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

Success and diffusion of various sports have produced more frequent capsular-ligamentous lesions of the shoulder. Diagnosis up to now has relied on traditional radiology using many projections to demonstrate extremity lesions and their congruences; however for capsular-ligamentous lesions, arthrography in used successfully. Since the last few years new investigating methods are used (U.S., C.T., M.N.R.). After examining benefits of each diagnosing method compared to traditional radiology, the authors conclude that traditional radiology still has a pre-eminent role in diagnosing sports pathology of the shoulder.

The authors report their results on E.S.R. variations within the first month post-surgery in 38 traumatologic and orthopaedic patients, to evaluate the time of normalization and its attendibility in case of infection. Normalization was found within the first month postoperatively, without significant differences between orthopaedic and traumatologic patients. They think that the E.S.R. becomes significant on the control of postoperative subacute infection after the third postoperative day and propose E.S.R. evaluation after this period.

The authors conducted an experimental study aimed at defining the response of the perichondrium to traumatic stimuli. Thirty rabbits were used, subdivided into two groups: in the first group, the perichondrium was submitted to indirect trauma (fracture of the growth nucleus); in the other, to direct trauma (decortication of th perichondrium). We observed that the lesions constitute a stimulus for cellular proliferation with successive differentiation depending on various procedures. The mesenchymal cells of the deeper layer of the perichondrium reveal a tendency towards differentiation in a chondroblastic sense; the portion of these cells which face the metaphysis are generally differentiated to constitute typical cytotypes of the periosteum, giving way to membranous ossification phenomena. The more external layer reveals proliferation of its fibrovascular component. This experimental model allowed us to emphasise the proliferative tendency of so-called perichondrial cells (those of the deep layer). Thus, their role in providing the growth cartilage of new chondrocytes was confirmed, contributing to the transverse development of the metaphysis.

A new method of treatment of dislocated fractures and apophyseal fractures, using direct traction by pins on the bone fragments, and cast is presented. The authors describe the technique employed and report the results of the 22 cases treated.

The authors emphasize the importance of the bone scan in long-term follow-ups of total hip arthroplasty and describe some technical details of the examination. The changes revealed in the bone scan are confirmed by the operative report. Even though the number of patients in the study was relatively small, the fact that the bone scan taken of patients with cementless total hip replacements revealed no pathological changes is considered significant.

Eleven cases of chordoma, localized at sacrum (3 cases), lumbar spine (6 cases), cervical spine (2 cases), are reported. Authors describe clinical and pathological findings of the tumor and underline peculiarity of spinal localization and difficulty of diagnosis, often delayed, particularly in sacral spine localizations. Radiotherapy and chemotherapy give poor results while surgery can be employed in the treatment on account of the slow evolution and of the not very frequent aptitude of the tumor to give metastases. However peculiar localization into the sacral spine allows to remove the whole tumor if only it is localized below the 2nd sacral vertebra; authors present such a case treated by means of subtotal resection of sacrum and coccyx. In proximal sacral localizations and in other spinal localizations, surgery is a palliative procedure and can only slow down the evolution of the tumor; recurrence is a rule, even in association with radiotherapy. However surgical treatment must be often performed because of myeloradicular involvement.

The authors discuss their 20 years of experience in the treatment of diaphyseal fractures of the humerus with Rush-type intramedullary nailing. The various operative and nonoperative methods for the treatment of this type of fracture are critically analyzed. The results were excellent in 60.5% of the cases, good in 29.6%, and poor in only 9.9%, in which healing was over 4 months late and a hypotrophic callus was present. The advantages of this treatment are as follows: adequate reduction of the fracture, simplicity of execution, good results, and shorter period of immobilization compared to other methods.

The authors report a series of affections which determine diffused modifications of the skeleton during early childhood. More common pathological forms are dealt with, of relatively simple diagnosis, and having pathological pictures which based on frequency, means of occurrence, and clinical-radiographic aspects, are rarely observed, and difficult to diagnose. Based on several clinical cases, the authors report problems related to diagnosis, emphasising the meaning of various radiographic pictures and the value and choice of hematochemical tests aimed at selecting patients in whom biopsy is required.

The authors, after referring the various pathogenetic hypotheses for Paget's disease (till the latest hypothesis of infection by slow-action virus) report their follow-up of forty-five patients with Paget's disease of bone; then explain their diagnostic method, and record complications stressing the sarcomatous degeneration. Finally they give details on their therapeutic treatment emphasizing the need of hematochemical and radiographic periodical controls in order to optimize the treatment case by case.