踝关节前外侧软组织撞击综合征的关节镜下诊断和治疗

目的 探讨踝关节前外侧软组织撞击综合征的关节镜下诊断和治疗.方法 对50例临床疑似踝关节前外侧软组织撞击综合征者行关节镜检查,确诊并行关节镜下清理术者40例.对诊断和治疗结果进行回顾性总结分析.结果 术前确诊率为80%,40例均获随访,随访时间平均18个月.术后优16例,良18例,可6例,优良率85%.结论 踝关节镜对踝关节前外侧软组织撞击综合征的诊断和治疗有重要价值.     

Diagnostic Value of Early Magnetic Resonance Imaging After Acute Lateral Ankle Injury

We report a retrospective study of 171 consecutive patients with a lateral ankle sprain. All the patients with direct or blunt force trauma were excluded. Within 21 days of injury, 115 (67.25%) patients had undergone magnetic resonance imaging to evaluate for more serious or significant injuries. The average patient age was 44.09 years. Of the 115 patients, 75 (65.23%) had findings noted to be “significant.” MRI can serve as a valuable and underused tool in the evaluation of acute lateral ankle injuries. The underuse of MRI might explain the high degree of variability in patients recovering from a lateral ankle sprain.     

Preoperative Assessment of the Peroneal Tendons in Lateral Ankle Instability: Examining Clinical Factors,Magnetic Resonance Imaging Sensitivity,and Their Relationship

The purpose of our study was to examine the preoperative clinical factors and magnetic resonance imaging (MRI) findings associated with peroneal pathology in chronic lateral ankle instability patients, as well as the clinical factors associated with peroneal lesions being detected on MRI. Peroneal pathology was determined from intraoperative findings. Patients with/without peroneal pathology were compared regarding their preoperative clinical findings. MRI reports were examined to determine the sensitivity of detecting peroneal pathologies. Clinical factors were compared between patients (N = 238) with undetected and detected peroneal lesions on MRI. Conservative treatment, preoperative physical therapy, and lack of a traumatic inciting event were associated with peroneal pathology. MRI had a sensitivity of 61.11% for detecting peroneal pathology. No clinical factors were significantly different between “detected” and “undetected” cases. Certain historical factors were associated with peroneal pathology in patients with chronic lateral ankle instability, and MRI had a high false-negative rate. Surgeons should exercise caution when ruling out peroneal pathology based on preoperative physical examination or MRI.     

磁共振成象（MRI）诊断腰椎间盘突出症

本文报告了60例术前经磁共振成象(MRI)诊断为腰椎间盘突出症病人的手术探查结果。其诊断正确率为84.2％,假阳性7例,假阴性6例。与CT的正确率相仿。MRI具有对软组织的高分辨率、无侵袭性以及可以做多方向的扫描等优点,在经过技术上的改进后,定将具有更大的临床意义。     

Intra-articular Lesions in Chronic Lateral Ankle Instability: Comparison of Arthroscopy with Magnetic Resonance Imaging Findings

Background

Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions.

Methods

Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated.

Results

Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had ''tram-track'' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions.

Conclusions

Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients'' residual symptoms and significantly increased patient satisfaction.     

Evaluation of the Prevalence of Os Trigonum and Talus Osteochondral Lesions in Ankle Magnetic Resonance Imaging of Patients With Ankle Impingement Syndrome

