RESUMO
Idiopathic scoliosis is the abnormal flexion and rotation of the vertebral bodies, causing respiratory symptoms and altered pulmonary function. Straight back syndrome is a decreased in the anteroposterior diameter of the thorax. We present a 13-year-old patient with idiopathic scoliosis who Deformidad torácica como causa de compresión traqueobronquial. A propósito de un caso clínico pediátrico Chest deformity as a cause of tracheobronchial compression. A pediatric case developed progressive dyspnea, inspiratory stridor and a significant decrease in pulmonary function, because of extrinsic compression of the right main bronchus and the middle third of trachea by the thoracic vertebral bodies. She had also a decreased anteroposterior diameter of the thorax, being a determining factor in the appearance of symptoms. Surgery was performed by thoracic vertebra fixation T3 to T11, with subsequent clinical and functional respiratory improvement. Scoliosis associated with altered pulmonary function and stridor should make us suspect the existence of airway compression, especially in patients with reduction of the anteroposterior diameter of the thorax.
La escoliosis idiopática es la flexión y rotación anómala de los cuerpos vertebrales, que puede causar sintomatología respiratoria y alteración de función pulmonar. El síndrome de la espalda recta es una alteración caracterizada por una disminución del diámetro anteroposterior del tórax. Se presenta a una paciente de 13 años afectada de escoliosis idiopática que desarrolló disnea de esfuerzo progresiva, estridor inspiratorio y disminución importante de función pulmonar, secundaria a compresión extrínseca del bronquio principal derecho y tercio medio traqueal por cuerpos vertebrales torácicos. A su vez, tenía una disminución del diámetro anteroposterior del tórax, factor determinante en la aparición de los síntomas. Se intervino mediante fijación de vértebra torácica T3-T11, con posterior mejoría clínica y funcional respiratoria. La escoliosis asociada a alteración de función pulmonar y estridor debe hacer sospechar la existencia de compresión de la vía aérea, especialmente, en pacientes con reducción del diámetro anteroposterior del tórax.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Broncopatias/etiologia , Escoliose/fisiopatologia , Doenças da Traqueia/etiologia , Adolescente , Obstrução das Vias Respiratórias/diagnóstico , Broncopatias/diagnóstico , Dispneia/etiologia , Feminino , Humanos , Sons Respiratórios/etiologia , Vértebras Torácicas/fisiopatologia , Doenças da Traqueia/diagnósticoRESUMO
This study aimed to analyze the coordination and variability between the thorax, lumbar, and pelvis segments in runners with chronic low back pain group (LBPG) and matched control group (CG). Twenty-six recreational runners were evaluated on a treadmill at 3.3 m/s. The coordination of the pelvis-lumbar and lumbar-thorax in all three planes and between the transverse and frontal plane of the lumbar segment were evaluated using the vector coding technique. Coordination was analyzed via histograms with the percentage of each pattern and the coupling angle during the cycle. The variability coordination was calculated from the angular deviation between the cycles. Differences were observed in the coordination patterns and in the coupling angle during the cycle. Between the pelvis-lumbar in the frontal plane, the LBPG (x¯ = 50.6% (SD = 10.7)) presented more in-phase pattern than the CG (38.6% (8.7; P = 0.05). For the lumbar-thorax, differences occurred in all planes. Between the frontal-transverse plane of the lumbar segment, the LBPG (27.6% (7.9)) presented more in-phase pattern than the CG (38.6% (8.7); P = 0.02). The variability did not demonstrate the differences between the groups; these differences were observed in coordination between the lumbar and adjacent segments in all planes. The model of rigid segments and the coordination analyses were sensitive to detect these differences, and the presence of more in-phase patterns could be related to the protection mechanism in order to avoid painful movements.
