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1.
Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures) 总被引:7,自引:0,他引:7
Klaus Bohndorf 《Skeletal radiology》1999,28(10):545-560
Fractures involving the articulating surfaces of bone are a common cause of chronic disability after joint injury. Acute fractures
of the articular surface typically run parallel to the surface and are confined to the cartilage and/or the immediate subchondral
cancellous bone. They should be distinguished from vertical or oblique bone fractures with intra-articular extension. This
article reviews the mechanism of acute articular surface injuries, as well as their incidence, clinical presentation, radiologic
appearance and treatment. A classification is presented based on direct inspection (arthroscopy) and imaging (especially
MRI), emphasizing the distinction between lesions with intact (subchondral impaction and subchondral bone bruises) and disrupted
(chondral, osteochondral lesions) cartilage. Hyaline cartilage, subchondral bone plate and subchondral cancellous bone are
to be considered an anatomic unit. Subchondral articular surface lesions, osteochondral fractures and solely chondral fractures are different manifestations of impaction injuries that affect the articulating surface. Of the noninvasive imaging
modalities, conventional radiography and MRI provide the most relevant information. The appropriate use of short tau inversion
recovery, T1-weighted and T2-weighted (turbo) spin-echo as well as gradient-echo sequences, enables MRI to classify the various
acute articular surface lesions with great accuracy and provides therapeutic guidance.
Received: 5 April 1999 Revision requested: 6 May 1999 Revision received: 21 June 1999 Accepted: 12 July 1999 相似文献
2.
OBJECTIVE: To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard. METHODS: Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three "masked" radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI. RESULTS: Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures, Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter-Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury. CONCLUSIONS: The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries. 相似文献
3.
Soo-Jung Choi Myung Jin Shin Sung Moon Kim Sang-Jin Bae 《Korean journal of radiology》2004,5(4):219-224
Objective
We wished to evaluate the incidence of non-contiguous spinal injury in the cervicothoracic junction (CTJ) or the upper thoracic spines on cervical spinal MR images in the patients with cervical spinal injuries.Materials and Methods
Seventy-five cervical spine MR imagings for acute cervical spinal injury were retrospectively reviewed (58 men and 17 women, mean age: 35.3, range: 18-81 years). They were divided into three groups based on the mechanism of injury; axial compression, hyperflexion or hyperextension injury, according to the findings on the MR and CT images. On cervical spine MR images, we evaluated the presence of non-contiguous spinal injury in the CTJ or upper thoracic spine with regard to the presence of marrow contusion or fracture, ligament injury, traumatic disc herniation and spinal cord injury.Results
Twenty-one cases (28%) showed CTJ or upper thoracic spinal injuries (C7-T5) on cervical spinal MR images that were separated from the cervical spinal injuries. Seven of 21 cases revealed overt fractures in the CTJs or upper thoracic spines. Ligament injury in these regions was found in three cases. Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively. The incidence of the non-contiguous spinal injuries in CTJ or upper thoracic spines was higher in the axial compression injury group (35.3%) than in the hyperflexion injury group (26.9%) or the hyperextension (25%) injury group. However, there was no statistical significance (p > 0.05).Conclusion
Cervical spinal MR revealed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the non-contiguous CTJ or upper thoracic spinal injury. 相似文献4.
Stallenberg B Rommens J Legrand C de Maertelaer V Metens T Alain Gevenois P 《Skeletal radiology》2001,30(1):31-38
Objective. To evaluate the supraspinatus muscle radiodensity on the outlet view as an indication of a tendon tear.
Design and patients. Plain radiographs and magnetic resonance imaging (MRI) examinations were obtained on both shoulders of 40 subjects aged
23–70 years, including 13 asymptomatic volunteers and 27 patients. Two readers analyzed the superior contour and the heterogeneity
of the supraspinatus muscle radiodensity and compared them with the MRI findings.
