Expanding role of 18F-fluoro-d-deoxyglucose PET and PET/CT in spinal infections

¹⁸F-fluoro-d-deoxyglucose positron emission tomography ([¹⁸F]-FDG PET) is successfully employed as a molecular imaging technique in oncology, and has become a promising imaging modality in the field of infection. The non-invasive diagnosis of spinal infections (SI) has been a challenge for physicians for many years. Morphological imaging modalities such as conventional radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are techniques frequently used in patients with SI. However, these methods are sometimes non-specific, and difficulties in differentiating infectious from degenerative end-plate abnormalities or postoperative changes can occur. Moreover, in contrast to CT and MRI, FDG uptake in PET is not hampered by metallic implant-associated artifacts. Conventional radionuclide imaging tests, such as bone scintigraphy, labeled leukocyte, and gallium scanning, suffer from relatively poor spatial resolution and lack sensitivity, specificity, or both. Initial data show that [¹⁸F]-FDG PET is an emerging imaging technique for diagnosing SI. [¹⁸F]-FDG PET appears to be especially helpful in those cases in which MRI cannot be performed or is non-diagnostic, and as an adjunct in patients in whom the diagnosis is inconclusive. The article reviews the currently available literature on [¹⁸F]-FDG PET and PET/CT in the diagnosis of SI.     

The value of 18F‐FDG PET/CT in diagnosing and localising deep sternal wound infection to guide surgical debridement

Deep sternal wound infection (DSWI) is a severe complication in patients after open heart surgery (OHS). But there is a lack of appropriate imaging tool to detect the infection sites, which may lead to incomplete debridement. The present study aims to investigate the value of ¹⁸F‐fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F‐FDG PET/CT) in comparison with CT scan in diagnosing and localising DSWI. A total of 102 patients with DSWI after OHS were retrospectively collected from January 2012 to December 2017 in our hospital. All the patients had surgical debridements for DSWI with pretreatment imaging of either ¹⁸F‐FDG PET/CT or CT scan. The sensitivity, specificity, and accuracy of localising infection sites were compared between PET/CT and CT groups, with surgical, microbiological, and histopathological findings as the gold standard. The length of hospital stays and the rate of recurrence were also compared. Ten patients in the PET/CT group had a follow‐up PET/CT scan after debridement, and the correlations between the changes of PET/CT findings and surgical outcomes were analysed. ¹⁸F‐FDG PET/CT is more accurate than CT in diagnosing and localising DSWI after OHS, which leads to a more successful surgical debridement with a lower rate of recurrence and a shorter length of hospital stay. In addition, follow‐up PET/CT after debridement could evaluate the treatment effect.     

颈椎手术中并发椎动脉损伤的诊断与治疗

 目的 探讨颈椎手术中并发椎动脉损伤的发生原因、治疗及预防。方法 回顾性分析2002年10月至2012年4月颈椎手术中并发椎动脉损伤的7例患者资料,男6例,女1例;年龄23～65岁,平均48.9岁;脊髓型颈椎病5例,颈椎外伤合并C^4,5半脱位1例,氟骨症致颈椎管狭窄1例。椎动脉损伤均为单侧,左侧4例,右侧3例。分析颈椎手术中并发椎动脉损伤的原因、处理过程及预后。结果颈椎前路手术4例,其中2例用环钻减压时偏离中线损伤椎动脉,1例切除椎间盘时刮匙过于偏外损伤椎动脉,1例颈椎外伤患者由于Ｃ^4,5半脱位造成椎动脉迂曲,减压时冲击式咬骨钳损伤椎动脉。颈椎后路手术3例,其中2例为行C4侧块螺钉固定时钻头偏外损伤椎动脉;1例氟骨症致颈椎管狭窄者在切除寰椎后弓时咬骨钳损伤椎动脉,术中出现椎动脉损伤后,迅速填塞压迫止血并关闭伤口,但术后4周发生迟发性出血,采用椎动脉栓塞止血及颈后路血肿清除术治疗。7例患者均未发生脑梗塞,其中2例患者术后出现一过性头晕。结论 椎动脉损伤是颈椎手术的严重并发症,其损伤原因与手术失误、解剖变异等有关;采用直接压迫及椎动脉栓塞治疗效果确切。     

