Hasil Pencarian  ::  Simpan CSV :: Kembali

"Diameter sagital kanalis spinalis servikal merupakan pengukuran penting pada trauma. degeneratif dan inflamasi. Diameter kanalis spinalis yg kecil sangat berhubungan dengan kejadian resiko trauma. Oleh karena itu, Pavlov dkk menerangkan ratio antara diameter sagital kanalis spinalis dibandingkan dengan diameter sagital korpus vertebra yang diukur dari foto lateral servikal. Trauma pada servikal adalah penyebab terbanyak pada kelumpuhan. Yang bermanifestasi terhadap terjadinya defisit neurologis dan berhubungan dengan stenosis di servikal. Pavlov ratio kurang dari 0,8 menunjukkan suatu stenosis kanalis dan resiko untuk kejadian transient neuropraksia yang merupakan suatu defisit neurologis. Penelitian ini untuk menjelaskan hubugan antara Pavlov ratio dan defisit neurologis pada penderita trauma servikal. METODA Design penelitian adalah penelitian cross sectional pada 28 kasus trauma servikal. Pavlov ratio diukur dengan menggunakan foto polos lateral servikal, sedangkan defisit neurologis diperiksa melalui autoanamnesa dan pemeriksaan fisik. HASIL Hasil penelitian ini didapatkan 21 kasus pada laki-laki dan 7 kasus adalah perempuan. Nilai Pavlov ratio yang mengalami stenosis kanalis sebanyak 14%. Berdasarkan jenis trauma ditemui pada penelitian ini 16 kasus vulmis' laseratum, 4 kasus fraktur nasal, 3 kasus fraktur clavikula, 3 kasus fraktur mandibula. 1 kasus fraktur maxilla dan 1 kasus lain-lain. Untuk analisa hubungan Pavlov ratio dengan kejadian defisit neurologis menggunakan Fisher's Exact Test Exact Sig 1 sided column, didapatkan p = 0,481, tidak bermak.na secara statistik. Sedangkan analisa kejadian defisit neurologis pada trauma yang terjadi menggunakan pearson chi-square nilai p yang diambil yaitu p"" 0,754 tidak bermakna secara statistik KESIMPULAN Pavlov ratio bertujuan menseleksi pasien dengan resiko tinggi untuk terjadinya defisit neurologis pada olahraga kontak tetapi pada penelitian ini tidak bermakna untuk mendeteksi adanya defisit neurologis dengan jenis trauma ringan pada servical bukan trauma hebat. Perlu penelitian selanjutnya untuk meneliti dengan trauma servical yang lebih berat.

---

The sagittal diameter of the cervical spinal canal is clinical importance in traumatic, degenerative, and inflammatory conditions. A small canal diameter has been associated with an increase risk of injury. For these reasons, Pavlov et al devised a ratio between the sagittal diameter of the canal and the sagittal diameter of the vertebral body, as measured on the lateral radiograph. Cervical spine injuries is commonest cause of disability. Cervical injury can manifests as neurologic deficits and correlates with stenosis of the cervical. Pavlov ratio less than 0,8 shows canalis stenosis and risks to transient neuropraxia which is a neurologic deficit. This study ~etermines the relation between Pavlov ratio and neurologic deficit in cervical trauma patients. METHOD This is a cross sectional study in 28 patient with cervical trauma Pavlov ratio was obtained from lateral cervical plain x-ray, while neurologic deficit status was obtained from the clinical appearance. RESULTS The study subject consists of 21 man and 7 woman. While Pavlov ratio with canal stenosis was found in 14% of the study subjects. From this study found 16 cases vulnus laceration, 4 cases nasal fracture, 3 cases clavicle fracture, 3 cases mandible fracture, 1 case maxilla fracture and 1 case corneal rupture. From Fisher's Exact Test Exact Sig 1 sided colwnn, p = 0,481, not significant. CONCLUSIONS Pavlov ratio was to screening patient with high risk of cervical trauma in contact sport but for this study is not satisfied to detect neurologic deficit. Further study is needed especially those with more severe cervical trauma."

