Pelvic granulocytic sarcoma

 Granulocytic sarcoma is an uncommon extraskeletal tumor most frequently associated with leukemia. We present a case of bone location with unusual pattern in a patient with no evidence of myeloproliferative disorder at presentation or follow-up.     

Study of the course of the incidence angle during growth

Standing posture is made possible by hip extension and lumbar lordosis. Lumbar lordosis is correlated with pelvic parameters, such as the declivity angle of the upper surface of the sacrum and the incidence angle, which determine the sagittal morphotype. Incidence angle, which is different for each individual, is known to be very important for upright posture, but its course during life has not yet been established. Incidence angle was measured on radiographs of 30 fetuses, 30 children and 30 adults, and results were analysed using the correlation coefficientr and Student's t test. A statistically significant correlation between age and incidence angle was observed. Incidence angle considerably increases during the first months, continues to increase during early years, and stabilizes around the age of 10 years. Incidence is a mark of bipedism, and its role in sagittal balance is essential.     

骨盆创伤的CT检查(附50例CT与X线平片检查对照)

目的分析急性骨盆损伤的CT征象,评价CT在骨盆损伤诊断中的应用价值和局限性。方法50例骨盆损伤的患者进行X线、薄层CT检查,分析CT检查征象,并与X线平片对照。结果50例中CT发现骨盆各骨骨折157处,X线显示骨折113处,X线平片及CT的检出率差异有显著性意义(χ2=38·72,P<0·01);CT发现关节脱位27处,X线显示脱位16处,X线平片及CT的检出率差异有显著性意义(χ2=9·09,P<0·01)。X线平片中有3处阳性征象CT检查未能显示。结论CT检查在显示骨、关节的骨折、脱位,盆腔脏器及软组织的损伤,判断骨盆骨折的严重程度等方面优于X线平片,并适合多发伤及危重患者同时进行多项检查时应用,为救治严重创伤患者的一种快速、准确的放射检查手段。     

冲击载荷作用下骨盆三维有限元分析及其生物力学意义

目的:探讨骨盆受到冲击载荷作用的力学行为特征,为临床分析及判断骨盆骨折类型、力学分布、冲击载荷影响提供力学基础。方法:采用计算机仿真模拟方法,将所构建骨盆三维实体模型导入三维有限元分析软件AN-SYS7.0,计算单侧髂前上棘和单侧髂骨正后方部位冲击载荷作用下骨盆的力学行为表现,冲击载荷为0～8000N,峰值8000N,时间自0～40ms,分析主应力值、应力分布情况以及主应力方向上骨盆单元的位移。结果:冲击载荷作用于单侧髂前上棘时,0～10ms主要的应力沿髂后上棘到髂前上棘分布,在冲击后期10ms以后,骶髂关节、髋臼和耻骨支都会产生较大的应力分布;作用于单侧髂骨正后方部位时,0～20ms主要的应力沿髂骨纵行传导,应力分布并没有在冲击峰值10ms时达到最大,而是从20ms之后,应力开始向骶髂关节、双侧耻骨支、坐骨支以及髋臼等部位传导并可见到明显的应力分布。结论:分析冲击载荷作用下骨盆各部位应力分布以及骨盆各个单元在应力作用下的位移变化,有助于临床上进行骨盆损伤内固定力点的选择以及进一步明确骨盆内在应力值分布。     

垂直旋转不稳定型骨盆骨折的手术治疗探讨

目的：探讨垂直旋转不稳定型骨盆骨折前联合入路内固定的临床疗效。方法：旋转垂直不稳定型骨盆骨折34例，男23例，女11例；年龄13-56岁，平均36岁。按Young—Burgess分类：APCⅢ型损伤9例，LCⅢ型损伤14例，VS损伤11例。入院骨盆外支架固定、抗休克处理，全身情况稳定后，均通过前联合人路切开复位钢板内同定。结果：34例术后获随访，时间12-48个月，平均21个月，术口愈合良好，骨折均3—6个月愈合。按Majeed疗效评价标准：优21例，良10例，中3例。无畸形愈合，遗留跛行3例，腰骶痛4例，双小腿、足麻木3例。结论：前联合入路切开复位内固定治疗旋转垂直不稳定型骨盆骨折，矫正畸形，重建骨盆环稳定性，效果满意。     

A multicenter clinical trial of gadolite oral suspension as a contrast agent for MRI

The purpose of this study was to assess the effectiveness and safety of Gadolite Oral Suspension as a gastrointestinal (GI) contrast agent for MRI in a phase II and two phase III multicenter clinical trials. Gadolite was administered to 306 patients with known or suspected abdominal and/or pelvic disease. MRI with T1- and T2-weighted sequences was performed before and after ingestion. Efficacy was evaluated by having two masked readers rate the certainty of their MR diagnosis (0 = uncertain, 1 = probable, 2 = definite) on randomly presented pre- and post-Gadolite Oral Suspension enhanced images. Principal investigators also evaluated the images and established the final diagnosis. Vital signs, clinical chemistries, and adverse events were documented. Blood and urine samples were analyzed for gadolinium content to determine whether Gadolite Oral Suspension was absorbed systemically. Certainty in MR diagnosis increased significantly (P < .001) for both blinded readers between pre- and post-Gadolite images (.49–1.18 for reader 1; .46–1.53 for reader 2). Sensitivity, specificity, and accuracy also increased for both masked readers. No gadolinium was detected in blood or urine samples. There were no serious adverse events and no apparent drug-related trends in mean vital signs or laboratory values. Gadolite is a highly effective, safe, and well tolerated contrast agent for clinical use with MRI.     

