Referrals to the Halifax Infirmary Neurosurgery Department are submitted with regards to spinal conditions with different degrees of complications. Although there exists a Spinal Condition Consultation Protocol to standardize spinal referrals, the information provided from referring physicians is frequently inadequate to accurately triage the patient's condition, partly due to missing diagnostic therapies. The Neurosurgery Department receives a high volume of referrals each year, which imposes a significant administrative workload on the staff. We propose to develop a protocol-driven decision support system to: 1) Provide primary care physicians with timely access to condition specific consultation treatment protocols; and 2) Automate the referral assessment process to eliminate processing delays and administration burden. To this aim, we transformed the Consultation Protocol into a semantic knowledgebase. The decision support services are integrated within a standardized electronic referral system. We believe this system can significantly improve the referral process at the Neurosurgery Division.

The purposes of this study were to: 1) determine absolute intrarater reliability of using the cervical range of motion device (CROM) for measuring cervical movements in older adults, and 2) determine the intrarater reliability and concurrent validity of the Candrive protocol, which uses a universal goniometer to measure rotation. Forty older adults (75.7 + 4.7 years of age) were tested in two sessions, one week apart, by two raters. Intrarater reliability scores were good for the CROM protocol (coefficient of variation (CV) values were 5.5% and 6.2 % for cervical rotation). The Candrive protocol values were higher (CV = 7.9 and 9.4%). Concordance analyses suggested that the Candrive protocol was less than good in terms of its validity, particularly when order effects were taken into consideration. In conclusion, the CROM protocol demonstrated good reliability for either group or individual analyses, whereas the Candrive protocol was less reliable and its validity marginal.

Three-dimensional movement analysis was used to evaluate head and neck movement in patients with neck pain and matched controls. The aims were to further develop biomechanical models of head and neck kinematics, to investigate differences between subjects with non-specific neck pain and whiplash associated disorders (WAD), and to evaluate the potential of objective movement analysis as a decision support during diagnosis and follow-up of patients with neck pain. Fast, repetitive head movements (flexion, extension, rotation to the side) were studied in a group of 59 subjects with WAD and 56 controls. A back propagation artificial neural network classified vectors of collected movement variables from each individual according to group membership with a predictivity of 89%. The helical axis for head movement were analyzed in two groups of neck pain patients (21 with non-specific neck pain and 22 with WAD) and 24 matched controls. A moving time window with a cut-off angle of 4° was used to calculate finite helical axes. The centre of rotation of the finite axes (CR) was derived as the 3D intersection point of the finite axes. A downward migration of the axis during flexion/extension and a change of axis direction towards the end of the movements were observed. CR was at its most superior position during side rotations and at its most inferior during ball catching. This could relate to that side rotation was mainly done in the upper spine, while all cervical vertebrae were recruited to stabilize the head in the more complex catching task. Changes in movement strategy were observed in the neck pain groups: Neck pain subjects had lower mean velocities and ranges of movements as compared with controls during ball catching, which could relate to a stiffer body position in neck pain patients in order to stabilize the neck. In addition, the WAD group had a displaced axis position during head repositioning after flexion, while CR was displaced during fast side rotations in the non-specific neck pain group. Pain intensity correlated with axis and CR position, and may be one reason for the movement strategy changes. Increased amount of irregularities in the trajectory of the axis was found in the WAD group during head repositioning, fast repetitive head movements and catching. This together with an increased constant repositioning error during repositioning after flexion indicated motor control disturbances. A higher group standard deviation in neck pain groups indicated heterogeneity among subjects in this disturbance. Wireless motion sensors and electro-oculography was used simultaneously, as an initial step towards a portable system and towards a method to quantify head-eye co-ordination deficits in individuals with WAD. Twenty asymptomatic control subjects and six WAD subjects with eye disturbances (e.g. dizziness and double vision) were studied. The trial-to-trial repeatability was moderate to high for all evaluated variables (single intraclass correlation coefficients >0.4 in 28 of 32 variables). The WAD subjects demonstrated decreased head velocity, decreased range of head movement during gaze fixation and lowered head stability during head-eye co-ordination as possible deficits. In conclusion, kinematical analyses have a potential to be used as a support for physicians and physiotherapists for diagnosis and follow-up of neck pain patients. Specifically, the helical axis method gives information about how the movement is performed. However, a flexible motion capture system (for example based on wireless motion sensors) is needed. Combined analysis of several variables is preferable, as patients with different neck pain disorders seem to be a heterogeneous group.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 6 uppsatser.

