Measurement of scoliosis by orthopedic surgeons and radiologists

Minimum medical standards for USAF flying personnel have been compiled in Air Force Regulation 160-43. This regulation specifies the maximum allowable amount of scoliosis, but does not specify who should read the X-ray film to determine, using the Cobb method, the degree of curvature in scoliotic individuals. In the present study, an X-ray of an individual with mild scoliosis was sent to departments of radiology and orthopedics at major U.S. Armed Forces Medical Centers. Although the mean estimated degree of curvature was the same for both the orthopedists and the radiologists, the variance in the radiologists' replies was considerably higher than normally expected. It is, therefore, recommended that scoliosis films of individuals being screened for flying duties should be reviewed by a qualified orthopedic surgeon.     

Taking medicine back: Dx and Rx for orthopedic surgeons

The present day practice of medicine is cause of considerable malaise for physicians. This article will invoke the ancient proverb, "Physician Treat Thyself". In other words this article addresses the problems from a diagnostic and therapeutic perspective, working toward a permanent cure. The history of medical practice groups, in-office surgery, and ancillary services is reviewed. The co-morbidity of health maintenance organizations, Evaluation and Management requirements, and cost shifting are mentioned. Finally a list of symptoms and the appropriate therapeutic measures are administered to control costs, increase income, and re-establish some form of authority in the practice of medicine.     

骨科医生职业病的认知现状及健康管理

分析骨科行业从业人员容易罹患的辐射损伤、颈腰椎疾病、消化道疾病等职业损伤类型,针对骨科医生对职业病存在的认知误区如认知程度不足、防治措施不清、重视程度不够等现状,提出休假制度保障、健康管理师授课、加强自我防护能力等方法进行骨科职业病的健康管理策略。     

Microfracture for knee chondral defects: a survey of surgical practice among Canadian orthopedic surgeons

Purpose

The purpose of this study was to describe the practice of microfracture surgery for knee chondral defects among Canadian orthopedic surgeons.

Methods

All orthopedic surgeon members of the Canadian Orthopaedic Association were invited to participate in a survey, designed to explore the microfracture technique used by orthopedic surgeons in the treatment for knee chondral defects The primary outcome measure was an emailed 26-item questionnaire, which explored indications for microfracture surgery, surgical techniques, types of postoperative rehabilitation regimes used and assessment of outcome. In addition, responses were compared between orthopedic surgeons with a sports medicine practice to surgeons with a non-sports medicine practice.

Results

The survey response rate was 24.6% (299/1,216), with 131 regularly performing microfracture. 41% of surgeons indicated that they had no upper limit for age at the time of surgery, and 87% indicated no upper limit for body mass index. The majority of respondents (97%) resected cartilage back to a stable margin, while 69% of respondents removed the calcified cartilage layer prior to creating holes. Only 11% of respondents used continuous passive motion (CPM) postoperatively, and 39% did not restrict weight bearing. Sports surgeons were more likely than non-sports surgeons to remove the calcified cartilage layer, use a 45° pick, use CPM and restrict weight bearing postoperatively (all P values?<?0.05).

Conclusions

This survey on microfracture for knee chondral defects revealed widespread variation among surgeons regarding the indications for surgery, surgical technique, postoperative rehabilitation and assessment of outcome. Sports surgeons demonstrate better evidence-based practice than non-sports surgeons for a few important parameters.

Level of evidence

Cross-sectional survey, Level II.     

Current practice in shoulder pathology: results of a web-based survey among a community of 1,084 orthopedic surgeons

Purpose  

The aim of this study was to report orthopedic surgeons’ management of choice for difficult clinical scenarios of shoulder pathologies.     

Quantitative assessment of intervertebral disc glycosaminoglycan distribution by gadolinium-enhanced MRI in orthopedic patients.

