of the acetabular fractures. In the study group Majeed score was significantly better (p<0.05). Seven patients from the study group had hip replacement due to PTOA with following results - 5 patients (13%) with anatomical or satisfactory reduction and 2 patients (50%) with displacement more than 3 mm of all reductions of acetabular fractures. DISCUSSION In polytrauma patients, the risk of the development of severe PTOA is increased because of high-energy trauma impact and a satisfactory reduction of acetabulum does not always protect against severe PTOA with following necessity for total hip replacement. CONCLUSIONS Our experience with using the modified Stoppa approach and its combination with iliac wing approach shows that these techniques provide better fracture reduction, gain mostly good radiological and functional results, may decrease the risk of development of severe symptomatic hip PTOA and hip replacement in polytrauma patients with both column acetabular fractures. Our results suggest that unsatisfactory reduction of an acetabular fracture is a strong predictor of symptomatic severe PTOA, which is treated by using total hip arthroplasty. Key words: acetabulum, modified Stoppa approach, iliac wing approach, post-traumatic osteoarthritis.
- MeSH
- acetabulum diagnostické zobrazování chirurgie MeSH
- dospělí MeSH
- fraktury kostí * chirurgie MeSH
- lidé MeSH
- os ilium chirurgie MeSH
- retrospektivní studie MeSH
- vnitřní fixace fraktury * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- osteokutánní laloky, homodigitální lalůček, dorsalis pedis flap,
- MeSH
- arteria iliaca anatomie a histologie transplantace MeSH
- bérec anatomie a histologie transplantace MeSH
- chirurgické laloky * chirurgie klasifikace krevní zásobení transplantace MeSH
- fascia lata krevní zásobení transplantace MeSH
- femur anatomie a histologie krevní zásobení transplantace MeSH
- fibula anatomie a histologie transplantace MeSH
- lidé MeSH
- lopatka krevní zásobení transplantace MeSH
- noha (od hlezna dolů) krevní zásobení MeSH
- os ilium krevní zásobení transplantace MeSH
- perforátorový lalok transplantace MeSH
- tibie krevní zásobení MeSH
- třísla anatomie a histologie MeSH
- žebra krevní zásobení transplantace MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY In patients older than 40 years of age, treatment of chondral lesions of the knee employing microfractures does not provide satisfactory outcomes. One of the contributing factors may be the age-related lack of sufficient mesenchymal stromal cells able to efficiently migrate into the desired site of the lesion. Concomitant application of mononuclear cells (MNCs) or cultured mesenchymal stem cells (MSCs) isolated from bone marrow and seeded on a 3D scaffold could provide an alternative enhancing therapeutic efficacy in these patients. The aim of our study was to assess two different sources of bone marrow for isolation of progenitor cells. To be specific, material obtained from proximal tibia and iliac crest (the commonly used bone marrow source) was compared in terms of quantity and quality of cells and their suitability for cellbased treatment of chondral lesions. MATERIAL AND METHODS Bone marrow was collected during a total knee replacement surgery from the iliac crest and the proximal metaphysis of the tibia from ten volunteers older than 40 years of age, using aspiration biopsy needles. The MNCs from the obtained material were isolated, cultured and analyzed for their phenotypic features. Both sources were compared as to the yield and viability of MNCs and MSCs as well as the ability of MSCs of chondrogenic differentiation. RESULTS The MNCs concentration/yield was significantly higher in samples from the iliac crests. Similar results were obtained with cultured MSCs after the first passage when the MSCs/MNCs ratio was compared. Nevertheless, the qualitative analysis that included MSCs immuno-phenotyping, viability and population doubling time showed no difference between the two tested bone marrow sources. DISCUSSION Particularly in older patients, therapies of chondral defects employing bone marrow-stimulating techniques result in unsatisfactory outcomes. Therefore, orthopedic surgeons have turned their attention to cell-based treatments. Bone marrow located in pelvic bone and metaphysis of long bones (distal femur, proximal tibia) contains mononuclear cells that possess features of MSCs. In accordance with other authors, quantitative differences between the cells from two anatomical locations were found in our cohort of patients. Qualitatively, however, there was no significant variability observed. We also confirmed that the metaphysis of proximal tibia is a suitable source for cultured MSCs. Moreover, in contrast to several reports, the quality of these cells does not appear to decrease with the patients age. CONCLUSIONS The iliac crest represents a superior bone marrow source for the MNCs and MSCs yield when compared with tibia. However, there was no qualitative difference between the isolated and cultured cells. The population doubling time analysis showed that the tibia is a good alternative source of MSCs which can be obtained at therapeutically relevant numbers for example for the treatment of chondral lesions of the knee. Key words: bone marrow, mesenchymal stem cells, MSC, mononuclear cells, chondral defects, osteoarthritis.
