Les caractéristiques techno-typologiques et fonctionnelles du débitage d’éclats au VSG : le cas et la place des sites hauts-normands dans le nord de la France

Suite à une première année test très concluante, le projet présenté dans le cadre de ce projet collectif de recherche triennal, concerne les problématiques relatives au débitage d’éclats au VSG/Blicquy (Néolithique ancien) dans le Bassin parisien, ses marges occidentales et plus particulièrement la Haute-Normandie. En effet, si les grandes lignes chronoculturelles et la nature des implantations du Néolithique ancien sont assez bien perçues dans notre région, les données sur le mobilier lithiq..

Les caractéristiques techno-typologiques et fonctionnelles du débitage d’éclats au VSG : le cas et la place des sites hauts-normands dans le nord de la France

Depuis plusieurs années, nombre de sites du Villeneuve-Saint-Germain ont été découverts en Haute-Normandie. Résultant notamment du développement de l’archéologie préventive cette dynamique de recherche a permis de préciser la nature des implantations au cours du Néolithique ancien mais reste toutefois à approfondir. Si le cadre chronoculturel et son évolution sont mieux définis depuis plusieurs années, nombre de données, et notamment de corpus mobilier, nécessiteraient une étude plus détaillé..

Utilisation de tiges sur mesures patients spécifiques dans les grandes déformations rachidiennes de l'adulte : étude descriptive

Thèse présentée sous la forme d'une "Thèse Article"Introduction : la compréhension de l'équilibre sagittal a mis en évidence l'importance de réaliser une planification chirurgicale appropriée pour chaque patient pris en charge pour une déformation rachidienne de l’adulte (ASD), le développement récent de tiges rachidiennes sur-mesure, spécifiques au patient (PSR) doit permettre une meilleure transposition de la planification en per opératoire. L’objectif de cette étude est d’analyser les résultats radiologiques, cliniques, et la survenue de complications à 1 an post opératoire d’une cohorte ayant bénéficié d’une instrumentation sur-mesure patient spécifique et d’identifier les facteurs influençant ces résultats. Matériel & méthodes : les adultes ayant bénéficié d’une prise en charge chirurgicale pour une déformation rachidienne, instrumentés avec des tiges rachidiennes sur-mesure patient spécifiques dans notre centre depuis septembre 2014 et présentant un recul de plus d’un an ont été sélectionnés. Les paramètres radiologiques ont été évalués et les patients ont été stratifiés en fonction de leur statut au dernier suivi (A: aligné Vs MA: mal aligné) selon les seuils de la classification SRS-Schwab liées à l’âge. Une analyse statistique à l’aide d’un test T de Student a été utilisés pour comparer les groupes.Résultats : 86 patients ont été inclus, d’âge moyen 57,2ans (+/- 19,2). Au total à 1an post opératoire Le SVA moyen et la différence IP-LL moyens étaient significativement améliorés, 22 patients étaient corrigés sur le plan sagittal et coronal (Alignés) , 52 patients conservaient malgré la chirurgie, un déséquilibre sagittal isolé, 3 patients conservaient un déséquilibre coronal isolé et 9 patients conservaient un déséquilibre combiné (Vs. 42 patients en pré opératoire).Conclusion : la corrélation statistique entre les paramètres radiologique pré et post opératoire confirme l’importance d’une planification chirurgicale basée sur ses paramètres et l’utilisation de tiges rachidiennes sur mesures apparait être un outil performant pour la transposition per opératoire de cette planification dans les chirurgies complexe de déformation rachidienne de l’adulte

(R)évolution en chirurgie du rachis

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Probing intervertebral discs with PhotoAcoustics

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“Patient-specific” rods in the management of adult spinal deformity. One-year radiographic results of a prospective study about 86 patients

International audienceIntroduction.-Based on global knowledge regarding sagittal alignment, preoperative planning is a crucial point in the management of adult spinal deformity (ASD). Patient-specific rods (PSR) have been recently developed in order to change preoperative planning into a postoperative reality. The aim of this study was therefore to analyze the 1-year radiographic results of prospective ASD cohorts managed using PSR.Methods.-In this prospective study, all patients managed for an ASD using PSR since 2014 and with a minimal follow-up of 1-year were included. Radiographic parameters were evaluated pre and postoperatively and patients were stratified according to their final sagittal alignment status (A: aligned vs. MA: malaligned) according to the age-related Schwab classification. Statistical analyses were performed using the Student's-t-test in order to compare groups.Results.-Eighty-six patients were included in the study, with a mean age of 57.2 years. At one-year follow-up, mean sagittal vertical axis and pelvic incidence-lumbar lordosis mismatch were significantly improved. Twenty-two patients were aligned on both sagittal and coronal planes, 52 patients were still considered as malaligned in the sagittal plane, 3 were still malaligned in the coronal plane and 9 patients were malaligned in both planes (vs. 42 patients preoperatively). At final follow-up, the rate of mechanical complications was 18%.Conclusion.-Based on our results, patient-specific rods can represent a useful supplementary tool in the management of ASD and transform preoperative planning into a postoperative reality. Corrections rates are comparable to other series in the literature with conventional rods, and fewer complications have been reported. However, further studies will be required in order to confirm these results

