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Biomedical subjects

C Argenson

Publications and source records attributed to C Argenson.

At least 19 recordsLinked to original sources
PubMed2001

[Videoscopic retropleural and retroperitoneal approach to the thoracolumbar junction of the spine].

PURPOSE OF THE STUDY: A minimally invasive anterior approach has been developed for the thoracolumbar junction of the spine. The aim of this study was to evaluate the possibilities of videoscopic treatment of fractures and malunions of the thoracolumbar junction and to report the first results obtained with this technique. MATERIAL AND METHODS: Video-assisted surgery was performed in eleven patients using costal resection and a retropleural and retroperitoneal approach. Anterior arthrodesis was performed in all cases, four with anterior instrumentation. The indications were trauma for six patients and malunion for five. RESULTS: Mean follow-up was 17.4 months. For malunion patients, the mean angular gain was 22.4 degrees. Radiological anterior fusion was achieved in all cases except one. The mean angular loss was 5.7 degrees. DISCUSSION: The surgeon can control the procedures by direct vision, while the assistant follows the operation on the video display screen. The upper par of L1 can be reached via a supradiaphragmatic retropleural approach, while a larger exposure is possible if the insertions of the diaphragm are released and the retroperitoneal space is opened. The crus does not have to be sectioned to expose the lateral part of the thoracolumbar vertebrae. Possible complications are similar to those which can be observed with open procedures. CONCLUSION: The videoscopic approach enables the exposure of throacolumbar junction with a smaller parietal lesion than with open procedures. It enables arthrodesis procedures with corporectomay, angular correction and anterior osteosynthesis.

Adolescent↗
PubMed2000

Five years' experience of the retroperitoneal lumbar and thoracolumbar surgery.

Retroperitoneal videoscopic spine surgery has been developed in our department since 1994. It has been used not only at the lumbar, but also at the thoracolumbar and lumbosacral level. Thirty-eight patients have been operated on. We have performed 12 thoracolumbar approaches, 23 lumbar approaches, and 3 retroperitoneal lumbosacral approaches. In every case, a video-assisted technique has been employed. These techniques have been used for anterior grafting in 18 cases of fracture, for corporectomy and grafting with or without anterior osteosynthesis in 6 cases of malunion, for cage implantation or isolated grafting in 10 cases of degenerative disc disease, and for the treatment of 4 cases of spondylodiscitis. Results were satisfactory for every type of pathology. The complications related to the approach were the same as those seen with open surgery; however, the videoscopic approach seems to us less invasive, with cosmetic benefit, less blood loss, and more rapid recovery. A video-assisted technique appears to be a good compromise between videoscopic technique and open surgery. With the development of these techniques, few indications remain for open anterior surgery on the lumbar spine in our opinion.

Adolescent↗
PubMed2000

Traumatic rotatory displacement of the lower cervical spine.

The authors describe the classification for traumatic rotary injuries of the cervical spine. The classification is based on a review of 306 severe lower cervical spine injuries observed in 255 patients between 1980 and 1994. Traumatic rotatory displacements (TRD) represented 39% of the 306 severe injuries. Three different lesions were observed: unilateral facet fractures, fracture-separation of the articular pillars, and unilateral facet dislocations.

Cervical Vertebrae↗
PubMed1999

[Prognostic factors during rehabilitation after shoulder prostheses for fracture].

