人工髋关节置换术后常见并发症的X线表现

目的 探讨人工髋关节置换术后常见并发症的X线表现，以期提高对人工髋关节置换术后并发症的早期诊断及病因鉴别诊断能力。方法 回顾性分析46例人工髋关节置换术后由于出现并发症而行翻修术的病例，观察其X线表现，并通过与手术对照以评价X线对并发症的诊断价值。结果 术后诊断股骨柄无菌松动34例，髋臼假体无菌松动13例，X线表现为假体周围≥2mm的轮廓与假体形态一致的透亮带伴或不伴假体移位；感染伴股骨柄和(或)髋臼假体松动4例，X线表现为假体周围≥3mm的轮廓与假体形态不一致的透亮带和(或)假体移位，同时伴有骨质破坏、窦道形成等；股骨头脱位6例，X线2例表现为股骨头位于髋臼外，2例表现为股骨头中心型移位，2例表现为股骨头在髋臼假体内不对称。结论 透亮带和假体移位是松动最重要的X线表现，透亮带的形态和窦道的形成有助于鉴别感染性和无菌性松动。髋臼内股骨头位置的不对称或股骨头完全位于髋臼外为股骨头半脱位或脱位的表现。     

全髋置换术后常见并发症的X线诊断及评价

目的 探讨全髋关节置换术后常见并发症的X线表现,以提高对全髋关节置换术后并发症的诊断水平,评价X线诊断价值.方法 分析76例全髋关节置换术后出现并发症的病例,观察其X线表现,评价X线对并发症的诊断价值.结果 股骨柄无菌松动49例,髋臼假体无菌松动14例,X线表现为假体周围轮廓与假体形态一致的透亮带伴或不伴假体移位;感染伴股骨柄假体松动3例,X线表现为假体周围轮廓与假体形态不一致的透亮带和(或)假体移位,同时伴有骨质破坏;股骨头脱位11 例,X线10例表现为股骨头位于髋臼外,1例表现为股骨头在髋臼假体内不对称.结论 X线平片检查是全髋关节置换术后并发症诊断和随访的重要方法.全髋置换术后并发症以假体松动最常见.     

全髋置换术后首次X线平片在评估假体稳定性中的临床价值

目的研究全髋置换术后首次X线平片在评估假体稳定性中的临床价值。方法初次全髋置换术患者53例,观测术后首次术侧髋关节正位片中假体周围骨质情况、人工髋臼的前倾角和外展角、假体柄位置;与其后1 a内复查片对比,观察假体的变化。结果术后1 a内发生假体不稳定共6髋,其中脱位3髋,假体周围骨折1髋,假体与骨界面之间出现连续宽度大于等于2 mm的透亮线2髋。术后首次X线平片中的假体周围骨质情况、人工髋臼的前倾角和外展角、假体柄位置均与假体稳定性的判断密切相关,P<0.05。结论全髋关节置换术后首次X线平片能预测短期内发生假体不稳定的风险,具有重要的临床价值。     

三维CT全髋关节置换术后远期临床效果评价

目的利用三维CT技术评价全髋关节置换术后远期临床效果。方法选取18例全髋关节置换术患者,跟踪随访2～4年,通过三维CT影像技术,对人工假体磨损、移位及周围骨溶解情况进行分析。结果 18例全髋关节置换术患者术后2年假体功能良好(Harris评分85.4),髋臼杯移位程度较小,磨损情况较轻(0.17±0.05)mm。结论三维CT技术与传统X线方法相比精密度高、重现性好,适用于全髋关节置换术术前及远期临床效果的评价。     

人工全髋关节置换术X线平片检查的临床意义

目的：探讨人工全髋关节置换术后X线影像学检查的临床价值。方法：回顾26例人工全髋关节置换术后X线影像学表现，并结合文献加以分析。结果：本组26例近期（3个月内）观察其人工全髋关节位置、形态正常．远期疗效正进一步观察中。文献报告，术后可出现股骨柄无菌松动和饿髋臼假体无菌松动；感染伴股骨柄和髋臼假体松动；可伴有骨质破坏、窦道形成等影像学改变。结论：X线平片检查简单易行，是观察人工全髋关节置换术后最为常用和有效的检查方法。     

