Axial rotation component of thoracic scoliosis

The axial rotation (rotation about a vertical axis) of the vertebrae, of the ribs, and of the back surface are components of the deformity recognized clinically as the "rib hump" in thoracic scoliosis. Relationships of these rotations to the lateral deviation and lateral curvature of the spine were studied in 40 patients with idiopathic scoliosis. Stereoradiographs of the spine and rib cage were used to measure three components of axial rotation: rotation of the vertebrae, of the rib cage, and of the plane of maximum curvature of the spine. Stereotopographs of the back surface were digitized to measure the axial rotation of the back surface. In individual patients, there were high correlations of all components of axial rotation at each spinal level with the corresponding vertebral lateral deviation from the spinal axis. By regression analyses of the maximum values of each rotation in each curve, the rotation of the apex vertebra was found to be generally of lesser magnitude than the rotation of the plane of maximum curvature of the spine and in an opposite sense in kyphotic curves. The rib cage rotation was generally of lesser magnitude than the vertebra rotation, and the back surface rotation was less than both of these skeletal rotations. Vertebra rotation correlated most closely with lateral deviation of the spine. Simple segmental coupling of axial rotation and lateral bending could not be responsible for this axial rotation.     

Tumors of the rib

The authors propose a pictorial review illustrating the imaging features of chest wall tumors and their specific features that discusses the main differential diagnoses. This review is based on published information and on our own experience.     

组织工程化人工肋骨三维支架材料的比较及生物学评价

目的 通过生物学评价考察多孔磷酸钙和聚乳酸-羟基乙酸共聚物(PLGA/HA)两种组织工程化人工肋骨材料的安全性,并筛选出较为合适的材料.方法 利用两种材料的浸提液进行热源试验、溶血试验、急性伞身毒性试验等生物学评价.利用micro-CT进行材料孔隙率和HA含量的测定,并将两种材料分别与猪骨髓基质干细胞进行培养,观察其接种后连续6 d细胞的生长情况和4、12、24 h细胞黏附情况.结果 两种材料均无急性全身毒性反应、溶血和热源作用.micro-CT结果显示,多孔磷酸钙较PLGA/HA有更高的HA含量(P≤0.05),与人松质骨接近,并且孔径大小均衡,互相连通.细胞增殖试验显示,多孔磷酸钙组细胞较PLGA/HA组生长明显快(P≤0.05).黏附试验显示,细胞对于两种材料的黏附率都不足50%,但两者无明显差异(P>0.05).结论 多孔磷酸钙和PLGA/HA对机体毒性较小,安全可靠;作为组织工程化人工肋骨的支架来说多孔磷酸钙比PLGA/HA更为合适.     

Acquired hyperostosis syndrome: Spectrum of manifestations at the sternocostoclavicular region. Radiologic evaluation of 34 cases

Summary Thirty-four patients with chest wall hyperostosis, a condition which has been designated by various terms in the literature were evaluated radiologically. We prefer the name acquired hyperostosis syndrome (AHS), which we categorize into the complete, incomplete and possible form. In complete AHS, sternocostoclavicular hyperostosis is associated with axial and/or peripheral (endosteal, periosteal, enthesopathic, metaplastic) hyperostosis and with psoriasiform or acneform dermatosis. In addition, these three manifestations are accompanied by erosive or nonerosive peripheral and/or axial arthritis to a variable degree. Sometimes, concomitant findings which are consistent with ankylosing spondylitis are also to be found in the axial skeleton. AHS is manifested at 11 different sites on the anterior chest wall. Ossification forms of the costal cartilage, inflammatory enthesopathies (three different insertions) and focal hyperostoses as well as processes of remodelling of the ribs, clavicles and sternum which are described in detail have particular diagnostic significance. AHS can start simultaneously at one, two or several sites on the anterior chest wall. Conventional tomography (possibly supplemented by CT) is necessary for early diagnosis and for analysis of the various findings on the anterior chest wall.     

多层螺旋CT肋软骨成像及在诊断肋软骨损伤中的价值

目的 探讨多层螺旋CT（MSCT）肋软骨成像方法及其在肋软骨损伤诊断中的价值。方法 利用西门子Sensation 4多层螺旋CT机按照胸部常规扫描条件对胸部外伤组36例和对照组100例患者进行容积扫描，然后进行薄层低对比及高对比图像重组，并将重组图像导人CT三维（3D）工作站，利用多平面重组成像（MPR）、最大密度投影（MIP）、表面阴影法成像（SSD）及容积成像技术（VRT）对图像进行后处理，由2名CT诊断医生一起对各种后处理图像进行观察和分析。结果 所有受检者的MSCT后处理图像均能显示肋软骨。正常肋软骨表现为周围密度均匀、形态规则、表面光滑；肋软骨损伤6例10处，表现为肋软骨密度不均匀或者其中有裂隙，2例呈粉碎状。MIP、SSD、VRT3种成像模式间图像质量差异无统计学意义（X^2=1．356，P=0．716），MIP、SSD、VRT成像模式与MPR成像模式间图像质量比较差异均有统计学意义（UMIP：MPR=12．981，USSD：MPR=12．652，UVRT：MPR=12．937，P值均=0．000）。结论 MSCT是1种无创伤性显示肋软骨形态的最佳影像学方法，其相关CT表现可望成为临床诊断肋软骨损伤的“金标准”。     

环抱式接骨器治疗外伤性肋骨骨折45例分析

目的探讨环抱式接骨器治疗外伤性肋骨、胸骨骨折的价值。方法对我院2009年3月～2011年8月间收治的45例肋骨骨折病人进行回顾性分析。所有45例患者均接受Ni-Ti形状记忆合金环抱接骨器治疗。结果所有手术均一次成功完成且骨折断端得到解剖复位,患者胸部疼痛较术前明显缓解。手术时间约20～80min,平均住院时间短10d。未发生感染、骨折不愈、骨折错位或再次骨折等并发症。结论应用环抱式接骨器治疗外伤性胸骨、肋骨骨折是目前比较有效安全且创伤小的方法。     

Abnormalities of fetal rib number and associated fetal anomalies using three dimensional ultrasonography

Aim

To determine incidence of abnormal number of fetal ribs and its association with other fetal anomalies using 3D ultrasonography.

