Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 1977
Case ReportsKyphotic deformity of the spine in ankylosing spondylitis.
Patients who present with apparent kyphotic deformity of the spine associated with ankylosing spondylitis may have their main deformity in the hip joints, in the lumbar spine, the thoracic spine, or it may be primarily cervical in situation. If any major correction is to be carried out, then the correction should be done in the area of the main deformity. Deformity in each of these areas is amenable to surgical correction, but this requires a very careful assessment, meticulous preoperative planning, and very precise attention to operative technique to allow reasonably consistent success without major risk to the patient.
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Infections of the spine usually involve the vertebral body and therefore by definition produce a kyphosis. Non-tuberculous infection usually staphylococcal and in the lumbar spine, is often diagnosed late and can involve the cord. Open exploration and stabilization with graft should therefore be considered. ⋯ The treatment of spinal tuberculosis should be aimed at correcting 5 basic defects associated with the disease and the deformity: mechanical instability; chronic smoldering infection; spinal cord and nerve root compression; disturbance of spinal growth; depressed lung function. The cornerstone to effective treatment for spinal tuberculosis is drug therapy and the anterior fusion operation. For the established tuberculous kyphosis, which is always a fixed deformity, multiple staged operations and gradual correction used the Halo-pelvic apparatus is the best treatment available at present.
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Clin. Orthop. Relat. Res. · Oct 1977
Transcutaneous electrical neurostimulation: a new therapeutic modality for controlling pain.
Transcutaneous electrical neurostimulation relieves chronic and acute pain by blocking the transmission of pain impulses with comfortable electrical stimulation of light touch sensation. The original Gate Control Theory of Melzack and Wall provides a working model to explain the significant pain relief afforded patients. As high as 80% of selected patients presenting with a wide variety of causes could achieve some relief after treatment. This comfortable, safe method is finding wide application in clinical practice.
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Clin. Orthop. Relat. Res. · Oct 1977
Functional anatomy of the deep motor branch of the ulnar nerve.
Our presently inadequate knowledge of the functional anatomy of the deep branch of the ulnar nerve handicaps our management of ulnar nerve lesions. The extensive anatomical variations in the distribution of this nerve preclude adherence to a textbook pattern of innervation. ⋯ Afferent fibers arise from muscle, joints, deep subcutaneous tissues and even skin. These findings suggest that it is unwise to look at any nerve as purely motor or having a set innervation pattern, and emphasize the pressing need for objective preoperative and/or intraoperative functional assessment in peripheral nerve surgery.