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

Percutaneous automated aspiration discectomy (Nucleotome, Surgical Dynamics) is a new procedure for treating herniated lumbar discs. In a series of 35 patients, followed-up after 6 months, the overall success rate was 74%. 19 patients resumed work 4 weeks after surgery. In 6 patients the interventions were judged as failures and required reoperation (laminectomies). All the patients obtained complete relief. Meticulous selection of patients for percutaneous lumbar discectomy is the key to success. No intra-operative or post-operative complications occurred.

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.

Authors show various techniques utilized in surgical treatment of forty-nine hand chondromas, specifying indications, advantages and long term results, and refer on one case with beginning malignancy and one case of chondrosarcoma in the hand. By analysis of clinical, roentgenographic, pathological and evolutive pictures they discuss on their conclusions in malignancy criteria, reporting their surgical choices in treatment of hand chondrogenic malignant tumors.

A case is presented of pigmented villonodular synovitis of the knee, macroscopic neoplastiform in appearance. The histologic examination leads to believe in a granulomatous rather than neoplastic nature of the process. The cause certainly is neither traumatic nor bacteriologic, but most probably dismetabolic lipidic. The neoformed mass, singular for its remarkable dimensions (12 cm. in length), nodular in appearance, pedunculated, had not yet provoked, at the time of operation, secondary osteocartilaginous and capsular-ligamentous lesions. At follow-up, more than 11 years later, no signs of relapse were noted and the radiographic examination was negative.

The authors, after putting forth several biomechanical premises, discuss their experience in total hip arthroplasty (THA) using a PCA-type press fit cementless prosthesis with partial Madreporic covering. Several cases which demonstrate the versatility of this type of replacement are discussed in depth. Even though the short follow-up precludes definitive conclusions, use of cementless total hip replacements must be considered a valid option in the future, especially in cases of early onset of hip pathology.

In order to evaluate the validity of a new method for measuring the whole body mineral content in diagnosing senile osteoporosis we studied 3 groups of male subjects: the first one composed by 40 young healthy subjects (mean age 24.7 years), the second composed by 40 normal patients (mean age 51.3 years); the 3rd group consisted of 26 elderly patients affected with typical osteoporotic fractures (mean age 77 years). All of them underwent a measurement of the spine as well as whole body mineral content performed with a dual photon absorptiometer. The measurements showed a decreasing in mineral content in the second versus the first group but a high correlation coefficient between spine and WB measurements characterized both groups; a striking decrease of it (r = 0.22) was found in the 3rd group. The relative unreliability of the spine measurement in elderly is probably due to the age-linked anatomical alteration. We therefore conclude that WB measurement must be considered the method of choice for the detection of senile osteoporosis.

The authors describe embryology and anatomy of synovial plica of the knee joint. They propose a clinic and pathogenic classification and after examining the diagnostic problem of plica syndrome, analyze their long-term results after surgical treatment.

This is a retrospective study of 8 cases of instability of the C1-C2 segment caused by R.A. or non-union and treated by posterior stabilization with wire loops and bone grafts. The authors reported good results in patients with mild recent neurological involvement and/or radiographic instability of the segment (posterior subluxation of the dens greater than 1/3 of the A-P diameter of C1 or tilting of the dens greater than 30 degrees). The death of a patient with non-union of the dens and severe neurological involvement due to respiratory palsy leads the authors to regard severe long-term neurological involvement (quadriparesis) a contraindication for this type of procedure.

Apert's syndrome is a rare malformation (dysostosis), probably of a hereditary nature. It is characterised by craniostenosis, caused by synostosis of the coronal sutures, and by bilateral and symmetrical membranous syndactyly of the hands and feet, to which metacarpal, metatarsal and phalangeal synostoses are associated. Less frequent are dysplastic modifications in other osteo-articular regions and malformations of the viscerae. The authors expose and discuss the etiopathogenetic, clinical and radiographic aspects of this syndrome, in relation to three clinical cases which came to their observation.

The authors refer their experience in management of thalamic fractures of the heel. Their series includes 22 patients with 24 fractures and comprises the 12-year period 1975-87. They assess the results based on radiological, clinical, functional and occupational criteria, emphasizing the role of the posterior subtalar joint, which imposes an anatomical reconstruction on the orthopaedist, since the final results are conditioned by its arthritic degeneration. Complex fractures with important displacement need surgical treatment with reduction and synthesis. In simple fractures with or without slight displacement, conservative treatment using cast immobilization is now the treatment of choice.