骨水泥叠加技术在髋关节置换术后股骨假体周围骨折中的应用

目的探讨骨水泥型假体人工髋关节置换术后发生股骨假体周围骨折的有效治疗方法。方法对2009年3月-2013年2月15例行骨水泥型假体人工髋关节置换术后发生股骨假体周围骨折患者均采取骨折复位内固定．骨水泥叠加技术固定假体;骨折发生时间为髋关节置换术后10d～3年,按Vancouver骨折分型：B2型11例,B3型4例。术后6个月对髋关节功能进行Harris评分,观察术后疗效。结果15例患者均获得随访,术后X线片检查骨折均愈合良好,假体稳定,位置安放合适;无感染、无内固定物及关节假体移位、断裂发生。髋关节功能Harris平均83分（76～87分）。结论骨水泥叠加技术是骨水泥型假体人工髋关节置换术后发生股骨假体周围骨折的有效治疗方法。     

X线、CT及MRI对髋关节置换术后并发症的诊断价值

目的:探讨髋关节置换术后常见并发症的X线、CT及MR表现,评价三者的诊断价值。方法:回顾性分析44例髋关节置换术后出现并发症行翻修术的病例,观察其X线、CT及MRI表现,并与手术及病理结果对照,统计分析三者诊断无菌性松动、骨溶解及感染的敏感性与特异性,以及三者诊断准确性。结果:44例患者术后并发症包括无菌性松动、骨溶解、感染、假瘤及假体周围骨折。X线、CT及MRI诊断无菌性松动的敏感度分别为84%、78%、80%,特异度分别为76%、81%、94%;诊断骨溶解的敏感度分别为73%、86%、78%,特异度分别为88%,100%,86%;诊断感染的敏感度分别是50%、60%、100%,特异度分别为72%、74%、100%。三者诊断假体无菌性松动及骨溶解的准确性无明显统计学差异(P>0.05),在诊断假体周围感染的准确性方面,X线和CT二者间无明显统计学差异(P>0.05),但都明显低于MRI(P<0.05)。结论:在髋关节置换术后并发症的诊断方面,X线、CT及MRI互为补充,但其中MRI是观察假体周围感染的最佳手段。     

全髋关节置换术后股骨假体周围骨折的治疗

目的探讨人工全髋关节置换术后发生股骨假体周围骨折的原因和治疗方法。方法2002～2008年第三军医大学大坪医院骨科共收治人工全髋关节置换术后股骨假体周围骨折16例。骨折发生时间为全髋关节置换术后3个月～5年,按Vancouver骨折分型为:A型2例,B1型6例,B2型3例,B3型3例,C型2例。非手术治疗3例,切开复位记忆合金环抱器内固定治疗8例,行长柄假体柄翻修联合记忆合金环抱器固定术2例,骨水泥长柄假体翻修术1例,长柄股骨假体柄翻修联合同种异体皮质骨板、形状记忆合金环环抱器固定术1例,单纯钢板钢缆系统固定1例。术后定期拍摄X线片观察骨折愈合情况,并采用髋关节功能评分标准(Harris评分)观察关节功能。结果除1例B2型患者术后第4天发生肺栓塞死亡外,其余15例均得到1～4年随访。术后半年X线片检查骨折均愈合良好,无感染、无内固定物及关节假体移位、断裂发生。术前Harris评分35分,术后1年评分80分9例,70～80分7例。结论应针对股骨假体周围骨折不同Vancouver类型采取个体化手术治疗。     

