The evalaution of the foot core system in individuals with plantar heel pain

ObjectiveTo compare foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance, and abductor hallucis morphology in individuals with and without plantar heel pain (PHP).DesignCross-Sectional.SettingLaboratory.ParticipantsSixteen individuals with PHP and sixteen matched healthy participants.Main outcome measuresStatic foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance and abductor hallucis morphology were evaluated. Foot posture was assessed with the Foot Posture Index-6. Abductor hallucis morphology and plantar fascia thickness were measured utilizing diagnostic ultrasound. Plantar foot sensation was assessed at the head of the first metatarsal and medial longitudinal arch using Semmes-Weinstein Monofilaments. Intrinsic foot muscle performance was assessed using the intrinsic foot muscle test (IFMT). Mann-Whitney U and independent t-tests were used to examine between group differences.ResultsIndividuals with PHP exhibited a more pronated foot posture and greater plantar fascia thickness at the proximal insertion compared to healthy controls. Plantar sensation thresholds were higher in the PHP compared to healthy controls at the head of the first metatarsal. There were no group differences in abductor hallucis morphology or IFMT performance.ConclusionsIndividuals with PHP exhibited a more pronated foot posture, thicker plantar fascia, and diminished plantar tactile sensation.     

放射性核素骨显像在腰腿痛患者中的应用价值

目的:探讨放射性核素全身骨显像在腰腿痛患者中的应用价值。方法:对我院以腰腿痛为主要症状、X线、CT检查结果完整的患者417例进行了全身骨显像,并按患者有无肿瘤病史将其分为两组,其中肿瘤病史组165例,非肿瘤病史组252例。分别观察了核素骨显像在这两组患者中的应用情况。结果:肿瘤病史组165例检出肿瘤骨转移68例,占39.4%,非肿瘤病史组252例检出肿瘤骨转移28例,占11.1%。核素骨显像对椎体退行性变、椎间盘突出、椎管狭窄等常导致腰腿痛的疾病没有特异性图像表现。结论:对有肿瘤病史的腰腿痛患者应首选核素全身骨显像检查。对于无肿瘤病史的腰腿痛患者,只对查不出确切病因或对症治疗无效的患者,加做全身骨显像以排除有无肿瘤骨转移。     

A heel cup improves the function of the heel pad in Sever's injury: effects on heel pad thickness, peak pressure and pain

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. Treating Sever's injury with insoles is often proposed as a part of a traditional mix of recommendations. Using a custom-molded rigid heel cup with a brim enclosing the heel pad resulted in effective pain relief without reducing the physical activity level in our previous two studies. The purpose of this study was to assess the effect of the heel cup on heel pad thickness and heel peak pressure (n=50). The difference in heel pad thickness and in heel peak pressure using a sports shoe without and with a heel cup was compared. With the heel cup the heel pad thickness improved significantly and the heel peak pressure was significantly reduced. These effects correlated with a significant reduction in pain when using the heel cup in a sports shoe, compared with using a sports shoe without the heel cup. A heel cup, providing an effective heel pad support in the sports shoe, improved the heel pad thickness and reduced heel peak pressure in Sever's injury with corresponding pain relief.     

Three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses

The three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses (UHPs) has not previously been elucidated. We evaluated 28 patients with complicated UHPs who had undergone total hip arthroplasty a very long time previously (range 3–20 years, mean 8.4). All the patients were surgically reviewed: 26 UHPs were found to be loosened and two infected. Nine asymptomatic UHPs were taken as controls. The dynamic phase was invariably negative in both loosened and asymptomatic UHPs while markedly positive in the infected ones. The blood pool phase was positive to various degrees in 16 of the 26 loosened UHPs as well as in the infected UHPs, but was invariably negative in painless replacements. In the bone phase, areas of significantly (discrete to marked) increased uptake were observed in all the loosened prostheses as well as in two-thirds of the asymptomatic ones. However, the regions of the lesser trochanter and/or tip and/or shaft were involved exclusively in the case of the loosened UHPs, and diffuse periprosthetic uptake was found only with loosened or infected implants. Areas of slight methylene diphosphonate (MDP) uptake were found at every periprosthetic site and areas of discrete to marked MDP uptake were commonly found in the acetabulum and/or the greater trochanter with both loosened and painless prostheses and are thus considered to be nonspecific findings.     

