RERUME: Les modèles personnalisés 3D sont de plus en plus demandés pour la planification chirurgicale et les recherches en biomécanique. L’objectif principal de cette thèse cotutelle était d’améliorer la méthode de reconstruction 3D à partir des images radiographies biplanes proposée par Lagacé, Ohl et al., afin que celle-ci puisse être plus facilement utilisée en clinique et qu’elle puisse permettre d’aider à la planification chirurgicale et/ou l’évaluation post-chirurgicale. Le système de radiographie biplane EOS à faible dose d’irradiation est le résultat d’une collaboration entre la société EOS imaging, l’institut biomécanique humaine Georges Charpak d’Arts et Métiers ParisTech, le laboratoire de recherche en imagerie et orthopédie (LIO) de l’école de technologie supérieure de Montréal, Georges Charpak, Jean Dubousset et Gabriel Kalifa (Dubousset et al. 2010). Le principe du détecteur de rayon X est basé sur les travaux développés par le Prof. Charpak, qui réduit significativement la dose de rayonnement comparé à la radiographie standard (Dubousset et al. 2010) Quatorze indices cliniques utilisés plus ou moins couramment en clinique pour le diagnostic et le suivi des pathologies de l’épaule et pour la planification chirurgicale et son évaluation post-opératoire ont été calculé. La justesse est acceptable (biais <1 mm sauf la distance sous acrominale) et une reproductibilité (2 fois écart-type inférieur à 5 mm ou 5° sauf 2 paramètres) qui est similaire à ce qui est présenté dans la littérature. L’approche proposée apporte sur une amélioration de la reconstruction dans un contexte où il serait intéressant qu’elle devienne utilisable en routine clinique. Bien que les améliorations soient encore nécessaires, cette contribution apporte une pierre à l’analyse de l’articulation intacte et pathologique et est prometteuse quant à la possibilité de son implantation dans la routine clinique pour évaluer les interventions chirurgicales en pré- et post-opératoire. / Three-dimensional subject-specific models are increasingly requested for surgical planning and research in biomechanics. The main objective of this cotutelle thesis was to improve the 3D reconstruction method using biplane radiography images proposed by Lagacé, Ohl et al., in order to facilitate its application in clinic, especially to assist surgical planning and/or post-surgical evaluation. The low-dose biplane radiography EOS was used and an improvement to the reconstruction method was proposed. Fourteen clinical indices used more or less routinely in clinical diagnosis for monitoring of shoulder disorders and for surgical planning and postoperative evaluation were calculated and evaluated. The accuracy is acceptable and reproducibility is similar to what is presented in the literature. The proposed approach brings an improvement of reconstruction in a context where it would be interesting for clinical routine use. Although improvements are required, this contribution brings a stone to the analysis of intact and pathological joint and is promising as to the possibility of its presence in the clinical routine for evaluating pre- and post-operative surgery.

