The correlation of arthrography with the results of treatment in late diagnosed congenital dislocation of the hip

Summary The aim of this study was to assess the value of arthrography of the hip in the investigation of late diagnosed congenital dislocation. The results of the treatment of 109 hips were related to the findings at arthrography. The hip radiographs at follow-up were normal in all cases where the arthrogram had demonstrated a congruent reduction (86). When the arthrogram had indicated a block in reduction the results were less favourable, and dysplasia or subluxation was present at follow-up in 19 cases, despite repeated conservative or operative treatment. Four hips appeared normal after operation.Arthrography gave valuable information and showed good correlation with the results of treatment.

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Résumé Le but de ce travail est d'évaluer l'intérêt de l'arthrographie dans le bilan des luxations congénitales de la hanche dépistées tardivement. Les résultats du traitement de 109 hanches ont été comparés aux données de l'arthrographie. Au cours de la surveillance les radiographies de contrôle étaient normales dans tous les cas (86) où l'arthrographie avait montré une réduction parfaite. Quand l'arthrographie avait décelé un obstacle à la réduction les résultats étaient moins bons et il persistait une dysplasie ou une subluxation dans 19 cas, malgré la reprise d'un traitement orthopédique ou chirurgical. Quatre hanches paraissaient normales après intervention.L'arthrographie fournit donc des renseignements valables qui concordent bien avec les résultats du traitement.

     

关节腔造影对微创治疗胫骨平台骨折的辅助复位意义

目的探讨关节腔造影技术在微创治疗胫骨平台骨折术中对骨折复位的指导意义。方法回顾性分析2019年1月至5月间西安交通大学附属红会医院创伤骨科医院下肢病区收治的9例胫骨平台骨折患者资料。男6例,女3例;年龄27~63岁,平均45.5岁;骨折根据Schatzker分型:Ⅱ型6例,Ⅲ型1例,Ⅳ型2例。术中所有患者均在关节腔内注入造影剂后透视寻找造影剂填充最低点;骨折复位植骨后再次造影透视,关节面复位满意后经皮微创置入接骨板。术前和术后6个月测量并比较膝关节活动度及美国特种外科医院(HSS)膝关节功能评分;术后6个月根据Rasmussen影像学评价标准对膝关节X线片进行评分,同时记录手术前后关节面塌陷程度及术后并发症发生情况。结果所有患者术后获3~10个月(平均7个月)随访。所有患者均于术后12周内达骨性愈合。术前膝关节屈曲60.7°±13.1°,伸直4.6°±2.9°,HSS评分为(51.9±5.7)分;术后6个月膝关节屈曲122.4°±10.8°,伸直4.4°±2.5°,HSS关节评分为(84.9±5.3)分。术前与术后6个月膝关节屈曲活动度和HSS评分比较差异均有统计学意义(P<0.05),但伸直活动度比较差异无统计学意义(P>0.05)。关节面塌陷程度由术前9.5 mm(5~15 mm)恢复至术后1.3 mm(0~3 mm)。术后6个月Rasmussen影像学评分:优6例,良3例。术后未出现切口感染、关节僵硬、内固定物松动及断裂等并发症。结论胫骨平台骨折术中通过关节腔造影可较好地观察骨折塌陷的情况,同时准确判断关节面间接复位的情况,有益于微创治疗胫骨平台骨折的疗效。     

超声造影在滑膜炎评估中的研究进展

滑膜炎是滑膜的一种无菌性炎症,可由多种病因引起,长期存在可导致关节软骨破坏,骨质暴露,最终导致骨性强直,严重影响患者生活质量。滑膜新生血管与炎症侵袭性和破坏性密切相关,是急性炎症和慢性疾病急性加重的重要特征,被认为是评估滑膜炎活动性的重要指标。超声对比剂的使用能检测到微量的血流灌注,提高关节内血管化的检测率,有效地增强了活动性滑膜炎和非活动性滑膜增厚的鉴别能力,并且可以通过超声造影时间-强度曲线参数对滑膜血流灌注进行量化分析,对患者病情的评估以及治疗策略的决策具有重要意义。相比于常规超声,使用超声造影对滑膜炎活动性的判断具有显著优势,与磁共振具有较好的一致性。超声造影是对滑膜炎进行早期诊断的有效的影像学方法。另外,超声造影也有助于病情在治疗过程中的监测以及治疗效果的评估。     

