This document discusses the classification and treatment of chondral lesions of the hip. It begins by describing the layers and structures of the hip joint. It then reviews various classification systems for grading chondral lesions of the acetabulum and femoral head, including the Outerbridge, Beck, and Sampson systems. Diagnostic tools for evaluating hip pathology such as x-rays, MRI, and arthroscopy are also discussed. Finally, the document outlines treatment options for chondral lesions based on the type and size of the lesion and any associated morphological abnormalities, including debridement, microfracture, and various grafting techniques.
The hip joint is a ball and socket joint consisting of the femoral head and acetabulum. This articulation provides multiple planes of movement and is highly congruent. Articular cartilage, consisting of type II collagen, covers the majority of the femoral head. The acetabulum peripherally consists of articular cartilage while the central floor is non-articular and filled with a fatty layer termed the pulvinar. The ligamentum teres arises from both the transverse acetabular ligament and the central non-articular layer of the acetabulum and attaches to the central femoral head. It may play a role in stabilizing the hip joint.
Hallux valgus - Practical approach and recent advances Dr Shivam R Shah
More than 140 types of different osteotomies are described for hallux valgus treatment . Here i have tried to present scarf osteotomy with recent advances in the corrective osteotomies for hallux valgus
Prof. Anisuddin Bhatti, Paediatric Orthopaedic Surgeon, Dr. Ziauddin University Hospital, Clifton campus Karachi, presented lecture on Congenital Clubfoot and PPV deformity evaluation & treatment. On 31 May 2021 to Resident's of AKUH and others. Acknowledged text & picture source as indicated in reference list.
The hip joint is a ball and socket joint consisting of the femoral head and acetabulum. This articulation provides multiple planes of movement and is highly congruent. Articular cartilage, consisting of type II collagen, covers the majority of the femoral head. The acetabulum peripherally consists of articular cartilage while the central floor is non-articular and filled with a fatty layer termed the pulvinar. The ligamentum teres arises from both the transverse acetabular ligament and the central non-articular layer of the acetabulum and attaches to the central femoral head. It may play a role in stabilizing the hip joint.
Hallux valgus - Practical approach and recent advances Dr Shivam R Shah
More than 140 types of different osteotomies are described for hallux valgus treatment . Here i have tried to present scarf osteotomy with recent advances in the corrective osteotomies for hallux valgus
Prof. Anisuddin Bhatti, Paediatric Orthopaedic Surgeon, Dr. Ziauddin University Hospital, Clifton campus Karachi, presented lecture on Congenital Clubfoot and PPV deformity evaluation & treatment. On 31 May 2021 to Resident's of AKUH and others. Acknowledged text & picture source as indicated in reference list.
Applied surgical anatomy of the craniovertebral spineKshitij Chaudhary
This presentation was made at the Advanced Cervical Spine Course conducted by Dr. Sandeep Sonone and Dr. Kshitij Chaudhary for the Bombay Orthopaedic Society. http://bombayorth.org/academics/instructional-courses/
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. The Porto Hip Unit
PHM2015
• Zonas
• Articulación de la cadera
• Compartimiento central
• Compartimiento
periférico
• Peritrocantérico
• Sub-Glúteo
• Isquio-femoral
• Isquio-tibiales
• Sacro-ilíaco
• Sínfisis púbica
4. Síndrome Piriforme
5. Lesões Isquiotibiais
6. Fracturas/avulsoes apofisárias
7. Hérnia Desportiva / Pubalgia
Fig. 1. Intra-articular pathology presents as groin pain, diamond sh
pathology such as lower abdomen or at the adductor tubercle can ind
Plante et al226
Classification and Treatment of Hip Chondral Lesions
4. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
5. The Porto Hip Unit
PHM2015
• Capas
• Osteocondral
• Inerte
• Contráctil
• Neuromecánica
differences, as they relate to normal osseous structure, os-
seous overcoverage and osseous undercoverage, is what led
to the development of the Layer System. (Table 1)
Diagnostic testing for identifying osseous, inert and soft
tissue hip pathology has included x-ray, magnetic resonance
imaging (MRI), computed tomography (CT) Scan, delayed
gadolinium-enhanced MRI of cartilage (dGEMRIC) studies,
diagnostic injection and clinical special tests[9, 10]. Computer
navigation surgical planning software, such as A2, can be
used to confirm and model osseous impingements. X-ray
views of AP lateral and Dunn view can be used along with 3
dimensional CTscans to identify osseous hip pathologies [11].