对外伤性骨盆骨折摄影角度的探讨(附30例分析)

目的:探讨骨盆多发性骨折各部位的摄影角度及影像显示的原理及方法,优势与不足以及临床应用价值。方法:首先选择骨髂标本做研究对象进行不同角度的摄影,并选择了最佳摄影角度及方法,进行了30例患者的摄片,均符合临床诊断要求。结果:骨盆多发性骨折的各部位最适宜的摄影角度。骨盆入口位,摄影角度向头侧倾斜25°位;骨盆出口位,摄影角度向足侧倾斜25°位;髂骨及闭孔斜位,一侧抬高25°位,影像显示效果较佳,优于有关报导的摄影角度及方法。结论:对外伤性骨盆多发骨折的患者,各部位摄影角度上述所示,此方法可行,完全符合临床诊断要求。     

盆环原发恶性肿瘤的切除与生物学重建

目的:探讨骨盆环恶性肿瘤的切除、重建方式与并发症的处理 .方法:手术治疗骨盆环原发恶性或低度恶性肿瘤5例,其中骶骨恶性畸胎瘤2例、脊索瘤1例,髂骨骨肉瘤1例、恶性骨软骨瘤1例.所有患者术前未行动脉栓塞、结扎髂内血管.髂骨翼肿瘤采用自体髂骨、髋臼肿瘤采用异体骨重建骨盆环、自体股骨头重建髋臼骨床 人工全髋关节置换术.结果:5例肿瘤均行根治性切除,3例骶骨肿瘤术中出血量150～800 mL,术后出血300～1 000 mL,1例切口感染,1例术后出现失血性休克.髂骨翼肿瘤和髋臼周围肿瘤术中出血量分别为1 000 mL和4 000 mL,术后分别为800 mL和1 100 mL.髂骨肿瘤切除与重建患者2月后恢复关节功能,髋臼肿瘤切除与重建患者6月后恢复功能,4例患者术后随访4～24个月,生存良好.结论:骨盆环恶性肿瘤的外科手术治疗关键是完整的手术切除,包膜外切除可以减少出血、预防复发,影响骨盆环稳定时应考虑重建,自体、异体骨移植能够恢复髋臼周围骨量、维持骨盆环生物学稳定.     

Reliability of the acetabular teardrop as a landmark

Summary This study investigated the effect of tilt and observer reliability on radiographic measurements of the position of a prosthetic acetabular cup in seven dry bone pelves using the teardrop as a landmark. Coronal or sagittal tilt of more than five degrees was easily recognisable and there was effectively no observer variation in the measurements up to this limit. In addition, 90 out of 100 randomly selected antero-posterior pelvic radiographs from an outpatient department were not significantly rotated and 93 demonstrated a clearly defined teardrop. Measurements about the teardrop on routine radiographs are therefore sufficiently accurate to allow assessment of prosthetic position.

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La valeur du sourcil cotyloidien comme repère d'analyse radiologique

Résumé Cette étude, conduite sur 7 bassins secs, apprécie l'effet de l'inclinaison du bassin sur la qualité de l'analyse radiographique de la position d'une cupule prothétique de hanche en utilisant le sourcil cotyloïdien comme repère. Une inclinaison du bassin dans les plans coronal et sagittal est aisément détectable et il n'existe pas de variation d'analyse entre les différents observateurs en dessous de 5° d'inclinaison. De plus, sur 100 radiographies antéro-postérieures de bassin choisies au hasard dans les dossiers de consultation, 90 avaient été réalisées sans incidence particulièrement adaptée et l'on pouvait repérer facilement le sourcil sur 93% d'entre elles. Les mesures faites sur des radios de routine sont donc suffisamment précises pour permettre l'évaluation de la position d'une prothèse à partir du sourcil cotyloïdien.

     

盆腔肿瘤供血及介入治疗选择

目的：探讨盆腔肿瘤供血特点对介入治疗选择的意义。材料和方法;分析58例盆腔肿瘤(男12例,女46例)年龄23岁～63岁,分别作双侧选择性髂内动脉造影,观察盆腔肿瘤的供血,行供血动脉选择性插管灌注栓塞治疗．化疗药物为阿霉素类、卡铂、5-Fu、MMC,栓塞剂主要为明胶海绵颗粒。结果：58例盆腔肿瘤中,54例为髂内动脉前干分支血管主要供血,仅少数病例是髂外动脉参与供血．并对52例妇科盆腔肿瘤及4例骶(尾)部肿瘤行肿瘤主要供血血管选择性灌注栓塞治疗,介入治疗术后所有病例均有全身情况改善,症状减轻,20例宫颈癌得以二期手术切除,4例子宫大出血得以控制;4例骶(尾)部肿瘤先行肿瘤供血动脉栓塞,栓后手术切除清楚,出血量减少。结论：盆腔血管解剖和肿瘤血管特点,是介入治疗选择基础,可作为盆腔肿瘤急诊止血症状,手术前后的辅助治疗或不能手术患者的姑息治疗不可缺少的手段．