新兵胫骨应力性损伤的高频超声与MRI观察

目的 通过比较高频超声与MRI在新兵胫骨应力性损伤中的影像学特征,评价高频超声对应力性骨损伤的诊断价值.方法 随机抽取炮兵某部两个新兵营各15名(共30名)集训新兵为研究对象,于开训前及集训各周分别应用高频超声及MRI监测胫骨应力性损伤情况,并进行对照研究.结果 高频超声监测结果 显示开训前与集训各周之间比较骨膜增厚程度有统计学意义(P＜0.05),开训后各周之间骨膜厚度无统计学意义(P＞0.05);MRI检查结果 显示开训前MRI监测均呈阴性,开训后第1周胫骨应力性损伤的程度较轻,随着集训时间延长而逐渐加重,至第7周趋于稳定.结论 MRI对应力性骨损伤的灵敏性高,可全面观察骨外膜、骨髓腔等的病理变化;高频超声检查应力性骨损伤虽难以显示骨髓腔内的病理变化,但对骨外膜的应力性损伤变化具有与MRI相似的高灵敏性.     

平片阴性的衰竭骨折:螺旋CT与MRI早期诊断的对比研究

目的:探讨螺旋CT和MRI对平片阴性的衰竭骨折的早期诊断价值。材料与方法:31例经X线平片检查无明显异常而临床高度怀疑衰竭骨折的病人,进一步行CT和MRI检查。分析确诊病例CT和MRI表现。比较两种检查方法的敏感度、特异度、准确性及观察者间符合度。结果:19例病人确诊为衰竭骨折。CT主要表现为线样模糊低密度影,在脊椎多为线片样高密度。MRI T1WI多表现为低或略低信号,T2WI为高低混杂信号,STIR多呈明显高信号。CT和MRI诊断的敏感度、特异度、准确性分别为89%/95%、92%/67%、90%/84%,但差异均无统计学意义(P>0.05)。CT的观察者间符合度优于MRI,Kappa值分别为0.728,0.459。结论:螺旋CT与MRI均有助于平片阴性衰竭骨折的早期诊断,但螺旋CT的准确性略高于MRI,可能因为螺旋CT具有较好的特异性。     

宫颈癌放疗后骨盆衰竭骨折MRI及相关临床特点分析

目的 探讨宫颈癌放疗后骨盆衰竭骨折的MRI特点、骨折率及相关因素。方法 收集176例具有完整临床及盆腔MRI资料的宫颈癌放疗后患者,分为衰竭骨折组及未骨折组,进行统计学分析。结果 176例中,发生骨盆衰竭骨折共15例(15/176,8.52%)。衰竭骨折组与未骨折组间宫颈癌首诊时年龄、月经状况、放疗治疗方式及是否适合手术治疗方面差异均有统计学意义(P均<0.05)。两组间体质量指数、FIGO分期、盆腔外放疗的辐射剂量、放疗结束至MR检查的时间间隔差异均无统计学意义(P均>0.05)。MRI示15例均累及骶骨,其中4例同时合并第1或2骶椎横行骨折,3例同时累及耻骨或髂骨。Kaplan-Meier曲线图示衰竭骨折5年累积发病率为31.80%。结论 宫颈癌放疗后骨盆衰竭骨折好发于骶骨,高龄和绝经状态是其主要危险因素。     

膝关节半月板损伤MRI分级与半月板半脱位的相关性分析

目的：探讨膝关节半月板损伤MRI分级与半月板突出的相关性。方法：回顾性分析420例有膝关节症状病人的膝关节MRI表现，进行半月板损伤MRI分级评价及半月板突出大小的测量，统计分析膝关节半月板损伤MRI分级与半月板半脱位之间的相关性。结果：420例病人，包括内外侧共840个半月板。MRI分级0级128个，其中半脱位4个；I级258个，半脱位44个；II级149个，半脱位25个；III级305个，半脱位81个。半月板MRI分级和是否发生半月板半脱位之间存在相关性（χ2＝34.074，P<0.01），I～III级的发生率高于0级，I、II级之间差别不大，III级高于I、II级。在154例脱位半月板中，内侧半月板98个，外侧半月板56个，两者之间的差别有显著统计学意义（χ2=14.026，P＜0.01）。结论：膝关节半月板MRI分级与半月板半脱位密切相关。     

