[The normal manubrio-sternal joint. Examination technic and study of variants].
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In 19 patients with ankylosing spondylitis, 11 presented some lesions of the manubrio-sternal joint. In 3 cases these lesions were more advanced than the sacro-iliac alterations which were very slight or even doubtful. In 8 patients with severe Reiter's disease, 7 developed an ankylosing spondylitis and 2 presented involvement of the manubrio-sternal joint 8 weeks, respectively 10 weeks after the appearance of the first symptoms.
An analysis of 14 patients with cleft sternum is presented. Eleven patients were operated upon. A classification of this defect is proposed. The clinical picture of each type of cleft sternum is given with a description of the operative technique. There were no lethal outcomes. Remote results were good.
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The manubrio-sternal joint was studied in 168 subjects divided up into two groups : one group of 80 control subjects and one group of 88 patients with chronic inflammatory rheumatism divided up into 3 sub-groups (rheumatoid arthritis 54 ; ankylosing spondylitis 25 ; peripheral psoriatic rheumatism 9). This was a clinical study (search for spontaneous and induced pain) and a radiological study (A.P. and lateral views) with classification in 5 groups : 0 normal appearance, 1 hazy appearance of the joint space, slight narrowing of the joint space, slight osteoporosis and/or subchondral bony condensation ; 2 irregularity of the margins of the joint space, increased osteoporosis and/or condensation, narrowing of the joint space ; 3 increase in the previous signs, erosion, vacuole formation ; 4 partial or total fusion. The results show that only spontaneous pain and the radiological appearances of class II and class III permit one to differentiate in a statistically significant way the control group from the rheumatism group. considering these data one may note a greater frequency of the clinical and radiological signs, together with greater clinical and radiological agreement in ankylosing spondylitis than in rheumatoid arthritis. The interest of a study of the manubrio-sternal joint in the early diagnosis of ankylosing spondylitis is recalled although the involvement of this joint is usually later than the sacro-iliac joint.
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A case of partial sternectomy for metastatic thyroid carcinoma is reported. En bloc excision was followed by reconstruction using a molded plate of methylmethacrylate. Sternal tumours are rare and operations for cure of metastases are justified only if the general condition of the patient permits and in the patient with a single metastasis whose primary cancer operation was a radical one. Extensive en bloc excision is based on preoperative investigation in which computerized axial tomography has an important place in delineating the extent of the tumour and providing accurate knowledge of the margins of the section. Reconstruction with methyl-methacrylate allows a rigid setting with a material that can be molded, is radiolucent, inert and well tolerated. In the upper sternum it contributes to the stability of the shoulder girdle and protects the underlying mediastinal structures in a cosmetically acceptable way.
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Manubriosternal joint involvement in rheumatoid arthritis is not rare and may be evidenced by erosion, reactive sclerosis and ankylosis. Frequent reports of such involvements appear in the radiological literature but only 3 cases where this had been associated with clinically evident subluxation of the joint have been reported previously. It is, nonetheless, our observation that clinical deformity of this joint is common and careful review at our clinic has revealed the 10 cases reported here. Chronic or recurrent chest infections have been incriminated in the production of this deformity. However, the evidence seen in our series suggests rather, that this deformity is closely associated with severe cervicodorsal spinal erosion and deformity and that its presence should alert clinicians to potential problems of cervical cord compression.
Sternal tumors are rare. The surgical indication in case of metastasis is only justified if the primitive tumor is considered cure and with solitary metastasis. The en-block surgical resection must be based on pre-operative exploration in which a thoracic CAT SCAN has a very important role to determine the extent of the tumor and the anatomico-pathological control of the margin of resection during surgery. The reconstruction using methyl-methacrylate plate is interesting because of its rigid mounting by a moldable substance during surgery, being radiotransparent, inert and well-tolerated by the organism. On high sternal position it contributes to stabilize the scapular belt and assures mediastinal protection. The authors present a case of a partial sternectomy due to metastatic thyroid carcinoma with en-block resection and reconstruction by a methyl-methacrylate moulded plate.
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Manubriotomy was performed in 11 cases of retrosternal goitre or extensive thyroid cancers. The advantages of this method, which is described in detail, are that sternotomy can be avoided in the majority of cases, and that the postopeuative period is particularly straightforward.
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