寰枢关节旋转运动CT扫描的临床意义

目的了解不同旋转状态下CT扫描寰枢关节的影像学变化,探讨CT对寰枢关节旋转固定的诊断价值。方法分别对正常组30例、寰枢关节旋转固定患者组16例、新鲜尸体标本组5例行头部功能位CT扫描,测量并比较各组的寰齿前间隙、寰齿侧间隙及寰枢椎相对旋转角的变化。结合标本解剖观察寰枢关节不同旋转状态在SSD法重建图像上的表现。结果不同旋转状态下CT扫描寰枢关节的影像表现变化较大。旋转前后正常组与寰枢关节旋转固定患者组相比:寰齿前间隙及寰枢关节相对旋转范围变化差异有显著性(P<0·01),寰齿侧间隙的变化差异无显著性(P>0·05),寰枢关节不同旋转状态下在SSD法重建图像上表现与标本解剖观察基本一致。结论静态CT扫描不能准确诊断Ⅰ型寰枢关节旋转固定,功能位CT扫描能够准确诊断寰枢关节旋转固定。     

正常人与尸体膝关节MRI二维图像重建前交叉韧带三维模型的比较研究

目的探讨基于MRI二维图像重建正常成人膝关节前交叉韧带(anterior cruciate ligament,ACL)三维模型的真实性。方法选择20例新鲜成人尸体双膝关节标本及20例正常成人志愿者双膝关节,采用MRI对膝关节进行扫描,获得层厚为1.0 mm连续图像资料,将其导入医学有限元仿真软件Mimics 10.01进行三维重建,建立包含ACL的完整双膝关节三维模型(尸体模型组及正常模型组)。利用医学有限元仿真软件Mimics 10.01自带测量工具测量ACL解剖指标;并对20例新鲜成人尸体双膝关节标本进行解剖,测量ACL解剖指标(尸体标本组)。结果尸体模型组各测量指标与尸体标本组比较,差异均无统计学意义(P>0.05);与正常模型组比较,差异亦无统计学意义(P>0.05)。结论采用MRI二维图像数据可三维重建正常成人膝关节ACL三维模型,且具有真实性。     

胭窝囊肿发病的解剖学基础探讨

目的探讨产生腘窝囊肿的解剖因素。方法对25侧成人膝关节标本进行解剖：a）观察半膜肌与腓肠肌内侧头滑液囊（gastrocnemius-semimembranosus bursa,GSB）是否存在,GSB与膝关节滑膜囊的关系;b）是否存在GSB与膝关节滑膜囊的通道口;c）向关节腔内注射生理盐水,观察当关节腔内压力增大后,生理盐水是否向GSB内外流。结果 a）所有标本均存在GSB,与膝关节滑膜腔相通占40%（10/25）,其他均存在与膝关节滑膜腔的薄弱区;b）膝关节腔内压力增大时关节液向GSB内外流。结论正常人膝关节存在形成腘窝囊肿的解剖基础。     

MRI对膝关节外伤后前后交叉韧带损伤的诊断价值

目的探讨MRI在膝关节外伤后前后交叉韧带损伤诊断中的临床应用。方法 2015年10月至2016年12月,共65例膝关节交叉韧带损伤患者,按照就诊顺序分为观察组(n=33)和对照组(n=32)。对照组采用CT扫描检查,观察组使用MRI,对患者关节进行扫描,比较两组的诊断效果。结果 MRI测量值与膝关节交叉韧带解剖标本的解剖测量值相比,差异无统计学意义(P0.05);与CT测量值相比,MRI测量值与解剖值更接近,差异有统计学意义(P0.05);MRI检查膝关节交叉韧带诊断符合率显著高于CT检查,差异有统计学意义(P0.05)。结论 MRI检查测量值能够反映膝关节交叉韧带的真实解剖值,诊断符合率优于CT检查,是膝关节韧带损伤无创性检查诊断的首选方法。     

