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后Pilon骨折是垂直压缩暴力与扭转暴力共同作用产生的特殊类型后侧胫骨远端关节内骨折,其损伤机制类似于Pilon骨折,临床上却容易误诊为经典的Volkmann骨折或漏诊。影像学诊断主要依靠X线、CT平扫及三维成像进一步明确判断骨折的形态和类型。非手术治疗难以获得满意的预后效果,临床多主张手术治疗。而治疗不当易导致踝关节功能障碍以及创伤性关节炎,因此诊断明确、患者体位、手术入路、复位策略及固定方式等都将影响到手术效果。 相似文献
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胫骨远端累及关节面的骨折临床上处理起来十分棘手,尤其是高能量损伤所致的Pilon骨折,其骨折复杂,软组织损伤严重,治疗更加困难.笔者对我院2003年5月-2006年5月施行手术治疗的Pilon骨折患者进行了回顾性分析,探讨其最佳手术时机和治疗方法.现报告如下. 相似文献
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目的 探讨Pilon骨折合并同侧跟骨骨折的治疗方法 . 方法 本组坠落伤7例,交通伤2例,重物砸伤1例,ISS评分为5~22分.开放性损伤7例,闭合性损伤3例.9例骨折达AO/OTA各分型中的2~3度,6例跟骨为关节内塌陷粉碎骨折.6例Pilon骨折行切开复位空心钉、螺钉或克氏针同定,其中4例加外固定架固定,跟骨骨折行撬拨复位克氏针或空心钉同定;2例单纯行跟骨骨折克氏针固定,2例两处骨折保守治疗. 结果 6例胫骨远端和跟骨骨折手术治疗者骨折对位改善;保守治疗者出现骨折成角畸形,关节面塌陷.7例伤几愈合良好,3例软组织愈合不良.4例随访患者踝-后足评分为82~94分. 结论 Pilon骨折合并同侧跟骨骨折为高能量暴力所致,局部软组织及骨组织损伤严重,有限内固定加外同定是比较适宜的治疗选择. 相似文献
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The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and
neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications
which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation
intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal
cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor
stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can
be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography,
are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant. 相似文献
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This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread. 相似文献
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Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease. 相似文献
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Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium. 相似文献