血清感染指标对颈后路单开门椎管扩大成形术后早期感染的诊断价值

目的：探讨白细胞计数（WBC）、C-反应蛋白（CRP）、血清降钙素原（PCT）及红细胞沉降率（ESR）水平对颈后路单开门椎管扩大成形术后早期感染的诊断价值,及时发现、预防和治疗术后感染患者。方法：回顾性分析2010年1月至2019年4月颈后路单开门椎管扩大成形术后早期发热的患者120例;按照患者伤口渗出液细菌学培养的结果将其分为感染组（53例）和未感染组（67例）,感染组中,男32例,女21例,年龄48～63（52.28±6.36）岁;未感染组中,男37例,女30例,年龄46～62（51.63±5.82）岁。并根据感染组患者术后感染类型将其分为深部手术部位感染组（30例）和浅表手术部位感染组（23例）,深部手术部位感染组中,男19例,女11例,年龄50～63（53.16±5.62）岁;浅表手术部位感染组中,男13例,女10例,年龄48～61（52.15±5.68）岁。比较组间患者及组内患者手术前后WBC计数、CRP、PCT及ESR血清感染指标。收集纳入的120例患者血清感染学指标数据并根据血清感染指标诊断感染的灵敏度及特异性,以1-特异性为横坐标,灵敏度为纵坐标绘制受试者工作特征（ROC）曲线对WBC计数、CRP、PCT以及ESR感染指标进行早期感染诊断的准确性评估。结果：术前：感染组和未感染组患者的WBC计数、CRP、PCT、ESR血清感染指标水平相近（P>0.05）;术后：感染组患者的WBC计数、CRP、PCT、ESR感染指标较未感染组高（P<0.05）。在术后感染的患者中,WBC计数、CRP、PCT以及ESR血清感染指标水平在不同术后感染类型的患者中存在差异（P<0.05）。未感染组患者的WBC计数、CRP、PCT以及ESR血清感染指标总体呈现出先升后降的趋势。WBC计数感染指标的受试者曲线下面积（AUC）为0.637（P<0.05）;CRP感染指标的AUC为0.792（P<0.05）;PCT感染指标的AUC为0.774（P<0.05）;ESR感染指标的AUC为0.783（P<0.05）。结论：WBC计数、CRP、PCT、ESR血清感染指标可用于颈后路单开门椎管扩大成形术后早期感染的诊断,除此之外,上述4种感染指标变化的综合分析可用于不同术后感染类型的鉴别。WBC计数指标对于早期感染诊断的准确性较低,CRP、PCT以及ESR指标对于早期感染诊断的准确性较好。总体上来说,CRP、PCT以及ESR血清感染指标对于颈后路单开门椎管扩大成形术后早期感染的诊断来说具有重要的临床意义,有助于临床工作者尽早发现术后早期感染以利于随后的相应治疗。     

Dumbbell-shaped chondrosarcoma that primarily developed in the cervical spine: a case report

There have been few reports describing dumbbell chondrosarcomas that primarily developed in the cervical spine; and among these cases even fewer can easily be diagnosed as chondrosarcoma. We report a 58-year-old man who complained of right cervical pain and swallowing difficulty without a particularly apparent cause. Magnetic resonance imaging (MRI) and computed radiography (CT) suggested a diagnosis of dumbbell tumor. ^99mTc HMDP bone scintigraphy and ²⁰¹Tl scintigraphy were negative, and surgery was performed assuming the presence of a neurogenic tumor. Intraoperative histopathological examination showed similar results. The postoperative histopathological diagnosis, however, was chondrosarcoma (grade II). Retrospective discussion regarding the diagnosis of the patient revealed that gadolinium-enhanced MRI was not appropriate for a precise diagnosis and that CT was more effective. We have thus experienced a patient with a rare dumbbell chondrosarcoma that primarily developed in the cervical spine for which a preoperative diagnosis was difficult.     