Minimally invasive triangular lumboiliac and iliosacral fixation of posterior pelvic ring injuries with vertical instability: Technical note

International audienceTo date, no strong consensus exists on the best way to treat posterior pelvic ring injuries when there is no neurological deficit. Various fixation methods have been described; more recently, constructs that combine lumboiliac and iliosacral fixation have been introduced. This type of fixation is mainly indicated in cases of spinopelvic dissociation with large displacement of fracture fragments in the sagittal plane. However, these techniques are associated with postoperative complications, particularly infections and severe skin complications. This led us to propose a minimally invasive lumboiliac and iliosacral fixation technique for posterior pelvic ring injuries. The procedure is done with the patient prone. It consists of pedicle screw insertion into L4 or L5 and screw fixation of the ilium with fluoroscopy guidance; intra-operative distraction can be done depending on the amount of displacement. An iliosacral screw is then inserted percutaneously to allow reduction in the transverse plane and yield a triangular construct. In the five patients that we have operated using this technique, the mean preoperative vertical displacement was 11.9 ± 6.9 mm (SD) (min 1.3, max 19.7) versus 3.7 ± 3.2 mm (min 0.3, max 6.7) postoperatively and the mean preoperative frontal displacement was 7.5 ± 3.7 mm (min 4.2, max 12.4) versus 2.5 ± 2.0 mm (min 0.3, max 4.3) postoperatively. Minimally invasive iliosacral and lumboiliac fixation is an option for treating posterior pelvic ring fractures free of neurological deficit and especially spinopelvic dissociation

Sagittal reduction of spinal deformity: Superior versus lateral screw-rod connection

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[The proximal femur fracture epidemic continued during the COVID-19 pandemic: results of an observational study].

INTRODUCTION: The aim of this study was to compare the volume and characteristics of emergency trauma surgery procedures done at our hospital between March 20 and April 20, 2020 (the first month of the national lockdown in France) and to compare these data to the same period in 2019. We hypothesized that a portion of fractures are unavoidable, thus specific preventative measures will be needed to reduce their incidence. METHODS: This was a continuous, observational, single center study. All patients who required urgent surgery for a fracture between March 20 and April 20, 2020, were included. Data for the same period in 2019 was retrieved. All the procedures were done at our hospital, which is a regional level II trauma center. RESULTS: During the first month of the lockdown, 70 patients underwent emergency surgery because of a fracture, versus 109 patients in the same period in 2019, thus an overall 36% drop. The mean age of the patients was higher in 2020 (68.4 years SD = 22) than in 2019 (60.3 years SD = 24, p = 0.0210). There were fewer recreational and motor vehicle accidents in 2020 (34 vs. 10) and fewer work-related accidents (7 vs. 2) although the number of accidents at home were similar (65 vs. 55). CONCLUSION: During a public health emergency, it is vital to continue doing trauma surgery procedures, even though it requires a specific care pathway. The lockdown and associated behavioral changes have altered the spectrum of trauma surgery. A major decrease in motor vehicle, recreation and work-related accidents is the avoidable portion of this surgical activity, justifying specific preventative measures during a public health crisis. Conversely, the incidence of geriatric fractures - particularly of the proximal femur - did not change much overall, thus there is need for additional preventative measures in these patients. LEVEL OF EVIDENCE: V, observational study

The proximal femur fracture epidemic continued during the COVID-19 pandemic: results of an observational study.

INTRODUCTION: The aim of this study was to compare the volume and characteristics of emergency trauma surgery procedures done at our hospital between March 20 and April 20, 2020 (the first month of the national lockdown in France) and to compare these data to the same period in 2019. We hypothesized that a portion of fractures are unavoidable, thus specific preventative measures will be needed to reduce their incidence. METHODS: This was a continuous, observational, single center study. All patients who required urgent surgery for a fracture between March 20 and April 20, 2020, were included. Data for the same period in 2019 was retrieved. All the procedures were done at our hospital, which is a regional level II trauma center. RESULTS: During the first month of the lockdown, 70 patients underwent emergency surgery because of a fracture, versus 109 patients in the same period in 2019, thus an overall 36% drop. The mean age of the patients was higher in 2020 (68.4 years SD = 22) than in 2019 (60.3 years SD = 24, p = 0.0210). There were fewer recreational and motor vehicle accidents in 2020 (34 vs. 10) and fewer work-related accidents (7 vs. 2) although the number of accidents at home were similar (65 vs. 55). CONCLUSION: During a public health emergency, it is vital to continue doing trauma surgery procedures, even though it requires a specific care pathway. The lockdown and associated behavioral changes have altered the spectrum of trauma surgery. A major decrease in motor vehicle, recreation and work-related accidents is the avoidable portion of this surgical activity, justifying specific preventative measures during a public health crisis. Conversely, the incidence of geriatric fractures - particularly of the proximal femur - did not change much overall, thus there is need for additional preventative measures in these patients. LEVEL OF EVIDENCE: V, observational study