Results and conclusion. Significant concordances (P<0.001) were found between the assessments of the superior contour and the heterogeneity of the muscle radiodensity, respectively,
on plain radiographs and MR images. For the diagnosis of a full-thickness tear, the analysis of the superior contour and the
heterogeneity of the muscle radiodensity reached an accuracy of 85% and 80% respectively. Stepwise discriminant analyses showed
low to moderate benefit of considering the contour and the heterogeneity simultaneously. The inter- and intraobserver agreement
ranged from moderate to good. We conclude that on the outlet view, modifications in the superior contour and heterogeneity
of the supraspinatus muscle radiodensity suggest a full-thickness tear.
Received: 6 December 1999 Revision requested: 6 March 2000 Revision received: 5 June 2000 Accepted: 4 October 2000 相似文献
5.
Objective. To demonstrate the MR depiction of the intertrochanteric or femoral neck extension of fractures of the greater trochanter,
when standard radiographs show only a fracture of the greater trochanter.
Design and patients. A retrospective review was performed of the MR and radiographic findings in 13 consecutive patients (10 men, 3 women; ages
24–86 years) with radiographic evidence of fracture of the greater trochanter who were examined with MR imaging.
Results. The MR study displayed the fracture of the greater trochanter in all cases. In all but three patients, MR examinations displayed
an extension of the fracture into the intertrochanteric region, and in one, also an extension into the femoral neck, although
the cortex at this level was not interrupted.
Conclusion. When there is radiographic evidence of an isolated fracture of the greater trochanter, MR often shows an intertrochanteric
or femoral neck extension of the fracture in both young and older adults. This finding may be a factor in determining the
need for surgical intervention.
Received: 25 January 2000 Revision requested: 31 March 2000 Revision received: 16 May 2000 Accepted: 22 May 2000 相似文献
6.
Cervical spine injury in the elderly: imaging features 总被引:2,自引:0,他引:2
An increase in the elderly population has resulted in an increased incidence of cervical spine injury in this group. No specific
type of cervical spine trauma is seen in the elderly, although dens fractures are reported to be common. Hyperextension injuries
due to falling and the resultant central cord syndrome in the mid and lower cervical segments due to decreased elasticity
as a result of spondylosis may be also characteristic. The imaging features of cervical spine injury are often modified by
associated spondylosis deformans, DISH and other systemic disorders. The value of MR imaging in such cases is emphasized.
Received: 14 April 2000 Revision requested: 30 June 2000 Revision received: 18 August 2000 Accepted: 4 October 2000 相似文献
7.
Objective. This study uses magnetic resonance (MR) imaging to delineate the types and frequencies of injuries seen in the knee after
ipsilateral femoral shaft fracture. We also compare the results of the orthopedic knee examination with the MR findings. Design and patients. MR imaging of the ipsilateral knee was performed on 34 patients with closed femoral shaft fractures. Indications for knee
MR imaging included knee pain at the time of fracture, soft tissue swelling or an effusion of the knee, or a positive knee
examination under anesthesia. The patients had a mean age of 27 years and all were stabilized with intramedullary nails. Imaging
was performed a mean time of 2.5 days after surgery. All patients had knee examinations done under anesthesia, and the MR
results were compiled and compared with the clinical examinations. Results. Ninety-seven percent of patients demonstrated knee effusions. Twenty-seven percent of patients demonstrated meniscal tears,
with the posterior horn of the medial meniscus most frequently torn. The medial collateral ligament was the most frequent
site of ligamentous injury (38%) followed by the posterior cruciate ligament (21%). Fifty percent of patients had injuries
of the extensor mechanism. Bone bruises were noted in 32% of patients. Articular cartilage injuries were confined to the patella
in four cases. One occult tibial plateau fracture and one meniscocapsular separation were seen. Conclusions. There is a common incidence of both ligamentous and meniscal injury to the knee after ipsilateral femoral shaft fracture.
MR imaging can be useful in assessing the extent of injury, and may reveal findings unsuspected after clinical examination
of the knee. 相似文献
8.