Assuntos
Dor Lombar/fisiopatologia , Corrida/fisiologia , Tronco/fisiopatologia , Adulto , Fenômenos Biomecânicos , Teste de Esforço , Feminino , Humanos , Vértebras Lombares/fisiopatologia , Masculino , Vértebras Torácicas/fisiopatologiaRESUMO
OBJECTIVE: To compare diaphragmatic mobility, lung function, and respiratory muscle strength between COPD patients with and without thoracic hyperkyphosis; to determine the relationship of thoracic kyphosis angle with diaphragmatic mobility, lung function, and respiratory muscle strength in COPD patients; and to compare diaphragmatic mobility and thoracic kyphosis between male and female patients with COPD. METHODS: Participants underwent anthropometry, spirometry, thoracic kyphosis measurement, and evaluation of diaphragmatic mobility. RESULTS: A total of 34 patients with COPD participated in the study. Diaphragmatic mobility was significantly lower in the group of COPD patients with thoracic hyperkyphosis than in that of those without it (p = 0.002). There were no statistically significant differences between the two groups of COPD patients regarding lung function or respiratory muscle strength variables. There was a significant negative correlation between thoracic kyphosis angle and diaphragmatic mobility (r = -0.47; p = 0.005). In the sample as a whole, there were statistically significant differences between males and females regarding body weight (p = 0.011), height (p < 0.001), and thoracic kyphosis angle (p = 0.036); however, there were no significant differences in diaphragmatic mobility between males and females (p = 0.210). CONCLUSIONS: Diaphragmatic mobility is lower in COPD patients with thoracic hyperkyphosis than in those without it. There is a negative correlation between thoracic kyphosis angle and diaphragmatic mobility. In comparison with male patients with COPD, female patients with COPD have a significantly increased thoracic kyphosis angle.
Assuntos
Diafragma/fisiopatologia , Cifose/fisiopatologia , Movimentos dos Órgãos/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Antropometria , Estudos Transversais , Diafragma/diagnóstico por imagem , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Cifose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Radiografia Torácica , Músculos Respiratórios/fisiopatologia , Fatores Sexuais , Espirometria , Estatísticas não Paramétricas , Vértebras Torácicas/fisiopatologia , Capacidade Vital/fisiologiaRESUMO
ABSTRACT Objective: To compare diaphragmatic mobility, lung function, and respiratory muscle strength between COPD patients with and without thoracic hyperkyphosis; to determine the relationship of thoracic kyphosis angle with diaphragmatic mobility, lung function, and respiratory muscle strength in COPD patients; and to compare diaphragmatic mobility and thoracic kyphosis between male and female patients with COPD. Methods: Participants underwent anthropometry, spirometry, thoracic kyphosis measurement, and evaluation of diaphragmatic mobility. Results: A total of 34 patients with COPD participated in the study. Diaphragmatic mobility was significantly lower in the group of COPD patients with thoracic hyperkyphosis than in that of those without it (p = 0.002). There were no statistically significant differences between the two groups of COPD patients regarding lung function or respiratory muscle strength variables. There was a significant negative correlation between thoracic kyphosis angle and diaphragmatic mobility (r = −0.47; p = 0.005). In the sample as a whole, there were statistically significant differences between males and females regarding body weight (p = 0.011), height (p < 0.001), and thoracic kyphosis angle (p = 0.036); however, there were no significant differences in diaphragmatic mobility between males and females (p = 0.210). Conclusions: Diaphragmatic mobility is lower in COPD patients with thoracic hyperkyphosis than in those without it. There is a negative correlation between thoracic kyphosis angle and diaphragmatic mobility. In comparison with male patients with COPD, female patients with COPD have a significantly increased thoracic kyphosis angle.
RESUMO Objetivo: Comparar a mobilidade diafragmática, a função pulmonar e a força muscular respiratória em pacientes que apresentam DPOC com e sem hipercifose torácica; verificar a relação do ângulo da curvatura torácica com a mobilidade diafragmática, variáveis da função pulmonar e de força muscular respiratória dos pacientes com DPOC; e comparar a mobilidade diafragmática e a cifose torácica entre os gêneros nesses pacientes. Métodos: Foram realizadas as seguintes avaliações: antropometria, espirometria, mensuração do ângulo da curvatura torácica e mobilidade diafragmática. Resultados: Participaram do estudo 34 pacientes com DPOC. No grupo de pacientes com DPOC e hipercifose torácica, a mobilidade diafragmática foi estatisticamente menor quando comparada à do grupo DPOC sem hipercifose torácica (p = 0,002). Não houve diferenças estatisticamente significantes entre esses grupos em relação a variáveis de função pulmonar e de força muscular respiratória. Houve uma correlação negativa significante entre o ângulo da curvatura torácica e a mobilidade diafragmática (r = −0,47; p = 0,005). Quando comparados homens e mulheres da amostra geral, houve diferenças estatisticamente significantes em relação à massa corpórea (p = 0,011), estatura (p < 0,001) e ângulo da curvatura da cifose torácica (p = 0,036), mas não em relação à mobilidade diafragmática (p = 0,210). Conclusões: Os pacientes com DPOC e hipercifose torácica apresentaram menor mobilidade diafragmática quando comparados com os pacientes com DPOC sem hipercifose torácica. O ângulo da curvatura torácica se correlacionou negativamente com a mobilidade diafragmática. O grupo feminino apresentou um aumento significante no ângulo da curvatura torácica quando comparado ao grupo masculino.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Diafragma/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Movimentos dos Órgãos/fisiologia , Cifose/fisiopatologia , Espirometria , Vértebras Torácicas/fisiopatologia , Músculos Respiratórios/fisiopatologia , Diafragma/diagnóstico por imagem , Radiografia Torácica , Fatores Sexuais , Capacidade Vital/fisiologia , Antropometria , Volume Expiratório Forçado/fisiologia , Estudos Transversais , Estatísticas não Paramétricas , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Força Muscular/fisiologia , Cifose/diagnóstico por imagemRESUMO