alpha angles, beta angles and McKibbon indices [12]. dGEM-
RIC studies can be used, when indicated, to determine the
health of the cartilage[9]. Intra-articular injections have prov-
en extremely reliable for differentiating between intra and
extra articular hip pathology [13]. MRI has been diagnostical-
ly sensitive to Layer II inert tissue (labrum, capsule, ligament
and ligamentum teres) pathology, as well as Layer III contrac-
tile tissue direct involvement and indirect enthesiopathies.
During the diagnostic process it may be helpful to cate-
gorize the hip as structurally normal, structurally overcov-
ered or structurally undercovered. A structurally normal hip
will have values that fall within a normal range for center
Table 1 The layer concept
Layer Name Structure Purpose Pathology
I Osteochondral Femur Joint congruence Developmental Dynamic
Acetabulum Arthrokinematic
movement
Dysplasia Cam Impingement
Innominate Femoral Version Rim Impingement
Acetabular Version Trochanteric Impingement
Delamination
Femoral Inclination Sub-spine impingement
Acetabular Profunda/Protrusio
II Inert Capsule Static Stability Labral Tear
Labrum Capsular Instability
Ligamentous Complex Ligamentum teres tear
Ligamentum Teres Adhesive capsulitis
III Contractile Musculature crossing hip Dynamic Stability Hemi-pelvic Pubalgia:
Lumbosacral muscles Anterior Enthesiopathy
Pelvic floor Hip flexor strain
Psoas impingement
Rectus femoris impingement
Medial Enthesiopathy
Adductor tendinopathy
Rectus abdominus tendinopathy
Posterior Enthesiopathy
Proximal hamstring strain
Lateral Enthesiopathy
Peri-trochanteric space
Gluteus medius tear
III Neuromechanical Thoroco-lumbar mechanics Communication, timing
and sequencing of the
kinematic chain
Neural Mechanical
Lower extremity mechanics Nerve entrapment Foot structure and mechanics
Neuro-vascular structures
referring to and regional
to the hip
Referred Spinal Pathology Scoliosis
Regional mechanoreceptors Neuromuscular Dysfunction Pelvic posture over femur
Classification and Treatment of Hip Chondral Lesions
6. The Porto Hip Unit
PHM2015
A Articulação da anca é uma diartrose em que a cartilagem cobre a cabeça
femoral e o acetábulo, permitindo o deslizamento entre ambos, com baixo atrito.
Células (Condrócitos)
Matriz cartilagínea
Colagénio
Proteoglicanos
Hialuronato
Cartilagem hialina
Camada superficial : 10 a 20% (Fibras orientadas de forma arqueada)
Camada intermedia: 40 a 60% (fibras orientadas radialmente)
Camada profunda: 30% (fibras orientação laminada)
A zona onde ocorrem a maior parte das lesões.
Classification and Treatment of Hip Chondral Lesions
7. The Porto Hip Unit
PHM2015
!
Bordo anterior do acetábulo
Bordo posterior do acetábulo
Linha ilio-isquiática
Ângulo CE (N: 25º a 40º)
Ângulo acetabular (0 a 10º)
Off-Set (N >= 7 mm)
Ângulo Alfa (N: < 50º)
!
• Face bacia com ancas
• Ancas P, de Dunn ou Cross Table
• Ancas P de Lequesnne
Classification and Treatment of Hip Chondral Lesions
8. The Porto Hip Unit
PHM2015
!
!
!
RM: Penetração, Ponderações, Cortes, Gadolinio. (Normal; artro-RM; dGEMRIC)
!
