Tesi sul tema "Chirurgie orthopédique et traumatologique"
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Debarre, Étienne. "Application du prototypage rapide à l'aide au diagnostic en chirurgie traumatologique et orthopédique". Thesis, Artois, 2011. http://www.theses.fr/2011ARTO0210/document.
Testo completoThe medical imaging technologies allow the visualization of diseases and injuries. However, even if dynamic perspective ones, these views remain a virtual 3D visualization because on a 2D screen. Real replicas have therefore a definite advantage: they can make palpable the notion of scale and volume and apparent hidden or ambiguous details and thus enhance or facilitate the diagnosis and the surgical solution.The rapid prototyping allows to achieve a replica from a CAD file issued from imaging data but this process is now only applied to specific cases. Our work shows that it can be applied with profit for complex but usual orthopaedic and trauma surgery cases. It can be so transfered from the research laboratory to the hospital.A methodology is defined to manufacture an ABS replica through rapid prototyping by fused deposition modelling from DICOM3 data and digital 3D reconstructions using dedicated software. The study of the capability, transferable to any process, quantifies the response and the accuracy of the machine and the optimal parameters. Three applications (from CT-scan) are presented through three clinical cases (osteotomy, arthroplasty and trochleoplasty) . The examples show that the method is appropriate (and economically reasonable) when it comes to complex geometry or assessment of bone volume. The objective representation of the volumes is the strength of the method and the interest is undeniable in many areas of orthopaedic surgery and traumatology
Fossat, Sébastien. "Plasties du ligament croisé antérieur (technique de Th. D. Rosenberg modifiée) rapport préliminaire à un an : à propos de 34 patients opérés dans le service de chirurgie orthopédique et traumatologique de l'H.I.A. Robert Picqué". Bordeaux 2, 1992. http://www.theses.fr/1992BOR2M188.
Testo completoBouthors, Charlie. "Etude de pédagogie médicale sur la simulation procédurale en chirurgie orthopédique et traumatologique pour les étudiants en 2ème et 3ème cycle des études médicales". Electronic Thesis or Diss., université Paris-Saclay, 2024. http://www.theses.fr/2024UPASW001.
Testo completoProcedural simulation is expending in orthopaedic and trauma surgery (OT) but in France its implementation amongst residents has not yet been reported. To enhance procedural training for medical students implies development of new teaching methods and simulators.A national survey was conducted amongst academic teachers and residents in OT. Results showed maximal potential was not reached. Main reasons were lack of funding and time. Both teachers and residents acknowledged the advantages of simulation.The traditional method to teach a procedure implies a continuous and uninterrupted demonstration of the entire procedure to the learner who is then expected to replicate it. To deconstruct the procedure into several key steps showed sequentially (micro-task method) could enhance learning of technical skills. Amongst a population of medical students undergoing simulation training on below elbow cast, immediately after the training session students trained by micro-task method demonstrated higher performance than by traditional method according various grading scales. Six months after the training, performance was decreased and equal in both groups. The only independent factor linked to better performance was a rotation in OT. To be effective, simulation training requires repeated practice and bedside teaching.The development of a procedural simulator for below elbow cast application and removal could enhance this training. A real size upper limb was modelized and constructed through three-dimensional printing. To objectively monitor the operator's gesture, different captors (pression, fracture and wrist mobility, temperature, cast saw vibrations, cast saw skin touch) were integrated to the simulator. Participants with different levels of expertise (novices and experts) tested the simulator. Although realism was deemed satisfactory in both groups, it did not mimic human's aspect perfectly, notably the soft tissues. The simulator appropriately recorded the participants' gesture and seemed to differentiate different levels of expertise. Its pedagogical interest remains to be evaluated
Lanusse, Pierre. "Apport de l'isocinetisme appliqué à l'évaluation des ligamentoplasties du genou en pré-et post-opératoire : à propos de 100 patients opérés dans le service de chirurgie orthopédique et traumatologique de l'H.I.A. [hôpital d'instruction des armées] Robert Picqué". Bordeaux 2, 1993. http://www.theses.fr/1993BOR2M122.
