髌骨软化症的X线分析

髌骨软化症(称髌骨软骨软化症)是膝关节疼痛的常见原因之一，由于该病临床症状轻重不一，早期无X线征象，常造成漏诊。病理变化可见髌软骨变性、糜烂。本文搜集了54例髌骨软化症资料。     

髌骨软化症的X线分析

髌骨软骨软化症(简称髌骨软化症)是膝关节疼痛的常见原因之一，由于该病临床症状轻重不一，早期无明显X线征象，常造成漏诊。本文搜集了72例髌骨软化症患者资料，旨在提高对髌骨软化症的认识。     

成年人先天性巨结肠的X线诊断

目的 研究成人先天性巨结肠症的Ｘ线表现。方法 对６例患者作了钡灌肠检查，全部经手术证实。结果 成人先天性巨结肠症的主要的Ｘ线表现为直肠部可见３～７ｃｍ的局限性狭窄，其近端的结肠壁增厚、肠腔明显扩张，最宽达２２ｃｍ，狭窄段和扩张段之间可见长２～６ｃｍ、呈圆锥或漏斗状逐渐扩张的移行段。２例合并有粪石形成。结论 钡灌肠是术前诊断本病的最可靠和简便的方法。     

髌骨软骨软化症的早期X线表现

髌骨软骨软化症亦称髌骨软化症，是膝部关节疼痛的常见原因之一。我们对30例髌骨软骨软化症患者的早期X线表现进行了分析。临床资料：30例患者中，男18例，女12例。年龄16—72岁，平均41．5岁。30例均有典型的临床表现：膝关节痛、髌周压痛15例，屈伸受限8例，膝关节肿胀12例，浮髌试验阳性21例，副韧带牵拉试验阳性者13例，髌骨研磨试验阳性5例。     

髌骨软骨软化症的X线诊断

髌骨软骨软化症又称髌骨软化症，是髌骨软骨与髌骨后股骨同时发生退行性变的痰炳，为膝关节疼痛的常见原因之一。近年来随着CT设备的不断更新，MRI技术的不断进步，对于该病的研究亦不断深入和发展．但是普通X线检查仍然是其最主要的检查办法和手段，特别是CR和DR等数字化X线设备的引进和使用，对该病较早期改变的显示亦明显提高，大大提高了对该病的检出率。本文共收集自2003—2005年的典型病历50例，并进行了系统地回顾和分析，旨在加深和提高对髌骨软化症的认识。现报导如下：     

2例成年人结肠套叠临床及X线分析

例1患者女26岁。近半年来数次腹痛并伴有不规则阴道出血，大便一日一次，便稀，消瘦体质，贫血，血色素6克／升。临床检查；于右下腹可触及一包块，质硬。超声检查：于右下腹可探及一包块，横断面呈强回声与弱回声交错表现，于纵断面见多层管状结构，呈同心圆状，肠壁增厚，界面不甚清晰，病变以上肠管未见明显淤滞改变。超声提示：肠套叠。次日行结肠气钡双对比造影，于造影前再次行超声检查，声像图同前，但位置由右下腹转到左中腹部，由于有超声的提示，所以在检查时将压强调至10KPa（一般为15KPa），将钡剂缓缓注入150ml后，停止注钡开动气泵，注入气体，在注入钡、气过程中于电视监视下示直肠、乙状结肠、降结肠充盈良好，无明显狭窄、扩张及梗阻征象。     

计算机X线摄影的临床应用

1．1自从伦琴于1895年发现X线以来，X线检查及诊断技术始终处在传统的屏／片组合水平上。到了20世纪70年代以后，随着物理学、电子学、计算机和微电子技术的飞跃发展、医学影像学领域先后发明了一系列的全新现代设备，如计算机X线断层摄影(CT)、核磁共振成像(MRI)、     

髌骨软骨软化症的早期X线表现及其演变过程

作者对有完整随访资料的１１４例髌骨软骨化症进行了Ｘ线分析，发现髌骨软骨软化症的演变过程如下：早期Ｘ线表现为髌骨关节面软骨下骨质吸收，骨性关节面模糊不清，进而可囊变伴髌骨后缘骨密度增高，或出现关节面限局性凹陷，常伴有髌骨上下角小骨刺。此外，还可见股骨髁软骨下骨质吸收，滑膜增厚，髌韧带增宽，边缘模糊，髌下脂肪垫呈粗大模糊网状结构以及股四头肌腱肥厚等一系列征象，上述征象大多随病程的延长而加重；而软组织改     