X线断层融合技术在膝关节置换术后评估中的应用

目的 :比较X线断层融合成像与数字化X线摄影显示膝关节假体及其周围结构的能力。方法 :连续选取行单侧或双侧膝关节置换术、且已行术后X线断层融合成像与数字化X线摄影复查的患者26例,分析其X线断层融合成像与数字化X线摄影影像资料。由2名高年资主治医师读片,并进行主观评分。结果:断层融合成像观察假体的图像质量频率分别为:2分58%,1分39%,0分3%;观察假体周围组织的图像质量频率分别为:2分70%,1分26%,0分4%。数字化X线观察假体的图像质量频率分别为:2分16%,1分57%,0分27%;观察假体周围组织的图像质量频率分布为:2分11%,1分53%,0分36%。断层融合成像的评分高于数字化X线摄影(P0.001)。结论:膝关节置换术后X线断层融合成像质量比数字化X线摄影图像质量好,观察假体周围结构更具优势。     

髋关节置换术后股骨假体周围骨折的处理

目的:探讨分析全髋关节置换术后股骨假体周围骨折的分型、治疗方法及临床疗效。方法:回顾分析性研究2007-03～2010-08治疗8例全髋关节置换术后股骨假体周围骨折的病例,根据Vancouver分型B1型3例、B3型3例、C型2例。B1型病例采用异体皮质骨板加钢丝环扎牢固固定骨折,B3型病例采用股骨加长柄行翻修术外加同种异体结构骨植骨钢缆环扎术,C型病例均采用柄部单皮质骨螺钉内固定远端骨折部双皮质螺钉钢板内固定并植骨术。结果:所有病例均获随访8～24个月,股骨假体固定可靠,骨折断端对位对线良好,骨折均达到骨性愈合,患肢无疼痛、无肌萎缩,功能恢复正常,Harris评分平均83分。结论:对于髋关节置换术后假体周围骨折治疗应根据其综合情况及骨折分型采用个体化的手术治疗方法,可取得较好的治疗效果。     

Pulmonary disease in liver transplant recipients. Spectrum of CT features

PURPOSE: To determine the features of pulmonary disease in liver transplant recipients by CT. MATERIAL AND METHODS: Of 792 patients, 102 were referred to thoracic CT 3-2093 days after the transplantation procedure (median 107 days). All CT studies were retrospectively analyzed and correlated with clinical, microbiological, serological and histopathological findings. RESULTS: Eighty-eight of 102 patients (86%) had an abnormal CT. In 25 patients (25%), an elevated right hemidiaphragm, basal atelectasis and small effusions were the only abnormalities. Fourty-one patients (40%) displayed an infiltrate and 13 (13%) a mass lesion. Evidence of cytomegalovirus (CMV) infection was found in 20 patients. CMV pneumonia was suggested by an interstitial pattern of pneumonia on CT (n=13). Pneumocystis carinii pneumonia was highlighted by peribronchovascular infiltrates (n=5/8), bacterial pneumonia (n=24) including legionellosis (n= 13) by bilateral effusions (n=14) and lobar consolidation (n= 13). In 7/41 patients (17%) with both clinically apparent pulmonary disease and CT signs of pneumonia, no pathogen could be detected. Neoplastic disease was mostly due to tumor recurrence (n=6). CONCLUSION: Thoracic CT of liver transplant recipients aids in detecting and classifying both infectious and neoplastic complications.     

人工髋关节置换术早期并发症26例

目的探讨应用组配柄对骨缺损情况下全髋股骨翻修的疗效。方法回顾性分析625例人工髋关节置换术患者，其中股骨头置换312例，全髋关节置换313例。总结并发症的临床特点及防治措施。结果26例（4．2％）患者出现并发症，其中伤151浅层感染1例（0．2％），脱位3例（0．5％），股骨假体周围骨折5例（0．8％），下肢深静脉栓塞11例（1．8％），应激性溃疡出血3例（0．48％），坐骨神经损伤1例（0．2％），假体松动2例（0．3％）。2例死亡。结论严格手术适应证、正确手术操作、强调术前准备和术后处理是减少术后并发症发生的关键。     

MR imaging of the cauda equina in hereditary motor sensory neuropathies: correlations with sural nerve biopsy

