前交叉韧带黏液样变性的MRI表现和伴随征象

目的：探讨前交叉韧带黏液样变性的MRI表现与伴随征象。材料与方法回顾性分析3年内4540例膝关节MRI数据库,所有MRI检查由2台1.5 T磁共振机检查完成。由2名有多年经验的骨放射医师依据先前的MRI表现和关节镜结果诊断前交叉韧带黏液样变性、韧带腱鞘囊肿、骨内腱鞘囊肿,评价前交叉韧带黏液样变性的MRI特征表现以及与伴随征象的共存性。结果在所有4540例膝关节MRI中,34例（34/4540,0.7%）诊断为前交叉韧带黏液样变性,13例（13/34,38%）为前交叉韧带单独黏液样变性,21例（21/34,62%）为黏液样变性伴有韧带腱鞘囊肿,腱鞘囊肿最大直径平均为16 mm （最小6 mm,最大30 mm）,18例（18/21,86%）发生在近端,2例（2/21,9%）发生在远端,1例为近端与远端均有（1/21,5%）。24例（24/34,71%）伴有骨内腱鞘囊肿。11例（11/34,32%）伴有严重的膝关节骨性关节病。结论前交叉韧带黏液样变性在MRI上表现为特征性的“芹菜梗”征,多伴有韧带腱鞘囊肿和骨内腱鞘囊肿。     

Ostéotomies tibiales de valgisation associées à la ligamentoplastie du ligament croisé antérieur. À propos de 15 cas

The management of patients aged 30 to 50 years and with an anterior knee laxity in ACL tear associated with medial osteoarthritis femorotibial, is very difficult. Recent publications have shown that the combination of an valgus osteotomy and ligamentoplasty of the ACL is possible to halt the progression of osteoarthritis while correcting the laxity of the knee. We report our experience of 15 patients who received a valgus osteotomy associated with the ACL ligamentoplasty.     

Rupture du LCA : cas de l’athlète féminine

Female athletes have 2–3 times more risks of ACL injury than male. Hormonal, anatomical and neuromuscular factors would explain this female predisposition. Prevention training, aimed to avoid “dynamic” valgus, leads to a reduction of ACL injury risks. These programs, including a neuromuscular training, improve knee dynamic control in female athletes and decrease the loadings on the ACL. The aim of this review is to make an inventory of the knowledge on this subject by analyzing theses predispositions and most specially the influence of the neuromuscular factors. Therefore, the purpose is to make a comparative assessment of the various prevention programs to determine the essential elements for an effective intervention of the physiotherapist.     

30°屈曲位膝关节MRI评价前交叉韧带断裂的价值

目的 探讨30°屈曲体位膝关节MRI对显示前交叉韧带（ACL）和评价ACL断裂的应用价值。方法 选取64例接受膝关节镜检查的膝关节外伤患者,依次行微屈位（约17°）及30°屈曲位膝关节MRI,由2名医师分别对ACL全长、双束结构、断裂ACL的断裂点及残端状况显示进行评分,并以关节镜结果为金标准,计算诊断ACL断裂的敏感度、特异度和准确率。结果 微屈位MRI诊断ACL断裂的敏感度、特异度和准确率分别为97.44%（38/39）、100%（25/25）和98.44%（63/64）,30°屈曲位MRI均为100%,二者诊断ACL断裂的一致性好（Kappa=0.967）。30°屈曲位扫描对ACL全长、断裂点及残端的显示优于微屈位（P均<0.001）,二者对ACL双束结构的显示差异无统计学意义（P=0.223）。结论 30°屈曲位与微屈位MR扫描诊断ACL断裂的敏感度、特异度及准确率均较高,30°屈曲位显示ACL全长及其断裂情况优于微屈位。     

Instabilité méniscale par subluxation récurrente de la corne postérieure du ménisque latéral