Testo completoMarchaland, Jean-Pierre. "Résultats à moyen terme du traitement chirugical des laxites antérieures du genou par la technique de "Mac in Jones" modifée : à propos de 53 observations de patients opérés dans le Service de Chirurgie Orthopédique et Traumatologique de l'Hôpital d'Instruction des Armées Desgenettes - Lyon". Lyon 1, 1994. http://www.theses.fr/1994LYO1M212.
Testo completoKohl, Patrick. "Traitement de l'hallux valgus par l'ostéotomie sous capitale du premier métatarsien selon Hohmann : à propos de 225 cas opérés au Centre de traumatologie et d'orthopédie de la CRAMAM de Strasbourg-Illkirch". Université Louis Pasteur (Strasbourg) (1971-2008), 1988. http://www.theses.fr/1988STR1M193.
Testo completoCarmoy, Roseline de. "Angoisse et chirurgie orthopedique infantile". Paris 5, 1989. http://www.theses.fr/1989PA05H004.
Testo completoStudy of 254 children from birth to 16, hospitalized for accident, orthopedic disease or congenital malformation. The hypotheses are focused on the anxiety of the child facing surgery : sensitive age, signs of anxiety, meaning of the anxiety, role of the parents and surgeon. Pre-adolescents and adolescents are most vulnerable to surgery : they show the most serious behavioural problems, the most important signs of anxiety, the deepest depression. These findings are based on a significant statistical study. In some cases of acute anxiety, they experiment a psychological breakdown. These crisis which look like a psychotic breakdown take place just before or immediately after surgery. Anxiety and depression are followed by many physical troubles and the expression of fantasies about death, mutilation, blood loosing, being abandonned or persecuted. The breakdown, which occur on vulnerable or upset personalities, leaves marks in the mental functionning of the adolescent. We have insisted on the impact of a congenital difformity on the child and his parents : depression goes along because of the narcissic wound felt by the parents and carried to the child. We have seen the surgeon as a moderator of the anxiety. The intensity of the transference established by the child and his parents on the surgeon shows the existence of the fantasies projected on him. His capacity to authorize the establishment of a transference link with him, helps the child to maintain his anxiety at a tolorable level
Bordji, Karim. "Étude de l'effet de différents traitements de surface sur les propriétés mécaniques et la cytocompatibilité de trois alliages a visée implantatoire : acier-inox 316L, Ti-A16-V4 et Ti-A15-Fe2,5". Nancy 1, 1995. http://www.theses.fr/1995NAN10470.
Testo completoChapon, Thierry. "Contribution à la conception du traitement chirurgical des laxites fraîches du genou : à propos de 63 cas traités et revus". Clermont-Ferrand 1, 1987. http://www.theses.fr/1987CLF11002.
Testo completoPerrin, Xavier. "Chirurgie orthopédique appliquée aux Témoins de Jehovah : aspects thérapeutiques, médico-légaux et éthiques". Montpellier 1, 1990. http://www.theses.fr/1990MON11298.
Testo completoKilian, Pascal. "Outils et méthodologies pour la chirurgie orthopédique assistée par ordinateur mini-invasive". Aix-Marseille 3, 2009. http://www.theses.fr/2009AIX30022.
Testo completoThis thesis presents an innovative methodology for the navigated Minimally Invasive Surgery (MIS) in the frame of orthopedics. Three final clinical applications validate the concepts exposed in each chapter: shoulder, hip and knee replacement. Firstly, the most commonly used techniques in Computer Assisted Surgery (CAS) are described in the context of a not addressed indication: total shoulder replacement. Although this kind of surgery is “open”, it involves the same challenges than the MIS one, by offering to the surgeon only a few “digitizable” anatomical zones. In order to solve these access problems we develop an ultrasound-based digitizer probe, enabling a wider bone surface digitization. We prove its feasibility by providing a fully functional ultrasound digitization chain, based on a 7,5MHz usage, associated to the previously described navigation techniques. The issues linked to its preoperative usage, to its calibration and to the necessary image processing are solved and validated. The provided set of solutions lets foresee a semi-automatic usage of this US digitizer, in clinical routine. The latter is then used for the initialization of a deformable model, getting a patient-specific reconstruction of its distal knee, without using preoperative ionizing imaging, but compatible with the MIS constraints. The fulfilled work covers all stages of a classical development CAS project, from the proof-of-concept to a first usage on patients
WILLER, CAROLINE. "Surveillance epidemiologique des infections hospitalieres dans un service de chirurgie orthopedique et traumatologique". Strasbourg 1, 1987. http://www.theses.fr/1987STR10682.
