La Chirurgia degli organi di movimento
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Review Comparative Study
Sacro-iliac joint pain: etiology and conservative treatment.
Orthopedic surgeons use many modalities in conservative treatment of low back pain (LBP) and sacroiliac pain (SIP) but few have been studied with randomized controlled trials. We have been studying the physiological effects of manipulation on joints and the clinical effect on patients. ⋯ The iliac and sacral surfaces of the sacroiliac joint develop differently. Although this statement need further study it seems that manipulations may play a role in the treatment of LBP and SIP.
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A total of 69 cases (73 hips) of the sequelae of septic osteoarthritis of the hip are studied. The sequelae are classified based on whether or not the femoral epiphysis is present, and on stability of the joint according to Hunka (1982). ⋯ The results were: good: 50 hips (72.5%); fair 12 (17.4%); poor: 11 (16%). The most significant sequelae were hip instability, joint function limitation, and shortening of the limb.
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Degenerative spondylolisthesis may manifest itself with different clinical pictures depending on the phase of the spondylotic disease. Based on pathophysiological criteria 24 patients affected with degenerative spondylolisthesis were divided into three groups: group I: those with spondylotic instability; group II: those with lumbar stenosis and current or potential segmental instability; group III: those with lumbar stenosis and naturally stabilized spondylolisthesis. ⋯ Long-term results were positive in 100% of the cases in group I, 90% in group II and 83% in group III, with no statistically significant differences between groups, because of the limited series of cases. The authors conclude that surgery for the treatment of degenerative spondylolisthesis must be based on age, symptoms, and the phase of the disease, and that when these indications suited to the clinical-radiographic picture are taken into account, good results may be obtained with different operations.
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The authors report the results obtained in a series of more than 80 cases submitted to 76 operations of the upper cervical spine by transoral approach with a minimum follow-up of two years. The cases include: 15 unstable fractures or non-union of the odontoid processes; 28 cases of post-traumatic instability of C1-C2 level without fracture of the odontoid process; 13 cases of rheumatoid arthritis with instability at C1-C2; 14 cases of severe anomalies of the craniovertebral junction, often associated with basilar impression and spinal cord compression, of which 7 cases presented with tetraparesis; 6 malignant tumors. The method used involves an anterior transoral approach, more often without tracheotomy, and with exposure of the anterior aspect of the atlas and of the odontoid process by means of a midline incision of the posterior wall of the pharynx. ⋯ There were no early intra- or postoperative deaths. Consolidation was obtained in most of the patients, and only in three cases did we observe a loss of postoperative reduction. Among patients affected with tetraparesis we observed many cases of neurological recovery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Elastic intramedullary osteosynthesis for the treatment of metaphysodiaphyseal non-union of the femur and tibia.
Elastic osteosynthesis is capable of producing the biomechanical conditions required to reconvert mature fibro-cartilaginous tissue interposed in the non-union in bone tissue. Theory is confirmed by a retrospective study of 54 patients affected with nonunion of the femur and tibia treated with elastic osteosynthesis.