- MeSH
- buněčná diferenciace MeSH
- buňky kostní dřeně MeSH
- kmenové buňky MeSH
- kultivované buňky MeSH
- lidé MeSH
- mezenchymální kmenové buňky * MeSH
- os ilium MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Our experimental study presents a set of bone grafts harvested by a minimally invasive procedure from selected deceased donors. Our objective was to compare the concentration of red bone marrow in the cancellous bone harvested in this way from selected regions with the reference harvesting from the iliac crest. Thus, the potential of grafts to heal complicated fractures or non-unions is assessed. MATERIAL AND METHODS The Hospital Department of Pathology provided 10 cadaver preparations - 7 male and 3 female for the experiment. In the process of selection, the age limit was 18-50 years, the other exclusion criteria were severe injuries and burning to death as mechanisms affecting the condition of the skeletal system, bone diseases except for osteoporosis, and malignant diseases. From each preparation, a total of 12 samples of cancellous bone tissue were harvested from pre-defined 6 harvest sites bilaterally - proximal humerus, proximal ulna, greater trochanter of proximal femur, distal femur, proximal tibia and from the reference region of the iliac wing. The grafts were harvested using a 10 mm bone cutter. In total, 120 samples of cancellous bone of the determined diameter and uniform length of 30 mm were obtained. The obtained preparations were laboratory processed, fixed, decalcified and hematoxylin-eosin stained. The samples were assessed microscopically. The share of the bone tissue and cancellous bone was expressed as a percentage. Determined as a healing potential parameter was the concentration of red bone marrow and its ratio to the yellow bone marrow was stated. The hypothesis was tested using the ANOVA analysis of variance. RESULTS The highest concentration of red bone marrow was observed in cancellous grafts harvested from the iliac wing with 34.95%, followed by greater trochanter of proximal femur with 31.7%, distal femur with 26.9% and proximal humerus with 21.9%. Its concentration was negligible in proximal tibia with 2.55% and proximal ulna with 0.15%. By ANOVA statistical method the values of reference samples from the iliac wing and greater trochanter of the femur, distal femur and proximal humerus were compared. The differences are not statistically significant - P 0.60, 0.48 and 0.34 (p < 0.05). No significant differences were found in the concentration of red bone marrow. Statistically compared were also the values of reference samples from the iliac wing and proximal tibia, proximal ulna. This difference is statistically significant - P 0.0008 and 0.0002 (p <0.05). Thus, the difference in the concentration of red bone marrow is obvious. DISCUSSION The aforementioned results suggest that the greatest potential to heal will be achieved with the use of bone grafts from the iliac wing region, followed by greater trochanter of the femur, distal femur and proximal humerus. When testing the hypothesis by the ANOVA method, the detected differences between the selected harvest regions are not statistically significant. Therefore, the iliac wing grafts can be used in practice just as the material from greater trochanter of the femur, distal femur or proximal humerus, which is of equal quality. The other regions, proximal tibia and ulna, contain only minimum concentration of red bone marrow. CONCLUSIONS The experimental study comparing the concentration of red bone marrow in grafts harvested using a minimally invasive procedure from the region of greater trochanter, distal femur and proximal humerus concluded that these samples are comparable with the grafts from the iliac wing. The grafts harvested from proximal tibia and proximal ulna show only negligible concentration of red bone marrow and their use in clinical practice is disputable. The benefits of our experimental study for treatment shall be further evaluated in a clinical study. Key words: bone marrow, stem cells, bone healing/orthobiologics, new technology assessment, autograft harvesting.