Our hypothesis was that the enhanced MRI of cartilage (dGEMRIC) imaging protocol could be used in patients to quantify the sulfated glycosaminoglycan (sGAG) in intervertebral discs (IVD). To test this hypothesis, 23 patients with degenerative disc pathology scheduled for surgery were studied by a specific dGEMRIC protocol: each patient underwent two MRI scans, before and 3.5 hr after Gd(DTPA)2-injection of a nonconventional dose of 40 mL. Then, T(1PRE-ENH) and T(1POST-ENH) parametric images of the disc were obtained, from which a new index DeltaT(1) of the molecular status of the IVD was computed (T(1PRE-ENH) - T(1POST-ENH)). A total of 31 tissue samples (one or two from each patient) obtained at herniectomy were collected and biochemically analyzed for sGAG content and used as the gold standard for comparison. DeltaT(1) values in correspondence to degenerated sectors were higher (158 +/- 36 ms) compared to normal sectors (80 +/- 13 ms). Linear regression analysis between MRI-derived and biochemistry-derived measurements resulted in a significant correlation (r = 0.73, P < 0.0001). The DeltaT(1) parametric images, calculated using the modified dGEMRIC technique, provided noninvasive quantitative information about sGAG content within discal tissue in vivo, which resulted in agreement with biochemical analysis. The application of this new MRI method could provide diagnostic information for standard treatment of lumbar discopathy and for innovative therapies of regenerative medicine.     

Predicting neuroradiologic outcome in patients referred for audiovestibular dysfunction.

PURPOSETo relate clinical presentation and results of audiovestibular testing to neuroradiologic outcome in patients with audiovestibular dysfunction.METHODSWe retrospectively reviewed the neuroimaging studies, results of audiometric and vestibular testing, and medical records of 118 patients referred for imaging over a 2-year period for evaluation of sensorineural hearing loss, dizziness, and/or vertigo, and to rule out acoustic neuroma. Patients'' presentation and results of audiometric and vestibular testing were associated with either a positive or negative neuroimaging outcome. Discriminant analysis was performed to identify variables related significantly to imaging results. Two-way cross-tabulation of these significant variables was performed to assess their sensitivity and specificity in predicting imaging outcome.RESULTSFifteen (13%) of 118 patients had neuroimaging findings related to presenting symptoms. Discriminant analysis identified vertigo, dizziness, and dysequilibrium as corresponding to negative radiologic outcome. Nonvestibulocochlear cranial nerve involvement correlated significantly with positive neuroimaging results. Of all audiovestibular testing, only vestibular testing results correlated significantly with neuroimaging outcome. In conjunction with the results of vestibular testing the symptoms and signs identified above yielded a sensitivity of 57% and specificity of 93% in predicting neuroradiologic results. In the absence of vestibular testing, sensitivity and specificity were 29% and 98%, respectively.CONCLUSIONSClinical presentation and audiovestibular testing could not sensitively predict the outcome of neuroimaging in our cohort of patients referred for audiovestibular dysfunction.     

Congenital and acquired orthopedic abnormalities in patients with myelomeningocele.

This article presents a radiologic review of the spectrum of acquired and congenital orthopedic abnormalities found in patients with myelomeningocele. These abnormalities are caused predominantly by muscle imbalance, paralysis, and decreased sensation in the lower extremity. Iatrogenic injury, such as a postoperative tethered cord, may also cause bone abnormalities. Selected images were obtained from more than 800 children. Important entities presented include spinal curvatures such as kyphosis, scoliosis, and lordosis; subluxation and dislocation of the hip, coxa valga, contractures of the hip, and femoral torsion; knee deformities; rotational abnormalities of the lower extremity and external and internal torsion; ankle and foot abnormalities such as ankle valgus, calcaneus foot, congenital vertical talus (rocker-bottom deformity), and talipes equinovarus; and metaphyseal, diaphyseal, and physeal fractures. Familiarity with congenital abnormalities and an understanding of the pathogenesis of acquired disorders in patients with myelomeningocele are essential for proper radiologic interpretation and timely therapy.     

骨科患者夜间疼痛的原因分析及护理

骨科患者一般需要外科手术治疗和住院观察,手术后夜间由于麻醉作用消失,环境安静,孤独感增强,疼痛感会格外强烈,严重者会影响患者睡眠,进而造成免疫力下降,导致伤情延迟恢复,影响机体康复及生活质量[1].故术后夜间疼痛的护理非常重要.笔者回顾性总结136例术后夜间疼痛患者的护理经验,现报告如下.     

