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[PMID]:27344347
[Au] Autor:Pinter NK; McVige J; Mechtler L
[Ad] Endereço:Dent Neurologic Institute, 3980 Sheridan Drive, Amherst, NY, 14226, USA.
[Ti] Título:Basilar Invagination, Basilar Impression, and Platybasia: Clinical and Imaging Aspects.
[So] Source:Curr Pain Headache Rep;20(8):49, 2016 Aug.
[Is] ISSN:1534-3081
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The congenital and acquired deformities of the craniovertebral junction (CVJ), such as basilar invagination, basilar impression, or platybasia, can present in the form of slowly progressive or acute neurologic deterioration. In many cases, an insidious headache is the only symptom and can be a diagnostic challenge for the neurologist. Proper imaging studies as well as recognizing often associated neurologic or systemic conditions are required for early diagnosis and effective therapy. In the current report, the primary focus will be on clinical aspects of these CVJ abnormalities; the pathologic and radiologic aspects, such as developmental and pathophysiologic background or radiographic analysis, will be discussed briefly, confined to clinically relevant data.
[Mh] Termos MeSH primário: Articulação Atlantoccipital/anormalidades
Cefaleia/etiologia
Platibasia/complicações
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1702
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160627
[St] Status:MEDLINE
[do] DOI:10.1007/s11916-016-0580-x


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[PMID]:27191237
[Au] Autor:Fernandes YB; Perestrelo PF; Noritomi PY; Mathias RN; Silva JV; Joaquim AF
[Ad] Endereço:Departamento de Neurocirurgia, Hospital Municipal Mário Gatti, Campinas, SP, Brasil.
[Ti] Título:3-D simulation of posterior fossa reduction in Chiari I.
[So] Source:Arq Neuropsiquiatr;74(5):405-8, 2016 May.
[Is] ISSN:1678-4227
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:We proposed a 3D model to evaluate the role of platybasia and clivus length in the development of Chiari I (CI). Using a computer aided design software, two DICOM files of a normal CT scan and MR were used to simulate different clivus lengths (CL) and also different basal angles (BA). The final posterior fossa volume (PFV) was obtained for each variation and the percentage of the volumetric change was acquired with the same method. The initial normal values of CL and BA were 35.65 mm and 112.66º respectively, with a total PFV of 209 ml. Ranging the CL from 34.65 to 29.65 - 24.65 - 19.65, there was a PFV decrease of 0.47% - 1.12% - 1.69%, respectively. Ranging the BA from 122.66º to 127.66º - 142.66º, the PFV decreased 0.69% - 3.23%, respectively. Our model highlights the importance of the basal angle and clivus length to the development of CI.
[Mh] Termos MeSH primário: Malformação de Arnold-Chiari/diagnóstico por imagem
Simulação por Computador
Fossa Craniana Posterior/diagnóstico por imagem
Imagem Tridimensional
Modelos Anatômicos
Platibasia/diagnóstico por imagem
[Mh] Termos MeSH secundário: Malformação de Arnold-Chiari/patologia
Seres Humanos
Imagem Tridimensional/instrumentação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160519
[St] Status:MEDLINE


