Spiral CT arthrography of multiplanar reconstruction and virtual arthroscopy technique in diagnosis of knee with internal derangements

To evaluate the values of spiral CTarthrography with multiplanar reconstruction and virtualarthroscopy technique in diagnosis of internal derangementsof the knee.     

牙颌面专用CT颞下颌关节造影的临床应用

目的　探讨牙颌面专用CT颞下颌关节 (temporomandibularjoint ,TMJ)造影对关节盘移位及关节骨结构的诊断效果。方法　对 10 9例 (119侧 )TMJ行牙颌面专用CT关节造影检查 ,将关节盘移位分为 5型 ,髁突骨质改变分为 4型。结果　① 119侧关节均有不同类型的关节盘移位 ,其中 84侧仅有关节盘前移位 ;另 35例则为关节盘旋转移位和侧向移位。②骨关节病的发生率 :男性、女性分别为 6 0 0 %和 6 1.7% ;骨关节病的发生率与关节盘移位类型无关 (χ2 =1.5 6 ,P >0 .0 5 )。③ 73侧骨关节病关节中 ,4 9侧 (6 7.1% )病变发生于髁突外侧 ,8侧病变发生于髁突内侧 ,另有 5侧髁突骨质改变部位不能确定。结论　TMJ造影牙颌面专用CT技术可同时多层面显示关节盘及关节骨性结构的病变 ,尤其是可对关节盘旋转移位及侧向移位、关节盘穿孔等作出准确诊断 ,因而明显优于常规关节造影     

Value of arthrography after supination trauma of the ankle

Objective. To investigate the merits of arthrography after supination trauma of the ankle. Design and patients. In a group of 160 consecutive patients operative exploration was performed in cases where arthrography and/or a delayed physical examination showed positive findings. In all patients arthrography was performed within 48 h after trauma. To determine interobserver agreement, all arthrograms were independently evaluated by two radiologists, both ignorant of the first assessment. Results. The prevalence of an ankle ligament lesion was found to be 76%. Of the 122 patients with a rupture of one or more ankle ligaments, 52% had an isolated anterior talofibular ligament lesion, 3% had an isolated calcaneofibular ligament lesion, and 45% had combined lesions. The site of the lesion was predominantly intraligamentous. In the determination of the presence or absence of an ankle ligament lesion, the specificity and sensitivity of the ankle arthrogram were 71% and 96% respectively. Interobserver agreement on the arthrogram was very good (κ 0.9). In 1% of patients a clear diagnosis was not possible by means of arthrography. Conclusion. Arthrography provides information of high diagnostic quality with excellent interobserver agreement and therefore remains the gold standard for early diagnosis (within 48 h) of a lateral ankle ligament rupture.     

3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy

Objective

To evaluate the value of hip MR for diagnosing acetabular labrum tears, and to further compare the diagnostic performances of conventional MR with MR arthrography in acetabular labrum tears.

Methods

90 patients undergoing both hip MR examination and subsequent hip arthroscopy were retrospectively evaluated. Of these patients, 34 accepted both conventional MR and MR arthrography; while the other 56 only underwent conventional MR examination. All hip MR images were independently reviewed by two radiologists, and further compared with the results of hip arthroscopy.

Results

59 of 90 patients were confirmed with acetabular labral tears by hip arthroscopy and 31 without tears. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional MR for evaluating the acetabular labral tears were 61.0%, 77.4%, 83.7% and 51.1% (radiologist A), and 66.1%, 74.2%, 82.9% and 53.4% (radiologist B), respectively, with good consistency between the two observers (K = 0.645). The sensitivity, specificity, PPV and NPV of MR arthrography for assessing the acetabular labral tears were 90.5%, 84.6%, 90.5% and 84.6% (radiologist A), and 95.2%, 84.6%, 90.9% and 91.7% (radiologist B), respectively, with excellent good consistency between the two observers (K = 0.810). The sensitivity and NPV of MR arthrography for diagnosing the acetabular labral tears were significantly higher than those of conventional MR (both P < 0.05).

Conclusion

Hip MR arthrography is a reliable evaluation modality for diagnosing the acetabular labral tears, and its diagnostic performance is superior to that of conventional MR at 3.0 T.     

术中造影监测下闭合复位内固定治疗儿童肱骨髁间骨折

目的:探讨术中造影监测下闭合复位内固定治疗儿童肱骨髁间骨折的临床疗效。方法:自2013年1月至2018年7月术中造影监测下手术治疗18例儿童肱骨髁间骨折患者,其中男13例,女5例;年龄3～12(8.50±2.57)岁;按照TonioloWilkinson分型,Ⅰ型8例,Ⅱ型10例。术中根据造影显示肱骨远端软骨关节面的断裂情况,行闭合复位内固定,必要时行切开复位内固定。术后6个月采用Mayo肘关节功能评分标准评定患肢临床疗效。结果:18例患儿均在术中行肘关节造影,其中5例软骨关节面未断裂,行闭合复位内固定;11例软骨关节面断裂,但台阶≤2 mm,行闭合复位内固定;2例软骨关节面断裂,且台阶2 mm,先撬拨复位软骨关节面,1例关节面平整的,行闭合复位内固定;1例关节面不平整的,台阶仍2 mm,行切开复位内固定。所有患儿术后获得了随访,时间8～26(20.28±4.40)个月。所有患儿骨折获得愈合,时间6～9(7.33±0.77)周。术后6个月Mayo肘关节功能评分为(89.44±11.36)分,其中优12例,良5例,差1例。术后发生肘关节功能障碍1例,其余未发生伤口感染、肘部畸形等并发症。结论:术中造影监测下治疗儿童肱骨髁间骨折,可以减少手术创伤和并发症,及时、清楚地确认软骨关节面的复位效果,促进肘关节功能的恢复。     