A young football player presented several episodes of locking knee associated with pain of the lateral compartment while MRI was considered normal. The occurrence of an irreducible blocking requires performing arthroscopy with evidence of instability of the posterior horn of the lateral meniscus. After reviewing the literature, it appears that popliteomeniscal fasciculi play an important role in maintaining the stability of the posterior horn of the lateral meniscus. Disruption of these structures, either by default or rupture leads to hypermobility of the lateral meniscus. Clinical examination is not contributory; at most, one finds a pain when tensioning the posterolateral compartment at the “Figure-4 Test” and hypermobility in internal rotation of the knee. The popliteomeniscal fasciculi can be viewed on the “classic” MRI of the knee. We need to know the search during an episode of locking knee without meniscal lesion. The management is surgical with the aim of preserving the meniscus.     

Percutaneous management of breast abscesses. An experience of 39 cases

This is a review of our experience with percutaneous drainage by means of needle aspiration or catheter drainage of breast abscesses under ultrasound (US) guidance, and a suggested management algorithm. A retrospective study of the 39 patients (36 women, 3 men; mean age: 28.9 years) with breast abscesses who were treated by percutaneous US-guided procedures over a period of 13 years (1989 to 2002) was carried out. Of the 36 women, 34 were nonlactating and two lactating. Needle aspiration was used in the cases of fluid collections < or = 3 cm and catheter drainage in fluid collections of > 3 cm. Postdrainage care and US evolutive controls were carried out on an outpatient basis. Fine-needle aspiration cytology was performed in masses unresolved after postdrainage. Mammography was performed in patients over 30 years old. In all cases, US examination revealed images of fluid collection. A single needle aspiration was sufficient in 19 cases; 3 patients needed a second aspiration to resolve the breast abscess. A total of 15 cases were resolved by means of percutaneous catheter drainage. In 2 of the 17 patients who underwent catheter drainage, the mass persisted postdrainage; histologic findings showed a chronic abscess requiring surgical intervention in one and a breast carcinoma in the second. Mean follow-up was 8.4 months. Recurrence of breast abscess occurred in 4 patients, and these were resolved by surgical excision. Percutaneous drainage procedures in breast abscesses are a safe and effective alternative to incision and drainage. Needle aspiration is employed in cases of small abscesses and catheter drainage in abscesses larger than 3 cm. Although, in chronic abscesses, the treatment of choice is surgical excision, percutaneous drainage remains as an intermediate therapeutic option.     

La rupture du tendon calcanéen : à propos de 53 cas

The Achilles tendon is the most resistant of the tendons of the human body; its rupture is increasingly frequent in the world and our country because of the considerable development of the sporting activities. This retrospective study relates to 53 observations listed in the service of traumatology and orthopedics of the Hospital Avicenne of Rabat over a period of 5 years between 2005 and 2009. Each patient underwent monitoring protocolisé. Criteria for Comis were used for clinical evaluation. All patients received open surgery. The middle age was of 37 years. The clinical examination was sufficient to pose the diagnosis. All the patients profited from an open surgery. Three patients presented pain after surgery. Infection local skin was noted in two patients. One patient presented a rerupture and 88.6% of the patients have very good performances. The rupture of the Achilles tendon is much more frequent in men; this is explained by the frequency of sports activity in men. Three patients had a history of tendinitis. Clinical examination was easy enough for diagnosis. Open surgical treatment remains the method most widely and most used. In the classic controversy between the effectiveness of surgical and orthopedic treatment in the rupture of the Achilles tendon, the emergence and development of percutaneous techniques still currently did not make it possible to conclude to the superiority of treatment over another.     