Chez le jeune adulte, le substitut valvulaire aortique idéal demeure inconnu. La prothèse mécanique est durable. Cependant, elle requiert une anticoagulation à vie. De récentes études ont démontré un excès de mortalité à long terme chez les patients après un remplacement valvulaire aortique (RVA) mécanique. D’autres part, plusieurs patientes sont en âge de procréer lorsqu’une chirurgie est indiquée. La grossesse chez les patientes porteuses de RVA mécanique est à risque d’évènements thromboemboliques. Dans ce contexte, ces derniers sont mieux prévenus par la warfarine comparativement à l’héparine chez les patientes enceintes porteuses de prothèses mécaniques. Cependant, la warfarine est associée à des malformations fœtales. Les prothèses biologiques évitent l’anticoagulation. Par contre, la dégénérescence structurelle de la prothèse est plus rapide chez les patients jeunes, ce qui les expose à un haut risque de réintervention. L’objectif de ce mémoire est d’étudier les issues à long terme suivant un RVA chez le jeune adulte. Deux études ont été réalisées dans le cadre de ce travail. La première avait pour objectif de déterminer la survie et les complications à long terme dans une population de jeunes adultes ayant subi un RVA mécanique isolé. La survie de ce groupe de patient est inférieure à celle de la population générale québécoise appariée pour l’âge et le sexe. De plus, il existe un risque faible, mais constant à long terme de dysfonction de la prothèse et de réopération dans cette population. La deuxième étude a pour objectif de déterminer les complications cardiaques, maternelles et fœtales durant la grossesse chez des patientes porteuses de RVA mécanique ou biologique. Les résultats obtenus démontrent que la grossesse chez ces patientes est associée à un risque de complications maternelles et cardiaques significatives, et ce surtout chez les patientes porteuses d’une prothèse mécanique. / In young adults, the ideal aortic valve substitute remains unknown. Mechanical prostheses are durable. However, their use requires lifelong anticoagulation. Recent reports suggest an excess in long-term mortality in patients following mechanical aortic valve replacement (AVR). Furthermore, many patients are of childbearing age when the surgery is indicated. Pregnancy in patients with mechanical prostheses is associated with an increased thromboembolic event. Those are better prevented by warfarin comparatively to heparin. However, warfarin is associated with fetal malformations. Bioprostheses avoid anticoagulation. Nevertheless, young adults experience a more rapid prosthetic valve deterioration, which exposes young patients to a significantly higher risk of early reoperation. The aim of this thesis is to assess long term outcomes following AVR in young adults. For this project, two different studies were completed. The first study examines the long-term survival and complications following isolated AVR in young adults. Long-term survival was lower than what was expected in a sex- and gender-matched Quebec general population. There was a low but constant occurrence of valve dysfunction and reintervention after AVR in this population. The goal of the second study was to assess cardiac, maternal and fetal complications during and after pregnancy in women with mechanical or biological AVR. Based on our results, we concluded that pregnancies in those women carried a significant risk of cardiac and maternal adverse outcomes, particularly with mechanical prostheses.

Abstract Endovascular aneurysm repair (EVAR) is a minimally invasive alternative to open surgery to exclude an abdominal aortic aneurysm from the circulation to avert a rupture. The aim of this thesis was to evaluate the early and mid-term results of EVAR using the Zenith® stent-graft (Cook Inc, Bloomington, IN, USA) in asymptomatic and symptomatic abdominal aortic aneurysm (AAA) patients in three Finnish university hospitals. Furthermore, the aim was to study whether preoperative embolization of the inferior mesenteric artery (IMA) before EVAR decreases the incidence of a type II endoleak or has an effect on the aneurysm sac shrinkage. Finally, the results after secondary interventions for a type II endoleak were evaluated. Two hundred six patients underwent elective endovascular repair of an intact AAA. The use of the Zenith® stent-graft was associated with good early and mid-term results. The thirty-day mortality rate (2.9%) was in accordance with other EVAR studies. Only one late aneurysm-related death occurred in this series, whilst no patients died of a late aneurysm rupture. No stent-graft migrations or fractures were observed. Endoleak, defined as persistent blood flow outside the graft and within the aneurysm sac, remains a long-term problem with EVAR. The overall endoleak incidence was 34.6%. A type II endoleak (retrograde perfusion via aortic side branches) occurred in 52 patients (25.4%). EVAR was performed for 14 patients with a symptomatic, unruptured AAA. The median delay from admission to intervention was 4 days. EVAR of a symptomatic, unruptured AAA was associated with a favourable outcome even in patients with a very high operative risk. There were no perioperative deaths. Altogether forty patients treated at Kuopio University Hospital had a patent IMA on preoperative computed tomography (CT) and were treated successfully with coil embolization before EVAR. Thirty-nine patients who underwent EVAR at Oulu University Hospital without preoperative embolization of a patent IMA served as a control group. Preoperative coil embolization of the IMA significantly reduced the incidence of type II endoleaks after EVAR, but the present study failed to show any influence on late postoperative aneurysm sac shrinkage. Overall, 14 patients underwent a secondary intervention to repair the type II endoleak. Ten patients had transarterial embolization and four patients had translumbar embolization. The results were unsatisfactory; clinical success after the first secondary intervention was achieved in only two patients in the transarterial embolization group and three patients in the translumbar embolization group. These results seem to favour direct translumbar embolization rather than transarterial embolization. In conclusion, EVAR with the Zenith® stent-graft is effective in excluding AAAs from the circulation and is associated with good mid-term results.

