Spinal fusion-hardware construct: Basic concepts and imaging review

The interpretation of spinal images fixed with metallic hardware forms an increasing bulk of daily practice in a busy imaging department. Radiologists are required to be familiar with the instrumentation and operative options used in spinal fixation and fusion procedures, especially in his or her institute. This is critical in evaluating the position of implants and potential complications associated with the operative approaches and spinal fixation devices used. Thus, the radiologist can play an important role in patient care and outcome. This review outlines the advantages and disadvantages of commonly used imaging methods and reports on the best yield for each modality and how to overcome the problematic issues associated with the presence of metallic hardware during imaging. Baseline radiographs are essential as they are the baseline point for evaluation of future studies should patients develop symptoms suggesting possible complications. They may justify further imaging workup with computed tomography, magnetic resonance and/or nuclear medicine studies as the evaluation of a patient with a spinal implant involves a multi-modality approach. This review describes imaging features of potential complications associated with spinal fusion surgery as well as the instrumentation used. This basic knowledge aims to help radiologists approach everyday practice in clinical imaging.     

Endobutton fixation of hamstring tendon grafts

The EndoButton (Acufex, Mansfield, MA) is one of many devices available for hamstring or patellar tendon graftfemoral fixation in anterior cruciate ligament reconstructive surgery. The strengths and weaknesses of the device are discussed. Recent modifications to the device and the operative technique may improve its effectiveness.     

颈椎柔性稳定一体化系统对维持犬颈椎间隙高度作用的研究

目的 评估人工髓核柔性稳定一体化系统对维持犬颈椎椎间隙高度的作用.方法 选择健康杂种犬40只,分成4个试验组:完整组(A组)、颈椎间盘病变组(B组)、钢板内固定组(C组)、柔性稳定组(D组).颈椎间盘病变组(B组)、钢板内固定组(C组)和柔性稳定组(D组)分别经前路行C3/4髓核摘除术、钢板内固定术、柔性稳定一体化系统...     

非融合寰枢椎椎弓根螺钉内固定术与Holo-Vest治疗Ⅲ型齿突骨折的对比研究

目的探讨非融合椎弓根螺钉内固定技术及Holo-Vest支架对于AndersonⅢ型齿突骨折的治疗效果。方法 2002年3月～2009年3月我院收治的Ⅲ型齿突骨折患者18例,其中8例行Holo-Vest支架固定,10例行非融合椎弓根螺钉内固定治疗。结果所有患者经过6～48个月随访（平均14.3个月）,症状均得到改善,但是对去除外固定或者内固定器械后颈椎活动度、术后JOA评分、骨折愈合率进行统计分析,非融合椎弓根螺钉内固定组要明显优于Holo-Vest支架组。结论非融合椎弓根螺钉内固定技术治疗Ⅲ型齿突骨折相对于Holo-Vest支架治疗具有固定牢靠,恢复快,融合率高,并保留寰枢椎生理活动功能的优点。     

股骨头骨折的治疗

目的 探计股骨头骨折的治疗方法．方法 对57例股骨头骨折进行随访．分析各种不同治疗方法的治疗效果．进行对比研究．结果 股骨头骨折的治疗效果与Pipkin分型、手术入路．固定方式和术后治疗都有关系。结论 股骨头骨折应根据其分型选择治疗方法,手术应尽量在6小时内进行,手术人路应综合多方面因素进行选择．内固定方式以可吸收钉棒为佳．术后应早活动、晚负重。     

股骨转子间骨折微创内固定术临床疗效评价

目的 探讨股骨转子间骨折微创内固定术临床疗效。方法 在C形臂X线机透视下闭合复位，设计微创手术入路，经皮动力髋螺钉（DHS）内固定术治疗股骨转子间骨折27例。其中男19例，女8例，年龄49-92岁，平均68.5岁。结果 切口长度平均5.2cm；出血量平均48.4ml；手术时间平均38min；临床愈合时间58-82d，平均67.5d，未出现切口血肿及感染，除1例髋关节外旋轻度受限外，其余26例髋关节功能均正常，X线评价：1例转子上移0.8cm；均未见骨折，手术简便快速，创伤少，固定牢，愈合快，术后并发症极少，是目前股骨转子间骨折较新的有效治疗方法。但微创手术内固定器械尚有待改进。     