Costo-vertebral arthropathy. Diagnostic and therapeutic value of arthrography

Summary The authors report five cases of costo-vertebral (CV) joint arthropathies, without osteo-arthritis. The patients had referred pain, with misleading irradiations to the loin or to the abdomen, so that the diagnosis was difficult. The authors have performed in these five cases an arthrography of T₁₁ and T₁₂CV joints. In every case, the arthrography triggered pain at one of these levels. The arthrography was followed by intra-articular injection of corticosteroid derivative in the symptomatic joint. In these cases, this procedure was a valuable diagnostic and therapeutic method. CV joint arthropathies are frequent, but often lead to incorrect diagnosis. These preliminary results encourage further use of this procedure in CV arthropathies.     

Diagnostic and therapeutic impact of MRI and arthrography in the investigation of full-thickness rotator cuff tears

Investigation of shoulder pain is important before surgical treatment. The presence or absence of a full-thickness rotator cuff tear (FTRCT) may determine the type of surgical treatment. Both MRI and conventional arthrography can be used, but little is known about their relative diagnostic and therapeutic impact. We performed a prospective trial assessing: (a) the influence of MRI and arthrography results on the clinician's diagnostic thinking (diagnostic impact); (b) the influence of the results on the clinician's therapeutic thinking (therapeutic impact); and (c) the diagnostic performance of the two techniques in patients with surgical confirmation. A total of 104 consecutive patients with shoulder problems referred to a specialist orthopaedic shoulder clinic underwent pre-operative investigation with MRI and arthrography. The surgeon's diagnosis, diagnostic confidence and planned treatment were measured before the investigation, and then again after the results of each investigation. Before the presentation of the investigation results, the patients were randomised into two groups. In one group MRI was presented first; in the other group, arthrography. The MRI results led to fewer changes in diagnostic category (14 of 46, 30 %) than arthrography (20 of 54, 37 %), but the difference was not significant (P > 0.5). Magnetic resonance imaging led to slightly more changes in planned management (17 of 47, 36 %) than arthrography (14 of 55, 25 %), but again the difference was not statistically significant (P > 0.3). The results of the second investigation always had less diagnostic and therapeutic impact than the first. The accuracy of MRI for FTRCT in 38 patients with surgical confirmation was 79 %, sensitivity 81 % and specificity 78 %; the accuracy of arthrography was 82 %, sensitivity 50 % and specificity 96 %. The clinical diagnosis and management plan can be adequately defined by a single radiological investigation. Magnetic resonance imaging and arthrography had fairly similar diagnostic and therapeutic impact and comparable accuracy, although MRI was more sensitive and less specific. Magnetic resonance imaging may be the preferred investigation because of its better demonstration of soft tissue anatomy. Received: 27 January 1998; Revision received: 27 May 1998; Accepted: 22 June 1998     

CT导引下的骶髂关节造影及其临床意义初探

目的探讨ＣＴ导引下的骶髂关节造影术及其临床意义。方法对５例骶髂关节病变患者和１５例腰腿痛的志愿者进行ＣＴ导引下的骶髂关节造影,造影后行ＣＴ扫描、Ｘ线拍片并填写疼痛图。结果骶髂关节ＣＴ扫描显影良好,Ｘ线片影像欠清晰。２例有骶髂关节病变患者的ＣＴ扫描发现有造影剂外溢及隐窝。本组共１４例感造影后穿刺侧臀部及大腿后上方酸痛,５例骶髂关节病变患者诉造影术引发的疼痛与术前疼痛部位相同。结论ＣＴ导引下的骶髂关节造影术与传统的造影方法相比,即避免了过多接触Ｘ线照射引起的伤害,又提高了工作效率,为临床诊断和开展相关研究提供了有意义的影像学信息。