Thesis (MEng)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Neck pain is a common phenomenon that occurs in a large percentage of the population every day. While many occurrences are not deemed critical such as those from muscle strain which can be treated with rest and pain medication, others due to sports injuries, whiplash from car accidents, bad posture or degeneration of the intervertebral disc can be quite severe. In extreme cases failure of the vertebra(e) or the intervertebral disc requires surgery and possibly the use of cervical implants. Where intervertebral discs fail due to herniation or Degenerative Disc Disease (DDD), Anterior Cervical Discectomy and Fusion (ACDF) is a common surgical method used to remove the a ected disc and replace it with a cervical cage implant. These implants are designed to restore the height between the vertebrae, allowing bone from both vertebrae to grow through them and mineralise. Additive Manufacturing (AM) technologies can produce parts with complex geometries not possible using conventional manufacturing methods. This design freedom, coupled with CT scans of a patient, allow for tailoring an implant to the speci c anatomy of the a ected vertebrae using CAD software. Such an approach must be regulated and shown to be technically and commercially feasible before it can be implemented in industry. This study sought to develop a framework for manufacturing customized cervical cage implants using additive manufacturing. The e cacy of customization to reduce the risk of subsidence was investigated by means of non-destructive and destructive mechanical testing on six cadaver specimens, using readily available PEEK cage implants as a benchmark. The results showed that the customized implant was comparable to the PEEK, with no statistically signi cant di erence between the two. In extreme cases, where PEEK implants cannot be used, customized implants could be a suitable alternative to reduce the risk of subsidence. A manufacturing cost analysis was conducted to determine economic feasibility. The estimated cost and selling price of the customized implants under various utilization scenarios and mark-ups was compared to readily available PEEK implants. The estimated selling prices of the customized implants compared favourably to the PEEK verifying the economic viability of using AM. / AFRIKAANSE OPSOMMING: Nek pyn is 'n algemene verskynsel wat daagliks na tevore kom in die bevolking. Baie gevalle word nie as krities geklasi seer nie soos byvoorbeeld spier pyn wat behandel kan word deur genoegsame rus en pyn medikasie. Pyn wat deur sportbeserings, sweepslag beserings 'whiplash' tydens motor ongelukke, verkeerde postuur, of deur slytasie van 'n intervertebrale skyf veroorsaak is, word dikwels as ernstig geklasi seer. In ekstreme gevalle waar die werwel(s) of die inervertebrale skyf(we) faal, sal chirurgie en servikale inplantate moontlik nodig wees. Waneer intervertebrale skywe faal weens herniatie of Degeneratiewe Skyf Siekte (DDD) kan 'n algemene chirurgiese metode, Anterieure Servikale Discectomie en Fusie (ACDF), gebruik word om die gea ekteerde skyf te verwyder en dit te vervang met 'n servikale samesmelting implantaat. Hierdie implantate herstel die hoogte tussen rugwerwels en is ontwerp sodat die been deur dit kan groei en mineraliseer. Komplekse geometrieë kan vervaardig word deur toevoegingsvervaardiging (AM) tegnologieë. Die ontwerp vryheid, gepaard met CT-skanderings en CAD-sagteware stel mens in staat om die geometrie van die implantaat aan te pas tot die spese eke anatomie van die gea ekteerde vertebra. So 'n benadering moet gereguleer word en eers tegnies en kommersieel uitvoerbaar bewys word voordat dit in die bedryf geïmplementeer kan word. Hierdie studie poog verder om 'n raamwerk vir die vervaardiging van persoonlike servikale implantate deur middel van toevoegingsvervaardiging te ontwikkel. Die doeltre endheid van persoonlike implantate om te verhoed dat die chirurg die eind-plaat beskadig, en sodoende die risiko van insakking te verminder, is ondersoek deur middel van meganiese toetse op ses kadawer monsters. Hierdie toetse is gedoen met behulp van geredelik beskikbaar PEEK servikale implantate as 'n maatstaf. Die resultate het getoon dat die persoonlike- en PEEK implantate vergelykbaar is. In moontlike gevalle waar PEEK implantate nie geskik sou wees nie, kan persoonlike implantate 'n alternatiewe opsie wees om die risiko van insakking te verminder.