MRI 对陈旧与新鲜椎体骨折的鉴别诊断价值

目的:探讨MRI对陈旧与新鲜椎体骨折的鉴别诊断价值。方法:45例(62个椎体)椎体骨折患者于外伤后1 d内行MRI检查,并分别于3、6、9个月行MRI随访复查。结果:62个椎体骨折中,54个椎体为新鲜骨折,SE序列T1WI上呈低信号或低信号中混有少许高信号,FSE序列T2WI呈高信号,STIR序列上呈更亮的高信号;随访3~9个月,3个月时有8个椎体T1WI、T2WI信号基本恢复正常,STIR序列仍呈高信号;6个月时有31个椎体T1WI、T2WI信号基本恢复正常,其中有19个椎体STIR序列仍呈高信号;9个月时54个椎体T1WI、T2WI、STIR序列均恢复正常信号。8个椎体为陈旧性骨折,在T1WI、、T2WI、STIR序列上与正常椎体信号相近。结论:MRI对鉴别陈旧与新鲜椎体骨折敏感,尤其是STIR序列更具鉴别诊断价值。     

膝关节周围隐匿性骨折MRI诊断的价值

目的:探讨膝关节周围隐匿性骨折MRI诊断的临床价值.方法:对30例有明确外伤史,临床症状明显但平片检查阴性患者行MRI检查,其中男19例,女11例.使用Philips Intera Achieva超导高场MRI系统,场强1.5 T.采用常规SE序列T1WI成像(TR、TE=700、20)、快速SE序列T2WI成像(TR、TE=4 700/100)和脂肪抑制序列.结果:30例患者共有40处骨髓信号异常,30处为T1WI低信号、T2WI高信号,10处为T1WI低信号、T2WI混杂信号.脂肪抑制序列均为明显高或混杂偏高信号.结论:MRI是早期诊断隐匿性骨折的理想方法,T2WI脂肪抑制序列最为准确和敏感.     

脊柱损伤的低场MRI诊断

脊柱损伤常合并脊髓、神经根受损和不同程度韧带损伤.传统X线平片和CT对骨性结构损伤显示清晰,但对无形态改变的骨挫伤以及脊髓和软组织损伤的检出能力有限;而低场MRI能全面地展示脊柱损伤的全貌,明确损伤的程度.     

女性压力性尿失禁患者尿道支持韧带损伤的MRI表现

目的：分析女性压力性尿失禁（SUI）患者的尿道支持韧带在MR上的异常表现,总结MR对其损伤性改变的诊断能力。资料与方法：分别选择女性SUI患者与健康成年人各20例进行盆底MR扫描,对比观察和分析耻骨尿道韧带、尿道周围韧带及尿道旁韧带的正常和异常形态学变化。结果：在健康成年女性中,尿道支持韧带表现为连续的线样低信号影,耻骨尿道韧带可通过矢状位结合横断位观察,尿道周围韧带及尿道旁韧带可通过横断位观察,在SUI患者中,尿道支持韧带均有不同程度受损,表现为韧带连续性中断或局部松弛变形。结论：MR检查可以有效判断患者尿道支持韧带损伤部位和类型。     

胫骨平台骨折合并膝关节损伤的MRI诊断

目的 评估胫骨平台骨折合并膝关节损伤的MRI影像诊断价值。方法 39例胫骨平台骨折病例经X线平片检查后作MRI扫描,MRI扫描序列包括膝关节矢状位、冠状位及横轴位SE T_1WI,矢状位及冠状位SE T_2WI;比较平台骨折的平片与MRI诊断结果;分析骨折合并膝关节损伤的MRI形态表现。结果 MRI可作出正确的骨折分型诊断,还能显示平片不能诊断的平台隐匿性骨折及骨挫伤;MRI能准确显示骨折合并的膝关节损伤性病变,如关节软骨断裂、半月板损伤、韧带撕裂等。结论 MRI是诊断胫骨平台隐匿性骨折、骨挫伤及骨折合并膝关节损伤的有效影像检查手段。     

失神性癫痫的动态功能MRI研究

目的 采用动态分析的功能MRI(fMRI)技术,观察失神性癫痫发生过程中脑区活动改变的特征.材料与方法 12例儿童失神性癫痫患者参与了研究.采用同步脑电图(EEG)-fMRI技术,采集17次全面棘慢波癫痫发放的fMRI数据.采用基于序列血流动态反应函数的广义线性模型分析技术及时间序列分析技术,观察失神性发作时癫痫全面性棘慢波发放引起的脑区动态改变过程.结果 丘脑以及包括默认网络在内广泛的皮层区域在癫痫发作时有显著的信号改变;在癫痫发作前18s丘脑与皮层即有信号的改变,并且随时间进程,BOLD信号的相位发生逐渐翻转改变;发作后丘脑的最大激活与皮层的最大负激活出现时间点不同.结论 丘脑活动与失神性癫痫的发作有关,而默认网络及外侧额叶等广泛脑区的负激活与癫痫发作意识损害等功能抑制有关;不同的脑区在癫痫发放过程中受到影响的时间不同;促进了对失神性癫痫发作时意识受损的病理生理机制的理解.     

