微创经皮钢板内固定治疗胫骨平台骨折35例分析

目的：总结微创经皮钢板接骨术（MIPPO）治疗胫骨平台骨折的手术方法和临床效果。方法：采用MIPPO技术治疗胫骨平台骨折35例,其中男22例,女13例,平均年龄40.6岁（21～66岁）。按Schatzker分类法,将胫骨平台骨折分为6型：I型7例;Ⅱ型3例;Ⅲ型5例;Ⅳ型5例;V型8例;VI型7例。结果：所有患者获得有效随访,骨折均愈合。术后1例有浅表伤口感染,经保守治疗获愈合;未发生内固定物断裂、深静脉栓塞、创伤性关节炎、关节腔感染的并发症。最终随访时HSS膝关节功能评分为68～95分（平均88分）,Lysholm评分为71～96分（平均89分）。结论：MIPPO在治疗胫骨平台骨折中具有创伤小、固定确实、感染率低、骨折愈合率高等优点,符合生物学固定理念。     

内外侧锁定钢板治疗中老年胫骨平台 SchatzkerⅤ、Ⅵ型骨折疗效观察

目的：通过应用锁定钢板治疗复杂中老年胫骨平台骨折,观察其临床疗效,探讨中老年胫骨平台复杂骨折的治疗方法。方法2009年3月～2012年6月,采用锁定钢板治疗中老年复杂胫骨平台骨折22例,男18例、女4例;年龄40～55岁,平均48岁。骨折按Schazker分型：Ⅴ型13例,Ⅵ型9例。术中取内后侧切口及前外侧切口,于胫骨前外侧及后内侧置入锁定钢板进行内固定。患者术后1个月、3个月,半年及1年常规摄X线片。术后3个月后逐渐完全负重,最后1次随访时按Honkonen-Jarvinen 标准对患者进行评分。结果22例均获随访,时间12～24个月,平均18个月,骨折平均愈合时间5个月。骨折愈合20例,延迟愈合2例。结论锁定钢板治疗中老年复杂胫骨平台骨折提供了持续稳定的固定,防止骨折的Ⅱ期移位和膝关节力线改变,术后膝关节功能恢复满意。     

内外侧锁定钢板治疗中老年胫骨平台SchatzkerⅤ、Ⅵ型骨折疗效观察

目的通过应用锁定钢板治疗复杂中老年胫骨平台骨折,观察其临床疗效,探讨中老年胫骨平台复杂骨折的治疗方法。方法2009年3月～2012年6月,采用锁定钢板治疗中老年复杂胫骨平台骨折22例,男18例、女4例;年龄40～55岁,平均48岁。骨折按Schazker分型：Ⅴ型13例,Ⅵ型9例。术中取内后侧切口及前外侧切口,于胫骨前外侧及后内侧置入锁定钢板进行内固定。患者术后1个月、3个月,半年及1年常规摄x线片。术后3个月后逐渐完全负重,最后1次随访时按Honkonen—Jarvinen标准对患者进行评分。结果22例均获随访,时间12—24个月,平均18个月,骨折平均愈合时间5个月。骨折愈合20例,延迟愈合2例。结论锁定钢板治疗中老年复杂胫骨平台骨折提供了持续稳定的固定,防止骨折的Ⅱ期移位和膝关节力线改变,术后膝关节功能恢复满意。     

胫骨平台伴髁间嵴骨折手术治疗的临床疗效

目的：探讨开放复位内固定治疗胫骨平台伴髁间嵴骨折的临床疗效。方法2007年6月～2011年6月对收治的42例胫骨平台伴髁间嵴骨折采用切开复位钢板内固定治疗,同时行钢丝固定髁间嵴骨折36例,6例未固定。胫骨平台骨折按Schatzker分型：Ⅲ型8例,Ⅳ型18例,Ⅴ型10例,Ⅵ型6例;胫骨髁间嵴骨折按Meyers McKeever分型：Ⅰ型6例,Ⅱ型17例,Ⅲ型13例,Ⅳ型6例。结果术后1例切口发生脂肪液化并感染,经清创、负压吸引及II期缝合后愈合,余伤口均Ⅰ期愈合。随访12～26个月,平均18个月。末次随访时,患者膝关节伸直均达到0°,屈膝80°～150°,平均122°;膝关节稳定性检查：3例Lachman试验及前抽屉试验（ ADT）为阳性;参照Rasmussen膝关节功能评分标准：优16例,良19例,可4例,差3例;优良率为83.3％。7例发生膝关节创伤性关节炎,3例胫骨髁间嵴骨折未愈合。结论手术治疗胫骨平台伴髁间嵴骨折应重视对髁间嵴骨折的固定,包括无移位的髁间嵴骨折,有利于术后早期功能锻炼及维持膝关节稳定。     

