O objetivo deste estudo é o de comparar os resultados clínicos e radiográficos do tratamento cirúrgico das fraturas da diáfise do úmero com haste intramedular bloqueada ou placa em ponte. Quarenta fraturas da diáfise do úmero, em 39 pacientes, dos tipos A, B ou C da classificação do grupo A.O., foram tratadas no período compreendido entre junho de 2003 e dezembro de 2007. Destas, após seleção por sorteio, 21 fraturas foram submetidas à osteossíntese com placas em ponte de 4,5 mm e parafusos (grupo PP) e 19 com hastes intramedulares bloqueadas não fresadas (grupo HIB). Duas eram fraturas expostas, uma do tipo II e outra do tipo III-a de Gustilo. Vinte e cinco pacientes eram do sexo masculino (64%) e a idade variou de 19 a 75 anos (idade média de 41 anos e 10 meses). O lado direito foi acometido em 22 pacientes (55%) e a queda, o mecanismo de trauma mais freqüente (46%). O tempo mínimo de seguimento foi de seis meses e o máximo de 60 meses para o grupo PP (M=34,5 meses) e de oito e 58 meses (M=27meses) para o grupo HIB. Em apenas um caso, operado com haste intramedular bloqueada, não houve a consolidação. Houve um caso de infecção profunda no grupo PP e um de infecção superficial no grupo HIB. Dois casos do grupo PP evoluíram com capsulite adesiva e, em apenas um dos casos do grupo HIB, o parafuso distal ficou saliente. Ocorreu neuropraxia do nervo cutâneo lateral do antebraço em um dos casos do grupo HIB que regrediu em três dias. Não houve diferença entre os grupos com relação ao tempo total da cirurgia. O tempo de utilização da radioscopia no ato operatório foi maior no grupo HIB. Houve semelhança entre os dois métodos de fixação nos resultados referentes à dor, à função, à flexão ativa e à força de flexão na articulação do ombro e também com relação à dor, mobilidade, força muscular e estabilidade na articulação do cotovelo. Segundo os critérios da UCLA para o ombro, obtivemos resultados excelentes e bons em 85,7% no grupo operado com placa em ponte e 79% no grupo com haste intramedular bloqueada e de acordo com os critérios de Broberg e Morrey para o cotovelo, obtivemos resultados excelentes e bons em 85,7% no grupo operado com placa em ponte e 90,5% no grupo com haste intramedular bloqueada. Na avaliação subjetiva, duas pacientes, uma do grupo HIB e outra do PP, não ficaram satisfeitas. Conclusão: Não houve diferença no resultado clínico e radiográfico entre os dois métodos / The purpose of the study is to compare clinical and radiographic outcomes between nonreamed locked intramedullary nail and bridging plate for the treatment of humeral shaft fracture. Forty humeral shaft fractures in 39 patients, A, B or C AO types were treated between June 2003 and December 2007. The cases were randomly assigned into two groups being 21 fractures fixed by a 4.5 mm bridging plate, and 19 by nonreamed intramedullary locking nail. Two cases had open fractures, one Gustilo type II, the other type IIIa. Twenty five patients were male (64%), ages ranging from 19 to 75 years old (mean age 41 years and 10 months). The right side was treated in 22 patients (55%) and fall was the most frequent cause of fracture (46%). The minimal period of follow-up was six months and the maximum was 60 months for the bridging plate group (mean=34.5 months) and ranged from eight to 58 months (mean=27months) for the nail group. Only one case from the nail group presented a nonunion. One case, in the plate group, developed a deep infection, and another one, in the nail group, had a superficial infection. Two cases of the bridging plate group had adhesive capsulites and in one case of the nail group the distal screw became prominent. A transient neuropraxis of the antebrachial lateral cutaneous nerve was found in one case of the nail group, but it recovered in three days. There were no differences between the groups concerning pain, function, active flexion and strength of flexion of the shoulder, as well as pain, range of motion, muscle strength, and stability of the elbow. According to the UCLA score, we had 85.7% excellent and good results in the plate group and 79% in the nail group. According to Broberg and Morrey score for the elbow, we had 85.7% excellent and good results in the plate group and 90.5% in the nail group. Just one patient, from the nail group, was not satisfied with the final result, according to subjective criteria. In conclusion, there were no differences in the final clinical and radiographic results between the two methods of fixation

