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Biomedical subjects

C R Michel

Publications and source records attributed to C R Michel.

At least 37 records · Page 2Linked to original sources
PubMed1985

[The Armstrong procedure in scoliosis surgery. Clinical, biomechanical and tridimensional study].

The Armstrong procedure combines the use of a conventional Harrington rod in the concavity of a curve, together with a distracting force on the convex side, this force being applied one vertebra lower. Workers have used this procedure in 35 cases. It is concluded that there are three advantages: A better horizontal disposition of the lower vertebra. Greatly diminished stress on the two rods shown by a biomechanical study. Derotation is more easily obtained and the spine is better balanced as a whole, as shown by a three-dimensional study comparing this method and conventional Harrington rodding.

Adolescent↗
PubMed1985

[Long-term course of lumbar curvature following Harrington instrumentation for thoracic or double major idiopathic scoliosis].

A long-term follow-up study has been made of 276 patients with thoracic or double major idiopathic curves treated by Harrington rodding between 1963 and 1971. 82 patients were able to be followed up to the present date, including 24 double major idiopathic curves and 58 thoracic or thoracolumbar curves. The average follow-up was 15 years with a maximum of 20 years. There were 71 female and 11 male patients. It was concluded that the lumbar curve associated with a thoracic or thoraco-lumbar curve lost about 9.9 degrees when the lower point of insertion of the rod was higher than L3. When it was at L3 or L4 loss of correction was only 3.6 degrees. During the same period the loss of correction of the main grafted curve was 13.6 degrees. In double major curves, the best results were obtained when the lumbar curve was completely or almost completely fused, with an average correction of 17.2 degrees. The results were good when the fixation extended to the apex of the lumbar curve, with an average correction of 11.6 degrees and was moderate when it extended to a higher level with an average correction of 10.9 degrees. It is concluded that in almost all cases, instrumentation needs to be extended to a low level at L3 or L4 to provide greater stability. A study on all 276 cases showed that the morphological adaptation beneath the grafts was satisfactory and long lasting. When the instrumentation stopped at the level of T12, L1 or L2 there was a danger of the development of secondary lumbar kyphosis. Low back pain was not made worse in any cases of low lumbar fixation.

Adolescent↗
PubMed1985

Late results of Harrington's operation. Long-term evolution of the lumbar spine below the fused segments.

Between 1963 and 1971, Harrington's technique was used by the senior author to operate on 493 scoliotic patients, of which 364 were idiopathic. A total of 276 patients were reexamined, of which 209 were idiopathic cases. All met the following criteria: a follow-up period of at least 10 years; the operation was performed by the same surgeon; and the review was undertaken by one person. The average follow-up period was 13 years, 10 months. A total of 95 patients had a follow-up period of more than 15 years, of these 75 patients were idiopathic. The surgical technique was similar in all cases: a distraction rod in the concavity, arthrodesis by decortication, and a corticospongious graft obtained from one or both iliac crests. Postoperative immobilization was assured by a plaster corset for 6 months, followed by a "plexidur corset lyonnais." The review of the patients examined was based on rigorous clinical and radiological analyses. Anteroposterior and lateral radiographs were obtained, complemented by a lateral radiograph of the lumbosacral segment. The angular results were disappointing, decreasing from 66.2 degrees to 38 degrees immediately postoperatively but increasing to an average final curve of 51.4 degrees. Clinical results were good: Only 21.3% of patients actually had back pain. The patients were satisfied with their appearance and their professional, social, and marital status. This study indicates the outcome of the lumbar spine below the graft. The vertebral bodies were modified morphologically; they became elongated and more trapezoidal leading to a quite normal average lordosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Congenital luxation of the hip in a newborn infant after tubal pregnancy (feto-salpynx). Plea for the postural theory of luxation].

The authors report a case of an infant born after a 37-week intra-tubal pregnancy (foeto-salpinx). There were several orthopaedic complications due to malposition: torticollis which will be treated by sternomastoid tenotomy at the age of three, pes valgus with metatarsus varus and congenital dislocation of the right hip. Conservative treatment proved inadequate and required treatment by pelvic osteotomy to correct a severe acetabular dysplasia. A review of the literature reveals that tubal pregnancies resulting in the birth of a mature and living new born are exceptional. From the mechanical point of view, the authors consider that, in this case, two factors combined to produce a congenital dislocation of the hip--excessive pressure exerted on the foetus by the tubal wall and an abnormal position of the foetus favouring the dislocation. The reasons for the ineffectiveness of conservative treatment to correct the severe acetabular dysplasia are discussed.

Female↗
PubMed1984

[Importance of the E. Luque technic in the surgery of major spondylolisthesis in children].

Following a brief summary of results of surgery of major spondylolisthesis of children using Harrington's technique, the outcome in 15 cases operated upon between 1967 and 1983 is discussed. Satisfactory short-term results (reduction perfect in 40% and fair in 60%) were not maintained and a relapse of sliding occurred in 50% at a later stage. In order to improve long-term stability. Harrington's classical procedure was combined with Luque's technique with binding of posterior arches of L3 and L4 to metallic spars in major L5-S1 spondylolisthesis. Two adolescents with very disabling L4-L5 spondylolisthesis were operated upon by Luque's original method combining partial resection of supra- and sub-jacent articular surfaces and isthmic reconstruction by grafts with excellent immediate results. This method is also discussed.

