L'ostéotomie périacétabulaire (OPA) est indiquée pour traiter la dysplasie de la hanche symptomatique avant l'apparition d'arthrose. Cette étude avait pour but de documenter les changements biomécaniques de la hanche après une OPA et d'en déterminer l'impact clinique. La surface de contact et les contraintes articulaires maximales ont été calculées avec la méthode HIPSTRESS selon des radiographies antéropostérieures du bassin. Le déplacement du centre de rotation de la hanche a été mesuré dans le plan frontal avec des radiographies antéropostérieure et dans le plan sagittal avec des tomodensitométries pré et postopératoires. La relation colonne-hanche a été évaluée par la mesure de l'incidence pelvienne et par l'amplitude de mouvement sagittale du bassin, mesurée sur des radiographies latérales en position debout puis assise. Le statut clinique postopératoire a été évalué avec le questionnaire iHOT33. Dix-huit hanches ont été incluses dans l'étude. La surface de contact articulaire a augmenté de 13,28 à 19,04 cm² (p<0,001) après l'OPA et les contraintes articulaires maximales ont diminué de 5,31 à 2,82 Mpa (p=0,02). Il n'y avait pas s'association significative entre le statut clinique postopératoire et ces paramètres biomécaniques. Dans le plan frontal, le centre de rotation de la hanche a été médialisé de 3 mm en moyenne. Dans le plan sagittal, l'OPA a peu affecté la relation colonne-hanche, tel que démontré par une incidence pelvienne inchangée et une amplitude de mouvement sagittale normale pour tous sauf deux patients. Cette étude s'intègre dans un projet multidisciplinaire s'intéressant aux technologies d'analyse tridimensionnelle personnalisée de la hanche. Les connaissances acquises au cours de ce projet permettront au clinicien de planifier son traitement de la dysplasie avec plus de précision et de reproductibilité. Éventuellement, une étude clinique pourrait comparer la planification standard de l'OPA à l'analyse tridimensionnelle personnalisée. / Periacetabular osteotomy (PAO) is indicated for treatment of hip dysplasia before the onset of osteoarthritis. The aim of this study was to assess hip biomechanics and its clinical relevance after periacetabular osteotomy. Hip weight bearing area and peak contact stress were calculated with HIPSTRESS method on pelvis AP radiograph. Hip center or rotation displacement was measured in the frontal plane with AP radiographs and in the sagittal plane with pre and postoperative CT-scans. Spine-hip relation was assessed with pelvic incidence and sagittal range of motion as measured on standing-sitting lateral radiographs. Postoperative clinical status was assessed with the iHOT33 survey. Eighteen hips were included in this study. Mean weight bearing area went from 13.28 to 19.04 cm² (p<0.001) after PAO and peak contact stress went from 5.31 to 2.82 Mpa (p=0.02). In the frontal plane, hip center of rotation was medialized by 3 mm on average. In the sagittal plane, PAO had little effect on spine-hip relation, as shown by an unchanged pelvic incidence and a normal sagittal range of motion for all patients except two. This is a two-part study on 3D hip assessment technologies. Acquired knowledge could help the clinician better plan his surgical treatment of hip dysplasia. Eventually, a clinical trial could compare standard planification of PAO to personalized 3D hip analysis.

Reproduction de : Thèse d'exercice : Médecine : Nancy 1 : 2003. / Thèse : 03NAN1107. Titre provenant de l'écran-titre.