Background: Plain radiography does not visualize every cervical spine injury sustained by blunt trauma victims. The purpose of this study
was to examine the prevalence and types of injuries missed by plain radiographs of the cervical spine and determine how frequently
such radiography fails to detect any cervical spine injury. Methods: Images from all radiographic studies performed on blunt trauma victims presenting to 21 participating institutions were reviewed
to compile an exhaustive list of all CSIs sustained by each individual. These injuries were then compared with the injuries
detected by plain radiography alone. Patients were classified as having a “sentinel” injury if one or more of their injuries
were visible on plain radiographs. Patients were classified as having a radiographically “occult” injury if none of their
injuries were visible on plain radiographs. The number and types of injuries missed on plain radiographs were then separately
tabulated for the sentinel and occult injury groups. Results: Plain radiographs were completed in 570 of 818 victims of acute cervical spine injury and revealed 702 of 1,056 injuries.
Plain films failed to detect 98 occult injuries present in 60 patients (10.5 %), and failed to detect 256 secondary injuries
in 510 patients (89.5 %) who had a sentinel injury identified. Plain radiographs failed to reveal 79 of 136 (58.1 %) lateral
mass injuries and 67 of 105 (63.8 %) lamina injuries, making these the most frequent sites of missed injury. Conclusions: Plain radiographs frequently fail to reveal injuries to the cervical spine, particularly those involving the lamina and lateral
mass. The majority of the missed injuries represent secondary injuries in patients with a sentinel injury identified on these
films. However, plain films fail to detect any injury in a minority of injured patients. 相似文献
9.
Juhng SK Lee JK Choi SS Yoon KH Roh BS Won JJ 《AJR. American journal of roentgenology》2002,178(3):583-588
OBJECTIVE: The purpose of this study was to evaluate associated knee injuries using MR imaging in patients with the "arcuate" sign, a term referring to avulsion fracture of the proximal fibula on conventional radiographs. MATERIAL AND METHODS: MR imaging of 18 cases (17 patients, both knees in one patient) with the arcuate sign on conventional radiographs was retrospectively interpreted to evaluate the associated meniscal, ligamentous, and bony injuries. In 12 cases, MR findings were correlated with surgical results. RESULTS: In all cases, avulsed bony fragments from the proximal pole of the fibula were attached to the fibular collateral ligament, the biceps femoris tendon, or both. Tear of the posterolateral capsule was seen in 12 cases (67%). Injury of the cruciate ligaments was noted in 16 cases (89%): injury to both the anterior cruciate ligament and posterior cruciate ligament was seen in nine cases (50%), injury to only the anterior cruciate ligament was seen in four, and injury to the posterior cruciate ligament only was noted in three. Bone bruises or gross fractures were seen in all cases: bone bruises on the anteromedial femoral condyle were noted in nine cases (50%) and were seen on the anteromedial tibial condyle in five cases (28%). Tear of the medial meniscus was seen in five cases (28%) and tear of the lateral meniscus in four cases (22%). Injury to the popliteus was seen in six cases (33%). Joint effusion was associated in all cases. CONCLUSION: MR imaging is useful for evaluation of associated soft-tissue injuries in patients with the arcuate sign on conventional radiographs. Avulsion injury to the proximal fibula is an important indicator of the internal derangement of the knee and for predicting the mechanism of an injury with varus stress. Cruciate ligament tear and bone bruises on the anteromedial condyle of the femur and tibia are common associated findings. 相似文献
10.
Purpose: The purpose of this study is to evaluate the MR findings in patients with long-term ankylosing spondylitis (AS) and acute
cervical spine fractures. Materials and methods: The magnetic resonance imaging (MRI) studies of five patients with AS and acute cervical spine fractures were retrospectively
reviewed for the presence of cervical spine instability, spinal cord compression, and epidural hematoma. Results: Spinal fractures were unstable in all five patients. Three patients had neurological symptoms and abnormal signal within
the spinal cord. All patients with neurological deficits had epidural hematomas posterior to the dural sac. Conclusion: MRI is useful for assessment of the integrity of intervertebral disks and spinal ligaments and, therefore, of the instability
of the spinal fracture. MRI is mandatory in patients with neurological symptoms, especially in those with a symptom-free interval
and those with neurological deterioration after established spinal cord injury, when suspicion for epidural hematoma is high.
