SARS患者骨缺血性坏死的MRI检查

目的 分析严重急性呼吸综合征(SARS)患者发生骨缺血性坏死的MRI表现特点。资料与方法 搜集44例SARS患者在接受激素治疗3个月后进行骨关节MRI随访检查的资料进行分析。结果 44例患者中有10例在MRI上发现骨缺血性坏死改变，受累部位包括股骨头、股骨髁、肱骨头、胫骨平台、跟骨和股骨干。病变的中央区信号近似脂肪信号，边缘区呈线样低信号，可见典型的“双线征”。结论 SARS患者在接受大剂量激素治疗后引起骨缺血性坏死是不可忽视的问题。MRI是SARS患者骨缺血性坏死随访筛选检查的一种有效方法。     

严重急性呼吸综合征康复者髋、膝关节骨坏死与激素治疗的关系

目的了解严重急性呼吸综合征（SARS）康复者下肢骨缺血与激素治疗的关系。资料与方法对来自广州市5所医院的148例SARS康复医务人员下肢骨包括双侧髋关节及膝关节进行MRI检查。148例中42例未使用激素治疗,106例使用不同剂量的激素治疗。MRI检查分为筛查与详查。筛查包括T1WI及短反转时间反转恢复序列（STIR）冠状位成像。筛查有阳性发现者则进行详查,在筛查的基础上加用横断位、冠状位T2WI及STIR成像。结果42例未使用激素治疗者未发现下肢骨坏死。106例使用激素治疗康复者中,共发现8例骨缺血改变,其中1例为双侧股骨头缺血坏死,2例为单侧股骨头缺血坏死,1例为双侧股骨头、胫骨髁及单侧股骨髁缺血坏死,1例单侧股骨髁缺血坏死,1例单侧股骨颈骨梗死并钙化,2例双侧股骨、胫骨骨髓水肿。多因素Logistic回归分析显示激素累积剂量是骨缺血性坏死最重要的危险因素（P=0．001）。结论使用激素治疗的SARS康复者中,少数发生下肢骨缺血坏死,而激素累积剂量与骨缺血性坏死关系密切。     

SARS康复患者骨坏死改变的MRI筛查

目的　探讨SARS康复患者骨缺血坏死的患病率 ,及其与激素使用的关系。方法　对76例SARS康复患者进行双髋和双膝关节MR扫描。其中男 17例 ,女 5 9例。在治疗SARS时 8例未使用激素 ,其余 6 8例均使用了激素治疗 ,其中 30例有确切激素用量、疗程。对患者全身骨关节症状进行问卷调查。由高年资医生阅读MR图像 ,诊断有无骨缺血坏死改变。对骨缺血坏死患病率、激素用量和症状等参数进行统计学分析。结果　 (1)SARS康复患者股骨头和股骨髁部位出现的骨缺血坏死及骨髓内骨梗死的MRI表现符合临床诊断骨缺血坏死者的MRI典型表现。 (2 ) 8例未用过激素的SARS康复患者无一例出现骨缺血坏死改变 ,而 6 8例使用激素患者中 2 5例出现骨缺血坏死改变 ,两组比较差异有显著性意义 (P <0 0 5 )。 2 5例中有 2 0例累及双侧髋或 (和 )膝关节。骨缺血坏死改变累及股骨头 32个 ,股骨髁 2 6个 ,股骨、胫骨骨髓坏死 6处。在 30例有确切激素用量患者中 ,有骨缺血坏死表现的患者 13例 ,其使用激素总量的中位数为 35 70mg、每日最大用量的中位数为 2 5 0mg、激素使用时间的中位为数 2 3d ,均大于无骨缺血坏死组 (17例 ) ,相应中位数分别为 2 5 6 0mg、2 4 0mg和 2 2d。两组之间 3个参数经秩和检验差异无显著性意义 (P值均 >0 0 5 )     