A Artroplastia Total de Quadril (ATQ) é um procedimento cirúrgico amplamente utilizado para o tratamento de afecções da articulação coxofemoral, sejam elas degenerativas inflamatórias ou traumáticas. Ela tornou-se um excelente método de tratamento no alívio da dor e melhora da capacidade funcional desses pacientes. No período pós-operatório, esses pacientes tornam-se dependentes da equipe enfermagem, devido à limitação para mobilizar-se e a restrição ao leito, visto que, não podem apoiar-se no chão, nem realizar exercício de adução com o membro operado pelo risco de luxação da prótese. Com base nestas características, o enfermeiro pode estabelecer o diagnóstico de enfermagem (DE) Mobilidade Física Prejudicada (MFP), dada a amplitude limitada de movimentos, trauma e dor no membro inferior afetado. Várias intervenções são realizadas, porém a avaliação de resultados ainda uma prática pouca explorada na enfermagem. A Classificação de Resultados Enfermagem (NOC) é uma terminologia usada no Processo de Enfermagem (PE) para medir, por meio dos Resultados de Enfermagem (RE), estados de saúde, comportamentos, reações e sentimentos dos pacientes, cuidador/familiar ou comunitário, e possibilita ao enfermeiro avaliar os efeitos das intervenções de enfermagem na prática clínica. Foi nessa perspectiva que se estabeleceu como objetivo geral avaliar a aplicabilidade da Classificação de Resultados de Enfermagem em pacientes com DE Mobilidade Física Prejudicada, submetidos à ATQ durante um período de até quatro dias. Trata-se de um estudo longitudinal realizado em um hospital universitário do sul do Brasil. Os dados foram coletados de agosto a dezembro de 2012 e os sujeitos foram pacientes submetidos à ATQ, que atenderam aos seguintes critérios: ambos os sexos; idade ≥ 18 anos; presença do diagnóstico MFP registrado em prontuário, com respectivos cuidados prescritos pelo enfermeiro assistencial; e permanecerem internados por quatro dias ou até a alta hospitalar. O instrumento de coleta de dados foi construído especialmente para esta pesquisa e cinco RE e 16 indicadores clínicos que compuseram o mesmo foram selecionados por meio de consenso. Os pacientes foram avaliados por duplas de coletadoras treinadas, de forma simultânea, por de maneira independente. Resultados: Participaram do estudo 21 pacientes, predominantemente do sexo feminino n=13(61,9%), brancos n=16 (76,1%), com idade média de 58,8 (±16,7), e 15 (71,4%) pacientes submetidos à ATQ primária. Os 21 pacientes mantiveram o DE MFP até o final das avaliações. De todos os pacientes, 15 (71,4%) foram avaliados num período de quatro dias de seguimento. Dentre os RE avaliados Posicionamento do Corpo: autoiniciado, Mobilidade, Conhecimento: atividade prescrita e Comportamento de prevenção de quedas apresentaram aumento significativo nos escores quando comparadas as médias da primeira com a última avaliação. Apenas o RE Nível de dor (p=0,265) não demonstrou diferença estatisticamente significativa. Esses dados indicam que o uso da NOC pode demonstrar a evolução clínica dos pacientes com Mobilidade Física Prejudicada submetidos à ATQ, sendo passível de aplicação neste cenário da prática de enfermagem. / The Total Hip Replacent (THR) is a widely used surgical procedure for the treatment of diseases of the hip joint, whether traumatic, degenerative or inflammatory. It be became an excellent method of treatment in relieving pain and improving functional capacity of these patients. In the postoperative period, these patients become dependent on nursing staff, due to the limitation to mobilize and bed restriction, since they cannot rely on the floor exercise or perform adduction with the operated limb at risk dislocation of the prosthesis. Based on these characteristics, the nurse can establish a nursing diagnosis Impaired Physical Mobility, given the limited range of motion, trauma and pain in the affected lower limb. Several interventions are performed, but the results evaluation still a little explored in nursing practice. The Nursing Outcomes Classification (NOC) is a terminology used in the Nursing Process to measure through Nursing Outcomes, health status, behaviors, reactions and feelings of patients, caregiver / family or community, and allows nurses to evaluate the effects of nursing interventions in the clinical practice. It was in this perspective that has established as purpose to evaluate the applicability of the Nursing Outcomes Classification in patients with Impaired Physical Mobility, undergoing THA for a period of up to four days. This is a longitudinal study conducted at a university hospital in southern Brazil. Data were collected from August to December 2012, and the subjects were patients undergoing THR, who met the following criteria: both sexes, age ≥ 18 years, presence of Impaired Physical Mobility recorded in patient records, with respective treatments prescribed by hospital nurses; and remain hospitalized for at four days. / La Artroplastia Total de Cadera (ATC) es un procedimiento ampliamente usado para el tratamiento quirúrgico de las enfermedades de la articulación de la cadera, si inflamatoria traumática o degenerativa. Ella se convirtió en un excelente método de tratamiento para aliviar el dolor y mejorar la capacidad funcional de estos pacientes. En el postoperatorio, los pacientes se vuelven dependientes de personal de enfermería, debido a la limitación de movilizar y por la restricción a la cama, ya que no pueden pisar el suelo o realizar la aducción de la extremidad operada en riesgo dislocación de la prótesis. En base a estas características, la enfermera puede establecer un diagnóstico de enfermería Deterioro de la Movilidad Física, dado el rango de movimiento limitado, el