PURPOSE: To evaluate the role, the difficulties of rehabilitation and to diagnose the eventual surgical complications after shoulder prosthesis for 4-part fractures. MATERIAL AND METHODS: Forty three patients (46 shoulders) who underwent shoulder arthroplasty after fracture of the proximal humerus underwent rehabilitation and follow-up at a special reeducation center for an average of 3 months (1 to 6). There were 42 four-part fractures (with 22 fracture-dislocation) and 4 three-part fractures. The patients were send by five different hospitals and have all been operated by senior surgeons. Three types of implants were used: the Modular Shoulder prosthesis (27 cases), the Global prosthesis (2 cases), and the Aequalis prosthesis (17 cases). The rehabilitation followed the protocol recommended by Neer (recovery of passive joint movements, muscular strengthening and stretching) to which were added hydrotherapy, physiotherapy and occupational therapy. Forty patients (43 épaules) were reviewed and radiographed with an average follow-up of 29 months (18 to 72 months). RESULTS: The functional results were disappointing with a normalised Constant score of only 60.2 per cent and an average active elevation of only 96 degrees. There appeared to be two factors which explained these poor results. Firstly, the advanced age of the population (52 per cent older than 70) who was often poorly or non-motivated (22 per cent) and debilitated (21 per cent chronic alcoholics) and who had significant medical and neuro-psychiatric histories. Secondly, incompletely resolved anatomical and surgical problems: damage to the circumflex nerve (6.5 per cent), early migration of the greater tuberosity (6.5 per cent), secondary migration with malunion (15 per cent) and/or nonunion (11 per cent) of the greater tuberosity. Migration of the greater tuberosity should be suspected clinically in three circumstances: 1) in patients who have an abnormally painful shoulder in the immediate post-operative period (16 cases in our series); 2) when there is no progression (24 per cent) or regression (9 per cent) of active shoulder mobility after three months of correct supervised rehabilitation; 3) later, if there is a dissociation between active anterior elevation (deficient) and passive anterior elevation (preserved). DISCUSSION AND CONCLUSION: The age and poor general condition of the patients as well as the difficulty of the surgical technique more than the rehabilitation, explain the disappointing results observed after shoulder prosthesis for four-part fractures. The discrepancy between active and passive elevation suggests that limited motion is not caused by a stiff shoulder because of glenohumeral scarring but instead by weakness of the deltoid (because of axillary lesion) and/or of the external rotators (because of greater tuberosity migration). There is some discordance between the necessity to early mobilise the shoulder and the high rate of tuberosity migration.

Adult↗
PubMed1999

[Retroperitoneoscopic anterior approach to the L2, L3, L4 vertebral bodies].

PURPOSE OF THE STUDY: We present a technique of retroperitoneal video assisted anterior approach of vertebral bodies and adjacent discs on L2-L3-L4 levels without CO2 insufflation. MATERIALS: A videosurgical material is required as well as fluoroscopic control. Ordinary anesthesia methods can be used. The patient is placed in right lateral decubitus. Ay. A3 cm incision is targeted moderately anteriorly at the level of the vertebra. Dissection of the retroperitoneal space is begun by blunt finger dissection and completed by a balloon. A camera is inserted. CO2 insufflation is not used for this open video-assisted technique. METHODS: We have performed 12 arthrodeses with this technique, 11 of them without corporectomy. In one case, a corporectomy with peroneal graft was used. RESULTS: Eleven arthrodesis fused. The possible complications are the same as with a full open procedure. DISCUSSION: Extension of this approach is limited cranially by the 12th rib and caudally by the iliac crest. CONCLUSION: Although this is an easy to perform mini open technique, a learning curve is necessary. Conservation to a full open procedure is possible at any point in the procedure.

Dissection↗
PubMed1999

[Plea for accelerated rehabilitation after ligament plasty of the knee by a bone-patellar tendon-bone graft].

Knee rehabilitation after ACL repair with bone-tendon-bone graft is still controversial. While there was a tendency to protect the graft and the donor site in the eighties, actual tendency is to propose more aggressive, so called accelerated rehabilitation protocol. An extensive analysis of the literature shows that this accelerated rehabilitation is justified because of histologic, biomechanic, surgical and clinical arguments. This accelerated rehabilitation is based on seven reasons, at least: 1) the necrosis of the graft, initially observed in animals, does not seem to be as important in humans as demonstrated by histological studies after in vivo biopsies; 2) the use of solid bone-tendon-bone graft, whose resistance is maximum in the early post-operative period and is superior to the resistance of the ACL; 3) the more precise positioning (more "isometric") because of optic magnification allowed by arthroscopy; 4) the absence of graft impingement, routinely controlled, because of a more posterior tibial placement of the graft and the eventual notch-plasty; 5) the solid and confident fixation of the graft because of interference screws; 6) anterior knee pain are less important when early constraints are applied on the knee; 7) finally, undisciplined and demanding patients who refuse all protection for the graft and the donor site, have good and stable results regarding stability of the knees. Early constraints on the knee after bone-tendon-bone graft and interference fixation give better tolerance on the extension mechanism without compromising integrity of the graft and knee stability. Appropriate level of constraints on the ACL graft and the donor site guides the collagenic reorganisation process. Early restoration of normal hyperextension, decreased knee pain and maintenance of muscular trophicity, allowing patients to go back to sport at 4 months, are the most evident benefits of this accelerated rehabilitation. These considerations cannot be applied to the other grafts (fascia lata, semi-tendinous, allografts ...) and to other ways of fixation (sutures, staples, ...).

