Biomedical subjects
Publications and source records attributed to R Scapinelli.
The authors report their experience in conservative management of idiopathic scoliosis treated in the last 10 years with the Risser localizer cast method. The conclusion is that this method, alone or in combination with braces, is still a particularly effective therapeutic means in the correction of both angular deviation and rotation, provided that a rigid protocol is followed.
The hypothesis that side-to-side migration of an extruded lumbar disc herniation can be blocked or restrained by the presence of the ventral meningovertebral ligaments has been verified by the author by using the presently available methods of imaging of the spinal canal in vivo. The images obtained at levels L4-L5 and L5-S1 from nine patients showing this type of pathology and preoperatively assessed by transverse CT (eight patients) or MRI (one patient) seem to support the above assumption. These ligaments should not be confused with pathologic adhesions.
Three patients with fresh displaced fractures of the capitulum humeri were treated by the fibrin sealant method, without additional internal fixation. At follow-up, between 1 1/2 and 4 1/2 years after surgery, clinical results were very good. Fibrin sealant has many advantages over traditional osteosynthesis techniques and is therefore recommended as an effective method for treating such serious but uncommon fractures of the elbow joint.
Among the minor soft structures of the lumbosacral spinal canal that computed tomography can visualize, the meningovertebral ligaments have been neglected. There are no specific reports on this subject, and the only knowledge we have comes from very ancient and nearly forgotten anatomical works. From our studies on cadaveric specimens, it has been confirmed that the ligaments consist segmentally of ventral and lateral fibrous bands, connecting the outer surface of the dura to the endostium of the spinal canal. The most characteristic component is the ventral one, running from the anterior wall of the dural sac to the posterior longitudinal ligament and vertebral endostium. Due to their anchoring function, the ligaments are significantly developed at the level of the dural conus (sacrodural ligaments of Trolard and Hofmann). On in vivo computed tomography studies, the ligament image appears most commonly on transverse scanograms of the lumbosacral segments as a median sagittal septum, easily identifiable when the extradural fat that it crosses is abundant. The meningovertebral ligaments may be implicated in pathological conditions of the spinal canal. They can calcify singly, though very rarely, and this process must be differentiated from degenerative marginal spurs, calcific disc herniation, circumscribed calcification of the posterior longitudinal ligament, or partial diplomyelia.
Massive osteolysis of the humerus occurred in a 19-year-old male. The lesion was successfully treated with an autogenous fibular shaft transplant. During the 20-year follow-up period, humerus function was restored. Roentgenograms showed incorporation of the graft without any recurrence of the disease. This experience and reports in the literature show that only predominantly cortical autogeneic bone grafting has been successful. This could be due to the intrinsic characteristic of cortical bone. In fact, it seems that cortical bone shows greater resistance to erosion than cancellous bone to the lymphangiomatous osteolytic tissue. Therefore, autogenous bone grafting could be considered as a reasonable alternative to radiotherapy, particularly in young people with monostotic disease localized in bones that are easily operable and have no soft-tissue involvement.
Independently of the local and general physiopathological factors that influence the repair of skin and bone, there seems to be marked parallelism in the same subject between hyperplastic scars, exuberant callus formation, and heterotopic ossification. The writer describes his findings in a series of personal cases. Arising out of these observations, he discusses the probable pathogenesis of this parallelism of behaviour, and its practical implications. Subjects in whom hyperplastic scars are produced are constitutionally more predisposed to form rapid and exuberant callus, or heterotopic ossification, than normal subjects.
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Obesity represents an accelerating factor in the development of osteoarthritis, mainly of the lumbar spine and knees. Overweight patients undergo, earlier than normal people, to painful syndromes which usually affect the elder. The mechansims through which joint degeneration gradually develops are analized; special reference is made to the rôle of mechanical and postural stresses. Some considerations are made about orthopaedic treatment in obesity and about orthopaedic surgery in selected cases.
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