Soft-tissue injuries of the lower extremity

A diverse set of conditions affect the lower extremities in athletes. Good history taking and knowledge of the anatomy of the affected areas can aid in accurate diagnosis. Most conditions can be treated conservatively with great success. Familiarity with rehabilitation strategies can assist physicians in working with physical therapists. New advances, especially in the therapy of plantar fasciitis, may aid physicians in more rapid treatment of conditions of overuse. Surgery can provide definitive relief from symptoms for athletes with whom conservative measures have failed.     

MRI评价体操运动员下肢骨关节损伤

目的 探讨MRI对评价体操运动员下肢骨关节损伤的价值.方法 回顾性分析18例体操运动队员45次下肢MR检查结果,其中4例与X线平片、CT检查结果比较.结果 45次MR检查包括足部3例11次、踝关节6例13次、膝关节4例6次以及髋关节6例15次.所有足舟骨均变扁,并出现片状水肿,10次(90.91%)显示骨折线.所有胫骨远端骨骺变扁、碎裂,9次(69.23%)内踝、8次(61.54%)胫骨远端骨骺内出现大片水肿.3次(50.00%)股骨外侧髁、4次(66.67%)胫骨近端骨骺斑片状水肿;5次(83.33%)显示半月板退变,以内侧半月板后角几率最高(4/6).5例13次股骨头变扁,并显示片状水肿;1例行9次检查显示了股骨头从损伤塌陷到逐渐恢复的过程.结论 MRI检查可以早期全面地显示体操运动员运动损伤的全貌,为早期进行康复提供客观依据.     

Tendon injuries of the lower extremity: magnetic resonance assessment

MR is rapidly establishing itself as a premiere imaging modality for the assessment of musculoskeletal trauma. Its utility in the evaluation of the menisci and ligaments of the knee is well known, but there is far less known about the use of MR for evaluation of the tendons. MR, by virtue of its unmatched soft tissue resolution capability, can determine not only the contour of an affected tendon, but the tendon sheath and internal signal alterations that accompany tendonitis, partial and complete ruptures. Injuries to the Achilles tendon are well known to the athlete and the imager alike; however, abnormalities of the posterior tibial tendon, peroneal tendon, and flexor hallucis longus also result in significant clinical symptoms, as well as imaging abnormalities.     

Nursing assessment of injuries to the lower extremity

When assessing injuries to the lower extremity, they can best be discussed if divided into two groups: (1) vehicular or crushing injuries; and (2) nonvehicular, torsion, or overuse injuries. Vehicular injuries require speedy, accurate assessment as they are often complex and frequently involve other systems. The patient is initially stabilized, then assessment of orthopedic problems is begun. The nurse's role is an assistive one. If the patient is admitted to the hospital, orthopedic care involves prevention of complications, reduction of pain, and assisting the patient in daily activities. Nonvehicular injuries are more chronic in nature. The patient may have unsuccessfully ignored the problem, tried home remedies, or attempted to work with it. At this point, they are seen in the physician's office, hoping for a cure. After diagnosis, proper instruction for a rehabilitation program is begun. Treatment for a sprain, strain, or overuse syndrome can often be done at home. An active program should be encouraged and the patient should be taught why the problem occurred initially and how it can be prevented in the future.     

Sonographic evaluation of lower extremity interosseous membrane injuries: retrospective review in 3 patients.

OBJECTIVE: To describe the sonographic findings of lower extremity interosseous membrane disruption with computed tomographic and surgical correlation. METHODS: Three patients with sonographic evaluation of the lower extremity interosseous membrane were identified through the clinical experience of 1 author over a 5-year period. Sonographic images of the symptomatic and unaffected lower extremities were retrospectively characterized and correlated with computed tomographic and surgical findings by 2 fellowship-trained musculoskeletal radiologists. RESULTS: The normal interosseous membrane was identified in the asymptomatic lower extremities in all 3 patients, which appeared as a thin, hyperechoic (nearly equal to bone cortex) line, continuous from the tibia to the fibula. The abnormal interosseous membrane in all 3 cases appeared abnormally hypoechoic, poorly defined, and discontinuous at the tibia. A proximal fibular fracture was shown on sonography in 1 of 3 symptomatic lower extremities with radiographic evidence of a fracture. The sonographic findings correlated with the computed tomographic images. Distal tibiofibular syndesmosis injuries were confirmed and treated at surgery in 2 patients. CONCLUSIONS: Sonography can show both normal and injured interosseous membranes of the lower extremity, as well as associated proximal fibular fractures.     