髋臼盂唇损伤的关节镜手术

目的 探讨髋臼盂唇损伤的诊断方法和关节镜治疗结果.方法 2008年11月至2009年12月收治单侧髋臼盂唇损伤行关节镜手术且随访时间超过半年的患者21例,男9例,女12例;年龄17～65岁,平均37.1岁.术前行体格检查、X线和MR关节造影明确诊断.于髋关节镜下行盂唇清理术14例、盂唇清理及股骨头颈区成形术5例、盂唇修复及股骨头颈区成形术2例.结果 Fadir试验阳性21例(100%,21/21),Fabir试验阳性15例(71%,15/21),McCarthy试验阳性9例(43%,9/21).X线片显示11例存在凸轮型撞击(其中6例合并钳夹型撞击),2例为单纯钳夹型撞击.MR关节造影均显示前上象限不同程度的盂唇损伤信号,阳性率100%;所有盂唇损伤均经关节镜证实,准确率100%.全部病例随访6～19个月,平均11.6个月.术后症状明显缓解,疼痛视觉模拟评分由术前(5.3±1.3)分降至术后6个月(1.4±0.9)分,Harris髋关节评分由术前(63±9)分提高至术后6个月(84±10)分,差异均有统计学意义.结论 髋臼盂唇损伤与股骨髋臼撞击有关.撞击试验和MR关节造影具有较高的诊断阳性率和准确率.关节镜下髋臼盂唇损伤的清理、修复与骨成形术可获得满意的早期临床效果.     

The sinus tarsi syndrome

Summary The sinus tarsi syndrome is now a well-defined entity of foot pathology. Usually post-traumatic, it is characterised by pain over the lateral opening of the sinus tarsi and a feeling of instability of the ankle.We were able to define two objective criteria for the syndrome: arthrography of the subtalar joint shows specific abnormalities and recording of the electromyographic function of the peronei demonstrates abnormalities during walking.Conservative treatment is successful in about two-thirds of the cases. In other cases a simple surgical procedure can cure or improve 90% of the patients.Clinical research supported by Hoffmann La Roche, Switzerland     

MR appearance of cartilage defects of the knee: preliminary results of a spiral CT arthrography-guided analysis

The aim of this study was to determine signal intensity patterns of cartilage defects at MR imaging. The MR imaging (3-mm-thick fat-suppressed intermediate-weighted fast spin-echo images) was obtained in 31 knees (21 male and 10 female patients; mean age 45.5 years) blindly selected from a series of 252 consecutive knees investigated by dual-detector spiral CT arthrography. Two radiologists determined in consensus the MR signal intensity of the cartilage areas where cartilage defects had been demonstrated on the corresponding reformatted CT arthrographic images. There were 83 cartilage defects at spiral CT arthrography. In 52 (63%) lesion areas, the MR signal intensity was higher than that of adjacent normal cartilage with signal intensity equivalent to (n=31) or lower than (n=21) that of articular fluid. The MR signal intensity was equivalent to that of adjacent normal cartilage in 17 (20%) lesion areas and lower than that of adjacent cartilage in 8 (10%) lesion areas. In 6 (7%) lesion areas, mixed low and high signal intensity was observed. The MR signal intensity of cartilage defects demonstrated on spiral CT arthrographic images varies from low to high on fat-suppressed intermediate-weighted fast spin-echo MR images obtained with our equipment and MR parameters.     

Joint fluoroscopy before arthrography: Detection and evaluation of loose bodies

Fluoroscopy before injection of contrast medium increased the usefulness and accuracy of arthrography in 14 of 22 patients with possible intra-articular loose bodies. Although loose bodies wedged between articular surfaces deep within the joint were immobile, a typical tumbling motion on fluoroscopy reliably identified most free-floating loose bodies. Fluoroscopy sometimes revealed abnormalities more clearly than the plain radiographs or arthrograms.     

肩袖损伤诊断中肩关节造影和MRI的敏感性和特异性比较

目的 通过随访分析,比较肩关节造影和ＭＲＩ诊断户袖部分和完全撕裂的敏感性和特异性。方法 对５３例怀疑有肩袖损伤（包括部分撕裂和完全撕裂）患者的术前关节造影和ＭＲＩ检查结果与术中发现进行比较分析。结果 肩关节造影、ＭＲＩ诊断肩袖部分撕裂的敏感性分别为７０％和８０％,特异性均为７５％。诊断肩袖完全撕裂的敏感性分别为８７％和９０％,特异性分别为１００％和７５％。结论 关节造影与ＭＲＩ诊断肩袖损伤敏感性无