Electronic Publication 相似文献
11.
Pectoralis major muscle and tendon tears: diagnosis and grading using magnetic resonance imaging 总被引:1,自引:0,他引:1
Carrino JA Chandnanni VP Mitchell DB Choi-Chinn K DeBerardino TM Miller MD 《Skeletal radiology》2000,29(6):305-313
Objective. To assess the accuracy and utility of magnetic resonance (MR) imaging in the detection and grading of pectoralis major muscle
and tendon tears.
Design and patients. A retrospective review was carried out of 10 patients referred for MR imaging for suspected pectoralis muscle injury and
possible operative therapy. The pectoralis muscle and tendon were imaged using thin (3–4 mm) axial sections with a variety
of sequences combined for anatomical delineation (T1-weighted SE or PD SE) and fluid detection (T2-weighted SE, T2-weighted
FSE with fat suppression, or STIR). Surgical correlation was available in six patients. Clinical follow-up was available in
four patients treated by nonoperative therapy.
Results. MR imaging identified five complete tears, four partial tears and one normal tendon. One complete and one partial tear were
at the myotendinous junction. The remaining seven injuries were at the enthesis. Surgical correlation consisted of five complete
tears and one partial tear. One complete and one partial tear were at the myotendinous junction with the remaining four complete
tears at the enthesis. The MR interpretation and surgical findings were in agreement in all six cases. All four patients treated
with nonoperative therapy demonstrated improvement at a clinical follow-up examination, with restoration of function and strength
consistent with a healed prior partial injury.
Conclusion. MR imaging is accurate and useful in detecting and grading tears involving the pectoralis major muscle and tendon, facilitating
the identification of patients with complete tears who are candidates for operative therapy.
Received: 7 June 1999 Revision requested: 22 June 1999 Revision received: 16 February 2000 Accepted: 21 February 2000 相似文献
12.
Marginal erosive discovertebral ”Romanus” lesions in ankylosing spondylitis demonstrated by contrast enhanced Gd-DTPA magnetic resonance imaging 总被引:5,自引:0,他引:5
Objective. To assess the value of Gd-DTPA magnetic resonance (MR) imaging in the demonstration of marginal destructive discovertebral
Romanus lesions in ankylosing spondylitis.
Design and patients. A prospective study of Gd-DTPA MR imaging was performed in 39 patients with a clinical diagnosis of ankylosing spondylitis
and typical Romanus lesions seen on radiographs of the thoracolumbar spine. MR morphological appearances and signal intensity
changes at the discovertebral junctions were analysed and compared with the radiographic findings.
Results. Ninety-nine discovertebral junctions with Romanus lesions showed low signal intensity on T1-weighted and high signal on
T2-weighted and T1-weighted postcontrast images at the vertebral corners consistent with oedematous hyperaemic inflammatory
tissue. There were nine discovertebral junctions with similar MR findings but normal radiographs. Fifty-three discovertebral
junctions showed syndesmophyte formation with increased signal intensity on both T1- and T2-weighted images with no contrast
enhancement. Sixty-five discovertebral junctions showed a mixture of radiographic features and varied high and low signal
changes at the vertebral rim on MR imaging with rims of enhancement in the vertebral body following contrast administration.
Conclusion. Gd-DTPA MR imaging demonstrates a variable signal pattern and degree of contrast enhancement which may reflect the evolutionary
stages of discovertebral enthesitis in ankylosing spondylitis. MR imaging may identify early erosive changes in radiographically
normal vertebra. The role of MR imaging needs further investigation.
Received: 6 April 1998 Revision requested: 7 May 1998 Revision received: 26 October 1999 Accepted: 27 October 1999 相似文献
13.
