发育性髋关节脱位Dega骨盆截骨术并发症原因分析

目的探讨Dega骨盆截骨术治疗发育性髋关节脱位并发症的发生原因。方法回顾性分析2001年12月至2006年12月采用Dega骨盆截骨术治疗的发育性髋关节脱位病例59例（72髋），对其并发症情况进行分析。结果59例（72髋）中，发生并发症7例（7髋），其中3髋出现股骨头缺血性坏死，均为男性，并有闭合复位病史，手术年龄均小于2岁；3髋发生半脱位，1髋为髂骨截骨部位嵌入骨块移位，1髋为髂骨截骨远端下翻不充分，1髋为再脱位术后关节囊不能紧缩缝合；1髋活动受限，与髂骨截骨远端下翻过多及股骨短缩不充分有关。结论Dega骨盆截骨术发生并发症的原因主要与术前对髋关节脱位的病理变化了解不充分，术中没有掌握好髂骨截骨要领及头臼压力过大有关。     

Dysplasia epiphysealis hemimelica—Trevor disease. Severe manifestations in a child

This report describes a case of dysplasia epiphysealis hemimelica with the first clinical manifestations at birth and increasing difference in the length of the lower extremities during infancy. The diagnosis was made at the age of 3 years when marked disability had already occurred. There was involvement of both legs and, to a lesser degree, the arms suggesting that this is a systemic disorder.Karl Gefferth (Budapest), the outstanding pediatric radiologist, in homor of his 80th birthday     

Unusual bone involvement in congenital syphilis mimicking the battered child syndrome

Congenital syphilis is re-emerging in modern society. The pediatric radiologist may contribute to its early diagnosis. A case of unusual bone involvement with fracture of the olecranon and facial bone lesions is described; the condition had to be differentiated from the “battered child syndrome”. The problem of congenital syphilis as an infectious disease versus bone dystrophy is also discussed.     

Changes in Calcaneal Trabecular Bone Structure Assessed with High-Resolution MR Imaging in Patients with Kidney Transplantation

The purpose of this study was to use high-resolution magnetic resonance (HR-MR) imaging to analyze the trabecular bone structure of the calcaneus in patients before and after renal transplantation and to compare this technique with bone mineral density (BMD) in predicting therapy-induced bone loss and osteoporotic fracture status. HR-MR imaging (voxel size: 0.195×0.195×1 mm) was performed at 1.5 T with an axial and sagittal orientation in 48 patients after transplantation, 12 patients before renal transplantation and 20 healthy controls. Structure measures analogous to standard histomorphometry and fractal dimension were determined in these images. BMD measurements of the lumbar spine and the proximal femur were obtained in the healthy female controls and the patients. Vertebral and peripheral fracture status were determined in all patients. The structural measures app.BV/TV, Tb.Sp, Tb.Th and Tb.N showed significant differences between controls and patients (p<0.05) while fractal dimension showed no significant differences. Neither the structural measures nor BMD showed significant differences between patients before and after transplantation. Correlations between time after transplantation versus structural measures and BMD were not significant. Differences between fracture and nonfracture patients were significant for the structural measures app.BV/TV, Tb.Sp and Tb.N (axial images) as well as for app.Tb.Th (sagittal images) and spine BMD (p<0.05) but not for hip BMD. Using odds ratios the strongest discriminators between patients with and without fractures were app. BV/TV, app.Tb.Sp (axial images) and app.Tb.Th (sagittal images), even after adjustment for age and BMD. Using receiver operating characteristic analysis the highest diagnostic performance was found for a combination of BMD and structural measures. In conclusion, our results indicate that structural measures obtained from HR-MR images may be used to characterize fracture incidence in kidney transplant patients; the best results, however, are obtained using a combination of BMD and structural measures. Received: 25 October 2000 / Accepted: 1 August 2001     

Variation in Pelvic Morphology May Prevent the Identification of Anterior Pelvic Tilt