"Pendahuluan. Sel punca mesenkimal (SPM) sangat menjanjikan dalam bidang rekayasa jaringan karena sifatnya yang multipoten, cepat berproliferasi, dan berkemampuan tinggi untuk beregenerasi. SPM sumsum tulang dapat menjadi terapi pilihan nekrosis avaskular (AVN) kaput femur yang banyak diderita oleh pasien lupus eritematosus sistemik (LES) pada masa sekarang ini. SPM sumsum tulang penderita LES mengalami gangguan fenotip, proliferasi, diferensiasi. Terapi SPM pada AVN kaput femur dapat menggunakan donor otologus yang dilaporkan memberikan hasil luaran yang baik dan keamanan yang signifikan. Oleh karena itu, diperlukan penelitian untuk mengetahui potensi, karakteristik, dan diferensiasi SPM sumsum tulang pasien LES yang dihubungkan dengan usia. Metode. Penelitian ini adalah penelitian in vitro yang meneliti 4 subjek penderita LES di Rumah Sakit Cipto Mangunkusumo Jakarta. Aspirat SPM sumsum tulang dilakukan isolasi, ekspansi dan diferensiasi. Analisis statistik menggunakan uji korelasi spearman untuk melihat hubungan usia pasien LES dengan waktu konfluensi, jumlah sel konfluens dan waktu diferensiasi osteogenik, kondrogenik, dan adipogenik. Hasil dan Diskusi. Rerata jumlah sel konfluens adalah 7.44 x 105 ± 3.06 x 105 sel/ml, rerata waktu konfluens adalah 20.75 ± 4.99 hari, median waktu diferensiasi adipogenik yaitu 17.5 hari (rentang 14-21), waktu diferensiasi osteogenik dan kondrogenik yaitu 21 hari. Terdapat korelasi positif bermakna antara usia penderita LES dengan waktu konfluens SPM (p<0.001) dan korelasi negatif bermakna antara usia penderita LES dengan jumlah sel konfluens SPM (p<0.001). Simpulan. SPM sumsum tulang krista iliaka penderita LES mampu diisolasi, berproliferasi dan berdiferensiasi. SPM sumsum tulang penderita LES memiliki waktu konfluens dan waktu diferensiasi yang lebih lama dan jumlah sel konfluens yang lebih sedikit.

---

Introduction. Mesenchymal stem cells (MSC) is very promising in the field of tissue engineering because it is multipotent, rapidly proliferate, and high ability to regenerate bone marrow. BM-MSC may be treatment of choice of avascular necrosis (AVN) of femoral head that affects many systemic lupus erythematosus (SLE) patients at the present time. BM-MSC of SLE patients has impairment in phenotype, proliferation, and differentiation. Mesenchymal stem cell therapy on femoral head AVN which use autologous donors are reported deliver good outcomes and safety. Therefore, research is needed to determine the potency, characteristics, and differentiation of BM-MSC in patients with SLE and related with age.

Methods. This study is in vitro study that examined four subjects as SLE patients in Cipto Mangunkusumo Hospital. BM-MSC of SLE patients is performed isolation, expansion and differentiation. Statistical analysis using pearson and spearman correlation test to see the correlation of age of SLE patients with confluence time, the number of confluence cells and differentiation time.

Result and Discussion. Mean of confluent cell numbers is 7.44 x 105 ± 3.06 x 105cells/ml, mean of confluent time is 20.75 ± 4.99 days, median of adipogenic differentiation time is 17.5 days (range 14-21), osteogenic and chondrogenic differentiation time is 21 days. There is a positive correlation between patient?s age with confluence time (p <0.001) and negative correlation with MSC confluence cell count (p <0.001).

Conclusion. BM-MSC form iliac crest in patients with SLE can be isolated, proliferated and differentiated. BM-MSC of SLE patients has longer confluence time and differentiation time and lower confluence cell count."

"ABSTRAKPendahuluan: Total Hip Replacement THR disebut sebagai operasi abad ini karena menunjukan hasil yang memuaskan walaupun memiliki harga yang relatif mahal. THR telah dilakukan lebih dari 1 juta kali/tahun secara global dan diperkirakan akan meningkat dua kali pada dekade depan. Pada institusi kami, permintaan THR meningkat 313 dari tahun 2011 -2016. Kini telah banyak hadir berbagai jenis desain implant terutama tipe bearing surface dengan kelebihan dan kekurangan masing-masing. Namun pemilihannya masih menjadi kontroversial. Metode: Kami melaporkan penelitian potong lintang terhadap tiga tipe bearing surface yang sering digunakan di institusi kami; ceramic on polyethylene CoP , metal on polyethylene MoP dan ceramic on ceramic CoC . Enam puluh tiga pasien berhasil dilakukan review dengan usia rata-rata 45 tahun dan follow up rata-rata 2,5 tahun. Kami menilai luaran fungsional dengan Harris Hip Score HHS dan radiologis. Hasil dan Pembahasan: Pada follow up terakhir, rata-rata HHS pascaoperasi yaitu 87,1 10,2 p=0,79 yang menunjukan tidak ada perbedaan antar kelompok. Rata-rata perbedaan HHS pascaoperasi ndash; praoperasi yaitu 46,48 14,1 p=0,005 yang menunjukan adanya perbedaan signifikan di dalam kelompok oleh analisis one-way ANOVA. Analisa post hoc menunjukan rata-rata perbedaan HHS pascaoperasi ndash; praoperasi secara statistik lebih tinggi pada kelompok CoC 56,82 12,7 dibandingkan dengan CoP 44,29 14,1, p = 0,007 dan MoP 42,05 11,9, p = 0,015 . Tidak ada perbedaan antara kelompok MoP dan CoP p = 1,000 . Tidak ditemukan perbedaan luaran radiologis pada ketiga kelompok. dimungkinkan karena follow up yang relatif pendek sehingga dibutuhkan studi dengan follow up yang lebih lama.

