棘突截骨钛网椎管成形术在胸腰椎骨折治疗中的应用研究

〓【摘要】〓目的〓棘突截骨钛网椎管成形术治疗胸腰椎骨折中的效果。方法〓选取2012年7月~2013年9月间我院收治的41例胸腰椎骨折患者,对其采用棘突截骨钛网椎管成形术进行治疗,并跟踪随访解患者恢复情况。结果〓41例患者中,术后3个月内骨折愈合良好的有23例,愈合程度一般的17例,手术无效的1例。一年后随访发现,患者均恢复良好,与术后最后一次检查结果无明显差异,前后对比,差异有统计学意义(P<0.05)。结论〓棘突截骨钛网椎管成形术在治疗胸腰椎骨折中效果良好,能够有效促进患者骨折部位尽快恢复正常,复发率低。     

Traumatic orbital encephalocele in an adult: report of one case

Orbital roof fractures after head injury is rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 24 cases published to date. We report the case of an adult with a post-traumatic orbital encephalocele. One day after a road traffic accident with head injury, the patient developed progressive pulsatile proptosis. Computed tomography and magnetic resonance imaging revealed an isolated blow-in fracture of the orbital roof with herniation of the left frontal lobe into the orbit. Neurosurgery to repair the orbital defect led to full recovery.     

Bilateral elastofibroma dorsi: A case report

INTRODUCTION

Elastofibroma dorsi(EFD) is slow-growing, benign, soft tissue tumor of unclear pathogenesis, typically located at the subscapular region of elderly people. It may be unilateral or bilateral. As it exhibits benign behavior, it should be surgically removed only in symptomatic patients. Magnetic resonance imaging (MRI) is a useful tool for assessment of EFD and can potentially help avoid the need for unnecessary biopsy and surgery.

PRESENTATION OF CASE

A 62-year-old woman presented with 2 years complaint of back pain, particularly aggravated with shoulder movements and swelling with bilateral elastofibroma dorsi. Both masses were totally excised with bilateral posterolateral subscapular incision. Symptoms were completely controlled and significant discomfort from the surgical procedure was completely resolved with in a few weeks interval from the operation.

DISCUSSION

The pathogenesis of the EFD still remains unclear. Elastofibroma dorsi has an unspecific clinical presentation and can be confused with other tumors of the periscapular region Imaging studies are useful for diagnosis.

CONCLUSION

Elastofibroma dorsi is benign soft tissue tumor mostly observed in the subscapular regions of elderly female patients. The surgery is indicated in symptomatic cases and must be confined to simple excision of the lesion.     

Diagnostic pitfalls in osteomyelitis of the odontoid process: case report

BACKGROUND

Pyogenic osteomyelitis of the odontoid process is a very rare disease associated with a variety of clinical symptoms, and previous reports have stressed the difficulties inherent in making the diagnosis. The authors present a case of osteomyelitis of the odontoid process with epidural abscess in which magnetic resonance imaging (MRI) was used in the diagnosis, assessment of the extent of concomitant epidural abscess, treatment effect, and long-term follow-up.

CASE DESCRIPTION

A 68-year-old male was admitted to our hospital with cervical pain, neck stiffness, and fever. Although the diagnosis was missed at the beginning, the patient was diagnosed with osteomyelitis of the odontoid process with a paravertebral epidural abscess by MRI. The patient became asymptomatic after 3 months of antibiotic therapy.

CONCLUSION

Pyogenic osteomyelitis of the odontoid process is a rare condition requiring a high index of suspicion for diagnosis. MRI examination should be considered in the diagnosis in patients with neck pain combined with fever. Serial MRI during and after antibiotic therapy provided an objective assessment of the healing rate of the lesions.     

Deltoid contracture: a case with multiple muscle contractures

Deltoid contracture is relatively uncommon. The literature consists primarily of case reports and few articles on large case series. The pathogenesis has been well studied. Muscle contractures can occur in the deltoid, biceps, triceps, gluteus and quadriceps muscles; however, cases of multiple muscle contractures are rare. We reported a patient with multiple contractures of the bilateral deltoid, bilateral gluteus, and bilateral quadriceps muscles, who had received repeated intramuscular injections during childhood and adulthood. The radiographic, including magnetic resonance imaging (MRI), features of the bone and joint abnormalities are presented. Some literatures reported that damage to the structures of the body due to intramuscular injection is related to the site of injection, age of the patient, and the volume, pH, chemical composition, and diffusional capacity of the injectate. Our patient had muscular contracture induced by needle injection regardless of her age, medication and injection site.     

Ossification of the discoid meniscus: A case report

Meniscal ossification, or bone formation within the substance of the meniscus, is a rare entity. Magnetic resonance imaging allows the unequivocal diagnosis of a meniscal ossification. We aimed to present a case of discoid meniscal ossification, which is quite rare, with the emphasis on imaging findings.     