Les infections de prothèses vasculaires (IPV) sont des maladies particulièrement graves. Malgré une fréquence finalement assez importante, elles demeurent mal connues. Staphylococcus aureus en est l’agent responsable principal. Les données concernant le traitement antibiotique à administrer pour ces infections sont excessivement pauvres. L’objectif de notre travail était donc de comparer l’efficacité de différents protocoles d’antibiothérapie à l’aide de divers modèles expérimentaux d’IPV. Six souches différentes de S. aureus ont été évaluées : 3 sensibles (SAMS) et 3 résistants à la méticilline (SARM). Nous avons comparé les concentrations minimales inhibitrices et éradicatrices (CMIB et CMEB) au sein du biofilm obtenues avec des techniques classiques sur polystyrène à ceux obtenus à l’aide d’un modèle original in vitro sur Dacron® (dCMIB et dCMEB) ®. Nous avons ensuite utilisé un modèle original d’infection de Dacron chez la souris pour comparer l’efficacité de différents protocoles thérapeutiques. Enfin nous avons visualisé l’effet de ces antibiotiques in vivo par microscopie confocale. Nous avons montré que les mesures classiques de CMIB et CMEB obtenues sur polystyrène pouvaient surestimer la baisse d’efficacité des antibiotiques dans le biofilm et que des mesures sur le matériel d’intérêt pouvaient être plus pertinentes. Dans notre modèle in vivo, la daptomycine pouvait être supérieure que les comparateurs pour certaines souches de SARM et de SAMS mais pas pour toutes. Par contre, si l’ajout de rifampicine était bénéfique pour la cloxacilline et la vancomycine, cela n’était pas le cas pour la daptomycine. Enfin, nous avons visualisés des effets totalement différents sur le biofilm selon les antibiotiques utilisés mais également selon les souches testées. Nos modèles ont permis d’obtenir des informations nouvelles concernant l’antibiothérapie des IPV qui, nous l’espérons, permettront d’aider à la prise en charge des patients. / Prosthetic vascular graft infection (PVGI) is an emerging disease, mostly due to staphylococci, with limited data regarding efficacy of current antistaphylococcal agents. We aimed to assess the efficacy of different antibiotic regimens. Six different strains of methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) were used. We compared results of minimal biofilm inhibitory and eradicating concentrations (MBICs and MBECs) obtained with a Calgary Biofilm Pin lid Device (CBPD) to those yielded by an original Dacron®-related minimal inhibitory and eradicating concentrations measure model. We then used an original murine model of Staphylococcus aureus vascular material infection to evaluate efficacy of different antibiotic regimens. We finally visualized the effect of antibiotics on biofilm by confocal microscopy. We demonstrated that classical measures of MBICs and MBECs with CPBD could overestimate the decrease of antibiotic susceptibility in material related infections and that the nature of the support used to measure biofilm susceptibility might be influent since results yielded by our Dacron®-related minimal eradicating assay were lower than those found on a plastic device. In our in vivo model, we shown that daptomycin was significantly more bactericidal than comparators for some strains of MRSA or MSSA but not for all. For the majority of strains, it was as efficient as comparators. The addition of rifampicin to daptomycin did not enhance daptomycin efficacy in our model. Finally, we highlighted an in vivo differential effect on biofilm depending on the antibiotic used but also on the bacterial strain evaluated. Our models represent an option to better define the best antibiotic options for PVGIs.

No description available.