La dysplasie acétabulaire est une pathologie causant de l'instabilité articulaire et une réduction de la superficie de chargement au niveau de la hanche. Celle-ci augmente le risque de développement précoce d'ostéoarthrose, causant de la douleur et menant à la perte de la fonction articulaire. La dysplasie est conventionnellement traitée par ostéotomie péri-acétabulaire, mais les effets précis de cette correction sur la biomécanique intra-articulaire restent à être élucidées. À l'aide de la méthode de simulation par éléments discrets, la distribution de pression articulaire a été évaluée de manière pré et post opératoire chez 9 patients dysplasiques. Différentes mesures orthopédiques évaluant le degré de correction acétabulaire ont été acquises et plusieurs scores numériques évaluant la surcharge articulaire ont été calculés. Des corrélations entre ces mesures et ces scores ont ensuite été effectués. Il a été noté que les mesures d'angle centre-externe latéral, d'index acétabulaire et d'index d'extrusion de la tête fémorale sont corrélés avec l'augmentation de l'aire de contact moyen durant la marche (p < 0.05, R² de 0.22 à 0.50). L'influence significative de la méthode de reconstruction cartilagineuse (distributions d'épaisseurs moyennes saine vs. dysplasique) et du profil de marche utilisé (phase d'appui moyen sain vs. dysplasique) a été remarqué auprès de la majorité des métriques évaluées. Ces résultats, ainsi que les facteurs qui les influencent, peuvent servir à assister la planification chirurgicale, effectuer des validations in-vitro d'optimisation d'ostéotomie péri-acétabulaire et, par la suite, guider la conception de nouveaux traitements. / Acetabular dysplasia causes articular instability and the reduction of the loading area in the hip. This causes the early onset of osteoarthritis which leads to pain and the eventual loss of articular function. Acetabular dysplasia is commonly treated by periacetabular osteotomy, but the precise effects of this correction on intra-articular biomechanics is not yet well known. Using discrete element analysis, pressure distribution has been calculated in the dysplastic hips of 9 patients before and after periacetabular osteotomy. A variety of radiographic measurements and numerical metrics have been evaluated in order to quantify the degree of acetabular correction and excessive loading. Correlations between these measures and metrics have been established in order to reveal any causal effects. In particular, the corrections of the lateral center-edge angle, acetabular index and femoral head extrusion index are correlated to the rise of average contact area during gait (p-value < 0.05, R² = 0.22 to 0.50). Additionally, the influence of cartilage layer reconstruction method (population-based healthy vs. dysplastic thicknesses) and loading parameters (healthy vs. dysplastic gait profiles) was significant for a majority of evaluated metrics. These results and influencing factors can help to assist with surgical planning, provide a basis for in-vitro validation of surgical optimization and act as a standard for designing new orthopedic treatments for acetabular dysplasia.

Cette étude se doit d’analyser ce que les textes de la Collection hippocratique, ainsi que l’apport des commentateurs d’Hippocrate, tels Celse, Galien, et jusqu’aux chirurgiens actuels permettent de connaître de l’art chirurgical des Vème et IVème siècles avant J.-C., en Grèce. Les textes dits « chirurgicaux » sont ceux qui mentionnent un acte technique sur le corps humain, le plus souvent à l’aide d’un instrument « chirurgical ». Ils nous donnent des indications sur les pathologies traitées. Quelques documents iconographiques et quelques rares vestiges sont un apport intéressant. En confrontant les textes hippocratiques et la technique chirurgicale actuelle, nous verrons dans quelle mesure il est possible de reconstituer les conditions de réalisation de l’acte chirurgical par les praticiens hippocratiques. / The present study focuses on surgery procedures in fifth and fourth century B.-C. Greece. The analysis of these procedures is based on information stemming from the text constituting the Hippocratic Corpus as well as from Hippocrates’ commentators such as Celsus and Galen- and modern surgeons. The texts analyzed particularly those named “surgical “are those describing a manual intervention on the human body, most frequently supported by an instrument considered as “surgical.” They offer indications on the pathologies treated. Certain iconographic documents are of particular interest. The confrontation between Hippocratic texts and modern surgical techniques will enable to estimate the possibility of restitution of the surgical procedures’ conditions by the Hippocratic surgeons

