EMC - Rhumatologie-Orthopédie最新文献

{"title":"Paralysies de la flexion et de l'extension du coude","authors":"F Teboul (Chef de clinique, assistant des Hôpitaux),&nbsp;J.-Y Beaulieu (Interne des Hôpitaux),&nbsp;C Oberlin (Chirurgien des Hôpitaux, Professeur des Universités)","doi":"10.1016/j.emcrho.2004.01.003","DOIUrl":"10.1016/j.emcrho.2004.01.003","url":null,"abstract":"<div><p>Palsies affecting elbow flexion result in major disability and therefore warrant routine surgical treatment, even in patients with permanent hand paralysis. When elbow flexion is good, restoring extension which is a classic priority in tetraplegic patients is also extremely useful to patients with peripheral palsies. When the time since the injury is fairly short, “anatomic” flexor or extensor muscles should be given a nerve supply, either by restoring normal anatomic pathways or by nerve transfers. Transferring ulnar nerve fibres to the biceps muscle is now the preferred treatment in patients with satisfactory ulnar nerve function. This technique provides better outcomes than does repair by implantation of grafts from the plexus roots. After 12 to 18 months, the arm muscles can no longer be re-innervated, particularly when the nerve is repaired far upstream from the muscle. Palliative muscle transfer can be used in this situation in patients with transferable muscles. To restore elbow flexion, triceps-biceps transfer is indicated only in patients with co-contractions. Transfer of the medial epicondyle muscles as described by Steindler is preferred when the “anatomic” flexors are grade 2: this procedure assists elbow flexion. Latissimus dorsi transfer is mainly indicated in patients with muscle defects in the anterior arm compartment. To restore elbow extension in patients with damage to the proximal radial nerve, unipolar latissimus dorsi transfer is an excellent procedure because of the synergistic action of this muscle. In patients with tetraplegia, the posterior deltoid muscle can be transferred and prolonged with a tendon graft. The biceps can be transferred to the triceps, particularly in patients with stiffness of the elbow limiting the range of flexion. In patients with massive paralysis and no local transferable muscles, i.e., with long-standing brachial plexus paralysis, the treatment consists in free muscle transfers with re-innervation by transferred local nerves; the muscle used may be the latissimus dorsi from the other side or a gracilis muscle.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 3","pages":"Pages 243-260"},"PeriodicalIF":0.0,"publicationDate":"2004-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89790980","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":"Cervicalgie commune et névralgies cervicobrachiales","authors":"J.-M Vital (Professeur des Universités, praticien hospitalier) ,&nbsp;B Lavignolle (Maître de conférence des Universités, praticien hospitalier) ,&nbsp;V Pointillart (Professeur des Universités, praticien hospitalier) ,&nbsp;O Gille (Praticien hospitalier) ,&nbsp;M de Sèze (Assistant hospitalier universitaire)","doi":"10.1016/j.emcrho.2004.03.002","DOIUrl":"10.1016/j.emcrho.2004.03.002","url":null,"abstract":"<div><p>The following is a description of neck pain. Such pain, which may radiate to the upper extremities, should be considered in the framework of cervical degenerative disorders. Neck pain often corresponds to referred pain from facet joints or may involve the greater occipital nerve. Neck pain is symptomatic or secondary to cervical degenerative osteoarthritis. In most cases treatment is conservative, associating physiotherapy, massages, traction and, in certain cases, chiropratic manipulation. The therapeutic arsenal includes facet joint injections, acupuncture and mesotherapy. Long-term treatment associating posture training, rehabilitation with cervical and periscapular muscle strengthening is intended to avoid recurrences. Cervicobrachial pain frequently involves compromised spinal nerve or nerve root, in most cases by a soft or calcified herniated disc. This neuralgia generally involves one root and is rarely accompanied by signs of motor deficit. Nerve root and spinal cord compression may lead to cervicobrachial pain, which is typically bilateral. Additional investigations to establish the cause of compression primarily include computed tomography and, above all, magnetic resonance imaging. Electrophysiological studies (electromyogram and somatosensory evoked potentials), can confirm nerve-root injury, establish the topographic distribution of this damage and clarify its severity. Conservative treatment should be proposed initially except in cases of neurological deficit. Such treatment includes immobilization with a cervical collar, axial traction, physiotherapy, medical treatment with analgesics, anti-inflammatory drugs and myorelaxants. Chiropractic cervical manipulation is controversial in case of subligamentous herniated disc but foraminal infiltrations with scan control or epidural infiltrations may be effective when other techniques fail. When all of these methods fail or in case of motor deficit, surgery is typically performed through an anterior approach. Isolated discectomy fosters kyphosis. Filling of the disc space can be performed using autologous bone graft, interbody cages, or even a disc prosthesis in young subjects.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 3","pages":"Pages 196-217"},"PeriodicalIF":0.0,"publicationDate":"2004-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81199169","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":"Éditorial","authors":"","doi":"10.1016/j.emcrho.2004.04.006","DOIUrl":"https://doi.org/10.1016/j.emcrho.2004.04.006","url":null,"abstract":"","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 3","pages":"Page 195"},"PeriodicalIF":0.0,"publicationDate":"2004-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.04.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136847684","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":"Sciatalgies et autres irradiations non discales","authors":"S Demaille-Wlodyka,&nbsp;M.-M Lefevre-Colau,&nbsp;S Poiraudeau,&nbsp;M Revel","doi":"10.1016/j.emcrho.2003.12.004","DOIUrl":"10.1016/j.emcrho.2003.12.004","url":null,"abstract":"<div><p>Sciatica is defined clinically by clear criteria including location within the distribution of a nerve root, occurrence of the pain upon exertion, marked spinal abnormalities, and often a protracted history of low back symptoms. These well-known criteria provide no information on the cause of the nerve root pain. A detailed medical history, an evaluation of changes in symptoms over time, and in some cases distinctive characteristics of the pain may provide useful orientation. Investigations for a cause should be carried out methodically, and accurate imaging studies (magnetic resonance imaging) should be obtained before a diagnosis of “common” sciatica is given. Failure to follow these rules may have devastating consequences in patients with sciatica due to a tumour.