侧后方入路钢板内固定治疗胫骨平台后髁骨折

目的探讨侧后方入路钢板内固定治疗胫骨平台后髁骨折疗效。方法对14例胫骨平台后髁骨折采用后内侧或后外侧入路切开复位钢板内固定治疗,观察其疗效。结果 14例随访12～24个月(平均15.2月),优10例,良3例,可1例。结论采用侧后方入路可充分暴露胫骨后平台后髁,直视下方便复位,结合钢板支撑内固定是治疗胫骨平台后髁骨折的一种有效方法。     

3D打印辅助改良前外侧双肌间隙入路治疗后外侧柱胫骨平台骨折

目的 探讨3D打印辅助改良前外侧双肌间隙入路复位内固定治疗累及后外侧柱胫骨平台骨折的临床疗效.方法 回顾性分析2018年2月—2020年2月新疆医科大学第一附属医院骨科收治的累及后外侧柱胫骨平台骨折患者21例,男性14例,女性7例;年龄27～65岁,平均41.6岁.道路交通伤13例,高处坠落伤7例,其他伤1例.均采用术前3D打印技术辅助改良前外侧双肌间隙入路,术前根据后外侧主要骨折块的压缩、大小、方位,在直视下复位骨块并充分植骨,胫骨平台外侧锁定钢板于腓骨头上方尽量偏后放置固定后外侧骨块.采用Rasmussen放射学评分评估胫骨平台骨折复位情况;采用Rasmussen膝关节功能及Lachman试验评价膝关节功能及稳定性.结果 手术时间55～95min,平均72.7min;术中出血量50～125mL,平均75.5mL.随访时间12～36个月,平均17.6个月.无严重神经、血管损伤及术区感染、膝关节活动受限等并发症发生.骨折均获骨性愈合,愈合时间10～15周,平均12.4周.术后1年随访时未见明显角度丢失及关节面的再次塌陷.术后Rasmussen放射学评分12～18分,平均16.3分,其中优15例,良6例,优良率100％.膝关节总伸屈度110°～150°,平均128.6°.末次随访时根据Rasmussen膝关节功能评分评定疗效:优13例,良8例,优良率100％.Lachman试验均为阴性.结论 3D打印辅助下改良前外侧双肌间隙入路复位内固定治疗累及后外侧柱胫骨平台骨折是一种可供优先选择的方法.     

后内侧入路治疗胫骨平台后内侧劈裂骨折

目的 探讨经后内侧入路治疗胫骨平台后内侧劈裂骨折的手术方法和临床疗效.方法 回顾性分析2006年1月-2011年11月经后内侧入路治疗的胫骨平台后内侧劈裂骨折患者36例,其中男23例,女13例;年龄21～70岁,平均40.1岁.致伤原因:交通伤19例,高处坠落伤10例,平地跌伤5例,运动伤2例.均为新鲜闭合性骨折,受伤至手术时间2～16d.骨折CT分型:后内侧劈裂骨折11例,后内侧劈裂及后外侧塌陷骨折25例.术前评估包括膝关节正、侧位X线片和CT扫描及三维重建,所有患者均采用后内侧入路治疗. 结果 36例均获随访12～32个月,平均17.5个月.无切口感染和皮肤坏死,无内固定松动及断裂,无骨不愈合,无膝关节内、外翻畸形和骨折再移位.1例术后出现小腿内下方感觉麻木,经甲钴胺营养神经对症治疗3个月后完全恢复.后内侧骨折均达解剖复位.术后根据Rasmussen膝关节功能评价:优21例,良13例,可2例,优良率为94％. 结论 后内侧入路具有显露直接、充分,软组织损伤少,不涉及重要血管神经等优点,是治疗胫骨平台后内侧劈裂骨折的理想方法.     