Pacienti s radiojodrefrakterním diferencovaným karcinomem štítné žlázy (RR-DTC) jsou indikováni k terapii inhibitory tyrosinkináz (TKI). Léčba je v České republice soustředěna do Komplexních onkologických center. Nemocní jsou většinou středního a vyššího věku, s komorbiditami. Kazuistika popisuje případ pacientky, která i přes pokročilost nádorového onemocnění, významnou komorbiditu a vzdálenost svého bydliště od našeho zdravotnického zařízení profituje z onkologické léčby.
Patients with radio-refractory differentiated thyroid carcinoma (RR-DTC) are indicated for therapy with tyrosine kinase inhibitors (TKI). In the Czech Republic, treatment is concentrated to Complex Oncology Centers. Patients are mostly middle age and older, with comorbidities.The case report describes the case of a patient who, despite the advancement of cancer, significant co-morbidity and the distance of her residence from our healthcare facility, benefits from cancer treatment.
- Klíčová slova
- lenvatinib,
- MeSH
- denosumab aplikace a dávkování MeSH
- inhibitory proteinkinas aplikace a dávkování škodlivé účinky MeSH
- komorbidita MeSH
- lidé MeSH
- metastázy nádorů terapie MeSH
- nádory pánve diagnostické zobrazování sekundární MeSH
- nádory plic diagnostické zobrazování sekundární MeSH
- nádory štítné žlázy * diagnostické zobrazování farmakoterapie terapie MeSH
- nežádoucí účinky léčiv terapie MeSH
- os ilium patologie MeSH
- PET/CT MeSH
- progrese nemoci MeSH
- radioisotopová scintigrafie MeSH
- senioři MeSH
- sorafenib aplikace a dávkování MeSH
- thyreoglobulin analýza MeSH
- tyrosinkinasy antagonisté a inhibitory MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
The stature/bi-iliac breadth method provides reasonably precise, skeletal frame size (SFS) based body mass (BM) estimations across adults as a whole. In this study, we examine the potential effects of age changes in anthropometric dimensions on the estimation accuracy of SFS-based body mass estimation. We use anthropometric data from the literature and our own skeletal data from two osteological collections to study effects of age on stature, bi-iliac breadth, body mass, and body composition, as they are major components behind body size and body size estimations. We focus on males, as relevant longitudinal data are based on male study samples. As a general rule, lean body mass (LBM) increases through adolescence and early adulthood until people are aged in their 30s or 40s, and starts to decline in the late 40s or early 50s. Fat mass (FM) tends to increase until the mid-50s and declines thereafter, but in more mobile traditional societies it may decline throughout adult life. Because BM is the sum of LBM and FM, it exhibits a curvilinear age-related pattern in all societies. Skeletal frame size is based on stature and bi-iliac breadth, and both of those dimensions are affected by age. Skeletal frame size based body mass estimation tends to increase throughout adult life in both skeletal and anthropometric samples because an age-related increase in bi-iliac breadth more than compensates for an age-related stature decline commencing in the 30s or 40s. Combined with the above-mentioned curvilinear BM change, this results in curvilinear estimation bias. However, for simulations involving low to moderate percent body fat, the stature/bi-iliac method works well in predicting body mass in younger and middle-aged adults. Such conditions are likely to have applied to most human paleontological and archaeological samples.