Objective. To examine the incidence, radiographic and histologic findings of medial femoral neck buttressing in a consecutive group of
patients undergoing total hip arthroplasty.
Design. Biomechanical parameters were evaluated on standard anteroposterior pelvic radiographs of 113 patients prior to hip replacement
surgery. Demographic information on all patients was reviewed and histologic evaluation was performed on specimens obtained
at the time of surgery.
Results. The incidence of medial femoral neck buttressing was found to be 50% in a consecutive series of patients undergoing total
hip arthroplasty. The incidence was slightly higher in women (56% vs 41%). Patients with buttressing had increased neck-shaft
angles and smaller femoral neck diameters than were seen in patients without buttressing. Histologic evaluation demonstrated
that the buttress resulted from deposition bone by the periosteum on the femoral neck in the absence of any evidence of femoral
neck fracture.
Conclusion. It would appear that femoral neck buttressing occurs in response to increased joint reactive forces seen at the hip being
transmitted through the femoral neck. The increased joint reactive force can be related to the increased neck shaft angle
seen in patients with buttressing.
Received: 22 July 1999 Revision requested: 27 October 1999 Revision received: 31 March 2000 Accepted: 22 May 2000 相似文献
14.
Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected 总被引:2,自引:0,他引:2
Objective. To describe the prevalence, location and sports distribution of pelvic avulsion fractures in adolescent competitive athletes.
Design and patients. One thousand two hundred and thirty-eight radiographs of the pelvis taken for focal traumatic symptoms in athletes with
an age range of 11–35 years over a period of 22 years were reviewed.
Results. One hundred and ninety-eight adolescent athletes were affected by 203 avulsion fractures of the pelvic apophyses (five cases
presented multiple locations). The localisation was the ischial tuberosity (IT) in 109 cases, anterior inferior iliac spine
(AIIS) in 45 cases, anterior superior iliac spine (ASIS) in 39 cases, superior corner of pubic symphysis (SCPS) in 7 cases
and iliac crest (IC) in 3 cases. Soccer (74 cases) and gymnastics (55 cases) were the sports with the highest number of avulsion
fractures documented.
Conclusions. Apophyseal avulsion fractures of the pelvis in adolescent competitive athletes are most common in soccer and gymnastics.
The lesions are usually the consequence of sudden and forceful muscle-tendon contractions during sport activities. Plain radiographs,
are determinant for the diagnosis.
Received: 5 November 2000 Revision requested: 8 February 2000 Revision received: 26 October 2000 Accepted: 20 November 2000 相似文献
15.
Objective. This study was designed to compare diagnostic quality of MR images of patients with spinal hardware acquired using a conventional
T1-weighted spin-echo sequence and a new metal artifact reduction sequence (MARS).
Conclusion. The new MARS sequence effectively reduces the degree of tissue-obscuring artifact produced by spinal fixation hardware and
subjectively improves image quality compared with the conventional T1-weighted spin-echo sequence.
Received: 30 May 2000 Revision requested: 12 September 2000 Revision received: 27 September 2000 Accepted: 27 November 2000 相似文献
16.
Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease 总被引:1,自引:1,他引:0
Objective. Signal intensity changes in lumbar pedicles, similar to those described in vertebral body endplates adjacent to degenerated
discs, have been described as an ancillary sign of spondylolysis on MRI. The purpose of this study was to determine whether
pedicle marrow signal intensity changes also occur in association with facet degenerative joint disease.
Design. Eighty-nine lumbar spine MRI examinations without spondylolysis were reviewed for marrow signal intensity changes in pedicles
and vertebral bodies as well as for facet degenerative joint disease.
Results. Five percent (46/890) of lumbar pedicles in 23 patients had marrow signal intensity changes. Ninety-one percent (42/46)
of the abnormal pedicles had adjacent degenerative joint disease of the facets, while only 21% (189/890) of normal pedicles
had adjacent facet degenerative joint disease (p<0.001). Eighty-nine percent (41/46) of the pedicles with marrow signal intensity changes had adjacent degenerative disc disease.