后外侧入路治疗胫骨平台骨折疗效分析

目的 探讨膝关节后外侧入路手术复位内固定治疗胫骨平台后外侧骨折的临床疗效. 方法 选择2006年1月- 2009年7月采用后外侧入路手术治疗胫骨平台后外侧骨折患者32例,其中男19例,女13例;年龄27 ～ 70岁,平均38.1岁.致伤原因:交通伤19例,高处坠落伤9例,其他伤4例.合并伤:合并前交叉韧带损伤7例,均为胫骨平台止点撕脱. 结果 本组32例均获随访12～36个月,平均18.2个月.骨折全部愈合,无切口感染,无内固定松动或断裂,无膝关节内、外翻畸形或骨折再移位.1例患者术后出现腓总神经牵拉伤,用甲钴胺片保守治疗2个月后恢复.术后根据Rasmussen膝关节功能评定评分标准:优19例,良11例,可2例,差0例,优良率为94％. 结论 膝关节后外侧人路手术治疗胫骨平台后外侧骨折,有利于骨折的复位和固定,具有暴露清楚、内固定安放方便、创伤小及临床疗效好等优点.     

Frosch入路治疗后外侧胫骨平台骨折的效果

目的探讨Frosch入路治疗后外侧胫骨平台骨折的效果。方法回顾性分析南京医科大学附属逸夫医院骨科2018年12月—2019年4月收治的后外侧胫骨平台骨折8例,男性6例,女性2例;年龄28~57岁,平均39.3岁;摔伤3例,道路交通伤5例。采用外侧Frosch入路治疗,骨折复位固定,对骨折复位丢失、骨折愈合、功能恢复进行半年以上随访观察。结果8例患者均得到直视下复位,6例采用后外侧钢板固定,骨折愈合顺利,无复位丢失,无感染和神经损伤。2例因骨折线纵裂,超过胫前动脉分叉处,未能从后外侧固定。功能恢复按Rasmussen膝关节功能评分标准进行,优6例(评分>27分),良1例(26~20分),中1例(19~10分),优良率87.5%。结论采用外侧Frosch入路可以直视观察,有效复位骨折,确切固定,预防术后复位丢失,促进愈合,恢复功能,适合用于胫骨平台后外侧柱骨折。     

胫骨平台后外侧髁骨折手术治疗的改良方法及临床应用

目的 探讨胫骨平台后外侧髁骨折治疗的难点及改良方法的临床优势.方法 回顾性分析2016年3月—2018年8月无锡市惠山区人民医院收治单纯胫骨平台后外侧髁骨折24例,根据治疗方法不同分为改良组和对照组,各12例.改良组男性8例,女性4例;年龄23～66岁,平均48.5岁;对照组男性7例,女性5例;年龄21～68岁,平均47.1岁.改良组采用腓骨头上方入路联合自制环抱支撑解剖钢板进行显露复位固定,对照组采用腓骨头上方入路联合普通L形钢板进行复位固定,术后定期复查,指导膝关节功能锻炼.比较两组相关指标,包括术中出血量、手术时间、骨折愈合时间、未次随访的Rasmussen放射评分、纽约特种外科医院(Hospital for Special Surgery,HSS)功能评分以及术后膝关节功能优良率.结果 术中出血量改良组(42.92±15.44)mL与对照组(51.25±14.64)mL比较差异无统计学意义(P>0.05),改良组与对照组手术时间(51.00±6.80)min vs.(63.58±7.79)min、骨折愈合时间[(10.75±1.48)周vs.(12.75±1.96)周]、末次随访的膝关节Rasmussen评分[(17.08±2.11)分vs.(12.58±4.38)分]和HSS评分[(88.42±7.69)分vs.(74.83±13.27)分]比较,差异有统计学意义(P<0.05).按膝关节HSS评分评定膝关节功能,改良组优10例,良1例,可1例,优良率为91.7％;对照组优4例,良2例,可4例,差2例,优良率为50.0％,两组差异有统计学意义(P<0.05).结论 腓骨头上方入路联合自制环抱支撑解剖钢板治疗胫骨平台后外侧髁骨折,具有简单安全、手术时间短、骨折固定可靠、术后功能恢复满意等优点,是一种值得推广应用的改良方法.     