---

ABSTRACTIntroduction Total Hip Replacement THR is considered to be the operation of the century with a high level of satisfactory result even though it has relatively high cost. It has been performed more than 1 million times year worldwide and its demand is estimated to double within decade. In our institution, its demand already increased by 313 from 2011 2016. Nowadays, we are faced with various implant design especially bearing surface with its benefits and weaknesses. But the ideal preference of bearing surface in THR remains a controversy. Methods We report a cross sectional study of three type of THR bearing surface which are ceramic on polyethylene CoP , metal on polyethylene MoP and ceramic on ceramic CoC , that was frequently used in our institution. Total patient of 63 were available for review with mean age of 45 years old and mean follow up of 2,5 years. We assessed their functional outcome with Harris Hip Score HHS and radiological outcome. Results and Discussion At the final follow up, mean post operative HHS was 87,1 10,2 p 0,79 that showed there were no difference between groups. Mean post operative ndash pre operative HHS differences was 46,48 14,1 p 0,005 that showed there were statically significant difference between groups as determined by one way ANOVA. A post hoc analysis revealed that postoperative ndash preoperative HHS differences were statistically significantly higher in CoC group 56,82 12,7 compared to CoP group 44,29 14,1, p 0,007 and MoP group 42,05 11,9, p 0,015 . There was no statistically significant difference between the CoP and MoP p 1,000 . Radiological outcomes reveal no loosening in all groups. This is predicted due to relatively short follow up time, thus longer follow up is needed. "

"Pendahuluan: Ekstrofi buli merupakan suatu kelainan kongenital yang ditandai dengan tidak menutupnya dinding anterior dari rongga abdomen disertai kandung kemih yang membuka dengan manifestasi pada sistem traktus urinarius dan muskuloskeletal. Meskipun tatalaksana ekstrofi berkembang pesat, studi mengenai luaran klinis pasien ekstrofi buli masih jarang dilakukan. Di Indonesia, belum ada penelitian yang membahas mengenai luaran anatomis dan fungsional pasien ekstrofi buli pada tahun 2011-2017.Metode: Studi penelitian ini adalah studi kohor retrospektif melalui penulusuran data rekam medis dari tahun 2011 hingga 2017 dan dilakukan di bulan Januari 2017. Seluruh pasien diperiksa untuk luaran klinis di poliklinik orthopaedi. Luaran anatomis dinilai dengan mengukur presentasi aproksimasi pubis pada foto pelvis. Sementara itu, luaran fungsional dinilai dengan menggunakan kuesioner Pediatric Quality of Life Inventory (PedsQL 4.0).Hasil: 19 pasien ekstrofi buli dengan rerata usia 4,8±2,4 tahun kontrol rutin ke poli orthopaedi. Data yang dikumpulkan terdiri dari jenis kelamin laki-laki 11 (57,9%); perempuan 8 (42,1%), tipe ekstrofi buli (17 (89,5%); ekstrofi kloaka (2 (10,5%), anomali organ terkait yaitu epispadia 2 (10,5%); hipospadia 1 (5,3%); sisanya tidak kelainan tambahan 16 (84,2%), metode fiksasi gips 10 (52,6%); eksternal fiksasi 9 (47,4%), periode pasca operasi ≤36 bulan 10 (52,6%); >36 bulan 9 (47,4%), median usia operasi 6 bulan dengan kisaran 1-71 bulan, median nilai presentase aproksimasi 78,5% dengan kisaran 65-98,1%, rerata skor PedsQL setelah operasi 97,2±1,6. Terdapat hubungan bermakna antara usia operasi dan diastasis setelah operasi terhadap presentase aproksimasi dan skor PedsQL setelah operasi (p<0,05).Diskusi: Luaran anatomis dan fungsional pada pasien ekstrofi buli menunjukkan hasil yang baik. Faktor usia operasi dan diastasis setelah operasi mempengaruhi nilai presentase aproksimasi dan kualitas hidup pasien ekstrofi buli.

---

Introduction: Bladder extrophy is an embryologic malformation that results in complex deficiency of the anterior midline, with urogenital and skeletal manifestations. Despite advances in management of bladder extrophy, the study of the patient outcome is rarely done. In Indonesia, there are no studies concerning about the anatomical and functional outcome of bladder extrophy patients in 2011-2017.Method: A cohort retrospective study of the hospital medical records from 2011 to 2017 was performed in January 2017. The patients were assesed for the clinical outcome in orthopaedic outpatient clinic. Data of patients with bladder exstrophy managed by anterior and posterior innominate osteotomy were analysed. The anatomical outcome was assessed by calculating the percentage pubic approximation and the functional outcome was assessed by using Pediatric Quality of Life Inventory (PedsQL 4.0) and compared with those of typical peers.Result: Nineteen children age 4,6±2,3 years presented to outpatient clinic for a routine control. Data was collected for gender man 11 (57,9%); woman 8 (42,1%), bladder extrophy 17 (89,5%); cloacal extrophy 2 (10,5%), epispadia 2 (10,5%); hipospadia 1 (5,3%); not having other congenital organ anomaly 16 (84,2%), fixation method slabs 10 (52,6%); external fixation 9 (47,4%), post operation period ≤36 months 10 (52,6%); >36 months9 (47,4%), the median of age at operation 6 months old with range from 1-71 m, the median of aproximation percentage 78,5% with range 65-98,1%, the mean of PedsQL score post operation 97,2±1,6. There was a significant correlation between age at operation and diastasis post operation to aproximation percentage and PedsQL score (p<0,05).Discussion: The clinical outcome of the bladder extrophy patients shows good result that's measured by percentage pubic approximation and PedsQL score. Age at operation and diastasis post operation affect aproximation percentage and quality of life of bladder extrophy patient."