Testo completoMELANGER, MICHEL. "Voies d'abord sous-periostees du massif facial superieur et moyen : interet dans la chirurgie esthetique, traumatologique et tumorale". Nice, 1993. http://www.theses.fr/1993NICE6571.
Testo completoTimar, Myrna. "Synthèse et caractérisation de nouveaux ciments acryliques pour les scellements en chirurgie orthopédique". Paris 13, 1985. http://www.theses.fr/1985PA132022.
Testo completoAliotti, Antoine. "Structuration et conception d'un système d'aide à la décision pour la chirurgie orthopédique". Saint-Etienne, 2005. http://www.theses.fr/2005STET4021.
Testo completoThis work is about a tool of a making aid for orthopaedic surgeon works. The main object is to define the good prosthesis for the orthopaedic surgeons from the standard x ray images. Our approach is about the process of the GMCAO between the perception, the reflexion and the action. From the patient radiographies, the surgeon determines the each anatomical element like region of interest and the good prosthesis from a data base is defined. Also, our study deals with the ergonomic definition of our software. We use two methods. The first describes an laboratory study from fifty femoral bones to validate the software. And the second is a clinical one with our associated surgeons from patients. We compare the software and manually solutions. We also analyse the surgeon interest about the use of this software
Maillet, Pierre. "Développement d'un robot pour la chirurgie orthopédique et d'une méthodologie pour sa mise en oeuvre". Montpellier 2, 2006. http://www.theses.fr/2006MON20129.
Testo completoSeveral surgical procedures in orthopaedics, neurosurgery, maxillofacial or ENT need to mill, drill or cut bones accurately. In conventional surgery, motorized tools are positioned and held by the surgeon to realize these tasks. But bone cavity accuracy and surface roughness depend on the surgeon dexterity. In this thesis, we present a robot that has been developed for orthopaedic surgery as well as a registration method to position it with respect to the patient while satisfying constraints such as accessibility. In the two first section of the dissertation, the surgical constraint are presented and a state of art on current devices developed to assist ther surgeon's gesture is done. The third section details the BRIGIT device (Bone Resection Instrument Guidance by Intelligent tool) including its software and hardware architectures. A dedicated procedure for total knee replacement is also described. The last section presents the registration problem: two methods are proposed, one deriving a single robot solution, the second deriving a set of solutions that allows to position the robot in a more flexible manner
Moungondo, Fabian. "Biomécanique du coude normal et après arthroplastie de tête radiale". Doctoral thesis, Universite Libre de Bruxelles, 2020. https://dipot.ulb.ac.be/dspace/bitstream/2013/311630/9/Annexe3.pdf.
Testo completoDoctorat en Sciences médicales (Médecine)
info:eu-repo/semantics/nonPublished
Bernard, Pierre. "L'instabilité lombaire et son traitement par la ligamentoplastie postérieure avec cale". Bordeaux 2, 1994. http://www.theses.fr/1994BOR23089.
Testo completoSCHILLIO, VALERIE. "La classification simplifiee des fractures : son utilite dans l'informatisation du dossier medical en chirurgie orthopedique et traumatologique". Nice, 1993. http://www.theses.fr/1993NICE6003.
Testo completoCostes, Stéphane. "Arthrodèse talo-crurale sous arthroscopie : technique et résultats d'une série de 16 cas". Bordeaux 2, 2000. http://www.theses.fr/2000BOR23057.
Testo completoLesprit, Éric. "Traitement des scolioses par le matériel de Cotrel-Dubousset : intérêt des potentiels évoqués sensitifs et moteurs, à propos de 54 cas". Bordeaux 2, 1995. http://www.theses.fr/1995BOR23050.
Testo completoBallongue, Xavier. "VIH et orthopédie". Bordeaux 2, 1993. http://www.theses.fr/1993BOR2M147.
Testo completoLiebaert, Philippe. "Étude "in-vivo" et "in-situ" de la propagation des vibrations dans l'articulation de la hanche : comparaison hanche saine - hanche munie d'une prothèse totale". Paris 12, 1992. http://www.theses.fr/1992PA120062.
