T. Ouedraogo

Anatomic study of the pre- and neonatal hip. Physiopathologic considerations on dysplasia and congenital dislocation of the hip

Therapeutic success in dysplasia and congenital dislocation of the hip depends on an early diagnosis. The physiopathology remains very debatable and several concepts are propounded. For a better physiopathologic understanding, the authors have carried out a study of the morphology and development of 22 pre- and neonatal hips. At first, the acetabulum is cartilaginous and distorted by the moving femoral head; this acetabulum is histologicaly affected by the femoral pressure. The pathologic hip is characterized by defective posterior bony coverage of the femoral head by the acetabulum. The acetabulum ossifies during the 3 months following birth, forming a cup-like cavity under the pressure of the femoral head. Therefore, neonatal screening tests such as sonography must take place in the first weeks of life.

Neonatal hip: from anatomy to cost-effective sonography

Abstract. Therapeutic success in treating congenital dysplasia of the hip is associated with early diagnosis, but the specific neonatal anatomy makes screening difficult. The purpose of this study was to determine whether this specific neonatal anatomy is taken into account by current ultrasound (US) techniques. Anatomic studies were performed on 22 hips, US examinations on 7750 neonatal hips; 2370 untreated hips were reexamined at 1 month by US and at 3 months by X-ray. The transformation of the neonatal cartilaginous acetabulum into an osseous cavity is dependent on harmonious metaphyseal growth and a properly seated femoral head. Defects in the acetabular roof, together with displacement of the femoral head, cause an abnormal anatomical relationship which leads to further deformities. The described sonographic techniques give only partial information on these specific abnormalities. The sonographic monoplanar methods as used in Grafs technique, which relies largely on acetabular development, lead to difficulties in assessing posterior coverage of the femoral head and difficulties in assessing alignment of the metaphyseal weight-bearing surface with the femoral head. Combining Grafs morphological analysis with Novicks dynamic technique enables one to more accurately define the relationship of the femoral head and the acetabulum and increases the reliability and predictive value of the examination, while reducing the number of doubtful cases. This makes screening cost effective.

Aide de l’informatique à l’enseignement : exemple de l’anatomie sectionnelle du crâne et de la face

Objectifs du CD-ROM ce CD-ROM a pour but l’enseignement de l’anatomie sectionnelle du crâne et de la face. Il utilise pour cela des coupes axiales scannographiques et anatomiques d’une tete, numerisees et de haute qualite. Chaque planche est visualisable avec et sans legendes. Il est dote d’une interface conviviale comprenant deux modes : un mode « enseignement », ou les deux types de coupes sont accessibles sans et avec les legendes. Des calques des structures osseuses, musculaires, et vasculaires sont aussi superposables sur les coupes anatomiques, un mode « jeu », ou l’ordinateur propose a l’etudiant pour une planche donnee de repondre a des QCM portant sur les differentes structures que le programme designe. Conclusion ce CD-ROM est destine aux etudiants en Medecine comme initiation a l’imagerie du crâne et de la face. Il sera prochainement accessible en telechargement direct sur le site du laboratoire d’Anatomie de la Faculte de Medecine de Reims.

Les bases anatomiques de l’oculomotricité

The oculomotricity rests on complex anatomo-physiological bases and allows the binocular vision, which is a sensory function very completed in the human. After a short embryologic recall, the binocular vision is defined. The anatomical structures, which take part in the binocularity, are reviewed within three functional stages: an effector peripheral stage (eye ball, extrinsic muscles and their nerves), a sub cortical central stage, generator of the movements (oculomotor nuclei, reticularis formation...), and a central, cortical and subcortical stage, incitator of the movements (cortical areas, vestibular nuclei, cerebellum...). These anatomical bases make it possible to understand the many disorders observed in pathology.