Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Nov 2003
[Geometrical and mechanical analysis of lumbar lordosis in an asymptomatic population: proposed classification].
The main objective of this study was to describe the morphology and the mechanism underlying the organization of lumbar lordosis in terms of position and shape of the pelvis. A classification of lumbar lordosis was proposed based on the orientation of the sacral plane. ⋯ Regarding sacral slope, lumbar lordosis can be classified into four types. When the sacral slope is low, lumbar lordosis can either be both short and curved with a low apex and a backward tilt (type 1) or both long and flat with a higher position of the apex (type 2). When the sacral slope increases, lumbar lordosis increases in angle and number of vertebrae with an upper apex, with a progressively forward tilt (types 3 and 4). Depending on the shape and position of the pelvis, and because of the relation between sacral slope and pelvic tilt, the morphology of lumbar lordosis could be the main mechanical cause of degenerative diseases of the lumbar spine.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2003
[Physiological value of pelvic and spinal parameters of sagital balance: analysis of 250 healthy volunteers].
Sagital balance of the spine is a fundamental element necessary for understanding spinal disease and instituting proper treatment. The aim of this prospective work was to establish the physiological values of pelvic and spinal parameters of sagital balance of the spine and to investigate their interactions. ⋯ This work provided a useful tool for analyzing and understanding anteroposterior imbalance in patients with spinal disease and also a means of calculating corrections to be made with treatment, established from the linear regression equations which were elaborated.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2003
Comparative Study[Static and dynamic modifications of the cervical spine after laminoplasty for cervical spondylotic myelopathy].
Cervical laminoplasty has been widely used in Japan as the treatment of progressive cervical myelopathy. However, in 1993, Guigui reported that extensive cervical laminectomy was enough for the treatment of cervical myelopathy secondary to stenotic conditions. The purpose of this report was to compare the results of extensive laminectomy as reported by Guigui in 1998 with those of laminoplasty in our series using exactly the same criteria for anatomic analysis. ⋯ Spinous process splitting laminoplasty causes an ossification between the remaining spinous process and an unexpected fusion of the lateral mass. These results may prevent postoperative segmental destabilization.
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Musicians occasionally consult orthopedic surgeons, particularly upper limb specialists. We wanted to learn more about the reasons why musicians attend orthopedic clinics. ⋯ This study presents a diversified panel of musicians consulting orthopedic surgery clinics. Practicing schedules varied in the study population from one to five hours daily. More than half the patients complained of pain but 18% consulted because they perceived a problem when playing and 17% consulted simply for advice. Our findings recall that musicians comprise a sensitive population requiring careful overall management. Unlike series published to date, we had a majority of men. Problems involving an orthopedic disorder or trauma and trauma sequelae predominated. In the literature, diagnosis has been oriented by the specialty of the consulting physician. We found that our patients who suffered from overuse had often recently changed their habitual practicing methods or conditions. The diagnosis of misuse was facilitated when the patient was examined with his/her instrument. The low rate of dystonic disorders was probably related to the fact that nearly half of our patients were followed regularly by a physical therapist. We did not observe any case of excessive laxity or Linburg Comstock syndrome which exceptionally have functional impact. The very large majority of our patients were referred by physical therapists and when surgery was necessary, the procedure was performed in accordance with accepted rules concerning the therapeutic management of musicians.
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Rev Chir Orthop Reparatrice Appar Mot · Sep 2003
[Segmental tibia fractures: a critical retrospective analysis of 49 cases].
Segmental tibia fracture is defined by the presence of two distinct fracture lines separating the cortical and completely isolating an intermediary segment of the tibia. Little work has been published on this clinical entity. We report a retrospective analysis of 49 patients treated in one center for segmental tibia fracture in order to determine more precisely the indications for three surgical techniques: locked intramedullary nailing with or without reaming, and external fixation. ⋯ Comparing our results with the therapeutic modalities used in published reports on segmentary tibia fractures showed that time to bone healing and the rate of nonunion were generally greater than in our series. A critical analysis of these results allows us to propose a more interventionalistic attitude before the development of late healing. We also propose a classification of segmental tibia fractures and a decisional tree for choosing between the three techniques based on the presence of soft tissue damage, the presence of compartment syndrome (nailing without reaming), and the presence of proximal or distal metaphyseal fractures (distal locked nail). Nailing with moderate reaming remains the preferred method.