Résumé
Preoperative diagnosis of free disc fragment is important in order to avoid treatment by chymopapain and percutaneous method of disc removal or anterior discectomy. This retrospective case analysis was to study the cause, physical findings and appropriate investigation to identify free disc fragment before surgery. One hundred and thirteen operative patients of herniated lumbar disc were studied. Of these, eleven patients (9.7%) were diagnosed with free disc fragment. The results revealed that one patient was diagnosed preoperatively with free disc fragment by myelography and MRI and three other patients using MRI alone. We concluded that preoperative diagnosis of free disc fragment can be made through identification of a large myelographic defect and/or sagittal scan MRI showing migration of disc material from native disc space.
Sujets)
Adulte , Sujet âgé , Discectomie percutanée/méthodes , Femelle , Corps étrangers/diagnostic , Migration d'un corps étranger/diagnostic , Humains , Déplacement de disque intervertébral/complications , Vertèbres lombales , Imagerie par résonance magnétique , Mâle , Adulte d'âge moyen , Myélographie , Soins préopératoires , Études rétrospectives , Sensibilité et spécificité , Espace subdural/anatomopathologieRésumé
The authors reported 16 cases of first to third grade painful spondylolisthesis. The treatment was posterior reduction and stabilization in one stage operation by modified Vidal et al and Luque techniques. The operation consisted of stabilization of an above involved vertebra and another one below with a rectangular rod and sublaminar wirings. The pedicular screws were inserted through the Harrington hooks which levered upon the rectangular rod for reduction of the displaced vertebra. The posterolateral intertransverse arthrodesis of two spinal segments was also added. A 2-5-year follow-up study showed all patients were relieved from pain initially, and could ambulate early following the operation. The vertebral displacement did not increase postoperatively and solid posterolateral fusion was obtained.
Sujets)
Adulte , Vis orthopédiques , Femelle , Études de suivi , Humains , Lombalgie/étiologie , Vertèbres lombales , Mâle , Adulte d'âge moyen , Arthrodèse vertébrale/méthodes , Spondylolisthésis/chirurgie , Spondylolyse/chirurgie , ThaïlandeRésumé
The author studied the iliac and fibular autogenous bone grafts in anterior lumbar discectomy for herniated disc of 29 patients. They were examined 2 1/2 to 8 years postoperatively. Iliac numbness was found in 4 of 15 patients (26.7%) and fibular pain was found in one of 14 patients (7.1%). For functional result, iliac and fibular graft were found excellent in 86.6 and 92.9 per cent respectively. There was no statistically significant difference in proportion of patients experiencing discomfort at donor site or in the functional result between iliac and fibular grafts.
Sujets)
Fibula/transplantation , Études de suivi , Humains , Ilium/transplantation , Déplacement de disque intervertébral/chirurgie , Vertèbres lombales/imagerie diagnostique , Arthrodèse vertébrale/méthodes , Tomodensitométrie , Résultat thérapeutiqueRésumé
Anatomical variations of the anterior tibial tendon insertion were studied by dissection in 44 normal feet of 22 embalmed adult cadavers. Three types of insertion were found. The most common insertion (56.8%) was a division of the tendon into two slips, equal in width, the one slip being inserted into the first cuneiform and the other slip into the base of the first metatarsal. The next most common (27.3%) was a division of the tendon into a large slip, inserted into the first cuneiform, and a small slip, inserted into the base of the first metatarsal. The third type, and least common tendon insertion (15.9%), was by a single slip into the first cuneiform only. Knowledge of these anatomical variations will assist surgeon in performing anterior tibial tendon transposition for recurrent congenital clubfoot.
Sujets)
Adulte , Pied bot varus équin congénital/chirurgie , Pied/anatomie et histologie , Humains , Transposition tendineuse , Tendons/anatomie et histologieRésumé
From January 1985 to May 1988, thirty-six patients with thoracolumbar burst fracture were treated and nine of these (25%) were associated with another burst fracture or wedge compression fracture. The etiology of injury was a fall from a height in four patients, motorcycle accident in three, and elevator crushing and house crushing in each of the other two patients respectively. The neurological implications were caused by the main burst fractures, and L1 was the most involved segment of the main burst fracture (44.4%). All three patients had associated wedge compression fracture, as well as three patients who had associated burst fracture, found adjacent to the main burst fracture. The remaining three associated burst fractures were found at a distant level to the main burst fracture.