MRI criteria for patella alta and baja

Objective To determine the range of the patellar tendon length to patellar length ratio on magnetic resonance imaging (MRI) of the knee in order to aid in the establishment of MRI criteria for patella alta and baja.Patients Two hundred and forty-five patients ages 6–85 (mean 44) years who went through 262 consecutive 1.5 MRI studies of the knee performed during November 2000 through February 2001 were evaluated, regardless of their clinical symptoms.Design Patellar length (PL) and patellar tendon length (TL) were measured by a single musculoskeletal radiologist on sagittal images by a line connecting the superior and inferior patellar poles and the shortest length of the inner margin of the tendon respectively. TL/PL ratio was subsequently calculated. The distribution of ratios was evaluated; the extreme 2.5% at each end of the distribution was defined as patella alta and baja.Results The TL/PL ratio ranged between 0.56 and 1.71 (mean 1.05). After plotting the ratios, we noted an asymmetric curve skewed to the left. Based upon calculation of the extreme 2.5% of the ratio at each end of the plot, we determined that the MRI definition of patella alta and baja is a ratio of TL/PL of more than 1.50 and less than 0.74 respectively. We found that females had significantly higher TL/PL ratio than males (1.0878 and 1.0032 respectively). Ratios defined for patella alta and baja were 1.52 and 0.79 respectively in females and 1.32 and 0.74 respectively in males (p<0.0001).Conclusion Patella alta and baja are determined as TL/PL of more than 1.50 and less than 0.74 respectively, somewhat different than traditionally quoted radiographic and previously described MRI criteria.     

Superior dislocation of the patella with early onset patellofemoral arthritis: a case report and literature review

Among the traumatic patellar dislocations, superior dislocation of patella without patellar ligament injury is very rare. We present in this article, a case of superior dislocation of the patella trapped by interlocked osteophytes in a 38-year-old female who had concurrent bilateral knee arthrosis. Succesful reduction was achieved by closed manipulation without anesthesia. Neither redislocation nor symptoms of instability was seen after 36 months of follow-up, although some progression of arthritis was observed. A new classification including all traumatic patellar dislocation was also proposed.     

儿童髌骨套状骨折的X线特点

目的 探讨儿童髌骨套状骨折的X线表现特点.方法 对11例儿童髌骨套状骨折的X线表现和临床资料进行回顾性分析,评价髌骨套状骨折的X线特征.结果 11例儿童髌骨套状骨折中,X线平片表现为关节肿胀11例、髌骨移位9例、髌股关节间隙增宽5例、髌骨上下极边缘毛糙或游离小斑状、蛋壳状骨片11例.1例儿童髌骨下极套状骨折初诊X线平片未显示骨折片,15 d后复诊时蛋壳样的撕脱骨折片可清晰显示.结论 儿童髌骨套状骨折X线表现具有特征性.     

髌骨轴位X线摄片方法改进及多种测量方法综合评价的临床应用

目的：评价改进后的屈膝25°髌骨轴位X线摄片及多种测量法的临床意义。方法：用特制髌骨轴位摄影架摄片，测量无症状者（正常人）30名作为对照组；有前膝痛（AKP），经轴位摄片发现髌骨排列异常者154例。测量沟角（SA）、适合角（CA）、髌骨侧方移位度（LS）、外侧髌骨角（LPFA）、髌骨指数（PFI）、髌骨横向移位距离（LPD）。结果：2组各参数平均值分别为：对照组：SA137．38°，CA-10．73°，LS 10．49％。LPFA13．70°，PFI 0．48，LPD0．45mm；AKP组：SA142．38°，CA 0．71°，LS 19．68％，LPFA 12．12°，PFI 1．13，LPD 0．42mm。2组各参数比较，t值分别为9．36、10．16、4．18、7．98、0．82、12．29，除LPD的P值〉0．05外，其他各项P值均〈0．01。反映髌骨排列异常的敏感性以PFI、CA、LS、LPFA、LPD较明显，分别为71．66％、63．33％、56．66％、21．60％、16．66％。结论：采用改进后的屈膝25°髌骨轴位摄片，可使摄片成功率及清晰度明显提高，使划线测量简易准确，得出的相关资料更为可靠。     

