肩关节不稳定的肩盂骨缺损评估:肩盂下部圆心的确定

目的 探讨在正常肩盂CT三维重建标准正面观影像上确定肩盂下部圆心的可行性,比较同一个体左、右肩盂的半径大小,为术前精确定量评估肩盂骨缺损比例提供影像学依据. 方法 本研究测量了35例成人双侧正常肩盂(共70个),每个肩盂均行64层螺旋CT扫描,由1位医生在三维工作站上获得肩盂的标准三维正面观影像及标尺,并将其以二维图像的格式导出.3位医生分别利用AutoCAD2006软件对图像进行处理,做肩盂下部前缘最突点、下缘最突点连线的垂直平分线,再做后缘最突点、下缘最突点连线的垂直平分线,将两垂直平分线的交点定为肩盂下部的圆心,分别测量该点到肩盂前下缘、后下缘和后缘的距离.比较3位医生测量的圆心到肩盂前下缘、后下缘和后缘距离值,以及左、右肩盂相应距离的测量数据. 结果 肩盂下部圆心到肩盂后缘最突点之间的距离(即圆的半径)为(14.1±1.6)mm,到肩盂前下缘的距离为(14.0±1.7)mm,到肩盂后下缘的距离为(14.1±1. 6)mm.3位医生测量的圆心到肩盂后缘距离值之间及左、右肩盂相应测量值之间差异均无统计学意义(P>0.05). 结论 在正常肩盂的CT三维标准正面观影像上利用肩盂下部前、后、下缘最突点确定肩盂下部圆心的方法是简便、可行的,可重复性较高.正常人左右肩盂下部的半径是一致的.以上结论可用于单侧肩盂骨缺损的精确定量评价.     

三维CT测量肩关节复发前脱位肩胛盂轨迹的可靠性研究

目的:本研究旨在评估三维CT测量肩盂轨迹的可靠性和可重复性.方法:由3位独立观察者(肩关节专科医生)通过三维CT评估60例单侧肩关节复发前脱位患者的肩胛盂及Hill-Sachs骨缺损情况,并按Di Giacomo等的方法,将损伤分类,制定手术方案.所有观察者在1周后重复测量.采用组内相关系数(intraclass co...     

基于三维CT重建影像评估Latarjet术后喙突骨块高低的一种方法

目的 提出一种基于三维CT重建影像评估Latarjet术后喙突骨块高低的方法,并检验其应用的可靠性与准确性.方法 回顾性分析自2017-01-2019-06完成的37例全关节镜下Latarjet手术,采用喙突顶点定位法在三维CT重建的关节盂正面图像上评估骨块的高低,并与Lafosse法、Zhu法、Boileau法进行比...     

螺旋CT三维及四维重建在复杂性髋臼骨折的应用

目的：探讨螺旋CT三维及四维重建在复杂性髋臼骨折的应用。方法：使用Picker6000螺旋CT机对14例行患侧髋臼SCT扫描,在Voxel工作站上进行三维表面遮盖法重建,并以容积重建技术实现四维重建。结果：三维及四维重建图像清晰地显示了复杂性髋臼骨折细节,对骨折块大小、 移位程度得到了最直观、最全面的了解。结论：螺旋CT三维及四维重建对复杂性髋臼骨折诊断和治疗具有一定临床指导意义,是目前理想的诊断髋臼骨折的方法。     

寰枢椎旋转性半脱位的诊断

目的：探讨X线检查,螺旋CT扫描以及三维影像重建在诊断寰枢椎旋转性半脱位的不同临床意义。方法：24例行颈椎张口位片检查,其中16例和5例对照组采用螺旋CT扫描。结果：平均50%以上2次摄片,部份齿状突与侧块间距显示不清。16例螺旋CT扫描均证实齿状突与寰椎侧块间距不等,三维影像重建立体地再现寰枢椎旋转性半脱位的移位程度和齿状突发育情况。5例对照组正常。结论：常规X线多能确诊,螺旋CT扫描及三维影像重建,可弥补6诊断上的困难,同时也有利于指导治疗。     