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 2","pages":"Pages 117-129"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2003.12.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79098466","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":"Sciatiques et autres lomboradiculalgies discales","authors":"M Revel (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emcrho.2004.02.001","DOIUrl":"10.1016/j.emcrho.2004.02.001","url":null,"abstract":"<div><p>Sciatica induced by a disc herniation is the result of both mechanical and chemical actions on nerve roots inside the lumbar canal. The main factors of inflammation seem to be interleukin 1 and tumor necrosis factor α. To be compressive, the herniation should be large. The diagnosis of sciatica by disc herniation is at first clinical. The association of a crossed Lasègue's sign and the increase of the leg pain during lumbar extension could have a good predictive value of disc herniation. The natural course of sciatica by disc herniation is not only good concerning the symptom but also concerning the herniation which decreases or disappears in more than 50 % of the cases. Except in cauda equina syndrom and in worsening paresis, the surgery can be delayed without endangering the prognosis.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 2","pages":"Pages 101-116"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85370649","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":"Rapports de congrès : Société française d'arthroscopie et Current Concepts in Joint Replacement","authors":"P Djian","doi":"10.1016/j.emcrho.2004.02.005","DOIUrl":"10.1016/j.emcrho.2004.02.005","url":null,"abstract":"","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 2","pages":"Pages 192-194"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.02.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76601391","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":"Lomboradiculalgies persistantes ou récidivantes après traitement chirurgical","authors":"P Anract (Professeur des Universités-praticien hospitalier) ,&nbsp;M Revel (Professeur des Universités-praticien hospitalier)","doi":"10.1016/j.emcrho.2004.01.002","DOIUrl":"10.1016/j.emcrho.2004.01.002","url":null,"abstract":"<div><p>Decompressive spinal surgery fails in 10 to 30 % of cases. All clinical data and imaging studies collected since the onset of low back pain should be reviewed to determine the cause of failure. The most common cause is inappropriate use of decompressive surgery secondary to an error in interpreting the clinical and imaging data. A repeat decompressive procedure is indicated only when nerve root compression due to recurrent disc herniation or a bony outgrowth is detected. Other causes of pain, most notably nerve root scarring and arachnoiditis, should be treated conservatively (analgesics, epidural injections, and rehabilitation therapy).</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 2","pages":"Pages 130-137"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.01.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91004099","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":"Cylindrome parotidien métastatique","authors":"D Clerc ,&nbsp;L Choudat","doi":"10.1016/j.emcrho.2004.02.003","DOIUrl":"10.1016/j.emcrho.2004.02.003","url":null,"abstract":"","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 2","pages":"Pages 188-191"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.02.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90633847","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":"Consolidation des fractures","authors":"J.-P Meyrueis (Ancien professeur du service de santé des Armées, chirurgien des Hôpitaux) ,&nbsp;A Cazenave (Ancien chirurgien des hôpitaux des Armées)","doi":"10.1016/j.emcrho.2003.11.003","DOIUrl":"10.1016/j.emcrho.2003.11.003","url":null,"abstract":"<div><p>Fracture healing is a complex cascade of cellular recruitment and differentiation directed by a series of growth factors and cytokines. Over the past three decades significant advances have been made in the knowledge of this process and in the ways surgeons treat fractures. Several biologic and biophysical approaches have been developped to promote healing in difficult to heal fractures. The idea that micromotion, during 5 or 6 weeks, may lead to an enhancement of healing has been scientifically validated. Electric and electromagnetic devices have been shown to affect the healing process positively in delayed unions, non unions and osteotomies. Low intensity ultrasound is approved by the Food and Drug Administration to accelerate and to augment the healing of fresh fractures. The potential uses of bone morphogenetic proteins to enhance fracture healing are encouraging. This potential has yet to be determined. Advances in regional gene therapy should provide orthopaedists with an additional treatment option for conditions requiring the formation of new bone. There is clearly a need for much more research into the basic biology of fracture and directed toward the enhancement of fracture healing.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 2","pages":"Pages 138-162"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2003.11.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76545242","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":"Maladie de Dupuytren","authors":"J.-P Moermans (Professeur)","doi":"10.1016/j.emcrho.2004.01.001","DOIUrl":"https://doi.org/10.1016/j.emcrho.2004.01.001","url":null,"abstract":"<div><p>Dupuytren’s contracture is characterized by the proliferation of retractile fibrous tissue on the volar aspect of the hand and of the fingers. Its origin, its evolution and the patho-physiological mechanisms involved in its development remain obscure. The therapeutic options are still uncertain as attested by the multiplicity of surgical techniques and palliative treatments that have been proposed. We succinctly develop the etiological, epidemiological and patho-physiological aspects of the disease that play a role in the choice of the most appropriate treatment or that have a prognostic value. We make a more detailed description of the anatomy and microanatomy of the cords and nodules that characterize the disease and play a very important role in the surgical technique. We analyze the therapeutic options and the criteria of choice of the most appropriate solution depending of the state of the pathological process and the presence of associated pathologies.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 2","pages":"Pages 163-187"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137220274","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}