双侧同时初次人工全髋关节置换术显性失血和隐性失血的分析

目的探讨双侧同时行初次人工全髋关节置换术患者的显性和隐性失血情况及处理对策。方法对2008年1月—2011年1月收治的48例患者术前、术后血常规及术中、术后出血、输血情况进行回顾性分析,对患者围术期隐性出血情况进行评估。结果本组48例全部进行术中自体血回输,术中出血量(791±155)ml,术后引流量(181±57)ml,全部病例均另予输红细胞悬液及血浆,输红细胞悬液量(800±425)ml。本组总失血量(2 532±341)ml,隐性失血量(1 521±116)ml,隐性失血量占总失血量的62.5%。结论进行双侧初次人工全髋关节置换手术应重视隐性失血量,及时采取相应的处理措施充分有效地恢复患者有效循环血量,以保证安全渡过围术期及患者的康复。     

全膝关节置换术的隐性失血及影响因素分析

目的 研究全膝关节置换术(total knee arthroplasty,TKA)后隐性失血的特点及影响因素,为临床工作提供参考依据. 方法对75例因膝关节骨性关节炎行初次单侧TKA患者(男21例,女54例;平均年龄68.7岁)进行回顾性分析;应用Gross方程推算隐性失血量.分析性别、术中是否松止血带止血、是否应用自体引流血回输等因素对TKA术后隐性失血量的影响. 结果 本组围术期总失血量(1 551.3±369.6)ml,隐性失血量(792.3±228.6)ml.男性患者的隐性失血量高于女性(P＜0.05);术中松止血带止血能减少隐性失血量(P＜0.05);应用自体引流血回输对隐性失血量无显著影响. 结论取术后红细胞压积(Hct)的最低值(行异体输血的患者选输血后的最低值)作为参数计算隐性失血量更具有代表性.男女患者之间的相对隐性失血量差异无统计学意义;术中松止血带止血可减少隐性失血量,但对围术期总失血量不产生影响.术后自体引流血回输并不影响围术期总失血量和隐性失血量,但可降低异体血输血率.     

股骨近端防旋髓内钉治疗股骨转子间骨折中显性和隐性失血量分析

目的 对采取股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定方法治疗的老年股骨转子间骨折的术前和术中显性、隐性出血量进行临床分析,为临床围术期处理提供必要的数据支撑。 方法 回顾性分析2005年12月-2010年9月采用PFNA内固定治疗的216例股骨转子间骨折患者的临床资料,对患者术前、术后血常规以及术中、术后出血、输血情况等进行分析,对患者围术期的显性和隐性出血情况进行评估。 结果216例患者术中平均失血48.9ml,无一例进行术中输血。42例术后第2～4天血色素下降明显(＜9 g/L)患者进行输血,平均输血300 ml;216例患者术后的平均显性失血量为62.3ml,平均隐性失血量为385ml,男女之间差异无统计学意义。 结论 股骨转子间骨折老年患者比较多见,与术中微创操作所见的出血量极少(＜70 ml)不同,PFNA内固定治疗转子间骨折术后的隐性失血量较多,提示应严格注意术后患者的生命体征监测以减少并发症的产生。     

老年股骨粗隆间骨折髓内和髓外固定治疗显性及隐性失血量的初步分析

目的：对采取髓内固定和髓外固定两种内固定方法治疗老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析,以探讨对术后隐性失血量的影响。方法回顾性分析2010年1月1日～2013年12月31日间采用髓内内固定手术治疗的64例及采用髓外内固定手术治疗的87例股骨粗隆间骨折患者的临床资料,对患者术前、术后血常规以及术中及术后失血、输血情况等指标进行分析,同时评估围手术期的显性、隐性失血情况。结果采用髓内固定治疗的患者平均术中失血（65.7±3.4） ml;术后平均显性失血量为（70.4±4.6）ml,平均隐性失血量为（431.6±17.8）ml。采用髓外固定治疗的患者平均术中失血量为（94.5±7.4）ml;术后平均显性失血量为（80.4±4.7）ml,平均隐性失血量为（298.4±5.3）ml。骨折髓外固定出血量均多于髓内固定（P＜0.01）,但髓内固定术后隐性出血量及总体出血量均多于髓外固定（P＜0.01）。结论髓内固定和髓外固定治疗股骨粗隆间骨折均存在较多的术后隐性失血量,但髓内固定术后隐性出血量更多,需引起重视。     

