EMC - Rhumatologie-Orthopédie最新文献

{"title":"Cyphoses pathologiques","authors":"C. Garreau de Loubresse (Professeur des Universités, praticien hospitalier) ,&nbsp;R. Vialle (Interne des hôpitaux de Paris) ,&nbsp;S. Wolff (Chirurgien adjoint)","doi":"10.1016/j.emcrho.2004.11.002","DOIUrl":"10.1016/j.emcrho.2004.11.002","url":null,"abstract":"<div><p>Kyphosis could be defined as an anterior spinal curvature. In physiological conditions, spinal sagittal plane is a succession of harmonious sagittal curves of opposite direction: lumbar lordosis, thoracic kyphosis, cervical lordosis. These curves are constituted during the growth and their amplitudes vary from one individual to another. For each individual, the spinal sagittal balance is a compensated combination resulting in an \"economic\" physiological standing posture. Many different physiological standing postures are present in the population to lead to this sagittal balance and multiple factors interfere for each person. It is necessary to take into account this great variability in spinal sagittal balance before qualifying a spinal curvature as \"pathological\". Pathological kyphoses are divided into two great groups. Regular kyphoses are localized in a harmonious way on a wide part of the spine. Their \"pathological\" character rests on the importance of the curve, its stiffness, its evolutivity, or its localization on a usually lordotic spinal segment. Angular kyphoses are localized only on a small number of vertebrae. They are often significant and stiff deformations whose \"pathological\" character is undeniable. Multiple causes, congenital or acquired, are responsible for the development of a pathological spinal kyphosis. Analysis of the deformation and knowledge of the natural course constitute an essential prerequisite for any therapeutic project. The principal diagnostic and therapeutic stages for each of the most frequent causes of pathological spinal kyphosis are summarized and analyzed in a didactic way.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 3","pages":"Pages 294-334"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.11.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89425136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lésions du labrum acétabulaire","authors":"A. Nogier (Chef de clinique à la faculté, assistant) ,&nbsp;T. Boyer (rhumatologue) ,&nbsp;H. Dorfmann (ancien chef de service de rhumatologie)","doi":"10.1016/j.emcrho.2004.11.003","DOIUrl":"10.1016/j.emcrho.2004.11.003","url":null,"abstract":"<div><p>The acetabular labrum is an important intraarticular structure of the hip. In terms of pathology, a significant risk exists in two situations: during traumatic dislocation of the hip (its interposition during the setting should be detected and treated), and in patients with insufficient acetabular covering (basal disinsertion in a hypertrophic labrum may be treated provided bone covering is undertaken in combination). Apart from these cases, idiopathic labral tears may be related with microtraumatic injuries, and be a part of femoroacetabular impingement. Some unclear joint abnormalities may be associated. Tomodensitometry and MRI can allow the visualisation of the labral tear. Hip arthroscopy is a well recognised technique that has a diagnostic role in this disease and that allows the resection of labral tears. These labral lesions are rarely isolated, and their prognosis is closely related to the associated cartilage lesions.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 3","pages":"Pages 276-293"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.11.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80639522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traitement chirurgical des pseudarthroses diaphysaires aseptiques","authors":"J. Brilhault (Docteur),&nbsp;L. Favard (Professeur)","doi":"10.1016/j.emcrho.2005.01.005","DOIUrl":"https://doi.org/10.1016/j.emcrho.2005.01.005","url":null,"abstract":"<div><p>Many factors may interfere with a repair of normal fracture resulting in non-union. In more than 90% of concerned patients, non-unions of long bone fractures can be treated successfully by a surgical procedure. Treatment must be individually adapted to the patient, addressing all components of the problem. Basic therapies applicable for the treatment of long bone fracture non-unions are reviewed, and specific treatments for non-unions in different locations (leg, femur, humerus, and clavicle) are analysed.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 3","pages":"Pages 217-247"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.01.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137289228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Techniques des butées de hanche","authors":"J. Witvoet (Professeur)","doi":"10.1016/j.emcrho.2005.03.001","DOIUrl":"https://doi.org/10.1016/j.emcrho.2005.03.001","url":null,"abstract":"<div><p>Among current indications for conservative surgery of hip arthrosis secondary to acetabular dysplasia, shelf procedure is an intervention of choice because of its relative simplicity and the relatively short period of post-operative rehabilitation. Since the first procedure performed by M. Lance, techniques have changed. These changes concern essentially incision and soft tissue exposure. Such as in any hip surgery, minimal invasive surgery appears the preferential choice as it limits the occurrence of complications and shortens the recovery period. Shelf procedure is indicated in case of a patient under 40 years, with a hip arthrosis secondary to acetabular dysplasia, without any abnormality of the upper femoral extremity and with a narrowing of the joint space less than 50%. In case of any morphologic deformation of the femoral upper part, correction must be undertaken during the same operative procedure. Good results can be expected for up to 10 years or more provided both the indication and the surgical technique have been correctly determined. Hip shelf procedure is usely propose about 40 years of age.