激素所致罕见部位骨坏死影像学分析

目的 探讨SARS恢复期患者罕见部位骨坏死影像学表现及原因。方法 采用平片、0．5T MR机，对2003年6～8月间复查的41例SARS恢复期患者四肢骨骼进行检查，分析影像学检查结果及其与应用激素的相关性；检查距最初使用激素的平均时间为88．2d(67～106d)；平均激素(甲基泼尼松龙)最大用量392(320～480)mg；平均持续用药时间为47．2(30～70)d。结果 MRI显示5例罕见部位骨坏死病变共累及11个部位。3例双侧肱骨头坏死，其中1例合并右侧坐骨坏死；1例右侧腕舟骨坏死；1例双侧跟骨坏死合并右侧距骨坏死。主要MRI表现为各部位的不规则异常信号病灶。平片仅显示1例右侧坐骨坏死。结论 SARS恢复期患者骨坏死早期发现需做MR扫描，而且是多部位扫描，激素用量、时间及患者对激素的敏感性和个体差异是骨坏死的重要原因。     

骨梗死的影像学表现

概述 骨梗死又称骨髓梗死、骨脂肪梗死，指发生于干骺端和骨干的骨性坏死，多发生于股骨下端、胫骨上端和肱骨上端，呈多发性和对称性改变。通常所指的骨坏死一般为骨骺或关节软骨面下的骨坏死，与外伤、激素等酗酒等因素有关，如：股骨头无菌坏死等，与骨梗死在发病部位、范围有明显区别，骨梗死也可累及骨骺引起关节面骨塌陷。骨梗死临床比较少见。以往主要依据病变进展到慢性期X线平片出现典型的钙化而诊断，对急性期容易漏诊或误诊。目前，影像学诊断骨梗死常用的检查方法有X线平片、CT、MRI、核素扫描等。其中．骨梗死急性期的MRI表现具有一定特征性。     

严重急性呼吸综合征康复患者骨缺血性坏死患病率的MRI筛查研究

目的采用MRI对康复的严重急性呼吸综合征（SARS）患者骨缺血性坏死进行筛查，探讨康复SARS患者骨缺血性坏死的患病率，及与激素使用的关系。方法用MRI对448例感染SARS的康复患者进行骨缺血性坏死筛查。所有受试者都做了双髋和双膝关节MR扫描，其中192例还扫描了肩和踝关节。采用体线圈同时扫描双侧关节，扫描序列常规做冠状面T1WI，如发现有骨缺血性坏死征象，加扫短时反转恢复（STIR）序列。178例在MR检查的同一天还行双髋关节正位和蛙式位数字X线摄影（DR）片。所有MR图像由3位高年资医生阅片，诊断有无骨缺血性坏死。由2位医生在不知道MRI结果的情况下阅读双髋关节正位和蛙式位DR片，判断有无骨缺血性坏死。448例中在“SARS临床研究数据库”有用药记载者386例，其中361人在治疗过程中使用激素并记载了剂量和时间；“SARS临床研究数据库”无用药记载的其余62例中有59例自述治疗时使用激素。结果骨缺血性坏死的MRI表现为关节面下骨髓内出现弧形或线形异常信号带，T1WI为低信号，在STIR序列上为高信号，与临床上所见的因其他疾病而使用激素或饮酒等原因引起的骨缺血性坏死表现相同。MRI筛查发现在448例中共有138例（30．8％）出现1处以上骨缺血性坏死。28例未用激素的患者中有1例出现有股骨干骨梗死征象（1／28），420例使用激素患者的MRI筛查发现137例（32．6％）出现至少1处骨缺血性坏死MRI表现，两组间差异有统计学意义（P〈0．05）。股骨头缺血性坏死101例，均有使用激素史，占激素使用者的24．0％（101／420）。膝关节骨缺血性坏死84例，占激素使用者的20．0％（84／420）。同时累及股骨头和膝关节者48例，占激素使用者的11．4％（48／420），仅发生在股骨头者53例，占激素使用者的12．6％（53／420），而仅发生于膝关节者36例，占激素使用者的8．6％（36／420）。192例双侧肩关节和踝关节MR扫描发现肱骨头缺血性坏死26例（13．5％），踝关节骨缺血性坏死13例（6．8％）。178例DR和MRI诊断股骨头坏死的阳性符合率为14．1％，DR诊断的敏感度为11．0％，特异度为97．0％。秩和检验显示骨缺血性坏死组的激素总剂量，甲泼尼龙（甲强龙）的使用时间、平均日剂量和总剂量均大于无坏死组（P〈0．05）。多因素Logistic回归分析表明甲泼尼龙日平均剂量和平均使用时间是发生骨坏死的危险因素（P〈0．05）。结论MRI筛查发现北京地区使用激素治疗的SARS患者的骨缺血性坏死患病率较高，主要发生在股骨头、膝、肩和踝关节，常累及多个部位，多数为双侧同时受累。是否使用激素、激素使用剂量和时间是发生骨坏死的危险因素。     

