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PubMed1981

[A study on the stress analysis of the pelvis by means of the three-dimensional photoelastic experiments (author's transl)].

The processes are as follows: 1) Life-sized photoelastic models molded from a cadaver pelvis are made of Epoxy resin. 2) In order to practice the stress freezing process, the models are set to our original loading apparatus in the electric heater. The forces exerted on the hip models are both body weight and four kinds of muscular forces, those of the abductor, adductor, rectus femoris and gluteus maximus. 3) After the stresses are frozen in the models, they are cut off into slices to observe isochromatic and isoclinic lines. 4) In the stress analysis both the shear difference method and the double slice method are utilized to obtain more accurate stress distributions. And the results have been summarized as follows: 1) In the ring-shaped slices large stresses are observed especially at four areas; namely the central area of the iliac bone, the acetabulum proximal to the ilium, the pubic ramus and the area adjacent to the sacroiliac joint. The specific areas where hydrostatic pressure works are seen at two points in the deep acetabular cavity. 2) The principal stress lines of almost all slices tend to flow smoothly and monotonously along the ilium, the sacrum and the pubic bone, but as they approach the acetabulum they run in complex patterns and make some singular points. 3) Around the acetabulum the principal stress lines of one group run in concentric circles and those of the other group radiate in all directions from the center of the acetabulum at the upper half of the dome which supports the load. The stress here was 5 to 6 times greater than in the lower half of the dome. 4) The acetabulum is stretched vertically and deformed into an oval shape. The horse shoe-shaped articular facet is deformed as both beaks approach each other. 5) As for the slices of the pelvic ring the normal acetabulum tends to be obviously deformed as it holds or embraces the femoral head. As a result of this deformity the stability between the acetabulum and the head increases. On the other hand the dysplastic acetabulum shows none of those phenomena. 6) The iliac bone of the pelvic ring is deformed into the "S" shape and the pubic ramus the "C" shape, the "S" shape, or the "Z" shape depending on the limb position. The pelvic ring tends to be deformed into a heart shape during abduction.

Acetabulum↗
PubMed1995

IgA nephropathy associated with hyper IgAnemia, psoriasis or pustulosis and ossification.

This is a report on two cases of IgA nephropathy associated with psoriasis vulgaris, having hyper IgAnemia (above 500 mg/dl) and ossification. Case 1 is a 47-year-old woman with a 7-year history of psoriasis vulgaris, and case 2 is a 57-year-old man with a 17-year history of this disease. IgA was 526 and 1,356 mg/dl, respectively. HLA analysis showed A2, A26 (10), Bw62 (15), Bw46, Cw3, DRw12 (5), and DRw8 in the former, and A2, A11, B13, Bw46, Cw11, DR4, and DRw8 in the latter. Renal biopsy specimens disclosed mild mesangial proliferative glomerulonephritis and moderate mesangial proliferative glomerulonephritis with predominant IgA deposition in mesangial area, respectively. A bone-scintigraphy revealed a high uptake of radioisotopes in the left shoulder, the vertebra, the sacroiliac joint, both sides of the knees and ankles, and the sterno-cost-clavicular area. An X-ray study showed ossification of the posterior longitudinal ligament (OPLL) in the former, and ankylosing spinal hyperostosis (ASH) in the latter. A review of the literature discloses three other case reports of hyper IgAnemia, IgA nephropathy, psoriasis or pustulosis, and ossification. The alertness of dermatologists, orthopedic surgeons, rheumatologists, and general practitioners will be required to attain to a more frequent diagnosis of the above combination.

Female↗
PubMed1995

Fatigue fracture of the sacrum in a child.

The authors describe a 9-year-old girl with stress fracture of the sacrum. Such fractures can cause low-back or hip pain in children but may not be evident on plain films. The appearance on scintigraphy is not diagnostic. Likewise, the findings on magnetic resonance imaging may be nonspecific or confusing, because changes in signal intensity in the marrow may not be sufficient to distinguish infection or malignancy from healing of the fracture. Computed tomography can be more specific in delineating a sclerotic fracture oriented parallel to the sacroiliac joint. Recognition of the characteristic radiographic findings in sacral fatigue fractures can prevent incorrect diagnosis and unnecessary diagnostic procedures or treatments.