"Pendahuluan: Malunion adalah komplikasi jangka panjang yang sering terjadi pada fraktur suprakondiler humerus yang bila tidak ditatalaksana dengan tepat dapat menimbulkan komplikasi yang dapat menurunkan kualitas hidup pasien. Osteotomi korektif dengan teknik lateral closed wedge osteotomy, merupakan teknik yang sering digunakan karena sederhana dan relatif mudah. Studi mengenai luaran klinis, fungsional dan radiologis pasca osteotomi korektif masih sedikit, khususnya di Indonesia. Metode: Penelitian ini menggunakan desain kohort retrospektif, dengan metode totalsampling pada tahun 2012-2017 di Rumah Sakit Pusat Nasional Cipto Mangunkusumo. Dilakukan penilaian luaran klinis dengan Mitchell and Adams Criteria, luaran fungsional dengan Mayo Elbow Performance Score (MEPS), dan luaran radiologis dengan Baumann Angle, Metaphyseal-diaphyseal angle, Humero-ulnar angle, Humero-capitellar angle, dan anterior humeral line pra dan pascaoperasi. Hasil: Terdapat 15 pasien yang diikut sertakan dalam penelitian dengan umur rata-rata 7,7 tahun, mayoritas laki-laki dan pada sisi sebelah kiri. Median interval waktu antara fraktur hingga osteotomi korektif adalah 11,2 bulan dengan rata-rata followup adalah 24,9 bulan. Luaran klinis berdasarkan Mitchell and adams criteria didapatkan kriteria good hingga excellent sebanyak 14 pasien (93,3%) dan hanya 1 pasien (6,7%) dengan hasil unsatisfactory. Luaran fungsional berdasarkan MEPS didapatkan kategori good hingga excellent sebanyak 14 pasien (93,3%), dan kategori fair sebanyak 1 pasien (6,7%). Terdapat perbaikan parameter radiologis yang bermakna yang diukur dengan baumann angle, metaphyseal-diaphyseal angle, humero-ulnar angle, humero-capitellar angle dan anterior humeral line. Terdapat korelasi yang kuat antara perbaikan baumann angle dengan Mitchel and Adams criteria dan terdapat korelasi yang moderat antara perbaikan metaphyseal-diaphyseal angle dengan MEPS. Kesimpulan: Tindakan osteotomi korektif dengan teknik lateral closed wedge osteotomy pada malunion fraktur suprakondiler humerus memberikan luaran klinis, fungsional dan radiologis good hingga excellent. Baumann angle dan Metaphyseal-diaphyseal angle dapat digunakan sebagai parameter untuk memprediksi luaran klinis dan fungsional pasca osteotomi korektif.

---

Introduction: Malunion is a late complication that often occurs after supracondylar humeral fractures This condition if not managed properly will cause such complications that potentially reduce the patient's quality of life. Corrective osteotomy by lateral closed wedge osteotomy is a technique that is often used due to it simplicity and relatively easy. Only few studies have reported clinical, functional and radiological outcomes in cases of malunion of supracondylar humeral fractures after corrective osteotomy, particularly in Indonesia. Methods: This study used a retrospective cohort design, with a total sampling method in period of 2012-2017 at the Cipto Mangunkusumo Central National Hospital. We assess clinical outcome by Mitchell and Adams Criteria, functional outcome by Mayo Elbow Performance Score (MEPS), and radiological outcomes by Baumann Angle, Metaphyseal-diaphyseal angle, Humero-ulnar angle, Humero-capitellar angle, and anterior humeral line, pre and postoperatively Results: There were 15 patients included in the study with an average age of 7.7 years, the majority were men and affected on the left side. The median of time interval between fracture to correction osteotomy was 11.2 months with a mean time of follow-up was 24.9 months. Clinical outcome after correction osteotomy based on Mitchell and adams criteria showed good to excellent criteria as many as 14 patients (93.3%) and only 1

patient (6.7%) with unsatisfactory results. While the functional outcomes based on MEPS showed good to excellent categories of 14 patients (93.3%), and the fair category was 1 patient (6.7%). There were a significant radiological improvement measured by baumannn angle, metaphyseal-diaphyseal angle, humero-ulnar angle, humero-capitellar

angle and anterior humeral line. There was a strong correlation between baumann angle improvement with Mitchel and Adams criteria and there was a moderate correlation

between the improvement of Metaphyseal-diaphyseal angle and MEPS. Conclusion: Corrective osteotomy by lateral closed wedge osteotomy on malunion supracondylar humeral fracture showed good to excellent clinical, functional and radiological outcomes. Baumann angle and Metaphyseal-diaphyseal angle can be used as parameter to predict clinical and functional outcomes after corrective osteotomy.

