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Biomedical subjects

J Dubousset

Publications and source records attributed to J Dubousset.

At least 91 records · Page 5Linked to original sources
PubMed1988

New universal instrumentation in spinal surgery.

A new instrumentation for posterior spinal surgery consists of metallic rods carved with diamond-shaped asperities on which vertebral hooks or screws can be screwed in any position, level, or degree of rotation. The rods are interlocked by means of devices for transverse traction (DTTs), rectangular constructs with multiple vertebral grips, the stability of which allows suppression of any postoperative external support. Initially designed to treat scoliosis, this instrumentation design allows mobilization of the vertebrae located at the apex of the curve and obtains a three-dimensional correction. Correction of the areas of the most important structural deformation can also be obtained at the level of the end vertebrae, without any need to resort to an important distraction force. The technique varies according to the various types of curvatures. Approximately 250 patients were operated upon from 1983 to 1985. In idiopathic scoliotic curvatures, the mean percentage of correction was 66%. An important improvement of the associated sagittal deformations and of the apical derotation was observed in flexible curves. In paralytic curves, particularly with a pelvic obliquity, the percentage of correction of the frontal deformation is 77%. All of the spine patients were ambulatory in the first postoperative week, without any external support, and returned to their school or family activities. In 43 patients with follow-up periods longer than two years, there were no technical errors in 38. The final angular loss of correction was less than 2 degrees in the error-free group.

Adolescent↗
PubMed1987

The radiological appearances of telangiectatic osteosarcoma. A study of 14 cases.

Fourteen telangiectatic osteosarcomas are reported. They are rare, clinically and radiologically aggressive lesions, involving mainly the femurs of young patients, often misdiagnosed as aneurysmal bone cysts. An explanation for a characteristic early radiological appearance consisting of regular parallel striations of the shaft is suggested.

Adolescent↗
PubMed1987

Histiocytosis X in the juvenile spine.

The authors studied 54 lesions, caused by histiocytosis X, that affected the spines of 28 children. The clinical, radiologic, biologic, and therapeutic aspects are described. The orthopaedic surgeon has a role to play in confirming the diagnosis, treating the lesion, and in following up.

Adolescent↗
PubMed1987

[The role of the pathologist in the treatment of osteogenic sarcoma].

The pathologist today has an important role in the treatment of osteosarcoma. He contributes during the operation by advising about the extent of the tumour and after the operation by studying the operative specimen to assess the extent of the tumour, and, when primary chemotherapy has been used, to estimate the effectiveness of the treatment by counting the percentage of viable tumour cells so that the type of chemotherapy used subsequently can be adapted to the situation. Only trained teams can make the best use of these studies.

Humans↗
PubMed1987

Treatment of adolescent scoliosis by the Cotrel-Dubousset method.

The new Cotrel-Dubousset segmental instrumentation systems allows the surgeon to correct scoliotic deformity in all three planes as well as providing such solid fixation that the use of external postoperative immobilisation is eliminated. The authors discuss the main theoretical concepts as well as its method of application.

Adolescent↗
PubMed1986

Histopathological predictive factors in Ewing's sarcoma of bone and clinicopathological correlations. A retrospective study of 261 cases.

A retrospective multifactorial analysis on 261 previously untreated patients with Ewing's sarcoma (Es) of bone has been carried out in order to ascertain the prognostic value of several histological variables on survival. Among those cases accepted as Es, 208 (80% of the patients) were considered to be "typical Es", while 40 (15%) displayed a large cell predominance, being subclassified as "atypical large cell Es". Furthermore, 13 patients (5%) possessed tumours of endothelial-like appearance. Eleven cases which displayed a mixed histological configuration were finally included within one of the three previous groups according to their predominant histological pattern. After adjustment for therapeutic regimens and initial location of the tumour, only two histological characteristics remain significant; i.e. the presence of necrosis (p = 0.002) and, to a lesser degree, the presence of filagree "en damier" pattern (p = 0.08), both of which are of poor prognostic value. From this study, it can be assumed that the morphological (and possibly histogenetical) heterogeneity of Es of bone has no prognostic influence on survival.

Bone Neoplasms↗
PubMed1986

[Pre- and postoperative anatomo-clinical correlations apropos of 30 conservative resections of osteogenic sarcomas. Surgical inferences].

The extent of osteogenic sarcoma has been measured in 30 bones obtained after local resection and compared with pre-operative evaluation. In only one case was the articular cartilage involved and the whole joint was resected. Other cases with a metaphyseal localisation were treated by disarticulation. Articular cartilage appears to provide good protection against local extension. In contrast, the growth cartilage, which was present in 11 cases, was crossed by tumour on three occasions. In only one case of diaphyseal localisation was a resection made across the tumour which had been previously rendered necrotic by chemotherapy. In most of the diaphyseal localisations, the post-operative study revealed that the resection had been over-extensive. Tomodensitometry is not very reliable in the precise evaluation of the extent of diaphyseal involvement.

Bone Neoplasms↗
PubMed1986

Torticollis in children caused by congenital anomalies of the atlas.

Hemi-atlas is a rare congenital anomaly in the formation of the first cervical vertebra. It may cause a rather severe and progressive torticollis. When a child is young, the neck, despite the deformity, is flexible and the torticollis can be passively corrected. However, in some patients it becomes increasingly severe and fixed. I describe the findings in seventeen patients, seven of whom were operated on between 1975 and 1983. Treatment with a brace was shown to be ineffective. In patients with severe deformities, fusion of the upper part of the cervical spine is recommended. Fusion was obtained in all seven patients in whom it was attempted, and there was good postural correction in all. Early operation is recommended if the deformity is increasing. Gradual correction in a halo cast followed by posterior fusion is recommended as the treatment of choice in patients with severe torticollis.