125I粒子植入术治疗转移性骨痛的临床应用

目的 初步探讨放射性粒子植入术治疗骨转移瘤所致骨痛的疗效.方法 诊治52例骨转移瘤患者,在CT引导下行125I放射性粒子植入治疗.结果 125I放射性粒子植入后,第2天患者疼痛感明显减轻;第5～7天患者胀痛感加重;术后10～ 30 d患者疼痛逐渐缓解.术后1个月疗效评估:Ⅰ级疼痛缓解率100％,Ⅱ级疼痛缓解率88.9％,Ⅲ级疼痛缓解率92.3％,总有效率93.7％ (P＜0.05).对不同疼痛程度患者局部疼痛缓解有效率高,但Ⅱ、Ⅲ级疼痛缓解率无明显差异(P=0.369).结论 125I放射性粒子植入治疗骨转移瘤所致骨痛,治疗时间短、短期内缓解疼痛疗效明显且并发症少.特别对于溶骨型骨转移瘤,其治疗效果较好,在临床保守治疗疼痛控制不理想时,125I放射性粒子植入可作为一种有效的治疗方法.     

Thallium-201 scintigraphy in bone and soft-tissue tumors: a comparison of dynamic, early and delayed scans

OBJECTIVE: It has been reported that delayed scan of thallium-201 (201Tl) scintigraphy is useful for differentiating malignant tumors from benign lesions and for evaluating treatment response. However, physiological muscle uptake which usually increases in delayed scans, often makes it difficult to evaluate 201Tl uptake and its washout in bone and soft-tissue tumors. The purpose of this study was to evaluate whether the delayed scan is necessary and whether a dynamic scan is useful in the evaluation of bone and soft-tissue tumors. METHODS: We studied 175 cases of bone and soft-tissue tumors (malignant 45, benign 130). Dynamic scans were acquired every 5 seconds for 10 minutes after 201Tl injection, and time activity curves (TACs) were generated by adaptive smoothing methods. Early and delayed scans were acquired at 10-15 minutes and 2 hours after injection. 201Tl images were visually interpreted and the radioactivity count ratio (T/N) of tumors to normal tissues and washout rate [WR = (early T/N - delayed T/N)/early T/N] were defined. RESULTS: When there were no 201Tl uptake in dynamic (n = 67) and early scans (n = 68), no tumor uptake was also appreciated in delayed scans, and all but two cases of negative scans were benign. In 107 lesions, although there were significant differences in T/Ns between malignant and benign lesions both on early scans (2.84 +/- 1.45 vs. 2.05 +/- 1.13, p < 0.05) and delayed scans (2.17 +/- 1.03 vs. 1.58 +/- 0.64, p < 0.05), there was a substantial overlap. The T/Ns decreased in delayed scans (i.e., WR > 0) in 100 of 107 cases due to increase of surrounding muscle uptake, and there was no difference in WR between malignant tumors and benign lesions (0.21 +/- 0.14 vs. 0.19 +/- 0.14). CONCLUSIONS: For evaluating bone and soft-tissue tumors, delayed scan had little clinical usefulness and it may be time consuming. Dynamic scan would be useful for demonstrating the differences between tumor blood flow and 201Tl uptake in tumors.     

用于骨痛治疗的放射性核素

介绍了用于骨疼痛治疗的放射性核素89Sr、153Sm、186Re、188Re和117Snm,评述了这些核素的生产以及在骨疼痛治疗中的应用,并对每个核素的优缺点进行了讨论。     

放射性核素治疗癌转移性骨痛

癌性骨转移原发病灶常见于前列腺癌、乳腺癌、肺癌等,转移发生的病理生理机制、疼痛机制目前不十分明确。止痛治疗尤其是对广泛骨转移性疼痛的治疗是临床医师面对的主要挑战,放射性核素及其标记药物治疗是一种有效、价廉、不良反应较小的治疗方法,对广泛转移的止痛治疗及微转移患者的治疗独具优势,目前有待充分利用。     

帕米膦酸二钠治疗癌症骨转移性疼痛疗效观察

目的：观察帕米膦酸二钠治疗转移性骨肿瘤疼痛的比较。方法：对32例癌症骨转移痛患者给予帕米膦酸二钠45mg/d,静脉滴注,连用2 d后停用26 d,28 d为1周期,连续4周期。结果：止痛显效13例（40.6%）,有效14例（43.8%）,无效5例（15.6%）,总有效率84.4%。结论：帕米膦酸二钠治疗癌症骨转移性疼痛的疗效肯定。     