trauma y el dolor en la extremidad inferior afectada. En varias intervenciones se llevan a cabo, pero la evaluación de los resultados todavía poco explorado en la práctica de enfermería. La Clasificación de de Resultados de Enfermería (CRE) es una terminología que se utiliza en el Proceso de enfermería para medir a través de los Resultados de Enfermería, estado de salud, comportamientos, reacciones y sentimientos de los pacientes, cuidadores / familia o la comunidad, y permite a las enfermeras para evaluar los efectos de las intervenciones de enfermería en la práctica clínica. Es en esta perspectiva que se ha establecido como objectivo avaliar la aplicabilidad de la Clasificación de Resultados de Enfermería en pacientes con Deterioro de la Movilidad Física, sometidos a una Artroplastia Total de Cadera, por un período de cuatro días. Se trata de un estudio longitudinal realizado en un hospital universitario en el sur de Brasil. The data collection instrument was built specially for this study with five outcomes and 16 clinical indicators that were selected by consensus. Patients were evaluated by pairs of trained coletadoras, simultaneously, by independently. Results: The study included 21 patients, predominantly female n = 13 (61.9%), whites n = 16 (76.1%) with a mean age of 58.8 (± 16.7), and 15 (71.4%) patients undergoing primary THR. The 21 patients maintained of Impaired Physical Mobility until the end of the evaluations. In all patients, 15 (71.4%) were assessed over a period of four days of follow up. Among the nursing outcomes assessed Positioning Body: self-initiated, Mobility, Knowledge: prescribed activity and Fall prevention behavior showed a significant increase in scores when comparing the mean of the first with the last evaluation. Only the NOC Level of pain (p = 0.265) showed no significant difference. These data indicate that the use of the NOC can demonstrate the clinical course of patients with Impaired Physical Mobility undergoing THR, which might be applied in this scenario of nursing practice.

Dans ce travail de thèse, la texturation de surface d‟alliages de titane a été étudiée en utilisant un procédé d'écriture directe par laser femtoseconde dans le but d'améliorer la mouillabilité d‟implants dentaires et orthopédiques par les fluides biologiques et la minéralisation de la matrice (formation osseuse) tout en réduisant l'adhésion bactérienne et la formation de biofilmes. Des surfaces de titane (Ti-6Al-4Vet cp Ti) ont été micro-, nano-texturées par laser femtoseconde et une biofonctionnalisation de ces surfaces a été ajoutée ou non par greffage de peptides d'adhésion cellulaire (peptides RGD) en surface de ces différents matériaux. Les textures de surface peuvent être classées comme suit: (a) structures périodiques de surface induites par laser (LIPSS); (b) étalage de nanopiliers (NP); (c) étalage de micro colonnes recouvertes de LIPSS (MC-LIPSS) formant une distribution bimodale de rugosité. Nous avons montré que la texturation de surface par laser améliore la mouillabilité des surfaces avec de l'eau ainsi qu‟une solution saline tamponnée Hank's (HBSS) et amène une anisotropie de mouillage. Une minéralisation cellulaire est observée pour toutes les surfaces des deux alliages de titane lorsque des Cellules Souches Mésenchymateuses humaines (hMSC) sont cultivées dans un milieu ostéogénique. La minéralisation de la matrice et la formation de nodules osseux sont considérablement améliorées sur les surfaces texturées LIPSS et NP. Parallèlement,l'adhésion de Staphylococcus aureus et la formation de biofilmes sont considérablement réduites pour les surfaces texturées LIPSS et NP. La biofonctionnalisation des différentes surfaces texturées (cp Ti) par laser a été réalisée et caractérisée par spectroscopie de photoélectrons (XPS) et par microscopie à fluorescence en utilisant des peptides fluorescents. L‟ensemble des résultats obtenus suggèrent que la texturation de surface d'alliages de titane (Ti-6Al-4V et cp Ti) en utilisant une technique d‟écriture directe par laser femtoseconde est un procédé prometteur pour l'amélioration de la mouillabilité de la surface d'implants dentaires et orthopédiques par les fluides biologiques et leur ostéointégration (différenciation ostéoblastique et minéralisation de la matrice), tout en réduisant l‟adhésion de Staphylococcus aureus et la formation de biofilmes. Enfin, la combinaison de la texturation par laser et du greffage covalent d‟un principe actif (ici un peptide d‟adhésion cellulaire comme le peptide RGD) amènera indéniablement une bioactivité utile pour favoriser l'adhésion des hMSC et faciliter laformation osseuse. / In the present thesis the surface texturing of Ti alloys using femtosecond laser direct writing method is explored as a potential technique to enhance the wettability of dental and orthopaedic implants by biological fluids and matrix mineralisation (bone formation), while reducing bacteria adhesion and biofilmformation. The surface texture was combined with biofunctionalisation by covalent grafting of a RGD peptide sequence as well. The surface textures