EMC - Rhumatologie-Orthopédie最新文献_第5页

Principes du traitement des sarcomes des tissus mous de l'adulte 成人软组织肉瘤的治疗原则

EMC - Rhumatologie-Orthopédie Pub Date : 2004-11-01 DOI: 10.1016/j.emcrho.2004.08.001

S. Bonvalot , D. Vanel , P. Terrier , C. Le Pechoux , A. Le Cesne

{"title":"Principes du traitement des sarcomes des tissus mous de l'adulte","authors":"S. Bonvalot , D. Vanel , P. Terrier , C. Le Pechoux , A. Le Cesne","doi":"10.1016/j.emcrho.2004.08.001","DOIUrl":"https://doi.org/10.1016/j.emcrho.2004.08.001","url":null,"abstract":"<div><p>Improving the quality of life of patients with a soft tissue sarcoma necessitates first the initiation of a first-line carcinologic treatment aimed at reducing the risk of local recurrence and reiterated surgeries likely to lead to mutilation; second, it necessitates a functional surgery which is increasingly feasible since the implementation of adequate multidisciplinary therapeutic management by a specialized team. No surgery should be undertaken without prior adapted imaging. Performing preoperating biopsy following the MRI allows a straightaway definition of the therapeutic management. Decision making should be based on definitive histological result since extemporaneous examination is associated with a high risk of error. Carcinologic surgery consists on a large exeresis with histologically healthy resection margins. <em>A priori</em> amputation is an outdated management, first of all because in this procedure the margins are not always healthy. The surgical access follows the member axis orientation. The biopsy scar, the tumour, and a round margin of non-tumoural tissue (a 2-cm depth of muscle, or a fibrous anatomical barrier such an aponeurosis) must be removed all together in order to avoid the occurrence of tumoural break-in and spreading. Advances in reconstructive surgery allow attenuating the functional consequences of a wide exeresis. The good quality of the surgery is determined by the histological analysis of the margins, i.e., the amount of peritumoural healthy tissue. Surgical re-intervention should be discussed in case of unhealthy margins because radiotherapy does not correct non-adapted surgery. In the standard procedure, radiotherapy is associated to carcinologic surgery. However, according to retrospective studies, the carcinologic surgical exeresis of some low-grade, superficially localized, small tumours may be sufficient, but this remains to be validated by prospective studies. Chemotherapy is discussed in young patients whose sarcoma is of high-grade malignancy. Finally, the technique of the isolated limb perfusion, using extra-corporeal circulation, allows perfusing high doses of chemotherapy, and improves the carcinologic and functional result of the second-line surgery undertaken for some recurrent tumours or locally advanced tumours. The organization and realization of such therapies is a matter for specialized multidisciplinary teams.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 6","pages":"Pages 521-541"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137440111","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}

引用次数: 0

Tuberculose osseuse et articulaire des membres 四肢的骨和关节结核

EMC - Rhumatologie-Orthopédie Pub Date : 2004-11-01 DOI: 10.1016/j.emcrho.2004.08.003

E. Pertuiset praticien hospitalier (Ancien chef de clinique des Universités)

{"title":"Tuberculose osseuse et articulaire des membres","authors":"E. Pertuiset praticien hospitalier (Ancien chef de clinique des Universités)","doi":"10.1016/j.emcrho.2004.08.003","DOIUrl":"10.1016/j.emcrho.2004.08.003","url":null,"abstract":"<div><p>Extraspinal sites account for half of bone and joint tuberculosis cases which are still frequent in areas of endemic tuberculosis, and which are not exceptional in developed countries among immigrants and immunocompromised patients. Bone and joint tuberculosis results from reactivation of resting tubercle bacilli and contains small amounts of bacilli. Two types have been identified: tuberculous arthritis and tuberculous osteomyelitis. All sites can be involved. Main characteristics are a subacute or chronique clinical disease, inconstant constitutional symptoms and inflammatory syndrome, presence of radiological signs, cold abscesses, draining sinus. Tuberculous arthritis leads to progressive joint destruction. MRI is a very effective method for local assessment. In some cases, diagnosis is based on an evidence of associated visceral or lymph node tuberculosis. In most cases, diagnosis is obtained by a local biopsy demonstrating bacteriological and/or histological proof. The prognostic depends on an early diagnosis, on a good therapeutic compliance and on the patient's immunological status. A majority of experts recommends a minimal duration of antituberculous chemotherapy of 9 to 12 months. Surgery, which has become less frequent, may be either an early surgery (abscess drainage, synovectomy or joint debridment, etc.) or a secondary surgery including arthrodesis and joint replacement. Total hip or knee arthroplasty need a quiescent period of sufficient duration and has to be associated with pre- and postoperative chemotherapy.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 6","pages":"Pages 463-486"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.08.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78078415","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}