MRI在前交叉韧带重建术联合滑膜部分切除术中的应用

目的探讨MRI在前交叉韧带（ACL）重建术联合滑膜部分切除术前指导及手术效果评估中的应用价值。方法选择2017年1月~2019年1月我院收治的80例ACL损伤患者作为观察组,接受ACL重建术和滑膜部分切除术治疗;另外选择无损伤的MRI检查者40例作为对照组。观察组手术前后、对照组均进行MRI检查,记录两组的ACL角、PCL夹角、PCL指数、Blumensaat角、胫骨前移指标。观察组患者术后1年来院接受MRI检查,进行前抽屉实验、Lachman实验、轴移实验,用Lysholm评分、Tegner评分评估膝关节功能,计算ACL移植物MRI评分。结果观察组术后ACL角较术前升高,PCL指数、Blumensaat角、胫骨前移较术前降低（P < 0.05）,与对照组差异无统计学意义（P < 0.05）,术后PCL夹角较术前升高,高于对照组（P < 0.05）。80例患者中,前抽屉实验、Lachman实验、轴移实验3项检查结果均为阴性者70例（87.50%）,1项或以上为阳性者10例（12.50%）。移植物的完整性和信号依据Rak’s法分级:1级73例（92.25%）,2级7例（8.75%）。Lysholm膝关节评分88.63±6.51分,Tegner膝关节运动评分8.02±1.56分,较术前升高（P < 0.05）,ACL移植物MRI评分72.13±10.02分。Pearson相关性分析结果显示,ACL移植物MRI评分与Lysholm膝关节评分、Tegner膝关节运动评分呈正相关（r=0.675、0.742,P < 0.05）。结论ACL重建术联合滑膜部分切除术对ACL损伤患者有较好的治疗效果,可恢复膝关节功能和稳定性,MRI是术前指导、术后手术效果评估的有力工具。      

Sonographically Guided Posteromedial Approach for Intra‐articular Knee Injections

Osteoarthritis of the knee can be a debilitating and extremely painful condition. In patients who desire to postpone knee arthroplasty or in those who are not surgical candidates, percutaneous knee injection therapies have the potential to reduce pain and swelling, maintain joint mobility, and minimize disability. Published studies cite poor accuracy of intra‐articular knee joint injections without imaging guidance. We present a sonographically guided posteromedial approach to intra‐articular knee joint injections with 100% accuracy and no complications in a consecutive series of 67 patients undergoing subsequent computed tomographic or magnetic resonance arthrography. Although many other standard approaches are available, a posteromedial intra‐articular technique is particularly useful in patients with a large body habitus and theoretically allows for simultaneous aspiration of Baker cysts with a single sterile preparation and without changing the patient's position. The posteromedial technique described in this paper is not compared or deemed superior to other standard approaches but, rather, is presented as a potentially safe and efficient alternative.     

CT引导下卵巢囊肿穿刺硬化治疗的探讨

目的总结CT引导下穿刺硬化剂治疗卵巢囊肿的方法及治疗效果。方法22例卵巢囊肿在CT定位下经皮穿刺抽吸,行无水乙醇反复冲洗法硬化剂治疗,其中单纯囊肿18例,巧克力囊肿4例,用18～22G穿刺针抽吸,注入99.7%无水乙醇。抽出囊液量为30～500ml,注射量为抽出量的25%～30%。术后每隔3个月复查,随访其疗效。结果22例病人囊肿均穿刺成功,随访3个月到1年,复查见16例囊肿消失,6例囊肿缩小50%以上(包括4例巧克力囊肿),有效率100%,无严重并发症。结论CT引导下经皮穿刺硬化剂治疗卵巢囊肿是一种安全,有效的治疗方法,具有较高的临床实用价值。     

Fine needle aspiration in the treatment of ganglion cysts

Twenty-eight ganglion cysts in 21 patients were diagnosed by fine needle aspiration (FNA) in the Cytopathology Service of The George Washington University Medical Center from January 1979 to December 1984. Twenty-four of these were aspirated by a pathologist. One patient had two ganglions. Seven of the 21 patients had recurrences and six were reaspirated. In five of those patients the cysts never attained their original size or interfered with function. Follow-up ranged from three to 71 months. Based upon our experience, we believe that FNA is a simple, fast, effective, nontraumatic, inexpensive method of treating ganglion cysts.     