合并骨与关节损伤多发伤患者的评估及救治

随着全球城市化进程的高速发展,特别是交通、工业以及高层建筑事业的飞速发展,多发伤发生率日益增多,严重威胁人类生命安全和健康。若处置不规范,常可增加伤残率和病死率。重视多发伤患者的院前急救和入院后的规范处理,能明显降低患者的病死率、致残率。强化培训,建好各级医疗体系、各阶段的急诊救治工作,可以提高多发伤诊断的准确率,降低误诊率及漏诊率,提高救治成功率,降低病死率等。规范地处理多发伤患者的骨与关节损伤,可以明显提高多发伤患者救治满意度,最大程度恢复其机体功能。充分认识和正确处理多发伤患者的骨与关节损伤,为进一步提高多发伤的救治水平提供有效的支撑。     

Incidence of adrenal masses in patients referred for renal artery stenosis screening MR

RATIONALE AND OBJECTIVES: Prior work has shown the efficacy of magnetic resonance (MR) in renal artery stenosis evaluation. The increasing role of renal artery stenosis in the differential diagnostic evaluation of hypertension raises the question of whether MR should be used as a screening modality. This project evaluated the additional potential benefits of MR by determining the incidence of adrenal masses in this selected population. METHODS: A 2-year retrospective study analysis of patients who failed to respond to antihypertensive medical management and were referred for renal MR for hypertension amassed 77 subjects ranging in age from 18 to 88 years. A masked analysis for adrenal masses was performed on this data set. Magnetic resonance techniques included T2-weighted turbo spin-echo (repetition time [TR] 2000-4000 ms, echo time [TE] 80-100 ms, turbo factor 2-16), T1-weighted spin-echo (TR 200-500 ms, TE 10-30 ms), gradient-echo time-of-flight (TR 26 ms, TE 6.9 ms, 40 degrees flip angle, 2 excitations), and dynamic gadopentetate dimeglumine-enhanced MR angiography (three-dimensional gradient recalled echo, TR 10 ms, TE 3 ms, 40 degrees flip angle, 1 excitation). RESULTS: Thirty-three patients had renal artery disease, 44 had normal renal arteries, and 7 had adrenal masses. Forty-three percent of patients who underwent renal MR had disease of the renal arteries detected, and 9% of patients referred for MR had adrenal masses that would have been missed with scintigraphy and/or angiography, of which 57% were responsible for hypertension. CONCLUSIONS: The ability to evaluate renal artery and adrenal anatomy globally can be useful, as exemplified in the current series, and the adrenals should be examined carefully in any renal MR in a hypertensive patient.     

Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme

Objectives

Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM.

Methods

During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar’s test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities.

Results

Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0 % (+3.1 %), specificity to 87.7 % (+45.7 %), PPV to 76.2 % (+36.5 %) and NPV to 100.0 % (+2.9 %) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p?<?0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p?<?0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed.

Conclusion

CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening.

Key Points

? CESM is feasible in the workflow of referrals from routine breast screening. ? CESM is superior to mammography, even in low disease prevalence populations. ? CESM has an extremely high negative predictive value for breast cancer. ? CESM is comparable to MRI in assessment of breast cancer extent. ? CESM is comparable to histopathology in assessment of breast cancer extent.     

Diagnostic accuracy of MDCT coronary angiography in patients referred for heart valve surgery

Purpose

The aim of our study was to evaluate the role of multidetector-row computed tomography (MDCT) in patients referred for heart valve surgery. We studied the diagnostic performance of CT coronary angiography (CTCA) compared with conventional coronary angiography (CCA) before valve surgery.

Materials and methods

During a 13-month period, 55 consecutive patients under evaluation for aortic (40/55) or mitral valve (15/55) disease before potential valve replacement underwent CTCA using a 64-detector-row scanner within 2 months of CCA for comparative purposes. All 17 major coronary artery segments were evaluated by one observer and compared with the reference standard. Patient-based, vessel-based and segment-based analyses of the data were performed.