Testo completoGuth, Michèle. "Les personnes âgées de 75 ans et plus, en chirurgie générale non traumatologique : étude portant sur 5000 cas observés dans un même service pendant une période de 20 ans". Université Louis Pasteur (Strasbourg) (1971-2008), 1992. http://www.theses.fr/1992STR1M155.
Testo completoParratte, Sébastien. "Méthodes d’évaluation objective et subjective en chirurgie de la hanche et du genou". Aix-Marseille 2, 2008. http://www.theses.fr/2008AIX20693.
Testo completoAn increasing number of patients is surgically managed for knee and hip arthritis related problems. Results reported in the literature are generally good but important discrepancies have been observed between patient reported outcomes and surgeons reported outcomes. Therefore we aimed: 1) to review and critic the current methods used for the orthopaedic evaluation of the outcomes, 2) to validate and use new quality of life questionnaires and new objectives functional tools on patients from the department of orthopaedic surgery in Marseille (Hôpitaux Sud, Pr JN Argenson) and from Mayo Clinic (Pr MW Pagnano et Pr DJ Berry) under the control of the Public health department from Marseille (Pr P Auquier); 3) to discuss the results of our studies and to propose future research projects. Results of our studies have shown that subjective and objective patient generated evaluation methods can provide a better understanding of surgical results. These new tools will have to be include in future orthopaedic research projects but also for the standard patient follow-up to improve knowledge on the reliability of the orthopaedic techniques and of their costefficiency
Gunepin, François-Xavier. "Positionnement isométrique des plasties du ligament croisé antérieur : de la théorie à la pratique (à propos de 24 cas)". Bordeaux 2, 1992. http://www.theses.fr/1992BOR2M141.
Testo completoMassé, Rémi. "Ligamentoplastie de cheville : étude d'une série de 57 retensions ligamentaires avec utilisation d'ancres trans-osseuses". Bordeaux 2, 1998. http://www.theses.fr/1998BOR2M024.
Testo completoMasson-Sibut, Agnès, e Agnès Masson-Sibut. "Développement d'un processus coopératif de traitement d'images ultrasonores pour le référencement géométrique de structures osseuses en chirurgie orthopédique". Phd thesis, Université Paris-Est, 2013. http://tel.archives-ouvertes.fr/tel-00906101.
Testo completoBerthonnaud, Éric. "Les mesures sur radiographies planes et tridimensionnelles en orthopédie : applications cliniques". Lyon 1, 2000. http://www.theses.fr/2000LYO1T005.
Testo completoGaillard, Thierry. "La reconstruction acetabulaire apres descellement aseptique ; travail du service de chirurgie orthopedique et traumatologique du professeur fischer et du professeur bejui, pavillon t, hopital edouard herriot". Lyon 1, 1994. http://www.theses.fr/1994LYO1M038.
Testo completoCouteau, Béatrice. "Modélisation 3D par la méthode des éléments finis du fémur humain. Application à l'étude des prothèses sur mesure". Toulouse 3, 1997. http://www.theses.fr/1997TOU30113.
Testo completoBissouma, Anna-Corinne. "Représentation de soi et visagéification dans les traumatismes orthopédiques de l’enfant : penser une approche psychique pour panser le corps". Thesis, Sorbonne Paris Cité, 2015. http://www.theses.fr/2015USPCD029/document.
Testo completoBetween here and elsewhere, between practices and disciplines, between patients, surgeons and psychiste, this thesis is the effect of meetings with children with orthopedic trauma suffered. Burglary, the fracture is orthopeadic trauma and made trauma. Desubjectivation, fragmentation of the body, violence, pain and suffering are then the lot of children in pediatric surgery. And when the end prevails over all the body, the body becomes other-I. From Abidjan to Paris, four clinical histories of children show that, amid terror and loss of the look, the face-losing is at work in pediatric surgery regardless of the quality or type of care. In these children, self-representation and subjective testing of three drawings helped to understand the disturbances in self-image and suffering taking’s face and other issues involved. It appeared that the repair is not always followed by restoration. Therapeutic and relational mediator, drawing has proven tool visage-ification of burglary and psycho revisage-ification its mirror function. In the time of care, then replays the mirror stage. The underpinning of mothering look and psychiste, in the process, promote rebuilding of the child's self whose effect is to give it a unified picture of him promoting a reappropriation of the body. Thus emerges a new function of psychiste in pediatric surgery, that of "psy-chir" to describe the terms of a particular psychotherapeutic assistance in support of the design and visage-ification, to heal the body
Bourdot, Laura. "Étude des effets d'une perfusion de kétamine à faible dose sur la douleur péri-opératoire et la récupération fonctionnelle lors de chirurgie orthopédique chez le chien". Lyon 1, 2015. http://www.theses.fr/2015LYO1V016.
