Bony ankylosis following thermal and electrical injury

Objective. Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter’s syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited. Design and patients. Thirteen cases of burn-related joint ankylosis in four patients are presented. Conclusion. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction. Received: 14 August 2000 Revision requested: 8 December 2000 Revision received: 26 December 2000 Accepted: 26 December 2000     

MR Imaging of Medullary Streaks in Osteosclerosis: A Case Report

We present a case of medullary sclerosis of the appendicular skeleton in a patient with chronic renal insufficiency for whom MR imaging findings were characteristic. T1- and T2-weighted MR images showed multiple vertical lines (medullary streaks) of low signal intensity in the metaphyses and diaphyses of the distal femur and proximal tibia.     

不同灭菌法对深冻及冻干人骨拉力螺钉生物力学性能的影响

目的 测试不同灭菌法对深冻及冻干人骨拉力螺钉（ｌａｇ－ｓｃｒｅｗ ｍａｄｅ ｗｉｔｈ ｈｕｍａｎ ｂｏｎｅ,ＬＨＢ）的剪切和扭转生物力学性能的影响。方法 取青壮年新鲜尸体标本的股骨干,经深冻后制成４８枚直径为５ｍｍ的ＬＨＢ,随机等分成６组（Ｆ￣Ｆ）。分别作如下处理：Ａ组：单纯深冻;Ｂ组：深冻＋环氧乙烷（ｅｔｈｙｌｅｎｅ ｏｘｉｄｅ,ＥＯ）熏蒸;Ｃ组：深冻＋＾６０Ｃｏ照射,Ｄ组：深冻＋冻干;Ｅ组：深     

超声联合PNS神经阻滞在老年下肢骨科手术中的效果及对认知功能的影响

【目的】探讨超声联合外周神经刺激器(PNS)行腰丛-坐骨神经阻滞麻醉在老年下肢骨科手术中的应用价值。【方法】本院收治的160例拟实施腰丛-坐骨神经阻滞麻醉的下肢骨科手术的老年患者,随机分为两组,各80例;观察组采用超声联合PNS引导下实施腰丛-坐骨神经阻滞麻醉,对照组采用PNS引导定位实施腰丛-坐骨神经阻滞麻醉;对比两组不同时间点的血流动力学指标、简易智力状态量表(MMSE)评分及麻醉相关指标。【结果】阻滞前(T0)~阻滞后60min(T3)时,两组患者的收缩压(SBP)、舒张压(DBP)、心率(HR)值比较差异均无显著性(P>0.05);两组患者的SBP、DBP、HR监测值随着时间的变化,均较本组T。时刻发生了显著地波动,且差异具有选择性(P<0.05);麻醉前、麻醉后12h、24h、72h,两组患者的MMSE评分比较差异均无显著性(P>0.05);麻醉后12h和24h,两组患者的MMSE评分随着时间的变化,均较本组麻醉前时刻发生了先降低后升高的显著改变(P<0.05);观察组患者的感觉神经和运动神经阻滞起效时间均显著地低于对照组(P<0.05),观察组患者的感觉神经和运动神经阻滞维持时间均显著地高于对照组(P<0.05)。【结论】老年下肢骨科手术患者腰丛-坐骨神经阻滞麻醉中采用超声联合外PNS引导有利于提高定位的快速准确性,神经阻滞时间更长,但是对血流动力学的波动及认知功能的影响与单独应用PNS定位差异不大。     

CT findings in osteoradionecrosis of the mandible

 CT scans of ten patients in whom the diagnosis of mandibular osteoradionecrosis was proven pathologically or by clinical follow-up were reviewed. All ten patients had bony abnormalities (cortical interruptions and loss of spongiosa trabeculation) on the symptomatic side. These were predominantly seen in the body of the mandible (premolar and molar region, eight patients), in some of these cases extending into the retromolar triangle (two patients) or mandibular angle (two patients). In the remaining two patients the abnormalities were in the ramus and angle. The two patients treated with iridium implantation showed localized lingual-sided cortical destruction. Three patients had a pathological fracture. The cortical destruction was buccal-sided in two and both buccal- and lingual-sided in three of the other five patients. Contralateral bony abnormalities were present in four patients. Soft tissue thickening on the symptomatic side was seen in nine patients. As the bony abnormalities in mandibular osteoradionecrosis are often associated with a soft tissue mass, CT differentiation from tumor recurrence can be diffficult. The association with cortical defects distant from the position of the original tumor (buccal surface or opposite side of mandible) should evoke the possibility of mandibular osteoradionecrosis.     