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[PMID]:27177855
[Au] Autor:Xu S; Gong R
[Ad] Endereço:Shandong Medical Imaging Research Institute, Shandong University, Jinan, China.
[Ti] Título:Clivus height value: a new diagnostic method for basilar invagination at CT.
[So] Source:Clin Radiol;71(11):1200.e1-5, 2016 Nov.
[Is] ISSN:1365-229X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To investigate whether clivus height (CH; the distance of the basion above Chamberlain's line) could be used to diagnose basilar invagination (BI) at computed tomography (CT). MATERIALS AND METHODS: This retrospective study received institutional review board approval, and was performed from 1 January 2013, to 1 July 2015 with a waiver of informed consent. CH was measured on mid-sagittal reconstructed CT images from 65 BI patients and 85 control subjects to compare the two groups by using the independent-samples t-test. Inter- and intra-observer reliability were evaluated with the intraclass correlation coefficient (ICC). To evaluate the diagnostic performance and determine the cut-off value of CH, receiver operating characteristic (ROC) curves were utilised. RESULTS: The measurement of CH showed good inter- and intra-observer agreement (ICC=0.96 and 0.98, respectively). Compared with control subjects whose mean CH value was 0.35±0.29 cm (range, -0.18 to 1.2 cm), BI patients had a significantly (p<0.001) larger CH, 1.2±0.55 cm (range, 0.43-3.2 cm). The area under the ROC curve was 0.949 (95% confidence interval: 0.916, 0.982), and based on the cut-off value of 0.65 cm, the sensitivity, specificity, positive predictive value, and negative predictive value were 0.88 (57/65), 0.88 (75/85), 0.85 (57/67), and 0.91 (75/82), respectively. CONCLUSION: Although not better than CL (the distance of the odontoid tip above Chamberlain's line), measurement of CH at CT is reproducible and can diagnose patients with BI.
[Mh] Termos MeSH primário: Fossa Craniana Posterior/diagnóstico por imagem
Tomografia Computadorizada Multidetectores/métodos
Platibasia/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Criança
Feminino
Seres Humanos
Processamento de Imagem Assistida por Computador/métodos
Masculino
Meia-Idade
Variações Dependentes do Observador
Curva ROC
Reprodutibilidade dos Testes
Estudos Retrospectivos
Sensibilidade e Especificidade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160515
[St] Status:MEDLINE


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[PMID]:26909827
[Au] Autor:Xu S; Gong R
[Ad] Endereço:Shandong Medical Imaging Research Institute, Shandong University, Jinan, China.
[Ti] Título:Clivodens Angle: A New Diagnostic Method for Basilar Invagination at Computed Tomography.
[So] Source:Spine (Phila Pa 1976);41(17):1365-71, 2016 Sep.
[Is] ISSN:1528-1159
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY DESIGN: Retrospective study. OBJECTIVE: To investigate whether clivodens angle (CDA) could diagnose basilar invagination (BI) at computed tomography (CT). SUMMARY OF BACKGROUND DATA: Over the years, multiple craniometric methods such as Chamberlain line, McGregor line, McRae line, Wackenheim clivus baseline, and Welcher basal angle have been described for evaluation of craniovertebral junction anomalies, initially with radiography and later with CT. However, such a variety of measurements in turn reflects the difficulty in making a definite diagnosis of BI and there is a certain disadvantage in all of these criteria because the anatomic landmarks vary within a normal range. METHODS: CDA, described an angle formed at the intersetion of a line that runs along the long axis of the clivus and one that runs along the long axis of the dens, was measured on mid-sagittal reconstructed CT images from 63 BI patients and 100 control participants to compare the two groups by using independent-sample t test. Interobserver reliability was evaluated with Kendall correlation coefficient. For evaluating the diagnostic performance and determining the cutoff value of CDA, receiver operating characteristic curve was utilized. RESULTS: The measurement of CDA showed good interobserver agreement (KCC = 0.891). Compared with control participants whose mean value was 135.8 degrees ±â€Š9.2 (range, 118-156°), BI patients had a significantly smaller one (P < 0.001), 110.4 degrees ±â€Š15.8 (range, 55-140°). The area under receiver operating characteristic curve was 0.937 (95% confidence interval: 0.901, 0.973), and the cutoff value of 125 degrees had the largest Youden index (J), 0.715. CONCLUSION: Having a better diagnostic performance than clivoaxial angle, CDA can be utilized for diagnosing BI. LEVEL OF EVIDENCE: 3.
[Mh] Termos MeSH primário: Cefalometria
Osso Occipital/cirurgia
Processo Odontoide/cirurgia
Tomógrafos Computadorizados
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Articulação Atlantoaxial/diagnóstico por imagem
Cefalometria/métodos
Feminino
Seres Humanos
Masculino
Meia-Idade
Osso Occipital/anormalidades
Processo Odontoide/anormalidades
Platibasia/diagnóstico por imagem
Curva ROC
Reprodutibilidade dos Testes
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160225
[St] Status:MEDLINE
[do] DOI:10.1097/BRS.0000000000001509