Fraturas e luxações vertebrais decorrente de trauma consistem afecção neurológica frequente na prática clínica veterinária, sendo a coluna tóraco-lombar a mais comumente afetada em cães, e em muitos casos o tratamento cirúrgico é de eleição. Existem diversas técnicas propostas a realizar estabilização vertebral, entretanto, estudos em coluna tóraco-lombar não foram realizados para avaliar as propriedades biomecânicas de cada técnica. Baseado nisso, nossa pesquisa teve como objetivo fazer uma avaliação biomecânica comparando a força e rigidez promovidas por cinco diferentes técnicas de estabilização em coluna toracolombar (Pinos com Cimento Ósseo, Técnica Segmentar Modificada, Placa Bloqueada e Clamp Rod Internal Fixation utilizando parafusos monocorticais e bicorticais) frente às forças de compressão e flexão. Foram utilizadas 34 colunas tóraco-lombares de cães, divididas em cinco grupos. Para realização dos testes biomecânicos, foi utilizada a máquina de ensaios Kratos (modelo KE3000MP) e célula de carga de 100 kg. Para cada corpo de prova, três testes biomecânicos foram realizados, o controle, no segmento íntegro, após desarticulação de T13/L1 e após realização de uma das técnicas de estabilização propostas. Os dados foram exportados para análise estatística para o programa Statistical Package for the Social Sciences (SPSS) versão 18.0. Os resultados permitiram concluir que, apesar de não haver diferença estatística significativa, a Placa Bloqueada foi a técnica que promoveu maior rigidez e estabilidade nas vértebras lesionadas, seguida do CRIF bicortical, técnica Segmentar Modificada e Pinos e Cimento Ósseo. Estatisticamente, a Placa Bloqueada e o CRIF com parafusos bicorticais apresentaram maior rigidez e estabilidade em T13/L1 quando comparados com a técnica CRIF monocortical, que por sua vez, não alcançou rigidez necessária para adequada estabilização das vértebras. / Spinal fractures and luxations resulting from trauma consist frequent disorder in clinical veterinary practice, being thoracolumbar spine the region that is the most commonly affected in canines, thus in many cases surgical treatment is necessary. There are several proposed techniques of implants to perform spinal stabilization; however, few studies of the thoracolumbar spine were carried out to evaluate the biomechanical properties of each technic. Therefore, the objective of the present study is to analyze biomechanical effects comparing the strength and the stiffness promoted by five different technics of stabilization in the thoracolumbar spine (pin with bone cement, modified segmental stabilization, locking plate and clamp rod internal fixation) under compression and bending forces. In the study, thirty four thoracolumbar dog spines were used, dividing the specimens in five groups. In order to perform the biomechanical tests, it was used a Kratos testing machine (model KE3000MP) and loading cell of 100 Kg. Each body of proof was submitted to three biomechanical tests, the control, in the segment intact, after disarticulation of the T13/L1 and after the realization of one of the proposed technics. Data were exported to statistical analyses to the Statistical Package for the Social Sciences (SPSS) version 18.0. The results led to the conclusion that despite there was no statistically significant difference between the techniques, the Locking Plate was the technique that promoted greater rigidity and stability in the injured vertebrae, followed by the Clamp Rod Internal Fixation bicortical, Modified Segmental Instrumentation and Pins with Bone Cement. Statistically, the locking plate and the Clamp Rod Internal Fixation with bicortical pins showed more stiffness and stability in T13/L1 when compared to the Clamp Rod Internal Fixation monocortical, which did not achieved the adequate rigidity for the stabilization of the vertebrae.

Fraturas e luxações vertebrais decorrente de trauma consistem afecção neurológica frequente na prática clínica veterinária, sendo a coluna tóraco-lombar a mais comumente afetada em cães, e em muitos casos o tratamento cirúrgico é de eleição. Existem diversas técnicas propostas a realizar estabilização vertebral, entretanto, estudos em coluna tóraco-lombar não foram realizados para avaliar as propriedades biomecânicas de cada técnica. Baseado nisso, nossa pesquisa teve como objetivo fazer uma avaliação biomecânica comparando a força e rigidez promovidas por cinco diferentes técnicas de estabilização em coluna toracolombar (Pinos com Cimento Ósseo, Técnica Segmentar Modificada, Placa Bloqueada e Clamp Rod Internal Fixation utilizando parafusos monocorticais e bicorticais) frente às forças de compressão e flexão. Foram utilizadas 34 colunas tóraco-lombares de cães, divididas em cinco grupos. Para realização dos testes biomecânicos, foi utilizada a máquina de ensaios Kratos (modelo KE3000MP) e célula de carga de 100 kg. Para cada corpo de prova, três testes biomecânicos foram realizados, o controle, no segmento íntegro, após desarticulação de T13/L1 e após realização de uma das técnicas de estabilização propostas. Os dados foram exportados para análise estatística para o programa Statistical Package for the Social Sciences (SPSS) versão 18.0. Os resultados permitiram concluir que, apesar de não haver diferença estatística significativa, a Placa Bloqueada foi a técnica que promoveu maior rigidez e estabilidade nas vértebras lesionadas, seguida do CRIF bicortical, técnica Segmentar Modificada e Pinos e Cimento Ósseo. Estatisticamente, a Placa Bloqueada e o CRIF com parafusos bicorticais apresentaram maior rigidez e estabilidade em T13/L1 quando comparados com a técnica CRIF monocortical, que por sua vez, não alcançou rigidez necessária para adequada estabilização das vértebras. / Spinal fractures and luxations resulting from trauma consist frequent disorder in clinical veterinary practice, being thoracolumbar spine the region that is