PATRICIA MORENO GRANGEIRO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Feasibility of Magnetic Resonance Angiography in Patients With Legg-Calve-Perthes Disease(2021) GRANGEIRO, Patricia Moreno; RODRIGUES, Joao C.; ANGELI, Luiz R. A. de; LEAO FILHO, Hilton; MONTENEGRO, Nei B.; GUARNIERO, Roberto; DEMPSEY, Molly; KIM, Harry K. W.Background: The etiology of Legg-Calve-Perthes disease (LCPD) remains unknown; however, interruption of medial circumflex femoral artery (MCFA) supply to the femoral head is the key pathogenic factor. The main purpose of this study is to determine the feasibility of using magnetic resonance angiography (MRA) to evaluate the course of the MCFA in the normal and affected hips of patients with unilateral LCPD. Methods: We analyzed 24 patients with unilateral LCPD using a time-resolved imaging of contrast kinetics magnetic resonance angiography (TRICKS-MRA). The course of the MCFA was divided into 4 segments in the coronal plane and in 3 segments in the axial plane, based on its location with respect to the femoral neck. The visibility of each segment was studied in the normal and affected sides. The segments were defined as not visible when no contrast was seen within the vessel lumen or visible when the lumen was partially or completely visualized with contrast. The statistical analysis was done using the chi(2) test. Results: TRICKS-MRA provided well-defined images of the first 2 segments of the MCFA on both the normal and affected sides of patients with LCPD (P=1). In half of the patients, the third segment was also visible using TRICKS-MRA on both sides (P=1). The fourth segment of the MCFA, which was the ascending lateral epiphyseal segment, was not visible on either side (P=0.49). No significant difference was found between the normal and affected hips in terms of visibility of the 4 segments of the MCFA using TRICKS-MRA. Anastomosis of the MCFA with the inferior gluteal artery was found in 3 hips (2 hips with LCPD and 1 normal hip). Conclusions: TRICKS-MRA provides well-defined images of the arterial supply to the proximal femoral epiphysis in children with LCPD, presenting a noninvasive and radiation-free alternative to conventional angiography. However, the TRICKS-MRA method used did not allow visualization of the ascending lateral epiphyseal segment of MCFA in the affected and the contralateral normal side. We believe that further advancement of this noninvasive imaging technique may open new opportunities for research aimed at evaluating the vascular supply of the femoral head in children.
- MODIFIED DEGA OSTEOTOMY IN TREATING DEVELOPMENTAL DYSPLASIA OF THE HIP (vol 26, pg 30, 2018)(2018) GUARNIERO, Roberto; SANCHEZ, Fernando Barbosa; MASSA, Bruno Sergio Ferreira; MONTENEGRO, Nei Botter; GRANGEIRO, Patricia Moreno; ANGELI, Luiz Renato Agrizzi De
- EXPERIMENTAL MODEL STUDY OF ISCHEMIC NECROSIS INDUCTION OF THE GROWING FEMORAL HEAD(2022) GORIOS FILHO, Antonio; SANTOS, Gustavo Bispo Dos; GUARNIERO, Jose Roberto Bevilacqua; ANGELI, Luiz Renato Agrizzi De; GRANGEIRO, Patricia Moreno; GUARNIERO, RobertoMany experimental models exist to better understand the necrosis of the femoral head etiology, both in terms of the species variety in which necrosis is induced and in the operative techniques used for treatment. Objective: This study has two main objectives, the first is to review the literature concerning experimental models of avascular necrosis of the growing femoral head, the second, to demonstrate the experimental pig model's reproducibility using a pilot study. Methods: This was a bibliographic review to describe the attempts over time to find the best species and technique for induction that would reproduce ischemic necrosis of the growing femoral head in humans. Simultaneously, a pilot study was performed to verify the replication of induction in pigs, the species that has more similarities with the human hip. The pilot's methodological analysis consists of conventional radiology and verification of possible anatomical, pathological changes. Results: In imaging exams; lateral sub-dislocation of the femur head and triangular appearance of the head were observed, characterizing its flattening; in macroscopic examination, the femoral head flattening with femoral neck widening and shortening was identified; in histology, the proliferation of articular cartilage with the presence of vascular granulation regenerative tissue, with osteoclasts and fibrocartilaginous tissue in the metaphyseal femoral neck region was identified. Conclusion: The experimental pig model can be used as a valuable tool for the reproducibility of anatomical, pathological changes in ischemic necrosis of the growing femoral head. The model is reproducible and feasible and can be beneficial for future studies on the anatomical pathology of necrosis of the growing femoral head. Level of Evidence III, Literature Review.
