[Recent advances in the treatment of bone metastases from cancer of the thyroid (author's transl)].
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Biomedical subjects
Publications and source records attributed to G Saillant.
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Hallux varus hypercorrection is reduced and maintained by a medial osteoplastic ridge fixed by screws in the head of the first metacarpal bone. It can be indicated to associate an extensor Hallucis longus lengthening.
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A plate designed from the model used by R. Judet for fractures of femoral neck is presented. It is adapted to the fixation of high femoral osteotomy with internal translation, affected or not with valgus or varus. The screwing of the plate, when in place, realizes systematically a compression at the level of the osteotomy. The system is very stable and enables the begining of reeducation without delay.
The authors have operated on 18 cases of severe strain of the cervical spine (six cases of C1-C2 and 12 cases of level cervical spine). They point out the difficulty of an accurate diagnosis in emergency. They emphasize the importance of flexion-extension X-rays when conventional X-rays are not strictly normal. After an analysis of the results they suggest that recent cases should be treated by posterior grafting at the level of C1 and C2, posterior plating at lower levels. Old and irreducible cases should be treated by osteotomy and anterior grafting: banding with grafting at C1 and C2, posterior screwed plating at the inferior cervical level.
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Twenty-three dogs underwent a complete transection of the spinal cord at L 1 level. Section was followed in eighteen animals by reconstruction effected through suture of the arachnoide with the aid of monofilament 10 X 0 thread. The operation was in all cases concluded by an osteosynthesis with metallic material in order to prevent any movements in the operated site, and a tight dural closure was achieved in order to prevent propagation of any epidural hematoma or secondary granuloma. This technique did not prevent an unfavorable evolution of the suture, which demonstrated three different morphological features:--necrosis of the spinal cord cut ends with secondary formation of a transverse cyst;--secondary infiltration of the operated focus by a fibrous scar growing from the inner aspect of the dura;--failure of axon regeneration through this fibrous block in spite of noteworthy proliferation of axons coming from the dorsal roots. A critical analysis of those results led to a comparaison with various previous works on the same subject. The most recent of these works have led to promising prospects which need confirmation.
The mobile spinal segment includes anatomically, all the soft parts which lie between two neighbouring vertebrae. Its involvement in trauma is not always obvious on initial X Ray. However, the course may lead to complete vertebral dislocation. The initial diagnosis is based on opening of the joint spaces, study of the mobility between two vertebrae by dynamic radiography. The distinction between a benign and a severe ligamentous sprain may thus be made. The attitude in cases of mobile spinal segment involvement, i.e. severe ligamentous injury, should include arthrodesis of the mobile segment affected and this is discussed here.
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The author think that the use of plates screwed in the vertebral pedicles is the most fiable osteosynthesis at thoracic and lumbar spine level. This opinion is based on an anatomical study detailing the measurements and orientations of the pedicles. A series of 56 clinical cases treated by this method is briefly analysed.
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