50岁以上髋关节撞击综合征患者关节镜治疗效果临床研究

目的:通过研究50岁以上髋关节撞击综合征(femoroacetabular impingement,FAI)患者关节镜治疗后的临床效果,初步探讨国人中老年髋关节撞击综合征患者的发病规律和治疗方案。方法:回顾性研究2012年5月到2017年5月71例(78例髋)因FAI在我科行关节镜治疗的50岁以上老年患者的临床资料并随访,随访时间6~66月,平均31.78±18.07月。患者关节间隙2 mm以上,髋关节骨关节病T?nnis评分Ⅰ至Ⅱ级,关节镜下进行增生滑膜清理、同时修复损伤盂唇及软骨,磨除股骨头颈部或髋臼增生,去除撞击因素,恢复髋臼和股骨头颈正常形态。术后随访,对比患者术前术后关节隙宽度、Dunn位X线片上的α角的变化和正位X线CE角变化;记录患者术中软骨和盂唇损伤、修复情况和髋关节撞击畸形纠正情况;通过患者术前术后的mHHS评分、VAS评分评估患者疼痛缓解和关节功能恢复情况;并对患者手术满意度、并发症等进行观察。结果:患者的平均年龄为55.15±5.02岁,男23例(27髋),女48例(51髋);年龄50~69岁,左髋33例,右髋45例。患者术前关节隙平均4.81±0.87 mm。术后切口均Ⅰ期愈合。患者术前α角50.11±4.75度,术后α角42.72±4.7度,7例髋8.97%的患者α角>55度,40例髋51.28%的患者α角>50度。患者术前CE角36.54±9.14度,术后CE角35.19±8.55度,27例髋34.62%的患者CE角>40度。患者主要临床表现为髋关节疼痛、肿胀,其中36例髋(36/78,46.15%)合并关节绞锁。查体70例髋(70/78,89.74%)存在腹股沟区压痛,髋内收内旋撞击试验(FADIR)阳性75髋(75/78,96.15%),髋外展外旋撞击试验阳性64髋(64/78,83.33%),均以引起髋关节疼痛或活动受限为阳性。术后患者疼痛症状均明显缓解或消失,VAS评分由术前的4.42±1.42分降至末次随访时的1.31±1.28分(P<0.01);髋关节功能恢复明显,mHHS评分由术前的52.4±19.38分提高至末次随访时的81.72±10.82分(P<0.01)。89%的患者mHHs和VAS评分有显著提高(P<0.01)。1例患者(1.28%)在随访期间行髋关节置换术,没有严重并发症。结论:50岁以上没有严重骨关节的患者,髋关节镜清理盂唇损伤和去除股骨髋臼撞击因素后,在绝大多数情况下,髋关节功能明显改善,疼痛明显缓解。髋关节镜对于中老年髋关节撞击综合征患者是一种安全有效的治疗方式     

体外高能震波治疗股骨头坏死中远期MRI评价

目的探讨MRI随访研究ESWT治疗股骨头坏死的Harris评分、VAS评分与病灶变化的相关性。方法选取2004年~2011年在我院采用ESWT治疗股骨头缺血性坏死的46例82髋。评价疼痛VAS评分、Harris评分改善与MRI显示股骨头内病灶大小和髋关节腔积液变化相关性。结果总随访髋数79髋,ESWT治疗后MRI显示病灶缩小共40髋(50.6%)、髋关节腔积液减少48髋(60.6%)。髋关节综合功能改善、疼痛症状变化与关节腔积液分级、积液变化有统计相关性(P0.05),与病灶大小变化无统计相关性(P0.05)。结论 ESWT治疗股骨头坏死患者临床评价改善与关节腔积液分级、积液变化具有相关性,与病灶大小变化无相关性。     

MRI对中药治疗早期股骨头缺血性坏死的疗效评价

目的 :探讨MRI对中药治疗早期股骨头缺血性坏死(ANFH)疗效的评价。方法 :观察中药治疗前后60例(72髋)ANFH的MRI表现,比较不同病因患者的治疗效果。结果 :60例(72个髋关节)早期ANFH经中药治疗后,MRI示58个髋关节积液消失,20个骨髓水肿消失,39个"双线征"消失;另有5个髋关节在MRI复查时未见明显变化。外伤所致早期ANFH的治疗结局优于非创伤性患者(P0.05)。结论:MRI能客观、有效地评价中药治疗ANFH的效果,中药治疗因外伤所致早期ANFH效果优于非外伤因素。     