Conclusions. Pedicle marrow signal intensity changes are not a specific sign of spondylolysis; they are commonly seen with adjacent facet
degenerative joint disease in the absence of spondylolysis. Pedicle marrow signal intensity changes are probably a response
to abnormal stresses related to abnormal motion or loading caused by the degenerative changes in the spinal segment.
Received: 2 May 2000 Revision requested: 18 July 2000 Revision received: 25 August 2000 Accepted: 1 September 2000 相似文献
17.
Subchondral changes in transient osteoporosis of the hip 总被引:7,自引:0,他引:7
Keita Miyanishi T. Yamamoto Yasuharu Nakashima Toshihide Shuto Seiya Jingushi Yasuo Noguchi Yukihide Iwamoto 《Skeletal radiology》2001,30(5):255-261
Objective. To review the subchondral changes on MR imaging in transient osteoporosis of the hip (TOH) and to consider the pathophysiology.
Design and patients. MR images of 12 hips of 11 consecutive patients with TOH were retrospectively studied. The diagnoses of TOH were confirmed
on the basis of previously published criteria, including decreased bone density of the femoral head and/or neck on radiographs,
bone marrow edema (BME) pattern on MR images, spontaneous resolution of the symptoms and a return to normal radiodensity.
Results. All 12 hips showed a BME pattern in the femoral head and/or neck. Linear patterns of very low signal intensity were identified
on T1-weighted images in the subchondral area within the diffuse low signal intensity area in all 12 hips. On T2-weighted
images, a low signal intensity line was observed in the corresponding area in eight hips only. These linear patterns were
thought to represent subchondral fracture lines.
Conclusions. The presence of a subchondral fracture may be important when considering the pathophysiology of TOH.
Received: 5 April 2000 Revision requested: 11 July 2000 Revision received: 22 January 2001 Accepted: 29 January 2001 相似文献
18.
Aim of work
The aim of this work is to assess the role of multi-detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in evaluation of spinal trauma.Patients and methods
Between January 2013 and April 2014, 98 patients (78 males and 20 females) with spinal injuries were investigated by MDCT and MRI. Assessment of the radiological findings of spinal injury was performed and the following were investigated: vertebral compression fractures, bursts and dislocations, posterior element fractures, C1 and C2 lesions, vertebral listhesis, bone marrow edema, spinal canal compression, disk herniation, extradural hematoma, spinal cord contusions, spinal cord swelling and posterior ligamentous complex injuries.Result
A total of 271 lesions were diagnosed as follows: 217 lesions were diagnosed using MRI alone, 1 54 lesions were diagnosed using MDCT alone and 100 lesions were diagnosed using MRI and MDCT conjointly. By using MRI 117 more lesions were detected than using MDCT. MRI was significantly superior to MDCT in the diagnosis of bone marrow edema, posterior ligamentous complex injuries, disk herniations, spinal canal compressions, and spinal cord contusions and edema. In cervical spine injuries, MRI was useful for the evaluation of the supporting ligaments and the spinal cord after the patient has been stabilized. The average times required to perform CT and MRI were 1.38 ± 19.83 and 2.00 ± 19.58 days, respectively; this difference was significant (p?0.05) according to the Mann–Whitney test.Conclusion
MRI was significantly superior to MDCT in the diagnosis of bone marrow edema, posterior ligamentous complex injuries, disk herniations, spinal canal compressions, and spinal cord contusions and edema. In cervical spine injuries, MRI was useful for the evaluation of the supporting ligaments and the spinal cord after the patient has been stabilized.MDCT and MRI are complementary to each other in evaluation of spine injuries. 相似文献19.