侧颅底区导航手术的实验研究

目前应用于神经外科的神经导航系统已比较成熟 ,并在各种神经外科手术中广泛运用 [1] 。但由于侧颅底解剖结构复杂、细微 ,导航精确度要求更高 ,使得神经导航系统在侧颅底手术中的应用受限[2 ,3 ] 。因此 ,我们采用侧颅底表面骨性解剖标志作为基准点与CT图像进行配准 ,应用StealthStation神经导航系统并在头颅标本上模拟颅中窝入路、乙状窦前入路 ,对侧颅底导航手术的可行性进行实验研究。一、材料和方法1.选取 10例甲醛固定的汉族成人尸体头颅标本 ,应用Simens公司螺旋CT机SOMATOMPLUS 4扫描 ,以眦耳线平面为基线进行轴向连续扫描 …     

腰椎关节突关节滑膜囊肿的诊断和治疗

目的探讨腰椎关节突关节滑膜囊肿的诊断及治疗方法。方法对2001-2005年收治的4例腰椎关节突关节滑膜囊肿患者的诊断及治疗进行回顾性分析。术前均行CT检查,其中2例行MRI检查。治疗均采用椎板减压囊肿切除术,术后随访时间为3-6个月。结果CT及MRI检查可明确诊断腰椎关节突关节滑膜囊肿。4例病人中,3例疼痛症状消失,1例缓解。结论CT及MRI检查对腰椎关节突关节滑膜囊肿有定性及定位诊断价值,手术治疗效果良好。     

膝关节损伤的CT扫描

本文介绍了膝关节损伤的CT扫描技术,并着重描述了经手术或关节镜证实的53例病人膝半月板撕裂,半月板囊肿和膝韧带损伤的CT特征。半月板撕裂所显示的层数除单纯水平型裂开外,其余各类型都连续出现2～3层扫描平面。同时还对膝关节骨折、关节积液和血肿的CT诊断进行评价。     

基于CT和MRI影像数据融合构建个体化OA膝关节三维解剖模型

目的探究一种基于CT和MRI影像数据融合构建包含主要解剖结构的骨关节炎(OA)膝关节三维模型的方法,并准确表达膝关节OA的解剖学特征。方法采集膝关节OA患者的CT和MRI影像数据,以DICOM格式导入Mimics软件中构建膝关节骨性结构模型和非骨性结构模型,基于图像特征的同层多点至多点的配准方法进行配准融合,构建OA膝关节三维解剖模型。结果基于CT和MRI影像数据融合构建出包括膝关节骨骼及关节软骨、半月板、韧带等结构的膝关节OA三维解剖模型,模型显示了关节间隙狭窄、半月板损伤、关节软骨磨损等膝关节OA的解剖学特征。结论通过CT和MRI影像数据融合可以个体化构建膝关节OA三维解剖模型,该模型能够真实且直观地展示骨性结构和非骨性结构的解剖学特征和空间解剖关系,为相关解剖学及生物力学研究提供三维解剖模型。     

腰椎关节突关节滑膜囊肿的诊断和治疗

目的：探讨腰椎关节突关节滑膜囊肿的诊断及治疗方法。方法：对2001～2005年收治的4例腰椎关节突关节滑膜囊肿患者的诊断及治疗进行回顾性分析。术前均行CT检查，其中2例行MRI检查。治疗均采用椎板减压囊肿切除术，术后随访时间为3～6个月。结果：CT及MRI检查可明确诊断腰椎关节突关节滑膜囊肿。4例病人中，3例疼痛症状消失，1例缓解。结论：CT及MRI检查对腰椎关节突关节滑膜囊肿有定性及定位诊断价值，手术治疗效果良好。     

MRI对半月板及软骨损伤的临床诊断研究

目的研究分析并评价MRI、CT在膝关节半月板及关节软骨损伤的临床诊断作用价值。方法选取2016年1月至2016年12月本院收治的外伤所致膝关节半月板及关节软骨损伤患者94例,临床医师对所有患者分别行膝关节镜、MRI、CT扫描检查。结果经膝关节镜确诊为半月板损伤共94个,诊断准确率均为100%;MRI检查后Ⅱ、Ⅲ级诊断准确率均高于CT检查诊断准确率(P0.05);MRI、CT检查膝关节半月板后的诊断准确率均低于膝关节镜检查(P0.05)。经膝关节镜确诊为关节软骨损伤共92个,诊断准确率均为100%;MRI检查后Ⅱ~Ⅳ期诊断准确率均显著高于CT检查诊断准确率(P0.05);MRI、CT检查膝关节关节软骨损伤后的诊断准确率均低于膝关节镜检查(P0.05)。结论 MRI检查对Ⅱ、Ⅲ级半月板和Ⅱ~Ⅳ期关节软骨的诊断准确率均高于CT检查,但上述两种影像检查方法对半月板、关节软骨的诊断准确率均低于膝关节镜,由于MRI及CT检查较关节镜检查方便,适合临床医师根据具体情况选择应用。     