"

"[ABSTRAKPada fraktur pelvis tidak stabil yang disertai dengan fraktur vertikal sakrum (AO Tipe C1.3) terdapat instabilitas terhadap gaya shearing aksial yang besar. Fiksasi pada fraktur tersebut harus memberikan kekuatan biomekanik yang baik dan minimal invasif. Penempatan sekrup iliosakral (SIS) di S1-S3 secara divergen dapat meningkatkan kekuatan biomekanik terutama kekakuan translasi. Tujuan penelitian ini adalah mengevaluasi kekuatan biomekanik SIS S1-S3 dan sekrup pubis (PS) dibandingkan konfigurasi fiksasi lain untuk memberikan solusi konfigurasi fiksasi baru pada fraktur pelvis AO Tipe C1.3.Simulasi fraktur pelvis dibuat dengan fraktur ramus pubis superior, inferior, dan fraktur vertikal sakrum ipsilateral (AO tipe C1.3) pada tulang sintetik Synbone®. Enam kombinasi fikasi yaitu Tension Band Plate (TBP)+PS, TBP+plat symphysis (SP), SIS S1-S2+PS, SIS S1-S2+SP, SIS S1-S3+PS, SIS S1-S3+SP diuji dengan diberikan beban aksial menggunakan mesin kompresi Tensilon® sampai titik kegagalan fiksasi sebesar ≥2 mm atau ≥20, kemudian dievaluasi kekakuan translasi, kekakuan rotasi, dan titik kegagalan fiksasi. Analisis statistik dilakukan dengan uji ANOVA dilanjutkan dengan uji post-hoc BonferroniDari hasil uji biomekanik didapatkan kelompok fiksasi SIS S1-S3+PS memiliki kekakuan translasi, kekakuan rotasi, dan titik kegagalan fiksasi tertinggi (830,36 N/mm, 599,68 N/°, dan 1522,20 N) terhadap beban aksial.Fiksasi SIS di S1-S3 dan sekrup pubis merupakan fiksasi terbaik untuk fraktur pelvis tidak stabil dengan fraktur vertikal sakrum karena mempunyai properti biomekanik yang baik dan secara klinis fiksasi ini memberikan keuntungan prosedur yang minimal invasif dan pasien dapat mobilisasi segera sehingga mengurangi komplikasi postoperatif.

---

ABSTRACTIn unstable pelvic fracture with vertical sacral fracture (AO Type C1.3), there are tremendous instability towards axial shearing load. Ideally, the fixation should provide good biomechanical properties and minimal invasive. Divergent Iliosacral screw (ISS) placement on S1-S3 could enhance biomechanical strength. The purpose of this research was to evaluate the biomechanical properties of ISS S1-S3 and pubic screw (PS) compared to other configuration to provide solution for new configuration of fixation in AO Type C1.3 pelvic fracture.A simulation of pelvic fracture was created on superior and inferior pubic rami, and ipsilateral vertical sacral fracture (AO Type C1.3) on a synthetic bone (Synbone®). Six fixation combination including tension band plate (TBP)+PS, TBP+symphyseal plate (SP), ISS S1-S2+PS, ISS S1-S2+SP, ISS S1-S3+PS, ISS S1-S3+SP were tested using compression machine Tensilon® until failure point defined by ≥2 mm or ≥20 displacement was met. Translational stiffness, rotational stiffness and load to failure were evaluated. Statistical analysis was performed with ANOVA test followed by Bonferroni post hoc-test.From biomechanical test, fixation using ISS S1-S3+PS had the highest translational stiffness, rotational stiffness, and load to failure (830,36 N/mm, 599,68 N/°, and 1522,20 N respectively) toward axial load.Fixation by ISS S1-S3+PS was the best configuration in unstable pelvic fracture with vertical sacral fracture due to its good biomechanical strength, minimal invasiveness which renders early immobilization for patients hence decreasing postoperative complications., In unstable pelvic fracture with vertical sacral fracture (AO Type C1.3), there are tremendous instability towards axial shearing load. Ideally, the fixation should provide good biomechanical properties and minimal invasive. Divergent Iliosacral screw (ISS) placement on S1-S3 could enhance biomechanical strength. The purpose of this research was to evaluate the biomechanical properties of ISS S1-S3 and pubic screw (PS) compared to other configuration to provide solution for new configuration of fixation in AO Type C1.3 pelvic fracture.A simulation of pelvic fracture was created on superior and inferior pubic rami, and ipsilateral vertical sacral fracture (AO Type C1.3) on a synthetic bone (Synbone®). Six fixation combination including tension band plate (TBP)+PS, TBP+symphyseal plate (SP), ISS S1-S2+PS, ISS S1-S2+SP, ISS S1-S3+PS, ISS S1-S3+SP were tested using compression machine Tensilon® until failure point defined by ≥2 mm or ≥20 displacement was met. Translational stiffness, rotational stiffness and load to failure were evaluated. Statistical analysis was performed with ANOVA test followed by Bonferroni post hoc-test.From biomechanical test, fixation using ISS S1-S3+PS had the highest translational stiffness, rotational stiffness, and load to failure (830,36 N/mm, 599,68 N/°, and 1522,20 N respectively) toward axial load.Fixation by ISS S1-S3+PS was the best configuration in unstable pelvic fracture with vertical sacral fracture due to its good biomechanical strength, minimal invasiveness which renders early immobilization for patients hence decreasing postoperative complications.]"

