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PubMedDate not supplied

Greater sciatic notch in sex differentiation in Nigerian skeletal samples.

A total of 150 X-ray films (A-P view) of the pelvis of adult (90 male and 60 female) Nigerians were used to measure the width, depth, posterior segment, total and posterior angles of the greater sciatic notch. Index 1 was calculated by dividing the greatest depth OC by the greatest width AB and multiplying by 100. Index 2 was calculated by diving the posterior segment OB by the greatest width (AB) and multiplying by 100. These indices were used to study the sex differences in the hip bones of these Nigerians. Demarking points of these parameters and indices were worked out to determine sex. The width, depth, total angle and index 1 were insignificant in sex determination. Posterior angle and index 2 were found to be the most useful assigning sex to 74.5% of the male and 90% of the female bones.

Adolescent↗
PubMed2000

[Morpho-metrical features of the pelvis in standing posture].

The morpho-metrical features of the human pelvis differ according to gender, particularly with regard to size and shape, and bipedal standing posture appears to have been a major determinant of pelvic structure. In standing posture, the three points of the right and left superior anterior iliac spines and pubic tubercle are in contact with the vertical frontal plane. In this situation, the superior anterior iliac spine is lower than the superior posterior iliac spine. From a lateral view, the vertical line from the body's center of gravity passes through the center of the hip joint or acetabulum. The anatomical or biomechanical problem has been whether the line of gravity passes through the promontory or the center of auricular surface. To clarify this point, the three points of the acetabular center, promontory and auricular center were examined as to how they are positioned in relation to each other and the distance of each on the vertical frontal plane. Those measurements are as followed: A) distance between vertical frontal plane and promontory, B) distance between vertical frontal plane and anterior margin of auricular surface, C) distance between vertical frontal plane and mid-point of auricular surface computed from (B + D)/2, D) distance between vertical frontal plane and posterior margin of auricular surface, E) distance between vertical frontal plane and mid-point of acetabulum, F) inclination angle of the pelvis. From the results, the acetabular center and promontory are in alignment with the vertical line. The auricular center is positioned further back than the acetabular center or promontory. In this situation, the mean angle of inclination of the pelvis was found to be 63 degrees in 16 Japanese male specimens. The means of the other Japanese populations are into range of 63 degrees to 66 degrees in the males. If the auricular center coincides with the acetabular center, it is possible the angle of inclination of the pelvis would exceed 63 degrees. The frontal plane in contact with the right and left superior anterior iliac spines and pubic tubercle is not vertical. The morphological features clarified in the present study are that the promontory and acetabular center are in vertical alignment when viewed laterally and that the angle of inclination of the pelvis is 63 degrees.

Asian People↗
PubMed2000

[Implantation of iliosacral screws. Simulation of optimal placement by 3-dimensional X-ray computed tomography].

PURPOSE OF THE STUDY: Percutaneous iliosacral screws are used advantageously to fix unstable pelvic girdle avoiding the morbidity of open access for conventional screw fixation. The insertion technique must be precise due to the risk of injury to the lumbosacral nerve trunk, the cauda equina roots, and the first sacral nerve. We undertook a study of the implantation site of iliosacral screws looking for a means of standardizing the drilling procedure on the basis of 3D computed tomography (CT) data. MATERIAL AND METHODS: A CT series with 3D reconstruction was performed on 11 pelvis bones. We retained pelvis parameters and characterized the axis and narrow zone of the sacral wing. The insertion routes of 6.5 mm cancelous bone screws were simulated: two iliosacral routes fixing S1, and two iliosacroiliac routes fixing S1 and S2. The values of the pelvic parameters and the positions of the screws were compared with the Spearman correlation test and graphic regression. RESULTS: The pelvic incidence was a mean 47 degrees. The length of the sacral wing was a mean 73 mm. The narrow zone of the wing was 47 mm from the lateral iliac fossa. In the narrow zone, the wing section showed an oval shape: 22 mm largest diameter, 11 mm smallest diameter. The wing was oriented 84 degrees in the paracoronal plane perpendicular to the plane of the sacral plate, 67 degrees in the para-axial plane parallel to the sacral plate, and 37 degrees in the sagittal plane of the subject. The length of the upper S1 screw was a mean 80 mm. This upper screw was inclined 89 degrees in the para-coronal plant, 61 degrees in the para-axial plane and 28 degrees in the sagittal plane. The length of the lower S1 screw as a mean 80 mm. This lower screw was inclined 74 degrees in the para-coronal plane, 91 degrees in the para-axial plane and 110 degrees in the sagittal plane. The fixation screws could be inserted in 12 out of 22 cases. Correlations were found with height of the subject, length of the wing and the screw, and screw inclination. The inclination of the upper S1 screw in the para-coronal plane was correlated with the larger diameter of the sacral wing. DISCUSSION: The pelvis parameters measured were comparable with data in the literature. The very small dimensions of the narrow zone dictate a very precise drilling for the narrow zone. This narrow zone determines the inclination of the screw insertion. In the sagittal plane the standard deviation was very large making it impossible to interpret the data. The route of the upper screw runs obliquely forward in the plane parallel to the sacral plate. The lower screw runs upwardly in the plane perpendicular to the sacral plate. It does not appear possible to insert fixation screws in a routine procedure. Preoperative assessment would be necessary before percutaneous insertion. CONCLUSION: The 3D CT reconstructions of the sacral wing can be used to determine the precise optimal position of the two iliosacral screws. The principle orientations can be deducted from the plane of the sacral plate. Approximate indications can help reduce operative time and exposure to irradiation (patient and surgeon). Percutaneous iliosacroiliac screw fixation cannot be proposed for all patients.