Value of intercondylar notch plasty. CT studies and peroperative measurements of 127 knees

The intercondylar notch diameter was measured in six knees on CT scans before and after anterior cruciate ligament reconstruction. During the operation, direct measurements of the anterior notch diameter was also performed before and after notch plasty. There was good agreement between CT and peroperative measurements, showing that the enlargement of the intercondylar notch can be measured on the CT scan. Twenty-one patients previously reconstructed because of old anterior cruciate ligament injuries were reexamined after a median of 4 years, and their notch diameters were measured by CT or at reoperation. The notch remained open in stable knees, but was narrowed in unstable knees. The notch diameter before notch plasty was assessed with a calliper at operation on 45 patients with acute and 60 patients with old injuries. Both groups had a mean intercondylar diameter of 16 mm. The conclusion that the notch plasty stays open in stable knees emphasizes the importance of this step in the reconstruction procedure.     

Value of intercondylar notch plasty: CT studies and peroperative measurements of 127 knees

The intercondylar notch diameter was measured in six knees on CT scans before and after anterior cruciate ligament reconstruction. During the operation, direct measurements of the anterior notch diameter was also performed before and after notch plasty. There was good agreement between CT and peroperative measurements, showing that the enlargement of the intercondylar notch can be measured on the CT scan. Twenty-one patients previously reconstructed because of old anterior cruciate ligament injuries were reexamined after a median of 4 years, and their notch diameters were measured by CT or at reoperation. The notch remained open in stable knees, but was narrowed in unstable knees. The notch diameter before notch plasty was assessed with a calliper at operation on 45 patients with acute and 60 patients with old injuries. Both groups had a mean intercondylar diameter of 16 mm.

The conclusion that the notch plasty stays open in stable knees emphasizes the importance of this step in the reconstruction procedure.     

Late results of transfer of the tibial tubercle for recurrent dislocation of the patella.

The authors wished to determine the late results of the Hauser operation, with special reference to the development of osteoarthritis. Predisposing factors associated with recurrent dislocation of the patella were also investigated. Thirty-five patients with forty-four surgically treated knees attended for review, ten to twenty-five (average sixteen) years after operation. Two patients had subsequently undergone excision of the patella. Ten patients gave a family history of recurrent dislocation of the patella and seven patients showed generalised joint laxity. Pain was present in eight knees before operation and was present in thirty-three knees (75 per cent) at the time of review. Patella crepitus was present in thirty-seven out of forty-two knees (88 per cent) at review. Osteoarthritis was present in thirty out of forty-two knees (70 per cent). The incidence increases with time since operation and the present age of the patient. It is concluded that the Hauser operation prevents further dislocation but does not prevent the development of osteoarthritis. It is possible that a simple soft-tissue operation which effectively prevents dislocation might achieve the same results.     

The results at ten years of the Insall-Burstein II total knee replacement. Clinical, radiological and survivorship studies.

We reviewed the outcome of 146 Insall-Burstein II total knee replacements carried out in 121 patients over a period of nearly four years in a general orthopaedic unit. At a mean follow-up of ten years, 94 knees in 78 patients were available for review. Six patients (7 knees) were lost to follow-up and 37 (45 knees) had died. The clinical outcome using the scoring system of the Hospital for Special Surgery (HSS) was excellent or good in 79% of patients, fair in 14% and poor in 7%. The mean preoperative HSS score was 31, improving to 79 at the latest review. Using the newer rating system of the Knee Society, the mean score at ten years was 87 and the mean functional score 56. The arc of flexion improved from a mean preoperative value of 88 degrees to 100 degrees. The 18 patients who had had a previous high tibial osteotomy were analysed separately and were found to have benefited equally from the operation. Nine prostheses were revised, giving a cumulative survival rate of 92.3% at ten years. Radiological evaluation of 104 radiographs showed radiolucent lines around ten tibial components, none of which required revision. Anterior knee pain was a significant problem.     