Made available in DSpace on 2015-12-06T23:47:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2007 / Introdução: Os equipamentos de eletroterapia mais utilizados no tratamento da lombalgia crônica não-específica são a Estimulação Elétrica Nervosa Transcutânea (TENS) e a Corrente Interferencial (CI). Ainda são escassas, porém, as evidências que justifiquem a sua utilização na prática clínica. Objetivos: O objetivo deste estudo foi comparar os efeitos da Estimulação Elétrica Transcutânea (TENS) com os da Corrente Interferencial (CI) em pacientes com lombalgia crônica não-específica. Métodos: Cento e cinqüenta pacientes com lombalgia crônica não-específica foram randomicamente divididos em três grupos: 1)TENS; 2) Corrente Interferencial e 3) Controle. Os pacientes designados à eletroterapia receberam 10 sessões de 30 minutos, em dias consecutivos, enquanto os pacientes do grupo controle permaneceram sem tratamento pelo mesmo período.Todos os pacientes foram avaliados, antes e depois do protocolo de tratamento, quanto à intensidade de dor através da EVA e do Questionário McGill; capacidade funcional, pelo questionário Roland-Morris; e utilização de medicamentos adicionais ao tratamento. Resultados: Cento e trinta e sete pacientes completaram o protocolo de tratamento, sendo 72,7 por cento do sexo feminino e 27,3 por cento do masculino, com média de idade de 47,16 ± 15,93 anos. Com relação à intensidade de dor, houve redução média na EVA de 44,86 mm (IC:- 52,4; -35,6) no grupo 2, de 39,18 mm (IC: -48,7; -29,7) no grupo 1, e de 8,53 mm (IC:-15,7; -01,3) no grupo 3, e no questionário McGill a redução do PPI no grupo 1 foi mais evidente, e do PRI e do NWC no grupo 2. No questionário Roland Morris, o grupo 2 teve redução média de 7,20, o grupo 1 de 6,59 e o grupo 3 de 0,70 pontos. É importante destacar que 84 por cento dos pacientes do grupo 1, 75 por cento do grupo 2 e 34 por cento do grupo 3 deixaram de tomar o medicamento após tratamento. Em todos os desfechos investigados, o grupo Controle apresentou diferença estatisticamente significante com relação aos demais grupos (p<0,0001), mas, apesar dos pacientes que receberam CI terem obtido melhores resultados na redução da dor e na melhora da capacidade funcional, estes não foram estatisticamente significantes quando comparados ao grupo de TENS (p>0,05). Conclusão: No tratamento da lombalgia crônica não-específica, tanto a TENS como Corrente Interferencial melhoram a capacidade funcional, reduzem a dor e diminuem a utilização de medicamentos quando comparados ao controle. Não há diferença, entretanto, entre os efeitos dos dois equipamentos de eletroterapia.. / Background: The electrotherapy equipments more used in non specific chronic low back pain are Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential Current (IFC). However, the evidences that support their use in clinical background are still scarce. Objectives: The purpose of this study was to compare the effects of the TENS and IFC in patients with non specific chronic low back pain. Methods: A hundred and fifty patients with non specific chronic low back pain were randomly divided into three groups: 1) TENS; 2) IFC; e 3) Control. The patients designed to electrotherapy received 10 sessions lasting 30 minutes each one in consecutive days, while the patients of the Control group stayed without any treatment in the same period. All the patients were evaluated before and after the protocol of the treatment, according to the intensity of the pain through the Visual Analogue Scale (VAS) and McGill Pain Questionnaire; specific functional disability by Roland Morris Disability Questionnaire (RMDQ); and the use of adding medicines to the treatment. Results: A hundred and thirty seven patients finished the protocol of the treatment being 72,7% females and 27,3% males, with an age average from 47,167 ± 15,939 years old. Related to pain intensity, there was an average reduction on the VAS of the second group of 44,86 mm (CI:-52,4; -35,6), of 39,18 mm (CI:-48,7; -29,7) on the first group and 08,53 mm (CI:-15,7; -01,3) on the third one, as on the McGill Pain Questionnaire the PPI decreasing was clearer on the first group and of PRI and NWC of group 2. On RMDQ, group 2 had an average reduction of 7,20, group 1 of 6,59 and group 3 of 0,70 points. It is important to testify that 84% of the patients from the first group, 75% of the second group and 34% of the third group left the medicines after the treatment. In all the accomplishments examined, the Control group presented a statistically significant difference related to the other groups (p<0,0001), but, despite the patients that received IFC had better results when related to the reduction of the pain and a functional improvement capability, these were not statistically significant differences when compared to group of TENS (p>0,05). Conclusion: In non specific chronic low back pain treatment as TENS as IFC improve the functional capability, reduce the pain and the use of medicines when compared to Control. There is no difference, however, between the effects of the two other equipments. / BV UNIFESP: Teses e dissertações

