ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The growing spine and its diseases and treatments are still the subject of numerous basic and clinical research articles. In 1998, more than 850 studies were published in the indexed literature. This article concentrates mainly on classical topics, new knowledge, and long-term follow-up. Adolescent idiopathic scoliosis is the topic of many articles in the areas of etiology, clinical evaluation, radiographic investigation, and conservative and surgical treatment. Important contributions are found in the fields of genetic studies of spinal growth in the prenatal period and in surgical treatment of congenital scoliosis. Although progressive spinal deformities attributable to cerebral palsy can profit nowadays from very effective surgical correction, global result assessment and long-term follow-up are mandatory to evaluate the results of these difficult and risky procedures. Upper cervical area trauma is specific to young children and can provoke important functional and neurologic damage; biomechanical and radiographic studies are useful for the treatment decision making process. Articles about infectious diseases, particularly tuberculosis and disk degeneration, also are discussed. Curr Opin Orthop 1999, 10:422–428 © 1999 Lippincott Williams & Wilkins, Inc.

ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Five to six percent of neurofibromatosis type 1 (NF1) patients have congenital tibial dysplasia, the lesion leading to congenital pseudarthrosis (CP). There is an equal sex distribution of NF1, but more boys than girls with NF1 have CP. Approximately 50% of patients with CP have NF1. Gait analysis in patients operated on for CP of the tibia showed that intramedullary rodding across the ankle joint resulted in a gait that was no more efficient than that of the amputee with a well functioning prosthesis. Three articles dealt with Ilizarov treatment of tibial CP, which is usually indicated after unsuccessful rodding and bone grafting. The union rate varied between 64% and 83%. None of these articles accounted for the functional outcome. Free vascularized fibular grafting seems at least as effective as Ilizarov treatment in obtaining union, and the functional outcome is good in most patients. This latter technique appears to be preferable in the rare CP of the upper extremity.Curr Opin Orthop 1999, 10:429–433 © 1999 Lippincott Williams & Wilkins, Inc.

ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This article analyzes recently published articles on disorders of the lower extremity in children. An effort has been made to avoid repetition of the comments and excellent reviews of previous authors on this topic in this journal, Cahuzac and DeGauzy (Curr Opin Orthop 1998, 9:9–16) and Albinana and Gonzalez-Moran (Curr Opin Orthop 1997, 8:10–15). The early diagnosis of congenital or developmental dislocation of the hip by the use of sonography and what it means for the long-term treatment of congenital dislocation of the hip is evaluated. Is open reduction of the unstable slipped capital femoral epiphysis the treatment of choice? Is the use of newer modalities of imaging producing better prognoses for Legg-Calvé-Perthes disease? The emerging incidents of sports injuries in children present us with challenges not previously considered. How do we handle these in children? Why is there so much treatment of the soft, mobile flat foot? Does it matter? Regarding the surgical treatment of cerebral palsy, are we evolving into an era in which the treatment of cerebral palsy will be all medical? Where are we going with leg lengthening? The known alternatives, such as epiphysiodesis and extremity shortening, are being overlooked. Is what we are teaching our residents and trainees regarding the treatment of pediatric orthopedic disorders appropriate, and why is there so much variation in what our trainees are learning?Curr Opin Orthop 1999, 10:434–443 © 1999 Lippincott Williams & Wilkins, Inc.

ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The limitations of autogenous and allogenic bone grafts have driven the search for synthetic alternatives. Using a tissue engineering approach, researchers have developed a series of scaffolds for bone repair applications. In the past year, implants with a variety of structures and compositions have been fabricated. Several of these structures have incorporated bone morphogenetic proteins to provide osteoinductive capabilities. This article describes new bone grafting methods highlighting recent advances in the design and evaluation of several synthetic bone graft substitutes. The trends toward the use of porous biphasic calcium phosphates as bone graft materials and the combination of poly(&agr;-hydroxy acid) scaffolds with recombinant bone morphogenetic proteins are discussed. A new form of synthetic bone graft that can be customized is also described.Curr Opin Orthop 1999, 10:445–451© 1999 Lippincott Williams & Wilkins, Inc.

ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The substantial clinical and socioeconomic effects of cartilage defects and chondral degeneration are well known. After trauma or without a known cause, young patients often suffer from pain and a loss of function leading to a decrease in physical activity or, more severely, to long-term disability and unemployment. Techniques for the regeneration of articular cartilage promise physiologic repair of even full-thickness defects. Bone marrow stimulation procedures, such as drilling, abrasion, and microfracture, induce the ingrowth of stem cells and fibroblasts into the defect with the anticipated result of regeneration of cartilage. Because of the fibrous texture of this repair tissue, the biomechanical resistance and durability are inferior to those of hyaline cartilage. To catalyze the differentiation of premature blood cells to mature chondrocytes, periosteum and perichondrium are used to cover the defect: Various growth-modulating factors are presumed to be released by the cambium layer of the periosteum. Because the intrinsic control mechanisms of cell differentiation are still unclear, another idea evolved for clinical use: Autologous, dedifferentiated chondrocytes are culturedin vitrobefore being delivered into the cartilage defect under a periosteal flap. The environmental factors in this bioactive chamber induce the chondrocytes to redifferentiate and synthesize new hyaline cartilage matrix with the characteristically predominant content of collagen II. Autologous chondrocyte implantation shows promising clinical results. Further experimental developments in areas such as the delivery of cells with bioresorbable scaffolds or the genetic control of cell differentiation are far from being approved for clinical application. Osteochondral transplantations do not represent a technique for the regeneration of cartilage but must be discussed because the regeneration of connective tissue between transplanted osteochondral plugs is essential for the outcome of the procedure. Limited harvesting sites, subtotal defect filling, and the impairment of the subchondral bone plate may impede the treatment of larger defects. The treatment of full-thickness cartilage defects still requires a differentiated therapeutic plan, which should include the horizons and limitations of new regenerative techniques, but caution should be taken until solid data can be presented.

ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Over the past decade, several interesting advances have occurred in the treatment of osteoarthritis, resulting in renewed interest in this field of medicine. Recent progress in the understanding of the pathophysiology of osteoarthritis has facilitated the development of therapeutic strategies aimed specifically at effectively retarding the disease process. This article presents several new approaches in gene therapy that have interesting potential in the treatment of osteoarthritis. Clinical studies currently are underway to determine if these therapies can exert structure-modifying effects to counteract the disease process. This article also reviews some major fields of investigation that show promise for the future.Curr Opin Orthop 1999, 10:458–465 © Lippincott Williams & Wilkins, Inc.

ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Skeletal development requires the integration of multiple extracellular signals into coordinated cellular responses. Repair of bone can be described as a regenerative process and, in essence, is the recapitulation of the molecular and cellular processes involved in formation of bone. The appendicular and axillary skeletal elements are formed by endochondral ossification, whereas most of the craniofacial bones are formed by intramembranous ossification. This article focuses on the signals and mechanisms that control endochondral bone formation and repair.Curr Opin Orthop 1999, 10:466–471© Lippincott Williams & Wilkins, Inc.

ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Giant cell tumor of bone is a locally aggressive, usually benign bone neoplasm that occurs most commonly in the distal femur and proximal tibia in young adults. The diagnosis is usually not difficult; typical radiographic features include an eccentric radiolucent lesion with a narrow zone of transition and a nonsclerotic margin with a juxta-articular location. Considerable progress has been made in the understanding of the behavior of this neoplasm. Whereas surgical margins are important for local tumor control, wide margins achieved with a surgical resection are not necessary for most patients. Thorough curettage and the use of polymethylmethacrylate as a filling material have reduced the rates of local recurrence from 50 to 60% to less than 15%. The benefit of other physical adjuvants such as phenol and liquid nitrogen in achieving local control is controversial. Pulmonary metastases of benign giant cell tumors of bone occur in approximately 2% to 3% of patients. Continued surveillance of these patients with plain radiographs after treatment is necessary for early detection of local recurrence and pulmonary metastases.

ISSN:1041-9918    

出版商:OVID    

年代:1999

数据来源: OVID