can be classified as follows: (a) Laser-Induced Periodic Surface Structures-LIPSS; (b) nanopillars arrays(NP); (c) arrays of microcolumns covered with LIPSS (MC-LIPSS), forming a bimodal roughness distribution. Laser texturing enhances surface wettability by water andHank‟s balanced salt solution (HBSS) and introduces wetting anisotropy, crucial incontrolling the wetting behaviour. Matrix mineralisation is observed for all surfaces of both Ti alloys when human mesenchymal stem cells (hMSCs) are cultured in osteogenic medium. Matrix mineralisation and formation of bone-like nodules are significantly enhanced on LIPSS and NP textured surfaces. On the contrary, Staphylococcus aureusadhesion and biofilm formation are significantly reduced for LIPSS and NP textured surfaces. The biofunctionalisation of the laser textured surfaces of cp Ti is sucessfully achieved. In general, these results suggest that surface texturing of Ti alloys using femtosecond laser direct writing is a promising method for enhancing surface wettability of dental and orthopaedic implants by biological fluids and their osseointegration (osteoblastic differentiation and matrix mineralisation), while reducing Staphylococcus aureus adhesion and biofilm formation. Finally, the combination of laser texturing and covalent grafting of a RGD peptide sequence may be potentially useful for increasing cell adhesion and facilitating bone formation.

No description available.

Introduction : La scoliose idiopathique de l’adolescent (SIA) est une déformation du tronc chez 4 % des 10-18 ans. Le corset est le seul traitement conservateur ayant démontré son efficacité pour limiter sa progression. On note un problème d’adhésion au traitement avec un temps de port moyen de 13 heures/jour (prescription de 22 heures), dont les causes ont été peu étudiées. Objectif et hypothèse : Développer et valider un questionnaire des facteurs liés à l’adhésion au corset. Nos hypothèses sont les suivantes : IMCO aura de bonnes validités de contenu et fiabilité, une validité de construit satisfaisante et pourra discerner les patients adhérents/non-adhérents. Ses scores varieront selon l’âge, l’indice de masse corporelle (IMC) et la sévérité de la courbe. Méthodologie : Un cadre conceptuel intégrateur a été défini. Les items candidats ont été élaborés puis sélectionnés avec les experts. IMCO a été validé avec des jeunes patients traités par corset (n=159) pour tester : la stabilité temporelle (ICC), cohérence interne (alpha Cronbach), validité convergente/divergente (Rho de Spearman) avec deux questionnaires de qualité de vie SF-12 et SRS-22, et capacité discriminante (ANOVA/régression). Résultat/discussion : IMCO comprend 34 items selon 4 barrières à l’adhésion : liées aux facteurs sociaux et émotionnels, au traitement, au patient, et au système de santé. La cohérence interne est excellente (0,89). Les scores IMCO sont associés au temps de port du corset, et varient selon la sévérité de la courbe, l’IMC et l’âge. Les scores sont corrélés avec le domaine satisfaction envers le traitement du SRS-22. Conclusion : IMCO rencontre les critères COSMIN, sauf pour la stabilité temporelle (échantillon inadéquat). Il constitue un instrument approprié pour la recherche. Une analyse factorielle est recommandée pour poursuivre sa validation. / Introduction: Adolescent idiopathic scoliosis (AIS) is a trunk deformity that affects 4% of 10– 18-year olds. The brace is the only effective conservative treatment that has been proven to limit its progression. A treatment adherence problem has been reported with an average wearing time of 13 hours/day (full time bracing prescription of 22 hours), for which underlying causes have been insufficiently studied. Objectives and hypotheses: our goal is to develop and to validate a questionnaire to measure the factors related to brace adherence. Our hypotheses are: The IMCO will display good content validity and reliability, acceptable construct validity, and will be able to discriminate adherent from non-adherent patients. Its scores will vary according to age, body mass index (BMI) and severity of the curve. Methodology: An integrative conceptual framework was defined. Candidate items were developed and selected with experts. The IMCO was validated with young AIS patients (n=159) to test: temporal stability (ICC), internal consistency (alpha Cronbach), convergent/divergent validity (Spearman's Rho) with two quality of life questionnaires SF-12 and SRS-22, and discriminant capacity (ANOVA/regression). Result/discussion: IMCO includes 34 items according to 4 barriers to adherence: related to social and emotional factors, to the treatment, to the patient, and to the health system. Internal consistency is excellent: 0.89. IMCO scores are associated with adherence to treatment, severity of the curve, BMI and age. Scores correlated with the SRS-22 satisfaction with treatment domain. Conclusion: IMCO meets the COSMIN criteria except for temporal stability (inadequate sample). It is an appropriate instrument for research. A factorial analysis is recommended for further validation.