改良Carlson入路在累及后外侧柱胫骨平台骨折手术治疗中的应用

目的 探讨改良Carlson入路治疗累及后外侧柱胫骨平台骨折中的临床疗效。方法 回顾性分析2017年1月—2019年1月南京中医药大学附属昆山市中医医院关节骨科收治的累及后外侧柱胫骨平台骨折患者37例,男性21例,女性16例;年龄33～77岁,平均50.2岁。道路交通伤19例,骑车摔伤11例,高处坠落伤7例。Schatzker分型：Ⅱ型19例,Ⅲ型7例,Ⅴ型11例。根据罗从风三柱分型：单纯后外侧柱骨折16例,后外侧柱合并外侧柱骨折10例,后外侧柱合并后内侧柱骨折3例,累及后外侧的三柱骨折8例。均采用改良Carlson入路结合T形锁定钢板内固定后外侧柱。术后定期随访,根据胫骨平台内翻角、后倾角及Rasmussen放射评分评价复位质量;特种外科医院（HSS）评分评价膝关节功能;Lachmann试验及轴移试验评价膝关节稳定性。结果 患者均获随访12～18个月,平均13.2个月。术后即刻、3、6和12个月的平台内翻角及后倾角比较差异均无统计学意义（P>0.05）。末次随访时Rasmussen放射评分优7例,良26例,可4例,优良率89%。HSS评分优27例,良8例,可2例,优良率95%。...     

前外侧锁定钢板固定治疗胫骨平台后外侧骨折临床分析

目的对比分析前外侧入路和后外侧入路锁定钢板固定治疗胫骨平台后外侧骨折的临床疗效。方法笔者选取2011年1月~2014年4月收治的胫骨平台后外侧骨折患者80例,分为前外侧入路切开复位内固定组(前外侧组)和后外侧入路切开复位内固定组(后外侧组)。前外侧组40例,Schatzker分型:Ⅳ型9例,Ⅴ型22例,Ⅵ型9例;后外侧组40例,Schatzker分型:Ⅳ型10例,Ⅴ型20例,Ⅵ型10例。对比两组患者手术前后的胫骨平台内翻角(TPA)、后倾角(PA)、膝关节活动度和美国纽约特种外科医院(HSS)评分。同时对比两组患者术后临床疗效。结果两组患者术后的TPA、内侧PA和外侧PA均显著低于术前(P0.05);前外侧组术后的TPA、内侧PA和外侧PA均显著低于后外侧组(P0.05)。两组患者术后的膝关节屈曲度、膝关节伸直度和HSS评分均显著高于治疗前(P0.05);前外侧组术后的膝关节屈曲度、膝关节伸直度和HSS评分均显著高于后外侧组(P0.05)。前外侧组的优良率显著高于后外侧组,χ2=4.0897,P=0.04310.05。结论前外侧入路锁定钢板固定治疗胫骨平台后外侧骨折可以保护后外侧骨折块,取得良好的临床疗效。     

后内侧联合前侧切口入路治疗胫骨平台后髁骨折的临床比较研究

胫骨平台后髁骨折为临床常见的关节内骨折,多因膝关节在屈曲/半屈曲位时,受垂直力、内外翻暴力引起胫骨平台内、外侧髁后1/3部分发生劈裂或压缩骨折。报道显示[1],单纯胫骨平台后髁骨折较少发生,多合并前侧髁骨折,多数医师采用单一切口治疗前后髁合并骨折,但因胫骨平台后髁的独特解剖结构,传统前侧入路无法完美显露该处骨折线,由后侧入路因该处与膝关节后方的解剖关系复杂,也难显露骨折端及复位前髁。因此,选择合适的切口入路,是临床亟待解决的问题。     