关节镜辅助下微创手术治疗胫骨平台骨折

目的 观察膝关节镜辅助下微创经皮螺钉内固定术治疗胫骨平台骨折的临床疗效。方法 2001年1月-2006年1月采用膝关节镜辅助下微创经皮螺钉内固定术治疗45例胫骨平台骨折。其中男34例，女11例；年龄17岁～66岁，平均34岁。闭合性骨折38例，开放性骨折7例（刀砍伤、重物砸伤）。按Schatzker分型：Ⅰ型8例，Ⅱ型22例，Ⅲ型15例。结果 45例患者随访12～72个月，平均38个月。术后膝关节功能评价参照Rasmussen评分标准：优29例，良13例，中3例，优良率为93．3％。结论关节镜辅助下微创治疗胫骨平台骨折（SehatzkerⅠ型、Ⅱ型、Ⅲ型），具有创伤小、复位准确、关节功能恢复良好、并发症少等优点，是一种治疗胫骨平台骨折较理想的方法。     

关节镜辅助下手术治疗胫骨平台骨折56例

目的观察膝关节镜辅助下微创经皮螺钉内固定术治疗胫骨平台骨折的临床疗效。方法自2007年1月～2011年1月采用膝关节镜辅助下微创经皮螺钉内固定术治疗56例胫骨平台骨折。其中男性39例,女性17例;年龄16～67岁,平均35岁;闭合性骨折46例,开放性骨折10例;按Schazker分型:Ⅰ型13例,Ⅱ型24例,Ⅲ型19例。结果 56例患者随访6～54个月,平均34个月。术后膝关节功能评价参照Rasmussen评分标准,疗效优35例,良18例,中3例;总优良率94.6%。结论关节镜辅助下微创治疗胫骨平台骨折(SchazkerⅠ型、Ⅱ型、Ⅲ型),具有创伤小、复位准确、关节功能恢复良好、并发症少等优点,是一种治疗胫骨平台骨折较理想的方法。     

手术结合早期功能锻炼治疗复杂型胫骨平台骨折的临床疗效评价

目的：探讨手术结合早期功能锻炼治疗复杂型胫骨平台骨折的临床效果。方法：回顾性分析手术治疗并获得随访的胫骨平台骨折患者38例,术后24 h后开始行CPM膝关节功能训练。Schatzker分型,Ⅳ型15例,Ⅴ型11例,Ⅵ型12例。结果：所有患者随访时间平均27.2个月（6～50个月）,骨折愈合时间9～17周,平均13.2周,无严重并发症出现。术后2周膝关节屈曲平均100.0°（75°～130°）;最后随访时膝关节屈曲平均118.5°（85°～130°）,膝关节HSS评分平均88.5分（80～100分）。结论：复杂型胫骨平台骨折手术复位内固定结合早期功能锻炼可获得良好的功能恢复。     

外固定复位器在复杂胫骨平台骨折中的应用

目的观察外固定复位器在治疗复杂胫骨平台骨折的作用。方法采用外固定器复位有限微创双切口内固定治疗复杂胫骨平台骨折30例。结果30例均获随访,随访时间为14~30个月,平均20个月,切口均一期愈合,未发生骨折不愈合,按照Lysholm评分标准,优良率为93.33%。结论外固定器复位有限切开内固定治疗复杂胫骨平台骨折复位容易,手术时间短,对膝关节软组织创伤小,固定牢靠能早期进行功能锻炼,是复杂胫骨平台骨折较为理想的治疗方法。     

加强型单环与单臂Hybrid外固定器结合有限内固定治疗复杂胫骨平台骨折

目的 探讨使用加强型单环与单臂Hybrid外固定器结合有限内固定治疗复杂胫骨平台骨折的手术方法及临床疗效。方法 回顾分析21例复杂胫骨平台骨折的临床特点、手术方法及临床疗效。本组男15例，女6例；年龄22～75岁，平均38．9岁。致伤原因：交通伤11例，坠落伤7例，重物砸伤3例。采用Schatzker分型：Ⅴ型骨折13例，Ⅵ型骨折8例。 结果 随访10～24个月，平均15．9个月，所有患者均骨性愈合。根据Merchant的评分标准，优7例，良10例，可4例，优良率达81％。结论 加强型单环与单臂Hybrid外固定器结合有限内固定技术能减少并发症，避免膝关节僵硬，是治疗复杂胫骨平台骨折的有效治疗方法。     