BACKGROUND AND PURPOSE: Although spinal root abnormalities are known to occur, spinal MR examination is seldom performed in hereditary motor and sensory neuropathies (HMSN). The following work was undertaken to assess the MR imaging spectrum of lumbosacral spinal nerve root abnormalities and determine whether intradural nerve root involvement could be related to any biopsy feature. METHODS: Ten consecutive patients (eight male, two female; age range, 28-65 yrs) with Charcot-Marie-Tooth (CMT) (type I = 5, type II = 2) and Déjèrine-Sottas disease (DSD) (n = 3) underwent a contrast-enhanced lumbosacral MR examination. Sural nerve biopsy was performed in all patients. Atypical clinical features were present in two patients. The MR scans of each patient were reviewed for possible causes of myeloradiculopathy, spinal nerve root and ganglia dimensions, signal change, and abnormal enhancement. RESULTS: In the seven patients with CMT, abnormal MR findings were intradural nerve root hypertrophy (n = 2), signal abnormalities (n = 2), and enhancement (n = 3). Two of three patients with DSD had the abnormal MR finding of intradural nerve root enhancement. In both patients with atypical clinical features, MR imaging showed nerve root hypertrophy and enhancement. Both findings were related to an increased number of onion bulbs at sural nerve biopsy. Inflammatory infiltrates were not observed in any patients. CONCLUSION: In patients with HMSN enhancement of intradural spinal nerve roots, whether or not associated with marked thickening, may be found on lumbosacral MR examinations. Spinal nerve root thickening may be responsible for atypical symptoms, and its visibility on MR images represents a useful adjunct to diagnosis. Lumbosacral spinal nerve root abnormalities were related to an extremely high number of onion bulbs (indicating active demyelination) at sural nerve biopsy. Nerve root enhancement does not seem to be related to inflammatory infiltrates.     

MR evaluation of the hippocampus in patients with congenital malformations of the brain

BACKGROUND AND PURPOSE: Developmental changes in hippocampal formations (HFs) have been reported in association with agenesis of the corpus callosum, lissencephaly, and holoprosencephaly. The purpose of this study was to evaluate the developmental changes in HFs in patients with a variety of other congenital brain malformations. METHODS: MR images of 44 patients with congenital brain malformations associated with 11 different brain disorders were reviewed retrospectively. Five patients had more than two anomalies. Imaging and clinical findings were evaluated for the shape, size, degree of inversion, and side of abnormal HF. RESULTS: Vertically oriented or globular-shaped HFs were observed in 28 patients (64%) on coronal MR images. All patients with agenesis of the corpus callosum (n = 7), lissencephaly (n = 1), holoprosencephaly (n = 3), and Fukuyama muscular dystrophy (n = 3) had an abnormal HF. A high prevalence of abnormalities was observed in patients with polymicrogyria (11/12, 92%), heterotopia (4/5, 80%), tuberous sclerosis (2/3, 67%), and schizencephaly (2/4, 50%). Patients whose abnormalities were symmetrical had bilateral abnormal HFs, whereas those with polymicrogyria, schizencephaly, and heterotopia, whose abnormalities were localized, tended to have unilateral abnormal HFs. CONCLUSION: Hippocampal developmental abnormalities are found in a high percentage of patients with congenital malformations. Focusing on the morphologic abnormalities of the HF on coronal MR images may help in the detection of diseases associated with brain anomalies, especially subtle cortical disorders.     

全髋关节置换术后脱位21例临床分析

目的分析全髋关节置换术后脱位的影响因素,探讨术中如何准确置人髋关节假体以减少髋关节脱位。方法分析我科2005年1月—2012年12月全髋关节置换术后脱位病例的影响因素。结果本组病人脱位发生率为1．3％。女性占脱位人数的比例为62％,男性占38％。早期脱位占脱位人数的比例为90％,晚期脱位占10％。前方脱位占脱位人数的比例为19％,后方脱位占81％。假体位置不良占脱位人数的比例为52％,精神神经功能不全者占29％,术后活动范围过度者占脱位人数的比例为19％。结论患者因素、术者因素及髋关节假体因素都对人工髋关节置换术后脱位产生影响,术中准确置人髋关节假体是影响髋关节脱位的关键因素。     

Sequential cranial MR findings of asymptomatic and neurologically symptomatic HIV+ subjects.