Animals↗
PubMed1998

[Amelioration of perioperative somatosensory evoked potentials in the surgery of injuries of the spine].

Somatosensory evoked potentials were performed in 38 patients with traumatic spine pre, per and postoperatively. In 3 cases, the S.E.Ps altered before surgery, were improved after decompression and reduction. This S.E.Ps improvement was associated to clinical improvement. Even though this study was carried out on few cases, it shows prognosis and diagnosis value of intraoperative S.E.Ps in traumatic spine surgery.

Adult↗
PubMed1996

Short device fixation and early mobilization for burst fractures of the thoracolumbar junction.

The authors present a retrospective study based on a homogeneous series of 34 patients with burst fractures of the thoracolumbar junction, fixed using Cotrel-Dubousset instrumentation. These patients underwent instrumentation using a short construct of hooks and screws gripping the two vertebrae above the lesion (2HS) and screws and hooks gripping the first vertebra below the lesion (1SH). This construct was therefore called "2HS-1SH". In order to evaluate just the material resistance after getting up, only the patients who were upright on the 4th day without a body cast and with no secondary anterior osteosynthesis were included in this study. Four patients showed some neurological symptoms on admission but recovery was so quick that they could be included in this study. Mean follow-up was 4 years 1 month (range 3 years 1 month and 6 years 2 months). Vertebral and regional kyphosis angles were measured preoperative, postoperatively and at the final follow-up. Functional recovery and complications were analyzed. Mean vertebral kyphosis was 21.2 degrees preoperatively, 3.8 degrees postoperatively and 5.3 degrees at the final follow-up. Regional kyphosis angles were respectively 19.2, 0.2, and 2.7 degrees. We had two cases of deep suppuration, one early and the other late. None of the patients required analgesics for more than 6 months after the operation. Patients returned to work after 5 months on average. The authors concluded that fixation by screw-and-hook constructs is an effective way to stabilize thoracolumbar junction burst fractures.

Adolescent↗
PubMed1996

New possibilities in L2-L5 lumbar arthrodesis using a lateral retroperitoneal approach assisted by laparoscopy: preliminary results.

Four patients underwent lumbar interbody fusion, performed via a video-assisted retroperitoneal laparoscopic approach, complementary to posterior osteosynthesis at the L2-L3, L3-L4 and/or L4-L5 level. In three cases the interventions were for lumbar fractures, and in one case for microcristalline arthritis. After surgical training on human cadavers and several porcine operative sessions, retroperitoneal lateral approaches on the left side were performed by the authors without CO2 insufflation, assisted by videoscopy. The fusion process was monitored by fluoroscopy. It is possible to perform this technique cranially above L2 or caudally below L5. Minimal blood loss was observed. Average time for these interventions was 127 min. Interbody fusion was achieved in the first, second and fourth cases; the outcome in the third case at the final check-up, 6 months after operation, was uncertain. The first patient had a complication of ureteral wound, which was certainly caused by insufficient experience with the new technique. The authors hope to extend the application of this technique to other procedures as they become more experienced.

Adult↗
PubMed1996

[Coral as support of traumatic articular compression. A prospective study of 23 cases involving the lower limb].

