Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
-
Rev Chir Orthop Reparatrice Appar Mot · Jun 2000
[Sagittal equilibrium of the pelvis: analysis of the inclination of the ischio-pubic ramus from the horizontal].
The sagittal equilibrium of the spine and pelvis has been examined in numerous studies looking for the origin of certain posture disorders of the spine and the cause of lower back pain. Sagittal x-rays of the pelvis provide an analysis of the degree of inclination of the pelvis from the horizontal and the bi-coxo-femoral axis and information on the form of the sacrum. There is no radiographic parameter however which analyzes the transition between the pelvis-sacrum component and the femoral component, i.e. the periacetabular region. In the sagittal plane, a line tangent to the ischio-pubic ramus would appear to best reflect the orientation of the periacetabular region and the muscular forces applied to this region. The purpose of this work was to analyze the inclination of the ischio-pubic ramus from the horizontal and its relations with other sagittal radiographic parameters in a population of growing children with spinal disorders. ⋯ The interdependence of sagittal radiographic parameters of the pelvis and the spine have been largely demonstrated. Certain pathological situations (isthmic spondylolysis with spondylolisthesis, lower back pain, etc.) can be explained by the value of these parameters, particularly incidence. The inclination of the ischio-pubic ramus from the horizontal reflects the periacetabular region. When analyzed in the sagittal plane, it was found to be a more stable parameter, independent of most clinical criteria (particularly age, and etiology) and of the other radiographic parameters studied. The only determining factor appears to be acquisition of the upright position. The consistency of this parameter constrasts with the variability of the other radiographic parameters of the pelvis and the spine, particularly incidence, although the inclination of the ischio-pubis ramus is an expression of a region different than the pelvis. This study suggests that the periacetabular region plays a key role in acquisition of the upright position in humans. The periacetabular region would be a fixed point around which the lower limbs and spine describe varying orientations.
-
Rev Chir Orthop Reparatrice Appar Mot · Jun 2000
[Implantation of iliosacral screws. Simulation of optimal placement by 3-dimensional X-ray computed tomography].
Percutaneous iliosacral screws are used advantageously to fix unstable pelvic girdle avoiding the morbidity of open access for conventional screw fixation. The insertion technique must be precise due to the risk of injury to the lumbosacral nerve trunk, the cauda equina roots, and the first sacral nerve. We undertook a study of the implantation site of iliosacral screws looking for a means of standardizing the drilling procedure on the basis of 3D computed tomography (CT) data. ⋯ The 3D CT reconstructions of the sacral wing can be used to determine the precise optimal position of the two iliosacral screws. The principle orientations can be deducted from the plane of the sacral plate. Approximate indications can help reduce operative time and exposure to irradiation (patient and surgeon). Percutaneous iliosacroiliac screw fixation cannot be proposed for all patients.
-
Rev Chir Orthop Reparatrice Appar Mot · May 2000
Comparative Study[Proximal femoral reconstruction with megaprosthesis versus allograft prosthesis composite. A comparative study of functional results, complications and longevity in 41 cases].
To compare femoral reconstruction using megaprosthesis versus allograft prosthesis composite. ⋯ Composite reconstructions probably allow a better functional result when considering proximal reconstruction of the femur. The radiological appearance of these allografts in the long term is however worry some without any evidence so far of worsening functional level or any evidence of prosthetic loosening. It would seem to us that the current level of knowledge would advocate the use of massive allografts together with prosthesis. This does seem still to remain the best choice for proximal femoral reconstruction.
-
Rev Chir Orthop Reparatrice Appar Mot · Apr 2000
Comparative Study[Results of lumbar and lumbosacral fusion: clinical and radiological correlations in 113 cases reviewed at 3.8 years].
Spinal fusion requires the use of hardware for reduction and stabilization. We present the clinical and radiological behavior of a population of patients with lumbar and lumbosacral spinal fusion. ⋯ Clinical results of lumbar and lumbosacral fusions are not unsatisfactory, but in our series almost one patient out of three had to be reoperated. One of the reasons for so many reoperations is certainly hardware rigidity. Hardware was not removed without testing the fusion as this is the only means of sure diagnosis of non-union. Reoperation should not be considered a failure in this difficult surgery of back pain which requires long-term surgical follow-up.
-
Rev Chir Orthop Reparatrice Appar Mot · Apr 2000
Comparative Study[Lesions of the radial nerve in fractures of the humeral diaphysis. Apropos of 62 cases].
Evaluate outcome of different techniques used for radial nerve repair after humeral shaft fractures. Identify situations where nerve exploration is required or inversely unneeded. Evaluate the risk of more systematic nerve exploration in case of radial nerve palsy. ⋯ In case of nerve rupture, the outcome of primary suture appears to be better than that of secondary grafts. The success of the graft depends on the length of the tissue loss after sectioning in healthy tissue and on the number of torons used. This difference in prognosis points out the usefulness of systematic exploration in order to use primary or early direct suture in cases of high-energy displaced fractures. Minimally displaced fractures often are accompanied by a simple contusion with spontaneous recovery. However, in intermediary cases, the decision to make a systematic nerve exploration during the osteosynthesis procedure (aimed at early mobilization) is based on the fact that recovery was achieved in 23 cases in which initial exploration of a continuous nerve has been performed. Indirectly, the favorable outcome of postoperative paralyses reported by several authors, also supports this policy.