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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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Background: Patients with anterior cruciate ligament reconstruction (ACLR) have demonstrated morphological and compositional changes in femoral articular cartilage. However, it is unclear how running biomechanics are associated with femoral cartilage thickness and composition for both ACLR patients and controls. Objectives: (1) to compare measures of femoral cartilage thickness and composition between ACLR patients and matched non-ACLR controls at resting, (2) to investigate how 30 minutes of running influences the aforementioned measures for ACLR patients and controls, and (3) to investigate relationships between running biomechanics and knee cartilage thickness and composition in ACLR patients and controls. Methods: Twenty ACLR patients (age: 23 ± 3 years; mass: 69.7 ± 9.9 kg; time post ACLR: 14.6 ± 6.1 months) and 20 matched non-ACLR controls (age: 22 ± 2 years; mass: 67.1 ± 10.9 kg) participated in the study. A running session required both groups to run for 30 minutes at a self-selected speed. Before and after running we measured femoral cartilage thickness via ultrasound imaging. An MRI session consisted of T2 mapping. Independent t-tests were used to examine differences in femoral cartilage thickness and T2 relaxation time at resting, and thickness changes following the run between the two groups. Pearson correlations were used to explore relationships between running biomechanics and femoral cartilage thickness and relaxation time at resting. Results: The ACLR group showed longer T2 relaxation times in three regions of the medial femoral condyle at resting compared with the control group (overall: 54.9 ± 14.2 vs. 39.3 ± 8.2 ms, P = 0.001; central: 51.2 ± 16.6 vs. 34.9 ± 13.2 ms, P = 0.006; posterior: 50.2 ± 10.1 vs. 39.8 ± 7.4 ms, P = 0.006). Following the run, the ACLR group showed greater deformation in the medial femoral cartilage than the control group (0.03 ± 0.01 vs. 0.01 ± 0.01 cm, P = 0.001). Additionally, the ACLR group showed significant negative correlations between resting T2 relaxation time in the central region of the medial femoral condyle and peak vGRF, and vertical impulse (r = -0.53, P = 0.013; r = -0.46, P = 0.041, respectively) during running. Conclusions: The ACLR group showed greater water content in medial femoral cartilage and greater deformation in medial femoral cartilage thickness following 30 minutes of running compared with the controls. In addition, the ACLR group demonstrated significant negative correlations between water content in medial femoral cartilage and vGRF. Our findings suggest that those who are at least 24 months post-ACLR have degraded cartilage composition and their cartilage is more sensitive to joint loading morphologically.