Made available in DSpace on 2014-07-29T15:25:18Z (GMT). No. of bitstreams: 1 Tese Marcela Souza Berquo.pdf: 1144728 bytes, checksum: 5ef0c624200c91e9dc3f54dd56320b9a (MD5) Previous issue date: 2012-02-15 / INTRODUCTION: The overactive bladder syndrome (OAB) is a lower urinary tract pathology that negatively affects the quality of life (QOL) of women whose main symptom is your definition for urinary urgency, with or without incontinence usually accompanied by urinary frequency and nocturia in the absence of metabolic, infectious or local. The diagnosis of BH is defined from the clinical symptoms, but the voiding diary and urodynamic studies are good tools for objective evaluation of this pathology. There are several forms of treatment for OAB, are the main pharmacological and physical therapy, physical therapy has been being considered an important option in a clinical setting. OBJECTIVES: to do a systematic review article about physical therapy in the treatment of female miccional urgency, to evaluate and compare the effects, discomfort and improvement in quality of life (QOL) of vaginal electrostimulation and percutaneous tibial nerve stimulation (PTNS) in women with overactive bladder. METHODS: We conducted a comparative, prospective, randomized trial of physiotherapy in the sector of the Hospital Materno Infantil (HMI) in Goiânia-GO, from march 2010 to august 2011. We randomized 40 women with urodynamic diagnosis of detrusor overactivity, mixed incontinence with predominant symptoms of overactive bladder or urinary urgency only in two groups: vaginal electrical stimulation (n=20) and PTNS (n=20), being held 10 sessions in each group. We used urodynamic studies, voiding diary and QoL questionnaire of King's Health Questionnaire (KHQ) before and after the two procedures, and then visual analog scale. Statistical analysis used: Fisher exact tests, chi quadratic, U Mann Whitney and Wilcoxon tests with a significance level of 0.05. RESULTS: In voiding diary was a reduction in urinary frequency, urge incontinence, nocturia and urgency in both groups. The urgency was present in all women and disappeared in 90% in the PTNS group (p<0.001) and 80% in vaginal electrical stimulation (p<0.001). According to urodynamic evaluation, the group of vaginal electrostimulation showed disappearance of detrusor overactivity in 60% (p=0.005) and PTNS in 75% (p= 0.002). The urodynamics showed significant differences in some parameters analyzed within each specific group and to compare the two groups was not observed differences. The scale and the KHQ domains of the two procedures had similar results as physical therapy to improve QOL, but no significant difference between them. In relation to the discomfort of procedures, PTNS in 80% of women reported no discomfort and 80% reported vaginal electrostimulation mild to moderate discomfort (p<0.001). CONCLUSION: There was no significant difference in the effects and QOL between the vaginal electrical stimulation and PTNS. The PTNS promoted less discomfort for women. / INTRODUÇÃO: A síndrome de bexiga hiperativa (BH) é uma patologia do trato urinário inferior que afeta negativamente a qualidade de vida (QV) das mulheres, cujo principal sintoma para a sua definição é a urgência miccional, com ou sem incontinência, geralmente acompanhada por polaciúria e noctúria, na ausência de fatores metabólicos, infecciosos ou locais. O diagnóstico da BH é definido a partir dos sintomas clínicos, porém o estudo urodinâmico e o diário miccional são bons instrumentos de avaliação objetiva dessa patologia. Existem diversas formas de tratamento para a BH, os principais são o farmacológico e a fisioterapia, uma vez que a fisioterapia vem sendo considerada como uma opção de relevância no meio clínico. OBJETIVO: Fazer um artigo de revisão sistemática sobre a atuação da fisioterapia no tratamento da urgência miccional feminina, avaliar e comparar os efeitos, o desconforto e a melhoria na qualidade de vida (QV) da eletroestimulação vaginal e da eletroestimulação transcutânea do nervo tibial posterior (PTNS) em mulheres com bexiga hiperativa. MÉTODOS: Foi realizado um estudo comparativo, prospectivo e randomizado no setor de fisioterapia do Hospital Materno Infantil (HMI) de Goiânia-GO, no período de março 2010 a agosto de 2011. Foram randomizadas 40 mulheres com o diagnóstico urodinâmico de hiperatividade do detrusor, incontinência urinária mista com predomínio dos sintomas de bexiga hiperativa ou apenas urgência miccional em dois grupos: eletroestimulação vaginal (n=20) e PTNS (n=20), sendo realizado 10 sessões em cada grupo. Foram utilizados o estudo urodinâmico, diário miccional e o questionário de QV King s Health Questionnaire (KHQ) antes e após os dois procedimentos, e posteriormente a escala visual analógica. Para análise estatística utilizou-se: os testes Exato de Fisher, Qui Quadrad, u Mann Whitney e Wilcoxon com nível de significância de 0,05. RESULTADOS: No diário miccional houve a redução da frequência miccional, urgeincontinência, noctúria e urgência nos dois grupos. A urgência estava presente em todas as mulheres e desapareceu em 90% no grupo PTNS (p<0,001) e 80% na eletroestimulação vaginal (p<0,001). Conforme avaliação urodinâmica, o grupo da eletroestimulação vaginal apresentou desaparecimento da hiperatividade detrusora em 60% (p=0,005) e na PTNS 75% (p=0,002). A urodinâmica demonstrou diferença significante em alguns parâmetros analisados dentro de cada grupo específico e ao comparar os dois grupos não foi constatado diferenças. Quanto à escala e os domínios do KHQ os dois procedimentos da fisioterapia apresentaram resultados similares quanto à melhora da QV, mas sem diferença significativa entre eles. Em relação ao desconforto dos procedimentos, na PTNS 80% das mulheres relataram ausência de desconforto e na eletroestimulação vaginal 80% relataram desconforto leve a moderado (p<0,001). CONCLUSÃO: não houve diferença significativa nos efeitos e na QV entre a eletroestimulação vaginal e a PTNS. A PTNS promoveu menos desconforto para as mulheres.