INTRODUCTION: Infection risk makes the management of a bone bank more and more difficult. On the other hand, realizing an autologous graft is not always without consequences. That is why we estimated the mechanical quality, the osteo-integration and the biocompatability of a coral graft. MATERIAL AND METHODS: Between 1988 and 1992, two of us systematically used coral graft as "support" after lifting of some articular depression in fractures of inferior limb. Osteosynthesis was systematically associated. In this way, we operated 13 fractures of the lateral tibial plateau, 8 thalamic fractures of the calcaneus and 2 fractures of the inferior extremity of the tibia. Average follow-up is 20 months, with extremes of 68 and 12 months. Material ablation was realized 13 times and coral graft biopsy 4 times. Bone integration was estimated radiologically in 3 stages: stage 1: non union = "margin" around the coral, stage 2: possible integration = the coral is perfectly visible, but its borders grow indistinct, stage 3: certain integration = peripheral disparition of the coral weft, radiological interpenetration between coral and bone framework. We systematically searched for secondary displacements and complications. RESULTS: Mechanical conditions were respected, there was no secondary displacement. "Possible integration" (stage 2) was found in 8 cases at an average follow-up of 20 months. In 9 cases, we found "certain integration" (stage 3), at an average follow-up of 28 months. It is possible that a more important follow-up time would allow to find more integration cases. Biocompatibility is debatable under the operating conditions of the authors. We counted 5 aseptic serous flows which continued to be aseptic (1 tibial plateau, 1 inferior extremity of the tibia, 3 calcaneum). Three coral grafts were removed to obtain healing. DISCUSSION: When biocompatibility is satisfactory the integration is certain. The longer the follow-up time, the more stage 3 cases can be observed. Nevertheless, this integration runs out with time. We did not find any explication to aseptic serous flows. It may result from some impurities. On the other hand, use of the coralin hydroxyapatite does not seem to drive to allergic complications. CONCLUSION: In accordance with this study, we use the coral graft only in case of tibial plateau fracture. Our experience with coral graft in the other fields of bone surgery is not sufficient to express an opinion.

Adult↗
PubMed1994

Motorcycle petrol tanks and their role in severe pelvic injuries.

Between 1985 and 1992, nine patients who sustained severe pelvic lesions as a result of motorcycle accidents were admitted to and treated in the authors' department. In six of these nine cases the petrol tank of the motorcycle was one of the wounding agents, and all six patients had the same kind of motorcycle with an oversized petrol tank. All six patients had unstable pelvic lesions. In addition, four had subperitoneal haematomas which required multiple transfusions; five had perineal and/or genital lesions, and one had a ruptured membranous urethra. Severe pelvic injuries are rare, but can have after-effects which jeopardize the social and family life of the patients. A national epidemiological study would be useful to evaluate the frequency of such injuries and to draw conclusions leading to improved safety for motorcyclists.

Accidents, Traffic↗
PubMed1994

Pedicled greater omentum transferred to the spine in a case of postoperative infection.

An alternate surgical treatment was proposed in a case of vertebral postoperative chronic infection. The combination of an anterior omental flap with a posterior internal fixation plus bone grafting was successful, allowing the patient to walk 8 weeks after surgery. This relatively short recovery period compares favorably with the long months of confinement to bed usually required after an all-anterior approach with bone grafting only.

Humans↗
PubMed1994

[Letournel's ilio-femoral way in acetabular fractures of the two columns. A prospective study].

PURPOSE OF THE STUDY: The authors present the anatomical and functional results of the systematic use of Letournel's extensive lateral approach for internal fixation of the fractures of the acetabulum involving the two columns. MATERIAL: This prospective study concerns 25 patients. Mean age was 38 years. Mean follow-up was 4 years and 6 months (with extremes of 1 year and 9 years 9 months). 13 cases had a minimum of 4 years of follow-up. There were 1 transversal fracture, 9 transversal fractures associated with a posterior wall fracture, 2 anterior column fractures associated with a hemitransversal posterior fracture, 6 "T" shaped fractures, 7 fractures of the two columns. During the procedure, a trochanterotomy was carried out. Not any of the patients was irradiated postoperatively and they did not take any indomethacin. The patients were operated on 10 days after the accident, on average (with the extremes of 2 and 60 days). The average time of the procedure was 4 H 20 and 1080 cc of globular sediment were used during the intervention on average. The same surgeons participated in each operation. METHODS: The anatomical results were analysed according to Matta's criteria and the congruence study head-roof and head-acetabulum of the SOFCOT symposium in 1981. The functional results were analysed using the quotation of Merle d'Aubigné. Complications were searched systematically. The appearance of heterotopic ossifications was analysed according to Brooker. RESULTS: 23 patients had a satisfactory anatomical reduction and 11 patients out of 13 did not present any arthrosis after a minimum of 4 years follow-up. 12 patients had very good or good functional results. 3 patients had no heterotopic ossifications, 7 were grade I, 5 grade II, 8 grade III, and 2 grade IV. The gluteus medius was quoted 4 in 18 patients and 5 in 5 patients. There were 2 cases of deep suppuration, one of them was a patient who died 6 months later of a pancreas cancer unrecognized at the time of the accident. There were 5 aseptic osteonecroses and 3 cases of regressive paralysis of the sciatic nerve. 4 total hip prosthesis were inserted secondarily. DISCUSSION: The Letournel extensive lateral approach was efficient to obtain an anatomical reduction but, functionally, it was only efficient in one case out of two. For the moment, the authors associate systematically a postoperative irradiation to reduce the ossifications (10 to 12 gray in 5 sessions). On the other hand, they try to obtain a more efficient reinsertion of the glutei muscles, thank to a bone fragment of the iliac crest. CONCLUSION: The authors limit their indications of the Letournel's extensive lateral approach to the fractures of the two columns, not older than 10 days or to the comminuted ones.