019 2 Cases of Mediastinitis After Median Sternotomy Surgery Treated with Vacuum‐Assisted Closure

Introduction: Mediastinitis, which is at times encountered after thoracic surgery with median sternotomy, is often resistant for treatments and in cases leads to death. We applied vacuum‐assisted closure (V.A.C.) for 2 cases of post‐sternotomy mediastinitis, in an original manner using readily available materials and made them healed. The details are reported. Methods: We applied polyurethane foam (HydroSite^®, Smith & Nephew) with silicone tube (BLAKE^®, ETHICON) on the debrided wound, covered it with surgical draping film (Ioban^® 2, 3M Health Care), and applied continuous negative pressure with a wall suction. The dressing was changed at intervals of 2 to 3 days. Results: (Case 1) A 53‐years old male with complications of diabetes mellitus and hypertension underwent coronal artery bypass graft surgery for angina pectoris. Sternal infection occurred in postoperative period and the wound was opened. (Case 2) A 78‐years old male underwent total aortic arch replacement surgery for aortic dissection. The wound was opened for a postoperative infection. We applied vacuum‐assisted closure therapy for these 2 cases in the method presented above and observed promoted wound granulation and rapid contraction of wounds, with no manifestations of increasing infection or changes of circular conditions. Each of the cases was healed with vacuum‐assisted closure in 7 Weeks without any surgical procedures. Conclusions: We viewed vacuum‐assisted closure therapy as another choice of the treatment for mediastinitis.     

颈椎前路术后并发脑脊液漏的早期规范离床效果：单中心连续对照护理研究

目的：探讨颈椎前路术后发生脑脊液漏（cerebrospinal fluid leakage CSFL）患者早期规范离床的安全性及可行性。方法：回顾性分析2019年1月至2019年12月在我院骨科诊断为颈椎病并行颈椎前路减压融合手术130例,其中男74例,女56例,年龄26～77岁,平均(59.7±10.4)岁,对术后发生CSFL患者有效实施护理计划并制定早期规范离床方案。结果：本研究中7例术后CSFL患者均实行早期规范离床,平均离床时间5.14天,未出现伤口不愈合、硬脊膜囊肿及神经系统感染等并发症。随访时间为 6～18个月。结论：优化护理管理策略并采取早期规范离床对颈椎前路术后并发脑脊液漏患者安全可行。     

颅脑损伤术后感染者调节细胞凋亡线粒体蛋白和星形胶质源性蛋白表达水平

目的探讨颅脑损伤术后感染者调节细胞凋亡线粒体蛋白（Smac）和星形胶质源性蛋白（S100B）水平,并分析其与疗效及预后的关系。 方法选取2016年1月至2018年1月解放军总医院第三医学中心收治的112例颅脑损伤术后感染者（术后感染组）、50例颅脑损伤术后未感染者（未感染组）和50例健康体检者（对照组）作为研究对象。采用酶联免疫吸附试验检测各组研究对象血清Smac和S100B蛋白水平。绘制受试工作者曲线（ROC）分析血清Smac和S100B对颅脑损伤术后感染的诊断价值;采用Logistic回归分析血清Smac和S100B蛋白对颅脑术后感染者预后的影响。 结果术后感染组、未感染组和对照组研究对象血清Smac和S100B水平比较,差异均有统计学意义（F = 11.346、 P = 0.001,F = 9.524、P = 0.008）,其中术后感染组患者低于未感染组（Smac：t = 5.836、P < 0.001,S100B：t = 7.782、P < 0.001）,未感染组患者低于对照组（Smac：t = 2.946、P = 0.004,S100B：t = 3.889、P < 0.001）。血清Smac和S100B单项检测对颅脑损伤术后感染有一定诊断价值（Smac：AUC = 0.689,95%CI：0.624～0.757,P = 0.023;S100B：AUC = 0.718,95%CI：0.653～0.749,P = 0.011）,两者联合检测则可提高其诊断效能（AUC = 0.857,95%CI：0.811～0.926,P = 0.005）。与治疗前比较,术后感染组患者治疗后血清Smac和S100B蛋白水平显著升高,差异有统计学意义（t = 4.802、6.499,P均< 0.001）。随访6个月,死亡患者、预后不良患者和预后良好患者血清Smac和S100B水平差异有统计学意义（F = 15.065、P < 0.001,F = 7.194、P = 0.016）,其中死亡患者水平显著低于预后不良者（t = 2.06、P = 0.046,t = 2.297、P = 0.028）,预后不良患者水平显著低于预后良好者（t = 4.225、7.110,P < 0.001）,差异均有统计学意义。经Logistic回归分析,治疗前血清Smac和S100B蛋白是颅脑术后感染者预后的保护性因素（P = 0.008、0.003）。 结论血清Smac和S100B蛋白水平在颅脑损伤术后感染者中低表达,对颅脑损伤术后病原菌感染有一定诊断价值,两者联合可显著提高其诊断效能,并影响疗效及预后。     

