La Clinica ortopedica最新文献

Inadequately treated cases of scoliosis with deterioration were studied. Biomechanics and pathology are discussed. It has been observed that permanent lateral deviation of the vertebral column continues irreversibly if not treated in time. A study of the evolution of scoliosis in relation to vertebral growth is reported. It is followed by a description of therapeutic management based on fundamental factors: --aetiology, the severity of the deformity, bone age and potential deterioration. A series of cases treated conservatively and by surgical fixation is illustrated.

After discussing some technical aspects of the surgical treatment of the congenital luxation of the hip, the Author reports on 148 of his own cases operated over a period of 8 years. He then goes on to evaluate the follow up also with regard to the age when treated and to describe the more unsuccessful cases. Also in the light of bibliographical data, he then considers the different indications for the treatment of the congenital luxation of the hip, pointing out in his conclusions that among the many reasons that have made him a firm upholder of the primary surgical treatment of the congenital luxation of the hip is the very small percentage of postreductive osteocondrosis which, as is known, often gives rise to serious, irrevocable invalidation.

Recent publications stress the importance of exogenous or environmental factors in the aetiology and pathogenesis of dysplasia of the hip. For this reason ante- and post-natal postures were studied in detail especially intra-uterine malposition and the so-called "forced" or "adaptation decubitus" (Zwangshaltung, Schrägseite-Lage Syndrome, Congenital pelvic obliquity). Even with the data obtained from very early (neonatal) diagnosis no distinction can as yet be made between dysplasic alterations of the hip which are sometimes associated with the above-mentioned anomalies and true congenital dysplasia. Furthermore, intra-uterine malposition and consequent breech presentation would seem to be a result rather than the cause of congenital dysplasia which only rarely occurs without underlying primary hip-joint pathology.

This paper provides a long-term review of 38 elderly patients with fracture of the neck of the femur. They had been discharged well and ambulant after application of Thompson's intra-articular prosthesis. Death supervened in 5 within an interval of 3-6 years after the operation. Twenty-six complained of pain in the joint. Another three had reduced mobility from ossification around the prosthesis. It is concluded that the insertion of an intra-articular prosthesis for fractures of the femoral neck does not give good long-term results and is not the ideal treatment for this injury in elderly patients.

After reminding how difficult it is to reach the diagnosis for an osteoid osteoma of rachis, the Authors report of a patient who was put under their observation after having been treated as lumbar scoliosis and discitis for one year. As they removed the osteoid osteoma, the painful symptomatology punctually disappeared and the rachis, after few months, was in its normal order.

The aetiology and pathogenesis of wide loss of bony tissue are discussed. Methods of treatment are described. Five cases thus treated and cured are reported.

The more frequently occurring bone lesions of leprosy of the foot are described with illustrations from patients with leprosy seen some years previously in Sardinia. These cases are classified into groups depending on the presence of osteoporosis, osteitis, lesions with predominantly inflammatory manifestations, those with a spindle-shaped appearance and lastly those with pathological fractures. The anatomical relationship between cutaneous and bone lesions is outlined.

The functional principles are described of an electromechanical method for the in vitro determination of microscopic deformities of the articular cartilage under stress. A first series of experiments of human and bovine cartilage obtained from different localizations and by different methods are described. The behaviour of the cartilage can be adequately assessed by means of this test which could be used to devise a mathematic model for the analogic simulation of tissue. By this method, together with other histological and physico-chemical investigations, a more complete formulation of the structure of cartilage is proposed.

Twenty cases of Ewing's bone tumor, seen at the Orthopaedics Clinic of Padua from 1958 to 1975, were classified into two groups on the basis of results obtained from different schemes of treatment. In the first group of patients, treated during the period 1958-69 by surgery and irradiation, the mean survival rate was one year with two exceptions still surviving since 17 and 11 years respectively (treatment: only amputation). The mean survival rate was prolonged to 5 years in the second group. Here, combined treatment included irradiation (4.000-6.000 r), medical treatment (Adriamycin, CCNU, Vincristine) vaccine therapy and surgery. In the Author's opinion it is more convenient to use the latter therapeutic approach because of the promising results, the improved survival rate and the more effective control of relapses and metastases.