髋关节镜下滑膜切削联合关节松解术治疗早期强直性脊柱炎髋关节病变18例

目的探讨髋关节镜下滑膜切削联合关节松解术治疗早期强直性脊柱炎髋关节病变的临床效果。方法 2010年12月—2013年12月,采用髋关节镜滑膜切削联合关节松解术治疗早期强直性脊柱炎髋关节病变患者18例(28髋),术后3个月采用Harris评分标准进行术前术后的疗效评定。结果所有患者均获随访。Harris评分由术前平均(62.3±6.7)分升至术后《86.5±18.8)分,其中优9髋,良16髋,可2髋,差1髋。结论髋关节镜下清理和滑膜切削联合关节松解术可有效控制早期强直性脊柱炎髋关节病变的发展,缓解疼痛,改善功能。     

金属大头髋(ASRTM XL)的临床应用特点

目的 探讨金属大头髋(ASRTMXL)的临床应用特点.方法 对14例患者采用ASRTMXL金属大头髋进行全髋关节置换术(total hip arthroplasty,THA),其中强直性脊柱炎合并髋关节融合2髋,股骨头坏死3髋,继发性骨关节炎2髋,股骨颈骨折7髋.根据随访结果对金属大头髋的设计特点、临床特点进行分析.结果 本组患者术后1周开始扶拐行走,6周去拐行走,髋关节前屈、后伸、内旋、外旋、内收、外展显著改善,Harris评分术后平均90分(75～100分)、比术前平均30分(13～50分)显著提高.术后X线片示假体位置正确,外翻角、前倾角正常.无早期并发症发生.结论 金属大头髋早期随访效果好,假体设计具有磨损率低、活动范围大、脱位发生率低、臼杯变形小等特点.     

导向器镜下精准钻孔减压联合冲击波治疗创伤性股骨头坏死的有效性

 目的 探讨精准微创治疗部队官兵创伤性股骨头坏死(avascular necrosis of femoral head, ANFH)的有效性并进行相关分析。方法 选取2014-02至2018-04解放军总医院第三医学中心骨科收治的共77例(93髋)ANFH患者,均为部队官兵。随机分为单纯体外冲击波(extracorporeal shock wave therapy,ESWT)治疗组(对照组)46髋,导向器镜下精准钻孔减压联合ESWT治疗组(联合治疗组)47髋,两组患者分别于治疗前、治疗后的3、6个月及最终随访时采用视觉模拟VAS评分和Harris髋关节评分进行主观疼痛和髋关节功能评估,并对两组股骨头塌陷及生存时间情况应用Kaplan-Meier生存曲线分析比记录。结果 平均随访时间为72个月,两组治疗前髋关节主观疼痛及功能评价比较无统计学意义,治疗后3、6个月及末次随访的髋关节主观疼痛及功能比较,联合治疗组明显优于对照组,差异有统计学意义(P<0.05),且联合治疗组优良率(85.11％)、股骨头塌陷及生存时间明显优于对照组,差异有统计学意义(χ²=6.948, P=0.016)。结论 导向器镜下精准钻孔减压联合ESWT较单纯ESWT治疗,对部队官兵ARCO Ⅰ-ⅢA期ANFH髋关节功能和延缓股骨头塌陷疗效更为满意。     

保留圆韧带的股骨颈旋转截骨术治疗中青年股骨头软骨下骨折的早期疗效

目的探讨保留圆韧带的股骨颈旋转截骨术治疗中青年股骨头软骨下骨折(SIFFH)的早期疗效。方法采用回顾性病例系列研究分析2017年1月至2022年1月解放军联勤保障部队第九二〇医院收治的13例SIFFH患者的临床资料, 其中男10例, 女3例;年龄22～49岁[(33.5±8.3)岁]。左髋6例, 右髋7例。患者均行保留圆韧带的股骨颈旋转截骨术治疗, 术后给予规范的关节功能训练。记录手术时间、术中出血量;比较术前、术后3, 6个月及末次随访时改良Harris髋关节功能评分和视觉模拟评分(VAS);通过影响学检查, 观察股骨头是否塌陷、截骨处不愈合及其他并发症情况。结果患者均获随访13～24个月[(17.9±3.1)个月]。手术时间为(127.3±9.8)min。术中出血量为(393.9±21.9)ml。术后3, 6个月及末次随访时改良Harris髋关节功能评分分别为(61.6±3.3)分、(80.2±4.4)分、(91.9±4.1)分, 较术前的(51.4±3.5)分明显提高(P均<0.05), 术后各时间点差异有统计学意义(P均<0.05)。术后3, 6个月及末次随访时VA...     