Lung metastasis from an ovarian granulosa cell tumor 36 years after the initial diagnosis: report of a case

This report presents the case of a late relapse of an ovarian granulosa cell tumor (GCT) that metastasized to the lung 36 years after the initial diagnosis. A 72-year-old female demonstrated multiple nodules with extrapleural signs on chest computed tomography. Positron emission tomography with ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG-PET) showed that the nodules had no FDG avidity. The nodules, which appeared as polypoid lesions of the visceral pleura on thoracoscopy, were resected and diagnosed as pulmonary metastases from the GCT. This case report indicates that thorough thoracoscopic exploration of the pleural cavity is essential when intrathoracic nodules are seen on postoperative imaging examinations in GCT patients, even when the [¹⁸F]FDG-PET results are negative.     

Glenohumeral and scapulohumeral kinematic analysis of patients with traumatic anterior instability wearing a shoulder brace: a prospective laboratory study

Study design

A retrospective case review of patients who underwent 18F sodium fluoride PET/CT imaging of the spine with postoperative pain following vertebral fusion.

Objective

To determine the benefit of 18F sodium fluoride PET/CT imaging in the diagnosis of persistent pain in the postoperative spine.

Summary of background data

The diagnosis of pain generators in the postoperative spine has proven to be a diagnostic challenge. The conventional radiologic evaluation of persistent pain after spine surgery with the use of plain radiographs, MRI, and CT can often fall short of diagnosis in the complex patient. 18F sodium fluoride PET/CT imaging is an alternative tool to accurately identify a patient’s source of pain in the difficult patient.

Methods

This retrospective study looked at 25 adult patients who had undergone 18F sodium fluoride PET/CT imaging. All patients had persistent or recurrent back pain over the course of a 15-month period after having undergone spinal fusion surgery. All patients had inconclusive dedicated MRI. The clinical accuracy of PET/CT in identifying the pain generator and contribution to altering the decision making process was compared to the use of CT scan alone.

Results

Of the 25 patients studied, 17 patients had increased uptake on the 18F sodium fluoride PET/CT fusion images. There was a high-level correlation of radiotracer uptake to the patients’ pain generator. Overall 88% of the studies were considered beneficial with either PET/CT altering the clinical diagnosis and treatment plan of the patient or confirming unnecessary surgery.

Conclusion

18F sodium fluoride PET/CT proves to be a useful tool in the diagnosis of complex spine pathology of the postoperative patients. In varied cases, a high correlation of metabolic activity to the source of the patient’s pain was observed.