Made available in DSpace on 2015-07-22T20:49:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-04-30. Added 1 bitstream(s) on 2015-08-11T03:25:48Z : No. of bitstreams: 1 Publico-10870.pdf: 69580 bytes, checksum: 9aba33341c44980cac0fc8ab7561d008 (MD5) / Embora a análise no domínio da freqüência do sinal Eletromiográfico (EMG) seja empregada na caracterização do processo de fadiga muscular localizada, sua aplicação, especificamente a da Freqüência Mediana (Fmed), é pouco explorada no âmbito esportivo. O objetivo do presente estudo foi verificar a viabilidade da aplicação do sinal EMG, através de sua análise no domínio da freqüência, como parâmetro para determinação e diferenciação no comportamento da fadiga muscular localizada. Dois grupos de sujeitos um caracterizado como atletas (n=12) e outro como sedentários (n=12), foram submetidos a análises baseadas em procedimentos executados em três diferentes situações experimentais, todos envolvendo a modalidade de exercício isométrico: i) teste máximo para determinação da Contração Isométrica Voluntária Máxima (CIVM); ii) teste de fadiga, sustentado por 35 seg. a 80% da CIVM; iii) teste de recuperação, sustentado por 10 seg. a 80% da CIVM; neste ultimo foi monitorado o comportamento da Fmed nos três primeiros (Fmedi) e três últimos segundos (Fmedf) do sinal EMG no músculo tibial anterior durante o teste de fadiga. Durante os 10 segundos do teste de recuperação foi calculada a Fmed referente a todo o período (Fmedr).parâmetro utilizado no cálculo do Índice de Recuperação Muscular (IRM). Os resultados apontam que a Fmedf apresentou valor menor em relação à Fmedi em ambos os grupos (p<0.05). Quando comparado ao grupo de sedentários, o grupo de atletas apresentou valores maiores de Fmedi e Fmedf (p<0.05). O valor médio e desvio padrão do IRM para o grupo de atletas foi de 62.1% ±28.7 e para o grupo de sedentários foi de 55.2% ±27.8 (p>0.05). Desta forma, os resultados apresentados neste estudo permitem inferir a viabilidade na aplicação de parâmetros no domínio da freqüência do sinal EMG para a determinação e diferenciação do comportamento da fadiga muscular localizada. / Though the analysis in the frequency domain of the Electromyographic Signal (EMG) was used in the characterization of the localized muscular fatigue process their application, specifically the Median Frequency (MF), is rarely explored in the sports. The objective of this study was to verify the viability in the application of the EMG signal, through of the frequency domain analysis, as parameter for determination and differentiation of the behavior of located muscle fatigue. Two groups of subjects one characterized as athletes (n=12) and other as sedentary (n=12), were submitted to analysis based in procedures executed in three different experimental situations, all involving the isometric exercise modality: i) maximum test for determination of the Maximum Voluntary Isometric Contraction (MVIC); ii) fatigue test, 35 sec. sustained load of 80% of MVIC; iii) recovery test, 10 sec. sustained load of 80% of MVIC; where was monitored the behavior of MF in the first three (Fmedi) and last three seconds (Fmedf) of the EMG signal of anterior tibial muscle during the fatigue test. During the 10 seconds of the recovery test MF was calculated regarding the whole period (Fmedr) this parameter was used to calculate the Recuperation Muscle Index (RMI). The results showed that Fmedf presented a low value in relation to Fmedi in both groups (p <0.05). Also the value of Fmedi and Fmedf for the athlete group presented larger higher value in comparison with the sedentary group (p <0.05). The mean value and standard deviation of RMI for the athlete group were 62.1% ±28.7 and for sedentary group was 55.2% ±27.8 (p>0.05). In general terms the results presented in this study allow inferring the viability in the application of the frequency domain parameters of the EMG signal for the determination and differentiation of the located muscle fatigue behavior. / TEDE / BV UNIFESP: Teses e dissertações