肱骨髁间骨折两种入路的疗效比较

目的评价尺骨鹰嘴截骨入路、肱三头肌舌状瓣入路治疗肱骨髁间骨折的临床疗效。方法2004年8月—2007年8月,手术治疗肱骨髁间骨折27例,按骨折AO/ASIF分型:C1型6例,C2型13例,C3型8例。分别尺骨鹰嘴截骨、肱三头肌舌状瓣切口入路,行切开复位钢板内固定术。结果27例患者随访8～12个月,平均10.4个月,骨折全部愈合,平均愈合时间4.6个月。肘关节功能根据Aitken和Rorbeck的肘关节功能评定标准进行评定,尺骨鹰嘴截骨入路组优良率82.4%,经肱三头肌舌状瓣入路优良率60%。结论经尺骨鹰嘴截骨入路的疗效明显优于经肱三头肌舌状瓣入路。     

New techniques in lumbar spinal instrumentation: what the radiologist needs to know

Lumbar spinal fusion is a commonly performed procedure, and, despite changes in cage types and fixation hardware, radiologists have, over the years, become familiar with the imaging features of typical spinal fusion and many of the complications seen in patients after surgery, including pseudoarthrosis, hardware loosening, and recurrent or residual disk herniation. Recently, however, novel approaches and devices have been developed, including advances in minimally invasive surgery, the increasing use of osteoinductive materials, and a wide variety of motion-preserving devices. These new approaches and devices manifest with characteristic imaging features and the potential for unusual and unexpected complications. Several of these devices and approaches are experimental, but many, including those devices used in lateral approaches to fusion, as well as the use of bone morphogenic protein, disk arthroplasty, and interspinous spacers, are seen with increasing frequency in daily clinical practice. Given the recent advances in spinal fusion surgery, it is important that radiologists have a basic understanding of the rationale behind these procedures, the common imaging features of the devices, and the complications associated with their use.     

Recurrent acute hemarthrosis after anterior cruciate ligament reconstruction

Arthroscopic-assisted and endoscopic operative techniques have allowed for less and less restrictive postoperative rehabilitation programs after cruciate ligament reconstruction. Accelerated rehabilitation programs may, however, also provoke mechanical problems at the transplant-bone interface, as reports in the literature of loosened fixation devices and loosened or even fractured bone pegs with subsequent hemarthrosis and recurrent instability have shown. We describe the case of a patient who presented with recurrent acute hemarthrosis after anterior cruciate ligament reconstruction without additional trauma and without instability. However, the symptoms and signs were clearly related to the fixation method employed.     

胸腰椎骨折后路单节段椎弓根钉固定与结合骨水泥强化固定的生物力学比较

目的 比较胸腰椎骨折后路单节段椎弓根钉固定与结合骨水泥强化固定的生物力学效果.方法 在8具新鲜小牛胸腰椎标本(T11～L3)的L1椎体上制作不完全爆裂骨折模型.标本依次行单节段椎弓根钉固定及单节段椎弓根钉固定+骨水泥强化固定.对标本施加扭矩为4 Nm的疲劳载荷共2 000次,加载频率为0.5 Hz.经脊柱三维运动测量系统测量完整、骨折、固定和周期性加载后固定节段前屈、后伸、左侧屈、右侧屈、左旋转和右旋转运动时固定节段的角位移运动范围(ROM).结果 两种固定状态及疲劳后各方向ROM均明显小于正常及骨折状态(P<0.05);单节段椎弓根钉固定结合骨水泥强化固定状态前屈、后伸、侧屈、旋转ROM分别为0.40°、0.53°、0.86°、0.55°,疲劳后前屈、后伸、侧屈、旋转ROM变化值分别为0.10°、0.07°、0.19°、0.08°,均小于单纯单节段椎弓根钉固定组,尤其在旋转和前屈方向,差异有统计学意义(P<0.05).结论 两种固定方式均可重建脊柱骨折的即刻稳定性并具有良好的抗疲劳载荷效果.但在前屈和旋转方向,单节段椎弓根钉固定并骨水泥强化优于单纯单节段椎弓根钉固定.     