Adult↗
PubMed2000

[Sagittal equilibrium of the pelvis: analysis of the inclination of the ischio-pubic ramus from the horizontal].

PURPOSE OF THE STUDY: The sagittal equilibrium of the spine and pelvis has been examined in numerous studies looking for the origin of certain posture disorders of the spine and the cause of lower back pain. Sagittal x-rays of the pelvis provide an analysis of the degree of inclination of the pelvis from the horizontal and the bi-coxo-femoral axis and information on the form of the sacrum. There is no radiographic parameter however which analyzes the transition between the pelvis-sacrum component and the femoral component, i.e. the periacetabular region. In the sagittal plane, a line tangent to the ischio-pubic ramus would appear to best reflect the orientation of the periacetabular region and the muscular forces applied to this region. The purpose of this work was to analyze the inclination of the ischio-pubic ramus from the horizontal and its relations with other sagittal radiographic parameters in a population of growing children with spinal disorders. MATERIALS AND METHOD: The study population included 100 children with spinal disorders who underwent a teleradiographic series with lateral view in the upright position. Most of the children had scoliosis (80 cases), 7 had kyphoscoliosis, 4 isthmic spondylolysis with spondylolisthesis, 1 spondylodiscitis and 4 lower back pain. Mean age was 13 years (range 2.5-22 years). We measured 7 radiographic parameters: lumbo-sacral angle, slope of the sacrum, pelvic version, incidence, thickness, overhang, and inclination of the ischio-pubic ramus from the horizontal. Data were analyzed to search for correlations between radiographic parameters and between radiographic parameters and clinical features. RESULTS: Mean inclination of the ischio-pubic ramus from the horizontal was 33.9 degrees (SD =5.9 degrees ). The only positive statistical correlation between the inclination of the ischio-pubic ramus and the clinical data was a relationship with the position of the arms compared with the horizontal (p =0.04). There was no correlation with age, sex, ethnic background, etiology. There was no correlation between the inclination of the ischio-pubic ramus and the other radiographic parameters (coefficient r ranging from 0.06 to 0.43). DISCUSSION: The interdependence of sagittal radiographic parameters of the pelvis and the spine have been largely demonstrated. Certain pathological situations (isthmic spondylolysis with spondylolisthesis, lower back pain, etc.) can be explained by the value of these parameters, particularly incidence. The inclination of the ischio-pubic ramus from the horizontal reflects the periacetabular region. When analyzed in the sagittal plane, it was found to be a more stable parameter, independent of most clinical criteria (particularly age, and etiology) and of the other radiographic parameters studied. The only determining factor appears to be acquisition of the upright position. The consistency of this parameter constrasts with the variability of the other radiographic parameters of the pelvis and the spine, particularly incidence, although the inclination of the ischio-pubis ramus is an expression of a region different than the pelvis. This study suggests that the periacetabular region plays a key role in acquisition of the upright position in humans. The periacetabular region would be a fixed point around which the lower limbs and spine describe varying orientations.

Adaptation, Biological↗
PubMed2000

Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Multicenter Project for Research in Osteoporosis.

The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck-shaft angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60-90 years) with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women; aged 60-90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly lower, and neck-shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45 (95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck-shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95% CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40 (95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.

Absorptiometry, Photon↗
PubMed1975

Disordered labor: objective evaluation and management.

Simplified techniques for analyzing the graphic patterns of dilatation and descent allow the practitioner to define aberrant labor using objective criteria for diagnosis. Six major disorders of labor are readily characterized. Once diagnosed, details concerning etiologic factors, efficacy of modalities of treatment, and prognostic outlook can be readily evolved. Programs of management are presented for each group of dysfunctional patterns based on such data. Introduction of the graphic analytic technique for diagnosing and managing labor adds a significant new dimension to our diagnostic potential and therapeutic capabilities.