Submitted by GABRIELA MARCHIORI BUENO null (gabi_marchiori@hotmail.com) on 2016-03-07T17:15:57Z No. of bitstreams: 1 DISSERTAÇÃO versão final.pdf: 1797120 bytes, checksum: 0d77becbe16bbbc7fd472c5e4119d56b (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-03-07T20:01:36Z (GMT) No. of bitstreams: 1 bueno_gm_me_jabo.pdf: 1797120 bytes, checksum: 0d77becbe16bbbc7fd472c5e4119d56b (MD5) / Made available in DSpace on 2016-03-07T20:01:36Z (GMT). No. of bitstreams: 1 bueno_gm_me_jabo.pdf: 1797120 bytes, checksum: 0d77becbe16bbbc7fd472c5e4119d56b (MD5) Previous issue date: 2016-02-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Devido à escassez de estudos mielográficos em bovinos e relatos de complicações no procedimento, o presente estudo teve por objetivo estudar a eficácia e segurança dos meios de contrastes utilizados a fim de nortear a escolha mais adequada para o diagnóstico de afecções vertebrais e medulares em bovinos. Foram utilizados dez bezerros holandeses, hígidos de sete dias a dois meses de idade. Os bezerros formaram dois grupos, um deles recebeu Ioexol e o outro Iopamidol, na cisterna cerebelomedular. Foi realizado estudo mielográfico da coluna vertebral na posição látero-lateral, que foram reproduzidas em tempos determinados em minutos totalizando 20 tempos, para posterior análise da opacidade, detalhes da imagem, distensão do canal medular e progressão da linha de contraste. Após a mielografia os animais foram observados durante a recuperação até deambulação. Após intervalo de sete dias foi realizado segundo período experimental, que compreendeu na inversão do meio de contraste dentro de cada grupo. Diferenças significativas em relação à qualidade da imagem e velocidade do preenchimento da coluna medular entre os dois meios de contrastes estudados não foram observadas. Não foram observadas anormalidades clínica após o exame mielográfico. Conclui-se que para a obtenção de imagens mielográficas com excelente radiopacidade, rica em detalhes, com distensão do espaço subaracnoide adequada e completa progressão da linha do contraste é necessário que as tomadas radiográficas sejam no segmento cervical de 6 a 8 minutos após a administração do contraste, no segmento torácico oitenta minutos após inoculação do contraste e nos segmentos lombar, sacral e cauda equina após vinte minutos da aplicação do meio de contraste. Os dois meios de contraste propostos foram seguros e equivalentes. / Due to the shortage of myelographic studies in cattle and reports of complications in the procedure, this study aimed to study the efficacy and safety of contrast media used to guide the most appropriate choice for the diagnosis of vertebral and spinal cord diseases in cattle. Ten Holstein calves, healthy seven days to two months of age were used. Calves formed two groups, one received iohexol and iopamidol other in cerebelomedular tank. Myelographic study was conducted on the spine side-to-side position, they are reproduced in time determined 20 minutes total time for analysis of the opacity image, details, distension medullary canal and contrast line progression. After myelography animals were observed during recovery to ambulation. After seven days interval was performed according to experimental period understood that the inversion of the contrast medium within each group. Significant differences in image quality and speed of fulfillment of the spinal column between the two means of studied contrasts were not observed. There were no clinical abnormalities after myelographic examination. We conclude that to obtain myelographic images with excellent radiopacity, rich in detail, with distension of subarachnoid space adequate and complete progression of contrast is line necessary that the radiographs are in the cervical segment 6 to 8 minutes after contrast administration in the thoracic segment eighty minutes after inoculation contrast and lumbar segments, sacral and cauda equina twenty minutes after the application of the contrast medium. The two contrast media were proposed insurance and the like.