人工关节置换治疗内固定失败的股骨转子间骨折

目的 分析人工关节置换治疗内固定失败的股骨转子间骨折的临床效果及手术技术. 方法 选择2001年- 2009年内固定治疗失败的股骨转子间骨折18例,动力髋螺钉(DHS)固定失败16例,股骨近端防旋螺钉(PFNA)固定失败2例.失败后对13例行人工双极股骨头置换,5例行全髋关节置换.Harris评分评估术后结果. 结果 12例获得完整随访,随访时间1～7年,平均2.3年.本组患者2例出现术中并发症;3例术后3个月内死亡,3例失访;l例出现关节脱位,闭合复位牵引治疗.患者疼痛均较术前明显减轻或消失,2例活动后有中度疼痛,4例活动后出现轻微疼痛.Harris评分术前平均34分,术后1年平均83分. 结论 人工关节置换能恢复髋关节功能,是治疗内固定失败的股骨转子间骨折的有效治疗方法.     

后外侧小切口全髋置换术治疗股骨颈骨折

目的 总结后外侧小切口全髋关节置换术治疗股骨颈骨折的经验.方法 2002年10月-2005年1月收治的199例(207髋)初次全髋置换,其中46例(46髋)为股骨颈骨折患者,新鲜骨折31髋,陈旧性骨折15髋.采用后外侧小切口全髋关节置换术,观察股骨颈骨折置换的切口长度、手术时间、出血量、引流量、住院天数、术后并发症、功能恢复和评分情况.结果 随访时间14～26个月,平均17.2个月.随访期间最后一次Harris评分:新鲜股骨颈骨折患者(84.1±8.6)分,陈旧性股骨颈骨折患者评分(85.8 ±7.6)分.所有患者术后X线片未见明显假体位置不良.新鲜和陈旧股骨颈骨折的手术切口、手术时间、出血量、引流量、住院天数差异均无统计学意义(P＞0.05).新鲜和陈旧性股骨颈骨折组各有1例患者脱位.结论 后外侧小切口全髋关节置换术具有创伤小、出血及并发症少和功能恢复快的特点,对于股骨颈骨折患者不仅能获得良好的髋关节功能,且减少了并发症的发生.     

髋关节镜导向器引导下精准钻孔减压治疗早期股骨头坏死的近期临床疗效

 目的 分析髋关节镜导向器引导下精准钻孔减压治疗早期股骨头坏死的近期临床疗效。方法 选取2015-04至2018-08解放军总医院第三医学中心骨科60例(93髋)诊断为股骨头坏死的患者,均接受导向器引导下股骨头坏死区精准钻孔减压治疗。患者18～53岁,平均38.3岁,男44例,女16例。其中激素性股骨头坏死28例,酒精性股骨头坏死11例,8例为武警战士训练后所致,13例不明原因。术前采用Harris评分系统进行患髋评分,术后予以对症治疗,定期随访,拍片复查。结果 60例(93髋)获得随访,失访2例,平均随访13个月。Harris评分由术前[(74.19±12.19)分]提高到末次随访时的[(87.40±5.34)分]。其中2例病情进展股骨头发生塌陷。无感染及术中、术后股骨转子间或股骨颈骨折发生。结论 导向器引导下股骨头坏死区精准钻孔减压能将钻孔位置精准定位到股骨头坏死区域,提高了钻孔减压的准确性,手术效果好。     

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.     

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.     

MR imaging of disorders of the brachial plexus

The authors evaluated 64 consecutive patients with suspected brachial plexus (BP) abnormalities of diverse cause with magnetic resonance (MR) imaging, using the body coil and a standardized protocol. Of the 43 patients for whom follow-up was available, 25 were suspected of having neoplastic involvement of the BP, nine had sustained injuries, and nine presented with BP symptoms of uncertain cause. MR imaging was 63% sensitive, 100% specific, and 77% accurate in demonstrating the abnormality in this diverse patient population. When patients with neoplastic and traumatic disorders were considered separately, sensitivity increased to 81%, accuracy to 88%, and specificity remained unchanged. In the patients with a clinical diagnosis of idiopathic or viral plexitis, the MR imaging findings were normal, serving to exclude other structural abnormalities. It is concluded that MR imaging is valuable in the assessment of a wide range of BP disorders.     