Cesarean Section↗
PubMed2001

[Is CV measurement relevant for the verdict "vaginal delivery prohibited"?].

INTRODUCTION: The clinical significance of conjugata vera (CV) values for estimating the possibility of vaginal delivery when caesarean section (CS) has earlier been performed is uncertain and therefore the prognostic value of this parameter was examined. MATERIALS AND METHODS: We reviewed retrospectively the case notes of women who had had a CS or a vaginal delivery after a previous CS at the Department of Obstetrics and Gynaecology, County Hospital in Herlev, in 1998. For comparison of the results and statistical analysis, probability values (P) were calculated by logistic regression analysis. RESULTS: The study comprised 246 women, whose CV was measured during the current or a previously performed CS. The probability of an emergency CS in the 106 women with a history of CS showed a clear decline with increasing CV values, (p = 0.006). No obvious difference was found in the distribution of CV values in the 179 women with CS deliveries in 1998, when we compared the indications, "asphyxia" and "others", but it was significantly lower for the indication, "cephalopelvic disproportion" (p = 0.001). Taking into account the CV values, no association was evident between the birth weight, the height of the mother, or the CS probabilities. DISCUSSION: Our study demonstrated that CV values are considerably predictive of repeated CS; women with CV values < or = 11 cm have a probability of more than 50% for repeated CS and with CV values < or = 10 cm the probability rises to two thirds. CONCLUSION: CV measurement has value as a parameter in itself and can help the obstetrician to estimate the route of delivery at subsequent births. There is an obvious correlation between low CV values and the probability of CS with "cephalopelvic disproportion" as the indication.

Adolescent↗
PubMed1975

[Is a vaginal breech delivery still justified? (author's transl)].

In our series of vaginal breech deliveries the morbidity from hypoxia and acidosis showed no difference to the same type of morbidity in our series of breech deliveries by Caesarean section. The correct selection of cases, intensive monitoring during labour and the management of the second stage of labour as outlined in our paper are the most important perequisites which permit to plan and justify a vaginal breech delivery in present obstetric practice.

Acidosis↗
PubMed2002

Diagnostic X-rays and ultrasound exposure and risk of childhood acute lymphoblastic leukemia by immunophenotype.

The objective of this study was to evaluate the association between in utero diagnostic X-rays and childhood acute lymphoblastic leukemia (ALL) and the less well-studied relationship of this malignancy to preconception and postnatal diagnostic X-rays or fetal ultrasound exposures. The Children's Cancer Group conducted a case-control study including interviews with parents of 1842 ALL cases diagnosed under the age of 15 years and 1986 individually matched controls. Associations of self-reported parental preconception, in utero, and postnatal X-ray exposure with risk of childhood ALL were examined using odds ratios (ORs) and corresponding 95% confidence intervals (CIs) obtained from logistic regression models among the overall group of ALL cases as well as immunophenotypic and age-specific subgroups. Overall, in utero pelvimetric diagnostic X-rays were not associated with the risk of pediatric ALL (OR, 1.2; 95% CI, 0.8-1.7). Childhood ALL, all types combined (OR, 1.1; 95% CI, 0.9-1.2) and specific types were also not linked with postnatal diagnostic X-ray exposures. Neither maternal (OR, 0.9; 95% CI, 0.8-1.2) nor paternal (OR, 1.1; 95% CI, 0.8-1.4) lower abdominal preconception diagnostic X-rays were associated with risk of childhood ALL. Among the multiple comparisons for age-, sex-, and subtype-specific subgroups, we observed an elevated risk of total ALL among children ages 11-14 at diagnosis (OR, 2.4; 95% CI, 1.1-5.0) in relation to in utero pelvimetric diagnostic X-ray exposures and a small increase in pre-B ALL for all ages combined (OR, 1.7; 95% CI, 1.1-2.7) in relation to postnatal diagnostic X-rays. In utero diagnostic ultrasound tests were not linked with risk of childhood ALL. We found little consistent evidence that in utero diagnostic ultrasound tests or X-rays were linked with an increased risk of childhood ALL. Small increases in total or pre-B ALL risks for children in selected age groups to very low ionizing radiation exposures from postnatal or preconception diagnostic X-ray exposures may represent chance findings or biases. Future studies of diagnostic X-rays and childhood leukemia in the United States will require extensive additional efforts and resources to quantify risk because of declining in utero exposures in the general population (thus necessitating large numbers of subjects, particularly cases) and the difficulty in validating reported exposures.

Adolescent↗