螺旋CT三维及四维重建在关节内骨折中的应用

目的 探讨螺旋ＣＴ三维及四维重建显示关节内骨折的价值及其临床意义。方法 使用Ｐｉｃｋｅｒ ６０００螺旋ＣＴ机对３７例物损伤关节进行扫描,在Ｖｏｘｅｌ Ｑ工作站上进行三信表面遮盖法重建;以容积重建技术实现四维重建;使用关节解体处理技术以充分展示损伤的关节面;在Ｚ轴及Ｘ轴上螺旋重建图像观察损伤细节。结果 三维及四维重建图像清晰地显示了所有病例的骨折细节;结合关节解体技术,三维重建逼真地显示了损伤的立体     

多层螺旋CT多平面重建及三维重建在肩胛骨骨折中的应用

目的 探讨多层螺旋CT（Multi-slice Spiral CT,MSCT）多平面重建和三维重建技术在肩胛骨骨折中的应用及临床价值。方法 26例肩胛骨骨折病人行MSCT扫描,图像经工作站处理后进行多平面重建和三维重建,由三位有经验的放射科医师共同阅片分析,统一评定。结果 本组26例均可以通过多平面重建和三维重建明确判断骨折情况。其中发现肩胛骨体部骨折18处,肩胛颈骨折8处,盂缘骨折9处,盂窝骨折5处,肩峰骨折11处,肩胛冈骨折4处,喙突骨折3处;同时合并肩关节脱位6例,合并锁骨骨折7例,合并多发肋骨骨折13例。多平面重建可多方位更全面地显示肩胛骨骨折的情况。三维重建能立体形象地显示肩胛骨骨折的范围和方向。结论 多层螺旋CT多平面重建及三维重建技术能清晰、直观地显示肩胛骨骨折情况。有利于临床诊断及治疗方案的确定。     

复发性肩关节前脱位伴骨缺损的治疗进展

复发性肩关节前脱位伴骨缺损是肩关节常见疾病之一。如何有效地修复关节盂骨缺损,降低肩关节脱位复发率是临床医师关注的问题。骨移植术能够发挥骨刺激作用,促进骨再生和骨重塑,恢复关节盂的正常解剖结构。其中,Bristow-Latarjet术是治疗复发性肩关节脱位的经典术式,Latarjet术能够修复更大的关节盂骨缺损,但对手术医师的操作要求更高;自体髂骨移植术是Latarjet术失败后翻修的首选方案;骨软骨移植术(自体和异体)在重建原始关节面和预防关节退行性改变方面有一定的优势,但自体骨软骨移植术会造成二次损伤,而异体骨软骨移植术的免疫排斥难以避免。随着复合材料的改进,对骨再生、重塑机制的探究,以及结合骨移植术的优缺点,组织工程技术将来有可能成为治疗关节盂骨缺损的重要方法。     

三维螺旋CT重建对下颌骨缺损修复的指导意义

目的 探讨多层螺旋CT三维重建影像在修复下颌骨缺损中的指导意义.方法 对15例下颌骨缺损患者行64排螺旋CT头颅扫描,层厚0.65 mm,应用表面投影显示法(SSD)重建三维图像,从不同旋转轴对下颌骨缺损进行三维重建,根据重建影像进行术前设计和术后效果对比观察.结果 螺旋CT三维重建能清楚显示下颌骨缺损的详尽立体解剖结构,所得重建图像逼真,可观察任意剖面和多视觉变换,显示下颌骨的空间位置关系和定量测量分析.结论 三维CT重建技术为下颌骨缺损修复的手术设计与实施,提供了新的可靠依据.     

多层螺旋CT及其图像后处理技术在齿状突骨折中的应用价值

[目的]探讨多层螺旋CT横轴位像、MPR及SVR成像在齿状突骨折的应用价值及相关技术要点.[方法]选择18例齿状突骨折病人,行X线和四层螺旋CT检查,将螺旋CT扫描容积数据传输至工作站进行MPR和SVR处理,观察骨折细节,并比较X线平片、CT轴位、MPR及SVR之异同.[结果]多层螺旋CT-3D技术可清晰地显示各种类型的枢椎齿状突骨折.MPR可从任意平面观察骨折及其周围情况,VR可以显示骨折的立体关系.[结论]螺旋CT二、三、四维图像在齿状突骨折诊治方面有重要应用价值.     