"[ABSTRAKPendahuluan: GCT tulang merupakan lesi jinak tetapi secara lokal dapat bersifat agresif pada daerah epifisis. Angka rekurensi yang tinggi, dilaporkan mencapai 75%. Tumor dapat bermetastasis ke paru (2-9%) dan tercatat 0-37% angka mortalitas akibat metastasis. Beberapa penelitian menghasilkan variasi berbeda penanganan tumor ini terhadap luaran onkologi dan fungsional serta angka kematian paska pembedahan. Penelitian ini bertujuan melaporkan pengalaman dalam penatalaksanaan pembedahan tumor ini dan untuk melihat adanya hubungan antara tatalaksana pembedahan dengan dampak klinis.Metode: Penelitian ini merupakan kohort retrospektif, sebanyak 99 pasien GCT tulang menjalani tindakan kuretase ataupun wide resection di Rumah Sakit Cipto Mangunkusumo pada 1995 - 2014. Luaran onkologi berdasarkan angka rekurensi lokal, metastasis tumor serta mortalitas dan luaran fungsional berdasarkan sistem penilaian Musculoskeletal Tumor Society (MSTS).Hasil: Lokasi tumor terutama di distal femur (25,2%). Rekurensi lokal terjadi pada 4 pasien, terutama di distal femur (50%). Rekurensi lokal terjadi seimbang pada wide resection dan kuretase dan secara statistik tidak bermakna (p 0.578, uji eksak Fischer). Tidak dijumpai kejadian rekurensi lokal pada seluruh pasien yang mengalami metastasis. Metastasis terjadi pada kelompok wide resection. Kematian terjadi pada 4 pasien yang mengalami metastasis. Sebagian besar pasien (51,1%) menunjukkan luaran fungsional kategori sangat baik (skor MSTS di atas 75%). Analisis kesintasan bebas rekurensi lokal secara statistik tidak bermakna (p 0.564). Analisis multivariat (regresi Cox) hanya faktor metastasis yang berpengaruh pada mortalitas (p. 0.001)Kesimpulan: Terdapat hubungan yang bermakna antara stadium tumor dengan metastasis dan jenis tindakan operasi. Tidak terdapat perbedaan bermakna antara kejadian rekurensi lokal dan metastasis serta luaran fungsional dengan jenis tindakan operasi.

---

ABSTRACTIntroduction: Giant cell tumor of bone is benign lesion with ability to be locally aggressive in epiphysis. Its recurrence rate was reported as high as 75%. Tumor can metastasize to lungs (2-9%) and up to 37% mortality rate due to metastasis. Several studies have reported different rates of local recurrence, lung metastasis, mortality rate, and functional outcome. This study aims to report our experience and analyze the correlation between surgery and clinical findings.Methods: In this retrospective cohort, 99 patients GCT of bone undergone curettage or wide resection in Cipto Mangunkusumo Hospital during 1995-2014. Oncological outcome were analyzed according to local recurrence rate, metastasis, and mortality rate, while functional outcome were measured according to Musculoskeletal Tumor Society Score (MSTS).Results: Tumor location were predominantly in distal femur (25.2%). Local recurrence were observed in 4 patient and mainly in distal femur (50%). Local recurrence were evenly balanced between surgical curettage and wide resection (50% each) and thus not statistically significant (Exact Fischer, p=0.578). Metastasis were observed in patients who undergone wide resection, however, no significant correlation were found between metastasis incidence and types of surgical intervention (Exact Fischer, p=0.318). Four have died related to metastasis. No local recurrence were observed in patients suffering from metastasis. In more than half of patients (51.5%), the functional status were very good (MSTS >75. Recurrence-free survival analysis not significant statistically (p 0.564).Multivariate analysis (Cox regression) showed that only metastasis was found to be significantly correlated to mortality (p. 0.001).Conclusion: Tumor stage was correlated to metastasis, and type of surgical intervention. No significant correlation were found between local recurrence, metastasis, and functional outcome to types of surgical intervention., Introduction: Giant cell tumor of bone is benign lesion with ability to be locally aggressive in epiphysis. Its recurrence rate was reported as high as 75%. Tumor can metastasize to lungs (2-9%) and up to 37% mortality rate due to metastasis. Several studies have reported different rates of local recurrence, lung metastasis, mortality rate, and functional outcome. This study aims to report our experience and analyze the correlation between surgery and clinical findings.Methods: In this retrospective cohort, 99 patients GCT of bone undergone curettage or wide resection in Cipto Mangunkusumo Hospital during 1995-2014. Oncological outcome were analyzed according to local recurrence rate, metastasis, and mortality rate, while functional outcome were measured according to Musculoskeletal Tumor Society Score (MSTS).Results: Tumor location were predominantly in distal femur (25.2%). Local recurrence were observed in 4 patient and mainly in distal femur (50%). Local recurrence were evenly balanced between surgical curettage and wide resection (50% each) and thus not statistically significant (Exact Fischer, p=0.578). Metastasis were observed in patients who undergone wide resection, however, no significant correlation were found between metastasis incidence and types of surgical intervention (Exact Fischer, p=0.318). Four have died related to metastasis. No local recurrence were observed in patients suffering from metastasis. In more than half of patients (51.5%), the functional status were very good (MSTS >75. Recurrence-free survival analysis not significant statistically (p 0.564).Multivariate analysis (Cox regression) showed that only metastasis was found to be significantly correlated to mortality (p. 0.001).Conclusion: Tumor stage was correlated to metastasis, and type of surgical intervention. No significant correlation were found between local recurrence, metastasis, and functional outcome to types of surgical intervention.]"