the most commonly affected in canines, thus in many cases surgical treatment is necessary. There are several proposed techniques of implants to perform spinal stabilization; however, few studies of the thoracolumbar spine were carried out to evaluate the biomechanical properties of each technic. Therefore, the objective of the present study is to analyze biomechanical effects comparing the strength and the stiffness promoted by five different technics of stabilization in the thoracolumbar spine (pin with bone cement, modified segmental stabilization, locking plate and clamp rod internal fixation) under compression and bending forces. In the study, thirty four thoracolumbar dog spines were used, dividing the specimens in five groups. In order to perform the biomechanical tests, it was used a Kratos testing machine (model KE3000MP) and loading cell of 100 Kg. Each body of proof was submitted to three biomechanical tests, the control, in the segment intact, after disarticulation of the T13/L1 and after the realization of one of the proposed technics. Data were exported to statistical analyses to the Statistical Package for the Social Sciences (SPSS) version 18.0. The results led to the conclusion that despite there was no statistically significant difference between the techniques, the Locking Plate was the technique that promoted greater rigidity and stability in the injured vertebrae, followed by the Clamp Rod Internal Fixation bicortical, Modified Segmental Instrumentation and Pins with Bone Cement. Statistically, the locking plate and the Clamp Rod Internal Fixation with bicortical pins showed more stiffness and stability in T13/L1 when compared to the Clamp Rod Internal Fixation monocortical, which did not achieved the adequate rigidity for the stabilization of the vertebrae.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The objective of this study was to identify and determine the prevalence of fractures and traumatic appendicular luxations in dogs treated between January 2004 and December 2013 at the Hospital Veterinário Universitário da Universidade Federal de Santa Maria. In a population of 1200 dogs with suspected traumatic orthopedic diseases in the locomotor system, 955 (79.58%) had appendicular fractures and 245 (20.42%) had appendicular luxations. Of the 955 dog with fractures, 23.56% had fractures of the femur (n = 225), 23.36% pelvic fractures (n = 223), 21.99% tibial and fibula fractures (n = 210), 17.58% radius and ulna fractures (n = 168), 7.54% humerus fractures (n = 72) and 5.97% distal fractures to the tarsus and carpus (n = 57), with the most frequent cause by car accidents (72.21%). The most affected dogs with fractures were male (52.46%), young (41.99%), mixed breed (51.41%) and small size (42.7%). Of the 245 dogs (20.42%) with traumatic luxations, 57.14% were composed by hip luxations (n = 140), patellar luxation 15.1% (n = 37), 9.8% elbow luxations (n = 24), 5.71% sacroiliac luxations (n = 14), 4.49% shoulder luxations (n = 11) and 7.76% of dogs had other luxations (n = 19), with the most frequent cause by car trauma (66.12%). The most affected dogs with traumatic luxations were males (50.2%), mature adults (36.73%), mixed breed (43.67%) and small size (50.48%). In conclusion, in the population of dogs evaluated, the most prevalent appendicular fractures were femoral fractures, pelvic fractures, fractures of the tibia and the fibula and radius and ulna fractures; and the most prevalent traumatic appendicular luxations were hip luxations, patellar luxations and elbow luxations. / O objetivo deste estudo foi identificar e determinar a prevalência das fraturas e luxações apendiculares traumáticas em cães atendidos entre janeiro de 2004 e dezembro de 2013 no Hospital Veterinário Universitário da Universidade Federal de Santa Maria. De um total de 1.200 cães com suspeita de doença ortopédica de origem traumática no sistema locomotor, 955 (79,58%) apresentaram fraturas apendiculares e 245 (20,42%) luxações apendiculares. Dos 955 cães com fraturas, 23,56% foram fraturas do fêmur (n=225), 23,36% fraturas da pelve (n=223), 21,99% fraturas da tíbia e da fíbula (n=210), 17,58% fraturas do rádio e da ulna (n=168), 7,54% fraturas do úmero (n=72) e 5,97% fraturas distais ao tarso e ao carpo (n=57), decorrentes principalmente de acidentes automobilísticos (72,21%). Os cães mais afetados por fraturas foram machos (52,46%), filhotes (41,99%), sem raça definida (51,41%) e de pequeno porte (42,7%). Dos 245 cães (20,42%) com luxações traumáticas, 57,14% foram constituídas de luxações coxofemorais (n=140), 15,1% luxações de patela (n=37), 9,8% luxações do cotovelo (n=24), 5,71% luxações sacroilíacas (n=14), 4,49% luxações escapuloumerais (n=11) e 7,76% dos cães apresentaram outras luxações (n=19), decorrentes principalmente de acidentes automobilísticos (66,12%). Os cães mais afetados por luxações foram machos (50,2%), adultos maduros (36,73%), sem raça definida (43,67%), de pequeno porte (50,48%). Com base nos resultados encontrados, na população de cães avaliada, conclui-se que: as fraturas apendiculares mais prevalentes foram: fraturas do fêmur, fraturas da pelve, fraturas da tíbia e da fíbula e fraturas do rádio e da ulna; e as luxações apendiculares traumáticas mais prevalentes foram: luxações coxofemorais, luxações de patela e luxações do cotovelo.