Child↗
PubMed1995

The timing of ossification of the limb bones, and growth rates of various long bones of the fore and hind limbs of the prenatal and early postnatal laboratory mouse.

In order to study the pattern of ossification of the skeletal components of the fore and hind limb of the mouse, intact embryos were isolated between days (d) 15 and 19 of pregnancy (the morning of finding a vaginal plug is termed d 1 of pregnancy), and postnatal animals isolated on d 1 (newborns), 7 and 14 after birth. The total number of fore and hind limbs studied for each day of pregnancy or postnatal day for the bone growth study is given in parentheses: d 15 (2), d 16, 17, 18 and 19 of pregnancy (5 specimens for each of these days), d 1 (newborn), wk 1 and 2, postnatal (4 specimens analysed at each of these times), since only the right limbs were studied. For the study involving the time of first appearance of ossification centres, either the right or the left limb of each of these prenatal and postnatal specimens was analysed. All specimens were fixed in 80% ethanol, bulk-stained using alizarin and Alcian blue, in order to stain ossification centres and cartilage, respectively, and cleared. The limbs were then disarticulated from the axial skeleton at the sternoclavicular and sacroiliac joints to facilitate (1) the determination of the sequential pattern of ossification in the various cartilage primordia analysed, and (2) the analysis of the pattern of growth of the humerus, ulna, femur and tibia. The latter values were plotted graphically, and the individual growth rate of each of the long bones studied was then deduced and also plotted graphically. The findings demonstrated that, with the exception of the femur and ulna, all of the long bones studied had significantly different growth patterns. The time of appearance of the various centres of ossification in the skeletal elements studied proceeded in a similar order to that described by previous authors, though there was some discrepancy in the exact time of first appearance of certain ossification centres. Of particular interest was the somewhat unusual pattern of ossification of the first digits of both the fore and hind limb compared with that of the other digits. The data presented here provide useful baseline information on the normal sequential pattern of ossification in the fore and hind limb, and the characteristic growth pattern of the individual long bones of the limbs in this species.

Animals↗
PubMed1995

[CT-guided pelvic osteosynthesis. Preliminary report on a new operative technic].

The authors proposed new method for surgical treatment of slightly dislocated fractures of the sacrum and acetabulum and also small traumatic dislocations in the sacroiliac joint. Cannulated screws were used for percutaneous osteosynthesis under guidance of computerised tomography. CT guided surgery enables to choose the correct direction and length of introduced screws with regard to the shape and localisation of the fracture. During the step by step procedure the reduction effect can be directly checked and the surgical strategy immediately modified. The advantages of this method are minimal invasiveness, high accuracy and possibility of rapid mobilisation of treated patient.

Adult↗
PubMed1995

Postnatal back care.

Musculoskeletal damage can be a major postpartum problem, and, if left untreated, may affect a women for the rest of her life. Common problems include: Sacrococcygeal pain Symphysis pubis strain Sacroiliac joint strain Lumbosacral joint strain Cervical and dorsal strain. The author recommends osteopathic care continuing through pregnancy (except during the third month) until six months postpartum.

Back Pain↗
PubMedDate not supplied

Surgical correction of congenital kyphosis in myelomeningocele.

A progressive kyphosis in myelomeningocele patients may occur when the lesion is in the lower thoracic spine (i.e., a high-level lesion). Previously described techniques for this difficult problem have been fraught with problems of loss of fixation, recurrent deformity, implant failure, and wound breakdown. The technique described involves resection of the apical vertebra and proximal portion of the gibbus followed by fixation with a single U-shaped rod implanted distally into the lumbosacral spine. The rod is fixed to the thoracic spine using the Luque technique. No wires are used distally and the sacroiliac joints are not violated. This paper presents the first four patients who have undergone this form of spinal surgery. To date these patients have maintained a satisfactory result, and there has been no implant failure. Although this is a small series and with a short follow-up, the results support the use of this technique.

Adolescent↗
PubMed1995

Relaxin and its role in pregnancy.