同期与分期行双侧全髋关节置换术的短期临床结果比较

目的 比较同期与分期行双侧全髋关节置换术(total hip arthroplasty,THA)的临床疗效及安全性. 方法 将2008年1月-2010年1月收治的行双侧THA的患者共58例(116个髋关节)行回顾性分析,随访期限为术后2年:同期行双侧THA 29例(同期组),分期行双侧THA29例(分期组).对比两组患者的手术总时间、总失血量、总输血量、住院时间及费用、术后双侧肢长差异、术前术后功能评分、围术期并发症. 结果 两组患者随访期限内均未出现切口感染、深静脉血栓、人工关节脱位、假体松动等并发症,仅4例患者出现术后谵妄症状(同期组3例,分期组1例).两组的总手术时间[同期组为(117.9 ±23.8) min,分期组为(124.1 ±18.8) min]、总失血量[同期组为338.1 ml(180 ～720ml),分期组为303.9 ml(200 ～ 600 ml)]、总输血量[同期组为227.6 ml(0 ～ 800 ml),分期组为189.7 ml(0 ～400 ml)]、术后功能恢复情况差异无统计学意义,而住院费用[同期组为9.5万元(7.0～11.3万元),分期组为10.5万元(8.8～11.0万元)]、住院时间[同期组为(12.1±3.2)d,分期组为(20.1±3.5)d]、术后肢长[同期组为(0.11 ±0.22) cm,分期组为(0.42±0.44) cm]差异有统计学意义(P＜0.05或P＜0.01). 结论 在患者身体条件允许、围术期管理得当、医师手术技术成熟的情况下,同期行双侧THA是安全可行的,且在患者住院费用、住院时间、术后肢长差异方面与分期行双侧THA相比有一定的优势.     

氨甲环酸围手术期小剂量给药对非骨水泥全髋关节置换术患者失血量影响的临床观察

目的探讨小剂量氨甲环酸注射液对非骨水泥全髋关节置换术(THA)患者失血量的临床效果。方法本研究以2014年1月~2015年12月深圳市龙华新区人民医院收治的行单侧非骨水泥THA的患者62例为研究对象。根据患者就诊顺序并结合随机数字表法,将受试者随机分为观察组(n=31)与对照组(n=31)。观察组在术前及术后分别给予氨甲环酸注射剂10mg/kg,对照组仅给予0.9%氯化钠注射液。研究者比较两组患者术中的出血量、术后3d内的出血量、绝对失血量、隐性失血量以及术后第3天的血红蛋白(Hb)、红细胞比积(Hct)、血小板计数(PLT)、出血时间及活化的部分凝血酶原时间(APTT)。结果观察组术中的出血量、术后3d内的出血量、手术隐性失血量及手术绝对失血量分别为(297.64±65.52)g、(179.45±40.47)g、(136.83±46.49)g、(625.26±106.08)g,均显著低于对照组的(357.55±65.41)g、(221.47±47.30)g、(194.26±33.10)g、(714.75±89.72)g(P0.05);术后第3天,观察组的血红蛋白浓度及红细胞比容分别为(92.54±12.66)g/L和(0.26±0.01)%,显著高于对照组的(82.26±11.57)g/L和(0.23±0.02)%(P0.05);两组术后的平均住院时间分别为(16.48±3.23)d,和(15.84±2.91)d,均未发现明显并发症的发生(P0.05)。结论氨甲环酸注射剂围手术期小剂量给药可显著减少非骨水泥THA后患者的失血量且不增加血栓栓塞等并发症的发生率。     

引流方式对经后路腰椎内固定术后显性及隐性失血的影响

目的 探讨引流方式对经后路腰椎内固定术后显性及隐性失血的影响.方法 回顾分析2010-10至2012-12实施的108例经后路腰椎内固定术患者资料,按术后引流方式不同分成普通引流组（56例）和低负压引流组（52例）,统计分析两组患者术前、术后血常规,以及术中、术后失血、输血情况,评估术后显性失血、隐性失血情况.结果 普通引流组围术期总失血量（1415.10±592.66）ml,其中显性失血量为（860.62-375.45） ml,隐性失血量为（516.73±314.71） ml;低负压引流组围术期总失血量为（1251.53±540.99）ml,其中显性失血量为（794.17 ±337.19）ml,隐性失血量（457.36±332.79）ml.普通引流组和低负压引流组两组之间术后显性失血量,隐性失血量比较均无统计学差异（P＞0.05）;隐性失血量占总失血量的比值无统计学差异（P＞0.05）.结论 两种引流方式对经后路腰椎内固定术后隐性及显性失血量的影响无统计学差异.     