The incorporation of tibial allografts in total knee arthroplasty

Twelve knees in ten patients had revision total knee replacement with insertion of an allograft for a large tibial defect. The knees were retrospectively evaluated at an average of thirty-two months (range, twenty-five to fifty-one months) by clinical examination, radiography, planar bone scintigraphy, and single-photon-emission computed tomography. The average age of the patients was sixty-two years (range, fifty-four to seventy-nine years). A constrained total-condylar prosthesis was used for all revisions. A contained tibial defect was present in five knees, and seven knees had an uncontained defect that was treated with a massive composite structural allograft, five of which were secured with internal fixation. The knee scores improved from an average of 51 points before operation to an average of 87 points post-operatively. Seven knees had a score of 85 points or more and were considered to have an excellent clinical result. Two knees had a good result, with scores of 77 and 72 points. One knee had another revision because of painful non-union of a medial structural graft, and the result in that knee was considered a failure. The average range of motion improved from 84 degrees to 105 degrees. There were no deep infections, and no graft showed evidence of fracture or collapse. Radiographs demonstrated complete incorporation of the graft in eleven of the twelve knees at an average of twenty-three months after operation. Single-photon-emission computed-tomography scans showed uniform activity in the area of the graft in four of the five knees that were studied.     

Double-contrast CT arthrography of the cartilage of the patellofemoral joint

For assessment of the value of computed tomography (CT) as a method for evaluating the cartilage of the patellofemoral joint, 100 knees were examined in 91 patients. With the patient in a supine position with the knee flexed at a 30 degree angle, a sufficient quantity of air and positive contrast material was required to obtain an accurate CT picture of the cartilage. Normal cartilage images of 53 knees and abnormal images of 47 knees were obtained by use of CT. The latter group was classified into eight types. When the CT findings of 70 knees were compared with arthroscopy and/or arthrotomy, the results showed that CT diagnosis was accurate in 68 of 70 knees, with a coincidence rate of 97.1%. Cartilage thickness at an arbitrary site and the extent of the ulcer within the deep layers were observed easily by CT. Although examination exclusively with arthroscopy had distinct disadvantages (e.g., the inability to assess either the specific thickness of the cartilage or the extent of the ulcers within deep layers), the combined use of arthroscopy with CT provided a precise three-dimensional image of the cartilage. CT was found to be a valuable noninvasive imaging method for patellofemoral joint cartilage evaluation.     

Posterior stabilized prosthesis. Results after follow-up of nine to twelve years.

We reviewed, nine to twelve years postoperatively, the records on an original cohort of 289 arthroplasties (218 patients) in which a posterior stabilized knee prosthesis with an all-polyethylene tibial component had been inserted at The Hospital for Special Surgery. One hundred and eighty intact prostheses in 139 patients were available for this analysis. Fourteen knees in fourteen patients had had a revision procedure. Five of these fourteen patients had had a bilateral arthroplasty, but only one knee of each of the five patients had been revised. Forty-eight of the patients (sixty-six knees) had died less than nine years after the operation. Twenty-nine other knees (twenty-two patients) had been lost to follow-up before a nine-year evaluation could be performed. Considering all 194 knees (including the fourteen that had been revised), the result with the system of The Hospital for Special Surgery was excellent for 117 knees (61 per cent), good for fifty-one (26 per cent), fair for twelve (6 per cent), and poor for the fourteen knees (7 per cent) that had been revised. The 180 knees in which the prosthesis was intact were also rated with the new scoring system of The Knee Society: the average postoperative knee score was 92 points (range, 35 to 100 points), and the average score for function was 66 points (range, 0 to 100 points). Survivorship analysis showed that the average annual rate of failure was 0.4 per cent and that the over-all rate of success at thirteen years was 94 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparison of primary and revision total knee arthroplasty using the kinematic stabilizer prosthesis