The purpose of this study was to evaluate the incidence of corrosion and fretting in 48 retrieved titanium-6aluminum-4vanadium and/or cobalt-chromium-molybdenum modular total hip prosthesis with respect to alloy material microstructure and design parameters. The results revealed vastly different performance results for the wide array of microstructures examined. Severe corrosion/fretting was seen in 100% of as-cast, 24% of low carbon wrought, 9% of high carbon wrought and 5% of solution heat treated cobalt-chrome. Severe corrosion/fretting was observed in 60% of Ti-6Al-4V components. Design features which allow for fluid entry and stagnation, amplification of contact pressure and/or increased micromotion were also shown to play a role. 75% of prosthesis with high femoral head-trunnion offset exhibited poor performance compared to 15% with a low offset. Large femoral heads (>32mm) did not exhibit poor corrosion or fretting. Implantation time was not sufficient to cause poor performance; 54% of prosthesis with greater than 10 years in-vivo demonstrated none or mild corrosion/fretting.

La performance du couple prothétique tête fémorale/cupule impacte fortement la durée de vie d’une prothèse totale de hanche. Les céramiques affichent une excellente combinaison de propriétés de biocompatibilité, mécaniques et tribologiques. Les composites ZTA formés d’une matrice d’alumine renforcée en zircone sont optimisés pour offrir le meilleur compromis de dureté, stabilité chimique, ténacité et résistance mécanique. La prédiction de la performance de ces matériaux doit prendre en compte les trois principaux modes de dégradation identifiés en configuration céramique/céramique (CoC) : le choc avec décoaptation, le frottement et le vieillissement à basse température. Ces modes sont susceptibles d’être simulés in vitro à partir de tests expérimentaux, respectivement, sur une machine de chocs, un simulateur de marche et en autoclave. L’objectif de ce projet est de combiner ces tests afin de mieux résoudre l’équation in vitro = in vivo. Les chocs dominent les processus de dégradation avec la formation de bandes d’usure. Le matériau testé a montré une excellente résistance au vieillissement. La dégradation induite par le test d’usure standard sur simulateur de marche est négligeable et pose la question de la pertinence de ce test pour les couples CoC. L’importance de la prise en compte des chocs dans les tests expérimentaux a été confortée grâce à une analyse d’explants. Une transformation de phase de la zircone a été mécaniquement induite dans les bandes d’usure créées in vitro et in vivo. Un mécanisme de dégradation a été suggéré au sein de ces bandes. La réponse du matériau est en partie déterminée par la force appliquée au cours des chocs. / The performance of the prosthetic couple (femoral head/cup) influences strongly the lifetime of a total hip prosthesis. Ceramics exhibit an excellent combination of biocompatibility, mechanical resistance and tribological properties. Zirconia toughened alumina (ZTA) composites are made of an alumina matrix and well dispersed zirconia particles. They are tailored in order to offer the best compromise of hardness, chemical stability, toughness and mechanical resistance. The prediction of the performance of such materials must take into consideration the three main sources of degradation identified for Ceramic-on-Ceramic (CoC) bearings: shocks due to micro-separation, friction and low temperature degradation (LTD). Experimental tests on a shock machine, a hip-walking simulator and in an autoclave are able to simulate in vitro each of these sources of degradation, respectively. The aim of the project is to combine these tests in order to solve better the equation in vitro = in vivo. Shocks dominate the processes of degradation with the formation of wear stripes. The tested material showed an excellent resistance to LTD. The damage induced by the standard wear test on a hip-walking simulator is negligible, which raises the question about the relevance of this test for CoC couplings. An analysis of explants confirmed the decisive role of shocks in experimental tests. Zirconia phase transformation was mechanically induced within both in vitro and in vivo wear stripes. A degradation mechanism was suggested within the stripes. The material response is partly determined by the force applied during shocks.

