Archivio "Putti" di chirurgia degli organi di movimento最新文献

The authors report the results of automated percutaneous diskectomy in the treatment of the herniated disk. During an 18-month period this procedure was used on 39 patients with both evident radicular pathology that had not regressed even after 4-6 weeks of medical and physical therapy as well as clear disk herniation revealed by diagnostic imaging. The level of the herniated disk was L4-L5 in 30 cases. L5-S1 in 7 cases, and L3-L4 in 2 cases. The clinical diagnosis was confirmed by CAT scan in 20 cases, by both CAT scan and x-ray of the spinal region in 14 cases, and by x-ray only in 5 cases. The patients were reviewed 2, 6, and 12 months after surgery. The results were classified according to Watters' criteria based on both the relief of pain and the resumption of everyday work activity. The satisfactory results (excellent and good) totaled 59% at the 6-month follow-up, with no substantial variation at the 1-year follow-up. Hemilaminectomy was performed in 12 cases with unsatisfactory results, confirming the diagnosis of disk herniation in 10 cases (extruded in 9 cases and protruded in 1 case). Diskectomy is a non-invasive, atraumatic method which is indicated for both protruded (non-sequestrated) and subumbilical hernias and allows rapid functional recovery. The rate of success can be increased with more accurate selection of patients based on imaging diagnosis (CAT scan and MRI).

Operating theatres expose health workers to close contact with body fluids and thus to the risk of contracting blood-borne infections. The conjunctiva of the eye offers a portal of entry for infection; an abrasive mixture of bone, marrow and blood propelled at high speed by power tools and reamers could damage any epithelial surface. 100 consecutive operations were studied and contaminating particles were counted on the glasses lens. 67% out of 100 times the surgeon's and the assistant's glasses were contaminated. Orthopaedic surgeons work in a high-risk environment and should protect themselves against possible contamination of the conjunctiva by wearing glasses with broad lens.

The characteristics of all the traumatic cases treated at the emergency unit of C.T.O. Hospital in Florence are here described. The year 1985 was taken as a sample to be compared to the previous statistics obtained in the past. The authors found an increase in the number and severity of the traumatic cases, particularly in old patients and localized in the extremities (hand and foot).

On the basis of evidence of the considerable damage caused by proteolytic enzymes in cases of degenerative arthritis, the authors propose the intra-articular introduction of an inhibitor of these enzymes (aprotinine). Both the immediate and long-term results of this therapy are very promising from a clinical standpoint. This drug not only acted on the symptoms of pain and stiffness, but also blocked the degeneration and consequent cell damage, restoring physiological homeostasis. Considering its high tolerability and absence of side effects, this drug represents a significant turning point in the treatment of degenerative joint disease, with results that are strikingly superior to those achieved with commonly used infiltrative drugs.

The results of radial head excision were studied in 33 patients with isolated fracture of the radial head. The follow-up period ranged from 1 to 19 years (mean 9.5 years). Overall results were excellent or good in 25 patients (76%) and fair or poor in 8 patients (24%) with functional limitation of the elbow. Range of motion was greatly limited in those patients who had a myositis ossificans or a radio-ulnar synostosis. Periarticular ossifications were observed in 17 elbows (54%) and subluxation of the inferior radio-ulnar joint in 20 wrists (60%). Excision of the radial head is the treatment of choice for comminuted isolated fractures of the radial head, even if in some patients limited elbow function should be expected.

Synovial membrane removed surgically from patients during developing degenerative joint disease were studied under a scanning and transmission microscope. The results show that the synovial membrane is folding into villi of average dimensions (microvilli and macrovilli) which project into articular cavity. In regard to the villi, the morphology is locally changeable, with the atrophic-sclerotic areas alternated with hyperplastic areas, but topographically well defined. In the last ones, structural modifications of the intima layer, are characterized by hypertrophy of B synoviocytes, which are constituent and predominant cells in comparison with other cell-types. In the subintima around ectatic vessels, the linfomonocitary inflammatory infiltrations may be found. These alterations are the results of active biological process and because of this synovial membrane is of big importance in developing of osteoarthritis.

The authors illustrate the different types of nervous disorders of the foot caused by congenital deformations of the lumbosacral spine. They classify these clinical forms according to the level of the neurological lesions, although emphasizing that more complex neurological damage may cause very atypical deformities that are difficult to classify. Today the treatment of nervous disorders of the foot caused by congenital deformations of the lumbosacral spine seems almost promising when compared to neurological and urological problems which have therapeutic priority. Possible methods of surgical correction, as well as indications that differ according to the age of the patient and the type and extent of the deformity, are discussed. These deformities of the foot evolve very quickly; treatment must be timely or reduction is difficult. Furthermore, their peculiar tendency to relapse necessitates periodic comprehensive follow-up exams and regular maintenance therapy (orthetic and physiatric). Special care must be taken before and during treatment to prevent trophic skin lesions. For this reason, solutions other than casts (external fixation, for example) may be preferable for the maintenance of the correction. The treatment of these deformities, whether conservative or surgical, should aim primarily to achieve adequate plantar support for future aided or autonomous ambulation.

The authors reviewed the clinical and radiographic documentation of 44 cases of metastatic lesion in the femoral diaphysis, all treated during a 15-year period at the Centro Traumatologico e Ortopedico of Florence. The results obtained with both initial nonoperative treatment (casts) as well as subsequent intramedullary fixation are evaluated with great care. The evaluation of the results in terms of survival was not possible for several reasons, not least of which the recent progress made in radiation-chemo-hormonal therapy for tumors. Despite the precarious general condition of most of the patients surgical treatment did not cause intraoperative or immediate postoperative mortality. Overall, the postoperative complications were not serious and were compensated for by good progress in systemic therapy, good nursing, and in some cases recovery of autonomy.

With their research, the authors intend to recall the existence of episacroiliac lipomas. These growths are important in as much as they cause low lumbar pain where the objective and instrumental signs typical of radicular lumbar syndromes are not present. Amongst other routine instrumental tests the echo scan is suggested for a more precise record. A simple operation relieves pain once and for all.