Pelvic tilt is often quantified using the angle between the horizontal and a line connecting the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). Although this angle is determined by the balance of muscular and ligamentous forces acting between the pelvis and adjacent segments, it could also be influenced by variations in pelvic morphology. The primary objective of this anatomical study was to establish how such variation may affect the ASIS-PSIS measure of pelvic tilt. In addition, we also investigated how variability in pelvic landmarks may influence measures of innominate rotational asymmetry and measures of pelvic height. Thirty cadaver pelves were used for the study. Each specimen was positioned in a fixed anatomical reference position and the angle between the ASIS and PSIS measured bilaterally. In addition, side-to-side differences in the height of the innominate bone were recorded. The study found a range of values for the ASIS-PSIS of 0–23 degrees, with a mean of 13 and standard deviation of 5 degrees. Asymmetry of pelvic landmarks resulted in side-to-side differences of up to 11 degrees in ASIS-PSIS tilt and 16 millimeters in innominate height. These results suggest that variations in pelvic morphology may significantly influence measures of pelvic tilt and innominate rotational asymmetry.     

Growing bone cysts in long-term hemodialysis

All patients with chronic renal failure undergoing hemodialysis for more than 10 years in the university hospitals of Leuven were selected for this study. The medical records and radiographs of these 21 patients were studied retrospectively. Skeletal surveys were examined for the presence and location of subchondral cysts. The predialysis films and the films taken after 5, 10, 15 and 20 years of dialysis were reviewed. Subchondral cysts that grew in size and number were found in the wrist, humeral head, hip, and patella. Accurate measurements were made of cysts in the wrist and compared with a control group. In the dialysis group, cystic involvement of the wrist was more common and the size and number of the cysts were larger. Soft tissue swelling was seen in the dialysis group but not in controls. Soft tissue swelling was assessed on shoulder radiographs by measuring the acromiohumeral distance (ACD) and in the knees by ultrasonic measurement of synovial thickness [25]. In 11 patients synovial or bone biopsies or aspirated synovial fluid were available. All these patients had swollen joints and multiple subchondral periarticular cysts. Amyloid deposition was found in ten of these patients, and this proved to be composed of B2 microglobulins in seven (Table 1).     

Disseminated BCG Infection in a patient with Severe Combined Immunodeficiency

Disseminated mycobacterial infection after bacillus Calmette-Guerin (BCG) vaccination is a very rare disorder, occurring mostly in patients with immunologic deficiency. We report a case of disseminated BCG infection in a 16-month-old girl with severe combined immunodeficiency. Plain radiographs showed multiple osteolytic lesions in the femora, tibiae, humerus, and phalanges. Abdominal sonography and CT scanning revealed multiple nodules in the spleen, and portocaval lymphadenopathy.     

Aneurysmal Bone Cyst of the Frontal Bone — A Case Report

A rare case of aneurysmal bone cyst of the frontal bone in a 33 years old male is presented with a brief review of the literature.     

手掌侧烧伤后瘢痕挛缩的治疗方案研究

【目的】研究手掌侧烧伤后瘢痕孪缩的治疗方案。【方法】选择2012年1月至2015年6月在本院就诊的80例手掌侧烧伤后瘢痕孪缩患者,按照随机数表法将患者分为观察组和对照组,每组各40例,对照组患者由康复师对其手部挛缩关节和瘢痕进行被动运动治疗,观察组患者采用掌骨指骨牵引矫治法,对两组患者的瘢痕情况、关节总活动度（TAM）、日常生活活动能力（ADL）进行评定,记录两组患者的不良反应率。【结果】治疗后,观察组瘢痕评分明显低于对照组,TAM评分、ADL评分明显较对照组高,差异均具有统计学意义（均P〈0．05）;观察组患者不良反应率为7．5％,与对照组患者5％的不良反应率比较差异无统计学意义（P〉0．05）;观察组患者复发率为0．0％（0／40）与对照组10．0％（4／40）比较差异具有统计学意义（P〈0．05）。【结论】掌骨指骨牵引能够有效治疗手掌侧烧伤后瘢痕挛缩,能够极大程度地提高患者关节活动度,缓解瘢痕挛缩,有助于患者手部功能的恢复,降低术后复发率。