Relaxin is a 6000-d polypeptide, structurally related to insulin and the insulin-like growth factors. Unlike insulin, the structure of which is remarkably well conserved among the vertebrates, relaxin sequences can vary by more than 50% between different species. Despite these large sequence variations, relaxins (with few exceptions) have very similar biologic activities in animal test systems. The reason for this has recently come to light: the receptor binding region of the B chain, in contrast to the rest of the molecule, is highly conserved between species. Relaxin is measured by bioassays employing interpubic ligament formation in mice and guinea pigs, and by inhibition of uterine motility. A more sensitive and efficient bioassay is urgently needed. In women, the target organs for relaxin are the uterine cervix, myometrium, endometrium, and decidua. Other presumptive but unproven targets are the pubic symphysis and sacroiliac joints, mammary glands, and pituitary gland. Circulating relaxin is secreted by the corpus luteum. The placenta, decidua, or both also produce relaxin, which does not enter the circulation but may act in an autocrine or paracrine fashion. hCG is a stimulus to luteal relaxin secretion. Other regulatory factors are poorly defined. Aluteal women are hyporelaxinemic, and yet are capable of normal vaginal delivery of their infants. Local effects of placental or decidual relaxin cannot be discounted in such subjects. Hyperrelaxinemia may occur in women with multiple gestations and ovarian stimulation, and may be associated with increased premature births. Serum relaxin also is elevated in pregnant diabetics, but its role in this condition has not been defined. Clearly, further investigations are needed to delineate the precise role of relaxin in human pregnancy.

Animals↗
PubMed1995

[Rheumatic diseases in China].

To determine the prevalence of rheumatic diseases in Chinese of Han nationality in the north and the south of China, samples of 4,192 adults in Beijing (north) and 5,057 in Shantou (south) area were studied. The same questionnaire was administered to each subject surveyed. Physical examinations were done in all who gave positive answers. For those who gave positive response to certain set of questions, blood antinuclear antibody and rheumatoid factor tests and radiographs of hand and/or sacroiliac joint were done. The prevalence of definite rheumatoid arthritis (RA) was 0.34% in the north (95% confidence interval 0.20-0.51) and 0.32% (0.95% CI 0.16-0.47) in the south and ankylosing spondilitis was noted in 0.26% of both samples (95% confidence interval in the north 0.11-0.42 and in the south 0.14-0.40). Only 3 cases of systemic lupus erythematosus in the north and one in the south were identified. General rheumatic pain was reported more frequently in the north. Lumbar problems were recorded on examinations 5 times more commonly in the north than in the south (men 25.0% vs 5.3%, women 38.0% vs 6.5%) and knee problems 10 times (men 24.0% vs 1.8%, women 36.0% vs 3.4%) more commonly in the north; the difference was greatest in the age of 55-64. A further study in the south is planned to assess the contribution of inter-observer error and/or difference in cultural response to the north/south difference observed in the prevalence of general rheumatic symptoms and back pain. A search for environmental risk factors such as climate, diet, degeneration or overuse would then be indicated to explain these differences.

Adult↗
PubMed1993

[Evaluation of diagnostic criteria for hyperostotic diseases on a series of skeletons. Epidemiological implications].

Three sets of diagnostic criteria for diffuse idiopathic skeletal hyperostosis were evaluated in 78 medieval skeletons from subjects aged 30 years or more at the time of death. Prevalence of the disease ranged from 7.6 to 11.5% according to the criteria used. Gross examination of skeletons was consistent with hyperostosis in 16.6% of cases. The lesions observed are described. A new set of criteria is suggested: 1) involvement of three vertebras (bridging of two intervertebral spaces) at the lower thoracic spine; 2) involvement of four vertebras (bridging of three intervertebral spaces) at any level; 3) flowing ossification along the anterolateral aspect of at least two contiguous vertebras; 4) enthesopathies without remodeling of the cortex symmetrically involving the posterior calcanei, olecranons, and upper patellas. Decreased disk height in elderly subjects and para-articular bony bridging of the sacroiliac joints do not rule out the diagnosis. The diagnosis is definite in patients with criteria 1 or 2, probable in patients with criteria 3 and 4, and possible in patients with criterion 3 or criterion 4.

Adult↗
PubMed1994

Psoriatic arthritis: a clinical, radiological and genetic study of 58 Italian patients.