Traitement chirurgical des luxations et fractures-luxations périlunaires du carpe. Étude rétrospective d’une série de 12 cas

We report a retrospective series of 12 dislocations or perilunate fracture-dislocations having occurred in sportsmen. The results of our series are compared with the data of the literature and we discuss epidemiology, types of lesions, surgical treatment, complications and prognosis of this pathology. The displacement of all these lesions was posterior. The mean age was 24 years. All 12 patients had undergone surgical treatment through a dorsal approach. They were reviewed clinically and radiologically with a mean follow-up of 27 months. The average Cooney functional score was 70 over 100 with two excellent, four good, four fair and two poor results. Average flexion–extension motion arc was 72%, the grip strength was 77% compared to the other wrist. Persistent wrist pain was almost constant.     

Fluoroscopically guided aspiration of a symptomatic lumbar zygapophyseal joint cyst: a case report

Lumbar zygapophyseal joint cysts are potential pain generators in patients with axial pain and/or lower-limb radicular pain. The traditional treatment of symptomatic cysts that do not respond to conservative measures is surgical decompression. Percutaneous needle aspiration under fluoroscopic guidance is a potential minimally invasive treatment option. We present a patient with a large symptomatic L4-5 zygapophyseal joint cyst and right L5 radiculopathy who responded well to percutaneous aspiration.     

Suture percutanée des ruptures fraîches du tendon calcanéen: À propos de 60 cas

A prospective study of 60 cases of percutaneous suture for Achille tendon rupture were done from January 2001 to September 2006. Twenty-eight patients practiced sport, three with high competitor level. Mean follow-up was 13 months (6–58). Eighty-nine percent patients return to sport activities at mean 5.2 months (3–12) at the same level in 68%. Return to work was mean 85 days (15–270).     

CT引导下注射无水乙醇治疗肾囊肿

目的 总结CT引导下穿刺注射无水乙醇治疗肾囊肿的经验。方法 收集有随访病例45例62个肾囊肿经皮穿刺抽吸后注射无水乙醇治疗。囊肿直径4～13cm。用18～20G Chiba抽吸针穿刺抽吸，抽出囊液为25～690ml。注入99．7％的无水乙醇，乙醇量以抽出囊液的25％为宜。结果 本组随访时间2个月～2年，本组资料显示有效率达96．77％(60／62)。囊腔缩小2／3以上者达72．58％(45／62)，其中囊腔消失者37个，占所有囊肿数的59．68％。并发症为局部疼痛，无严重并发症。结论 CT引导下注射无水乙醇治疗肾囊肿是一种微创，并发症低，值得推广的治疗方法。     

Avulsion de l’insertion fémorale du ligament croisé antérieur chez un adulte de 20 ans. À propos d’un cas

The cruciate ligament (ACL) injury is known in adults and his surgical treatment is often necessary. In addition, avulsion fracture of the ligament's tibial insertion especially interested. Indeed, only a few cases of avulsion or proximal femoral ACL have been reported and always concerned children. Through this article, the authors describe a rare case of femoral osteochondral avulsion fracture of ACL in a young adult of 20 years which followed a sports accident.     

Lésions méniscales isolées chez le sportif. À propos de 120 cas

Meniscal lesion is a frequent affection in sport practice and which can affect – in mid and long terms – the fonctionnal prognosis of the knee and thus the sport career of the patient. Hence the importance of precocious diagnosis and adequate take-in-charge. We report a series of 120 cases of isolate meniscal lesions (76% internal meniscal lesions and 24% external meniscal lesions) in a sports population treated under arthroscopy and rechecked after a mean relapse of four years. Our results were good to excellent in 82.5% of the cases with retake of sport activity in 90% of our patients of which 60% in the preoperative level. 54% of the cases underwent standard radio control in their last visit. This control was normal in 46% of them, showed a pinching in the internal compartment in 22% of the cases and external in 32% of the cases. As for its reliability, its simplicity and relative innocuteness, the treatment of meniscal lesions under arthroscopy fulfills the requirements imposed by sport population's tasks.     