踝关节创伤性病变的MRI检查

目的：明确踝关节MRI检查对踝关节创伤性病变的诊断价值。方法：回顾性分析经证实的78例踝关节MR图像，重点评价踝关节MRI对外侧副韧带、距骨软骨、肌腱以及滑膜病变的诊断能力。结果：①MRI对距腓前韧带损伤具有非常高的诊断敏感性（91％），对跟腓韧带损伤的敏感性则约为50％～75％。②MRI对于距骨骨软骨损伤总的敏感性仅为67％，但对同时合并软骨下骨改变的软骨损伤非常敏感（100％）。③MRI诊断肌腱病变准确。④MRI诊断滑膜增生以及前外撞击综合征的能力有限。结论：MRI对于踝关节创伤性病变有一定的诊断价值，但同时存在很多诊断不足。     

Modes of balanced regional anesthesia in patients with lower extremity injuries

The basic hemodynamic (systolic blood pressure (BP), diastolic BP, heart rate, stroke volume, cardiac output, RPP) and respiratory parameters (respiratory rate, tidal volume, respiratory minute volume) during operations on the lower extremities under epidural anesthesia (n=24; Group 1) versus lumbar plexus block by the 3-in-1 technique (n= 23; Group 2) were studied in 47 traumatological patients. With balanced epidural anesthesia, there was a short-term decrease in hemodynamic parameters and a worse external respiratory function; in 5 patients requiring its performance WL, balanced block of peripheral nerves of the lumbar plexus was, on the contrary, marked by a greater hemodynamic and respiratory stability.     

Gait variables of patients after lower extremity burn injuries

Functional ambulation is an expected outcome of physical therapy after burn injuries on the lower extremities. The purpose of this study was to document temporal and spatial gait parameters of adult patients with the use of the GAITRite system (CIR Systems Inc, Clifton, NJ) after the patients were burned on their lower extremities and to compare these results with previous data reported for normal subjects. Twenty-five adults with lower extremity burns (19 men and 6 women; mean age, 35.6+/-8.3 years) were evaluated within 5 days of discharge from an acute care facility. The GAITRite system, which consists of an electronic walkway that contains 6 sensor pads encapsulated in a rolled-up carpet, was used to collect temporal and spatial variables. The patients walked at their preferred rate of ambulation and completed 2 passes; the 2 passes were then averaged by the software to determine the patients' gait parameters. A 2-tailed t test was used for comparison of the mean values for the patients and the previously published data. The results indicated that for both men and women, cycle time and base of support were significantly higher (P < or = .01) in the patients with burn injuries than in normal subjects. For men, all of the remaining parameters were significantly lower (P < or = .01) in the patients with burns except stride length, which was not significantly different (P > .05). For women, stance time as a percentage of the gait cycle and cadence, velocity, step length, and stride length, were all significantly lower (P < or = .01) in the patients with burn injuries, whereas double support as a percentage of the gait cycle was not significantly different (P > .05) between the 2 groups. These results indicate that immediately after an acute care hospitalization, patients with lower extremity burns have significantly different gait patterns than gender-and age-matched normal subjects. Future studies are necessary to determine whether these impairments in gait limit the functional abilities of a patient.     

Penetrating injuries to the nerves of the lower extremity: principles of diagnosis and treatment

Background. Lower extremity nerve injuries caused by wounds are often not noticed immediately after trauma. The purpose of this article was to analyze the localization of penetrating injuries to the nerves, the mechanism and extent of the lesions, and the microsurgical techniques used. The diagnostic and therapeutic basics in penetrating injuries of lower extremity nerves are also described. Material and methods. The clinical material consisted of 67 patients treated surgically for penetrating injuries of lower extremity nerves. Results. In our material we observed penetrating injuries to the common peroneal nerve (41 cases), tibial nerve (9 cases), sciatic nerve (6 cases), combined common peroneal and tibial nerves (8 cases), and miscellaneous (foot injuries, 3 cases). The mechanism of injury included 51 cases of neurotmesis (primary injuries) and 16 cases of nerve compression (secondary injuries). In 5 cases, lesions of the major vessels and common peroneal and tibial nerves were observed. Conclusions. Penetrating injuries to the common peroneal nerve are the most frequent lesions of the peripheral nervous system within the lower limbs. The early detailed inspection of wounds, especially those localized in areas posing a particular threat to peripheral nerves, is an essential part of surgical treatment.     

Stress-related pain behavior in rats with peripheral nerve injuries

The effects of cold stress were studied on rats with unilaterally sectioned sciatic nerves. Behaviors suggestive of pain occurred in a number of these animals. These behaviors vanished when removing the rats from the stressful environment. Some severely painful syndromes in man might in part be due to mechanisms similar to those underlying the described behaviors in rats.