Base teórica: Disfunções do trato urinário inferior são sintomas não motores comuns na Doença de Parkinson (DP) e incluem a Síndrome da Bexiga Hiperativa Neurogênica (SBHN), caracterizada pela urgência miccional, com ou sem urgeincontinência, acompanhada de aumento da frequência urinária e noctúria. A estimulação do nervo tibial posterior (ENTP) é uma das modalidades de tratamento disponíveis para o tratamento da SBHN. Objetivo: Determinar e comparar os efeitos do tratamento com ENTP em pacientes com DP e sintomas de SBHN e a manutenção dos resultados em 1 e 3 meses após o término do tratamento. Métodos: Ensaio-clínico, duplo-cego, randomizado, controlado e comparado com placebo. A pesquisa foi realizada com mulheres com DP e sintomas de SBHN no Hospital de Clínicas de Porto Alegre. Para o tratamento com ENTP domiciliar por 12 semanas as pacientes foram divididas em dois grupos: grupo ENTP e grupo ENTP sham/placebo. A avaliação da resposta pré e pós-tratamento foi realizada através de formulário específico, questionários de avaliação da incontinência urinária e qualidade de vida (OAB-V8 e KHQ) e de um diário miccional (DM) de 24 horas. Após, o fim do tratamento foi feito seguimento dos resultados para avaliação da melhora subjetiva em 30 e 90 dias. Resultados: O grupo ENTP apresentou uma diminuição da noctúria, número de episódios de urgência micciional e urge-incontinência, número de uso de proteções para incontinência, pontuação OAB-V8 e em sete domínios do KHQ (p <0,001). Embora, o grupo controle também tenha apresentado melhora dos sintomas, o grupo ENTP apresentou uma melhora superior no final do tratamento nas medidas do DM, OAB-V8 e na maioria dos domínios do KHQ. A ETNTP foi considerada um tratamento efetivo para SBHN em 93,3%, enquanto 33,3% dos tratados com placebo também melhoraram (p = 0,002). No seguimento de 30 e 90 dias, 53,3% e 33,31%, respectivamente, do grupo ENTP relataram que mantinham- se melhores dos sintomas da SBHN. Conclusão: a ENTP foi um tratamento efetivo para as pacientes com DP e SBHN. Nossa hipótese de superioridade clínica do grupo ENTP foi confirmada e a melhora subjetiva foi considerada positiva, mesmo que parcialmente em 30 e 90 dias após fim do tratamento. / Blackround: Lower urinary tract dysfunctions are common non-motor symptoms in Parkinson's disease (PD) and include Neurogenic Overactive Bladder Syndrome (NOBS), characterized by urinary urgency, with or without urge incontinence, accompanied by increased urinary frequency and nocturia . Posterior Tibial Nerve Stimulation (PTNS) is one of the treatment modalities available for the treatment of NOBS. Objective: To determine and compare the effects of PTNS treatment in patients with PD and NOBS symptoms and to maintain long-term results (1 and 3 months). Methods: Controlled, randomized, double-blind and compared with placebo clinical trial. The research was carried out with women with PD and symptoms of NOBS at the Hospital de Clínicas de Porto Alegre. For treatment with PTNS at 12 weeks, patients were divided into two groups: PTNS group and PTNS sham/placebo group. The evaluation of the pre- and post-treatment response was through a specific form, questionnaires to evaluate incontinence and quality of life (OVA-V8 and KHQ), and a voiding diary. After the end of the treatment, the results were followed up to evaluate the subjective improvement in 30 and 90 days. Results: The PTNS group presented a decreased nighttime urinary frequency, number of urgency and urinary incontinence episodes, number of incontinence protection, OAB-V8 and 7 domains of KHQ (p<0.001). Although the control group also showed improvement of the symptoms, the ENTP group presented a superior improvement at the end of the treatment in DM, OAB-V8 and most KHQ domains. PTNS was considered an effective treatment for OAB in 93.3%, while 33.3% of those treated with placebo was considered a responder (p=0.002). After 30 and 90 days, 53.3% and 33.31%, respectively, of the ENTP group reported that they maintained better SBHN symptoms. Conclusion: PTNS was an effective treatment for patients with PD and NOBS. Our hypothesis of clinical superiority of the ENTP group was confirmed and the subjective improvement was considered positive, even if partially at 30 and 90 days after the end of the treatment.!