MR imaging characteristics of noncancerous lesions of the prostate.

Radical prostatectomy specimens from 53 men with clinical stage A or B prostate cancer were retrospectively reviewed and compared with correlative axial T2-weighted magnetic resonance (MR) images obtained just before surgery. Non-cancerous lesions were evaluated for signal intensity and location. Focal high-signal-intensity areas (n = 72) were present in 81% of patients. The 26% of lesions seen in the central gland all correlated with cystic atrophy. Of the 53 lesions seen in the peripheral prostate, 47 (89%) were cystic atrophy without associated cancer, four (7.5%) cystic atrophy with cancer, and two (3.8%) focal inflammation. Focal low-signal-intensity areas (n = 42) were present in 60% of patients. Of the 31% of lesions in the central prostate, one-fifth correlated with benign prostatic hyperplasia (BPH) and four-fifths with fibrous tissue. Of the 69% of peripheral lesions, 83% corresponded to fibrous tissue, 10% to BPH, and 7% to normal tissue. Mixed lesions (n = 42) were present in 64% of patients; 86% of these were located centrally and 14% peripherally. All mixed central lesions were BPH; the peripheral lesions were areas of combined cystic atrophy and fibrosis. BPH of low or mixed signal intensity can extend into the peripheral prostate and mimic cancer. High-intensity cystic atrophy associated with cancer can mimic normal tissue.     

肾细胞癌的MRI研究进展

肾细胞癌是最常见的成人肾脏恶性肿瘤。近年来，多种功能MRI成像技术（如扩散加权成像、灌注加权成像等）、多参数MRI联合分析以及影像组学等新兴影像处理技术被证实在肾细胞癌的诊断中具有较大的价值。目前，研究热点多集中于良恶性肿瘤的鉴别、组织学亚型的区分、肿瘤分期、预测核分级及判断预后。就MRI新技术及图像处理技术在肾细胞癌中的研究进展予以综述。     

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.     

Influence of in vivo copper on MR images of the liver in rats

To investigate the effects of in vivo copper on magnetic resonance (MR) images, the authors studied Long-Evans cinnamon rats, which develop hepatitis and hepatocellular carcinoma as a result of abnormal copper metabolism. The livers of the rats were imaged before hepatitis developed; the absence of hepatic disease was confirmed histopathologically. The copper that accumulated in the liver of the rats was thought to exist in the form of divalent ions, which were suspected of reducing the T1 and T2 of neighboring protons. However, the signal intensities of the liver on T1- and T2*-weighted images did not change, suggesting that in vivo copper, even when accumulated abnormally, does not influence the signal intensity of MR images.     

Techniques for high-resolution MR imaging of atherosclerotic plaque

Atherosclerotic cardiovascular disease is the most common cause of death in the United States. Investigation of atherosclerotic plaque morphology and composition is important because the findings may be useful in predicting prognosis or response to therapy. This study presents high-resolution magnetic resonance (MR) imaging techniques developed on a 1.5-T whole-body imager with a custom-built surface coil, for characterizing the composition and morphology of plaque removed at carotid endarterectomy. The initial comparison of MR imaging and histologic results showed good correlation. In conjunction with MR angiography, these techniques could be used in in vivo imaging to define the size, location, and contents of atherosclerotic plaque at the carotid bifurcation.     

Dynamic MRI of the gallbladder lesions: Differentiation of benign from malignant

Forty-nine pathologically proven gallbladder lesions were evaluated in 45 patients using dynamic MRI with a spoiled gradient pulse sequence (SPGR), to access the ability of this technique to differentiate benign from malignant gallbladder lesions. The studies were reviewed retrospectively. Signal intensity of the lesions were measured. Twenty-one malignant and 28 benign lesions were classified into three categories: polypoid, diffuse wall thickening, and exophytic. Early and delayed enhancement patterns were evaluated. For the polypoid masses, malignant lesions (n = 9) demonstrated early and prolonged enhancements, whereas benign lesions (n = 14) had early enhancement with subsequent washout (P < .05). For diffuse gallbladder wall thickening, malignant lesions (n = 6) demonstrated early and prolonged enhancement and benign lesions (n = 14) showed relatively slow, prolonged enhancement (P < .05). The exophytic masses (n = 6) all were malignant and demonstrated early and prolonged enhancement. Dynamic MRI can help differentiate benign from malignant gallbladder lesions.