OBJECTIVES: No studies have compared monoaxial and polyaxial pedicle screws with regard to the von Mises stress of the instrumentation, intradiscal pressures of the adjacent segment and adjacent segment degeneration. METHODS: Short-segment monoaxial/polyaxial pedicle screw fixation techniques were compared using finite element methods, and the redistributed T11-L1 segment range of motion, largest maximal von Mises stress of the instrumentation, and intradiscal pressures of the adjacent segment under displacement loading were evaluated. Radiographic results of 230 patients with traumatic thoracolumbar fractures treated with these fixations were reviewed, and the sagittal Cobb's angle, vertebral body angle, anterior vertebral body height of the fractured vertebrae and adjacent segment degeneration were calculated and evaluated. RESULTS: The largest maximal values of the von Mises stress were 376.8 MPa for the pedicle screws in the short-segment monoaxial pedicle screw fixation model and 439.9 MPa for the rods in the intermediate monoaxial pedicle screw fixation model. The maximal intradiscal pressures of the upper adjacent segments were all greater than those of the lower adjacent segments. The maximal intradiscal pressures of the monoaxial pedicle screw fixation model were larger than those in the corresponding segments of the normal model. The radiographic results at the final follow-up evaluation showed that the mean loss of correction of the sagittal Cobb's angle, vertebral body angle and anterior vertebral body height were smallest in the intermediate monoaxial pedicle screw fixation group. Adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group but more likely to be observed in the intermediate monoaxial pedicle screw fixation group. CONCLUSION: Smaller von Mises stress in the pedicle screws and lower intradiscal pressure in the adjacent segment were observed in the polyaxial screw model than in the monoaxial pedicle screw fixation spine models. Fracture-level fixation could significantly correct kyphosis and reduce correction loss, and adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group.
Assuntos
Fixação Interna de Fraturas/instrumentação , Vértebras Lombares/lesões , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Adulto , Análise de Variância , Fenômenos Biomecânicos , Desenho de Equipamento , Feminino , Análise de Elementos Finitos , Fixação Interna de Fraturas/métodos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pressão , Radiografia , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiopatologia , Índices de Gravidade do Trauma , Resultado do TratamentoRESUMO
OBJECTIVES: No studies have compared monoaxial and polyaxial pedicle screws with regard to the von Mises stress of the instrumentation, intradiscal pressures of the adjacent segment and adjacent segment degeneration. METHODS: Short-segment monoaxial/polyaxial pedicle screw fixation techniques were compared using finite element methods, and the redistributed T11-L1 segment range of motion, largest maximal von Mises stress of the instrumentation, and intradiscal pressures of the adjacent segment under displacement loading were evaluated. Radiographic results of 230 patients with traumatic thoracolumbar fractures treated with these fixations were reviewed, and the sagittal Cobb's angle, vertebral body angle, anterior vertebral body height of the fractured vertebrae and adjacent segment degeneration were calculated and evaluated. RESULTS: The largest maximal values of the von Mises stress were 376.8 MPa for the pedicle screws in the short-segment monoaxial pedicle screw fixation model and 439.9 MPa for the rods in the intermediate monoaxial pedicle screw fixation model. The maximal intradiscal pressures of the upper adjacent segments were all greater than those of the lower adjacent segments. The maximal intradiscal pressures of the monoaxial pedicle screw fixation model were larger than those in the corresponding segments of the normal model. The radiographic results at the final follow-up evaluation showed that the mean loss of correction of the sagittal Cobb's angle, vertebral body angle and anterior vertebral body height were smallest in the intermediate monoaxial pedicle screw fixation group. Adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group but more likely to be observed in the intermediate monoaxial pedicle screw fixation group. CONCLUSION: Smaller von Mises stress in the pedicle screws and lower intradiscal pressure in the adjacent segment were observed in the polyaxial screw model than in the monoaxial pedicle screw fixation spine models. Fracture-level fixation could significantly correct kyphosis and reduce correction loss, and adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Vértebras Torácicas/lesões , Fraturas da Coluna Vertebral/cirurgia , Parafusos Pediculares , Fixação Interna de Fraturas/instrumentação , Vértebras Lombares/lesões , Pressão , Vértebras Torácicas/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Fenômenos Biomecânicos , Radiografia , Índices de Gravidade do Trauma , Reprodutibilidade dos Testes , Estudos Retrospectivos , Análise de Variância , Amplitude de Movimento Articular , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Análise de Elementos Finitos , Desenho de Equipamento , Fixação Interna de Fraturas/métodos , Vértebras Lombares/fisiopatologia , Vértebras Lombares/diagnóstico por imagemRESUMO