Syfte: Syftet  med  studien var  att undersöka  om  det  finns  en skillnad  i  livskvalité mellan  individer  med  transfemoral  amputation  som använder  mikroprocesstyrd knäkomponent (MPK) respektive mekanisk knäkomponent (Mek.). Design: Tvärsnittsstudie Försökspersoner: 14 protesbrukare  med unilateral transfemoral amputation (10 män, 4 kvinnor; 4 Mek., 10 MPK), amputerade på grund av trauma, kongenital orsak, infektion eller tumör och som använt sig av samma typ av knäled i minst ett år. Metod: För  att  studera  livskvalité  i  målpopulationen  genomfördes  en enkätundersökning bestående av RAND-36 samt kompletterande frågor. Deltagarna fördelades i två grupper med avseende på knäkomponent för att möjliggöra analys av resultaten. Resultat: Ingen signifikant  skillnad  i livskvalité uppmättes mellan  grupperna. De största  skillnaderna observerades  dock  i  den fysiska-  (Mek.:  0 MPK:  50) och emotionella (Mek.: 41,75 MPK: 100) rollfunktionen. Slutsats: Resultatet  i  studien  visade  ingen  signifikant  skillnad i  livskvalité mellan grupperna. Vidare  bör  mer  specifika  mätinstrument,  inriktade  mot  individer  med amputation, användas för att undersöka livskvalité i målpopulationen. / Purpose: The purpose of the study was to investigate if there is a difference in qualityof  life  (QoL)  between  individuals  with  a  transfemoral  amputation  usingmicroprocessor-controlled  knee  components  (MPK)  versus  mechanical  kneecomponents (Mech.). Design: Cross-sectional study Subjects: 14 prosthesis users with a unilateral transfemoral amputation  (10 men, 4women; 4 Mech., 10 MPK), amputated due to trauma, congenital reasons, infection ortumor and used the same prosthetic knee for at least one year. Method: To study QoL in the  population concerned a questionnaire was carriedout, including the RAND-36 and supplementary questions. The  participants  were divided into two groups with regard to the knee component to enable the results to be analyzed. Results: No significant difference in QoL were found between the groups. The largest differences were observed in physical (Mech.: 0 MPK: 50) and emotional (Mech.: 41.75MPK: 100) role function. Conclusion: The result of the study showed no significant difference in QoL between the groups. Furthermore, specific measuring instruments targeting individuals with amputation should be used to investigate quality of life in the population concerned.

No description available.

Orientadores: Wander José da Silva, Altair Antoninha Del Bel Cury / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-27T01:05:41Z (GMT). No. of bitstreams: 1 Bergamo_EdmaraTatielyPedroso_M.pdf: 7968983 bytes, checksum: ebd79c42e62e1085b97f070b982adcce (MD5) Previous issue date: 2015 / Resumo: Os sistemas cerâmicos representam na odontologia uma alternativa aos metais na reabilitação protética, sendo que a zircônia é o material com melhores propriedades mecânicas. Coroas confeccionadas em zircônia sem aplicação de cerâmica de cobertura, chamadas monolíticas, têm se mostrado uma alternativa favorável para reabilitação oral, pois associam alta resistência à fratura e estética satisfatória, assim como evitam a complicação mais evidente em infraestruturas de zircônia que é a fratura da cerâmica de cobertura. A zircônia pura pode assumir 3 formas cristalográficas: monoclínica, tetragonal e cúbica, dependendo da temperatura. A união da zircônia com óxidos estabilizadores, como o óxido de ítrio (Y-TZP) faz com que a zircônia se mantenha na fase tetragonal. No entanto, a zircônia permanece metaestável e mediante relativamente baixas temperaturas, umidade e estresse uma progressiva transformação de fase de tetragonal para monoclínica pode ocorrer e afetar a resistência da mesma. Assim sendo, o presente estudo avaliou a carga à fratura e a transformação de fases da zircônia em coroas monolíticas submetidas ao envelhecimento através de testes térmicos e mecânicos. Setenta coroas monolíticas de zircônia (Y-TZP) foram cimentadas em réplicas de resina composta e separadas aleatoriamente em 5 grupos (n=14): Controle (C), sem tratamento; Envelhecimento