La maladie d'Alzheimer (AD) est une pathologie neurodégénérative caractérisée par une atrophie cérébrale progressive associée à une mort neuronale. Plus récemment, il a été suggéré que la perte des fonctions cognitives survenant pendant la maladie s'explique principalement par une atteinte au niveau synaptique préalable à la mort neuronale. Ainsi il a été observé que le peptide β-amyloïde ou Aβ constituant des plaques séniles, l'un des deux marqueurs histologiques de la maladie, existe sous une forme soluble/oligomérique (Aβo), et cette conformation lui confère des propriétés synaptotoxiques. L'Aβo agit préférentiellement sur le compartiment post-synaptique des synapses excitatrices également appelées épines dendritiques, structures sub-cellulaires dont la forme est régie par un cytosquelette d'actine riche et dynamique. Parmi les nombreuses hypothèses émises pour expliquer la synaptotoxicité de l'Aβo, il a été suggéré que la disparition des épines était due à une dépolymérisation anormale des filaments d'actine par une enzyme : la cofiline. Pourtant des données récentes ont montré à l'inverse une phosphorylation/inactivation de la cofiline dans le cortex frontal de patients AD, mais aussi dans le cerveau de la lignée de souris APP/PS-1, modèle de AD. De plus, des analyses morphologiques des synapses de la région CA1 chez la souris APP/PS-1 ont montré une réduction de la densité d'épines, associée à une augmentation du volume des épines survivantes. Les variations de volume de la tête de l'épine sont des phénomènes très fréquents lors d'une induction de potentialisation à long terme, le corrélat électrophysiologique de la mémoire.. Au cours de ma thèse, nous avons cherché dans un premier temps à caractériser les altérations morphologiques des épines dendritiques chez la souris APP/PS-1 par microscopie électronique. Nous avons pu confirmer que dès 3 mois, les synapses excitatrices sont moins nombreuses, que les épines restantes sont plus larges, mais surtout, que l'épaisseur de la densité post-synaptique n'est plus proportionnelle à la surface de l'épine, ce qui suggère un découplage entre modifications morphologiques et fonctionnelles. Nous avons également mis en évidence la présence de spinules anormales sur les épines.En utilisant des cultures primaires de neurones corticaux, nous avons pu montrer qu'un traitement aigu avec de l'Aβo induit la formation de protrusions riches en actine filamenteuse ressemblant aux spinules observés chez les animaux transgéniques. En purifiant la fraction post-synaptique, nous avons montré que cette formation de protrusions est concomitante à une phosphorylation anormale de la cofiline induite par l'Aβo. Ainsi l'inactivation de la cofiline qui en résulte pourrait être à l'origine d'une stabilisation et donc d'un allongement des filaments d'actine synaptique conduisant à la formation des protrusions. Cette inactivation de la cofiline a également été retrouvée chez la souris APP/PS-1 et chez l'humain. En conclusion, l'ensemble des résultats de cette thèse montre que l'Aβo induit des déformations morphologiques des épines, qui se caractérisent par la formation de protrusions membranaires ressemblant à des spinules. Ces protrusions ne sont pas activité-dépendantes, mais proviennent plutôt d'une dérégulation de l'activité enzymatique de la cofiline par l'Aβo. / Alzheimer's disease (AD) is a neurodegenerative pathology associated with progressive cerebral atrophy linked to neuronal death. It has been recently suggested that loss of cognitive functions occurring during the disease was a consequence of synapse dysfunction and prior to neuronal death. Thus, it has been observed that Amyloïd-β peptide (Aβ), the main component of senile plaques, one histological marker of the disease, also exists as soluble/oligomeric Aβ (Aβo). This Aβ conformation is known to