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[PMID]:26754441
[Au] Autor:Mourad F; Giovannico G; Maselli F; Bonetti F; Fernández de las Peñas C; Dunning J
[Ad] Endereço:Alumno de Doctorado, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain. firas.mourad@me.com.
[Ti] Título:Basilar impression presenting as intermittent mechanical neck pain: a rare case report.
[So] Source:BMC Musculoskelet Disord;17:7, 2016 Jan 11.
[Is] ISSN:1471-2474
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Neck pain is one of the most common musculoskeletal disorders in clinical practice. However neck pain may mask more serious pathology. Although uncommon in most musculoskeletal physiotherapy practices, it is possible to encounter rare and extremely life-threatening conditions, such as craniovertebral congenital anomalies. Basilar invagination is an abnormality where the odontoid peg projects above the foramen magnum and is the commonest malformation of the craniocervical junction. Its prevalence in the general population is estimated to be 1%. Furthermore, it is a well-recognised cause of neck pain insomuch as it can be easily overlooked and mistaken for a musculoskeletal disorder. Diagnosis is based on the patient's symptoms in conjunction with magnetic resonance imaging (MRI). If life-threatening symptoms, or pressure on the spinal cord are present, the recommended treatment is typically surgical correction. CASE PRESENTATION: This case report describes the history, relevant examination findings, and clinical reasoning used for a 37 year old male who had the chief complaint of neck pain and occipital headache. After the history and the physical examination, there were several key indicators in the patient's presentation that appeared to warrant further investigation with diagnostic imaging: (1) the drop attack after a triggering event (i.e., heading a football), (2) several episodes of facial numbness immediately and shortly after the trauma, (3) the poorly defined muscle upper extremity muscle weakness, and (4) the modification of symptoms during the modified Sharp-Purser test. Therefore, the decision was made to contact the referring neurosurgeon to discuss the patient's history and his physical examination. The physician requested immediate cervical spine MRI, which revealed a "basilar impression". CONCLUSION: This case report highlights the need for more research into a number of issues surrounding the prevalence, diagnosis, and the central role of primary care clinicians such as physiotherapists. Furthermore it underlines the importance of including Basilar invagination in the differential diagnosis. Physiotherapists working within a direct access environment must take a comprehensive history and be capable of screening for non-musculoskeletal medical conditions (on a systems, not diagnosis level) in order to avoid providing potentially harmful musculoskeletal treatments (e.g., cervical mobilization or manipulation, stretching, exercise) to patients with sinister medical pathologies, not benign musculoskeletal disorders.
[Mh] Termos MeSH primário: Cervicalgia/diagnóstico por imagem
Cervicalgia/etiologia
Platibasia/complicações
Platibasia/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Diagnóstico Diferencial
Seres Humanos
Masculino
Radiografia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1610
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160113
[St] Status:MEDLINE
[do] DOI:10.1186/s12891-015-0847-0


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[PMID]:26281025
[Au] Autor:Chandra PS
[Ad] Endereço:Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
[Ti] Título:In Reply: Different Facets in Management of Congenital Atlantoaxial Dislocation and Basilar Invagination.
[So] Source:Neurosurgery;77(6):E987-8, 2015 Dec.
[Is] ISSN:1524-4040
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Articulação Atlantoaxial/cirurgia
Procedimentos Ortopédicos/métodos
Platibasia/cirurgia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:COMMENT; LETTER
[Em] Mês de entrada:1602
[Cu] Atualização por classe:151120
[Lr] Data última revisão:
151120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150818
[St] Status:MEDLINE
[do] DOI:10.1227/NEU.0000000000000959


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[PMID]:26270196
[Au] Autor:Salunke P; Sahoo S; Deepak AN
[Ad] Endereço:Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
[Ti] Título:Different Facets in Management of Congenital Atlantoaxial Dislocation and Basilar Invagination.
[So] Source:Neurosurgery;77(6):E985-7, 2015 Dec.
[Is] ISSN:1524-4040
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Articulação Atlantoaxial/cirurgia
Procedimentos Ortopédicos/métodos
Platibasia/cirurgia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:COMMENT; LETTER
[Em] Mês de entrada:1602
[Cu] Atualização por classe:151120
[Lr] Data última revisão:
151120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150814
[St] Status:MEDLINE
[do] DOI:10.1227/NEU.0000000000000958