Testo completoGuichet, Jean-Marc. "Clou centro-médullaire d'allongement progressif : essai mécanique, résultats à deux ans de l'expérimentation animale et protocole humain". Aix-Marseille 2, 1991. http://www.theses.fr/1991AIX20654.
Testo completoIRIBARNEGARAY, MICHEL. "Etude comparative de l'emploi du polyester sulfurique de pentosane et de l'heparine calcique dans la prevention des accidents thrombo-emboliques : a propos de 61 observations de chirurgie orthopedique et traumatologique du membre inferieur incluant une phlebographie au sixieme jour". Amiens, 1988. http://www.theses.fr/1988AMIEM047.
Testo completoReynaud, Patrick. "La trochleoplastie-creusement dans le traitement de l'instabilite rotulienne : a propos de 33 cas : travail de la clinique de chirurgie orthopedique et traumatologique du centre hospitalier lyon-sud ; professeur h. dejour, professeur j.p. carret". Lyon 1, 1994. http://www.theses.fr/1994LYO1M156.
Testo completoMorchikh, Abdelmoujoud. "Etude longitudinale de la densité osseuse péri prothétique sur des implants fémoraux cimentés et non cimentés par absorptiométrie biphotonique". Bordeaux 2, 2000. http://www.theses.fr/2000BOR23082.
Testo completoMahieu, Béatrice. "Prévalence du déficit en facteur Willebrand antigène : apport d'une technique rapide de dosage du facteur Willebrand antigène : à propos de 1107 patients hospitalisés en chirurgie orthopédique au C.H.U. de Montpellier entre mai 1994 et octobre 1995". Montpellier 1, 1996. http://www.theses.fr/1996MON11156.
Testo completoIonescu, Gelu. "Segmentation et recalage d'images échographiques par utilisation de connaissances physiologiques et morphologiques". Phd thesis, Université Joseph Fourier (Grenoble), 1998. http://tel.archives-ouvertes.fr/tel-00005189.
Testo completoLepage, Daniel. "Restauration cartilagineuse. : A propos de l'utilisation d'un greffon ostéo chondral costal : implication dans le resurfaçage articulaire au membre thoracique et conditions anatomiques de son prélèvement". Thesis, Besançon, 2014. http://www.theses.fr/2014BESA3001/document.
Testo completoThe use of costal graft in reconstructive surgery is known and used for a long time in maxillo-facial surgery. It is the same practice for the service of traumatologic, orthopédic, plastic and reconstructive surgery of the university hospital of Besançon. Firstly proposed in the surgical treatment of trapezo-metacarpal osteoarthritis, the operators of this service gradually appropriated this technique and used it for other traumatic or degenerative indications to restore a cartilage defect. Thus, since 15 years, this surgical technique has been proposed in trapezo-metacarpal osteoarthritis, peri-scaphoid or radio-carpal osteoarthritis, for some cases of post-traumatic fingers joint reconstruction, for malunion of distal radius, for advanced Kienbock disease and defect of osteo-cartilaginous substance of a humeral head. In a first time, this work reports the different therapeutic indications and clinical results of this original technique which have been the subject of scientific publications, especially in radio-scaphoid osteoarthritis and in a case of humeral head reconstruction.To obtain the osteo-chondral costal graft, this technique needs the surgical approach of the thorax and generally of the 8e rib. Pleuro-pulmonary complications are very uncommun. This surgical technique is simple but must be "demystified". Therefore, the second phase of this work proposes giving topographical and anatomical landmark necessary to obtain this graft. An anatomical study supplemented by a radio imaging study helped to situate the 8e osteo-chondral rib junction between the epineus process of the 11e thoracic vertebra and the first lumbar vertebra but more often at the 12e thoracic vertebra. In the thoraco-abdominal hemi perimeter, this junction was locate at the 2/3 starting from the median furrow of the back, whatever the thoracic morphology, age and sex of the patient. This 8e junction is more always located under the obliquus externus abdominis muscle and coated by a thick perichondrium which protects it from the inter costal pedicle, from the endo thoracic fascia and the parietal pleura. In surgery of upper limb, the pyrocarbon implants, used actually in radio carpal osteoarthritis and trapezo metacarpal osteoarthritis, with the same principles as the osteo chondral costal graft, do not appear to give satisfactory results. Autologous transplantation of chondrocytes or mesenchymal stromal cells cultures have problem of their matrix which must contain the grafted cells, growth factors and have to substitute for the cartilaginous defect. Finally, due to this interesting results brought by this costal osteo chondral grafting technique in orthopaedic surgery of the upper limb, we considered eventual cartilaginous transplants to restore articular defect to the lower member following a injury or a degenerative lesion such as dissecans osteo chondritis of knee or ankle. Biomechanical tests should be realised to verify the ability of the costal osteo chondral graft to support a load on a bearing joint
Rouleau, Dominique. "Mécanisme de référence en orthopédie pour mono-traumatisme dans un centre de traumatologie niveau 1". Thèse, 2008. http://hdl.handle.net/1866/2747.