be synaptotoxic. Aβo acts preferentially on the post-synaptic compartment of excitatory synapses, also named dendritic spines, sub-cellular micro-domains containing dynamic and filamentous actin as their main cytoskeleton component. Among numerous theories explaining Aβo synaptotoxicity, it has been suggested that spine collapsing was due to an abnormal actin depolymerisation through Cofilin enzyme. Yet, recent evidences inversely showed Cofilin phosphorylation/inactivation in frontal cortex of AD patients and in the APP/PS-1 transgenic mice brain, an AD animal model. Moreover, synapse morphological analysis in the CA1 region of APP/PS-1 mice showed a reduction in spine density and an increase in spine head volume of remaining ones. Spine head volume variations are commonly occurring during induction of Long Term Potentiation, the electrophysiological correlate of memory.During my thesis, we firstly characterized APP/PS-1 mice dendritic spine morphological alterations using electron microscopy. We confirmed that even at 3 month-old, excitatory synapses are fewer, but also that remaining ones display larger surfaces. In addition, PSD thickness is not proportional to spine surface anymore, which suggests an uncoupling between functional and morphological modifications. We also demonstrated the presence of abnormal shaped spinules onto spines.Using primary cortical neuron cultures, we demonstrated that acute Aβo treatment induces the formation of filamentous actin enriched protrusions, resembling spinules observed in transgenic mice. By purifying post-synaptic protein fraction, we showed that protrusions formation is correlated to an abnormal Cofilin phosphorylation/inactivation by Aβo. Thus, resulting Cofilin inactivation could trigger actin filament stabilization, leading to protrusion formation. We also found Cofilin phosphorylation in APP/PS-1 mice and in AD brains. Taken together, these results show that Aβo triggers dendritic spine abnormal alterations, characterized by the formation of membrane protrusions ressembling spinules. These protrusions are not activity-dependant, but may instead originate from a disregulation of Cofilin enzymatic activity by Aβo.

Made available in DSpace on 2015-03-26T13:47:20Z (GMT). No. of bitstreams: 1 texto completo.pdf: 786382 bytes, checksum: 57cd0809363705fb0abb73b2bc5efd11 (MD5) Previous issue date: 2003-07-14 / In this study, two experiments were conducted in order to evaluate the iliac crest autograft and this association to fresh autogenous bone marrow in the lumbar dorsolateral vertebral union in rabbits. Thirty-three animals, separated in two groups, were used in each experiment. Nine animals in group 1 (G1), corresponding to the control group, where only L5-L6 transverses processes decortications were created and twenty-four animals in group 2 (G2) where, besides the decortication, the graft material was also deposited on L5-L6 transverses processes. The anesthetic protocol and surgical technique were the same in both works, difering the graft material used. In the first work, only the iliac crest autograft was associated to 2 millimeters of fresh autogenous bone graft. Manual palpations, radiographic, histological and biomechanical evaluations of the operated segments (L5-L6) and adjacents (L4-L5 and L6-L7); the solid segments were classified as solid union. The radiographics analysis was based on the presence of bone mass, bilaterally, without the interlaminar space was the object of study in histological analysis as the type of predominant tissue; and during the biomechanical test the force and resistence of vertebral union were evaluated. The manual palpation and radiographics evaluations demonstrated do not be the method of choice to determine the vertebral union level due to the great variation observed in the results comparing to