The prevalence of os trigonum and osteochondral lesions of talus (OCLT) have been presented in different prevalences among different groups in the literature for the patients with ankle impingement syndrome. Our main objective in the study was to determine the possible relationship between the impingement syndrome and the prevalence of os trigonum and OCLT in specific groups. The presence of anterior ankle impingement syndrome (AAIS), posterior ankle impingement syndrome (PAIS), os trigonum, OCLT, and the location of OCLT were evaluated in a blinded manner on magnetic resonance imaging from patients clinically considered to be diagnosed with ankle impingement syndrome from January 2014 to July 2017. The patients were separated into specific groups according to the confirmation of their clinical diagnosis of ankle impingement syndrome on magnetic resonance imaging . A total of 333 patients were included. The prevalence of os trigonum was found to be 1.3% in patients with PAIS(-) AAIS(+), 7.7% in patients with PAIS(-) AAIS(-), 63.3% in patients with PAIS(+) AAIS(-), and 81.1% in patients with PAIS(+) AAIS(+) (p < .001). The prevalence of OCLT was found to be 41.3% in patients with PAIS(-) AAIS(+), 23.1% in patients with PAIS(-) AAIS(-), 18.3% in patients with PAIS(+) AAIS(-), and 27% in patients with PAIS(+) AAIS(+) (p= .005). Our study showed that, for patients with isolated PAIS and AAIS combined with PAIS, the prevalence of os trigonum was 63.3% and 81.1%, respectively, which is more common than previously reported. For patients with isolated AAIS and PAIS, the prevalence of OCLT was 41.3% and 18.3%, respectively. Of the OCLTs combined with ankle impingement syndromes, 87.1% were medially located.     

Intra-articular Plica Causing Ankle Impingement in a Young Handball Player: A Case Report

Ankle sprains are common injuries that respond well to rehabilitation. In the case of persisting symptoms, the differential diagnosis should include osteochondral defects, tendon injury, mechanical instability, and ankle impingement. In the present case report, we describe a 16-year-old male handball player who presented with persisting pain and locking in the right ankle 3 years after having sustained multiple minor inversion trauma. The clinical examination and conventional radiography showed no abnormalities. On magnetic resonance imaging, a flake fracture at the anteromedial talar dome and/or loose body was assumed. Arthroscopic examination revealed an intra-articular plica originating from an osteochondral fossa at the anteromedial tibial plafond. The plica was debrided. Retrospectively, the arthroscopic findings matched the radiographs and magnetic resonance images. The postoperative protocol consisted of early mobilization. At 6 weeks of follow-up, the patient had no pain and had returned to his sports activities. The present case report illustrates, to the best of our knowledge, the first case of ankle impingement due to a, most likely congenital, intra-articular plica arising from an osteochondral fossa at the anteromedial tibial plafond. This rare clinical condition can be diagnosed with magnetic resonance imaging. Arthroscopic debridement will effectively relieve the symptoms.     

小腿岛状穿支蒂螺旋桨皮瓣与股前外侧皮瓣修复足踝部复合组织缺损对比分析

目的:比较小腿岛状穿支蒂螺旋桨皮瓣与股前外侧皮瓣修复足踝部复合组织缺损的疗效.方法:按照随机数字表法将2019年1月-12月笔者医院收治的40例足踝部复合组织缺损患者分为A组与B组,每组20例.A组患者采用小腿岛状穿支蒂螺旋桨皮瓣进行修复,B组患者采用股前外侧皮瓣进行修复,术后随访12个月.比较两组的手术时间、皮瓣愈合...     

游离股前外侧皮瓣治疗小儿足踝部严重软组织损伤

目的 探讨游离股前外侧皮瓣修复小儿足踝部严重软组织缺损的临床经验.方法 1997年2月至2012年1月对16例小儿足踝部严重软组织缺损应用吻合血管的股前外侧皮瓣修复,并对手术方式、手术时机及疗效进行分析.结果 16例患儿移植皮瓣顺利成活12例,术后于24～48 h内发生动脉性血管危象4例,经取栓切取对侧大隐静脉移植后2例成活,但仍有2例出现皮瓣坏死.结论 游离股前外侧皮瓣移植是修复小儿足踝部严重软组织缺损的一种良好的选择,熟悉小儿游离皮瓣移植的特点,可获得满意的治疗效果.     

Functional Magnetic Resonance Imaging in Prostate Cancer

Context

Magnetic resonance imaging (MRI) combined with magnetic resonance spectroscopy imaging (MRSI), dynamic contrast-enhanced MRI, and diffusion-weighted MRI emerged as promising tests in the diagnosis of prostate cancer, and they show encouraging results.