云克(99Tc-MDP)治疗恶性肿瘤转移性骨痛近期疗效观察

目的:目的:通过云克(99Tc—MDP)治疗38例恶性肿瘤多发性骨转移疼痛患者1-8周骨痛变化分析,观察云克治疗转移性骨痛近期疗效。方法:云克100mg/d加入250ml生理盐水静滴,5d一疗程,共用3疗程。结果:一周CR3例,PR10例,MR16例,76.3%(29/38)患者起效,2-3周CR达50%,8周总有效率81.57%。结论:云克治疗恶性肿瘤转移性骨痛具有疗效好、见效快、毒副作用小、尤适用于开展核素内照射不便的边远地区。     

Role of technetium-99m planar bone scanning in the evaluation of low back pain

The records of 1018 patients with low back pain in a tertiary spine referral practice were reviewed. One hundred thirty-nine out of 1018 (13.6%) underwent technetium-99m planar bone scanning as part of their investigation. Seventy-three out of 139 scans (52%) showed increased uptake in some area, but only 27 out of 139 (19.4%) showed increased uptake specifically in the low back. Scans consistently yielded no findings with reference to the back when the prescan diagnosis was spinal stenosis, lumbar pain syndrome, herniated nucleus pulposus, or postlaminectomy syndrome. Some scans gave positive findings in patients with a diagnosis of degenerative disc disease, pseudarthrosis, spondylolisthesis, fracture, infection, metabolic disorder, or tumor. Positive scans were generally obtained early after presentation (within 3 months) and negative scans obtained later (after 6 months), suggesting that clinical suspicion is still the main indication for early scanning. Planar bone scanning was helpful in both diagnosis and therapeutic decisionmaking in many conditions.     

Imaging of pelvic rhabdomyosarcoma by bone scintigraphy

Urinary tract distortion caused by pelvic rhabdomyosarcoma was imaged during ^99mTc-oxidronate bone scintigraphy for suspected metastatic disease. This appearance correlated well with the anatomy defined on other imaging modalities. Bone scanning also proved valuable in detecting an otherwise occult osseous metastasis from this unusual tumor.     

The role of bone scintigraphy in osteogenic sarcoma

Hospital records of 27 children with osteogenic sarcoma were reviewed in an effort to define the usefulness of skeletal scintigraphy in the initial evaluation and follow-up of their disease. Serial bone scans as well as plain radiographs, linear tomograms, and computed tomograms were evaluated for evidence of bone or lung metastases. Eighteen patients developed lung metastases and three developed bone metastases. Seven patients demonstrated uptake of tracer in lung metastases, however, the lesions were all easily identifiable by radiographic means. All bone metastases were detected by scintigraphy, in one instance prior to radiographic abnormality. In no cases were bone metastases known to occur in the absence of lung metastases. None of the bone scans performed for routine follow-up pruposes resulted in altered therapy for the patient. We propose that skeletal scintigraphy is useful in the initial metastatic work up of osteogenic sarcoma, and may be helpful in some patients with specific indications during their follow-up, but is less valuable when there is no clinical suspicion for bone metastases.     

The role of bone scintigraphy in treatment planning, and predicting pain relief after kyphoplasty

BACKGROUND: The role of whole-body Tc-MDP bone scanning in the management of vertebral compression fractures with kyphoplasty has not been clearly established. OBJECTIVE: To determine the accuracy of bone scanning in patient selection, planning treatment and predicting response to kyphoplasty. METHODS: Retrospective chart reviews were undertaken of all kyphoplasties performed by the same orthopaedic surgeon between June 2000 and June 2004. All patients who underwent plain radiographs (X-ray) of the spine and bone scanning within 4 weeks of treatment were included. Response to treatment was assessed via a questionnaire administered to the patient 3 weeks after intervention and concomitant objective assessment. Response was graded as excellent, intermediate or poor. Each bone scan was reviewed by two nuclear physicians blinded to the initial scan results, level of treatment and therapeutic response. The readers were asked to indicate the level(s) to be treated according to the bone scan findings. Sites of chronic fractures were also recorded. RESULTS: Sixty-six procedures on 60 patients fulfilled the selection criteria. Fifty-three patients were managed by X-ray and bone scanning (A) and seven were managed by X-ray only (B). There was a significant difference in the rates of sub-optimal results between (A) and (B) (11/53 vs. 7/7, P=0.0001). There was also a significant difference in chronic fracture rates between patients with excellent outcome and those with sub-optimal results (3/42 vs. 7/11, P=0.0002). A high rate of incorrect level selection (3/7) was found in (B). In 12 patients (20%) X-ray showed multiple fractures but the bone scanning demonstrated only one level of acute disease. CONCLUSIONS: Bone scanning is an excellent predictor of response to kyphoplasty and decreases the number of vertebrae to be treated as suggested by X-ray. Preoperative bone scanning is recommended to avoid incorrect selection of treatment level. Even when the appropriate level has been selected an incomplete response can be expected if additional chronic fracture is seen on bone scanning. In the event of unexpected incomplete response, re-evaluation with bone scanning may demonstrate new disease amenable to therapy.     