股骨头挖除后螺旋CT三维重建在髋臼粉碎性骨折中的应用

目的 探讨股骨头挖除后螺旋CT三维重建在髋臼粉碎性骨折中的应用价值。资料与方法 对27例经普通X线诊断的髋关节骨折患者,应用螺旋CT扫描获得原始轴面图像,在工作站对兴趣区进行染色显影,通过关节解体技术去除股骨头,然后对髋臼采用多平面重建（MPR）及表面遮盖法（SSD）和容积漫游技术（VRT）三维重建。结果 股骨头挖除后三维重建图像能直观显示髋臼骨折的全貌及关节腔内的游离碎骨片及相互之间的解剖关系。结论 股骨头挖除后SSD和VRT三维重建对外科手术前充分了解髋臼损伤情况、手术方案的制定及内固定器械的选择,均有重要的指导作甩。     

老年骨质疏松性股骨远端骨折治疗方法的研究进展

股骨远端骨折是老年骨质疏松性下肢骨折常见的类型。由于这类患者多存在骨质疏松、骨折粉碎、全身情况不良等特点,临床治疗面临挑战。随着对该类骨折认识的深入以及内固定器械的发展和手术技术的进步,更多新的治疗方法逐渐得到应用。笔者对近年该类骨折手术入路、固定方式选择、假体置换及抗骨质疏松治疗等方面的最新进展进行综述,为老年骨质疏松性股骨远端骨折的临床治疗提供参考。     

Revision anterior cruciate ligamentsurgery: Preoperative evaluation and considerations

An orthopedic surgeon must carefully evaluate each patient before proceeding with revision anterior cruciateligament (ACL) surgery. A concerted effort directed at delineating the reason(s) for failure of the primary reconstruction should be undertaken to prepare an orthopedic surgeon for revision ACL surgery. The evaluation should include a detailed history from the preoperative period of the primary ACL until the present. Physical examination should evaluate the knee for previous scars as well as associated laxity. Diagnostic studies should at a minimum include plain radiographs and magnetic resonance imaging. In addition, the operative surgeon should be experienced in ACL surgical techniques, have the appropriate tools and fixation devices, and have several graft choices. Finally, if there is any question about the ability to place the tunnels appropriately or obtain solid fixation, strong consideration should be given to staging the revision reconstruction.     

Cadmium zinc telluride detectors for industrial radiation measurement

Cd_1−xZn_xTe room temperature semiconductor detectors offer improved measurement capability, stability and lifetime over currently employed devices such as CdTe and HgI₂ detectors. These improved features along with the compactness, durability and other properties inherent in solid-state devices often make it the correct decision to use Cd_1−xZn_xTe in place of detectors such as NaI(Tl) scintillators and proportional counters, and provide the basis for new approaches to instrumentation, including the use of imaging arrays and current-mode operation.     

Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques

In this prospective study high tibial osteotomy for medial gonarthrosis was performed in 95 patients (105 knee joints). The patients underwent simultaneously diagnostic and operative arthroscopic surgery of the knee joint. A follow-up arthroscopic examination could be performed in 75 patients (85 knee joints) at the time of implant removal. In group 1 (20 knee joints), the osteotomy was performed after diagnostic arthroscopy without arthroscopic operation of the knee joint. The fixation of the osteotomy was accomplished by staples, postoperative plaster fixation and physiotherapy. In group 2 (20 knee joints), osteotomy was performed without additional operative arthroscopy after diagnostic arthroscopy, internal fixation by AOT-plate, no external fixation postoperatively and physiotherapy. In group 3 (22 knee joints), osteotomy was performed with additional operative arthroscopy (Pridie drilling), internal fixation by AOT-plate no external fixation postoperatively no external fixation, physiotherapy and continuous passive motion. In group 4 (23 knee joints), osteotomy was performed with additional operative arthroscopy (abrasio-arthroplasty), internal fixation by AOT-plate, no external fixation postoperatively, physiotherapy and continuous passive motion. All patients underwent arthroscopic examination of the knee with cartilage biopsies taken from three different regions of the femoral condyle during the same operative session as the osteotomy. At follow-up arthroscopy cartilage biopsies were taken from the same regions. There was no great difference in clinical outcome after 1 year between all groups. Arthroscopy as well as routine and electron microscopy showed better cartilage regeneration in groups 3 and 4. Groups 1 and 2 showed only regeneration isles, sometimes not well fixed to the underlying bone, while in groups 3 and 4 cartilage regeneration was thicker and more stable, sometimes covering all of the pre-existing erosions. Therefore, we recommend osteotomy of the tibia for osteoarthritis together with operative arthroscopy in the same operative session. Received: 8 October 1997 Accepted: 5 April 1998     