Base teórica: Disfunções do trato urinário inferior são sintomas não motores comuns na Doença de Parkinson (DP) e incluem a Síndrome da Bexiga Hiperativa Neurogênica (SBHN), caracterizada pela urgência miccional, com ou sem urgeincontinência, acompanhada de aumento da frequência urinária e noctúria. A estimulação do nervo tibial posterior (ENTP) é uma das modalidades de tratamento disponíveis para o tratamento da SBHN. Objetivo: Determinar e comparar os efeitos do tratamento com ENTP em pacientes com DP e sintomas de SBHN e a manutenção dos resultados em 1 e 3 meses após o término do tratamento. Métodos: Ensaio-clínico, duplo-cego, randomizado, controlado e comparado com placebo. A pesquisa foi realizada com mulheres com DP e sintomas de SBHN no Hospital de Clínicas de Porto Alegre. Para o tratamento com ENTP domiciliar por 12 semanas as pacientes foram divididas em dois grupos: grupo ENTP e grupo ENTP sham/placebo. A avaliação da resposta pré e pós-tratamento foi realizada através de formulário específico, questionários de avaliação da incontinência urinária e qualidade de vida (OAB-V8 e KHQ) e de um diário miccional (DM) de 24 horas. Após, o fim do tratamento foi feito seguimento dos resultados para avaliação da melhora subjetiva em 30 e 90 dias. Resultados: O grupo ENTP apresentou uma diminuição da noctúria, número de episódios de urgência micciional e urge-incontinência, número de uso de proteções para incontinência, pontuação OAB-V8 e em sete domínios do KHQ (p <0,001). Embora, o grupo controle também tenha apresentado melhora dos sintomas, o grupo ENTP apresentou uma melhora superior no final do tratamento nas medidas do DM, OAB-V8 e na maioria dos domínios do KHQ. A ETNTP foi considerada um tratamento efetivo para SBHN em 93,3%, enquanto 33,3% dos tratados com placebo também melhoraram (p = 0,002). No seguimento de 30 e 90 dias, 53,3% e 33,31%, respectivamente, do grupo ENTP relataram que mantinham- se melhores dos sintomas da SBHN. Conclusão: a ENTP foi um tratamento efetivo para as pacientes com DP e SBHN. Nossa hipótese de superioridade clínica do grupo ENTP foi confirmada e a melhora subjetiva foi considerada positiva, mesmo que parcialmente em 30 e 90 dias após fim do tratamento. / Blackround: Lower urinary tract dysfunctions are common non-motor symptoms in Parkinson's disease (PD) and include Neurogenic Overactive Bladder Syndrome (NOBS), characterized by urinary urgency, with or without urge incontinence, accompanied by increased urinary frequency and nocturia . Posterior Tibial Nerve Stimulation (PTNS) is one of the treatment modalities available for the treatment of NOBS. Objective: To determine and compare the effects of PTNS treatment in patients with PD and NOBS symptoms and to maintain long-term results (1 and 3 months). Methods: Controlled, randomized, double-blind and compared with placebo clinical trial. The research was carried out with women with PD and symptoms of NOBS at the Hospital de Clínicas de Porto Alegre. For treatment with PTNS at 12 weeks, patients were divided into two groups: PTNS group and PTNS sham/placebo group. The evaluation of the pre- and post-treatment response was through a specific form, questionnaires to evaluate incontinence and quality of life (OVA-V8 and KHQ), and a voiding diary. After the end of the treatment, the results were followed up to evaluate the subjective improvement in 30 and 90 days. Results: The PTNS group presented a decreased nighttime urinary frequency, number of urgency and urinary incontinence episodes, number of incontinence protection, OAB-V8 and 7 domains of KHQ (p<0.001). Although the control group also showed improvement of the symptoms, the ENTP group presented a superior improvement at the end of the treatment in DM, OAB-V8 and most KHQ domains. PTNS was considered an effective treatment for OAB in 93.3%, while 33.3% of those treated with placebo was considered a responder (p=0.002). After 30 and 90 days, 53.3% and 33.31%, respectively, of the ENTP group reported that they maintained better SBHN symptoms. Conclusion: PTNS was an effective treatment for patients with PD and NOBS. Our hypothesis of clinical superiority of the ENTP group was confirmed and the subjective improvement was considered positive, even if partially at 30 and 90 days after the end of the treatment.!