Reliability and interobserver variability in radiological patellar height ratios

This study evaluated the reliability and interobserver variability of five patellar height ratios as measured by two examiners on standard radiographs: Insall-Salvati (IS), modified Insall-Salvati (MIS), Blackburne-Peel (BP), Caton-Deschamps (CD), and Labelle-Laurin (LL). Plain lateral radiographs with a knee flexion angle of 20° for IS, MIS, BP, and CD ratios and 90° for the LL method of 22 knees of 21 patients with varying pathological knee conditions were analyzed. Statistical results revealed a low interobserver variability with high correlation coefficients (0.86 for IS, 0.82 for MIS, 0.86 for BP, 0.92 for CD, and 0.81 for LL; P > 0.3) and low mean interobserver errors. However, regarding the reliability of the radiographic results of the different methods for patella alta, baja, or norma we found varying results in 68% of the patients. In two patients the patellar height was classified as alta, norma, or baja depending on the ratio used. Regarding the definitions of patellar height used by the authors of these methods, we found the lowest number of normal patellae with the IS ratio and no patella alta for the CD ratio. The LL method revealed the highest number of patella alta. The BP ratio showed intermediate results for both patella alta and baja, being the most moderate method. This study showed that there was a good interobserver reliability for the evaluation of patellar height according to the common radiological ratios. However, the high frequency of differing results between the different radiographic ratios showed that patellar height classification as “alta,”“norma,” or “baja” depends heavily on the chosen index. The differing results were due mainly to the normative patellar height data and to anatomical differences. Based on these findings we recommend a ratio using the articular surface of the patella in relation to the joint line. We recommend the BP method because it revealed the lowest interobserver variability and discriminated best among the groups alta, norma, and baja. Received: 6 December 1999 Accepted: 15 March 2000     

MRI findings in bipartite patella

Purpose Bipartite patella is a known cause of anterior knee pain. Our purpose was to detail the magnetic resonance imaging (MRI) features of bipartite patella in a retrospective cohort of patients imaged at our institution. Materials and methods MRI exams from 53 patients with findings of bipartite patella were evaluated to assess for the presence of bone marrow edema within the bipartite fragment and for the presence of abnormal signal across the synchondrosis or pseudarthrosis. Any other significant knee pathology seen at MRI was also recorded. We also reviewed 400 consecutive knee MRI studies to determine the MRI prevalence of bipartite patella. Results Of the 53 patients with bipartite patella 40 (75%) were male; 35 (66%) had edema within the bipartite fragment. Of the 18 with no edema an alternative explanation for knee pain was found in 13 (72%). Edema within the bipartite fragment was the sole finding in 26 of 53 (49%) patients. Bipartite patella was seen in 3 (0.7%) of 400 patients. Conclusion In patients with bipartite patella at knee MRI, bone marrow edema within the bipartite fragment was the sole finding on knee MRI in almost half of the patients in our series.     

Paget's disease of the patella

Five patients with Paget's disease involving the patella were evaluated for the following radiographic features: trabecular pattern, cortical integrity, density, and size of the affected patella. Radiographic appearances consisted of minimal trabecular coarsening in the patella of nearly normal size and progressed to considerable cortical thickening and osteoblastic remodeling in a dramatically enlarged patella. The radiologic features of Paget's disease of the patella are distinctive and should obviate biopsy.The opinions and assertions contained herein are the private views of the authors and do not reflect the views of the Department of the Army or of the Department of Defense     

DR髌骨站立轴位的体位设计及临床应用

目的探讨数字X线摄影(DR)髌骨站立轴位的体位设计及其临床应用。方法患者取站立位,手扶机架单脚站立,被检侧膝关节屈曲30～60°,足尖尽量绷直,足背或小腿紧贴探测器边缘,然后调整中心线的入射点从头侧进行摄影。结果采用髌骨站立轴位摄影共100例,其中优质片79例,占79%;良质片18例,占18%;劣质片3例,占3%。结论髌骨站立轴位摄影操作简便,患者舒适易配合,可作为髌骨的补充摄影方法。     

Dorsal defect of the patella: concept of its origin and relationship with bipartite and multipartite patella

In a series of 2286 single radiographic examinations of the knee in 1985, 6 dorsal defects of the patella (DDP) were detected. The diagnosis was made if a round lucent lesion of the dorsal superolateral surface of the patella [9] was found abutting against articular cartilage [10]. In four of our patients, an association with a multipartite patella (MP) was found. Biopsy of one lesion showed dense connective tissue and areas of bone necrosis. In one patient, the pattern of reossification of the lesion could be demonstrated. Our observations provide further evidence that the DDP is a stressinduced anomaly of ossification rather than a posttraumatic subarticular cyst of the patella, a diagnosis sometimes suggested by the clinical context. The initial lesion is probably a traction lesion at the insertion of the vastus lateralis muscle rather than ulceration of articular cartilage. We suggest a possible relationship between dysfunction of the quadriceps mechanism, patellar subluxation, and the genesis of the DDP.     

Focal lesions of the patella

Focal lesions of the patella may be identified during the investigation of anterior knee pain or as an incidental finding on radiological images. This pictorial review describes the radiographic appearances of a wide range of conditions that have been seen in this sesamoid bone. Where appropriate, computed tomography and magnetic resonance features have been included.