颈胸段脊柱结核的手术入路选择

目的:探讨颈胸段脊柱结核的外科治疗原则及手术入路选择.方法:近3年我院收治颈胸段脊柱结核患者9例,其中Frankel B级2例,C级2例,D级3例,E级2例.低位下颈椎前方入路病灶清除、椎管减压、钛笼植骨钢板内固定术1例;低位下颈椎前方入路联合劈开胸骨柄/胸骨上2/3病灶清除、椎管减压、钛笼植骨钢板内固定术2例;经左侧肩胛骨下胸腔入路病灶清除、椎间钛笼植骨、前路钢板内固定术4例;后方椎弓根内固定、复合经椎弓根侧前方入路病灶清除术2例.术中清除病灶组织送病理检测和结核杆菌培养及药物敏感试验,术后根据药物敏感试验实行个体化的化疗方案治疗1年.结果:9例患者均安全度过围手术期,随访6个月至2年,平均11个月.术后截瘫或神经损伤全部恢复,Frankel B级-C级平均恢复时间为3个月,D-E级平均恢复时间为1个月,伤口均一期愈合,随访时间内结核未见复发.所有病例病理检测确诊脊柱结核,6例培养出结核杆菌,3例结核杆菌耐单药,无耐多药病例.结论:对颈胸段脊柱结核,术前应根据X线、MRI和CT等影像学资料,仔细评估受累节段和椎体受累情况,根据发病部位、病灶性质和受累程度,以及患者体型及身体一般状况,有针对性地加以选择手术入路和手术方式.     

后路椎弓根螺钉治疗齿状突骨折伴可复性寰枢椎脱位

目的 总结后路寰枢椎椎弓根螺钉固定、复位、融合治疗齿状突骨折伴可复性寰枢椎骨折脱位的疗效.方法 对27例齿状突骨折伴可复性寰枢椎骨折脱位的患者经术前颅骨牵引,采用后路椎弓根螺钉,行寰枢椎复位、固定及植骨融合.结果 患者寰枢椎椎间稳定性得到恢复,无并发症发生;随访12-48个月(平均24个月),27例患者均获骨性融合.结论 经后路寰枢椎椎弓根螺钉固定融合术可为齿状突骨折伴可复性寰枢椎骨折脱位的患者提供牢固的三维固定,是一种更为有效的治疗方法.     

第1掌骨基底部骨折手术治疗疗效分析

目的比较不同的手术方法、手术距受伤时间、术后外固定时间的长短对第1掌骨基底部骨折最终疗效的影响。方法2000年1月—2007年10月,手术治疗62例第1掌骨基底部骨折,其中克氏针固定32例,微型螺钉固定20例,微型钢板固定10例:手术距受伤时间间隔<2周者41例,>2周者21例;手术后石膏等辅助外固定时间<6周者41例,>6周者21例。术后随访至内固定物取出后功能康复锻炼无明显进展为止。功能评定采用TAM系统评定法,评定结果分别进行统计学分析。结果克氏针固定、微型螺钉固定、微型钢板固定术后功能康复优良率分别为63.1%、75.0%、70.0%,三组差异无统计学意义(P>0.05);手术距受伤时间<2周及>2周术后功能康复优良率分别为78.0%、52.4%,2周内手术组优于2周后手术组(P<0.05);手术后石膏等辅助外固定时间<6周及>6周者术后功能康复优良率分别为81.4%、42.1%,术后第1腕掌关节固定>6周组明显优于术后外固定>6周组(P<0.01)。结论第1掌骨基底部骨折手术治疗,手术距受伤的时间及术后外固定的时间是影响术后第1掌腕关节功能恢复的主要因素。     

股骨骨折合并颅脑损伤48例治疗

目的 探讨股骨骨折合并颅脑损伤治疗的时机及疗效.方法 回顾分析48例股骨骨折合并颅脑损伤病例,比较死亡率、手术时间、手术失血量、住院时间、骨不连例数、骨折愈合时间,观察急诊行内固定手术(≤48小时)、早期外固定延期内固定(＞48小时)对股骨骨折合并颅脑损伤的治疗效果.结果 早期外固定延期内固定手术时间更短、手术失血量更...     

Orthopedic fixation devices

Orthopedic fixation devices are used in the treatment of fractures, soft-tissue injuries, and reconstructive surgery. After fracture reduction, internal, external, or intramedullary fixation devices may be used to provide stability and maintain the alignment of bone fragments during the healing process. They must be strong and secure enough to allow early mobilization of the injured part, as well as the entire patient. Compression is used whenever possible to increase the contact area and the stability between fragments and to decrease the stress on the implant. Screws are used primarily to provide interfragmental compression or to attach plates, which can then provide compression, prevent displacement, and support the fragments during healing. Pins and wires can be used for fixation of small fragments or fractures in small bones and for attachment of external fixation devices and traction. A basic understanding of the devices and principles of use is needed to interpret radiographs obtained after the treatment of musculoskeletal injuries.