INTRODUÇÃO: Estudos experimentais e clínicos, realizados por diversos autores, demonstraram a susceptibilidade à compressão nervosa periférica na vigência da diabetes mellitus e modificações na evolução natural da doença após descompressões nervosas cirúrgicas dos sítios propícios a constrição neural. Em membros inferiores, a síndrome do túnel do tarso sobreposta às neuropatias vigentes ainda gera conflitos na literatura. A anatomia do nervo tibial e seus ramos ao nível do terço distal da perna e túnel do tarso apresentam variações importantes que não são contempladas nos livros texto e atlas de anatomia. OBJETIVO: Determinar, através de dissecção em cadáveres frescos, a anatomia topográfica do nervo tibial e seus ramos ao nível do tornozelo, em relação ao túnel do tarso. MATERIAL E MÉTODOS: O estudo foi realizado através da dissecção anatômica bilateral de 26 cadáveres frescos. Foi fixada, entre o cento do maléolo medial e o centro do calcâneo, uma linha de referência (eixo maleolar-calcaneal). Com base nesse eixo as localizações da bifurcação do nervo tibial e dos ramos calcâneos mediais e inferiores foram aferidas em milímetros. Para as bifurcações foi estabelecida uma classificação por tipos de I a V, baseada no posicionamento em relação ao túnel do tarso (definido como dois centímetros proximais e distais ao eixo). Para os ramos calcâneos, a quantidade e seus respectivos nervos de origens também foram analisados. Os resultados foram transformados em taxas (porcentagem) e comparados aos achados de outros estudos. RESULTADOS: Vinte e seis cadáveres (50 pernas) foram pesquisados. A bifurcação do nervo tibial ocorreu sob o túnel em 88% dos casos e proximalmente em 12%. Tivemos o tipo I em 52%, tipo II em 14%, tipo III em 22%, tipo IV em 12% e o tipo V não foi visualizado. Quanto ao ramo calcâneo medial encontramos: um (58%), dois (34%) e três (8%), com a origem mais comum ocorrendo do nervo tibial (90%). De um total de 75 ramos calcâneos mediais dissecados, 40 tiveram sua origem fora do túnel proximalmente (53,3%) e os demais dentro. Com referência ao ramo calcâneo inferior, constatou-se a presença de um único ramo por perna, com 92% emergindo sob o retináculo flexor, 4% proximalmente e 4% distalmente a ele. A origem mais comum foi do nervo plantar lateral (70%), seguida do nervo tibial (18%). CONCLUSÕES: 1- A bifurcação do nervo tibial nos ramos plantares medial e lateral ocorreu sob o retináculo flexor em 88% das pernas, localizando-se, em 70% das vezes, em uma área compreendida entre 10 mm proximais e distais ao EMC. 2- O ramo calcâneo medial apresentou grande variação tanto na sua origem e número de ramos quanto na sua localização em relação ao túnel do tarso. A apresentação de um ramo com origem do nervo tibial, no túnel ou proximalmente a ele, foi a mais observada (58%). 3- O ramo calcâneo inferior esteve sempre presente e com certo grau de variação quanto a sua origem. A apresentação de ramo único oriundo do nervo plantar lateral foi a mais constante (70%) / INTRODUCTION: Experimental and clinical studies developed by several authors displayed the susceptibility to peripheral nerve compression in the presence of diabetes mellitus and changes in the natural evolution of the disease after surgical nerve decompressions of the propitious sites of neural constriction. In lower members, the tarsal tunnel syndrome overlapped on neuropathies still generates conflicts in the available literature. The tibial nerve and its branches anatomy at the distal leg level present significant variations that are not contemplated in textbooks and anatomy atlas. OBJECTIVE: Determine through dissection in fresh cadavers, the topographic anatomy of the tibial nerve and its branches at the ankle, in relation to the tarsal tunnel. MATERIAL AND METHODS: The study was accomplished through bilateral anatomical dissection of 26 fresh cadavers. A reference line was fixed between the center of medial malleolus and the center of calcaneus (malleolarcalcaneal axis - MCA). Based on this axis, the locations of the tibial nerve bifurcation and its medial and lower calcaneal branches were measured in millimeters. For the bifurcations, it was established a classification by types I to V, based in positioning related to the tarsal tunnel (defined as two centimeters proximal and distal to the axis). For the calcaneal branches, the amount and their respective nerves of origin were also analyzed. The results were transformed in rates (percentages) and compared with findings of other studies. RESULTS: Twenty six cadavers (50 legs) were investigated. The tibial nerve bifurcation occurred under the tunnel in 88% of the cases and proximally in 12%. The study had the type I in 52%, type II in 14%, type III in 22%, type IV in 12% and type V was not visualized. As for the medial calcaneal branch it was found: one (58%), two (34%) and three (8%), with the most common source occurring in the tibial nerve (90%). A total of 75 medial calcaneal branches dissected, 40 had their origin outside the