STUDY DESIGN: Biomechanical cadaver study. OBJECTIVE: To evaluate the relative effectiveness of Ponte osteotomies for spinal release in deformity correction. SUMMARY OF BACKGROUND DATA: Controversy exists as to the role of Ponte osteotomy in deformity correction surgery. Very little has been written about the biomechanical effects of Ponte osteotomy. Past biomechanical studies have been limited to application of forces through endplates, single functional units, or lack of comparison with anterior release. METHODS: Twelve fresh-frozen human full thoracic spinal units were tested for motion in axial rotation, flexion/extension, and lateral bending in a custom-designed robotic environment. Testing was repeated after sequential facetectomy and Ponte osteotomy (6 specimens) and compared with partial and full discectomy (6 specimens). RESULTS: Motion in axial rotation is increased 21% by Ponte osteotomy compared with 35% for full discectomy. Anterior displacement of the spinal column, creating lordosis, was increased 15% by Ponte osteotomy and 40% by full discectomy. Posterior displacement of the spinal column, creating kyphosis, was increased 23% by Ponte osteotomy and 89% by full discectomy. Finally, in coronal force application the Ponte osteotomy had virtually no effect (2%) compared with 40% increased motion by full discectomy. CONCLUSION: Posterior Ponte osteotomy releases produced more motion than facetectomy alone in axial rotation and sagittal correction maneuvers, but had no effect on coronal correction. Anterior discectomy release destabilized spinal column significantly more than posterior releases in all force applications. Despite ample clinical experience demonstrating the effectiveness of posterior-only surgery, the biomechanical effect of Ponte osteotomies is modest. LEVEL OF EVIDENCE: N/A.
Assuntos
Discotomia/métodos , Cifose/cirurgia , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Vértebras Torácicas/cirurgia , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Cifose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Rotação , Vértebras Torácicas/fisiopatologiaRESUMO
CONTEXT Congenital absence of the tibia is a rare anomaly with an incidence of one per 1,000,000 live births. It is mostly sporadic and can be identified as an isolated disorder or as part of malformation syndromes. CASE REPORT A male child, born to unaffected and non-consanguineous parents, presented with shortening of the legs and adduction of both feet. Physical examination at six months of age showed head circumference of 44.5 cm (75th percentile), length 60 cm (< 3rd percentile), weight 7,700 g (50th percentile), shortening of the left thigh and both legs with varus foot. There were no craniofacial dysmorphisms or chest, abdominal, genital or upper-extremity anomalies. Psychomotor development was normal. His workup, including renal and cranial ultrasonography, brainstem auditory evoked potential, and ophthalmological and cardiological examinations, was normal. X-rays showed bilateral absence of the tibia with intact fibulae, distally hypoplastic left femur, and normal right femur. In addition, spinal radiographs showed hemivertebrae at T9 and T10. CONCLUSION This novel association expands the spectrum of tibial hemimelia. Moreover, this observation highlights the usefulness of this inexpensive diagnostic method (X-rays) for characterizing the great clinical and radiological variability of tibial hemimelia.
Assuntos
Ectromelia/diagnóstico por imagem , Vértebras Torácicas/anormalidades , Vértebras Torácicas/diagnóstico por imagem , Tíbia/anormalidades , Ectromelia/fisiopatologia , Humanos , Lactente , Masculino , Radiografia , Reprodutibilidade dos Testes , Vértebras Torácicas/fisiopatologia , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologiaRESUMO
CONTEXT Congenital absence of the tibia is a rare anomaly with an incidence of one per 1,000,000 live births. It is mostly sporadic and can be identified as an isolated disorder or as part of malformation syndromes. CASE REPORT A male child, born to unaffected and non-consanguineous parents, presented with shortening of the legs and adduction of both feet. Physical examination at six months of age showed head circumference of 44.5 cm (75th percentile), length 60 cm (< 3rd percentile), weight 7,700 g (50th percentile), shortening of the left thigh and both legs with varus foot. There were no craniofacial dysmorphisms or chest, abdominal, genital or upper-extremity anomalies. Psychomotor development was normal. His workup, including renal and cranial ultrasonography, brainstem auditory evoked potential, and ophthalmological and cardiological examinations, was normal. X-rays showed bilateral absence of the tibia with intact fibulae, distally hypoplastic left femur, and normal right femur. In addition, spinal radiographs showed hemivertebrae at T9 and T10. CONCLUSION This novel association expands the spectrum of tibial hemimelia. Moreover, this observation highlights the usefulness of this inexpensive diagnostic method (X-rays) for characterizing the great clinical and radiological variability of tibial hemimelia. .