     

脊髓型颈椎病前后路手术的选择

目的：探讨脊髓型颈椎病前后路手术的适应证并评定其疗效。方法：自2002年6月至2006年6月采用前后路治疗125例脊髓型颈椎病患者,男71例,女54例;年龄28-69岁,平均53．4岁。病程0．5-48个月,平均14个月。58例行前入路,67例行后入路。通过JOA评分系统对手术前后神经功能分析,总结颈椎前后路手术疗效。结果：所有患者均获得随访,时间6-30个月,平均18个月。按JOA评分标准：颈前路手术组术前（8．78±2．43）分,术后（14．68±2．37）分,其中优40例,良10例,有效6例;颈后路手术组术前（8．49±2．58）分,术后（14．26±2．83）分,其中优42例,良12例,有效8例。6例手术无效,其中前路2例,后路4例,后路1例术后症状加重。两组间疗效无统计学差异（P〉0．05）,但同一入路术前术后比较有统计学差异（P〈0．05）。结论：前后路手术均能对脊髓型颈椎病的治疗起到良好的作用,来自前方的压迫,少节段病变,以锥体束受压症状为主者,原则上采取前路手术;而对于来自脊髓后方的压迫,多节段病变,以感觉障碍为主、伴有颈椎椎管狭窄者,则以颈后路手术为主。     

Update on positron emission tomography for imaging of prostate cancer

Prostate cancer is the most common non‐cutaneous malignancy among men in the Western world, and continues to be a major health problem. Imaging has recently become more important in the clinical management of prostate cancer patients, including diagnosis, staging, choice of optimal treatment strategy, treatment follow up and restaging. Positron emission tomography, a functional and molecular imaging technique, has opened a new field in clinical oncological imaging. The most common positron emission tomography radiotracer, ¹⁸F‐fluorodeoxyglucose, has been limited in imaging of prostate cancer. Recently, however, other positron emission tomography tracers, such as ¹¹C‐acetate and ¹¹C‐ or ¹⁸F‐choline, have shown promising results. In the present review article, we overview the potential and current use of positron emission tomography or positron emission tomography/computed tomography imaging employing the four most commonly used positron emission tomography radiotracers, ¹⁸F‐fluorodeoxyglucose, ¹¹C‐acetate and ¹¹C‐ or ¹⁸F‐choline, for imaging evaluation of prostate cancer.     

颈椎前路术后吞咽困难的相关原因分析

目的 :探讨颈椎前路术后发生吞咽困难的相关原因。方法 :对2011年7月至2013年10月进行颈前路手术的328例患者进行回顾性分析,其中男157例,女171例;年龄28~81岁。手术方式包括颈椎体次全切钛网植骨融合内固定术、颈前路椎间盘摘除植骨融合内固定术、颈椎体次全切椎间盘摘除植骨融合内固定术、颈椎间盘置换。术后1个月根据Bazaz食道功能标准对患者进行评价,将所有患者分成吞咽困难组和吞咽正常组,比较两组年龄、性别、手术节段数、颈前路钛板使用率。结果:术后1个月共有63例患者出现吞咽困难,男19例,女44例,男女性别之间吞咽困难发生率差异有统计学意义(P=9.1×10-280.05);吞咽困难组:年龄38~81岁,平均年龄65.0岁;吞咽正常组:年龄28~73岁,平均年龄53.6岁;发生吞咽困难组与吞咽正常组之间年龄差异有统计学意义(P=1.4×10-80.05);63例吞咽困难患者均使用钛板内固定,而21例吞咽正常患者均为人工颈椎间盘置换(未使用颈前路钛板固定),应用颈前路钛板固定与人工颈椎间盘置换术后的吞咽困难差异有统计学意义(P=0.0180.05);手术单节段3例,双节段24例,3节段及3个以上节段36例,3节段及3个以上节段钛板内固定组与单、双节段钛板内固定组吞咽困难发生率之间差异有统计学意义(P=3.6×10-330.05)。结论 :颈前路术后吞咽困难的原因较多,其中应包括女性、高龄、钛板内固定的应用以及多节段手术等因素,临床医生在进行颈前路手术时应引起高度重视。     