Classification and Treatment of Hip Chondral Lesions
9. The Porto Hip Unit
PHM2015
Artro-RM da articulação coxo-femural direita revelando sinais de conflito
femuro-acetabular misto de predomínio "CAM", com ângulo alfa
aumentado, onde coexiste patologia quística de herniação sinovial e
alterações labrais e condrais importantes
Classification and Treatment of Hip Chondral Lesions
10. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
11. The Porto Hip Unit
PHM2015
CFA Resulta em trauma de repetição ou agudo
Lesão labral
Lesao condral
Cascata degenerativa não focal
Classification and Treatment of Hip Chondral Lesions
12. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Hip Arthroscpy is an excellent way
to evaluate, diagnose and treat chondral
and labral lesions.
Hip
Arthroscopy
Acetabulum
Cartilage
Fovea
Teres ligament
Labral-Cartilage
junction
labrum
Femoral
Cartilage
13. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
ANCA NORMAL
Normal Hip
Acetabular
cartilage
Fovea
Labrum
Femoral
Cartilage
Capsula
14. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Parece anormal
Cicatriz estrelada
Fossa supra-acetabular
Cicatriz da fise
Sulco condro-labral
15. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Parece normal, mas…
Cabeça&
Fovea&
VI&
16. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Parece normal, mas…
Labrum'
Car)lagem'
Sulco??'
Rot.'CL??'
17. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Parece normal, mas…
“”Wave'lesion””'
18. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Parece normal, mas…
Labrum'
Car)lagem'
Delaminação'
19. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Claramente anormal
Labrum'
Car)l.'Acetab.'
Fissuração'e+fragmentação+car2l.'
20. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Claramente anormal
Fovea&
Cabeça&femoral&
Labrum&
Acetabulo&Zona&3&
Lesao&car7laginea&&
grau&V&de&Beck&
Exposição&ossea&
Delaminação&
21. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Claramente anormal
Acetábulo*
Zona*4*
Labrum*
Lesão*condral*5po*V*de*Beck*
Exposição*ossea*
Fibrilação*
22. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Fovea&
Labrum&
Fragmentação&Car2laginea&
Exposição&ossea&
23. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Cabeça&
Erosão&car-laginea&
24. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Labrum'
Cabeça'
Erosão&car)laginea&generalizada&
25. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
OUTERBRIDGE classification (Acetabulo e femur) - 1961
0 - Normal cartilage
Macroscopically sound cartilage
I - Malacia:
Cartilage with softening and swelling
III- Parcial-thickness defect:
That reach subchondral bone in an area that exceed 1,25 cm
IV - Exposed subchondral bone
II- Parcial-thickness defect:
That do not reach subchondral bone or exceed 1,25 cm
Labrum'
Car)l.'Acetab.'
Fissuração'e+fragmentação+car2l.'
Fovea&
Labrum&
Fragmentação&Car2laginea&
Exposição&ossea&
ANCA NORMAL
26. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
BECK classification (Acetábulo) - 2005
0 - Normal cartilage
Macroscopically sound cartilage
I - Malacia:
Cartilage with softening and swelling. Fibrillation.
III - Cleavage:
Loss of fixation to the subchondral bone.
Frayed edges, thinning of the cartilage, flap.
IV - Defect:
Full-thicknes defect
II - Debonding:
Loss of fixation to the subchondral bone.