引用次数: 47

Implants et prothèses du poignet et du carpe 手腕和鲤鱼的植入物和假体

EMC - Rhumatologie-Orthopédie Pub Date : 2004-11-01 DOI: 10.1016/j.emcrho.2004.07.001

P. Ledoux

{"title":"Implants et prothèses du poignet et du carpe","authors":"P. Ledoux","doi":"10.1016/j.emcrho.2004.07.001","DOIUrl":"10.1016/j.emcrho.2004.07.001","url":null,"abstract":"<div><p>Total or partial replacement of the wrist is not yet a current surgery. Total wrist arthroplasty has less satisfactory clinical outcomes compared to hip and knee arthroplasty. With the silicone spacers developed by Swanson, the revision rate is important because of implant fracture, carpal collapse and synovitis but preservation of wrist function through the years seems enhanced by titanium grommet. Some authors continue selective use of the Swanson wrist implant. For total wrist arthroplasty, the changes in design from the first to the third generation, with closer approximation to the wrist joint's center of rotation, have led to encouraging results. Total implant seems to be a good solution to restore functional range of motion after posttraumatic wrist arthritis when arthrodesis is required by non manual laborers older than 50 years of age. Nevertheless long term loosening of total wrist arthroplasty is a significant problem. The use of a ulnar head prosthesis seems could be a solution to restore stability and relieve secondary symptoms that may be associated with partial or total excision of the ulnar head. Total or partial carpal bone replacements with silicone implant are abandoned. The series of Titanium bone replacement are very rare. The problem of this type of replacement is that the carpal instability is not treated.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 6","pages":"Pages 564-579"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85990823","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}

引用次数: 0

Scoliose « de novo » de l'adulte

EMC - Rhumatologie-Orthopédie Pub Date : 2004-11-01 DOI: 10.1016/j.emcrho.2004.10.003

D. Clerc

引用次数: 0

Index des mots clés 关键词索引

EMC - Rhumatologie-Orthopédie Pub Date : 2004-11-01 DOI: 10.1016/S1762-4207(04)00134-6

引用次数: 0

Index des auteurs 作者索引

EMC - Rhumatologie-Orthopédie Pub Date : 2004-11-01 DOI: 10.1016/S1762-4207(04)00133-4

引用次数: 0

Luxations traumatiques de hanche : luxations pures et fractures de tête fémorale 外伤性髋关节脱位:纯脱位和股骨头骨折

EMC - Rhumatologie-Orthopédie Pub Date : 2004-11-01 DOI: 10.1016/j.emcrho.2004.08.002

G. Burdin (Interne des Hôpitaux) , C. Hulet (Professeur des Universités) , S. Slimani (Interne des Hôpitaux) , H. Coudane (Professeur des Universités) , C. Vielpeau (Professeur des Universités)

