腕头月关节脱位的X线平片和CT表现

目的 分析头月关节脱位的X线平片和CT表现,提高对本病的认识和诊断水平.方法 回顾性分析24例头月关节脱位患者的X线平片及CT薄层扫描、多平面重组(MPR)和容积再现技术(VRT)表现,总结不同影像学检查方法的应用价值.结果 24例患者中,月骨脱位2例,月骨周围后脱位22例,其中不伴有腕舟骨骨折的单纯月骨周围后脱位18例,经舟骨月骨周围后脱位4例;合并尺桡骨远端骨折4例7处,合并腕骨撕脱性骨折6例7处.X线平片准确诊断月骨脱位2例、单纯月骨周围后脱位16例、经舟骨月骨周围后脱位2例,漏诊单纯月骨周围后脱位2例、经舟骨月骨周围后脱位1例,误诊经舟骨月骨周围后脱位1例,漏诊腕骨撕脱性骨折4例5处.CT薄层扫描结合重建技术全部准确显示脱位及骨折(100%).结论 CT薄层扫描及重建技术对显示头月关节脱位更优于X线平片.     

腕骨脱位的X线平片及40层螺旋CT诊断比较

目的 探讨腕骨脱位X线平片及多层螺旋CT的影像学表现,并对两者的检出情况进行比较,以提高对腕骨脱位的诊断水平,减少漏诊误诊.资料与方法对2006年8月-2009年11月共21例腕骨脱位病人的X线平片、多层螺旋CT薄层扫描及容积再现(VR)三维重组和多平面重组(MPR)影像进行回顾性分析.其中男19例,女2例,年龄19~45岁,平均(31±7)岁.腕骨脱位位于左侧14例,右侧7例.结果 月骨脱位8例;月骨周围型脱位13例,其中,单纯月骨周围型脱位3例,经舟状骨月骨周围脱位4例,经舟状骨、三角骨月骨周围脱位1例,经三角骨月骨周围脱位3例,经桡骨茎突月骨周围性脱位2例.在伴有其他腕骨骨折的病例中,桡骨茎突及舟骨骨折于X线平片均得到确诊,而3例合并三角骨骨折的病例在X线平片上或不能显示骨折,或显示骨折片但不能确定具体部位.运用螺旋CT薄层扫描及重组后均做出了正确诊断.结论 X线平片对于腕骨脱位大多可以做出正确诊断,但当合并腕骨骨折,特别是细微骨折时,漏诊率较高,多层螺旋CT的MPR、VR技术可全面、准确地显示腕骨脱位及合并骨折情况,具有较高的临床应用价值.     

不典型月骨周围脱位的影像表现及鉴别

目的：总结不典型月骨周围脱位影像特点及与相关骨折脱位的鉴别要点。方法本组16例不典型月骨周围脱位均摄有腕关节正侧位片,5例同时行64排CT扫描及重建,仔细观察分析每一病例的影像表现及特点。结果本组16例均为不典型月骨周围后脱位,伴不同程度月骨向前半脱位。单纯不典型月骨周围后脱位10例,其中同时伴舟骨后脱位3例,半脱位2例,无脱位5例,舟骨无脱位病例中,1例正位头舟间隙明显增宽;经舟骨不典型月骨周围脱位6例,除月骨向前半脱位外,舟骨骨折近段亦随月骨向前半脱位。结论单纯不典型月骨周围后脱位均伴有不同程度月骨向前半脱位,可伴或不伴舟骨后脱位;经舟骨不典型月骨周围后脱位,月骨及骨折近段同时向前半脱位。     

腕关节损伤与常用诊断标准的对照研究(附300例测量分析)

目的：通过测量分析,研究腕关节损伤和常用诊断标准在Ｘ线诊断中的应用价值,提高腕关节损伤诊断的准确性。方法：详细测量分析我院有探讨价值的资料３００份,用三条弧线,腕关节方框,侧位轴线,舟月角,舟骨环征,腕高率,腕尺距进行详细分析。结果：腕骨损伤１９４例。腕骨脱位１０６例。在常用诊断标准中三条弧线：对舟骨骨折成角型,移位型,翻转型,三角骨横折型,纵折型骨折。经舟骨月骨周围腕脱位,月骨周围腕脱位,月骨掌侧脱位中的诊断价值极高,阳性率为１００％。腕关节方框：对移位型舟骨骨折阳性率为２７％,三角骨横行骨折阳性率为３６％,经舟骨月骨周围腕脱位阳性率为２０％。侧位轴线：对经舟骨月骨周围腕脱位,月骨周围腕脱位,月骨掌侧脱位阳性率为１００％,对舟骨骨折移位型阳性率为３６％。舟月角：仅对舟骨骨折翻转型和常见腕骨脱位有诊断价值。腕高率、腕尺距仅在腕骨结构紊乱中有较高的诊断价值。另外,舟骨环征仅是一个征象,不是一个诊断标准。结论：七条诊断标准对常见的舟骨稳定型和三角骨背、掌侧型骨折均无特异性改变。在腕骨损伤中三条弧线的诊断价值极高,侧位轴线次之。     