阴道内镜技术在诊治无性生活女性宫内病变中的临床应用

目的分析及评估以阴道内镜技术治疗无性生活女性宫腔内疾病的临床效果。 方法回顾性分析2016年3月至2022年3月,73例无性生活女性行阴道内镜手术的完成情况、手术时间、术中出血量、平均住院时间、术中镜下诊断与术后病理情况、术后及随访情况。 结果73例患者均成功实施阴道内镜诊疗,其中宫腔镜下子宫肌瘤电切术34例、宫腔镜下宫颈息肉电切19例、宫腔镜下子宫内膜息肉电切15例、宫腔镜下宫颈肌瘤电切3例、宫腔镜下生殖道畸形整形2例。73例手术均顺利完成,手术时间12~130 min,平均(54.2±30.0)min。平均术中出血量(12.4±16.0)ml。平均住院时间(3.6±1.9)d。术中镜下诊断,34例子宫肌瘤(其中FIGO 0型7例、FIGO 1型10例、FIGO 2型12例、FIGO 3型1例、弥漫性子宫肌瘤病4例)、19例宫颈息肉、15例子宫内膜息肉、3例宫颈肌瘤、2例生殖道畸形。所有患者无一例损伤处女膜及宫颈,无子宫穿孔、严重TURP等并发症。所有患者术后及随访过程中,无阴道异常分泌物、阴道异常出血、腹痛、发热等不良反应。 结论阴道内镜手术技术在有效治疗妇科下生殖道疾病的同时,可有效保护处女膜的完整性,对无性生活女性患者的身心健康均加以保护。     

脊髓型颈椎病前路手术并发症的防治探讨

目的探讨脊髓型颈椎病前路手术并发症的原因分析及防治方法。方法近5年来我科采用颈前路减压植骨钢板内固定治疗单或双节段脊髓型颈椎病162例。结果本组患者术后出现反应性脊髓水肿3例,脑脊液漏1例,食管漏1例,喉返神经损伤3例,肺部感染5例,其中1例因呼吸衰竭死亡。随访6个月～5年(平均3.5年),按JOA评分,术后12～16分,平均14.6分。结论充分的术前准备,熟悉颈前入路解剖,严格规范化手术操作及围手术期管理,可有效预防颈椎前路手术各种并发症的发生。     

可吸收止血流体明胶在钩椎关节切除术中的应用

目的探讨可吸收止血流体明胶(Surgiflo~(TM))应用于钩椎关节切除术中的有效性和安全性。方法 2017年1月—2019年5月海军军医大学附属长征医院采用钩椎关节切除术治疗神经根型颈椎病患者126例,术中使用可吸收止血流体明胶止血61例(Surgiflo组),采用明胶海绵止血65例(明胶海绵组)。记录2组术中止血时间、术中出血量、术后1 d和2 d引流量、术后1 d和末次随访日本骨科学会(JOA)评分,以及术后有无过敏、感染等并发症,综合评价2组治疗效果。结果 Surgiflo组术中止血时间、术中出血量、术后1 d和2 d引流量、术后1 d JOA评分均优于明胶海绵组,差异有统计学意义(P 0.05);2组末次随访JOA评分差异无统计学意义(P 0.05)。Surgiflo组和明胶海绵组术后伤口感染发生率分别为0和1.5%(1/65)。结论可吸收止血流体明胶是一种安全、有效的止血剂,在钩椎关节切除手术中可减少术中止血时间、术中出血量、术后引流量,且围手术期症状缓解迅速,不增加伤口感染的风险。     