微创内固定系统治疗胫骨近端粉碎性骨折的疗效观察

目的回顾微创内固定系统(less invasive stabilization system,LISS)治疗复杂胫骨近端骨折的临床效果,总结手术技术,分析骨折复位丢失原因,探讨预防措施。方法2003年11月-2004年6月单独应用LISS治疗复杂胫骨近端骨折32例,其中男18例,女14例;年龄31～70岁,平均47.6岁。按AO分型:41C型25例(C1型7例,C2型10例,C3型8例),41A3型7例。闭合性骨折27例,开放性骨折5例(3例GustiloⅠ型,1例GustiloⅡ型,1例GustiloⅢA型)。12例合并其他骨折。结果患者平均随访17.7个月(12～24个月),骨折愈合时间平均13.2周(12～16周)。术后开始完全负重时间平均14.2周(12～18周)。术后1年膝关节美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分平均87.4分(65～98分),功能优21例,良9例,中2例。术后复位不良2例(6%),术后骨折复位丢失4例(13%)。本组无深部感染、腓浅神经损伤、骨折不愈合和内固定松动。结论正确理解和使用LISS治疗复杂胫骨近端骨折,可以获得满意疗效,而针对特殊病例,应考虑结合其他固定方式。     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Uterine contractions: Possible diagnostic pitfall at MR imaging

A total of 206 nongravid patients with various gynecologic problems underwent pelvic magnetic resonance (MR) examinations that included both sagittal T2-weighted and contrast agent–enhanced T1-weighted images. MR images were retrospectively reviewed to identify changes in endometrial configuration on serial images obtained during the same MR examination. In 20 MR examinations (all in women of reproductive age), endometrial distortion due to myometrial bulging was noted on T2-weighted or contrast-enhanced T1-weighted images. It was absent on other MR images obtained at different times. Myometrial bulging exhibited low signal intensity in 18 examinations. The finding resembled adenomyosis or leiomyoma on T2-weighted or contrast-enhanced T1-weighted images. These results evidence the presence of transient myometrial bulging and transient low-intensity myometrium in the nongravid uterus. This phenomenon is thought to represent uterine contraction. Clinicians should be aware of the potential presence of transient low-signal-intensity myometrial bulging that could present diagnostic problems in the normal uterus.     

Controversies in cervical spine imaging in trauma patients

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to clear the cervical spine in comatose patients.Presented at the Annual Meeting of the American Society of Emergency Radiology, Las Vegas, Nevada, 22–25 October, 2003     

Brodie Abscess: MR imaging appearance in 10 patients

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic “target” appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypoin-tense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.     

Right-side aortic arch with aneurysm of aberrant left subclavian artery: MR imaging appearance.

Reports of aneurysms of the subclavian artery in both normal and anomalous aortic arches have been rare. The authors describe a patient with a right-side aortic arch and an aneurysm of the aberrant left subclavian artery, which, to the authors' knowledge, is a previously unreported association. At presentation, the aneurysm appeared as a calcified left superior mediastinal mass. Magnetic resonance imaging enabled preoperative diagnosis and guided surgical planning.     

Adrenal tissue characterization with 0.5-T MR imaging: Value of T2*-weighted images

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor–liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.     

MR angiography of congenital heart disease: Value of segmented two-dimensional inflow technique and maximum-intensity-projection display

Magnetic resonance (MR) angiography of the cardiovascular system was evaluated in 41 patients with congenital heart disease by using a two-dimensional (2D) inflow technique based on a magnetization-prepared gradient-echo pulse sequence with segmented k-space data acquisition and electrocardiographic gating at 0.5 T. Inversion and saturation prepulses were used to suppress stationary tissue and enhance intravascular signal. Presaturation slabs were applied where certain vascular structures had to be suppressed. Sequence parameters were optimized by evaluating signal intensity and contrast characteristics for various flip angles and inversion and saturation delay times. The heart and intrathoracic vasculature were encompassed with 40–50 overlapping sections. Both 2D angiograms and maximum-intensity-projection images were evaluated. Combining data sets acquired in the sagittal and transverse orientations provided the most satisfactory information about the pulmonary arteries. The highest signal-to-noise ratios were obtained with a flip angle of 65° and short prepulse delay times. Two-dimensional MR angiography can provide useful diagnostic information but requires a thorough understanding of in-plane and hemodynamically induced signal intensity changes.