Avaliação da efetividade de compressão interfragmentária em fêmures de gatos (ex- vivo) com o uso de HIB-AE (haste intramedular bloqueada de ângulo estável) associada a dispositivo de compressão interfragmentária (patente BR 10 2018 016021 4) por meio de MINO (osteossíntese minimamente invasiva com haste intramedular)
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Data
2023-02-28
Autores
Nobile, Matheus [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
O presente estudo teve como objetivo avaliar radiograficamente a efetividade da compressão interfragmentária em fêmures de gatos (ex-vivo) com o uso de haste intramedular bloqueada associada a dispositivo de compressão interfragmentária (patente BR 10 2018 016021 4) por meio de osteossíntese minimamente invasiva (MINO). Para tal, utilizaram-se cadáveres de gatos adultos (n=16), dos quais um espécime (n=1) foi direcionado ao ensaio “piloto”, enquanto os restantes (n=15), foram direcionados aos ensaios definitivos. Todos os fêmures foram avaliados por meio de imagens radiográficas, como forma de identificar alterações anatômicas passíveis de exclusão. Após a seleção dos ossos ideais, foram realizadas, também, tomografias computadorizadas, para mensuração do eixo anatômico femoral, dos ângulos anatômicos laterais proximais e distais e do ângulo de anteversão, bilateralmente, previamente ao procedimento cirúrgico. Os animais foram aleatoriamente sorteados em três grupos, com 5 espécimes cada (10 fêmures por grupo) e submetidos à osteotomias transversas (acesso pela face medial da coxa): G1-DP (osteotomia na diáfise femoral proximal de ambos os fêmures); G2-DM (osteotomia diafisária femoral média) e G3-DD (osteotomia femoral diafisária distal). Ato contínuo, os 30 fêmures foram novamente radiografados. Após o planejamento cirúrgico prévio, a haste intramedular bloqueada de ângulo estável (HIB-AE) associada ao Dispositivo 3 (BR 10 2018 016021 4) foi alocada nos fêmures pela técnica de MINO e a compressão interfragmentária foi executada, juntamente com os bloqueios da haste. Posteriormente à implantação das hastes em todos os cadáveres felinos (n=30 fêmures), foram realizadas novas radiografias e novas tomografias computadorizadas, para avaliar a aposição óssea, a efetividade da compressão interfragmentária, o alinhamento alcançado, a disposição dos implantes colocados e comparar estatisticamente os resultados finais dos eixos anatômicos e dos ângulos obtidos, comparados às radiografias prévias à implantação das hastes, observando a presença ou não, de alterações significativas. Os resultados indicaram que todos os gaps mantiveram-se dentro da classificação ideal ou aceitável (entre 0 e 1 mm). Não houve diferença estatística significativa entre os momentos pré e pós-implantação para os AaLDF (ângulo anatômico lateral distal do fêmur). Houve diferença significativa apenas no grupo G2-DM para avaliação do AaLPF (ângulo anatômico lateral proximal do fêmur). Todos os grupos apresentaram diferença estatística significativa em relação ao AAF (ângulo de anteversão femoral). Concluiu-se que o novo modelo de implante foi eficaz quanto à realização de compressão interfragmentária nas linhas transversas realizadas em fêmures de cadáveres de gatos.
