后方关节囊舌形瓣成形术对防止全髋置换术后假体后脱位的作用

目的探讨髋关节后方关节囊舌形瓣成形术对防止人工全髋关节置换术后假体后脱位的作用。方法通过回顾分析1997—2002年的120例采用髋关节后方关节囊切除术与2003—2006年134例采用髋关节后方关节囊舌形瓣成形术加强人工全髋关节后方软组织支撑力量两组病例，比较两组术后假体后脱位发生率。前者切除髋关节后方关节囊，后者以髋臼后缘为基底将髋关节后方关节囊切修成一舌形瓣；关闭切口时．在转子间嵴上钻3～4个小骨孔．前者只将外旋短肌群缝合到转子间嵴上，后者将髋关节后方关节囊舌形瓣和外旋短肌群一并缝合到转子间嵴上。结果前者120例因软组织修复欠佳发生假体后脱位8例，发生率6．7％；后者134例因软组织修复欠佳发生假体后脱位2例，发生率1．5％，后者比前者术后假体后脱位发生率明显降低（P〈0．05）。结论采用髋关节后方关节囊舌形瓣成形术加强人工全髋关节后方软组织支撑力量，有助于恢复髋关节的软组织平衡，增加关节稳定性，对防止术后假体后脱位有一定作用。     

后方关节囊舌形瓣成形术对防止全髋置换术后假体后脱位的作用

目的 探讨髋关节后方关节囊舌形瓣成形术对防止人工全髋关节置换术后假体后脱位的作用.方法 通过回顾分析1997～2002年的120例采用髋关节后方关节囊切除术与2003～2006年134例采用髋关节后方关节囊舌形瓣成形术加强人工全髋关节后方软组织支撑力量两组病例,比较两组术后假体后脱位发生率.前者切除髋关节后方关节囊,后者以髋臼后缘为基底将髋关节后方关节囊切修成一舌形瓣;关闭切口时,在转子间嵴上钻3～4个小骨孔,前者只将外旋短肌群缝合到转子间嵴上,后者将髋关节后方关节囊舌形瓣和外旋短肌群一并缝合到转子间嵴上.结果 前者120例因软组织修复欠佳发生假体后脱位8例,发生率6.7%;后者134例因软组织修复欠佳发生假体后脱位2例,发生率1.5%,后者比前者术后假体后脱位发生率明显降低(P＜0.05).结论 采用髋关节后方关节囊舌形瓣成形术加强人工全髋关节后方软组织支撑力量,有助于恢复髋关节的软组织平衡,增加关节稳定性,对防止术后假体后脱位有一定作用.     

全髋关节置换术后早期脱位原因分析及预防

目的：探讨全髋关节置换术后6个月内脱位原因及有效预防方法。方法：对320例全髋关节置换术患者，进行侧卧外展试验和放射学测量，分析术后早期脱位原因。结果：在320例全髋关节置换术后6个月共发生脱位15例，脱位率4．7％，其中翻修手术26例，发生脱位3例，脱位率11．5％，两者有显著差异（P〈0．01）。侧卧外展试验阳性患者132例，脱位8例，脱位率6．06％，试验阴性患者188例，脱位7例，脱位率3．72％，两者有统计学差异（P〈0．05）。测量术后X片臼杯安放位置在安全区内共285例，发生脱位7例，脱位率2．8％，在安全区外共35例，发生脱位8例，脱位率22．9％，两者有显著差异（P〈0．01）。使用具有防脱位高边的髋臼假体患者240例，发生脱位者8例，脱位率3．33％，使用普通髋臼假体患者80例，发生脱位7例，脱位率8．75％，两者有统计学差异（P〈0．05）。经后外侧入路手术患者160例，发生脱位9例，脱位率5．62％，经后外侧入路并保留修复关节囊患者160例，发生脱位6例，脱位率3．75％，两者有统计学差异（P〈0．05）。不同年龄、体重、性别的患者术后脱位率无显著差异。结论：全髋关节置换术后脱位与假体的放置位置、组织肌力平衡、手术是否保留修复关节囊、假体设计和是否翻修等因素有关，而与年龄、性别、体重等因素无关。精确假体置入、术后完善的护理可有效降低脱位发生率。     