PURPOSE: To compare results of a prospective MR and clinical reevaluation of HIV+ asymptomatic and neurologically symptomatic subjects who had had initially abnormal cranial studies to determine what cranial MR changes occur and how these changes correlate with serial neurologic and neuropsychologic findings. PATIENTS AND METHODS: Thirty-one asymptomatic (n = 20) and neurologically symptomatic (n = 11) subjects seropositive for the human immunodeficiency virus (HIV+) were prospectively reevaluated by cranial magnetic resonance (MR) one to two years following an initially abnormal MR of the brain. RESULTS: All 31 HIV+ subjects with initial abnormal MR had abnormal follow-up scans (showing atrophy and/or white matter lesions). Twenty-seven showed no progression of MR abnormalities (among whom were 18 with minimally abnormal scans who remained asymptomatic with improved or static neuropsychologic performance). Of the four subjects with scan changes (all with clinically suspected HIV encephalopathy), one showed MR, clinical, and neuropsychologic test improvement; the remaining three showed MR (n = 3), neurologic (n = 3), neuropsychologic (n = 1) worsening and autopsy (n = 1) confirmed the presence of HIV-1 containing multinucleated giant cells in the brain. CONCLUSIONS: This study suggests that: 1) Progression of intracranial MR abnormalities due to HIV-1 is seen only in a minority of HIV+ subjects over a 1- to 2-year time period, only in those neurologically symptomatic, and correlates with clinical deterioration. 2) Minor cerebral MR abnormalities seen in HIV+ subjects who remain neurologically asymptomatic do not change over a 1- to 2-year period. 3) Although HIV is known to infect the brain early, it may, nevertheless, not routinely do significant anatomical damage early on in the disease, as based on MR criteria.     

儿童臀肌挛缩症的髋关节测量及其临床意义

目的　探讨臀肌挛缩症对髋关节发育的影响 ,并说明早期治疗的重要性。方法　 10 2例臀肌挛缩症患儿 ,术前均摄骨盆平片 ,并由专人测量其髋臼指数、CE角、颈干角及臼头指数。结果　臀肌挛缩症的颈干角、CE角增大 ,臼头指数减小 ,髋臼指数在正常范围。结论　臀肌挛缩症引起儿童髋关节外翻及半脱位 ,应早期手术治疗     

Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids

PURPOSE: To evaluate whether there is a relationship between steroid treatment and risk for osteonecrosis of the hip and knee in patients with severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: The hospital ethics committee approved the study, and all patients provided written informed consent. A total of 254 patients with confirmed SARS treated with steroids underwent evaluation with magnetic resonance (MR) imaging for osteonecrosis. Clinical profiles, joint symptoms, relevant past medical and drug history, steroid dose, and radiographic and MR imaging evidence of osteonecrosis and other bone abnormalities were evaluated. Mann-Whitney, Kruskal-Wallis, and Pearson exact chi(2) tests were performed, and univariate and multivariate logistic regression analyses were applied. RESULTS: One hundred thirty-four (53%) of 254 patients had recent onset of large joint pain, but 211 (80%) of 264 painful joints were not associated with abnormality on MR images. MR images in 12 (5%) of 254 patients showed evidence of subchondral osteonecrosis in the proximal femur (n = 9), distal femur (n = 2), and proximal and distal femora and proximal tibiae (n = 1). Additional nonspecific subchondral and intramedullary bone marrow abnormalities were present in 77 (30%) of 254 patients. Results of multiple logistic regression analysis confirmed cumulative prednisolone-equivalent dose to be the most important risk factor for osteonecrosis. The risk of osteonecrosis was 0.6% for patients receiving less than 3 g and 13% for patients receiving more than 3 g prednisolone-equivalent dose. No relationship was found between additional nonspecific bone marrow abnormalities and steroid dose. CONCLUSION: An appreciable dose-related risk was found for osteonecrosis in patients receiving steroid therapy for SARS. Additional nonspecific bone marrow abnormalities were frequent. Joint pain was common after SARS infection and was not a useful clinical indicator of osteonecrosis.     