tunnel proximally (53.3%) and others had within. With reference to the lower calcaneal branch, it was detected the presence of a single branch per leg, with 92% emerging under the flexor retinaculum, 4% proximally and 4% distally to it. The most common origin was the plantar lateral nerve (70%) followed by the tibial nerve (18%). CONCLUSIONS: 1- The bifurcation of the tibial nerve in the medial and lateral plantar branches occurred under the flexor retinaculum in 88% of the legs, locating, 70% of the time, in an area between 10 mm proximal and distal to the MCA. 2- The medial calcaneal branch presented wide variation as much in its origin as in its location in relation to the tarsal tunnel. The presentation of one branch originating from the tibial nerve in the tunnel or proximally to it was the most observed (58%). 3- The lower calcaneal branch was always present and with a certain degree of variation related to its origin. The presentation of a single branch from the lateral plantar nerve was the most constant (70%)

A contração muscular gerada por impulsos elétricos provenientes de duas fontes nervosas distintas pode ser alternativa no tratamento de lesões do plexo braquial e na paralisia facial. O objetivo desta tese foi avaliar e comparar diferentes técnicas de reinervação dupla com a técnica de reinervação única do músculo gastrocnêmio em ratos. Cinquenta ratos Wistar adultos, após terem seu nervo fibular direito seccionado, foram divididos em cinco grupos com relação ao procedimento realizado no nervo tibial: controle (C); seccionado (S); neurorrafia término-terminal (TT); neurorrafia primária associada à transferência nervosa fibular para tibial de maneira término-lateral (TL); e neurorrafia término-terminal convergente entre os cotos proximais dos nervos tibial e fibular com o coto distal do nervo tibial (TTC). Os resultados foram avaliados 12 semanas após o experimento por meio do teste da marcha, eletromiografia, índice de massa do músculo gastrocnêmio e contagem axonal no coto distal do nervo tibial. Os grupos de reinervação dupla (TL e TTC) revelaram maiores resultados funcionais (p < 0,05) em relação ao grupo de reinervação única (TT). O grupo TTC apresentou maior amplitude (p=0,006) e maior latência (p=0,041) do que o grupo TT. Em relação ao índice de massa muscular, não houve diferença entre os grupos de reinervação (p > 0,705). A análise histológica revelou maior densidade axonal no grupo TTC em relação ao grupo TT (p=0,001) e ao grupo TL (p=0,002). Ambas técnicas de dupla reinervação revelaram recuperação funcional do músculo gastrocnêmio mais precoce e maior quando comparadas à técnica de reinervação única (TT). Os animais do grupo TTC apresentaram maior número de axônios regenerados no coto distal do nervo tibial do que os do grupo TT e TL / Muscle contraction generated by electrical impulses simultaneously originating from two different neural sources may be an interesting treatment alternative for facial palsy and brachial plexus injury. The purpose of this thesis was to evaluate and compare distinct double reinnervation techniques with single reinnervation technique of gastrocnemius muscle in rats. Fifty adult Wistar rats underwent transection of their right peroneal nerve and were divided into five groups related to tibial nerve procedure: the control group (C), tibial nerve section group (S), tibial nerve end-to-end neurorrhaphy (EE) group, tibial nerve primary repair associated with end-to-side peroneal-to-tibial nerve transfer (ES) group, and tibial nerve repair by convergent end-to-end neurorrhaphy between the proximal stumps of the tibial and peroneal nerves to the distal stump of the tibial nerve (CEE) group. The outcomes were assessed 12 weeks after the experiment by use of a walking track, electromyography, gastrocnemius muscle mass index, and histomorphometric analysis of the distal tibial nerve. The double reinnervation groups (ES and CEE) showed greater functional recovery (p < 0.05) than the single reinnervation group (EE). The CEE group showed greater amplitude (p=0.006) and higher latency (p=0.041) than the EE group. There was no difference in the muscle mass index among the reinnervation groups (p > 0.705). Histologic analysis revealed greater axonal density in the CEE group than EE group (p=0.001) and ES group (p=0.002). The double reinnervation techniques showed earlier and greater functional recovery of the gastrocnemius muscle than did the single reinnervation technique. The CEE group showed a higher number of regenerated axons in the distal tibial nerve stump