"Pada kasus lumbal spinal stenosis, penentuan terapi dibedakan menjadi konservatif termasuk medikamentosa dan rehabilitasi medik dan pembedahan. Secara general, pembedahan dilakukan pada pasien yang tidak mengalami perbaikan klinis setelah menjalani terapi konservatif. Tesis ini membahas perbedaan gambarandegenerative lumbar spinal stenosis berupa pengukuran faktor determinan menggunakan MRI lumbosakral pada pasien yang menjalani pembedahan kelompok uji dan konservatif kontrol. Pengamatan perubahan radiologis yang akurat akan membantu klinisi memperkirakan terapi yang sesuai untuk pasien secara lebih dini dan efektif. Sebagai hasil, secara bivariat, faktor determinan yang bermakna adalah stenosis kanalis lumbal L3-4; stenosis recessus lateral L4-5 dan L5-S1; stenosis foraminal L3-4 bilateral dan L5-S1 kiri; hernia nukelus pulposus L3-4 dan L5-S1, hipertrofi ligamentum flavum L3-4 dan degenerasi sendi facet L4- 5 kanan. Dengan analisa multivariat, didapatkan hanya hernia nukelus pulposus L3- 4 dan L5-S1 saja yang menentukan keputusan operasi.

---

In degenerative lumbal spinal stenosis, choice of treatment divide into conservative with medication and rehabilitation included and surgical. Generally, surgery to patient perform when there is no improvement in clinical examination after adequate conservative treatment. In this thesis, we describe difference in determinant factors seen with MR study to patients with lumbar spinal stenosis who had surgical treatment case group and conservative treatment control group. Carefull observation in radiologic changes will help clinician to predict patient outcome and decide adequate treatment. As results, using bivariate analysis, we conclude that there are significantly differences in lumbal canal stenosis at L3 4 level lateral recessus stenosis at L4 5 and L5 S1 level, foraminal stenosis at L3 4 bilaterally and at left side of L5 S1 level hernia nucleus pulposus at L3 4 and L5 S1 level flavum ligament hypertrophy at L3 4 level and facet joint degeneration at right side of L4 5 level. Meanwhile, using multivariate analysis, only hernia nucleus pulposus of L3 4 and L5 S1 level bring decision to surgery."

"ABSTRAKPendahuluan. Tumor Ganas Jaringan Lunak Soft Tissue Sarcoma merupakan kelompok heterogen tumor ganas mesenkim dengan jumlah kasus yang sangat sedikit dengan gejala klinis sulit dibedakan dengan tumor jinak, menjadikan tumor ini sering ditangani tanpa mengetahui batas tumor yang jelas unplanned excision . Penanganan tumor ganas jaringan lunak secara inadekuat ini mengakibatkan tumor masih tersisa sehingga beresiko terjadi rekurensi dan mortalitas. Penelitian ini bertujuan untuk mengetahui rekurensi dan mortalitas pasien tumor ganas jaringan lunak ekstremitas yang telah dilakukan unplanned excision, serta faktor-faktor yang memengaruhinya.Metode Penelitian. Penelitian ini merupakan penelitian deskriptif analitik dengan rancangan kohort retrospektif yang menggunakan data pasien RS Cipto Mangunkusumo tahun 2005 hingga 2015. Pada penelitian ini, didapati yang memenuhi kriteria sebanyak 87 subjek, yakni pasien unplanned excision tumor ganas jaringan lunak ekstremitas yang dilakukan analisis angka rekurensi dan mortalitas serta faktor-faktor yang berhubungan dengan rekurensi dan mortalitas tersebut.Hasil Penelitian. Terdapat hubungan yang bermakna antara tingkat rekurensi dengan operator yang tidak berkompeten non orthopaedi onkologi p0,05 . Tidak terdapat hubungan yang bermakna secara statistik antara mortalitas dengan operator pembedahan, lokasi tumor, ukuran awal tumor dan tipe rumah sakit P>0,05 .Kesimpulan. Faktor yang memengaruhi rekurensi pada pasien unplanned excision tumor ganas jaringan lunak yakni operator non orthopaedi onkologi.