histological and biomechanical analysis. In the histological analysis it was possible to observe the bone formation sequence from the reabsorption of bone fragments graft, the intense periosteal reaction over the decorticated transverse processes until the bone integration andconsequent vertebral union. In the biomechanical test, the force and rigidity of the operated segments were bigger than adjacents vertebras, although this diference was not significant throughout the analysis. In the first work, it was observed that the autogenous iliac crest bone graft when used in adequate amounts conduced to vertebral union in rabbits, which was intensified nine weeks after the surgical procedure. In the second work, the fresh autograft bone marrow associated to the iliac crest bone graft anticipate the bone formation which began at five weeks after surgery consisting an option for those patients whose sufficient bone graft amount can not be obtained to induce vertebral fusion. / Neste trabalho foram conduzidos dois experimentos para avaliação do autoenxerto da crista ilíaca e de sua união à medula óssea autógena fresca na união vertebral dorsolateral lombar em coelhos. Em cada experimento foram utilizados trinta e três animais, divididos em dois grupos, com nove animais no grupo 1 (G1), que correspondeu ao grupo controle, onde foi realizada somente a descortificação dos processos transversos de L5-L6 e vinte e quatro animais no grupo dois (G2), onde foi realizada além da descortificação, a enxertia entre os processos transversos de L5-L6. Os protocolos anestésicos e a técnica cirúrgica foram os mesmos em ambos os trabalhos, diferindo o material de enxertia utilizado. No primeiro trabalho utilizou-se apenas o autoenxerto da crista ilíaca, considerado material de escolha na união vertebral. No segundo trabalho foi associado ao autoenxerto da crista ilíaca dois mililitros de medula óssea autógena fresca. Foram realizadas análises por palpação, radiografias, histologia e teste biomecânico nos segmentos operados às cinco, sete e nove semanas após o procedimento cirúrgico. Na análise por palpação manual movimentos de flexão e extensão foram realizados nos segmentos operados (L5-L6) e adjacentes (L4-L5 e L6-L7); os segmentos sólidos foram classificados como união vertebral. As análises radiográficas foram baseadas na presença de massa óssea bilateralmente sem radioluscência; na análise histológica estudou-se os espaços interlaminares e o tipo de tecido predominante; e no teste biomecânico foram analisados força e resistência da união vertebral. As avaliações por palpação manual e radiografias demonstraram não ser métodos de escolha para a determinação do grau de união vertebral, devido à grande variação observada nos resultados comparados às análises histológicas e biomecânicas. Na histologia foi possível observar a seqüência da formação óssea, desde a reabsorção dos fragmentos ósseos enxertados, a intensa reação periosteal nos processos tranversos descortificados e a formação óssea endocondral proveniente do periósteo descortificado, culminando na osteointegração e conseqüente união vertebral. No teste biomecânico a força e a rigidez dos segmentos operados foram maiores que as vértebras adjacentes, porém essa diferença não foi significativa no decorrer das análises. No primeiro trabalho, foi observado que o osso autógeno da crista ilíaca utilizado em quantidades adequadas como material de enxertia em coelhos possibilitou a união vertebral, que se intensificou às nove semanas após o procedimento cirúrgico. No segundo trabalho, a medula óssea autógena fresca associada ao autoenxerto da crista ilíaca precipitou a formação óssea, que se iniciou às cinco semanas após a cirurgia, o que constitui uma opção nos pacientes que não se pode coletar enxerto ósseo suficiente para a obtenção de artrodese vertebral.