Macroscopically sound cartilage - CARPET LESION
ANCA NORMAL
“”Wave'lesion””'
27. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
SAMPSON classification (Acetábulo) - 2011
AC 0 - Normal cartilage
Fovea&
Labrum&
Fragmentação&Car2laginea&
Exposição&ossea&
ANCA NORMAL
AC 1 - Softening no wave sign
AC 1w - Softening with wave sign, intact labrocartilage junction (CARPET LESION)
AC 1wTj - Softening with wave sign and torn labrocartilage junction
AC 1wD - Softening with wave sign, intact labrocartilage junction, with delimitation (DELAMINATION)
AC 1wTjD- Softening with wave sign and torn labrocartilage junction, with delimitation (DELAMINATION)
AC 2 - Fibrillation
AC 2Tj - Fibrillation with torn labrocartilage junction
AC 3 - Exposed bone small area < 1cm2
AC 4 - Exposed bone small area > 1cm2
Abbreviations: A, acetabulum; C, cartilage; D, lemamination; Tj, torn labrocartilage junction; W, wave sign
Labrum'
Car)lagem'
Delaminação'
28. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
SAMPSON classification (Femur) - 2011
HC 0 - Normal cartilage
ANCA NORMAL
HC 0T - Uniform Thinning (T)
HC 1 - Softening
HC D - Traumatic defect ( size in mm)
HC 2 - Fibrillation
HC 2T - Demarcation zone from FAI (Pincer)
HC 3 - Exposed bone
HC 4 - Any delamination
Abbreviations: HC, femoral head cartilage; T, thinning; TD, traumatic defect; DZ, demarcation zone
exposição)ossea)
Zona%de%demarcação%
Labrum%
Cabeça%
29. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
SAMPSON classification - Modified by The Porto Hip Unit
AC 0 - Normal cartilage
AC 1 - Softening no wave sign
AC 1w - Softening with wave sign, intact labrocartilage junction (CARPET LESION)
AC 1wTj - Softening with wave sign and torn labrocartilage junction
AC 1wD - Softening with wave sign, intact labrocartilage junction, with delimitation (DELAMINATION)
AC 1wTjD- Softening with wave sign and torn labrocartilage junction, with delimitation (DELAMINATION)
AC 2 - Fibrillation
AC 2Tj - Fibrillation with torn labrocartilage junction
AC 3 - Exposed bone small area < 1cm2
AC 4 - Exposed bone small area > 1cm2
Abbreviations: A, acetabulum; C, cartilage; D, lemamination; Tj, torn labrocartilage junction; W, wave sign
AC 3D - Exposed bone small area < 1cm2, with delimitation (FLAP)
AC 4D - Exposed bone small area < 1cm2, with delimitation (FLAP)
30. The Porto Hip Unit
PHM2015
“Relógio”
“Zonas”
Ilizaliturri VM Jr, Byrd JW, Sampson TG, et al. - 2008
Como na cabeça avaliamos
A extensão da lesão,
• Periférica < 10%
• Lateral 1/3 periférico
• Mediana 1/3 intermédio
• Central 1/3 central
MAPEAMENTO CIRURGICO DAS LESÕES CONDRAIS!
!
Classification and Treatment of Hip Chondral Lesions
(Porto Hip Unit)
ip U
31. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
32. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
33. The Porto Hip Unit
PHM2015
“…. perante a lesão cartilagínea focal, o tratamento
visa evitar a progressão, minimizar a lesão e reparar/
regenerar a cartilagem articular…”
J. Cruz de Melo
Classification and Treatment of Hip Chondral Lesions
34. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Opções de Tratamento:
1) O tipo e extensão da lesão cartilagínea
2) As alterações morfologicas associadas
3) O labrum
Cartilage
LesionShaving
Shaving
micro-fractures
Shaving
micro-fractures
cola fibrina
Enxertos
…….
C. Pluripotentes
35. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Opções de Tratamento - Acetabular cartilage
1) O tipo e extensão da lesão cartilagínea
2) As alterações morfologicas associadas
3) O labrum
Protocolo de tratamento de The Porto Hip Unit
36. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
Opções de Tratamento - Acetabular cartilage
1) O tipo e extensão da lesão cartilagínea
2) As alterações morfologicas associadas
Protocolo de tratamento de The Porto Hip Unit
37. The Porto Hip Unit
PHM2015
Classification and Treatment of Hip Chondral Lesions
A lesão cartilagínea é de difícil caracterização na avaliação
imagiológica, sendo a sua caraterização essencialmente
per-operatória.
Tratamento continua a ser um grande desafio.
Tratar sempre o fator causal (CFA, DDA, Corpos livres, etc )
Objectivo é minimizar a lesão, evitar a progressão,, tentar
“restabelecer” a cartilagem ou fibrocartilagem cicatricial.
O DIAGNOSTICO PRECOCE E O TRATAMENTO ADEQUADO É
O MELHOR FATOR PROGNOSTICO