- REPRODUCIBILITY OF MODIFIED WALDENSTROM CLASSIFICATION IN PERTHES DISEASE(2021) CORDEIRO, Felippi Guizardi; GRANGEIRO, Patricia Moreno; MASSA, Bruno Sergio Ferreira; MONTENEGRO, Nei Botter; GUARNIERO, RobertoObjective: The purpose of our study is to evaluate intraobserver and interobserver reliability of modified Waldenstrom classification system for Legg-Calve-Perthes disease and assess the influence of the professional's area of expertise in the assessment. Methods: Twelve evaluators assessed 40 pairs of pelvic radiographs of patients with Legg-Calve-Perthes disease. After two weeks, a new evaluation was performed by the same evaluators. Kappa and Kendall's W indexes were used to evaluate both intraobserver and interobserver reliability and determine the influence of the evaluators' experience and area of expertise. Results: The average intraobserver kappa value was 0.394, with a reasonable agreement level. The interobserver Kappa value was 0.243 in the first evaluation (95% CI, 0.2270.259 and p < 0.0001) and 0.245 in the second evaluation (95% CI, 0.229-0.260 and p < 0.0001). The Kendall's W values obtained for pediatric orthopedists, radiologists and resident physicians were 0.686, 0.630 and 0.529 ( p < 0.0001), respectively. Conclusion: The modified Waldenstrom classification presented both moderate and reasonable levels of intraobserver agreement, and reasonable level of interobserver agreement. The evaluators' degree of experience and area of expertise influenced the concordance level found.
- MODIFIED DEGA OSTEOTOMY IN TREATING DEVELOPMENTAL DYSPLASIA OF THE HIP(2018) GUARNIEIRO, Roberto; SANCHEZ, Fernando Barbosa; MASSA, Bruno Sergio Ferreira; MONTENEGRO, Nei Botter; GRANGEIRO, Patricia Moreno; ANGELI, Luiz Renato Agrizzi DeObjective: To retrospectively evaluate the preliminary postoperative results of modified Dega-type acetabular osteotomy to treat developmental dysplasia of the hip, confirming the efficacy and reproducibility of this technique. Methods: This retrospective study included patients older than 18 months. A total of 19 hips underwent modified Dega osteotomy. Results: Satisfactory results were obtained, with an average decrease of the acetabular index from 39.2 to 20.6 degrees. The final average center edge angle was 29.6 degrees. Hip joint congruence was reestablished in all cases, and as of this writing, only one case developed necrosis in the femoral head during follow-up. Conclusion: Modified Dega osteotomy demonstrated good initial results, as well as the potential for use in treating developmental dysplasia of the hip.
- Double femoral osteotomy fixed with a Puddu plate and a retrograde intramedullary nail to treat biapical deformity of the femur(2018) GRANGEIRO, Patrícia Moreno; REZENDE, Márcia Uchoa de; HELITO, Camilo Partezani; FELIX, Alessandro Monterroso; OCAMPOS, Guilherme Pereira; GUARNIERO, RobertoABSTRACT Biapical femoral deformities are challenging to treat. In order to correct concomitant metaphyseal and diaphyseal deformities of the femur, the authors propose a double femoral controlled osteotomy with combined internal fixation, consisting of a Puddu plate and an intramedullary nail. The method was described in two patients. Results were analyzed using a visual analog scale (VAS), the Lysholm score, and SF-36. No complications were found. Complete consolidation of the osteotomies and radiographic alignment correction were achieved. Results were obtained with a minimum follow-up of 66 months. Both patients had improved for pain (VAS from 60 to 40 and from 50 to 20 at reassessment), function (Lysholm score from 78 to 93 and from 55 to 73) and quality of life (SF-36, both mental – from 40.7 to 57.1 in case one and from 24.7 to 59.7 in case two – and physical – from 27.7 to 45.6 and from 28.2 to 46.8). The authors have found that this technique is a reliable, accurate, and reproducible solution for biapical deformities of the femur.