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 3","pages":"Pages 248-261"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137289229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risque infectieux en chirurgie orthopédique","authors":"H. Migaud (Professeur des Universités, chef de service) ,&nbsp;E. Senneville (Praticien hospitalier) ,&nbsp;F. Gougeon (Praticien hospitalier, chef de service) ,&nbsp;E. Marchetti (Interne des hôpitaux de Lille) ,&nbsp;M. Amzallag (Interne des hôpitaux de Lille) ,&nbsp;P. Laffargue (Professeur des Universités, chef de service)","doi":"10.1016/j.emcrho.2004.11.001","DOIUrl":"10.1016/j.emcrho.2004.11.001","url":null,"abstract":"<div><p>In the orthopaedic field, the specifically patient-related risk factors for infection may be evaluated using the NNIS (National Nosocomial Infection Surveillance) score that takes into account non-adjustable data such as the patient’s condition as evaluated by the score ASA, intervention duration, type of intervention, etc. The risk of infection depends also on numerous factors of which the most important have an influence during the perioperative period. Some of them are patient-related (cutaneous flora, methicillin-resistant <em>Staphylococcus aureus</em> (MRSA), underlying disease, pre-existing infection, patient with multiple trauma …), others are related to the patient’s environment (operating theatre, air and water quality, hygiene of the surgical team and caregivers, instruments …). The patient with multiple traumas has a specific risk of infection related to the multiple traumatic lesions, visceral lesions, and to those invasive acts necessary for resuscitation. Actions aimed at diminishing the risk of infection may be undertaken, principally on this second group of factors. In particular for the preoperative period, validated procedures allow reducing the risk of contamination: preparation of the patient, hygiene standards for the operating theatre, surgical hand cleaning, quality of air and water, adequate antibioprophylaxis, management of other diseases, preoperative duration of hospitalisation, etc. A recent study has emphasized the potentially increased risk of contamination by MRSA related to the underutilization of sepsis containment units. Regulatory recommendations and traceability obligations aim at standardizing and optimizing preventive means. Informing the patient on the infectious risk and its consequences is a mandatory part of the traumato-orthopaedic surgical management.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 2","pages":"Pages 151-172"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88212058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumeurs malignes osseuses du fémur proximal : exérèses et reconstructions","authors":"F. Langlais (Professeur des Universités),&nbsp;N. Belot (Chef de clinique-assistant),&nbsp;H. Thomazeau (Professeur associé),&nbsp;J.-C. Lambotte (Praticien hospitalier),&nbsp;M. Ropars (Chef de clinique-assistant)","doi":"10.1016/j.emcrho.2005.01.002","DOIUrl":"https://doi.org/10.1016/j.emcrho.2005.01.002","url":null,"abstract":"<div><p>The femur upper extremity is the second most frequent localisation of bone primitive tumours. In most cases, reconstruction must be performed by the implementation of a composite total hip prosthesis with combined allograft. Resection includes the upper extremity of the femur together with the surrounding muscles, and the gluteï tendons. An allograft composite prosthesis is used, with the suture of the patient’s gluteal tendons on the allograft gluteal tendons. The distal prosthetic stem is fixed in the recipient femur. The prosthesis stability is ensured by a capsuloplasty and the tendon suture allows restoring adequate abduction. Rarely, the tumour spreads to the joint; in such case a total resection of the upper femur, capsule and acetabulum must be performed, using the Ollier approach. Femoral reconstruction consists of a combined composite prosthesis, while the pelvis is reconstructed by acetabular allograft in which a cup is fixed. Alternative solutions exist, such as a saddle prosthesis. Upper extremity of the femur is the most frequent site of limb metastases. Palliative therapy is undergone for metastatic osteolysis, using a reconstruction prosthesis implanted in the healthy bone after resection of the osteolytic zone. The approach is a digastric trochanteric slide. A capsuloplasty stabilises the hip. This simple intervention allows rapid restoration of full weight bearing and early complementary radiotherapy.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 2","pages":"Pages 196-209"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.01.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137440723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathologie traumatique du muscle strié squelettique","authors":"P. Christel (Ancien professeur des Universités et chirurgien des hôpitaux de Paris) ,&nbsp;H. de Labareyre (Médecin du sport, ancien médecin de l'équipe de France d'athlétisme) ,&nbsp;P. Thelen (Ancien chef de clinique assistant, radiologue) ,&nbsp;J. de Lecluse (Médecin de médecine physique et de rééducation)","doi":"10.1016/j.emcrho.2004.10.007","DOIUrl":"10.1016/j.emcrho.2004.10.007","url":null,"abstract":"<div><p>Striated muscle injuries of the limbs are quite usual in sports medicine. All grades of severity can be met but several basic principles of diagnosis and treatment allow providing a solution in most of the cases. After a brief review of the histological structure of the striated muscle and the risk factors for muscle injury, this chapter will separately analyse the management of acute- and chronic-muscle strain. It is necessary to distinguish between direct injuries, secondary to direct blow, and indirect ones, the most frequent, where the intrinsic strength of the muscular tissue is overwhelmed by the velocity and magnitude of the external forces. In most of the cases, histological lesion occurs at the myo-aponeurosis or myo-tendinous junction. In the acute setting, clinical examination and imaging allow identifying the lesion type (contracture, tear, rupture), the severity, the location, and to draw the consequences in terms of therapeutic strategy and disability duration. Ultrasonography is here a key for the diagnosis and the prognosis evaluation. Diagnosis of chronic muscle injuries relies also both on clinical examination and imaging. Imaging identifies the type of injury: fibrous scar, pseudo-cyst, calcifications. Due to its 3-D representation MRI is the best imaging tool for diagnosis and for pre-operative planning. Prevention plays a major role in avoiding muscle injuries. Investigating for the athlete’s specific risk factors, correcting muscle balance and metabolic disturbances, training properly, improving muscle flexibility have significantly decreased the incidence of muscle injuries. Most acute injuries are treated conservatively. Therapy is adapted to the type of the lesion: physiotherapy, rehabilitation, eccentric isokinetic muscle strengthening, appropriate training and return to athletic activities avoid injury recurrence. Surgery is indicated only in case of major muscle lesions or compressive syndromes. Chronic muscle injuries are most of the time best treated by surgical means. The surgical method and strategy will depend on the type of lesion: from the excision of a simple fibrous scar or calcifications to functional removal of a muscle, sometimes associated with local neurolysis.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 2","pages":"Pages 173-195"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.10.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88722154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Un cas rare de kyste intra- et extra-articulaire de hanche","authors":"J.-Y. Vandensteen ,&nbsp;P. Djian ,&nbsp;T. Boyer ,&nbsp;H. Dorfmann","doi":"10.1016/j.emcrho.2005.01.003","DOIUrl":"10.1016/j.emcrho.2005.01.003","url":null,"abstract":"<div><p>Nous rapportons un cas de kyste du bourrelet de hanche particulier à développement intra- et extra-articulaire.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 2","pages":"Pages 210-214"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82261632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spondylolisthésis par lyse isthmique","authors":"J.-M. Vital (Professeur des Universités, praticien hospitalier),&nbsp;M. Pedram (Praticien hospitalier)","doi":"10.1016/j.emcrho.2005.01.006","DOIUrl":"10.1016/j.emcrho.2005.01.006","url":null,"abstract":"<div><p>Spondylolisthesis refers to a permanent forward slippage of the vertebral body, in most cases L5, more rarely L4 or higher lumbar vertebrae. Spondylolisthesis by isthmic spondylolysis or fractures of the pars interarticularis - acquired most of the time by repeated microtrauma during childhood – differ from congenital spondylolisthesis in which developmental abnormalities of the posterior arch are often associated to a pars stress fracture. Other causes of lower lumbar spondylolisthesis (gross trauma, degenerative or neoplastic disease, or surgical, iatrogenic injury) are not included in the present chapter. In terms of etiopathological mechanisms, isthmic spondylolysis involves genetic factors, since it has been observed that whites are more frequently affected than blacks, and less affected than some ethnic groups such as the Eskimos. Obviously, there is a contribution of a mechanical factor to the development of pars lesion since only bipeds with lumbar lordosis are affected, after acquisition of ambulation and, because repeated sports-related microtrauma in positions of hyperextension considerably increases the frequency of spondylolysis. Clinically, asymptomatic forms are frequent. Acute low-back pain may involve initial episode of fracture. At a later stage, chronic lower lumbar pain develops; in some patients sciatica occurs, in most cases by compression of the L5 nerve root. In severe dysplastic spondylolisthesis, this may even lead to lumbosacral kyphosis with pelvic retroversion. Radiologically, the diagnosis of isthmic spondylolysis is based upon oblique lumbar images, CT scans perpendicular to the isthmus and radionuclide bone scans performed early after initial pains. Spondylolisthesis is assessed using lateral films that allow, for prognosis determination, both the quantification of the degree of slippage and the determination of the lumbosacral kyphosis angle. Magnetic resonance imaging may reveal recent spondylolysis. MRI also permits evaluation of the state of discs adjacent to the spondylolisthesis and it can show radicular compromise. The natural history of spondylolisthesis by isthmic spondylolysis depends on the possible collapse of the intervertebral disc. The course of dysplastic spondylolisthesis is more severe, because it affects young subjects before maturity, and the deformity depends on osteocartilaginous growth. In terms of therapy, orthopedic treatment that consists of an orthosis immobilizing one of the thighs to prevent movement of the lumbosacral junction can be proposed at early stages. Isthmic reconstruction should be considered in young athletes reluctant to limit their physical activity. In case of spondylolisthesis, conservative treatment by immobilization using an orthosis, facet joint infiltrations and physical therapy can be proposed. In case of failure, or in case of compressive radicular pain, decompressive surgery followed by arthrodesis should be considered, by posterior approach. Combined ante","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 2","pages":"Pages 125-150"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.01.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80953600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instantanés","authors":"D. Clerc","doi":"10.1016/j.emcrho.2005.01.004","DOIUrl":"https://doi.org/10.1016/j.emcrho.2005.01.004","url":null,"abstract":"","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 2","pages":"Pages 215-216"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.01.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137088030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}