Objective

This review emphasizes different functional MRI techniques in the diagnosis of prostate cancer and includes information about their clinical value and usefulness.

Evidence acquisition

The authors searched the Medline, Embase, and Cochrane Library databases. There were no language restrictions. The last search was performed in October 2008.

Evidence synthesis

The combination of conventional MRI with functional MRI techniques is more reliable for differentiating benign and malignant prostate tissues than any other diagnostic procedure. At present, no guideline is available that outlines which technique is best in a specific clinical situation. It also remains uncertain whether improved spatial resolution and signal-to-noise ratio of 3-T MRI will improve diagnostic performance.

Conclusions

A limited number of small studies suggest that functional MRI may improve the diagnosis and staging of prostate cancer. This finding needs further confirmation in larger studies, and cost-effectiveness needs to be established.     

Posterior Ankle Impingement: Clarification and Confirmation of the Pathoanatomy

The diagnosis of posterior hindfoot pain may prove to be elusive as there are many potential causes of hindfoot pain, including both soft tissue and osseous abnormalities. This is a case presentation of os trigonum syndrome, with the diagnosis suggested by magnetic resonance imaging (MRI), confirmed by ultrasound, and treated with os trigonum resection. Specific findings of os trigonum syndrome can be seen on MRI, including bone marrow edema pattern and high signal intensity in the synchondrosis as well as in the surrounding soft tissues. Diagnostic injections performed with imaging guidance can help confirm the diagnosis in equivocal cases. Diagnostic and interventional imaging procedures can help confirm the diagnosis of os trigonum syndrome in a patient presenting with hindfoot pain.     

Magnetic Resonance Imaging of Shoulder Arthroplasty

Background

Magnetic resonance (MR) imaging evaluation of the painful failed shoulder arthroplasty is a useful imaging modality due to advancements in metal artifact reduction techniques, which allow assessment of the integrity of the supporting soft-tissue envelope and the implant.

Questions/Purposes

The focus of this pictorial review is to illustrate the benefits of MR imaging, whether used alone or as an adjunct to other imaging modalities, in aiding the clinician in the complex decision making process.

Methods

A PubMed (MEDLINE) search focusing on the complications and imaging assessment of shoulder arthroplasty was performed. Articles were selected for review based on their pertinence to the aforementioned topics.

Results

We discuss the ability of MR imaging to identify why a patient’s arthroplasty may have failed. Specific causes including component loosening and implant failure, rotator cuff and deltoid integrity, infection, subtle fractures, and nerve pathology are reviewed, with illustrative sample images.

Conclusion

MRI is a valuable tool in the assessment for pathology in the shoulder following arthroplasty.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-014-9399-3) contains supplementary material, which is available to authorized users.     

Usefulness of Preoperative Diagnosis with Magnetic Resonance Imaging for Conservative Surgery in Paget's Disease of the Breast

BACKGROUND: Paget's disease (PD) of the breast is a relatively rare condition (incidence 1-3%) among primary breast cancers [6]. It presents with suggestive symptoms like erythema, nipple bleeding and ulceration. PATIENT AND METHODS: A 76-year-old woman was followed up for cancer of the left breast that had been operated 10 years before. During her annual check, a lesion suggestive of PD was detected. Mammography and ultrasound were performed, without evidence of a new breast lesion. In consideration of a possible underestimation of the real extent of the disease, we performed magnetic resonance imaging (MRI). RESULTS: MRI showed an irregularly shaped tissue infiltrating the external side of the right breast. The pathologically bright signal involved the nipple and deformed the areolar skin. The characteristics of the increased signal were typical of a hypervascular invasive pattern and for tumoral neoangiogenesis. We performed a mastectomy with sentinel lymph node (SLN) biopsy, with evidence of a DIN 3 carcinoma associated with PD of the nipple at the final pathology report. CONCLUSION: The MRI was instrumental for the assessment of the existence and extent of malignant disease in a patient with PD but without a palpable lesion detectable with negative ultrasound and mammography.