It is well known that genetic heterogeneity and/or the complex interaction of several MCH-linked risk factors can explain the onset and the broad spectrum of Psoriatic Arthritis (PsA) from the clinical point of view. Fifty-eight patients with PsA (Moll and Wright criteria), 35 men and 23 women, mean age of 45, 14, were studied; all the patients were assessed by both clinical and radiological examination, with particular attention to the sacroiliac joints. HLA typing of the patients confirmed the association between PsA and HLA-B39 (p = 0.0008) and Cw6 (p = 0.0011). In addition a significant increase in DQ2 antigen (p = 0.004) has been found. No correlation of any particular HLA antigen with clinical subsets (oligo-polyarticular peripheral PsA, axial PsA and axial with peripheral PsA) or erosive incidence of joint involvement-generally related to the duration of the disease--was found.

Adult↗
PubMed1993

[Radiologic evaluation of the rotation center of the hip].

We studied 98 normal hips in 54 patients in order to assess precise settlement of the theorical hip center using the U landmark as reference i.e. determine A distance (vertical settlement) and C distance (horizontal settlement)) A being the vertical distance between U landmark and the femoral head center, C the horizontal distance between U landmark and the femoral head center. We found two indexes (A/E = 0.2 and C/D = 0.3) which allowed us to fix that center in vertical (A/E) and in horizontal (C/D) direction even in case of bilateral hip dysplasia, and which can be used either in pre-operative planning or in post-operative evaluation. D being the horizontal distance between the U landmarks, and E the vertical one between the U landmark and the sacroiliac joint.

Adult↗
PubMed1976

The association of HL-A B27 with Forestier's disease (vertebral ankylosing hyperostosis).

Despite the lack of apophyseal or sacroiliac joint involvement, Forestier's disease (vertebral ankylosing hyperostosis) shares with the inflammatory forms of spondylitis, the roentgenographic appearance of spinal new bone formation. Because of this apparent similarity, the prevalence of the HL-A B27 antigen was determined in 47 white patients with Forestier's disease. Sixteen of the patients (34 per cent) possessed the B27 antigen (P is less than 0.001). The mere presence of B27 therefore, does not confirm the diagnosis of inflammatory spondylitis in all patients with roentgenographic evidence of osseous bridging. Applying available epidemiologic information, these data further suggest that patients with the B27 antigen may be at substantial risk of developing Forestier's disease. As Forestier's disease and virtually all of the other B27 associated arthropathies manifest abundant new bone, an association may exist between this antigen and genes controlling new bone formation.

Aged↗
PubMed1993

[Osteitis condensans ilii].

OBJECTIVE: The description of a case of osteitis condensans ilii. DESIGN: Descriptive. SETTING: Base health area. PATIENTS AND OTHER PARTICIPANTS: A 24-year-old puerperal woman. INTERVENTIONS: Analgesic treatment. MEASUREMENTS AND MAIN RESULTS: We were presented with the history of a woman with low lumbar pain of a mechanical character, after a dystocial birth two months previously. The radiology showed a triangular bony condensation on the edge of the sacroiliac joints. CONCLUSIONS: Osteitis condensans ilii is a benign structure, almost only ever found in women who have borne children. Its presentation is asymptomatic or nonspecific (low lumbalgia). Its very specific radiological image needs to be distinguished carefully in order to avoid diagnostical confusion with ankylosing spondylitis and other causes of sacroiliitis.

Adult↗
PubMed1993

[Ankylosing spondylitis with acute anterior uveitis--correlation between HLA-B27 and clinical and radiologic findings].

Six cases of ankylosing spondylitis (AS) complicated with acute anterior uveitis (AAU) were reviewed. Clinical and radiologic findings of these cases were correlated with HLA-B27. All the patients were men; four of them were HLA-B27 positive, and two were B27 negative. The average age of onset was younger in B27+ patients than in B27- patients. Ophthalmologic study showed no definite difference in inflammatory change of AAU between B27+ patients and B27- patients. AAU in B27+ patients was completely cured in three months. A history of low back pain was more apparent in B27+ than in B27- patients. Three out of four B27+ patients showed complete bony ankylosis in sacroiliac joints, whereas no ankylosis was seen in B27- patients. CT scan was useful to demonstrate sacroilitis in cases with equivocal radiologic findings. Spondylitic changes were more extensive in B27+ than in B27- patients. The results support the concept that HLA-B27+ AS and B27- AS are different entities with similar phenotypic expression, and HLA-B27 is an arthritogenic gene in the Japanese population as well.

Acute Disease↗
PubMed1993

The treatment of acetabular fractures through the ilioinguinal approach.

