盂肱关节前方不稳MR表现与关节镜手术所见比较

 目的 探讨盂肱关节前方不稳的关节镜检查和3.0T MRI表现。方法 收集45例盂肱关节前方不稳患者的MRI检查及关节镜检查资料,回顾性对照分析MRI与多角度镜头关节镜手术结果,总结损伤类型、程度,采用Kappa检验分析MRI与关节镜诊断结果的一致性,观察MRI对各种损伤诊断结果及敏感度。结果 盂唇损伤在盂肱关节前方不稳病变中占84.4%(38/45),其中前下盂唇损伤占 51.1%(23/45),盂唇损伤合并Hill-sachs损伤、关节囊损伤占44.2%(20/45),盂唇损伤合并骨性Bankart损伤占17.7%(8/45)。MRI诊断前下盂唇损伤、HAGL病变、Hill-sachs病变的敏感度分别为78.2%、71.0%、90.0%。MRI与关节镜诊断结果具有一致性,其中诊断肩胛下肌及肌腱损伤及骨性Bankart损伤的结果完全一致,诊断前下盂唇损伤、HAGL病变及Hill-sachs病变的一致性较好,诊断SLAP损伤一致性一般。结论 3.0T MRI能够较准确地显示盂肱关节前方不稳常见病变及MRI征象,为临床早期诊断和治疗提供依据。     

肩关节损伤MRI与关节镜的对比分析

目的探讨常规MRI对肩关节损伤的诊断价值。方法回顾性分析因肩关节损伤行常规MRI和关节镜检查的55例病人资料,MRI观察指标包括肩袖、盂唇形态及信号,有否肩峰下撞击及骨性损伤。以肩关节镜为诊断金标准,统计MRI对不同类型肩关节损伤的诊断结果,并分别计算MRI的诊断敏感度、特异度和准确度。采用Kappa检验分析MRI与肩关节镜诊断结果的一致性。结果肩关节损伤的MRI征象中分别有25%部分肩袖撕裂、13.3%Bankart’s损伤、20%盂唇上部前后方向(SLAP)损伤和11.6%肩峰下撞击漏诊。MRI诊断损伤性病变的特异度及肩袖全层撕裂(100%)、骨性损伤(100%)、肩峰下撞击(88%)和Bankart’s损伤(87%)的敏感度较高,诊断SLAP损伤(75%)和肩袖部分撕裂(75%)的敏感度较低;诊断肩袖全层撕裂(100%)和骨性损伤(100%)的准确度最高,其次是Bankart’s损伤(96%),诊断SLAP损伤(89%)的准确度较低。MRI和关节镜诊断肩袖全层撕裂、骨性损伤的κ值为1,结果完全一致,诊断Bankart’s损伤的κ值为0.904,一致性较好,诊断肩袖部分撕裂、SLAP损伤和肩峰下撞击的κ值虽稍低,但均0.75,一致性也较好,P均0.05。结论 MRI是有效诊断肩关节损伤的影像方法,但对SLAP损伤和肩袖部分撕裂的诊断准确度有待提高。     

少见的髌下滑膜皱襞综合征3例报告

总结 3例少见的膝关节髌下滑膜皱襞综合征 ,对该疾患的病史、诊断及治疗进行了阐述 ,认为关节镜可以确诊 ,关节镜下和联合小切口手术切除病变皱襞是治疗的有效方法。     

3D-SPACE序列在肩关节MR造影中评估上盂唇前后撕裂

目的：评价肩关节 MR造影三维各向同性脂肪抑制快速自旋回波（SPACE）序列对上盂唇前后撕裂（SLAP损伤）的诊断价值。方法：影像诊断医师回顾性分析经关节镜证实的肩关节 MR 造影图像,判定有无SLAP 损伤及分型,对比常规二维序列和SPACE序列对SLAP损伤的敏感度、特异度及准确率,比较常规二维序列与SPACE 序列的诊断价值。结果：肩关节镜证实SLAP损伤12例,肩关节 MR造影SPACE序列与常规二维序列对SLAP 损伤的敏感度分别为83．33％（10/12）及91．67％（11/12）,特异度分别为81．25％（13/16）及87．50％（14/16）,准确度分别为82．14％（23/28）及89．29％（25/28）。SPACE序列与常规二维序列对 SLAP 损伤的诊断效能无明显统计学差异（P＞0．05）。结论：肩关节MR造影中SPACE序列是评价SLAP损伤准确、可靠的影像学方法。     

实用关节镜手术学

本书由解放军总医院和大连医学院多位知名专家共同编写，共7篇38章，围绕微创化、有限化治疗等核心理念，充分展示了关节镜微创外科手术创伤小、消除或减轻功能障碍效果肯定的优越性，并对下述内容进行了详细讲解：关节镜设备与器械；膝关节镜手术操作，包括检查方法、半月板损伤、半月板囊肿、交又韧带损伤的修复与重建、骨性关节炎、关节软骨损伤、粘连松解、滑膜病变等十分实用的诊疗技能，特别介绍了关节镜技术在骨性关节炎单髁置换术中的评估价值；髋关节镜手术操作；足踝关节镜手术操作；肩关节镜手术操作；肘腕关节镜手术操作；关节镜下撬拨复位固定治疗关节内骨折；关节镜技术在关节外的临床应用。     