严重急性呼吸综合征康复患者骨坏死与骨髓转化的MRI研究

目的 采用MRI观察严重急性呼吸综合征（SARS）康复患者骨缺血坏死和股骨骨髓转化,分析SARS骨坏死的MRI特征及骨髓转化的意义。资料与方法 112例SAPS患者行股骨MRI检查,检查序列为SE T1WI及短时间反转恢复序列（STIR）。骨髓转化系数（MCI）值为T1WI干骺端信号强度与大转子信号强度的比值。结果 112例SAPS患者中23例发生骨坏死,双侧股骨头坏死13例,双侧股骨头坏死合并双侧股骨干远端骨梗死1例,单侧股骨头坏死2例,干骺端骨坏死6例,双侧膝关节骨坏死1例,MRI显示坏死区均含黄骨髓。21例无骨髓水肿的骨坏死患者MCI值高于年龄相似的无骨坏死患者,差异具有显著意义（P〈0．05）,两组激素的总量及日平均量差异显著（P〈0．05）。结论 SAPS康复患者骨坏死发生于黄骨髓含量高的部位,MCI对骨坏死的预测有重要意义。     

成人股骨头缺血坏死的MRI诊断

目的：分析股骨头缺血坏死(ANFH)的MRI征象，评价ANFH的MRI分期。方法：对58例股骨缺血坏死的患者进行双侧股骨头MRI检查并将．ANFH的影像学分期与MRI信号特征对比。结果：①90个股骨头缺血坏死20个X线平片为阴性；27个在T2WI上“见双线征”。Ⅲ、Ⅳ期22个在T1WI股骨头碎裂、塌陷、续发退行性变；②ANFH的MRI分期依据Ficat分期法共分为五期；③早期ANFH引起的关节积液多为2—3级。结论：MRI能够准确显示ANFH的范围程度及信号特征，尤其对早期ANFH的诊断尤其敏感是常规X线CT所不及。     

常期服用激素导致双侧股骨头及双侧肱骨头坏死2例报告

我们在实际工作当中，经常遇到股骨头坏死病例，国内外文献有过报道，在日常工作当中，单侧股骨头坏死有35例，双侧股骨头坏死20例，其中二例病人服用激素导致双侧股骨头及双侧肱骨头坏死病例。因长期大剂量服用强地松龙治疗导致双侧肱骨头坏死病例很少见。我院发现双侧坏死二例，二例病人均属男性。长期服用大剂量激素导致双侧股骨头坏死及双侧肱骨头坏死病例。     

股骨头缺血坏死影像分期与骨髓水肿及关节积液的相关性研究

目的探讨股骨头缺血坏死与骨髓水肿及髋关节积液的关系。方法回顾性分析经手术病理证实的42例股骨头缺血坏死患者的影像资料及临床症状,将病例按临床症状分为髋部疼痛和非髋部疼痛两组,将股骨头缺血坏死分为4期,骨髓水肿分为4级,髋关节积液分为4度,分别进行统计分析。结果 42例患者(60个髋关节)中,Ⅰ期5个,Ⅱ期12个,Ⅲ期19个,Ⅳ期24个。0级骨髓水肿10个,1级骨髓水肿21个,2级骨髓水肿9个,3级骨髓水肿20个。0度积液13个,1度积液14个,2度积液15个,3度积液18个。各期骨髓水肿分级构成比差异无统计学意义。髋部疼痛组与非疼痛组的股骨头骨髓水肿分级差异具有统计学意义。髋部疼痛组与非疼痛组的髋关节积液分度差异具有统计学意义。结论骨髓水肿程度和髋关节积液可以反映疾病的进展程度,可用于指导临床治疗和观察疗效。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.