Testo completoPatients with isolated traumatic limb injuries usually consult primary care for first line treatment. The primary care physician will often refer the patient to an orthopaedic surgeon when needed. The research objective was to study the referral mechanism to an Orthopaedic Service in a Level 1 Trauma Center for patients with an isolated limb injury. Access to specialized care and quality of primary care are used to describe the referral mechanism. We studied 166 consecutives patients referred to orthopaedic surgery over a 4 months period. Before the orthopaedic visit, 23 % had seen 2 or more doctors for their injury. The time between the first primary care visit and the orthopaedic evaluation was greater (68 hours) then the interval between the injury and the visit with primary care (21 hours). Among the cases that were considered urgent, 36 % had not been seen within the recommended delay. Quality of initial care was judged sub optimal for 49 % of patients in terms of immobilization, analgesia and/or walking aids. Factors associated with decreased access or quality of care are: smoking, younger age, living far from the hospital, consulting first in a private clinic, lower limb or soft tissue injury and a patient‟s low self-perception of severity. These results underline the necessity of targeting primary care education and improving the referral mechanism for patients with isolated limb injuries.
Jodoin, Marianne. "Récupération suite à un traumatisme orthopédique avec ou sans traumatisme craniocérébral léger concomitant". Thesis, 2020. http://hdl.handle.net/1866/24819.
Testo completoA variety of factors can affect the functional recovery of patients with an orthopedic trauma (OT), including concomitant traumatic brain injuries (TBI). The recovery profile of patients with combined traumas (OT and TBI) has been studied primarily in the context of severe injuries (moderate/severe TBI and multiple fractures), in order to maximize recovery and medical resources. On the other hand, there is limited evidence on the impact of concomitant TBI in the context of milder injuries, such as in patients sustaining a mild TBI combined with an isolated limb fracture, despite both injuries being highly prevalent and sharing various similarities (e.g., overlapping injury mechanisms and physiological mechanisms). The current thesis sought to bridge this knowledge gap via a multifaceted approach. We first investigated the risk of sustaining a concomitant mild TBI in patients with an isolated limb fracture (article 1) as well as its impact on post-fracture recovery according to various clinical measures (articles 2, 3, 4). The results showed that mild TBI was frequent, although highly underdiagnosed, in patients seeking care for an isolated limb fracture in the emergency department. Moreover, the presence of a concomitant mild TBI had a significant detrimental impact on the level of perceived pain, on return to work delays, and on the risks of developing heterotopic ossification (a type of orthopedic complication). Secondly, this thesis used a theoretical (article 5) and a clinical (article 6) approach to study the physiological mechanisms underlying pain perception, a key symptom following a fracture, in order to limit the risks for pain chronification and to propose intervention methods tailored to the studied population. In particular, results highlighted an association between pain intensity as perceived by patients in the acute phase post-fracture and the degree of cortical excitability impairments of the primary motor cortex, as measured by transcranial magnetic stimulation (TMS). Finally, based on theoretical evidence highlighted in a review article included in this thesis, there are evidence supporting the use of TMS in a traumatically injured population as a method to investigate and intervene given its ability to target key physiological mechanisms involved in the transition from acute to chronic pain.