CONTEXTO Ausência congênita da tíbia é uma anomalia rara, com incidência em 1 por 1.000.000 de nascidos vivos, é principalmente esporádica e pode ser identificada como um distúrbio isolado ou como parte de síndromes de malformações. RELATO DO CASO Criança do sexo masculino, nascida de pais não afetados e não consanguíneos, apresentou-se com encurtamento das pernas e adução de ambos os pés. O exame físico realizado com seis meses de idade mostrou perímetro cefálico 44,5 cm (percentil 75), comprimento de 60 cm (percentil < 3), peso 7.700 g (percentil 50), encurtamento da coxa esquerda e as duas pernas com o pé varo bilateralhavia. Não houve dismorfismos craniofaciais, nem tórax, abdômen, genitais e anomalias das extremidades superiores. O desenvolvimento psicomotor foi normal. Os exames, incluindo ultrassonografia renal e da cabeça, potenciais auditivos evocados de tronco cerebral e exames oftalmológicos e cardiológicos, estavam normais. Raios-X revelou ausência bilateral da tíbia com fíbula intacta, hipoplasia distal do fêmur esquerdo e fêmur direito normal. Além disso, as radiografias de coluna mostraram hemivértebras em T9 e T10. CONCLUSÃO Esta associação nova expande o espectro de hemimelia tibial. Além disso, esta observação destaca a utilidade de tal método diagnóstico barato (raios-X), caracterizando a grande variabilidade clínica e radiológica de hemimelia tibial. .
Assuntos
Humanos , Lactente , Masculino , Ectromelia , Vértebras Torácicas/anormalidades , Vértebras Torácicas , Tíbia/anormalidades , Ectromelia/fisiopatologia , Reprodutibilidade dos Testes , Vértebras Torácicas/fisiopatologia , Tíbia/fisiopatologia , TíbiaRESUMO
La hernia de hiato es una situación patológica que se da cuando parte del estómago se introduce hacia el tórax. El esófago entra en el abdomen desde el tórax a través de un agujero o hiato que se encuentra en el diafragma. El estómago protruye a través de este hiato debilitado y produce ardores (pirosis) y dolor torácico. La persistencia en el tiempo de esta hernia, puede provocar una metaplasia de la mucosa esofágica dando al lugar al esófago de Barret el cual puede malignizar produciéndose cáncer de esófago. (1) La hernia de hiato es relativamente frecuente, afectando hasta un 20 por ciento de la población. Del total de pacientes con el trastorno, cerca del 10 por ciento son asintomáticos, dependiendo del grado de protrución estomacal y de que tanto esté afectado el esfinter esofágico inferior (EEI). Un 40 por ciento de las hernias de hiato son hernias deslizantes, en las que el EEI protruye conjuntamente con una porción del estómago y solo un 5 por ciento son paraesofágicas, en la que solo una porción del estómago se hace intratorácica mientras tanto que el EEI permanece intraabdominal. Los síntomas más comunes de una hernia de hiato incluyen pirosis, dolor torácico, disfagia, palpitaciones y ocasionalmente regurgitación o reflujo gastroesofágico. El diagnóstico de una hernia hiatal comienza con el éxamen físico por razón de la sintomatología. Los estudios radiográficos y la endoscopia digestiva demuestran la hernia hiatal y ayudan a descartar otras causas de molestias digestivas altas. (2) Se recomienda un procedimiento quirúrgico conocida como fundoplicación de Nissen, (3) Cuando los síntomas causados por una hernia de hiato son tan severas que pueden resultar en lesiones al esófago o incluso cáncer del esófago. (6) Se trata de lactante mayor de seis meses de edad quien es natural de la localidad y procedente de Cordero, quien inicia enfermedad actual el día de hoy en la madrugada según refiere la madre, caracterizado por vómitos en número incontables.