hidrotérmico (EH), 122°C, 2 bar de pressão por 1 hora; Fadiga térmica (FT), 104 ciclos, de 5 a 55°C por 30 segundos; Fadiga Mecânica (FM), 106 ciclos, 70 N de carga, deslizamento de 1,5 mm da cúspide mesiopalatina com frequência de 1,4 Hz; e Fadiga Mecânica associada com tratamento térmico (FMT). Ao final de cada tratamento, a carga à fratura foi determinada em máquina de testes universal com célula de carga de 10KN e velocidade de 1mm/min (n=12/grupo). Avaliação de alterações de superfície e o modo e a origem da fratura foram realizadas no microscópio eletrônico de varredura. A transformação de fases foi analisada através da difração de raios X (n=2/grupo). Os dados de resistência à compressão foram analisados por Análise de variância a um fator e o nível de significância foi de 5%. Também foi realizada a distribuição de Weibull. Todas as restaurações sobreviveram aos testes de envelhecimento e não foram observadas diferenças significantes entre os tratamentos para a carga à fratura (p>0,05). O módulo de Weibull variou de 6,2 a 16,6, com diferença significativa para o grupo envelhecido pelo tratamento hidrotérmico. Falhas catastróficas com origem na superfície foram evidenciadas. Na análise da difração de raios X foi observado que houve transformação de fases, para todos os grupos, nas diferentes faces da coroa, variando entre 1,9 a 8,9%. Com base nos dados concluí-se que coroas monolíticas de zircônia evidenciam uma alta carga à fratura, confiabilidade estrutural e apresentaram baixa transformação de fase / Abstract: Nowadays, in dentistry, zirconia ceramic systems represent an alternative to metals in prosthetic treatment due to the excellent mechanical properties. Zirconia crowns made without porcelain veneering, called monolithic, have proven to be a favorable alternative to oral rehabilitation, as they associate high strength and satisfactory aesthetic, while avoiding the most known complications in zirconia prosthesis, chipping and delamination. Pure zirconia can assume three crystallographic forms: monoclinic, tetragonal and cubic depending on the temperature. The zirconia association with stabilizing oxides, such as yttrium oxide (Y-TZP), maintains the zirconia in the tetragonal phase at room temperature. Therefore, zirconia remains metastable and at low temperatures, with moisture and stress a progressive transformation of tetragonal to monoclinic phase can occur and affect its strength. The present study evaluated the fracture load and phase transformation of zirconia monolithic crowns submitted to thermal and mechanical aging tests. Seventy monolithic zirconia crowns (Y-TZP) were cemented in resin-based replica and randomly divided into 5 groups (n = 14): Control (C), no treatment; Hydrothermal aging (HA), 122°C, 2 bar for 1 hour; Thermal Fatigue (TF), 104 cycles between 5 and 55°C for 30 seconds; Mechanical Fatigue (FM) 106 cycles, with a load of 70 N sliding of 1.5 mm in mesiopalatal cusp at 1.4 Hz; Mechanical and Thermal Fatigue associated (MTF). After each treatment, the fracture load was determined in a universal testing machine with 10KN load and speed of 1mm/min (n=12/group). Surface modifications and fracture origin and mode were evaluated by scanning electron microscope. The phase transformation was analyzed by x-ray diffraction (n=2/group). The fracture load data were analyzed by one-way ANOVA at a level of 5%. Also, the Weibull distribution was performed. All restorations survived the aging tests and no significant differences were observed in between treatments (p> 0.05). There was no statistically significant difference in the mean fracture load and characteristic fracture load among the groups (p>.05). The Weibull modulus ranged from 6.2 to 16.6, with significant difference between control and hydrothermal aging groups. Catastrophic failures were observed. Phase transformation was shown at the different surfaces of the crown in all groups (1.8-8.9%). In conclusion, monolithic zirconia crowns showed high fracture load, structural reliability and low phase transformation / Mestrado / Protese Dental / Mestra em Clínica Odontológica