Fuentes, Alexandre. "Apport d’une évaluation biomécanique 3D du genou dans la prise en charge orthopédique de patients ayant une rupture du ligament croisé antérieur". Thèse, 2010. http://hdl.handle.net/1866/4764.
Testo completoThe anterior cruciate ligament (ACL) is involved in approximately 20% of all sports-related knee injuries. An injury to the ACL, the primary stabilizer of the knee, will lead to knee joint instability and functional impairment. Unfortunately, current clinical assessments of ACL-deficient patients present limitations with respect to the investigation of the impact of the injury on knee function. A 3D knee biomechanical assessment could provide innovative information to overcome these drawbacks. The main objective of the doctoral theses is to demonstrate the role of biomechanics in (1) the investigation of the impact of the injury on knee function and in (2) the diagnostic process. Twenty-nine ACL-deficient patients and a control group of fifteen healthy participants took part in a 3D knee biomechanical assessment during treadmill walking. By assessing the 3D knee biomechanical patterns of each group we observed that ACL-deficient patients adopted a gait compensatory mechanism: the Pivot-shift avoidance gait. The explanation for this adaptative strategy is to avoid placing the knee in a position biomechanically favorable to anterolateral rotatory instability during gait. Furthermore, an automatic classification method capable of distinguishing ACL deficient patients from an asymptomatic population was developed. Features were extracted from the 3D knee biomechanical patterns using a wavelet decomposition method and then classified by the nearest neighbour rule. The proposed classification method obtained a level of accuracy, sensitivity and specificity of 88%, 90% and 87% respectively. This method shows great potential as a diagnostic aid in a clinical setting. This thesis demonstrates that biomechanics plays a substantial role in the management of ACL injuries by improving the understanding of the impact of the injury on knee function and by its capacity to serve as a diagnostic aid.
Fuentes-Dupré, Alexandre. "Apport d’une évaluation biomécanique 3D du genou dans la prise en charge orthopédique de patients ayant une rupture du ligament croisé antérieur". Thèse, 2010. http://hdl.handle.net/1866/4764.
Testo completoThe anterior cruciate ligament (ACL) is involved in approximately 20% of all sports-related knee injuries. An injury to the ACL, the primary stabilizer of the knee, will lead to knee joint instability and functional impairment. Unfortunately, current clinical assessments of ACL-deficient patients present limitations with respect to the investigation of the impact of the injury on knee function. A 3D knee biomechanical assessment could provide innovative information to overcome these drawbacks. The main objective of the doctoral theses is to demonstrate the role of biomechanics in (1) the investigation of the impact of the injury on knee function and in (2) the diagnostic process. Twenty-nine ACL-deficient patients and a control group of fifteen healthy participants took part in a 3D knee biomechanical assessment during treadmill walking. By assessing the 3D knee biomechanical patterns of each group we observed that ACL-deficient patients adopted a gait compensatory mechanism: the Pivot-shift avoidance gait. The explanation for this adaptative strategy is to avoid placing the knee in a position biomechanically favorable to anterolateral rotatory instability during gait. Furthermore, an automatic classification method capable of distinguishing ACL deficient patients from an asymptomatic population was developed. Features were extracted from the 3D knee biomechanical patterns using a wavelet decomposition method and then classified by the nearest neighbour rule. The proposed classification method obtained a level of accuracy, sensitivity and specificity of 88%, 90% and 87% respectively. This method shows great potential as a diagnostic aid in a clinical setting. This thesis demonstrates that biomechanics plays a substantial role in the management of ACL injuries by improving the understanding of the impact of the injury on knee function and by its capacity to serve as a diagnostic aid.
Wang, Han Ting. "La fragilité comme prédicteur de la durée du séjour hospitalier après les chirurgies orthopédiques majeures électives chez les patients âgés". Thèse, 2017. http://hdl.handle.net/1866/20515.
Testo completoVuille-Lessard, Élise. "Impact de l’anémie postopératoire sur la récupération fonctionnelle et la qualité de vie après une arthroplastie de la hanche ou du genou". Thèse, 2011. http://hdl.handle.net/1866/6237.