Adolescent↗
PubMed1982

[Negative bone scintigraphy in osteomyelitis in children. Difficulties in interpretation].

The authors relate 7 cases of hematogenous osteomyelitis in children where skeletal scintigraphy with TC 99m diphosphonate was said as normal. They analyse the lack of positive radionuclide findings; misinterpretation, abnormal tracer accumulation which probably relates to regional hyperemia, transient area of discreased uptake of the tracer in the early phase of the disease and real negative bone scan; these cases are rare; when there is a high suspicion of osteomyelitis in spite of a normal bone scan Gallium imaging may be helpful.

Child↗
PubMed1982

[The lumbar spine in profile after Harrington's operation. Apropos of 100 cases].

After Harrington's procedure, the authors analyse anatomical modifications observed on the 3 last grafted vertebrae and on the underlying healthy lumbar segment. At the level of the grafted vertebrae it was observed a quite constant discal piching and a change in morphological aspect of the vertebra which become higher than large. The ratio between width and length physiologically at 1,20 was at 0,96. At the level of mobile underlying segment to the graft, lordosis remains at physiological value, although distributed on a shorter lumbar segment and that without change in discal angle. This fact was induced by an increase of the lordosis percentage incumbent to the vertebral body. This percentage physiologically at 10 passed 30 after Harrington's procedure because of an increased wedge-shaped of the 4th and 5th lumbar vertebra. This phenomenon was as much marked as the graft was precociously performed and as they descended lower. This might explain the good long term tolerance for the increased work of the free underlying rachis to a Harrington's procedure.

Adolescent↗
PubMed1981

[Perthes' disease treated by Chiari pelvic osteotomy (author's transl)].

The author has studied the results of 17 pelvic osteotomies performed during the course of Perthes' disease in cases in which the femoral head was poorly covered by the acetabular roof. They found improved cover anteriorly and superiorly after operation. Bone remodelling as seen on radiographs and by arthrography was favourably influenced by the better cover. The technical details for the production of a satisfactory osteotomy are given.

Child↗
PubMed1980

[The review of 4300 Charnley total hip replacements inserted between 1968 and 1979 (author's transl)].

4 300 Charnley total hip replacements have been performed since 1968 using either a lateral or a posterior approach. The operative and post operative complications are analysed. 10 p. 100 of the cases had venous complications. There were 125 early dislocations which were easily reduced, and 38 dislocations occurring 6 to 8 years after the operation which were reduced under general anesthesia. There were 5 fractures of the stem of the femoral prosthesis. Instances of wear of the acetabular component were rare. 1.5 p. 100 of severe sepsis occurred leading to the need for the removal of the prosthesis in 23 cases. The percentage of septic complications was much higher in hip that had previously been operated on (5 p. 100) compared with when there had been no previous operation (1. p. 100). Functional results were rated excellent in 85 p 100, good and failure in 2 p. 100. In their conclusions, the authors state that the assessment of the results is difficult because of the age of the patients, the variability in methods of assessment and the presence of associated diseases. They emphasize that the results were consistent even after long periods of time and that wear in the prosthesis is not a hazard, any particles being produced by wear being well tolerated.

Follow-Up Studies↗
PubMed1979

[The use of an articulated brace in the treatment of juvenile kyphosis (author's transl)].

The authors have attempted to assess the efficiency of an articulated brace in the treatment of juvenile kyphosis (Scheuermann's disease and idiopathic kyphosis). Two series of patients were compared. Patients in both series were treated in a first stage by a plaster cast and in a second stage by a bivalve brace in the first series and an articulated brace in the second series. The technique of treatment by a plaster cast and by the brace is fully described. It is concluded that control of the lumbar lordosis is of great importance. The results were better with an articulated brace. The indications for treatment are given depending on the age at the onset of treatment, the type of spine deformity and its severity. In some cases of severe dorsolumbar kyphosis, surgery may be indicated.

Adolescent↗
PubMed1979

[Chiari pelvic osteotomy in treatment of sequellae of hip osteochondritis (author's transl)].

The authors analyze the results of Chiari pelvic osteotomy in treatment of sequellae of hip osteochondritis with 11 cases of children 6 to 10 years old, operated and reviewed with an average follow up of 21 months. They used the operative procedure decided by Chiari, on orthopaedic table, followed by plaster cast immobilisation for 3 weeks. The Xray results are specially analyzed as the peroperative functional troubles were absent. This procedure is mainly effective on articular congruence with gain not only in lateral but also in anterior head-coverage. The secondary modelling appears to affect either the head and the acetabulum. But the medialization remains poor, which is explained by an analyze of the lower fragment operative displacement. Actually, this operative procedure may be used in late osteochondritis with a coxa magna and specially when a coxa vara or a short neck contra-indicate a femoral osteotomy.

Child↗
PubMed1978

[The resection of lumbosacral hemivertebrae (author's transl)].

The spinal deformities due to lumbo sacral hemivertebrae are difficult to correct: The orthopedic treatment is not effective. Surgical correction of the lumbar compensatory curve is of no use as it does not correct the oblique take off. The resection of the hemivertebra is actually the more efficient way. The surgical technique used in 2 cases is described. The results depend mainly upon the age of operation, which should be performed in the first years of life, in order to correct the oblique take off before the lumbar compensatory curve become a structural one.

Adult↗