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.     

Quantitative bone gallium scintigraphy in osteomyelitis

Gallium imaging offers many practical advantages over indium-111-labeled leukocyte imaging, and calculating quantitative ratios in addition to performing the routine bone-gallium images allows accurate and easy evaluation of patients with suspected osteomyelitis. To add objectivity and improve the accuracy and confidence in diagnosis of osteomyelitis, quantitative comparison of abnormalities seen on bone scans and gallium scans was performed. One hundred and ten adult patients with 126 sites of suspected osteomyelitis were evaluated and categorized by gallium-to-bone ratios, gallium-tobackground ratios, and spatial incongruency of gallium and bone activity. Combined evaluation using these criteria gave a 70% sensitivity and 93% specificity for the diagnosis of osteomyelitis.     

Evaluation of Differences Between Fan-Beam and Pencil-Beam Densitometers

We compared the bone and body composition results in vivo on two bone densitometers using fan-beam geometry (EXPERT and PRODIGY) with those using pencil-beam geometry (DPX). Measurements were made on large groups of adults ranging in weight from about 50 to 120 kg. Both spine and femur neck BMD on the fan-beam densitometers averaged within 1% of the pencil-beam results, and there was no magnitude dependence of the results by Bland-Altman analysis. Total body BMC and BMD on the PRODIGY and DPX were congruent, but on the EXPERT, BMC was about 2% lower and BMD 2% higher than corresponding values on the DPX. Soft-tissue composition was closely congruent for the PRODIGY and DPX; the comparable EXPERT-DPX differences showed greater scatter but no significant magnitude dependence. The smaller fan-angle of the PRODIGY (4°) probably contributed to its better congruence to pencil-beam results compared with the EXPERT (12°). Received: 23 February 2000 / Accepted: 14 April 2000 / Online publication: 27 July 2000     

髋臼坐骨切迹周围骨盆截骨对儿童DDH的疗效探讨

目的介绍一种新的骨盆截骨即髋臼坐骨切迹周围骨盆截骨操作技术,并初步评价治疗儿童发育性髋关节脱位(Development Dysplsia of the Hip,DDH)的临床疗效。方法骨盆截骨线起自髂前上、下棘中点,与髋臼后上缘平行,并向髋臼后下方延长,止于距离坐骨切迹骨皮质3～5mm处,撑开截骨间隙时产生坐骨切迹皮质不完全性骨折,获得髋臼向前外方向的旋转,再用自体或异体楔形骨块嵌入截骨间隙,从而实现改变髋臼方向和增加对股骨头覆盖的目标。结果我院自2002年以来创用该术式治疗儿童发育性髋关节脱位64例(76髋)。对随访时间大于2年的12例14髋,按照McKay髋关节评定标准和Severin放射学分类评价标准评价其疗效,优12髋,良2髋。结论髋臼坐骨切迹周围骨盆截骨兼有Salter和Pemberton骨盆截骨的优点,但手术操作更为安全简便,适应征也比较宽泛。     

Musculoskeletal involvement in sarcoidosis,

Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly affects the pulmonary system but can also affect the musculoskeletal system, albeit less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic. It can be the presenting symptom of the disease or can appear during its progression. Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and Löfgren''s syndrome, which is defined as the presence of lung adenopathy, arthralgia (or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis, appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic sarcoidosis is based on X-ray findings and magnetic resonance imaging findings, although the definitive diagnosis is made by anatomopathological study of biopsy samples. Musculoskeletal involvement in sarcoidosis is generally relieved with nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant or -dependent forms of the disease, immunosuppressive therapy, such as treatment with methotrexate or anti-TNF-α, is employed. The aim of this review was to present an overview of the various types of osteoarticular and muscle involvement in sarcoidosis, focusing on their diagnosis and management.     

地方性氟中毒病区中氟对胎儿影响的研究

本文以不同氟水平地区153名怀孕4个月以上的孕妇为对象研究氟对胎儿可能产生的影响。结果表明,随着孕妇尿氟水平的升高其胎儿羊水氟含量也升高,差异显著(p<0.01)。通过对29例胎儿股骨的光镜观察及3例扫描电镜的观察,发现孕妇尿氟、胎儿羊水氟水平高者有明显病理改变,主要表现为骨生成活跃且紊乱。病理改变与尿氟、羊水氟氟水平有关,当尿氟小于2.0mg/L、羊水氟小于0.03mg/L 无病理改变发生。尿氟水平低于3.5mg/L 组,病理改变率为17.39%,(4/23),高于7mg/L 组病理改变率为83.33%(5/6),两者差异显著(P=0.0055);羊水氟水平低于0.05mg/L 组病理改变率为8.3%(1/12),高于0.05mg/L 组为47.06(8/17),差异显著(p=0.0422)。研究结果提示,氟能经过胎盘进入胎儿体内且可用羊水氟水平反应胎儿受氟量的高低及判断能否受到影响,说明氟对人体的作用在胎儿时期即可发生,这为氟中毒的早期防治提供了依据。     

Radiological vignette. Insufficiency fracture of the acetabulum

Summary An insufficiency fracture (IF) involving the acetabulum is presented. This fracture occurred in a 67-year-old woman who had been hysterectomized and oophorectomized 27 years earlier for a carcinoma of the uterine cervix, and who had received external pelvic irradiation. This IF location has been rarely described earlier, and its awareness should preclude unnecessary aggressive diagnostic procedures especially in patients with osteoporosis and previous pelvic radiotherapy.     

骨韧带样纤维瘤外科手术疗效分析

目的：探讨骨韧带样纤维瘤外科手术治疗效果。方法：自2000年6月至2010年6月,手术治疗15例骨韧带样纤维瘤患者,男4例,女11例;年龄18～64岁,平均39岁。部位分别是股骨上段4例、股骨下段3例、胫骨下段2例、肱骨上段1例、肱骨下段1例、肩胛骨1例、耻骨支1例、髂骨1例、胸骨柄1例。15例中1例行单纯病灶内刮除,14例按手术方式分两组,广泛切除组（7例）,扩大刮除加灭活组（7例）。观察术后复发情况,采用Enneking功能评分对术后恢复情况进行评定。结果：15例患者均获随访,时间18～132个月,平均56个月。未发现转移。复发2例,1例为单纯病灶内刮除,1例为广泛切除组,复发率13．3％（2/15）。根据Enneking功能评估标准,广泛切除组术后（21．6±3．8）分,扩大刮除加灭活（28．3±1．3）分。广泛切除组优2例,良5例;扩大刮除加灭活组优7例。结论：扩大刮除加灭活手术较广泛切除组功能恢复更好,在重建较为困难的特殊部位建议优先考虑。