{"title":"Luxations traumatiques de hanche : luxations pures et fractures de tête fémorale","authors":"G. Burdin (Interne des Hôpitaux) , C. Hulet (Professeur des Universités) , S. Slimani (Interne des Hôpitaux) , H. Coudane (Professeur des Universités) , C. Vielpeau (Professeur des Universités)","doi":"10.1016/j.emcrho.2004.08.002","DOIUrl":"10.1016/j.emcrho.2004.08.002","url":null,"abstract":"<div><p>Traumatic hip dislocation refers to the permanent displacement of the femoral head, outside the acetabulum cavity. It may consist of a pure dislocation or may be associated with a fracture of the femoral head. It constitutes a severe lesion that is the consequence of an aggressive trauma, often associated with potential lesions that must be sought. Most of the time, the diagnosis is clinic. Front pelvis radiography is necessary and mandatory in case of polytrauma, in order to confirm the diagnosis, to identify the clinical type, and to screen for a fragment of the femoral head in the joint. Traumatic hip dislocation constitutes a therapeutic emergency that necessitates a setting of the dislocation under good anaesthetic conditions. Femoral head fractures also constitute emergency cases but the therapeutic decision making is debated. Two principles remain very important: the setting of the dislocation without any strength manoeuvre, and the preservation and surgical repositioning of the femoral head fragment in case it has been displaced after the dislocation reduction. Considerable complications exist, mainly a risk for osteoarthritis and post-traumatic necrosis.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 6","pages":"Pages 508-520"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84182183","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}

引用次数: 8

Éditorial 编辑

EMC - Rhumatologie-Orthopédie Pub Date : 2004-11-01 DOI: 10.1016/j.emcrho.2004.10.001

H. Dorfmann

引用次数: 0

Examens d'imagerie dans la pathologie lombaire dégénérative 腰椎退行性疾病的影像学检查

EMC - Rhumatologie-Orthopédie Pub Date : 2004-09-01 DOI: 10.1016/j.emcrho.2004.06.002

J.-L. Drapé (Professeur des Universités, praticien hospitalier), F. Bach (Chef de clinique à la Faculté, radiologiste des hôpitaux de Paris), H. Guerini (Chef de clinique à la Faculté, radiologiste des hôpitaux de Paris), S. Malan (Chef de clinique à la Faculté, radiologiste des hôpitaux de Paris), L. Sarazin (Attaché, radiologiste des hôpitaux de Paris), A. Chevrot (Professeur des Universités, praticien hospitalier)

{"title":"Examens d'imagerie dans la pathologie lombaire dégénérative","authors":"J.-L. Drapé (Professeur des Universités, praticien hospitalier), F. Bach (Chef de clinique à la Faculté, radiologiste des hôpitaux de Paris), H. Guerini (Chef de clinique à la Faculté, radiologiste des hôpitaux de Paris), S. Malan (Chef de clinique à la Faculté, radiologiste des hôpitaux de Paris), L. Sarazin (Attaché, radiologiste des hôpitaux de Paris), A. Chevrot (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emcrho.2004.06.002","DOIUrl":"10.1016/j.emcrho.2004.06.002","url":null,"abstract":"<div><p>The high frequency and the low clinical correlation of the degenerative lumbar spine abnormalities depicted on imaging complicate the reading of radiological examinations. The dynamic characteristics and the weight-bearing of the spine provide important information but remain reserved to radiography. In case of spinal stenosis, computed tomography is the gold standard to differentiate the “soft” and the osseous compressive components. These last years, MRI was helpful in understanding the degenerative disk phenomena and the associated bone abnormalities. MRI is also the unique imaging technique to evaluate fluids (CSF, zygapophyseal effusions and cysts, interspinous bursae). These modern imaging techniques have considerably reduced the indications for discography and myelography. Henceforth MRI is the gold standard imaging technique for the postoperative lumbar spine.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 5","pages":"Pages 365-394"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83866579","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}

引用次数: 2

Arthroplastie totale de hanche par voie antérieure et son évolution mini-invasive 前路全髋关节置换术及其微创进展

EMC - Rhumatologie-Orthopédie Pub Date : 2004-09-01 DOI: 10.1016/j.emcrho.2004.06.001

E. Lesur (Ancien chef de clinique-assistant, attaché au CHU de Nancy) , F. Laude (Ancien chef de clinique-assistant, attaché au Groupe hospitalier Pitié-Salpêtrière)

引用次数: 15