Materials and methods

A prospective study conducted on 188 singleton pregnant women searching for fetal anomalies including the incidence of abnormal number of fetal ribs and other anomalies. Static 3D volumes with volume contrast imaging using spine map were used. Rendered images were displayed and the ribs were counted.

Results

173 fetuses (92%) were having normal number of ribs. Fifteen fetuses (8%) were found to have abnormal number of ribs; ten fetuses (5.3%) had 11 ribs. On the other hand five fetuses (2.7%) had supernumerary 13 ribs. Eight fetuses (4.2%) were having abnormal number of ribs with no associated anomalies (isolated abnormal number). Seven fetuses (3.7%) in this study had associated anomalies.

Conclusion

Abnormal number of fetal ribs more to be an isolated finding (4.3%) but it may also be seen with other anomalies (3.7% in this study). 3DUS is useful for scanning the fetal ribs in the mid trimester of the pregnancy for early detection of associated genetic aberrations.     

声通道的条状障碍物对高强度聚焦超声在离体牛肝内形成凝固性坏死的影响

目的 研究相同输出声功率下,声通道的条状障碍物对高强度聚焦超声(HIFU)在离体牛肝内形成凝固性坏死的影响.方法 在离体牛肝组织中进行HIFU辐照,首先在自由场进行HIFU辐照,然后将用条状障碍物模拟的肋骨置于声通道,引导声束轴线沿肋间隙正中、沿肋缘及正对肋骨,在每种情况下将肋骨分别置于距焦平面3 cm、6 cm、9 cm处在离体牛肝中进行HIFU辐照,辐照结束后观测凝固性坏死的形成率、体积、形态、位置与模拟肋骨表面的情况.结果 ①凝固性坏死形成率:自由场情况下,凝固性坏死形成率为100%.当肋骨距焦平面3 cm时,声束轴线沿肋间隙正中,凝固性坏死形成率为100%;声束轴线沿肋缘、正对肋骨时,凝固性坏死形成率急剧降低.分别为25%、8%;当肋骨距焦平面6 cm、9 cm,无论声束轴线与肋骨相对位置如何,形成率均在50%以上.②凝固性坏死体积:当声通道有肋骨存在,凝固性坏死体积比自由场明显降低,差异均具有统计学意义(P<0.05);肋骨与声束轴线的相对位置以及肋骨距焦平面的距离不同,凝固性坏死的体积、长度、宽度、形态、位置不同.③当肋骨置于接近焦平面的位置时,在形成凝固性坏死的同时,观察到肋骨表面被烫伤.当肋骨置于远离焦平面的位置时,在形成凝固性坏死的同时,不会对肋骨表面形成损伤.结论 声通道有肋骨存在时,HIFU在牛肝内形成的凝固性坏死体积明显减小.声通道的肋骨与声束轴线的相对位置以及肋骨距焦平面的距离均对凝固性坏死的形成率、体积、形态、位置有影响,声束透过肋间隙正中时在牛肝中形成的凝固性坏死体积较大,形态规则,易于控制.声通道的肋骨距离焦平面越近,越有可能对肋骨表面造成损伤.     

漏斗胸肋软骨生物力学特性研究

目的：探讨漏斗胸肋软骨生物力学特征。方法：19例漏斗胸患儿肋软骨手术标本经处理后,用日本岛津AG－1000A电子式万能实验机行拉伸、压缩和弯曲试验,载荷精度0．25％,加载速度5mm/min。取年龄相同死于非骨骼肌肉系统疾病的尺体标本作对照。记录应力－应变关系曲线或应力－时间关系曲线并根据该曲线计算平均最大压缩、拉伸、弯曲强度和平均最大应变。结果：病变组拉伸强度、压缩强度、弯曲强度和平均最大应变均小于对照组。在相同的应力作用下,病变组的应变较大。病变组破坏应力也小于对照组。结论：漏斗胸肋软骨生物力学性能有下降,这种改变可能与漏斗胸的形成有一定关系。     

Soft tissue involvement,mediastinal pseudotumor,and venous thrombosis in pustulotic arthro-osteitis

A syndrome of hyperostosis of the thoracic wall, nonspecific signs of inflammatory disease, and palmar and plantar pustulosis is described in eight patients (Table 1). Seven had intersternocostoclavicular ossification [12], and one had chromic recurrent multifocal osteomyelitis [2]. This complex of findings has been called pustulotic arthro-osteitis [5, 12]. This report emphasizes the periosseous soft tissue inflammation and the unexplained subclavian and mediastinal vein thrombosis seen in two patients [8]. Inflammatory periosseous and mediastinal lesions were seen on plain films in all eight patients and on computed tomographic (CT) scans in seven. Radiographs of the spine showed a spondyloarthropathy in three patients. This was characterized by ossification of the vertebral ligaments and sclerosis of the vertebral bodies. Awareness of the radiologic features of pustulotic arthro-osteitis is important because the clinical, biochemical and pathologic findings are often nonspecific and misleading [5, 8, 12].