膝关节前交叉韧带损伤的MRI检查与诊断

目的探讨膝关节前交叉韧带(ACL)损伤的MRI检查方法与诊断。方法采用膝关节伸直位、微屈位和屈曲位斜矢状位快速自旋回波序列,对36例疑有膝关节ACL损伤患者进行MRI扫描,分析其显示效果及MRI表现。结果膝关节前交叉韧带损伤在斜矢状面伸直位、微屈位和屈曲位显示率分别为55.60%、83.33%、92.0%,微屈位和屈曲位2者之间无统计学差异(P>0.05),但2者均明显高于斜矢状面伸直位(P<0.01)。结论 ACL带在MRI上屈曲位斜矢状面显示最佳,可作为其诊断的首选检查方法。     

Clinical and sonographic management of viable hydatid liver cysts

Aim

The aim of this study was to review our 18-year experience in the treatment of viable hydatid liver cysts (HLCs) with double percutaneous aspiration and ethanol injection (D-PAI) and to provide indications for the clinical management of HLCs.

Materials and methods

From January 1989 to December 2007, 127 patients (100 males; 13–80 years) with 184 viable HLCs (137 univesicular, 47 multivesicular; 2.8–20 cm) underwent D-PAI.

Results

Ultrasonography (US) showed complete disappearance of 125/184 (68%) cysts; in the remaining 59 cases, an inactive solid (37 cases, 20%) or liquid pattern (22 cases, 12%) was observed with volume decreases of 50–80%. The final US pattern was unmodified during the follow-up in 96.8%. Local recurrences were observed in 5 patients (3.9%): 4 patients with 8 multivesicular cysts and 1 patient with a bilocular cyst (with a solid pattern on US) that ruptured into the biliary tree 2 years after the procedure and disappeared after endoscopic sphincterectomy. The mortality rate was 0.8%, and the overall morbidity was 8.6%. The mean hospital stay was 2.9 days. The time of healing for smaller cysts (<5 cm) was shorter than that of large cysts (≥5 cm) (P < 0.001).

Conclusion

Our long-term results confirm the high effectiveness of D-PAI in the treatment of HLCs. These results suggest that multilocular cysts require closer follow-up than unilocular cysts.     

Hospitalisation en court séjour pour reconstruction du ligament croisé antérieur : étude prospective comparative

Introduction

In France, the median duration of hospitalization for a reconstruction of the anterior cruciate ligament (ACL) is 3 days. The purpose of this study was to evaluate the feasibility and acceptability of hospitalization for one day for this surgery.

Patients and methods

A prospective study conducted in 2011 included patients who underwent surgery for an ACL rupture. Exclusion criteria were age > 60 years, scores ASA3-4 and patients unmanageable in short-stay. Two groups of patients were formed: “short-stay” with an output at D1 and “conventional hospitalization” with an output at D3. The postoperative analgesia protocol included analgesics I-II, morphine on demand during hospitalization. “Short-stay” group received a telephone follow-up (D1–D4). The primary outcome was patient satisfaction at D3. The secondary endpoints were postoperative pain assessed on a visual analogue scale at D3 and adverse events. Thirty patients were included in each group, 34 men and 26 women, mean age 29 ± 5 years.

Results

Patients in group “short-stay” were on average more satisfied than the “conventional hospitalization” group, P = 0.01. The pain was significantly less pronounced in the “short-stay” group, P = 0.00001. No complications occurred.

Conclusion

Inpatients short-stay were significantly more satisfied and less painful than those in conventional hospitalization group. Future studies should evaluate the feasibility of ambulatory surgery for ACL reconstruction.