CT/MRI of musculoskeletal complications of AIDS

While uncommon, many musculoskeletal disorders may be seen in association with the acquired immune deficiency syndrome (AIDS). Infections such as osteomyelitis, bacterial myositis and septic arthritis, neoplasms such as non-Hodgkin lymphoma and Kaposi sarcoma, and myopathies and polymyositis have been reported in this patient population. Computed tomography and magnetic resonance imaging frequently detect unanticipated musculoskeletal disease in a patient with AIDS, and may further help to distinguish infections from neoplastic disorders.     

Unusual cough related stress injuries

Two cases of unusual cough related stress injuries of the ribs are described. Both were detected on a 2 h delay bone scan. To our knowledge, cough stress injuries have been not previously described scintigraphically.     

Bone metastases as the presenting manifestation of rhabdomyosarcoma in childhood

Rarely, rhabdomyosarcoma can present with bone pain and bone lesions on radiographs without evidence of a primary tumor. Of 428 children with biopsyproven rhabdomyosarcoma, four presented with radiographic evidence of bone metastases, but no primary tumor was found on subsequent evaluation. On radiographs, these metastases, located most commonly in the metaphyses of the extremities and in the spine, displayed a destructive or diffusely permeative pattern without sclerotic margins and mimicked the more common neuroblastoma. One patient also had diaphyseal cortical lytic metastases of the tibia. Radiographs defined metastases of the extremities better than the correlative bone scans. In the spine, on T2-weighted magnetic resonance (MR) images, metastases displayed high signal intensity which contrasted with the low-signal-intensity marrow in these pediatric patients. On histopathologic examination, metastatic rhabdomyosarcoma was composed of small cells of variable size, shape, and growth pattern similar to other round cell tumors. A positive desmin immunohistochemical test helped to establish the diagnosis. The radiologist, pathologist, and clinician should be aware of this unusual presentation of rhabdomyosarcoma so that suitable immunohistochemical tests are performed and appropriate chemotherapy given.     

肾癌骨转移的治疗

目的　探讨肾癌骨转移的临床特点及治疗效果。　方法　对 2 6例肾癌骨转移患者先期行辅助性肾切除后 ,根据骨转移情况不同分三组进行治疗。第 1组 :骨孤立转移灶 12例 ,行彻底切除 ;第 2组 :多发骨转移有潜在性病理骨折或截瘫危险患者 8例 ,选择性行骨病灶肿瘤囊内刮除或椎板减压 固定术 ;第 3组 :多发骨转移患者 6例 ,骨转移病灶未行手术治疗。 3组均接受系统性免疫治疗。随访时间 4～ 6 6个月 ,平均 (45 .8± 11.7)个月 ,分析三组临床资料及治疗效果。　结果　第 1组 1、3、5年生存率分别为 83%、75 %、5 8% ,平均生存期 (48.5± 6 .7)个月、半数生存期 (37± 13.2 )个月 ,均高于 2、3组。生存曲线比较 ,1组与 2、3组差别有显著性意义 (P <0 .0 5 ) ,2、3组之间比较差别无显著性意义 (P >0 .0 5 )。第 3组中出现病理性骨折和截瘫各 1例。　结论　肾癌骨转移患者除实施辅助性肾切除 辅助性治疗外 ,有指征的针对骨转移病灶进行手术可提高肾癌骨转移患者的生存期或生存质量。     

The reproducibility of single photon absorptiometry in a clinical setting

The reproducibility of single photon absorptiometry (SPA) results for detection of changes in bone mineral content (BMC) was evaluated in a clinical setting. During a period of 18 months with 4 different sources, the calibration scans of an aluminium standard had a variation of less than 1% unless the activity of the ¹²⁵I source was low. The calibration procedure was performed weekly and this was sufficient to correct for drift of the system. The short term reproducibility in patients was assessed with 119 duplicate measurements made in direct succession. The best reproducibility (CV=1.35%) was found for fat corrected BMC results expressed in g/cm, obtained at the site proximal to the 8 mm space between the radius and ulna. Analysis of all SPA scans made during 1 year (487 scans) showed a failure of the automatic procedure to detect the space of 8 mm between the forearm bones in 19 scans (3.9%). A space adjacent to the ulnar styloid was taken as the site for the first scan in these examinations. This problem may be recognized and corrected relatively easy. A significant correlation was found between BMC of the lower arm and BMC of the lumbar spine assessed with dual photon absorptiometry. However, the error of estimation of proximal BMC (SEE=20.0%) and distal BMC (SEE=19.4%) made these measurements of little value to predict BMC at the lumbar spine in individuals. The short term reproducibility in patients combined with the long term stability of the equipment in our clinical setting showed that SPA is a reliable technique to assess changes in bone mass at the lower arm of 4% between 2 measurements with a confidence level of 95%.