Articular cartilage covers the articulating ends of diarthrodial joints. It plays a vital role in the function of the musculoskeletal system by allowing almost frictionless motion to occur between the articular surfaces of a diarthrodial joint. Study of cartilage contact behavior will help to understand the intrinsic biomechanical properties related to cartilage degeneration and related pathology. In order to study the mechanical behavior of the cartilage a FEM based computational model of the knee-joint was developed from MRI data. A heuristic algorithm was developed based on Image processing techniques using Evolve2D toolbox and edge detection. An indigenous path following algorithm to capture minute details of bone and soft tissue curvature was developed using Image Processing Toolbox of Matlab. Parts including femur, tibia, femoral and tibial cartilages, lateral & medial menisci were extracted as a point cloud from each of the slices and rendered into a 3D model using GUI driven CAD package RHINOCEROS 4.0. Commercial FE software HYPERMESH 9.0 was used to develop FE model from geometric model. Cartilage and Menisci were modeled using eight node hexahedral elements and bones were modeled using four node quadrilateral elements. Bones were assumed to be rigid. Cartilage and menisci were assumed to be linearly elastic, isotropic and homogenous. The knee joint was subjected to a uniaxial compressive load with tibia remaining fixed and femur subjected to two primary boundary conditions: 1.Flexion - extension and Varus - Valgus rotation constrained; 2.Only Varus - Valgus rotation constrained. Parameters such as contact area, contact pressure, contact force, centre of contact pressure, mises stress distribution; maximum and minimum principal stresses were studied at maximum compressive load condition and also in intermittent steps. This model considered both geometric and contact non-linearity. From the FE analysis, it was observed that peak contact deformation and contact area on both femoral and tibial medial cartilage was found to be greater than the lateral side under full extension condition. More than 50% of the load transmission was through the medial side - which could be an indication of cartilage degeneration. Deformation of lateral meniscus was more than the medial meniscus under angular constrained conditions. Loading history during intermittent steps suggested that contact area on lateral tibial cartilage increased with load, indicating joint asymmetry. These results indicate the importance of the rotational constraints (boundary conditions) and represent more accurate physiological behavior of knee joint. Role of menisci in this study was analyzed, which indicated that consideration of menisci is essential in biomechanical estimation of load transmission. In conclusion, detailed segmentation to develop geometric model, precise boundary conditions & time dependent behavior of cartilage and menisci helped in understanding knee joint load bearing capacity to a better accuracy and can potentially give rise to designing better cartilage implants.

Osteoporose ist eine Krankheit, die weltweit Millionen Menschen betrifft und in Anbetracht der überalternden Gesellschaft in Zukunft weiter an Relevanz gewinnen wird. Dass sich eine Ganzkörpervibration vorteilhaft auf Osteoporose auswirken kann, wurde schon in vorausgegangenen Studien belegt (Rubin et al. 2001b; Flieger et al. 1998; Oxlund et al. 2003; Sehmisch et al. 2009; Stuermer et al. 2010a; Stuermer et al. 2010b). Jedoch konnte bisher keine Klarheit über die optimale Anwendung (Dauer, Häufigkeit, Frequenz, Ausrichtung, Amplitude) gewonnen werden. Die bisherigen Versuche unterschieden sich lediglich in den verwendeten Frequenzen und der Therapiedauer.  Um die unterschiedlichen Einflüsse von vertikaler und horizontaler Vibration auf die osteoporotische Frakturheilung zu untersuchen, wurde in der vorliegenden Arbeit ein Tierversuch mit 90 weiblichen Ratten durchgeführt. 15 wurden scheinoperiert und 75 wurden ovarektomiert. Innerhalb einer Latenzzeit von 8 Wochen entwickelten die ovarektomierten Versuchstiere eine Osteoporose. Im Folgenden wurden alle Tiere an der Tibiametaphyse standardisiert osteotomiert und mittels Plattenosteosynthese versorgt. Es wurden sechs Versuchsgruppen gebildet: Vier Gruppen wurden einer horizontalen bzw. vertikalen Ganzkörpervibration mit 35 Hz oder 70 Hz ausgesetzt (35Hz vert, 70Hz vert, 35Hz horiz und 70Hz horiz). Die übrigen zwei Gruppen erhielten keine Ganzkörpervibration, wobei eine Gruppe aus nicht ovarektomierten (SHAM) und die andere Gruppe aus Tieren nach Ovarektomie bestand (OVX). Die Ganzkörpervibration wurde zweimal täglich über einen Zeitraum von vier Wochen mit einer Amplitude von 0,5 mm durchgeführt. Nach Beendigung dieses Zeitraumes wurden die Tiere per Dekapitation getötet und die Tibiae entnommen. Anschließend wurden ein biomechanischer Test, eine μCT-Untersuchung, eine mikroradiographische Untersuchung sowie eine polychrome Sequenzmarkierung durchgeführt. Die ersten beiden Untersuchungen konnten am präparierten Knochen vorgenommen werden. Die letzteren erfolgten nach Einbettung der Knochen in Methylmetacrylat und der Anfertigung von ca. 120 µm dicken histologischen Schnitten. Der biomechanische Test zeigte keine signifikante Veränderung der Elastizität oder der Streckgrenze in allen Gruppen zueinander. Die biomechanischen Eigenschaften des Kallus konnten nur tendenziell bei den hohen Frequenzen von 70 Hz vertikal und 70 Hz horizontal verbessert werden. In der μCT-Untersuchung konnte weder durch horizontale noch durch vertikale Ganzkörpervibration ein signifikanter positiver Einfluss auf die Frakturheilung im Vergleich zur osteoporotischen Kontrollgruppe nachgewiesen werden. Es zeigten sich jedoch positive Tendenzen durch die horizontale Vibration bei 70 Hz. Die mikroradiographische Untersuchung ergab einen positiven Einfluss der vertikalen und der horizontalen WBV bei 70 Hz. Die horizontale Vibration bei 70 Hz konnte im Vergleich zur osteoporotischen Kontrollgruppe die Kortikalisdicke distal ventral, den Knochendurchmesser proximal, die Kallusdicke ventral, die Knochendichte des ventralen und die des endostalen Kallus verbessern.  