鞘内注射ETAR拮抗药对大鼠骨癌疼痛改善情况及其对ERK通路的影响

 目的 观察鞘内注射内皮素A受体(ETAR)拮抗药对大鼠骨癌疼痛(BCP)改善作用及其对细胞外调节蛋白激酶(ERK)通路的影响。方法 取60只大鼠均进行鞘内置管,随机分为假手术(sham)组、假手术+ETAR拮抗药(sham+BQ123)组、骨癌痛(BCP)组、骨癌痛+ETAR拮抗药(BCP+BQ123)组。BCP组、BCP+BQ123组采用股骨远端骨髓腔内接种Walker256细胞法建立BCP大鼠模型,sham组、sham+NS同法注射等量生理盐水。建模成功大鼠于建模第14 天,BCP+BQ123组和sham+BQ123组各14只,鞘内注射7 μl BQ123;BCP组13只、sham组14只鞘内注射等量生理盐水。鞘内注射前即刻、注射后0.5、1.0、1.5、2.0、2.5、3.0 h分别评估各组大鼠疼痛行为学:机械性缩足反射阈值(PWT)、自发抬足次数(NSF);末次评估疼痛行为学后,影像学评估各组骨质破坏情况;RT-qPCR、Western blot法检测脊髓组织中内皮素1(ET1)、ETAR、ERK1/2 mRNA和蛋白表达量及p-ERK1/2蛋白表达量。结果 与sham组、sham+BQ123组比较,注射前BCP组、BCP+BQ123组的PWT降低和NSF增多(P<0.05),鞘内注射后T0.5~3.0 h期间,BCP组的PWT和NSF均保持不变,而BCP+BQ123组的PWT先升高后降低,NSF先减少后增多,PWT和NSF均于1.5 h达到最高和最少,3.0 h恢复至注射前水平。胫骨骨质X线片显示,sham组和sham+BQ123组胫骨骨质密度均匀、骨皮质连续无缺失;BCP组注射后14 d出现大范围骨破坏、骨皮质缺损严重;BCP+BQ123组股骨远端见较小骨破坏病灶,部分皮质缺损。与sham组、sham+BQ123组比较,BCP组、BCP+BQ123组脊髓ET1、ETAR mRNA和蛋白及p-ERK1/2蛋白相对表达量均升高,且BCP+BQ123组低于BCP组,差异有统计学意义(P<0.05)。结论 BCP疼痛反应与脊髓ET-1及ETAR有关,鞘内注射ETAR拮抗药可有效减轻BCP大鼠的疼痛反应,可能通过抑制脊髓ERK通路发挥调控作用。     

The role of radionuclide bone scintigraphy in fibrous dysplasia of bone

PURPOSE: The purpose of this study was to study the characteristics of fibrous dysplasia (FD) of bone on bone scans and to evaluate the diagnostic value of radionuclide bone scans in FD. METHODS: Radionuclide bone scans were performed in 42 cases of histopathologically proven FD and the results were compared with other imaging modalities. A retrospective study method was used to analyze the imaging results. RESULTS: Although FD showed nonspecific increased 99m-Tc MDP uptake, its appearance is different than bone metastates and other bone diseases. Combining scans with x-rays and other imaging modalities can improve the diagnostic accuracy of this disease. CONCLUSIONS: Radionuclide bone scans are of certain value in the diagnosis of FD. The diagnostic specificity of FD with radionuclide bone scanning can be improved in association with other imaging modalities such as x-rays.     

骨转移癌痛的立体定向放射治疗

目的评价立体定向大剂量少分次放射治疗骨转移癌痛的临床疗效。方法采用深圳奥沃公司生产的OUR-QGD型立体定向伽玛射线体部治疗系统(简称体部伽玛刀)治疗156例骨转移癌痛患者,用50%等剂量曲线覆盖整个靶区,单次周边剂量给予7.5～10Gy,周边总剂量控制在30Gy,分割3～4次,1周内完成治疗总剂量控制在30Gy,分割3～4次,1周内完成治疗。结果 156例患者治疗后疼痛症状完全缓解110例(70.51%)、部分缓解43例(27.56%),总有效率为98.08%。治疗后随访时间2～20个月,疼痛的中位缓解时间为12.6个月。结论立体定向大剂量少分次放射治疗骨转移癌痛,疗效满意,治疗时间短,止痛起效快,缓解时间长,复发率低,是一种安全、有效的止痛方法。