Adolescent↗
PubMed1985

Problems and pitfalls in the use of computed tomography for the local evaluation of long bone osteosarcoma: report on 30 cases.

Forty-eight, computed tomography (CT) examinations undertaken in 30 patients with osteosarcoma of long bones were studied in detail, their diagnostic information being compared with that obtained from corresponding plain films. The latter were of more value in assessing peripheral bony involvement, by cortical extension and periosteal reaction, while the former, in general, permitted more accurate observation of extensions into adjacent soft tissues. Recognition of such extensions, however, was vitiated when they arose in relation to the proximal ends of the tibia, fibula, and humerus and when a haematoma had developed as a result of a biopsy. Plain films were also of more value in appreciation of response to chemotherapy. On the other hand CT is the only examination which permits a satisfactory study of intramedullary extensions of the tumour and in consequence is invaluable in determining the exact sites required for local resection. No cases of skip metastases were observed in our series, although similar appearances due to nutrient vessels or bony ridges, remote from the primary tumour, were noted on several occasions. Differentiation of these densities proved to be easy, particularly in the case of nutrient vessels when examination of the contralateral bone showed them to be symmetrical. Several authors have described the role of CT in the evaluation of local extensions. This paper reports the difficulties and errors encountered by us.

Bone Neoplasms↗
PubMed1985

[Conservative surgical treatment of osteogenic sarcoma of the limbs. Technics and functional results].

Sixty-three osteogenic sarcomata of the limbs in patients aged between 10 and 20 years were treated by en bloc resection combined with chemotherapy. A review was made after an average follow-up of less than four years, which is too short a time to assess the carcinologic value of this type of treatment but sufficiently long to assess functional results and surgical technique. The resection was made through apparently normal tissues, thanks to meticulous pre-operative investigation and an appreciation of the extent of the tumour at operation. The tissues contaminated by a biopsy were removed. Three local recurrences were seen and in three other cases further extension in the operated limb was due to metastases. Reconstruction almost always utilised inert prosthetic implants often made during the pre-operative phase of chemotherapy. In cases of resection of the upper tibia an original procedure was developed to reconstruct the quadriceps using muscle-plasties. In 32 out of 39 knees, the immediate functional result was good. Only 10 still survived after two years, with nine good functional results. The authors conclude that en bloc resection is preferable to amputation in young patients both for those who will have a limited survival and those who will have long survival because of improvements in chemotherapy treatment. The risk of secondary loosening requires the use of more grafting procedures in reconstruction.

Adolescent↗
PubMed1985

[Reinforcement of the tension of the knee extensor apparatus in triple-flexion gait in children with motor disorders].

Surgical reinforcement of the knee extensor mechanism produces improvement in gait in children with cerebral palsy who walk with a crouch gait with flexion of the hips and knees. In these patients, the defect is related to excessive length of the patellar tendon as shown by the presence of greater passive extension than active extension of the knee, and a high position of the patella on lateral radiographs of the knee. Surgical treatment combines shortening of the patellar tendon with lengthening of the hamstrings and tenotomy of the rectus femoris. In a series of eighteen patients, the authors obtained fifteen satisfactory results, the procedures being performed bilaterally. The average follow up was four years. These results are compared with those obtained by other methods.

Adolescent↗
PubMed1984

[A new technic for segmental spinal osteosynthesis using the posterior approach].

The authors have designed a new method of instrumentation aimed at obtaining a surgical fixation of the scoliotic curve without any post-operative external support. It is particularly strong and rigid and allows an adequate reduction of the curve. This technique avoids the sublaminar space and thus prevents excessive blood loss and diminishes the danger of cord damage. The instrumentation is made of two parallel rough cylindrical rods inserted independently in the convexity and the concavity of the curve. If necessary they can be bent pre-operatively. They are attached to hooks placed on the laminae or pedicles which are locked by bolts thus allowing progressive straightening of the curve. They are joined by two transverse bars, one above and one below to provide better rigidity to the device and allow correction of rotation. The parts of the vertebrae left free by the device are denuded to allow the addition of grafts. Laboratory tests have demonstrated that this type of fixator is more rigid than the Harrington or Luque rods. Fifteen patients, either idiopathic or paralytic cases were operated on without any neurological impairment. No loss of correction was observed since the hooks have been locked.

Adolescent↗
PubMed1983

[Role and indications for surgery in Duchenne de Boulogne muscular dystrophy with rapid development].

One hundred and fifteen children suffering from muscular dystrophy had been treated surgically during the previous 12 years. The aim of the treatment was to slow the progression of development of spine deformity and obtain a prolongation of walking and standing ability. The indications for surgery were in relation to trauma in 17 cases or for progressive lower limb or spine deformity. In walking patients (21 cases) surgery was indicated only for contractures limiting walking ability. Surgery was also indicated in 35 cases soon after walking capability had ceased. In these cases correction of deformity allowed children to walk again with calipers for an average of 3 years. In 37 cases surgery was performed only to allow standing or to prevent or delay the development of spinal deformity. The indications for extensive spine fusion are discussed in relation to the speed of development of deformity, the pulmonary vital capacity, the dynamometric estimation of muscle strength, and the estimated duration of survival. Human, family and ethical factors are discussed.

Adolescent↗