ROBERTO GUARNIERO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina - Líder
20 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 20
- 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.
- MANAGEMENT OF INFANTILE BLOUNT'S DISEASE WITH MOLDED ORTHOSES: A NEW PERSPECTIVE (vol 24, pg 85, 2016)(2016) LUZO, Maria Candida de Miranda; MONTENEGRO, Nei Botter; MASSA, Bruno Sergio Ferreira; ANGELI, Luiz Renato Agrizzi de; CORDEIRO, Felippi Guizardi; GUARNIERO, Roberto
- Initial experience of use of an articulated external fixator in treating Legg-Calvé-Perthes disease by means of arthrodiastasis during the active phase of the disease(2016) LUZO, Carlos Augusto Malheiros; GUARNIERO, Roberto; MONTENEGRO, Nei Botter; GODOY JUNIOR, Rui Maciel deABSTRACT OBJECTIVE: To present the preliminary results from treating patients with Legg-Calvé-Perthes Disease (LCPD) by means of hip arthrodiastasis using a monolateral external fixator applied to the hip and to succinctly describe the surgical technique used, in a prospective study. METHODS: Prospective study on 18 patients with LCPD who underwent surgical treatment by means of the hip arthrodiastasis technique using a monolateral external fixator. There were 13 male and five female patients of mean age 8.5 years, ranging from five to 13 years. All the patients presented unilateral hip impairment: nine on the right side and nine on the left. The results were evaluated at maturity using clinical and radiological criteria. RESULTS: All the patients evolved with improvement of joint mobility, and pain relief was achieved in 88.9% of them. Reossification of the femoral epiphysis occurred within the first three months of the treatment. The hips operated at the necrosis stage of the disease did not passed through the fragmentation stage, thus shortening the evolution of the disease. The results were 77.8% satisfactory and 22.2% unsatisfactory. CONCLUSION: Hip arthrodiastasis with a monolateral external fixator during the active phase of LCPD improved the degree of joint mobility. Use of the arthrodiastasis technique at the necrosis stage or at the fragmentation stage (active phase of the disease) presented satisfactory results from treatment of LCPD.
bookPart Pioartrites comunitárias(2013) GUARNIERO, Roberto- 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.
- HEMIEPIPHYSIODESIS USING EIGHT-PLATE VERSUS BLOUNT STAPLE TO CORRECT GENU VALGUM AND GENU VARUM(2020) RODRIGUES, Natasha Vogel Majewski; GUARNIERO, Roberto; BOAS, Paulo Jose Fortes Villas; MIRANDA, Bruno Rodrigues de; MONTENEGRO, Nei BotterObjective: Our objective is to evaluate whether the use of guided growth with eight-plates is more effective than the use of Blount staples for the correction of the idiopathic genu varum or idiopathic genu valgum. Methods: A systematic review (SR) was carried out according to the appropriate methodology for randomized clinical trials (RCTs). We searched seven databases through a previously defined methodology, and we included RCTs, regardless of language, period of publication and status of publication. Results:Resulted in 6830 articles retrieved. Of theses, we identified 14 potential eligible studies. but just one RCT was included for the SR. The included RCT compares the eight-plate and the Blount staple and showed no statistically significant difference for the outcomes of time to correct the deformity, postoperative pain after 24 hours and postoperative pain after 72 hours. The study is of low or very low level of evidence to determine the most effective technique. We didn't find a RCT that compared the correction of the genu varum..Conclusion: Good quality randomized clinical trials comparing Blount staples versus eight-plaque must be performed to determine which technique is superior for coronal plane corrections.
- 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.
- Quality of life evaluation in patients with mucopolysaccharidosis using PedsQL(2019) MATOS, Marcos Almeida; FERRI-DE-BARROS, Fabio; GUARNIERO, RobertoMucopolysaccharidosis (MPS) is a rare and neglected disorder. Only a few studies to date have focused on humanistic impacts of the disease, particularly health-related quality of life (HRQOL). The objective of our research is to (1) evaluate HRQOL in Brazilian patients with MPS and (2) assess the validity of the PedsQL 4.0 Generic Core Scales (PedsQL) in this specific disease. We performed an analytical cross-sectional study using the Brazilian Portuguese version of the PedsQL in 22 patients with MPS between the ages of 8 and 21. With regard to assessing the validity of the PedsQL for MPS, we evaluated internal consistency using Cronbach's alpha coefficient and reliability using the Spearman-Brown estimate of agreement. The mean HRQOL score in our sample was 63.6 points. The worst score was obtained in the Psychosocial domain (61.9) on account of interference with school (56.1), while the Physical Health domain had the highest score (67.6). The total PedsQL internal consistency was .764 points. The Physical Health domain obtained the highest internal consistency (.914), whereas the Psychosocial Health domain obtained the lowest one (.754). MPS was demonstrated to decrease HRQOL, and PedsQL seems to be a valid instrument to perform this kind of analysis.
bookPart Principais afecções ortopédicas pediátricas(2022) FARIA, Adriana Melo de; OLIVEIRA, Alessandro Perez de; GUARNIERO, Roberto