[Quality of life and scales measuring]. / La qualité de vie et ses mesures.

SCOPE: To present a review of the concept and the measurement of quality of life. CURRENT SITUATION AND SALIENT POINTS: The concept of quality of life was developed in the seventies aiming to complete the medical evaluation. It appeared with improvement of disease prognosis, medical evaluation and the development of patient autonomy of patients. The methodology used to construct quality of life scales is presented. Problems raised by adaptation of instruments for use in other culture are briefly discussed. PERSPECTIVES: These scales are now used in clinical research, medical economic studies and day-to-day practice. However, ethical issues surrounding these measures persist.

[Asymptomatic blunt vertebral artery injury after cervical spine nonpenetrating trauma]. / Thrombose asymptomatique de l'artère vertébrale au cours des traumatismes fermés du rachis cervical.

OBJECTIVE: To show the possibility of vertebral injury after cervical spine trauma. METHOD: We observed 2 cases of asymptomatic thrombosis of the vertebral artery after cervical fracture. DISCUSSION: Thrombosis of the vertebral artery is acute in 20% of cases of cervical trauma. It may be asymptomatic. Magnetic resonance angiography is the best noninvasive investigation for such cases to systematically detect the complication. Treatment with anticoagulants or antiaggregants should be initiated.

[Acute low back pain induced by calcifying nucleopathy]. / Lombalgie aiguë révélant la résorption d'une nucléopathie calcifiante.

INTRODUCTION: The nucleopathy calcifying of the inter vertebral disk is mostly asymptomatic. CASE RECORD: We report a cave miming a spondylodiscit. DISCUSSION: Although idiopatic in most case, it is necessary to look for a calcifying metabolic disease. The treatment base on the immobilization of the spine and non steroidal anti inflammatory medications.

[Nonsurgical treatment of tennis elbow]. / Les traitements non chirurgicaux de la tendinopathie des épicondyliens.

OBJECTIVE: To review the literature on nonsurgical treatment of tennis elbow. METHODS: We searched Medline for all randomized controlled trials (RCTs), controlled clinical trials (CCTs) and literature reviews published from 1966 to December 2003 on nonsurgical treatment of tennis elbow. We used the keys words controlled clinical trial, tennis elbow on lateral epicondylitis, and treatment. We found 46 reports of RCTs and CCTs on 14 nonsurgical treatments and 11 literature reviews. RESULTS: Corticosteroid injection is the best treatment option for the short term. However, beneficial effects persisted only for a short time, and the long-term outcome could be poor. For the long term, physiotherapy (pulsed ultrasound, deep friction massage and exercise programme) was the best option but was not significantly different from the "wait-and-see" approach. Some support is offered for the use of topical nonsteroid anti-inflammatory drugs, at least for the short term. There is insufficient evidence to support or refute the use of acupuncture, extracorporeal shock wave therapy, manipulation, orthoses, low-energy laser, glycosaminoglycan polysulfate injection, botulinum toxin injection, or topical nitric oxide application. CONCLUSION: Further trials, with use of appropriate methods and adequate sample sizes, are needed before conclusions can be drawn about the effects of many of the treatments for tennis elbow and their ability to change the condition's natural course.

The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients.

The anatomic pelvic parameter "incidence" - the angle between the line perpendicular to the middle of the sacral plate and the line joining the middle of the sacral plate to the center of the bicoxo-femoral axis - has been shown to be strongly correlated with the sacral slope and lumbar lordosis, and ensures the individual an economical standing position. It is important for determining the sagittal curve of the spine. The angle of incidence has also been shown to depend partly on the sagittal anatomy of sacrum, which is established in childhood while learning to stand and walk. The purpose of this study was (1) to define the relationship between the sacrum and the angle of incidence, and (2) to compare these parameters in three populations: young adults, infants before walking, and patients with spondylolisthesis. Forty-four normal young adults, 32 infants not yet walking and 39 patients with spondylolisthesis due to isthmic spondylolysis underwent a sagittal full-spine radiography. A graphic table and the software for bidimensional study of the sacrum developed by J. Hecquet were used to determine various anatomic and positional parameters. Comparison tests of means, and multiple and partial correlation tests were used. A study of the reliability of the measurements using factorial plan methods was performed. The sagittal anatomic parameters of the sacrum were found to have a close relationship with the pelvic parameter of incidence angle, and therefore with the sagittal balance of the spine. The anatomy of the sacrum in spondylolisthesis patients is particular in that some features are much like those of young infants, but it is more curved and the incidence angle is significantly larger. There is a close relationship between angle of incidence and the slip of spondylolisthesis. All the parameters of young infants are significantly smaller than those of adults. It can be concluded that the sagittal anatomy of the sacrum plays a key role in spinal sagittal balance. The sacral bone is an integral a part of the pelvis and constitutes the undistorted part of the spinal curves. Organization of sagittal curves during growth can be followed up by looking at the sacrum. The sacrum in the spondylolisthesis group differs from the normal, and the greater angle of incidence and sacral slope in this group could predispose to vertebral slip.

[Anterior snapping of the hip associated with the ilial psoas]. / Les ressauts antérieurs de hanche liés au psoas iliaque.

UNLABELLED: Anterior snapping of the hip was first described in 1951 by Nunziata and Blumenfeld. The aim of this study, based upon a personal series and backed up by literature reports, is a current review of this common clinical condition, usually asymptomatic, but sometimes painful especially in athletes. MATERIAL AND METHOD: 12 cases in 11 patients were treated surgically: 4 men and 7 women, mean age 25 years, 7 of them regularly involved in sport. The onset of the snapping was sudden in 6 cases, related to a precise movement, while in 6 cases pain preceded the gradual development of snapping. Pain may coincide with snapping, or may be of a "chronic" nature after exercise. The problem had been present for 2 years on average before treatment. Surgery consisted of posterior psoas aponeurotic fascia division and was sufficient in 11 cases. In one patient, disappearance of snapping was obtained only after division of the ilio-femoral ligaments. Mean postoperative follow-up was 6.5 years (1 to 12 years). Pain disappeared in all patients. A slight, intermittent and asymptomatic snapping persisted in 3 cases. All athletes regained their previous performance level. DISCUSSION: CLINICAL: Symptoms consist of a dull, deep clicking sensation in the groin during active mobilization of the hip. It never occurs with passive mobilization. The entire problem is that of attributing painful symptomatology to snapping. ANATOMICAL STUDY: In almost all cases, snapping is due to a sudden movement of the psoas aponeurotic fascia on the ilio-pectinate eminence. Other causes have been reported: ilio-femoral ligaments on the femoral head, rectus femoris or psoas tendon on bony crests or of psoas on the cotyloid cup of an artificial hip. INVESTIGATIONS: These are primarily designed to rule out any other cause of snapping or inguinal pain (foreign body, acetabular labrum lesion, etc). Bursography and dynamic ultrasonography identify the snapping site, but it is sometimes difficult to confirm that this is responsible for painful symptoms. TREATMENT: If such responsibility is confirmed, and if any psychological component can be ruled out, this should first be "medical" by stretching and local injections in the serous bursa. Surgery should consist in division of the psoas aponeurotic fascia, leaving the muscle fibers intact. The procedure should be performed under sensory epidural anesthetic, the only way of ensuring peroperatively that snapping has disappeared. Division of the psoas distal tendon at the lesser trochanter is not appropriate.