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[PMID]:26141361
[Au] Autor:Zoli M; Mazzatenta D; Valluzzi A; Mascari C; Pasquini E; Frank G
[Ad] Endereço:Department of Neurosurgery, Center of Pituitary Tumors and Endoscopic Skull Base Surgery, IRCCS Scienze Neurologiche, via Altura, 3, Bologna 40139, Italy. Electronic address: matteozeta@libero.it.
[Ti] Título:Endoscopic Endonasal Odontoidectomy.
[So] Source:Neurosurg Clin N Am;26(3):427-36, 2015 Jul.
[Is] ISSN:1558-1349
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Odontoidectomy is the treatment of choice for irreducible ventral cervical-medullary compression. The endonasal endoscopic approach is an innovative approach for odontoidectomy. The aim of this article is to identify in which conditions this approach is indicated, discussing variants of the technique for selected cases of craniovertebral malformation with platybasia. We believe that the technical difficulties of this approach are balanced by the advantages for patients. Some conditions related to the patient and to the anatomy of the craniovertebral junction may favor adoption of the endoscopic endonasal approach, which should be considered complementary and not alternative to standard approaches.
[Mh] Termos MeSH primário: Descompressão Cirúrgica/métodos
Neuroendoscopia/métodos
Processo Odontoide/cirurgia
Compressão da Medula Espinal/cirurgia
[Mh] Termos MeSH secundário: Vértebras Cervicais
Seres Humanos
Cirurgia Endoscópica por Orifício Natural/métodos
Nariz
Seleção de Pacientes
Platibasia/complicações
Compressão da Medula Espinal/complicações
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1603
[Cu] Atualização por classe:150704
[Lr] Data última revisão:
150704
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150705
[St] Status:MEDLINE


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[PMID]:25828488
[Au] Autor:Klekamp J
[Ad] Endereço:Department of Neurosurgery, Christliches Krankenhaus, Quakenbrück, Germany.
[Ti] Título:Chiari I malformation with and without basilar invagination: a comparative study.
[So] Source:Neurosurg Focus;38(4):E12, 2015 Apr.
[Is] ISSN:1092-0684
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECT: Chiari I malformation is the most common craniocervical malformation. Its combination with basilar invagination in a significant proportion of patients is well established. This study presents surgical results for patients with Chiari I malformation with and without additional basilar invagination. METHOD: Three hundred twenty-three patients underwent 350 operations between 1985 and 2013 (mean age 43 ± 16 years, mean history of symptoms 64 ± 94 months). The clinical courses were documented with a score system for individual neurological symptoms for short-term results after 3 and 12 months. Long-term outcomes were analyzed with Kaplan-Meier statistics. The mean follow-up was 53 ± 58 months (the means are expressed ± SD). RESULTS: Patients with (n = 46) or without (n = 277) basilar invagination in addition to Chiari I malformation were identified. Patients with invagination were separated into groups: those with (n = 31) and without (n = 15) ventral compression by the odontoid in the foramen magnum. Of the 350 operations, 313 dealt with the craniospinal pathology, 28 surgeries were undertaken for degenerative diseases of the cervical spine, 3 were performed for hydrocephalus, and 6 syrinx catheters were removed for cord tethering. All craniospinal operations included a foramen magnum decompression with arachnoid dissection, opening of the fourth ventricle, and a duraplasty. In patients without invagination, craniospinal instability was detected in 4 individuals, who required additional craniospinal fusion. In patients with invagination but without ventral compression, no stabilization was added to the decompression. In all patients with ventral compression, craniospinal stabilization was performed with the foramen magnum decompression, except for 4 patients with mild ventral compression early in the series who underwent posterior decompression only. Among those with ventral compression, 9 patients with caudal cranial nerve dysfunctions underwent a combination of transoral decompression with posterior decompression and fusion. Within the 1st postoperative year, neurological scores improved for all symptoms in each patient group, with the most profound improvement for occipital pain. In the long term, late postoperative deteriorations were related to reobstruction of CSF flow in patients without invagination (18.3% in 10 years), whereas deteriorations in patients with invagination (24.9% in 10 years) were exclusively related either to instabilities becoming manifest after a foramen magnum decompression or to hardware failures. Results for ventral and posterior fusions for degenerative disc diseases in these patients indicated a trend for better long-term results with posterior operations. CONCLUSIONS: The great majority of patients with Chiari I malformations with or without basilar invagination report postoperative improvements with this management algorithm. There were no significant differences in short-term or long-term outcomes between these groups. Chiari I malformations without invagination and those with invaginations but without ventral compression can be managed by foramen magnum decompression alone. The majority of patients with ventral compression can be treated by posterior decompression, realignment, and stabilization, reserving anterior decompressions for patients with profound, symptomatic brainstem compression.
[Mh] Termos MeSH primário: Malformação de Arnold-Chiari
Descompressão Cirúrgica/métodos
Processo Odontoide/cirurgia
Platibasia/complicações
Platibasia/cirurgia
Fusão Vertebral/métodos
[Mh] Termos MeSH secundário: Adulto
Malformação de Arnold-Chiari/complicações
Malformação de Arnold-Chiari/patologia
Malformação de Arnold-Chiari/cirurgia
Feminino
Seguimentos
Forame Magno/patologia
Forame Magno/cirurgia
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Processo Odontoide/patologia
Fatores de Tempo
Tomógrafos Computadorizados
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1512
[Cu] Atualização por classe:150401
[Lr] Data última revisão:
150401
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150402
[St] Status:MEDLINE
[do] DOI:10.3171/2015.1.FOCUS14783