The first 121 arthroplasties (in 105 patients) in which the cemented kinematic-stabilizer total knee prosthesis was used for primary arthroplasty or surgical revision at the Mayo Clinic were reviewed. Sixty-six patients (seventy-nine arthroplasties) were followed for a mean of thirty-seven months. There were fifty-three revision and twenty-six primary arthroplasties. The average range of motion in both groups increased from 95 to 101 degrees. Although none of these patients could ascend stairs without support before the operation, thirty-two (51 per cent) could do so at the time of the final follow-up. The incidence of moderate or severe pain was reduced from 86 to 6 per cent. Moderate or severe ligamentous instability had been present in thirty-three knees (42 per cent) preoperatively, but only five knees had significant medial, lateral, anterior, or posterior instability at final follow-up. The Hospital for Special Surgery knee score increased from an average of 56 points to 83 points in all of the knees. At follow-up, the patients who had had primary arthroplasty had 92 per cent good or excellent results and the patients who had had surgical revision had 81 per cent good or excellent results (p less than 0.05). There was no significant difference in the results between the patients who had osteoarthritis and those who had rheumatoid arthritis. Over-all, 85 per cent of the results were good or excellent at final follow-up. Tibial radiolucent lines of one to two millimeters were observed in 29 per cent of the knees at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)     

Proximal osteotomy of the tibia for the treatment of genu recurvatum in adults.

Twenty-seven opening-wedge osteotomies of the proximal part of the tibia were performed in twenty-five patients who had genu recurvatum. In sixteen knees, the genu recurvatum was due entirely to osseous deformity. In the remaining eleven knees, it was due to a combination of osseous and soft-tissue deformity; in five, the deformity was predominantly osseous and in six, primarily in the soft tissues (the ligaments and capsule). The average age of the patients was twenty-three years (range, fifteen to fifty-four years). The osteotomy was proximal to the tibial tuberosity in twenty-two knees. In eighteen of these knees, the tuberosity was detached with its patellar ligament and then reattached to the proximal part of the tibia over the block of bone in the opened wedge; in the remaining four knees, the tibial tuberosity was not detached. The osteotomy was distal to the tuberosity in five knees. The patients were followed for an average of 14.5 years (range, three to thirty years). Of the eighteen knees in which the osteotomy had been proximal to the tibial tuberosity and the tuberosity had been detached and then reattached, nine (50 per cent) had a result that was excellent; five (28 per cent), good; and four (22 per cent), fair. Of the four knees in which the operation had been proximal to but without detachment of the tuberosity, one had a result that was excellent; two, good; and one, fair. Of the five knees in which the osteotomy was distal to the tibial tuberosity, one had a result that was good; three, fair; and one, poor. Of the twenty-one knees in which the deformity was entirely or predominantly osseous, eighteen (86 per cent) had an excellent or good result. None of the six knees in which the deformity was predominantly in the soft tissues had an excellent or good result. Patients in whom the deformity was not primarily osseous, and those in whom the operation was distal to the tibial tubercle, were much more likely to have a fair or poor result.     

半关节置换术在小儿胫骨上段恶性骨肿瘤中的应用

目的探讨半关节置换术用于儿童膝关节恶性骨肿瘤,以保留膝关节或重建膝关节的疗效。方法2000年3月~2005年6月对5例胫骨上段骨肉瘤患儿行半膝关节假体置换,年龄8~12岁。均经病理确诊为胫骨上段骨肉瘤,Enneking分期为B期以下。病变范围9~11cm,术前均行穿刺活检和正规化疗,并根据X线片、CT、MRI等影像学结果确定病变范围,测量和设计假体大小,假体长度略长于截骨段1~2cm。术后4周在支具保护下行走,并行2个疗程新辅助化疗。结果5例患儿均成功进行了半膝关节假体置换,术后4周膝关节活动度分别为伸170~180°,屈90~120°。术后除1例局部皮肤坏死,经皮瓣移位修复伤口期愈合外,余患儿伤口均期愈合。随访24~36个月,1例于术后8个月因肿瘤肺转移死亡,余均无肿瘤转移和复发,均能进行日常生活和学习。结论半膝关节置换用于儿童膝关节周围恶性肿瘤,具有保留正常骨骺及膝关节和重建膝关节优点,同时达到保肢手术的目的,为成年后全膝关节置换创造了条件。