Results

Prevalence of significant coronary artery disease, defined as having at least one stenosis ≥50% per patient, was 36%. On a patient-based analysis, sensitivity, specificity and positive and negative predictive values were 100%, 91%, 83% and 100%, respectively.

Conclusions

The diagnostic accuracy of 64-row CTCA for ruling out the presence of significant coronary stenoses in patients undergoing valve surgery is excellent and allows CTCA to be used as a gatekeeper for invasive CCA in these patients. MDCT is a necessary preoperative examination that provides useful information for identifying potential operative complications of surgical procedures.     

影响创伤骨科患者术后疼痛的相关因素研究

目的探讨创伤骨科患者术后疼痛的影响因素。方法回顾性分析2011年9月—2015年9月武汉市东西湖区人民医院收治的224例创伤骨科患者行外科手术治疗的临床资料,根据患者术后主诉情况分为疼痛组(n=89)与非疼痛组(n=135)。采用多元Logistic回归模式对创伤骨科患者术后疼痛的相关影响因素进行观察、分析。结果疼痛组患者平均年龄较低、女性、性格外向、高学历、心理状态不佳、体位不当,治疗过程中牵引、外固定等,医护人员对疼痛评估知识缺乏比例均显著高于非疼痛组(P0.05),但两组患者骨折部位及骨折原因方面的差异均无统计学意义(P0.05);经多元Logistic回归模型分析,最终得出影响创伤骨科患者术后疼痛相关因素包括:年龄、性别、性格、文化程度、心理状态、体位、治疗中的因素以及医护人员自身因素(P0.05)。结论影响创伤骨科患者术后疼痛相关因素较多,应注意对这些因素的密切观察,并采取相关处理措施,以改善患预后状况。     

骨科病人伤口应用负压封闭引流的护理观察

伤口引流是骨科治疗中的主要治疗方法之一。伤口引流是否彻底、有效,常常对疾病的治愈起着决定性的作用。2005年6月-2008年10月,我科将高负压封闭引流应用于慢性化脓性骨髓炎和术后愈合较差分泌物多的伤口,通过护理人员的仔细观察和精心护理,取得了较满意的效果,现介绍如下。     

急性高容血液稀释联合控制性降压在骨科手术中应用的观察

目的 观察急性高容量血液稀释（AHH）联合控制性降压（CH）对骨科手术患者血液动力学、氧代谢的影响。方法 择期骨科手术患者48例,ASAⅠ～Ⅱ级,随机分为2组,每组24例：A组为对照组;B组为AHH联合CH组。两组患者均采用全身麻醉,术中连续监测平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）、心电图（ECG）、脉搏血氧饱和度（SPO2）和尿量。分别于稀释前插管后（T0）、稀释后即刻（T1）、稀释后1h（T2）、术毕（T3）测定血红蛋白（Hb）、红细胞压积（Hct）、乳酸、动脉血氧含量（CaO2）及凝血指标等变化,并计算氧摄取率（ERO2）,术中记录输血量、输液量和失血量。结果 与A组比较,B组术中失血量、平均输血量以及输血例数减少（P〈0.01）,尿量增多（P〈0.01）。与T0比较,B组AHH后CVP升高（P〈0.01）;两组AHH后Hb、Hct、CaO2均明显下降（P〈0.01）,但两组间同期比较差异无显著性意义。两组ERO2、乳酸各时点及组间比较变化无显著性差异（P〉0.05）。B组PLT、FIB在AHH后、术毕均显著降低（P〈0.01）,但两组间差异无显著性意义。两组患者其他凝血机能指标（PT、TT、APTT）手术前后均无明显变化。结论 术前急性高容量血液稀释联合控制性降压能较好维持骨科手术患者机体血液动力学和氧代谢的相对稳定,显著减少出血量和异体输血。     

Comparing diagnosis of midfacial fractures by radiologists and plastic surgeons

Emergency Radiology - Clinicians who manage facial fractures often rely on radiologist interpretations to help with assessment and management. Among treating physicians, facial fractures are...