3-matic软件测量负重状态平足指标的可行性分析

目的:比较3-matic软件与传统X线平片对平足指标测量结果是否具有一致性。方法:在3-matic软件中,根据重建的足踝部负重状态三维骨骼模型,获取足踝部负重状态下的正位、侧位及后足冠状位图像,然后进行平足相关指标的测量,并与同一个体、同一指标的普通平片测量结果进行对比。结果:两种方法对于跟骨倾斜角、距舟覆盖角、正位距骨第一跖骨角的测量,两种测量方法没有统计学差异(P>0.05)。对于侧位距骨第一跖骨角、距骨倾斜角、跟骨外移距离、内侧柱长度、内侧足弓角、外侧柱长度、外侧足弓角和跟骨外翻角的测量,两种测量方法具有显著统计学差异(P<0.05)。结论:在3-matic软件中进行平足相关指标的测量具有直观清楚、非侵袭性、测量结果稳定等优点,测量时可以根据需要去除不相关的骨块,消除骨骼重影的干扰。对于平足各指标的测量,3-matic软件测量与平片测量结果不具有一致性,因此,利用数字化技术进行平足模拟手术时,不能直接参考平片测量的正常范围。     

经肋骨入路椎体强化术适应证的影像解剖学观察及临床应用效果

目的:探讨经肋骨入路行椎体强化术的适应证和治疗效果。方法:回顾性研究。纳入无锡市第九人民医院影像科数据库2019年1—12月100例患者的胸椎CT影像资料,其中男女各50例,年龄20~70岁。利用CT影像模拟经肋骨入路沿通道中心轴插入直径4 mm穿刺针,观察穿刺针在横断面和矢状面上可到达椎体内的位置。纳入2018年1月...     

近节指骨滑车损伤对近指间关节侧方稳定性影响的应用解剖学研究

目的　通过近节指骨滑车损伤实验，探究其对近指间关节侧方稳定性影响，为治疗提供解剖依据。 方法　解剖6具成人双上肢手标本，选择示指、中指、环指共36只手指进行研究。分别测量0 °屈曲位时近指间关节近节指骨滑车未损伤及桡侧损伤10%、20%、30%、40%、50%的桡偏角度。 结果　未损伤时近节指骨滑车两端长度平均为（10.25±1.12）mm，桡偏角度为（0.14±0.10）°，损伤10%时桡偏角度为（5.06±0.53）°，损伤20%时桡偏角度为（8.47±0.42）°，损伤30%时桡偏角度为（12.28±0.71）°，损伤40%时桡偏角度为（16.33±0.76）°，损伤50%时桡偏角度为（20.03±0.75）°。近节指骨滑车损伤程度越重，近指间关节桡偏角度越大，关节稳定性越差（P<0.0001，Wilcoxon检验）。 结论　近节指骨滑车缺损对近指间关节侧方稳定性具有显著影响，损伤达10%时即可发生侧方不稳定。     

Mid-Term Outcomes of Arthroscopic Rotator Cuff Repair in Patients with Rheumatoid Arthritis

Objective

The effectiveness of arthroscopic rotator cuff repair (ARCR) on rheumatoid arthritis (RA) patients remains a controversial topic. This study investigates the mid-term outcomes of ARCR in RA patients and identifies the factors influencing clinical efficacy.

Methods

This retrospective study enrolled RA patients with small or medium rotator cuff tears (RCTs) between February 2014 and February 2019. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant–Murley scores were collected at each follow-up time. Ultimately, magnetic resonance imaging (MRI) and X-ray were employed to assess rotator cuff integrity and progression of shoulder bone destruction, respectively. Statistical methods used two-way repeated-measures ANOVA or generalized estimation equations.

Results

A total of 157 patients were identified and divided into ARCR (n = 75) and conservative treatment (n = 82) groups. ARCR group continued to be divided into small tear (n = 35) and medium tear (n = 40) groups. At the final, all scores were better in ARCR group than in the conservative treatment group (p < 0.05). A radiographic evaluation of the final follow-up demonstrated that the progression rate in ARCR group (18.67%) was significantly lower than that of the conservative treatment group (39.02%, p < 0.05). In the comparison of the small tear and medium tear groups, all scores increased significantly after surgery (p < 0.05), and the final follow-up scores were better than preoperative scores (p < 0.05) but worse than those of the 6-month postoperative follow-up (p < 0.05). Comparison between the two groups revealed that all scores of the small tear group were significantly better than those of the medium tear group at 6-month postoperative follow-up (p < 0.05). Although the scores of small tear group remained better than those of the medium group at the final postoperative follow-up, the difference was not statistically significant (p > 0.05). Radiographic assessment of the final follow-up demonstrated that the progression rate in the small tear group (8.57%) was significantly lower than that in the medium group (27.50%, p < 0.05), and the retear rate of small tear group (14.29%) was significantly lower than that of the medium tear group (35.00%, p < 0.05).

Conclusion

ARCR could effectively improve the quality of life for RA patients with small or medium RCTs, at least in the medium term. Despite the progression of joint destruction in some patients, postoperative retear rates were comparable to those in the general population. ARCR is more likely to benefit RA patients than conservative treatment.