Liam D. Spence Arnold Savenor I. Nwachuku John Tilsley S. Eustace 《Skeletal radiology》1998,27(5):244-249
Objective. To compare the evaluation of fractures of the distal radius with MRI and conventional radiographs. To demonstrate the ability
of MRI to detect unsuspected soft tissue derangement accompanying this common injury. Design and patients. Twenty-one consecutive inpatients admitted following fracture of the distal radius underwent preoperative evaluation with
both conventional radiographs and MRI. In each case, analysis was made of both the osseous and soft tissue injury. MRI findings
were compared with those identified on conventional radiographs and at subsequent surgical fixation. Results. Of 21 patients with fractures of the distal radius, 20 had extension to the radiocarpal articulation, 14 had distal radio-ulnar
joint extension and 5 had avulsion of the ulnar styloid.Occult carpal bone fractures accompanying fracture of the distal radius
were identified in two patients: one of the capitate and the other of the second metacarpal base. Ten patients (48%) had associated
soft tissue injury: six patients had scapholunate ligament rupture, two patients had disruption of the triangular fibrocartilage,
one patient had extensor carpi ulnaris tenosynovitis and one patient had a tear of a dorsal radiocarpal ligament. Of five
patients with ulnar styloid avulsions, none had evidence of triangular fibrocartilage tears. Conclusion. MRI affords better evaluation of osseous injury accompanying distal radial fractures than conventional radiographs. Intra-articular
soft tissue injury accompanies distal radial fractures in almost 50% of cases. Scapholunate ligament disruption commonly accompanies
intra-articular fracture through the lunate facet of the distal radius. Fracture of the ulnar styloid is infrequently associated
with tear of the triangular fibrocartilage. 相似文献
20.
Objective. Prevertebral soft tissue swelling (PVSTS) is an important marker of spinal trauma. In patients with missed or occult cervical
fractures, it may be the only indication of serious injury. It has been anecdotally suggested that PVSTS is not useful following
placement of a nasogastric (NGT) or endotracheal (ETT) tube because of possible iatrogenic trauma and/or soft tissue compression.
Consequently, we investigated trauma patients for evidence of PVSTS, comparing radiographs performed before and after placement
of NGTs and/or ETTs.
Design and patients. PVSTS at the C2 and C6 levels was measured on lateral cervical spine radiographs in 102 patients with cervical spine fractures.
Measurements were obtained in 66 patients before and after placement of either an NGT (23), ETT (8), or both an NGT and ETT
(35). They were also obtained in 36 control patients with fractures and neither an NGT nor ETT, at presentation and after
an interval temporally matched to that in the patients with tubes in place.
Results. The group with ETTs showed variable changes to PVSTS (31% increase, 63% decrease, and 6% no change). The group with NGTs
also showed variable changes to PVSTS (33% increase, 53% decrease, and 13% no change). The group with ETTs and NGTs similarly
showed variable changes to PVSTS (25% increase, 72% decrease, 3% no change). Surprisingly, the control group showed similar
temporal changes without tube placement (49% increase, 36% decrease, 13% no change). Analyses using the one-tailed F-test of the ratio of the variance of the tube to non-tube groups and the Mann-Whitney test were performed. No significant
difference was found in the prevertebral soft tissues at the C2 level between those with tubes in place and the control subjects.
However, at the C6 level there was statistical significance between the groups with NGTs and both NGTs and ETTs versus the
non-tube groups. Probability under the F-test for the groups with NGTs and both NGTs and ETTs was 0.001 and 0.005, respectively. Under the Mann-Whitney test, P values for groups with NGTs and both NGTs and ETTs were 0.0002 and 0.0001, respectively.
Conclusion. The appearance of PVSTS showed variable and unpredictable changes following ETT, NGT, or combined ETT/NGT placement at the
C2 level. This appears to be an artifact of temporal changes. However, at the C6 level, the presence of PVSTS following NGT
or ETT and NGT placement (but not ETT placement alone) may be an accurate indirect sign of cervical spine injury.
Received: 14 September 1999 Revision requested: 30 December 1999 Revision received: 4 February 2000 Accepted: 8 February 2000 相似文献