Testo completoRed blood cell transfusions are frequently used to treat anemia after total hip or knee arthroplasties. The indications for transfusions remain unclear despite published guidelines. Clinicians have adopted a restrictive transfusion threshold (75-80 g/L) but the consequences of such a strategy on functional outcome and quality of life are not known. First, we characterized the transfusion practice inside the Centre hospitalier de l’Université de Montréal (CHUM). Our hypothesis was that transfusion practice varies inside the CHUM due to uncertainty. A retrospective study of 701 charts of patients operated for a hip or knee arthroplasty was conducted. We observed that there was no difference among hospitals regarding the way transfusions are used and that physicians mainly based their decision to transfuse on a single variable, the hemoglobin concentration, adopting a restrictive transfusion strategy. Sixty-six percent of patients had a hemoglobin concentration under 100 g/L after surgery. Second, we evaluated the impact of this postoperative anemia on functional outcome and quality of life. We hypothesized that a threshold hemoglobin concentration exists below which these become impaired. A prospective, observational cohort study was conducted in 305 patients categorized in groups according to their postoperative hemoglobin concentration. Hemoglobin groups (≤ 80, 81-90, 91-100 and > 100 g/L) were similar in the evolution of the distance walked in six minutes, perception of effort, maximal dominant hand strength and quality of life scores. Thus, moderate anemia is not associated with an impaired functional recovery or quality of life early after hip and knee arthroplasties. Further studies will be required to determine the long-term consequences of a restrictive transfusion strategy in these patients.
Dessureault-Dober, Ingrid. "Une étude clinique sur la validité des tests orthopédiques utilisés pour diagnostiquer un syndrome du défilé thoracique". Thèse, 2016. http://hdl.handle.net/1866/19513.
Testo completoThoracic outlet syndrome (TOS) is defined as a neurovascular syndrome associated with compression of the brachial bundle (brachial plexus and/or subclavian vessels). Patients may have a compression of one structure or a combination of neurovascular symptoms, which can complicate the diagnosis. Based on the clinical presentation, the clinician often performs selected provocative tests to identify a site of compression of the brachial bundle specific to a type of TOS to confirm the syndrome and propose a management plan. However, due to the lack of accepted criteria for the diagnosis of TOS, test results may be unable to confirm or rule out the presence of the syndrome. This has important implications for the generalization of results relating to test performance. The purpose of this thesis was to establish the validity of orthopedic tests commonly used to diagnose a thoracic outlet syndrome. A systematic literature review was first conducted on the subject. Afterward, a clinical research on the accuracy of commonly used orthopedic tests used in practice was done using an echography Doppler machine. A better understanding of the validity of these tests should improve the clinical diagnosis and help define a clear plan of management. The advantages offered by this research project are multiple for clinicians, the study provides a better understanding of this controversial syndrome, knowledge on the quality of the research done up until now and lastly, clinicians have a better understanding of the validity of TOS orthopedic tests in an objective to help improve its diagnosis.
Beetz, Gabrielle. "Importance du sommeil chez des patients orthopédiques avec fracture, une revue de la littérature". Thesis, 2020. http://hdl.handle.net/1866/25182.
Testo completoSleep disturbances are highly relevant in the orthopedic field, as they can increase the risks of falls, decrease bone density, and lead to poor fracture and health outcomes in patients with fractures. It is estimated that between 20% to 40% of patients presenting one fracture will report difficulty to sleep 3 months following trauma. However, the impact of sleep in the acute phase following fracture is less studied. Therefore, this present thesis aimed to propose a clinical research project evaluating the impact of sleep on the recuperation of patients in the acute phase following fracture. To this end, we will use an actigraphy watch over a 14-day period following fracture to collect various sleep parameters, in combination with questionnaires on sleep quality, pain intensity and function of the fractured limb. A longitudinal follow-up (>3 months) will allow evaluating if sleep difficulties persist over time, using aforementioned questionnaires. The second part of this thesis presents a detailed narrative review of the literature describing the impact of sleep disturbances on falls, motor vehicle accidents and fractures in addition to their impact on fracture outcomes and the underlying physiopathological mechanisms. We observed that not only optimal sleep quality is essential in prevention of motor vehicule accident, but is also a key element to recovery after an orthopedic trauma. Futur research will allow a better understanding of sleep and bone relation.