Biomedical subjects
J Debeyre
Publications and source records attributed to J Debeyre.
[Comparative trial of 2 series of ruptures of surgically and non-surgically treated rotary cuffs].
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Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study.
The results in ninety-three knees that had been treated by proximal tibial opening-wedge osteotomy for varus deformity and osteoarthritis of the medial compartment were evaluated after a mean length of follow-up of 11.5 years (range, ten to thirteen years). After ten years, only forty-two (45 per cent) of the ninety-three knees had an excellent or good result, and in fifty-one knees there was recurrent pain for which seventeen had another operation. At five years, on the other hand, 90 per cent of the knees had a good result. Deterioration occurred at an average of seven years after the osteotomy and was always associated with recurrence of pain. Although the results deteriorated with time, time was not the only determinant of the result. Alignment, measured as the hip-knee-ankle angle on radiographs of the whole limb that were made with the patient bearing weight, was also a determinant of long-term results. The best results were obtained in the twenty knees that had a hip-knee-ankle angle of 183 to 186 degrees. In these knees, there was no pain and no progression of the arthrosis in either the medial or the lateral tibiofemoral compartment. Of the five knees that had an angle of more than 186 degrees, all five had progressive degenerative changes in the lateral compartment. In the sixty-eight undercorrected knees (an angle of less than 183 degrees), the results were less satisfactory, and there was a tendency toward recurrence of the varus deformity and progression of the arthritis of the medial compartment. However, when the correction was insufficient the deterioration was slow (average, seven years), and it was not associated with lateral laxity and deterioration of the lateral compartment, which are the changes that characterize the natural course of gonarthrosis as described by Hernborg and Nilsson. Therefore, proximal tibial osteotomy is a very suitable operation for patients who have gonarthrosis of the medial compartment, but a rigidly standardized and precise operative technique is required as well as accurate radiographic measurements of the mechanical axis of the limb, because exact postoperative alignment is the prerequisite for the longest possible period of relief of symptoms after osteotomy.
[Outcome at more than 10 years of 93 tibial osteotomies for internal arthritis in genu varum (or the predominant influence of the frontal angular correction)].
Ninety three high tibial valgus osteotomies have been performed by the authors for degenerative arthritis and reviewed more than 10 years later. The mean age of the 66 patients was 70 years. The results were somewhat disappointing. Seventeen knees had to be operated on before the tenth post-operative year and only 42 knees were painless at the time of review. Radiological improvement in the medial tibio-femoral joint was rarely seen. Fortunately, deterioration in the lateral tibio femoral joint was exceptional and joint laxity was rarely troublesome. The authors conclude that the amount of correction at the time of the osteotomy is of extreme importance. The results were satisfactory only in cases where valgus ranging between 3 and 6 degrees had been obtained. When an osteotomy produced a greater amount of valgus, deterioration of the lateral tibio-femoral joint was seen. When the osteotomy produced less than 3 degrees of valgus, recurrence of the varus deformity developed. In these cases, functional deterioration was noted after seven years. Thus, the osteotomy appeared to have slowed down the natural evolution of the disease. The results of valgus osteotomy were satisfactory in most of the cases, but they were excellent only in cases in which a valgus ranging from 3 to 6 degrees had been produced. The importance of a precise radiological measurement is stressed, the accuracy of measurement being doubtful in cases with associated flexion deformity or joint laxity. The precision of the surgical procedure is also very important.
[Sprains of the knee (Henri Mondor)].
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[Role of orthopedic surgery in the treatment of bone metastasis].
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[Surgical treatment of ruptures of the rotator cuff of the shoulder].
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[Use of carbon fibers in repair of articular ligaments (experimental study)].
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[Knee prosthesis].
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[The surgical management of the forefoot in rheumatoid arthritis. A review of 150 cases (author's transl)].
The authors have performed 150 surgical procedures in 95 patients. In most of the cases, the procedure was a resection - realignment of the metatarsal heads. The results were assessed in 80 patients and were found to be satisfactory as regards pain and functional ability. Good results persisted as regards pain which remained absent in 90% of cases but the functional results tended to worsen with time. Good results being present in only 70% after a 10 year follow up. In 34 cases a prosthetic implant (Swanson type) was used. The results were deceptive.
[Ruptures of the rotator cuff. Results and perspectives of the retrostructure (author's transl)].
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[Pes anserinus transfer and medial transplantation of the tibial tubercle in the treatment of rotary instability of the knee (author's transl)].
23 cases of rotary instability of the knee have been reviewed with an average follow up of 5 years. They have been treated by a combination of pes anserinus transfer using Slocum's technique with medial transposition of the tibial tubercle. Functionally the results were satisfactory and there was no antero-posterior instability. No secondary patello-femoral arthrosis was seen. All the knees seemed to be more stable but most cases showed some degree of effusion, quadriceps wasting and some pain. It is concluded that this type of surgical procedure may provide a satisfactory knee for lighter sporting activities but not for competitive sport.
[Our experience with surgery of the rheumatoid metatarsus. 150 cases].
The authors report on the results of their experience with surgery of the rheumatoid metatarsus (95 patients operated on--150 operations). The operation most frequently performed was the Lelievre metatarsian resection-alignment. They confirm the advantage of this type of surgery, which provides very handicapped patients with substantial relief, both of pain and of the functional troubles, despite the nature of the disease involved. Out of 80 patients operated on and followed up over a period of 2 to 14 years, and considering the correction of the deformities, the effect on pain and functional troubles, the authors report 103 very good and good results, and 18 poor results and failures. The good results obtained deteriorate only very little in the long run: after 10 years, the very good and good results involving effect on pain, has gone from 96 to 90%. On the other hand, as far as functional troubles are concerned, very good and good results go from 90% to 70%. The authors underline the advantage of a very through examination, in order to look for post-operatory risk factors (peripheral circulatory deficiency and poor resistance to infection). They insist for exercising great prudence when advising an operation consisting of the interposition of an endoprosthesis (Swanson's implant). Indeed, in subjects who are in any way fragile, delays in scarification, related to hematomas complicated or not with skin necrosis appear with increased frequency after interposition of the implant.
[Total iliectomy with preservation of the lower limb (author's transl)].
We treated a chondro-sarcoma of the ilium by total resection of the hemipelvis preserving the lower limb. We describe our technique and give the fonctionnel result of this operation which we believe could in certain cases replace a hemipelvectomy.
Intraoperative hemodynamic changes during total knee replacement.
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[Pulmonary hemodynamic variations during total prostheses of the knee].
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[Surgical treatment of lumbosacral spondylolisthesis with gross displacement].
The authors studied the results of surgery for lombosacral spondylolisthesis with gross displacement. The technique of arthrodesis makes intersomatic fusion easy in displacement of grades II and III. This fusion, without reduction of the displacement, leads to good functional rsults climating low back pain, and most sciatic pain without which time would be necessary for posterior liberation at the olisthetic stage. The authors also believe that preliminary correction of displacement, although satisfying in orthopaedic terms but still difficult to achieve with current techniques, is at present rarely indicated.
[Recentering of the patella; treatment of choice in lateralised femoropatella arthrosis (author's transl)].
The authors have followed up for than 2 years, 22 cases of lateralised femoro-patella arthrosis treated by recentering of the patella. They confirm the value of this operation and emphasize the necessity of controlling the precise position of the patella during the operation. They also believe that one should avoid, especially if the treated arthrosis is not too advanced, perfect reaxation which may favour progressive narrowing of the joint space, once weight beraring is allowed and which may be the origin of the secondary functional degradation of this series.