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[PMID]:25793730
[Au] Autor:Chandra PS; Prabhu M; Goyal N; Garg A; Chauhan A; Sharma BS
[Ad] Endereço:*Departments of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India; ‡Department of Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
[Ti] Título:Distraction, Compression, Extension, and Reduction Combined With Joint Remodeling and Extra-articular Distraction: Description of 2 New Modifications for Its Application in Basilar Invagination and Atlantoaxial Dislocation: Prospective Study in 79 Cases.
[So] Source:Neurosurgery;77(1):67-80; discussion 80, 2015 Jul.
[Is] ISSN:1524-4040
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recent strategies for treatment of basilar invagination (BI) and atlantoaxial dislocation (AAD) are based on simultaneous posterior reduction and fixation. OBJECTIVE: To describe new modifications of the procedure distraction, compression, extension, and reduction (DCER), ie, joint remodeling (JRM) and extra-articular distraction (EAD) in patients with "vertical" joints, and to quantify the improvement in joint indices, ie, sagittal inclination (SI), craniocervical tilt (CCT), and coronal inclination. METHODS: Prospective study (May 2010 to September 2014). Joint indices measured included (normal values): SI (87.15 ± 5.65°), CCT (60.2 ± 9.2°), and coronal inclination (110.3 ± 4.23°). Surgical procedures included DCER alone (performed in SI <100°, group I) or JRM with DCER (in SI: 100-160°, group II), or EAD with DCER in severe BI with almost vertical joints (SI >160°, group III). RESULTS: Seventy-nine patients were selected (mean, 22.5 years of age). All conventional indices improved significantly (P < .001). CCT improved in all groups (P < .01); group I (n = 32): 54 ± 8.7° (preoperative 80.71 ± 12.72°); group II (n = 40): 58 ± 7.0° (preoperative 86.5 ± 14°); group III (n = 7): 62 ± 10.0° (preoperative 104 ± 11.2°). SI improved in both group I and II, P < .01 (cannot be measured in group III). At long-term follow-up (n = 64, 29 ± 8 months, range 12-39 months), the Nurick grade improved to 1.5 ± 0.52 (preoperative: 3.4 ± 0.65; P < .001). CONCLUSION: DCER seems to be an effective technique in reducing both BI and AAD. JRM and EAD with DCER are useful in moderate to severe BI and AAD (with SI >100°). Joint indices provide useful information for surgical strategy and planning.
[Mh] Termos MeSH primário: Articulação Atlantoaxial/cirurgia
Procedimentos Ortopédicos/métodos
Platibasia/cirurgia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Luxações Articulares/cirurgia
Masculino
Meia-Idade
Osteogênese por Distração/métodos
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1601
[Cu] Atualização por classe:161125
[Lr] Data última revisão:
161125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150321
[St] Status:MEDLINE
[do] DOI:10.1227/NEU.0000000000000737



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