The ilioinguinal approach was developed in 1965 as an anterior approach to the pelvis and acetabulum. Before this date, the Smith-Petersen incision or a modification of it called the iliofemoral approach provided the only access to the upper part of the anterior column of the acetabulum. In the current study of 195 acetabular fractures, the ilioinguinal approach was used alone in 178 cases (90%) and in combination with the Kocker-Langenbeck as a double incision in 17 cases (10%). There were 39 simple and 156 complex associated fracture patterns. There were two large groups of associated fractures: anterior column posterior hemitransverse (39 fractures) and both column fractures (98 cases). Of these fracture patterns stabilized through the ilioinguinal approach, there was a rate of perfect reduction of 85% and 73%, respectively. Of 70 fractures involving the anterior column, anterior wall, and anterior column posterior hemitransverse, there were 61 perfect reductions (87%). The complication rate was extremely low, without any evidence of external iliac fossa heterotopic ossification. The ilioinguinal approach provides total and complete access to the anterior column from the sacroiliac joint to the pubic symphysis. An experienced acetabular surgeon may achieve excellent results even with complex fracture patterns.

Acetabulum↗
PubMed1995

[Multifocal bone tuberculosis: apropos of a case].

INTRODUCTION: Tuberculosis of bone is rare (10 to 20 per cent of all skeletal tuberculosis). The multifocal form is exceptional even in endemic countries of tuberculosis. It constitutes less than 5 per cent of all osseous tuberculosis. CASE REPORT: O.H. 34 year-old, Moroccan woman of black race not vaccinated against tuberculosis, with a contagion, complained for a year from scapular pain and weight loss. She noticed that two masses had appeared six months ago. The patient was feverish (38 degrees). The physical exam showed a non inflammatory mass 10 cm wide located in front of the left sacroiliac joint and seeming to be a cold abscess. The radiologic assessment showed a lytic image of the humerus upper extremity, the right iliopubis branch, the left ischium and the left iliac wing. The surgical biopsy of the humerus showed an evolutive caseo-follicular tuberculosis. The nuclear scan of bone found two other localizations in the fourth lumbar vertebra and the ninth left rib. We concluded to a multifocal bone tuberculosis with seven localizations: The upper extremity of both humerus Right pubis Left ischium Left iliac wing 4th lumbar vertebra 9th left rib. The treatment consisted in a specific antibiotic therapy for 6 months associated to the evacuation of the cold abscess. DISCUSSION: Multifocal bone tuberculosis is more frequent in young adults of black race. The beginning of the disease is progressive and the fistulas are the main reason of consultation. The radiologic lesions are not specific and have a geodic shape rimmed with an osteocondensation. Multifocal bone tuberculosis in black african predominate in flat bones. Otherwise in the white race it is located in the long bones extremities. The diagnosis of certitude is based on histologic findings of the peripheric bone lesion. The specific antibiotic therapy leads to the recovery if given early. Short protocols (9 or 6 months) are recently more used with success.

Adult↗
PubMed1995

Anatomic considerations for dorsal sacral plate-screw fixation.

Five cadaveric pelves and 40 dry bony specimens were used to assess the feasibility of the lumbosacral plate fixation extending to beyond the S1 region and quantitatively to evaluate the posterior sacroiliac region and the dimensions of S1 and S2 pedicle and lateral mass. Partial removal of the posterior ilium was undertaken to measure the surface area available for plate fixation on the dorsal aspect of the sacrum. The results showed that the average distances between the outer edges of S1 and S2 dorsal foramina and the medial edge of the posterior ilium increased from 11.3 mm before removal of a portion of the medial posterior ilium to 16.6 mm after removal at the S1 level, and from 8.4 mm before removal of partial medial posterior ilium to 13 mm after removal at the S2 level, respectively. The average depths of the S1 and S2 pedicles were 37.1 and 32.2 mm in the direction anteromedial to the sagittal plane, respectively. The average depths of the S1 and S2 lateral mass were 37.3 and 33.9 mm in the direction anterolateral to the sagittal plane, respectively. In cases of vertebral metastases or osteoporosis, plating extending to S2 may be needed if good bony purchase cannot be achieved by the S1 pedicle or lateral mass screw. This study suggested also that partial removal of the posterior ilium enhances the space on the posterior aspect of the sacrum without severe compromise of the sacroiliac joint.

Aged↗