16层螺旋CT与X线平片在腕骨外伤诊断中对比及临床应用研究

目的探讨多层螺旋CT（MSCT）与x线平片在腕骨外伤中的诊断价值。方法31例腕骨外伤患者于受伤后30min-20d分别进行了x线平片、MSCT检查，将cT扫描数据传至工作站进行多平面重组（multiplanar reformation，MPR）、容积再现技术（vdume reformation，VR）和曲面重组（curved—planar reformation，CPR），观察MSCT各种成像方法对腕骨骨折和脱位的显示效果，并与x线平片对比分析。结果31例中，x线平片显示关节脱位6例，腕骨骨折14例，其中假阳性1例；可疑骨折7例，经MSCT确诊4例，排除3例。MSCT共检出28例（37处）骨折，脱位10例。二者腕骨骨折的检出率有统计学差异（x2=16．05，P〈0．05）。结论在腕骨外伤的诊断中，x线平片仍是基础的影像学检查方法；MSCT明显优于x线平片，各种成像方法的综合应用可提高腕骨损伤的检出率。     

大弧损伤性月骨脱位的分型及影像学表现

目的 探讨腕关节大弧损伤性月骨脱位的分型及影像学表现.方法 回顾性分析23例腕关节大弧损伤性月骨脱位病例资料.16例行数字X线摄影(DR)检查,19例行CT扫描,应用多平面重建(MPR)、曲面重建(CPR)及容积再现(VR)技术进行图像重建.结果 23例患者近排腕骨近侧及远侧关节面连线均不连续.综合X线平片及CT改变,...     

经舟骨月骨周围脱位的诊断与治疗

经舟骨月骨周围脱位的诊断与治疗１００８５３北京解放军总医院肖嵩华，张伯勋中国图书资料分类号Ｒ６８４．７经舟骨月骨周围脱位是较为少见的腕部严重损伤，约占所有腕骨骨折脱位的３％。由于腕骨的排列复杂，在Ｘ线片上的影像不易辩认，故常因漏诊而延误治疗。本文着重...     

X线透视结合切线位点片诊断腕舟骨骨折的符合率

目的探讨X线透视结合切线位点片诊断腕舟骨骨折的应用价值。方法选择120例腕骨骨折患者为研究对象,所有患者入院后均摄取腕骨正侧位片,透视结合切线位点片及螺旋CT检查。记录腕骨骨折的部位及数量,以螺旋CT检查结果为标准,比较X线平片正位、正侧位及X线透视结合切线位点片对腕舟骨骨折诊断符合率。结果 120例中,舟骨骨折比例最高,为67.5%;其次为月骨骨折,占13.3%。X线透视结合切线位点片对腕舟骨骨折检出率为93.8%,显著高于正侧位的78.8%和正位片的61.7%(P<0.05);与单纯正位片比较,正侧位片对腕舟骨骨折检出率更高(P<0.05)。结论 X线透视结合切线位点片对腕舟骨骨折诊断符合率高,是常规X线正侧位片的有力补充。     

MSCT在腕关节外伤中的应用

目的:探讨MSCT在腕关节外伤中的应用价值。方法:连续收集本科室2008年1月~12月因外伤进行腕关节MSCT检查的病例共计34例。MSCT扫描采用16层螺旋CT扫描仪(Siemens Somatom Sensation 16)。扫描及重建参数:120kV,120mAs,准直器宽度0.75mm,螺距0.55,1.0mm重建层厚、0.5mm重建间距,采用高分辨骨算法重建。重建的薄层图像传至Siemens多功能后处理工作站(MMWP)进行图像后处理。评价各种后处理技术对腕关节外伤的诊断价值。结果:在34例腕关节外伤中,共发现骨折40处。以舟状骨的骨折最多见,共计14处,月骨骨折3处,三角骨骨折3处,大多角骨骨折2处,小多角骨骨折1处,头骨骨折1处,钩骨骨折2处,尺桡骨远端骨折7处,掌骨基底部骨折7处。上述部分骨折伴有月骨脱位、月骨周围脱位等。薄层多平面重组(MPR)图像能清晰显示细微的骨折和骨折脱位的方向;曲面重组(CPR)图像可以在一幅图像上显示不同平面的结构和骨折;容积重建(VR)图像可以清晰显示复杂骨折脱位时各腕骨间的空间关系。结论:MSCT的各种重建和重组技术能清晰显示腕关节外伤的各种骨折和脱位,在腕关节外伤的临床诊断中有较大应用价值。     

足踝部骨折诊断——选择平片还是多层螺旋CT

目的 以多层螺旋CT(MDCT)为金标准,评价CR平片在足踝部骨折诊断的应用价值.方法 收集急性足踝损伤病例72例,先后进行CR平片检查及MDCT扫描.将骨折按部位分为胫骨远端、腓骨远端、距骨、跟骨、足舟骨、足中部其他跗骨(骰骨、楔骨)、跖骨及趾骨等7个部分.以MDCT为金标准,评价CR平片在以上7个部分的骨折,及对一些特殊类足踝骨折中的诊断的准确性.结果 足踝部共检出骨折150处.CR平片在足中部骨折的检出率为25%～33%,对Lisfranc骨折脱位的检出率为28.6%,对Tillaux骨折的检出率为25%.跟骨骨折在足踝骨折中的发生率为26.7%,CR平片对其的检出率为82.5%.结论 在足踝部的复杂骨折患者中,CR平片的检出率较低.如果CR平片检查为阴性,而临床怀疑可能存在骨折,应进一步行MDCT检查,甚至可考虑首选MDCT检查.     

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.     

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.     

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).     

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.