老年患者半髋关节置换围手术期隐性失血与功能锻炼的相关性研究

目的探讨功能锻炼在预防老年髋部骨折患者半髋关节置换围手术期隐性失血中的应用。方法回顾性分析2010年1月—2015年8月131例因单侧股骨颈骨折于南京中医药大学附属八一医院行初次半髋关节置换术的老年患者(年龄70~90岁,平均81.8岁),根据围手术期功能锻炼强度分为少量功能锻炼组(59例)和正常功能锻炼组(72例)。根据患者身高、体重、术中出血量、术后引流和渗出量、手术前后红细胞压积和输血量,计算所有患者的总失血量及其占原血容量的比例、隐性失血量及其占总失血量的比例,按照平均隐性失血量占总失血量的比例分为低和高隐性失血量患者,分析功能锻炼与隐性失血量、高隐性失血发生率之间的关系。结果所有患者总失血量平均为(964.05±284.92)m L,占原血容量的23.23%;隐性失血总量平均为417.86m L,占总失血量的43.34%。有52例患者发生高隐性失血,其中少量功能锻炼组33例,正常功能锻炼组19例,差异有统计学意义(P0.05)。总失血量及其占原血容量比例、隐性失血量及其占总失血量比例、高隐性失血发生率均随着功能锻炼强度的增加而逐渐降低(P0.05);显性失血量随着功能锻炼强度的增加而降低,但差异无统计学意义(P0.05)。结论老年患者关节置换术后早期正常强度的功能锻炼能够有效预防并减少围手术期总失血量和高隐性失血发生率。     

联合应用重组人促红细胞生成素与蔗糖铁治疗初次全髋关节置换围术期贫血的疗效分析

目的探讨联合应用重组人促红细胞生成素(recombinant human erythropoietin,rhEPO)与蔗糖铁治疗初次全髋关节置换(THA)患者围术期贫血的临床疗效。方法回顾性研究2013年6月—2017年6月北部战区总医院骨科行初次THA的股骨颈骨折患者108例,根据治疗方法分为治疗组和对照组,各54例。治疗组给予rhEPO 10 000IU/d皮下注射,术前3d至术后7d连续应用,根据Ganzoni公式及预估手术失血量计算缺铁量,按需补铁。对照组未予以上治疗。主要观察指标为两组患者围术期输血率、总输血量、平均输血量、Hb水平及血细胞比容(Hct)的变化,次要观察指标为两组患者围术期网织红细胞计数(Ret)变化及两组患者围术期并发症[包括假体周围感染、深静脉血栓(deep vein thrombosis,DVT)形成、肺栓塞(pulmonary embolism,PE)、过敏及发热]。结果治疗组术后有2例(3.7%)接受输血治疗,对照组术后有9例(16.7%)接受输血治疗,两组比较差异有统计学意义(P<0.05)。治疗组平均输血量(0.05±0.24)U与对照组平均输血量(0.28±0.64)U比较,差异有统计学意义(P<0.05)。两组患者术后2h,1、3、6、9d Hb水平、Hct、Ret比较,治疗组均高于对照组,差异均有统计学意义(P<0.05)。两组患者围术期均未发生假体周围感染,PE、DVT及与使用rhEPO与蔗糖铁有关的过敏反应;治疗组术后发热2例,对照组发热3例,给予对症治疗后体温均恢复正常,两组比较差异无统计学意义(P>0.05)。结论初次THA围术期联合rhEPO与蔗糖铁(按需补铁)可增加患者围术期红细胞储备,提高患者造血潜能,从而显著改善患者围术期贫血状态,降低患者围术期输血率。     

隐性失血在脊柱手术术后临床意义的初步探讨

目的：探讨行脊仕前路与后路手术术后隐性失血的相关机制及其对临床的影响。方法：1999年10月-2007年10月，行脊柱前路手术50例，其中男31例，女19例；行脊柱后路手术50例，其中男26例，女24例。术中输入一定异体血，术后补充液体均以生理需要量（50ml／kg）为准。根据手术前后平均红细胞压积变化计算出患者总失血量，从而得到隐性失血量。结果：前路组的总失血量平均为1500ml，隐性失血为655ml；后路组的总失血量平均为835ml，隐性失血为245ml，两组隐性失血量比较有一定差异。结论：脊柱术后隐性失血量较多，术后除补充有效的循环血量外，还必须警惕隐性失血所带来的危害，帮助患者安全度过围手术期。     

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.     

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.     

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     

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.     

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.     

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.     

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.