骨水泥股骨柄和非骨水泥臼杯在首次全髋关节置换术中的应用

目的 随访一组采用同一类型骨水泥型股骨假体和非骨水泥型髋臼假体组合在首次人工全髋关节置换术中的应用，并探讨该种混合型假体对于全身健康情况和骨质质量一般较差的老年患者的适用情况。方法 共有75例患者84髋得到临床和影像学随访，平均年龄为67．9岁。其中老龄股骨颈骨折患者41例41髋，平均年龄72．1岁。随访时间为4．1年。随访内容包括患者的健康状况、手术方法、术后恢复情况以及对于骨形态、骨水泥固定质量和假体稳定性的判断。结果 2例股骨假体发生无菌性松动，臼杯则未见骨溶解或松动征象。未出现骨水泥相关的术中或术后死亡，各类全身性疾病在围手术期无加重表现。41例股骨颈骨折患者术后Harris评分为81.1分。股骨近端骨形态A型17髋（20％），B型47髋（56％），C型20髋（24％）。骨水泥固定质量分别为A级31髋（37％），B级40髋（48％），C级13髋（15％）。结论 混合型人工关节置换术的短期随访结果良好；混合型人工关节的术后即时稳定性有利于老年患者的康复；在手术中必须应用现代骨水泥技术。     

数字骨科技术在全髋关节置换术中假体选择及置入的应用研究

目的探究数字骨科技术在全髋关节置换术(THA)中假体选择及置入的应用意义。方法选取自2007年5月~2015年4月收治的39例(44髋)行THA的患者资料,男性21例,女性18例;平均年龄62(58~79)岁。其中19例患者(21髋)为观察组,术前借助CT三维重建及医学影像控制系统Mimics17.0,通过在数字模型上测量进而选择用于患者的假体型号进行THA;另外20例(23髋)为对照组,利用X线显影模板选择置入假体型号进行THA。术后进行两组患者假体选择准确率的比较分析。结果 39例(44髋)术后均获随访,平均随访时间为13.1(9~23)个月。观察组术前选择的THA假体型号与术中真实使用的假体型号差异个数为4个,对照组THA的假体型号差异个数为12个,观察组THA的假体准确率(80.9%)优于对照组(47.8%),并且差异有统计学意义(P=0.044);观察组THA术后优良率(85.7%)虽高于对照组THA术后优良率(73.9%),但组间差异无统计学意义(P=0.095)。结论应用数字骨科技术辅助THA中假体的选择及置入,可以提高THA假体置入的准确性,是一种理想的假体选择方法。     

非感染性人工髋关节翻修术28例

目的探讨非感染性人工髋关节翻修的原因、术中常见的困难及对策。方法1994年1月-2004年12月收治的28例中，男17例，女11例；年龄42～87岁，平均65．5岁。左侧13髋，右侧15髋似体松动14例、臼松动11例，柄松动3例；股骨侧假体下沉4例；髋臼磨透3例；股骨柄似体过长3例；合并股骨假体周围骨折1例；股骨柄穿通皮质1例；头臼不匹配1例；臼后倾1例。股骨柄假体15例取出顺利，13例取出困难，结果翻修成功27例。失败1例。全部患者经6个月-8年随访，平均3年7个月、Harris评分术前平均为45分，随访时评分平均为84分。结论（1）无菌性松动和医源性错误是非感染性人工髋关节翻修的主要原因；（2）人工关节翻修手术难度大，术前要做好周密的准备，没有手术经验的医师尽量不要尝试；（3）股骨柄假体取出困难是髋关节翻修中常见的难题，骨水泥型更为突出；（4）术后科学的康复锻炼对功能恢复十分重要.     