小细胞型肝细胞癌MR影像诊断1例

患者男,36岁。体检时发现肝脏病变。查体：一般状况尚可,否认肝炎病史。实验室检查：Hb164g／L。RBC5．36×10^12／L;     

Proximal ulna stress fracture and stress reaction of the proximal radius associated with the use of crutches: a case report and literature review

We report a case of complete stress fracture of the ulna and stress reaction of the radius resulting from the use of crutches in an overweight patient with severe lower extremity arthritis. Plain radiograph showed an undisplaced complete fracture of the proximal metaphysis of the ulna. Magnetic resonance imaging (MRI) was performed to exclude a pathological cause in view of the unusual fracture site, which confirmed the plain radiographic findings and additionally demonstrated a stress reaction in the proximal radius. There are three cases of stress fracture of the ulnar diaphysis resulting from the use of crutches reported previously in the English literature and a further case of bilaterally symmetrical ulnar diaphysial fracture reported in the Danish literature. We report the first case of ulnar metaphysis stress fracture with concomitant stress reaction of the radius.     

Proximal ulna fractures in adults: A review of diagnosis and management

Proximal ulna fractures are relatively common upper limb injuries, which may represent fragility fractures or result from high-energy trauma. These include fractures of the olecranon, coronoid and associated radial head dislocations. A wide variety of treatment options are available for the management of these injuries that makes the selection of most appropriate treatment difficult. We aim to provide a brief overview of the treatment options for such injuries.     

Vertical fracture of the odontoid process. A case report

Odontoid process fractures are commonly classified as types I through III according to the Anderson & D'Alonzo scheme. A fourth type of fracture not included in this classification has been described as "vertical odontoid fracture". These fractures are located in the vertical plan of the dens. We describe a new case of an oblique coronally oriented fracture through the odontoid process with extension to the body of C2. Our patient is a 22-year-old lady who sustained a road traffic accident with head, facial and cervical trauma. Computed tomography with 2D and 3D reconstruction characterized the fracture. We suppose that the mechanism of injury was an axial load associated with dorsal to ventral force. The patient was placed on a halo-vest for 12 weeks with good healing and no evidence of instability on flexion-extension studies 6 months later. This case demonstrates that the odontoid and C2 vertebral body fractures belong to the same spectrum and are determined by the patient's anatomy and the mechanism of the injury.     

Chondroid chordoma of the L5 spinous process and lamina: a case report

Chordoma is a rare bone tumor that originates from the remnants of the notochord. These tumors have axial distribution particularly at the upper and lower ends of the vertebral column. This paper reports a rare occurrence of a chordoma in the posterior elements of the L5 vertebra. A differential diagnosis of a benign tumor (giant cell tumor, aneurysmal bone cyst or osteoblastoma) was made initially. Other differential diagnoses included plasmacytoma and metastasis. The tumor was removed enbloc. Histopathological examination revealed the tumor mass to be chordoma. There were no clinical or radiological signs of recurrence at 21 months follow-up. Chordomas are tumors of the axial skeleton. However, they may occur in unusual sites in ectopic notochordal tissue. The case is being presented for its unusual site of occurrence.     

成人幕上原始神经外胚层肿瘤1例

<正>患者男,28岁,15天前无明显诱因出现头痛、头晕,间断恶心、呕吐,就诊于当地医院,诊疗不详,症状未缓解,头颅CT示左侧额叶占位性病变,建议转上级医院手术治疗,遂来我院。MRI表现:左侧额叶可见团块状囊实性混杂低T1混杂高T2信号(图1A、1B),FLAIR序列呈混杂信号,DWI(b=1 000s/mm~2)呈高信号,病灶周围可见片状稍低T1高T2信号,相邻脑组织及双侧侧脑室前角受压推移,中线向右偏移。     

Intramedullary tuberculoma of the conus: a case report

Tuberculomas of the spinal cord are rare. The objective of this study was to illustrate the diagnosis and treatment of tuberculomas of the conus medullaris. They must be suspected in patients with a clinical context and a typical spinal cord mass lesion. Treatment is primarily medical. Surgery is reserved for cases of rapid neurological deterioration or doubts concerning the diagnosis. We report a case of intramedullary tuberculoma of the conus in a 27-year-old woman with paresthesias and weakness of the lower limbs who had been treated for pulmonary tuberculosis. The spinal MR showed a characteristic intramedullary ring-enhancing lesion. She improved neurologically one month after the beginning of the antituberculous drugs and a laminectomy. Seven months later, the patient is asymptomatic and the lesion has nearly completely disappeared completely.     