Made available in DSpace on 2016-12-06T17:07:13Z (GMT). No. of bitstreams: 1 Dissertacao - Fabio.pdf: 2269771 bytes, checksum: 8ff775f5d92ce2397baa5a139a979e97 (MD5) Previous issue date: 2007-07-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The main objective of this study was to evaluate the movement and positioning of the vertebral spineof the sailor during the hiking position. This research was characterized as descriptive and exploratory and the sample was of the intentional type. This was composed for 3 sailors selected through contacts with clubs of sailing of the city, the Santa Catarina Sailing Federation and the Brazilian Sailing and Motor Federation. The research is part of the Project Human Performance of Sailing and had approval in the Ethics Committee in Research with Human beings of the UDESC. For the acquisition of the images four cameras of video of the System Peak Motus® of 60 Hz had been used. To this research, a Laser Standard boat was used, and was raised to 1,20m of height to allow the visualization of the markers of the spine. Marking reflexives of 7mm had been used, applied in 21 anatomical points of the body for the three-dimensional reconstruction through DLT. For the evaluation of the spine the spinal processes of C7, T7, L1, L3 and L5 had been used, beyond the Temporomandibular joints and trochanters of the hips. The other reflexives had been used for the calculation of the CG. For the processing of videos APAS-XP® was used to make the digitalization of pictures. The gotten data had been filtered through the cubic spline interpolation filter of APAS system. Principles of descriptive statistics with calculation of: maximum angles and moments of shoring, average, absolute standard deviation (in each execution), average standard deviation (between the executions) and minimum angles and moments of shoring. In the antropometrical values we can observe an disparity in subjects and one of the athletes was demonstrated low weight. In the calculation of the hiking moment an average value of 796,54±28,58 N.m was gotten. In the flexion angle of head 113,56±2,70º and in the thoracic kyphosis angle 154,15±2,92º. For data of lumbar lordosis the average values had 170,15±2,98º, for angle of rotation of trunk - 3,08±4,05º and for inclination of trunk -1,00±3,78º. This study identified the movements and adjustments realized by the sailor s trunk in hiking position. It was demonstrated that hiking is not a static posture. The body micro-movements executed to control and adjust the boat on water during this posture should be considered. So, to study the hiking position considering trunk as a fixed segment is not the better choice. / O objetivo principal deste estudo foi avaliar a movimentação e posicionamento da coluna vertebral do velejador durante a postura de escora. Esta pesquisa foi caracterizada como descritiva, exploratória, multicaso e a amostra foi do tipo intencional. Essa foi composta por 3 velejadores selecionados através de contatos com clubes de vela da cidade, a Federação Catarinense de Vela e a Federação Brasileira de Vela e Motor. A pesquisa faz parte do Projeto Performance Humana no Iatismo e teve aprovação no Comitê de Ética em Pesquisas com Seres Humanos da UDESC. Para a aquisição das imagens foram utilizadas quatro câmeras de vídeo do Sistema Peak Motus® com freqüência de aquisição de 60 hz. Para coleta, foi utilizado um barco Laser Standard, que foi elevado à 1,20m de altura para permitir a visualização dos marcadores da coluna. Foram utilizados marcadores reflexivos de 7mm, aplicados em 21 pontos anatômicos do corpo para a reconstrução tridimensional através de DLT. Para a avaliação da coluna foram usados os processos espinhosos de C7, T7, L1, L3 e L5, além das articulações temporomandibulares e trocânteres maiores dos quadris, sendo que os outros reflexivos foram usados para o cálculo do CG. Para o processamento dos vídeos foi utilizado o sistema de digitalização quadro a quadro APASXP ®. Os dados obtidos foram filtrados através do filtro de interpolação cubic spline do próprio sistema. Foram utilizados princípios da estatística descritiva com cálculo de: ângulos e momentos de escora máximos, média, desvio padrão absoluto (em cada execução), desvio padrão médio (entre as execuções) e ângulos e momentos de escora mínimos. Quanto aos valores antropométricos observou-se uma disparidade entre os sujeitos sendo um dos atletas demonstrou-se muito leve. No cálculo do momento de escora obteve-se um valor médio de 796,54±28,58 N.m. No ângulo de flexão da cabeça obteve-se 113,56±2,70º e no ângulo de cifose torácica 154,15±2,92º. Para os dados da lordose lombar os valores médios foram de 170,15±2,98º, para o ângulo de rotação do tronco -3,08±4,05º e para a inclinação do tronco -1,00±3,78º. Por fim, observou-se que o velejador realiza, nos três eixos, uma soma de pequenos ajustes posturais e movimentos durante a escora e que estes podem influenciar na performance do gesto. Com isso demonstra-se que a escora não é uma postura estática, e que estudar esse gesto usando o tronco como um segmento ou haste fixa pode não ser a melhor escolha