Respiratory viral infections in lung transplant recipients: radiologic findings with clinical correlation

PURPOSE: To evaluate radiologic finding of respiratory viral infection in lung transplant recipients with clinical correlation. MATERIALS AND METHODS: Over 5 years, 21 episodes of respiratory viral infection (parainfluenza [n = 9], respiratory syncytial virus [n = 8], adenovirus [n = 5], influenza [n = 2]) were diagnosed 6-727 days (mean, 270 days) after lung transplantation in 20 recipients. Chest radiographs, computed tomographic (CT) images, and clinical records were reviewed. RESULTS: Sixteen episodes of respiratory viral infection were diagnosed in patients with symptoms of lower respiratory tract infection or acute allograft dysfunction; five were diagnosed in asymptomatic patients. Chest radiographs were abnormal in 11 (52%) episodes; findings included heterogeneous or homogeneous opacities and masslike consolidation. All patients with radiographic abnormalities were symptomatic. Chest radiographs were unchanged from baseline in 10 (48%) episodes; in one, CT revealed findings not depicted at radiography. Adenoviral infection (n = 5) was typically symptomatic, was associated with new radiographic abnormalities, and was rapidly lethal (n = 4). Infection with parainfluenza and/or respiratory syncytial virus was commonly asymptomatic and was not associated with radiographic abnormalities; affected patients had good outcomes. CONCLUSION: Respiratory viral infections are important causes of morbidity and mortality in lung transplant recipients. Radiographic abnormalities in patients with respiratory viral infections were usually accompanied by symptoms of lower respiratory tract infection. Adenoviral infection was frequently accompanied by progressive pulmonary opacity and fatal outcome.     

股骨近端髓内钉-螺旋刀片内固定与人工关节置换术在老年髋部骨折中的临床比较研究

目的对比老年髋部骨折患者采用人工关节置换术或股骨近端髓内钉-螺旋刀片内固定治疗的疗效差异。方法前瞻性分析2015年5月-2017年5月河北省沧州市人民医院骨科收治的125例老年髋部骨折患者,根据随机数字表法将其分为内固定组(n=65)和关节置换组(n=60)。内固定组接受股骨近端髓内钉-螺旋刀片内固定治疗,关节置换组接受人工关节置换术治疗。比较两组患者术中出血量、术后负重时间、并发症发生率、关节功能以及骨γ-羧基谷氨酸蛋白(BGP)、甲状旁腺激素(PTH)、骨碱性磷酸酶(BALP)水平。同时,采用Tecnobody PK254P平衡康复系统评估两组前后标准差(SD)、运动长度及运动面积以及压力中心(COP)相关参数XCOP、YCOP及左右SD、前后运动速度、左右运动速度。结果关节置换组并发症如关节/伤口感染,内置物松动,心血管疾病,肺部、尿道感染总发生率为6.67%,低于内固定组的20.00%(P<0.05)。术后6、12个月关节置换组的髋关节功能优良率均高于内固定组(P<0.05)。术后12个月两组患者BGP、PTH、BALP水平均高于术前,且关节置换组高于内固定组(P<0.05)。关节置换组患者前后标准差(SD)、运动长度及运动面积均大于内固定组(P<0.05),但两组患者压力中心(COP)相关参数XCOP、YCOP及左右SD、前后运动速度、左右运动速度比较差异无统计学意义(P>0.05)。结论股骨近端髓内钉-螺旋刀片内固定治疗老年髋部骨折患者的出血量较少、术后平衡能力较好;人工关节置换术治疗老年髋部骨折患者康复较快,并发症发生率较低。两者各具优势,医师应根据临床实际选择合适的术式。