全髋关节置换术后股骨皮质的肥厚反应

目的 观察全髋转换术后股骨皮质的肥厚反应及其临床意义。方法 １９９３年１月～１９９５年８月，应用同一设计的骨水泥和非骨水泥股骨假体，共施行２４６髋全髋关节转换术。骨水泥组１１７髋，平均随访４．５年；非骨水泥组１２９髋，平均随访４．１年。结果骨水泥组无一例有股骨皮质肥厚，髋关节功能优良率８８．９％，无一例假体松体；非骨水泥组３６髋（２７．９％）出现股骨远侧皮质肥厚反应，髋关节功能优良率９５．３％，假     

组配型股骨柄在骨缺损的股骨翻修术中的应用

目的探讨应用组配柄对骨缺损情况下全髋股骨翻修的疗效。方法自2001年12月至2006年6月，应用Link MP^TM翻修组配假体共进行56例股骨翻修术。其中男24例，女32例；年龄38～77岁，平均58．8岁。翻修原因：无菌性假体松动48例，髋关节假体周围感染7例，股骨干骨折假体周围骨折1例。感染性股骨翻修均为Ⅱ期翻修。术中取出假体：水泥型30例，非水泥型26例。股骨缺损采用Mallory分类：Ⅱ型5例，ⅢA型22例，ⅢB型28例，ⅢC型2例。术中植骨12例。使用钢缆钢丝固定28例。术中并发症：大转子部分劈裂1例，股骨干骨折3例，骨干皮质穿孔1例。结果对手术半年以上的52例患者进行随访，时间8～56个月，平均31、78个月。翻修组配假体远端均无移位，假体中置，仅1例近端假体下沉1、5cm。Harris评分，术前平均46分（22～52分），最后随访平均89分（70—94分）。无明显肢体不等长和大腿疼痛，无关节脱位。结论应用组配假体进行涉及近端明显骨缺损的全髋关节置换翻修的方法中期疗效满意。其优势是可以调节长度、偏心距、前倾角，可以独立匹配远近端股骨，从而达到初始的与长期的假体稳定性。     

后路小切口人工全髋关节置换术

目的 观察后路小切口人工全髋关节置换术（total hip arthroplasty，THA）的临床效果。方法 将70例患者按年龄、性别、体重指数、病种、髋关节功能配对分为两组进行前瞻性研究。35例小切口组，术前Harris评分52．21（24～76），35例标准后路手术组（简称标准组），术前Harris评分51．6（33～68）。分析手术时间、术中出血＋术后12h引流量、并发症、切口长度、疼痛评分、Harris评分等。结果 平均随访11.5个月（6～14个月）。两组手术时间相近。小切口组平均切口长9．0cm（7．0～12cm），标准组16cm（12—20cm），两组差异有统计学意义（P〈0．01）；小切口组平均出血500ml（270～700m1），29％（10／35）需输血，输血量约400ml，而标准组平均出血约950ml（600～1200m1），100％需输血，平均输血650ml，小切口组明显比标准组具有优势（P〈0．05）；小切口组疼痛评分平均为4．8分，标准组为6．8分（P〈0.01）。术后6个月，小切口组Harris评分94．0（84～100），标准组Harris评分90．5（82～94）。结论 后路小切口微创技术具有创伤小、出血少、疼痛小、恢复快的特点，可获得与常规后路手术相同的冶疗效果。     

人工髋关节置换术早期并发症26例

目的探讨应用组配柄对骨缺损情况下全髋股骨翻修的疗效。方法回顾性分析625例人工髋关节置换术患者，其中股骨头置换312例，全髋关节置换313例。总结并发症的临床特点及防治措施。结果26例（4．2％）患者出现并发症，其中伤151浅层感染1例（0．2％），脱位3例（0．5％），股骨假体周围骨折5例（0．8％），下肢深静脉栓塞11例（1．8％），应激性溃疡出血3例（0．48％），坐骨神经损伤1例（0．2％），假体松动2例（0．3％）。2例死亡。结论严格手术适应证、正确手术操作、强调术前准备和术后处理是减少术后并发症发生的关键。     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Uterine contractions: Possible diagnostic pitfall at MR imaging