The present study aimed to radiographically evaluate the occurrence of interfragmentary syndrome in femurs of cats (ex-vivo) with the use of a locked intramedullary nail associated with an interfragmentary compression device (patent BR 10 2018 016021 4) through minimally invasive osteosynthesis (MINO). For this purpose, cadavers of adult cats (n=16) were used, of which one specimen (n=1) was directed to the “pilot” test, while the rest (n=15) were directed to the definitive tests. All cases (right and left femurs) were evaluated by means of radiographic images, as a way of identifying anatomical alterations subject to exclusion. After selecting the ideal bones, computed tomography scans were also performed to measure the femoral anatomical axis, the proximal and distal lateral anatomical angles and the anteversion angle, bilaterally, prior to the medical procedure. The animals were randomly drawn into three groups, with 5 specimens each (10 femurs per group) and submitted to transverse osteotomies (access through the medial aspect of the thigh): G1-DP (osteotomy in the proximal femoral diaphysis of both femurs); G2-DM (middle diaphyseal femoral osteotomy) and G3-DD (distal diaphyseal femoral osteotomy). Then, the 30 femurs were radiographed again. After prior surgical planning, the angle stable locked intramedullary nail (AS-ILN) associated with Device 3 (BR 10 2018 016021 4) was placed in the femurs by the MINO technique and interfragmentary compression was performed. After the implantation of the interlocking nails in all feline cadavers (n=30 femurs), new radiographs and new computed tomography scans were taken to evaluate the bone position, the alignment, the achieved, the disposition of the placed implants and to statistically compare the results end points of the anatomical axes and the obtained angles, compared to the radiographs prior to the implantation of the interlocking nails, observing the presence or not of alterations. The results indicated that all gaps remained within the ideal or acceptable classification. There was no statistically significant difference between the pre- and post-implantation moments for the AaLDF (distal lateral anatomical angle of the femur). There was a significant difference only in the G2-DM group for the evaluation of the AaLPF (proximal lateral anatomical angle of the femur). All groups showed a statistically significant difference in relation to the AAF (femoral anteversion angle). It was concluded that the new implant model was effective in terms of performing interfragmentary compression on transverse lines performed on femurs of cat cadavers.
The present study aimed to radiographically evaluate the occurrence of interfragmentary syndrome in femurs of cats (ex-vivo) with the use of a locked intramedullary nail associated with an interfragmentary compression device (patent BR 10 2018 016021 4) through minimally invasive osteosynthesis (MINO). For this purpose, cadavers of adult cats (n=16) were used, of which one specimen (n=1) was directed to the “pilot” test, while the rest (n=15) were directed to the definitive tests. All cases (right and left femurs) were evaluated by means of radiographic images, as a way of identifying anatomical alterations subject to exclusion. After selecting the ideal bones, computed tomography scans were also performed to measure the femoral anatomical axis, the proximal and distal lateral anatomical angles and the anteversion angle, bilaterally, prior to the medical procedure. The animals were randomly drawn into three groups, with 5 specimens each (10 femurs per group) and submitted to transverse osteotomies (access through the medial aspect of the thigh): G1-DP (osteotomy in the proximal femoral diaphysis of both femurs); G2-DM (middle diaphyseal femoral osteotomy) and G3-DD (distal diaphyseal femoral osteotomy). Then, the 30 femurs were radiographed again. After prior surgical planning, the angle stable locked intramedullary nail (AS-ILN) associated with Device 3 (BR 10 2018 016021 4) was placed in the femurs by the MINO technique and interfragmentary compression was performed. After the implantation of the interlocking nails in all feline cadavers (n=30 femurs), new radiographs and new computed tomography scans were taken to evaluate the bone position, the alignment, the achieved, the disposition of the placed implants and to statistically compare the results end points of the anatomical axes and the obtained angles, compared to the radiographs prior to the implantation of the interlocking nails, observing the presence or not of alterations. The results indicated that all gaps remained within the ideal or acceptable classification. There was no statistically significant difference between the pre- and post-implantation moments for the AaLDF (distal lateral anatomical angle of the femur). There was a significant difference only in the G2-DM group for the evaluation of the AaLPF (proximal lateral anatomical angle of the femur). All groups showed a statistically significant difference in relation to the AAF (femoral anteversion angle). It was concluded that the new implant model was effective in terms of performing interfragmentary compression on transverse lines performed on femurs of cat cadavers.
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Palavras-chave
Compressão, Fratura, Gatos, Ortopedia veterinária