16层螺旋CT血管成像检查评价冠状动脉搭桥血管

目的探讨16层螺旋CT冠状动脉造影评价冠脉桥血管的价值。方法10例冠状动脉搭桥术后患者在心电门控技术下采用16层螺旋CT行冠状动脉造影扫描，将所得原始数据进行薄层重叠400ms R-R间期重建，重建图像系列调入3D任务卡内进行容积再现、最大密度投影、曲面重建和多平面重建等图像后处理，全面观察桥血管有无狭窄、钙化及吻合口情况。结果10例冠状动脉搭桥术的患者共有29条桥血管，其CT图像均能清晰显示，满足临床诊断要求，可用于影像学评价；4例桥血管有不同程度的钙化和狭窄变细，经DSA检查得到证实。结论16层螺旋CTA作为一种无创性的检查在冠状动脉桥血管随访的诊断和评价中是安全可靠的检查技术，有很高的临床价值。     

多排螺旋CT结肠成像术在结直肠肿瘤性病变检出诊断中的应用

目的探讨64排螺旋CT结肠成像术（CTC）在检出结直肠肿瘤性病变中的应用价值。方法对132例疑诊结直肠病变患者进行CT扫描、结肠气钡双重造影（DCBE）检查、结肠镜检查,将CT数据传至工作站后处理。获取CTC图像,将所得CTC、DCBE的检查结果与结肠镜及手术病理结果进行对比分析。结果CTC检出病变的敏感度96．49％、特异度90．91％、准确率95．59％。DCBE检出病变的敏感度91．23％、特异度72．73％、准确率88．24％。两种检查对病变检出差异无统计学意义（χ2=0．566,P=0．319）。CTC检查直径≤5．0mm病变的敏感度80．95％、特异度86．96％、准确率84．09％。DCBE对直径≤5．0mm病变检出的敏感度57．14％、特异度69．56％、准确率63．64％。两种检查对直径≤5．0mm病变检出差异无统计学意义（χ2=0．679,P=0．422）。CTC检查直径5．1～9．9mm病变的敏感度91．67％、特异度100％、准确率94．12％;DCBE检出直径5．1～9．9mm病变的敏感度75．00％、特异度80．00％、准确率76．47％。两种检查对直径5．1～9．9mm病变检出的差异无统计学意义（χ2=0．631,P=0．374）。CTC、DCBE检出直径≥10．0mm病变的敏感度、特异度、准确率均为100％。结论CTC是一种无创性检查方法,在结直肠肿瘤性病变检出的应用中具有一定优势。     

Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: Surgical technique and results

Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. 10 patients (9 males, 1 female) were followed for an average of 16 months (4–36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%). ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency.     

Individualized coracoid osteotomy and 3D congruent arc reconstruction of glenoid for the treatment of recurrent anterior shoulder dislocation

Background

The present study investigated individualized coracoid osteotomy for 3D congruent arc glenoid reconstruction and evaluated the clinical outcomes in recurrent anterior shoulder dislocation.

Methods

From January 2005 to July 2015, 78 patients with glenoid defect underwent coracoid and conjoint tendon transposition. The patients were divided into the individualized group (n?=?34) and the non-individualized group (n?=?44). All patients had CT data to reconstruct the shoulder model using Mimics software. In the individualized group, the individual coracoid osteotomy and bone fixation position parameters were measured from preoperative planification through simulating a 3D congruent arc glenoid reconstruction model. The non-individualized group underwent classic Bristow-Latarjet (B-L) procedure. The postoperative evaluation parameters included 3D congruent arc index, coracoid bone position, shoulder osteoarthritis index (Samilson-Prieto) and shoulder function score (Rowe, Constant-Murley score).

Results

The mean follow-up time was 51.0 months (ranging from 24 to 146). The individualized group got 3D congruent arc reconstruction of the glenoid by postoperative CT scanning. Bone position was more precise in the individual group than that in the B-L group. There was a lower incidence of shoulder osteoarthritis (Samilson-Prieto) in the individual group compared with that in the B-L group: 0 vs 13.6% (mild 6/44, P?=?0.027), respectively. No significant difference was observed between the individual and B-L groups in rate of re-dislocation: 0 vs 4.5% (2/44, P?=?0.315), respectively. The postoperative Rowe and Constant score was significantly improved but was not significantly different between the two groups.

Conclusion

The individual procedure achieved 3D congruent arc glenoid reconstruction. The clinical effects in patients with medium glenoid defect were good, especially the low incidence of shoulder osteoarthritis in middle-term follow-up.