实用关节镜手术学

本书由解放军总医院和大连医学院多位知名专家共同编写，共7篇38章，围绕微创化、有限化治疗等核心理念，充分展示了关节镜微创外科手术创伤小、消除或减轻功能障碍效果肯定的优越性，并对下述内容进行了详细讲解：关节镜设备与器械；膝关节镜手术操作，包括检查方法、半月板损伤、半月板囊肿、交又韧带损伤的修复与重建、骨性关节炎、关节软骨损伤、粘连松解、滑膜病变等十分实用的诊疗技能，特别介绍了关节镜技术在骨性关节炎单髁置换术中的评估价值；髋关节镜手术操作；足踝关节镜手术操作；肩关节镜手术操作；肘腕关节镜手术操作；关节镜下撬拨复位固定治疗关节内骨折；关节镜技术在关节外的临床应用。     

肱二头肌长头腱病变的诊疗进展

<正>随着影像学技术的发展和关节镜的应用,人们对肱二头肌长头腱(long head of biceps tendon,LHBT)病变的认识也不断提高。LHBT病变是引起肩关节疼痛及功能障碍的常见疾病之一[1],其病变类型包括肌腱炎、部分撕裂和完全断裂、半脱位和完全脱位[2]。目前对LHBT在肩关节运动中的生物力学功能还不完全明确,因此对LHBT病变的治疗也一直存在争议[3]。单纯的LHBT病变比较少见,大多数LHBT病变常常合并肩关节其他病变,如肩袖损伤、肩峰下撞击综合征、盂肱关节不稳、盂肱关节炎等,保守治疗效果欠佳,通常需     

关节镜下Bankart修复治疗训练伤所致慢性肩关节前方不稳

目的观察关节镜下Bankart修复治疗训练伤所致慢性肩关节前方不稳的临床疗效。方法选择21例肩关节前方不稳的患者,关节镜下锚钉修复盂唇损伤,同时修复合并出现的上盂唇前后(SLAP)损伤,较大的Hill-sachs损伤。采用UCLA功能评分标准和SST评分进行疗效的评估,记录术前和终末随访的得分。结果术后患者随访12~45个月,平均随访27个月。SST得分术前为(6.72±2.38)分,术后终末随访评分为(11.24±1.46)分,同术前比较差异有统计学意义(P<0.01)。术前UCLA平均得分为(19.55±5.02)分,术后终末随访评分为(33.19±4.61)分,与术前比较差异有统计学意义(P<0.01)。结论关节镜下Bankart修复治疗训练伤所致肩关节前方不稳疗效满意,可以很好恢复肩关节功能。     

实用关节镜手术学

本书由解放军总医院和大连医学院多位知名专家共同编写，共7篇38章，围绕微创化、有限化治疗等核心理念，充分展示了关节镜微创外科手术创伤小、消除或减轻功能障碍效果肯定的优越性，并对下述内容进行了详细讲解：关节镜设备与器械；膝关节镜手术操作，包括检查方法、半月板损伤、半月板囊肿、交又韧带损伤的修复与重建、骨性关节炎、关节软骨损伤、粘连松解、滑膜病变等十分实用的诊疗技能，特别介绍了关节镜技术在骨性关节炎单髁置换术中的评估价值；髋关节镜手术操作；足踝关节镜手术操作：肩关节镜手术操作；肘腕关节镜手术操作；关节镜下撬拨复位固定治疗关节内骨折；关节镜技术在关节外的临床应用。本书附有600余幅手术照片，内容丰富，讲解清晰，图文并茂，可操作性强，特别适合广大骨科医师开展关节镜临床工作时参考，也可作为基层医师、进修医师业务提升的高级培训教材使用。     

MRI和MR关节造影在肩部损伤中的诊断价值

目的 :探讨MRI(核磁共振成像 )和MR关节造影在肩部损伤中的诊断价值。方法 :自 1999年 3月至 1999年11月 ,共有 73个患者 75例肩关节接受了肩部MRI检查 ,其中 16例经关节镜或手术证实。对手术中所见与核磁共振表现进行比较。结果 :对肩袖完全撕裂 ,MRI和MR关节造影对全层撕裂诊断阳性率分别为 90 .6 %和 10 0 % ,特异性分别为 96 %和 97.6 %。MRI对肩袖部分撕裂诊断正确率低 ,可靠性差 ;MR关节造影诊断正确率达 80 % ,是肩袖部分撕裂诊断的可靠方法。MRI对急性Bankart损伤诊断阳性率 10 0 % ,对慢性或陈旧损伤 ,阳性率低 ,只有 33.3% ;而MR关节造影对慢性或陈旧损伤诊断阳性率达 10 0 %。对SLAP损伤 ,MR关节造影较MRI诊断阳性率高 ,但目前关节镜仍是SLAP损伤更可靠的定性诊断手段。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.