A total of 206 nongravid patients with various gynecologic problems underwent pelvic magnetic resonance (MR) examinations that included both sagittal T2-weighted and contrast agent–enhanced T1-weighted images. MR images were retrospectively reviewed to identify changes in endometrial configuration on serial images obtained during the same MR examination. In 20 MR examinations (all in women of reproductive age), endometrial distortion due to myometrial bulging was noted on T2-weighted or contrast-enhanced T1-weighted images. It was absent on other MR images obtained at different times. Myometrial bulging exhibited low signal intensity in 18 examinations. The finding resembled adenomyosis or leiomyoma on T2-weighted or contrast-enhanced T1-weighted images. These results evidence the presence of transient myometrial bulging and transient low-intensity myometrium in the nongravid uterus. This phenomenon is thought to represent uterine contraction. Clinicians should be aware of the potential presence of transient low-signal-intensity myometrial bulging that could present diagnostic problems in the normal uterus.     

Controversies in cervical spine imaging in trauma patients

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to clear the cervical spine in comatose patients.Presented at the Annual Meeting of the American Society of Emergency Radiology, Las Vegas, Nevada, 22–25 October, 2003     

Brodie Abscess: MR imaging appearance in 10 patients

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic “target” appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypoin-tense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.     

Adrenal tissue characterization with 0.5-T MR imaging: Value of T2*-weighted images

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor–liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.     

Pericerebellar fluid collections in infancy,sequelae of birth injury? A retrospective CT study

Summary Retrospective analysis of axial CT scans from 600 consecutive pediatric patients revealed 37 patients (6%) with abnormal low density pericerebellar spaces. Fourteen of these 37 patients (38%) were diagnosed as cerebellar atrophy, whereas 23 of the 37 patients (62%) were diagnosed as mass-like pericerebellar fluid collections. Detailed analysis of the morphology of these spaces suggests that the CT criteria proposed in this paper distinguish between (a) those low attenuation pericerebellar spaces that represent cisternal dilatation caused by cerebellar atrophy (Group I — Atrophy) and (b) those low attenuation pericerebellar spaces that represent low density mass-like collections of fluid which distort a relatively normal cerebellum (Group II — Collections). Analysis of the medical records of the patients in Group II — Collections reveal a high incidence of prematurity, developmental delay, difficult birth and head trauma, possibly indicating that such collections represent sequelae of birth.     

Localized proton MR spectroscopy of the brain in children

Small-voxel (3.0–8.0 cm³), magnetic resonance (MR) imaging–guided proton MR spectroscopy was performed in 54 patients (aged 6 days to 19 years) with intracranial masses (n = 16), neurodegenerative disorders (n = 34), and other neurologic diseases (n = 4) and in 23 age-matched control subjects without brain disease. A combined short TE (18 msec) stimulatedecho acquisition mode (STEAM) and long TE (135 and/or 270 msec) spin-echo point-resolved spatially localized spectroscopy (PRESS) protocol, using designed radio-frequency pulses, was performed at 1.5 T. STEAM spectra revealed short T2 and/or strongly coupled metabolites; prominent resonances were obtained from N-acetyl aspartate (NAA), choline-containing compounds (Cho), and total creatine (tCr). Lactate was well resolved with the long TE PRESS sequence. Intracranial tumors were readily differentiated from cerebrospinal fluid (CSF) collections. All tumors showed low NAA, high Cho, and reduced tCr levels. Neurodegenerative disorders showed low or absent NAA levels and enhanced mobile lipid, glutamate and glutamine, and inositol levels, consistent with neuronal loss, gliosis, demyelination, and amino acid neuro-toxicity. Preliminary experience indicates that proton MR spectroscopy can contribute in the evaluation of central nervous system abnormalities of infants and children.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.