胫骨Pilon骨折的外科治疗策略

目的 探讨胫骨Pilon骨折的外科治疗策略. 方法随访我院2005年5月-2008年3月治疗的47例Pilon骨折患者,其中男37例,女10例;年龄23～63岁,平均42.6岁.本组共47例51侧胫骨.致伤原因:交通伤34侧,坠落伤12侧,重物砸伤5侧.开放性骨折7侧,闭合性骨折44侧.根据Ruedi-Allgower分型标准:Ⅰ型6侧,Ⅱ型28侧,Ⅲ型17侧.软组织损伤根据Tscherne-Gotzen分度:开放性骨折1度2侧,2度3侧,3度2侧;闭合性损伤0度2侧,1度27侧,2度15侧.出于对内固定具体的选用,又将胫骨远端分为三柱:前外侧、前内侧及后侧柱.胫骨骨折采用Depuy的"T"形钢板18侧,AO三叶草钢板10侧,短"T"形钢板2侧,锁定钢板2侧,Link的前外侧解剖钢板4侧,Orthofix超踝关节外固定支架合并有限内固定15侧. 结果随访时间为12～44个月,平均23.2个月.踝关节功能按Mazur评分标准:优29侧,良13侧,可7例,差2侧,优良率为82%. 结论根据Ruedi-Allgower分型和软组织Tscherne-Gotzen分度选择手术时机和治疗方案,根据骨折累及胫骨远端三柱的情况选择合适的内固定,术后并发症少,可取得良好、满意的临床疗效.     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Uterine contractions: Possible diagnostic pitfall at MR imaging

A total of 206 nongravid patients with various gynecologic problems underwent pelvic magnetic resonance (MR) examinations that included both sagittal T2-weighted and contrast agent–enhanced T1-weighted images. MR images were retrospectively reviewed to identify changes in endometrial configuration on serial images obtained during the same MR examination. In 20 MR examinations (all in women of reproductive age), endometrial distortion due to myometrial bulging was noted on T2-weighted or contrast-enhanced T1-weighted images. It was absent on other MR images obtained at different times. Myometrial bulging exhibited low signal intensity in 18 examinations. The finding resembled adenomyosis or leiomyoma on T2-weighted or contrast-enhanced T1-weighted images. These results evidence the presence of transient myometrial bulging and transient low-intensity myometrium in the nongravid uterus. This phenomenon is thought to represent uterine contraction. Clinicians should be aware of the potential presence of transient low-signal-intensity myometrial bulging that could present diagnostic problems in the normal uterus.     

Controversies in cervical spine imaging in trauma patients

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to clear the cervical spine in comatose patients.Presented at the Annual Meeting of the American Society of Emergency Radiology, Las Vegas, Nevada, 22–25 October, 2003     

Brodie Abscess: MR imaging appearance in 10 patients

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic “target” appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypoin-tense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.     

Right-side aortic arch with aneurysm of aberrant left subclavian artery: MR imaging appearance.

Reports of aneurysms of the subclavian artery in both normal and anomalous aortic arches have been rare. The authors describe a patient with a right-side aortic arch and an aneurysm of the aberrant left subclavian artery, which, to the authors' knowledge, is a previously unreported association. At presentation, the aneurysm appeared as a calcified left superior mediastinal mass. Magnetic resonance imaging enabled preoperative diagnosis and guided surgical planning.     

Adrenal tissue characterization with 0.5-T MR imaging: Value of T2*-weighted images

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor–liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.     

MR angiography of congenital heart disease: Value of segmented two-dimensional inflow technique and maximum-intensity-projection display

Magnetic resonance (MR) angiography of the cardiovascular system was evaluated in 41 patients with congenital heart disease by using a two-dimensional (2D) inflow technique based on a magnetization-prepared gradient-echo pulse sequence with segmented k-space data acquisition and electrocardiographic gating at 0.5 T. Inversion and saturation prepulses were used to suppress stationary tissue and enhance intravascular signal. Presaturation slabs were applied where certain vascular structures had to be suppressed. Sequence parameters were optimized by evaluating signal intensity and contrast characteristics for various flip angles and inversion and saturation delay times. The heart and intrathoracic vasculature were encompassed with 40–50 overlapping sections. Both 2D angiograms and maximum-intensity-projection images were evaluated. Combining data sets acquired in the sagittal and transverse orientations provided the most satisfactory information about the pulmonary arteries. The highest signal-to-noise ratios were obtained with a flip angle of 65° and short prepulse delay times. Two-dimensional MR angiography can provide useful diagnostic information but requires a thorough understanding of in-plane and hemodynamically induced signal intensity changes.