Recurrent idiopathic epidural hematoma: a case report

Spinal epidural hematoma is a relatively rare condition in children. We report the case of a 6-year-old girl who presented to a regional hospital with the complaints of severe thoracic back pain, neck stiffness, and gait disturbance of sudden onset. Clinical examination revealed no obvious cause for the symptoms. Spinal magnetic resonance imaging (MRI) revealed the presence of an epidural mass lesion extending from T1 to T3, compressing the spinal cord; the findings suggested a diagnosis of idiopathic spinal epidural hematoma. Twelve days after admission, the patient was transferred to our hospital for further observation. Blood tests, including a coagulation profile, were normal. At 22 days after the initial presentation, repeat MRI revealed resolution of the hematoma, with the mass showing an appreciable decrease in size. The patient became symptom-free and was walking normally at the time of discharge 28 days after her initial presentation. At 59 days after the initial presentation, she was readmitted with complaints of a sudden recurrence of back pain and weakness of both legs. Repeat MRI at this time revealed reappearance of the spinal epidural hematoma at the same level. Operative evacuation of the hematoma was performed 3 days after the diagnosis of the recurrence, with laminoplasty from T1 to T3. At a clinical review conducted 30 months after the operation, the patient remained symptom-free. Idiopathic resolution of a spinal epidural hematoma has previously been reported in 36 patients. However, we found no record in the literature of any case in which an epidural hematoma recurred following earlier MRI-confirmed idiopathic resolution.     

A split cord malformation with paresis of the unilateral lower limb: case report

BACKGROUND

We report a rare case of split cord malformation.

CASE DESCRIPTION

A female neonate presented with split cord malformation (SCM) manifesting as right lower limb paresis. Myelomeningocele and meningocele were found in the lumbosacral region at birth. Magnetic resonance imaging (MRI) demonstrated division of the spinal cord into two hemicords below the T5 level. The right hemicord formed a hemimyelomeningocele and the left hemicord terminated in the low-lying conus. Three-dimensional computed tomography (3D CT) showed extensive vertebral body abnormalities. The hemimyelomeningocele was repaired 1 day after birth, and septectomy and the repair of the meningocele were performed when the patient was 1 year old. The patient has been followed up as an outpatient, and has residual right lower limb paresis.

CONCLUSION

SCM can be associated with multiple spinal abnormalities. MRI and 3D-CT are useful for identifying such abnormalities and planning the surgical treatment.     

A historical report on Riccardo Galeazzi and the management of Galeazzi fractures

Fracture of the shaft of the radius associated with a dislocation of the distal radioulnar joint is an uncommon injury. In 1934, Riccardo Galeazzi of Milan reported his experience with the management of 18 such cases before the Lombard Surgical Society and subsequently received the eponym for this injury. Galeazzi was one of Italy's pioneering orthopedic surgeons, with an extensive bibliography that included nearly 150 publications. This article examines the evolution of management of the Galeazzi fracture and sheds light on this notable physician's life.     

骨骼系统多发罗道病1例

患者,男,50岁,左大腿近端酸胀不适感1个月入院。患者自诉1个月前无明显诱因出现左大腿近端酸胀不适,行走后症状加重。查体:左大腿上部轻度深压痛,无局部红肿及下肢麻木感,Feber及Thomas征阴性。实验室检查:血常规、尿     

An attempt to treat Hoffa fractures under arthroscopy: A case report

We treated a 15-year-old female patient with fracture of the post-lateral femoral condyle and the bone shifted in front of the knee. Considering that the traditional surgical approach has the shortcomings of significant trauma and poor prognosis, we designed an arthroscopic procedure, which achieved satisfactory short-term efficacy, effectively reduced and fixed the fractures, avoided damage to vascular nerves, and maximally reduced the trauma caused by surgery itself.     

胸腰椎骨折后部韧带复合体损伤中MRI诊断价值的探讨

目的 评估MRI对诊断胸腰椎骨折患者后部韧带复合体损伤的可靠性. 方法 95例胸腰椎骨折患者,术前进行棘突间隙触诊、X线片、MRI检查,其中MRI检查在传统的成像基础上,加做矢状12抑脂序列.采用后入路手术,手术中仔细检查后部韧带复合体损伤情况. 结果 触诊棘突间隙增宽41例,X线片55例,MRI发现韧带复合体损伤85例,其中棘上韧带损伤85例,棘间韧带损伤83例,黄韧带损伤26例;手术发现棘上韧带损伤82例,棘间韧带损伤80例,黄韧带损伤20例.触诊与手术所见无相关性,X线片诊断、MRI诊断与手术所见有明显相关性. 结论 MRI矢状,12抑脂序列是评估后部韧带复合体损伤的高敏感度和准确度的检查方法,可推荐为诊断胸腰椎骨折后部韧带复合体损伤的常规检查方法.