---

ABSTRACTIntroduction. Soft tissue sarcoma is part of mesenchymal malignant tumor heterogeneous group with very little number of cases. Unplanned excision often become the choice of treatment due to difficulties to differentiate it with benign tumor. The inadequate treatment of this soft tissue sarcoma often leave trace of the tumor, leading to recurrence and mortality. We studied the recurrence and mortality of patients with unplanned excision on soft tissue sarcoma of extrimities, including affecting factors.Methods. This is an analytical descriptive study with retrospective cohort design, using patient rsquo s data in Cipto Mangunkusumo hospital during 2005 to 2015. Our study acquired 87 subjects with unplanned excision on soft tissue sarcoma of extrimities. Analysis of recurrence rate, mortality rate, and related factores were examined and analysed.Results. There was significant relationship between recurrence rate with incompetent surgeon non oncology orthopaedics p0,05 . However, this study could not find statistical significance between mortality with non oncology orthopaedic surgeon, location of the tumour, initial size of the tumour, and hospital type P 0,05 .Conclusion. There is relationship between recurrence rate with non oncology orthopaedics operator. "

"ABSTRAKPendahuluan: Strategi koreksi akut pada penyakit Blount menyajikan metode yang lebih praktis dan singkat tanpa memberikan dampak psikososial dan resiko infeksi situs pin. Namun demikian, luaran anatomis pada berbagai derajat deformitas perlu dikaji kembali. Disamping itu, luaran fungsional juga merupakan aspek penting yang belum banyak dilaporkan. Metode: Sampel diambil tahun 2014-2017 dan dibagi menjadi kelompok deformitas ringan-sedang dan deformitas berat. Luaran anatomis dievaluasi berdasarkan Tibiofemoral Angle (TFA) dan Metaphyseal-Diaphyseal Angle (MDA). Rekurensi dinilai satu tahun pasca operasi. Luaran fungsional dievaluasi berdasarkan Lower Extremity Functional Scale (LEFS). Hasil: Terdapat 19 pasien dengan total 31 ekstremitas dan rerata usia operasi 8,19 (±3,10). Pada deformitas ringan-sedang, rerata pre operatif TFA adalah 32,90 (±4,38) dan MDA adalah 24,60 (±6,16). Pada deformitas berat, rerata pre operatif TFA adalah 57,57 (±11,88) dan MDA adalah 45,20 (±16,85). Berdasarkan analisa statistik, tidak didapatkan hubungan bermakna antara derajat deformitas pre operasi dengan luaran post operasi (TFA p=0,147; MDA p=0,327), satu tahun post operasi (TFA p=0,981; MDA p=0,265) dan angka rekurensi (TFA p=0,690; MDA p=0,445). Tidak didapatkan komplikasi neurovaskular maupun sindrom kompartemen post operasi. Rerata LEFS pre operasi adalah 67,00 (±7,95) pada deformitas ringan-sedangan dan 70,08 (±4,35) pada deformitas berat. Sedangkan post operasi adalah 73,85 (±2,73) pada deformitas ringan-sedang dan 75,33 (±2,46) pada deformitas berat. Pembahasan: Luaran anatomis koreksi akut pada deformitas ringan-sedang dan deformitas berat memberikan hasil yang sama baiknya. Angka rekurensi tidak dipengaruhi oleh besarnya deformitas pre operasi. Strategi ini aman diterapkan sepanjang tidak adanya komplikasi neurovaskular dan sindrom kompartemen yang didapatkan. Secara umum didapatkan peningkatan fungsional pada pre dan post operasi pada kedua kelompok.

---

ABSTRACT

Introduction: Acute correction strategy in Blount disease provides more practical technique and shorter monitoring without psychosocial impact and pin site infections. However, the anatomical outcomes in various degree of deformity need more investigation. Moreover, functional outcomes are important aspect that had not widely reported. Method: Samples took in 2014-2017 and divided into mild-moderate deformity and severe deformity group. Anatomical outcomes evaluated from the tibiofemoral angle (TFA) and metaphyseal-diaphyseal angle (MDA). Recurrences were evaluated one year after operation. Functional outcome was evaluated with Lower Extremity Functional Scale. Result: There are 19 patients with total of 31extremity and operation age mean 8.19 (±3.10). In mild-moderate deformity group, the pre-operative TFA mean was 32.90 (±4.38) and MDA was 24.60 (±6.16). In severe deformity group, the pre-operative TFA mean was 57.57 (±11.88) and MDA was 45.20 (±16.85). By statistical analysis, we found no correlation between the pre-operative degree of deformity with outcomes in post-operative (TFA p=0.147; MDA p=0.327), one year after operation (TFA p=0.981; MDA p=0.265) and recurrence rate (TFA p=0,690; MDA p=0.445). There are no post-operative neurovascular and compartment syndrome complication. The pre-operative LEFS score mean was 67.00 (±7.95) in mild-moderate deformity group and 70.08 (±4.35) in severe deformity group. The post-operative mean was 73.85 (±2.73) in mild-moderate deformity group and 75.33 (±2.46) in severe deformity group. Discussion: Anatomical outcomes of acute correction strategy between mild-moderate deformity group and severe deformity group show equal good result. Recurrence rate were not related by pre-operative degree of deformity. The acute correction was a safe strategy since there were no neurovascular and compartment syndrome complication founded in this study. Generally, the functional state was increase from pre to post-operative in two groups."