No description available.

Dans cette thèse, nous présentons une méthode de segmentation d’images radiographiques des membres inférieurs en régions d’intérêt (ROIs), une méthode de recalage rigide tridimensionnel (3D) / bidimensionnel (2D) des prothèses du genou sur les deux images biplanaires radiographiques calibrées et une méthode de reconstruction 3D des membres inférieurs à partir de deux images biplanaires radiographiques calibrées. Le premier article présente une méthode de segmentation de rotule, astragale et bassin des images radiographiques en régions d’intérêt basée sur la fusion de multi-atlas et superpixels. Cette méthode utilise l’apprentissage d’une base de données d’images radiographiques de ces os segmentées manuellement et recalées entre elles pour estimer un ensemble de superpixels permettant de tenir compte de toute la variabilité locale et non linéaire existante dans la base, puis la propagation d’étiquettes basée sur le concept d’entropie pour raffiner la carte de segmentations en régions internes afin d’obtenir le résultat final. Le deuxième article présente une méthode de recalage rigide 3D / 2D des composants tibiaux et fémoraux de prothèse du genou sur deux images biplanaires radiographiques calibrées. Cette méthode utilise une mesure de similarité hybride basée sur les notions de contours et régions puis un algorithme d’optimisation stochastique pour estimer la position des composants. La similarité basée sur les régions est stable et robuste contre les bruits. Cependant, cette mesure n’est pas précise car le nombre de pixels aux contours est inférieur au celui à l’intérieur de la région. Au contraire, la similarité basée sur les contours est précise mais plus sensible au bruit ou à d’autres artefacts existant dans les images. C’est pourquoi la combinaison de ces deux similarités fournit une méthode de recalage robuste et précise. Le troisième article représente une méthode statistique biplanaire de reconstruction 3D de rotule, astragale et bassin. Cette méthode utilise un algorithme de réduction de dimensionnalité pour définir un modèle déformable paramétrique qui contient toutes les déformations statistiques admissibles apprises à partir d’une base de données des structures osseuses. Puis un algorithme d’optimisation stochastique est utilisé pour minimiser la différence entre la projection des contours / régions des modèles surfaciques osseux avec ceux segmentés sur les deux images radiographiques. / In this thesis, we present a segmentation method of lower limbs of X-ray images into regions of interest (ROIs), a three-dimensional (3D) / two-dimensional (2D) rigid registration method of knee implant components to biplanar X-ray images, and a 3D reconstruction method of the lower limbs using biplanar X-ray images. The first paper presents a superpixel and multi-atlas-based segmentation method of the patella, talus, and pelvis into regions of interest. This method uses a training dataset of pre-segmented and co-registered X-ray images of these bones to estimate a collection of superpixels allowing to take into account all the nonlinear and local variability existing in the dataset, then a propagation of label based on the entropy concept for refining the segmentation map into internal regions to the final result. The second paper presents a 3D / 2D rigid registration method of tibial and femoral components of knee implants to calibrated biplanar X-ray images. This method uses a hybrid edge- and region-based similarity measure then a stochastic optimization algorithm to estimate the component position. The region-based similarity is stable and robust to noise. However, this measure is not precise because the number of pixels in the border is fewer than the number of pixels inside the region. On the contrary, the edge-based similarity is accurate but more sensitive to noise or other artifacts existing in the images. That’s why the combination of these two similarity types provides a robust and accurate registration method. The third paper presents a statistical biplanar 3D reconstruction method of the patella, talus, and pelvis. This method uses a dimensionality reduction algorithm to define a deformable parametric model which contains all admissible statistical deformations learned from the bone structure dataset. Then a stochastic optimization algorithm is used to minimize the difference between the contour / region projection of bone models and the contours / regions in two segmented X-ray images.