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Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2015-04-15T04:01:01Z No. of bitstreams: 1 JANDRICE CARRASCO DE ANDRADE.pdf: 918910 bytes, checksum: 95056da51d91bae3c0135582b190ad2f (MD5) / Made available in DSpace on 2015-04-15T04:01:01Z (GMT). No. of bitstreams: 1 JANDRICE CARRASCO DE ANDRADE.pdf: 918910 bytes, checksum: 95056da51d91bae3c0135582b190ad2f (MD5) Previous issue date: 2014-09-26 / Osteonecrose da Cabeça Femoral (ONCF) é uma das complicações da anemia falciforme, a doença hematológica hereditária mais prevalente no Brasil. O presente estudo teve como objetivo verificar a prevalência de ONCF em pacientes portadores de anemia falciforme com disfunção do quadril na faixa etária infanto-juvenil e identificar os fatores de risco associados à ONCF nestes indivíduos. Foi realizado estudo de corte transversal descritivo e analítico; para coleta dos dados utilizamos a entrevista, avaliação clínica e radiográfica realizadas em um serviço de referência ortopédica em Salvador. Foram avaliados 43 pacientes identificados como portadores de disfunção de Quadril. Destes, 10 não compareceram; dos 33 participantes, treze indivíduos compuseram o “grupo com ONCF” e 20 o “grupo comparação”. Diante da análise quantitativa, foi evidenciada uma prevalência de 39,4% de ONCF. A osteonecrose, nestes casos, esteve associada ao maior tempo de diagnóstico da doença (97 meses), trauma prévio do quadril em 92% dos casos, escore médio de Chanrley de 15 pontos. Houve também associação entre ONCF e menor taxa de hemoglobina fetal (7,2 versus 11,8), dando suporte à hipótese de que a hemoglobina fetal pode funcionar como fator de proteção contra a necrose avascular.

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We introduce a new way to accurately segment the 3D femur from pelvic CT scans. The femur is a difficult target for segmentation due to its proximity to the acetabulum, irregular shape and the varying thickness of its hardened outer shell. Atypical bone morphologies, such as the ones present in hips suffering from Femoral Acetabular Impingements (FAIs) can also provide additional challenges to segmentation. We overcome these difficulties by (a) dividing the femur into the femur head and body regions (b) analysis of the femur-head and neighbouring acetabulum’s composition (c) segmentations with two levels of detail – rough and fine contours. Segmentations of the CT volume are performed iteratively, on a slice-by-slice basis and contours are extracted using the morphological snake algorithm. Our methodology was designed to require little initialization from the user and to deftly handle the large variation in femur shapes, most notably from deformations attributed to cam-type FAIs. Our efforts are to provide physicians with a new tool that creates patient-specific and high-quality 3D femur models while requiring much less time and effort. We tested our methodology on a database of 20 CT volumes acquired at the Ottawa General Hospital during a study into FAIs. We selected 6 CT scans from the database, for a total of 12 femurs, considering wide inter-patient variations. Of the 6 patients, 4 had unilateral cam-type FAIs, 1 had a bilateral cam-type FAI and the last was from a control group. The femurs segmented with our method achieved an average volume overlap error of 2.71 ± 0.44% and an average symmetric surface distance of 0.28 ± 0.04 mm compared against the same, manually segmented femurs. These results are better than all comparable literature and accurate enough to be used to in the creation of patient-specific 3D models.

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Current ACL reconstruction techniques are performed with little regard to cutaneous nerves despite the evidence that iatrogenic nerve injury often leads to painful neuromas, reflex sympathetic dystrophy, or anterior knee/kneeling pain which directly impacts patients whose profession requires kneeling (Cerulli et al. 2013; Ruffilli et al. 2016; Hurley et al. 2018). In this study, the femoral cutaneous and saphenous nerves from two embalmed lower extremities were dissected in exquisite detail to create topographic maps of the anterior thigh and knee, detailing the nerves' anatomical course and relationship to relevant landmarks. To further characterize the cutaneous innervation at the knee joint, ultrasound techniques to locate sensory nerves were also explored. In both specimens, all branches of the femoral cutaneous and saphenous nerves were located, dissected, and mapped. In addition, the ability to locate terminal branches of the anterior femoral cutaneous nerve in a cadaveric specimen on ultrasound was successfully demonstrated. However, due to the small sample size, further research implementing similar methods is necessary to ensure the results are representative of the population and can be applied to surgical innervation. These findings highlight the importance of considering cutaneous nerves in ACL reconstruction techniques to minimize the risk of iatrogenic nerve injury and associated complications.

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Hip resurfacing is an alternative to total hip arthroplasty for the young and active patient likely to outlive traditional means of hip joint replacement. The acetabular cup is implanted in much the same fashion as an uncemented total hip arthroplasty, however, implantation of the femoral component is unique to hip resurfacing, presenting both distinct benefits and limitations. Hip resurfacing spares much of the proximal femur including the femoral neck and portions of the femoral head. This may be advantageous if the patient requires revision surgery; however, preservation of the femoral neck bears with it the risk of femoral neck fracture. The exact mechanism of neck fracture is not fully understood. Avoiding potential fracture risks is vital to ensuring optimal patient outcomes. The current work investigated mechanical femoral head preparatory factors that may predispose to femoral neck fracture. Intra-operative computer navigation is emerging as the gold-standard in orthopaedic care. In hip resurfacing, navigation may improve the surgeon’s ability to optimally implant the resurfacing prosthesis; however, much of this technology is still in its infancy and requires investigation into the accuracy and repeatability of this peri-operative tool. Pre-operative planning can assist the surgeon in optimally determining the size and position of the resurfacing components, specifically in reference to the patient’s unique anatomy, prior to performing the operation. This may aid in correct implant selection and provide a basis on which to conduct intra-operative navigation. However, the accuracy and repeatability of pre-operative planning for hip resurfacing has not yet been established. Thus, this body of work looked to establish a clear methodology for pre-operative planning, intra-operative computer navigation and surgical technique in order to optimize preparation of the femoral head, ultimately reducing the risk of femoral neck fracture in hip resurfacing.