大剂量甲基强的松龙在脊髓型颈椎病围手术期应用的探讨

目的：探讨大剂量甲基强的松龙（MP）在脊髓型颈椎病患者围手术期应用的价值。方法：脊髓型颈椎病患者125例，分为3组，A组：术后未用激素治疗组，42例；B组：氟美松治疗组，38例；C组：大剂量MP＋抗酸药组，45例。比较三组患者手术前后的神经功能评分（JOA 17分法），统计并发症，观察患者术后咽部不适的时间。结果：3组患者术前、术后1周及术后3个月的JOA评分比较无显著性差异；C组患者术后无症状反跳现象，术后咽部不适的时间明显短于A、B两组（P〈0．001）；A组发生l例伤口感染，B组出现1例消化道隐性失血，C组出现1例毛囊炎、2例消化道隐性失血。结论：大剂量甲基强的松龙可以改善脊髓型颈椎病患者术后咽部不适的症状，应用安全，但对神经功能恢复无明显作用。     

单侧与双侧引流对颈椎后路全椎板切除侧块螺钉内固定术后主要并发症的影响

目的 比较放置单侧与双侧引流管对颈椎后路全椎板切除侧块螺钉内固定术后主要并发症的影响,为引流方案的选择提供依据.方法 回顾性分析2015年1月—2017年12月在本院接受颈椎后路全椎板切除侧块螺钉内固定术治疗的75例患者资料.根据引流管放置数量分为单侧组(n=45)和双侧组(n=30).统计并比较2组患者年龄、性别、疾...     

Correlation between mechanical stress by finite element analysis and 18F‐fluoride PET uptake in hip osteoarthritis patients

¹⁸F‐fluoride positron emission tomography (¹⁸F‐fluoride PET) is a functional imaging modality used primarily to detect increased bone metabolism. Increased ¹⁸F‐fluoride PET uptake suggests an association between increased bone metabolism and load stress at the subchondral level. This study therefore examined the relationship between equivalent stress distribution calculated by finite element analysis and ¹⁸F‐fluoride PET uptake in patients with hip osteoarthritis. The study examined 34 hips of 17 patients who presented to our clinic with hip pain, and were diagnosed with osteoarthritis or pre‐osteoarthritis. The hips with trauma, infection, or bone metastasis of cancer were excluded. Three‐dimensional models of each hip were created from computed tomography data to calculate the maximum equivalent stress by finite element analysis, which was compared with the maximum standardized uptake value (SUV_max) examined by ¹⁸F‐fluoride PET. The SUV_max and equivalent stress were correlated (Spearman's rank correlation coefficient ρ = 0.752), and higher equivalent stress values were noted in higher SUV_max patients. The correlation between SUV_max and maximum equivalent stress in osteoarthritic hips suggests the possibility that ¹⁸F‐fluoride PET detect increased bone metabolism at sites of stress concentration. This study demonstrates the correlation between mechanical stress and bone remodeling acceleration in hip osteoarthritis. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:78–83, 2015.     

手术切除治疗颈椎管内良性肿瘤的疗效观察

目的：探讨手术切除治疗颈椎管内良性肿瘤的方法及临床疗效。方法：回顾性分析自2001年至2005年经病理证实的颈椎管内良性肿瘤22例,男16例,女6例;年龄18～56岁,平均43.8岁。22例患者术前主要症状为颈部疼痛、四肢麻木无力、大小便失禁、锥体束征等。术前行X线、CT和MRI检查,诊为神经鞘瘤11例,神经纤维瘤4例,脊膜瘤3例,脂肪瘤和椎管内囊肿各2例。完全切除18例,切除60%以上3例,切除25%并取活检1例。11例Ⅰ期行颈椎稳定性重建。结果：22例均获得随访,时间6～84个月,平均12.5个月。复发并再手术2例。JOA评分：术前为（6.52±1.10）分,术后为（11.42±0.79）分,手术前后差异有统计学意义（t=35.38,P〈0.001）。手术改善率为（46.70±2.46）%,颈椎稳定性重建手术改善率为（62.37±3.58）%,其他手术方法的改善率（41.21±4.63）%。按JOA评定方法：优18例,良2例,中1例,差1例。结论：手术切除治疗颈椎管内良性肿瘤,术后复发率较低,肿瘤切除不全是复发的主要原因之一。MRI（MRA）是鉴别诊断、指导手术的有效影像学方法。