     

螺旋CT三维重组与多平面重组在诊断腕舟状骨骨折中的价值

目的 探讨螺旋CT（SCT）三维重组（3D）与多平面重组（MPR）在腕舟状骨骨折中的临床应用价值。方法17例腕舟状骨骨折患者经腕关节常规X线检查后,采用16层SCT进行腕关节的多层面扫描,在工作站上作3D及MPR影像后处理,就X线平片与16层SCT影像进行比较及综合分析。结果X线平片漏诊1例结节部骨折和2例不完全性腰部骨折,2例完全性腰部骨折误诊为不完全性腰部骨折,此5例平片漏误诊的骨折均为16层SCT予以确诊。讨论16层SCT能够显示X线平片难以诊断的腕舟状骨隐匿性骨折;3D和MPR成像技术十分有利于观察腕舟状骨骨折的形态变化及移位情况,是16层SCT横轴位扫描的重要补充,同时也有利于手术方案的拟定。     

CT三维重建技术对肩胛骨骨折的诊断价值

目的：探讨螺旋CT三维表面遮盖法重建(surface shaded display，SSD)及容积重建技术(volume rendering technique，VRT)对肩胛骨骨折的诊断应用价值。方法：使用SIEMENS PLUS4螺旋CT机对20例肩胛骨骨折患者进行扫描，全部数据输入工作站进行SSD及VRT处理，并与X线、二维CT(2D CT)检查结果进行对照分析。结果：2D CT扫描的结果经临床与手术证实为临床诊断的重要依据，经统计学分析，X线检查及SSD的诊断准确率分别为94．44％和97．78％，假阴性率分别为17．65％和7．84％，X线检查的假阳性率为0．76％；VRT诊断正确率为100％。SSD、VRT检出骨折创伤的数量与X线、2D CT的结果差异无显著性意义，但是显示损伤的质量优于X线和2D CT。术后对8例进行3D CT复查，VRT能立体显示术后肩胛骨骨质及内固定物的形态与结构。结论：螺旋3DCT是诊断肩胛骨骨折的有效手段，可指导手术计划的制定和内固定物的选择，应作为诊断复杂性肩部骨折的首选方法。VRT对骨折术后内固定物的位置及复位效果的判断有较高的应用价值。     

Asymptomatic anterior shoulder dislocation of 24-year duration

A 73-year-old woman presented with a very long-standing anterior dislocation of her right shoulder. She had no pain, mild impairment of active shoulder motion and clinical features suggesting no tear of the rotator cuff. CT 3D reconstructions showed a newly formed glenoid cavity below the coracoid process. This case indicates that an anterior shoulder dislocation lasting even decades may be compatible with an almost normal shoulder function.     

Computerized assessment of Bankart lesions under tension with magnetic resonance arthrography

Accurate anatomic depiction of Bankart lesions based on magnetic resonance imaging (MRI) is crucial for the treatment of posttraumatic recurrent dislocation of the glenohumeral joint. MR arthrography, the intraarticular injection of dilute gadolinium before MR imaging, improves sensitivity in the detection of shoulder pathology. Abduction and external rotation (ABER) of the shoulder places dynamic stress on the inferior capsular pouch and anterior labroligamentous complex, important structures for anterior shoulder stability. This study sought to determine whether MR arthrography, by use of computerized image analysis, can visualize Bankart lesions better with the shoulder in the neutral position or in ABER. We evaluated 12 shoulders after traumatic anterior dislocation. The MR images were analyzed with image-analyzing software. We compared 3 parameters at 5 levels of the glenoid in the neutral position and in ABER: detachment (the length of detachment between the anterior glenoid rim and the anterior periosteal attachment), displacement (the distance between the anterior glenoid rim and the tip of the displaced labrum), and Bankart area (the area bounded by the detachment line, the displacement line, and the anterior aspect of the Bankart lesion). MR images revealed that Bankart lesions were under tension in ABER and lax and redundant with the shoulder in the neutral position. All 3 parameters were greater in ABER than in the neutral position in all cases (P = .012, P = .0006, and P = .012). Computerized image assessment of MR arthrography with the shoulder in ABER provides excellent visualization and evaluation of Bankart lesions.