In der polychromen Sequenzmarkierung konnte insgesamt durch die WBV eine Verschlechterung der frühen und eine Verbesserung der mittleren und späten osteoporotischen Frakturheilung gezeigt werden. In der frühen Phase wirkten sich ventral sowie endostal alle Frequenzen nachteilig aus. In der mittleren Phase war die horizontale Vibration bei 70 Hz in Bezug auf die dorsale Kallusfläche signifikant vorteilhaft gegenüber der osteoporotischen Kontrollgruppe. In der späten Phase erreichte die Gruppe mit horizontaler 35 Hz-Therapie in Bezug auf die ventrale Kallusfläche gegenüber der osteoporotischen Gruppe und der Gruppe mit vertikaler 35 Hz-Therapie signifikante Steigerungen. Dorsal zeigten beide horizontalen Frequenzen signifikant größere Kallusflächen als die Gruppe mit vertikaler 35 Hz-Therapie.  In der Zusammenschau aller durchgeführten Untersuchungen dieser Arbeit kristallisierte sich die horizontale Ganzkörpervibration bei 70 Hz als die vorteilhafteste Frequenz heraus, um die osteoporotische Frakturheilung an der Tibiametaphyse positiv zu beeinflussen.

No description available.

Greater trochanteric pain (GTP) is a regional pain syndrome characterized by lateral hip pain and tenderness. Its incidence after total hip arthroplasty (THA) is variable. Bursal inflammation, degenerative changes of the attachment of the gluteal muscles, direct operative trauma and biomechanical disturbance of the operated hip have been discussed as being related to GTP. The diagnosis is purely clinical because radiological and laboratory investigations show no definite pathology. Although most treatment modalities are conservative, some patients may develop refractory complaints leading to surgical intervention. In study I we studied the incidence of GTP in 172 consecutive patients who underwent THA during 2002 at Sundsvall Hospital. Patients with GTP (n=21, incidence 12%) were matched with controls from the same cohort. The THA outcome was assessed using the Western Ontario and McMaster Universities Arthrosis (WOMAC) Index. Trochanteric tenderness was studied using an electronic pressure algometer. We found an association between the occurrence of GTP and postoperative uncorrected lengthening of the operated limb of ≥ one centimetre. The WOMAC index revealed a reduction of the clinical outcome in the GTP group. In Study II we tested the value of using an algometer in the diagnosis of GTP after THA. We measured the pressure-pain threshold (PPT) over the greater trochanter and ilio-tibial band in 18 patients and 18 matched controls. Both groups were evaluated using the visual analogue scale (VAS). We found the algometer to have a good predictive validity and reproducibility. However, there was large inter-individual variability across subjects. The PPT ratio of 0.8 (affected vs. unaffected side) can be used as a cutoff ratio to establish GTP. There was no correlation between PPT measurements and VAS. Because of a low positive predictive value and large inter-individual variability, the pressure algometer has a limited value as a screening tool. In study III we proposed a new surgical treatment for refractory GTP after THA consisting of distal lengthening of the ilio-tibial band (ITB) by Z-plasty under local anaesthesia. This method was used in 12 women between March 2004 and June 2006. The patients were followed up by phone interview 3-4 months postoperatively and by an EQ-5D questionnaire and clinical examination including evaluation with the algometer at 1-3 years postoperatively. We found that the patients‘ quality of life was markedly improved following the operation (EQ-5D = 0.26 preoperatively vs. 0.67 postoperatively; p &lt;0.005). There were no postoperative complications. In study IV we evaluated the accuracy of a commonly used clinical method of LLD measurement (anterior superior iliac spine-medial malleolus) by comparing it to a reliable radiological method (tear drop-lesser trochanter) in 139 patients before and after THA. We found the correlation between the clinical and radiological methods to be weak preoperatively (r=0.21, ICC= 0.33) while the correlation was moderate postoperatively (r= 0.45, ICC=0.62). It is therefore recommended that the radiological method be used to measure leg length discrepancy in patients who undergo THA.