Acetabulum↗
PubMed1994

[Triple and quadruple images in scan of fractures of the articular processes of the lower cervical spine].

The authors describe the triple and quadruple image aspects of the articular pillar, which are encountered respectively in one-sided uni- and biarticular fractures of the lower cervical spine, and they have analysed these images' specificity from a retrospective study. This study concerned 52 cases out of a group of 220 patients hospitalised between 1979 and 1992, with an injury of the lower cervical spine and who underwent a CT-scan examination in addition to the conventional radiographic check-up. Among a total of 70 lesions, 14 uniarticular and 4 biarticular one-sided fractures were recorded. All presented these characteristic aspects, formed by the separated fragment of the articular process; the unseparated component of the process and, concerning the triple image the intact process, or concerning the quadruple image the fragments of the second fractured process. An only case of a transisthmian fracture associated with a fracture of the lower articular process showed a similar aspect, which underlines the high specificity of these images.

Cervical Vertebrae↗
PubMed1994

[Modular construction (2 HS-1 SH), using Cotrel-Dubousset's universal instrumentation for comminuted fractures of the thoracolumbar junction. Comparison with various other constructions].

INTRODUCTION: The authors' objective was to study the anatomical and functional results of an original construct using the Cotrel-Dubousset instrumentation. MATERIAL AND METHODS: This construct is called "Modular construct" or "2 H.S.-1 S.H." fits up two vertebrae above the fracture and a single below. So if the fracture is situated on the L1 level, a supra-laminar hook is set up on each side of T11, and two pedicular screws in T12 (2 H.S.). In the same way, a pedicular screw and an infra-laminar hook are set up on each side of L2 (1.S.H.). Two transverse bars connect together the right and the left rod. This retrospective work is based on the study of 24 patients who had a Thoraco-lumbar burst fracture according to Denis'classification, who were operated on in our Department, and started again to walk without external contention. All the patients had a postero-lateral bone graft. There were no [corrected] anterior arthrodesis performed. The average follow up was 4 years. This series was compared with a concomitant series of miscellaneous constructs realized by the same operators with the C.D. instrumentation. RESULTS: The average regional kyphosis angles went from 16.9 degrees in pre-operative to 3.9 degrees in post-operative, and 8 degrees at the maximum follow up. The average vertebral kyphosis angles went from 18 degrees in pre-operative to 3.8 degrees in post-operative, and 6.3 degrees at the maximum follow up. The miscellaneous constructs had poorer results. There were two severe infections, one early the other late. DISCUSSION: These results compared with the literature show that the 2 H.S.-1 S.H. construct is a competitive one. We think that its mechanical qualities arise from adding systematically hooks at the ends of the construct. These hooks protect the screws during flexion and from pull out constraints.

Female↗
PubMed1993

[Fuel tanks of motorcycles. Role in severe trauma of the pelvis].

Between 1985 and June 1992, 8 subjects who sustained severe pelvic lesions as a result of motor cycle accidents were admitted and treated in our department. In 5 of these 8 patients the fuel tank of the motor cycle was one of the wounding agents. All 5 patients had unstable pelvic lesions. In addition, 4 had a subperitoneal haematoma which required multiple transfusions; 4 had perineal and/or genital lesions, and 1 had a ruptured membranous urethra. A national epidemiological study would be useful to evaluate the frequency of these particular injuries and draw lessons that would lead to better safety of motor cyclists.

Accidents, Traffic↗