基于连续切片主韧带内神经脉管三维重建定位材料的研究

目的：比较经不同染色前后四种定位材料在组织连续切片上的粘附能力,探讨一种适合子宫主韧带神经脉管三维重建的定位材料。方法：获取因IBl期宫颈癌行经腹广泛性子宫切除术的新鲜主韧带标本1例（左侧）,经固定、脱水、浸蜡后分别将1根普通缝线（3-0）、1根人发、1根可吸收缝线（8-0）及1条生物组织（直径约0．6ram）作为定位杆标记与标本一起进行石蜡包埋,采用石蜡切片机对所取标本进行连续切片,将切片随机分成四组,各30张,分别进行常规HE染色、TH染色、VIP染色和D2-40染色,在显微镜下观察并记录各种材料在染色后定位点的数目,比较分析不同定位材料染色前后标记点的粘附情况。结果：在人发、普通缝线、可吸收缝线与生物组织四种定位材料中,生物组织在染色后贴片率较其它三种材料高,经统计学检验差异有统计学意义（x2=115．12,P〈O．01）;生物组织在四种染色前后贴片率无明显差异（x2=O．16,P=O．98）。结论：利用穿刺针获取生物组织作为定位材料成功解决了定位标记点的脱失问题,其在HE染色和免疫组化染色中均具有很好的粘附效果。     

B超与X线定位技术在体外冲击波碎石中的应用比较

目的：探讨B超和X线定位技术在体外冲击波碎石中的应用差异。方法对近7年来使用两种不同定位技术治疗的7820例尿路结石,从医学基础理论、诊断准确率、治疗安全性和对人体有无危害方面进行比较。结果两者在结石检出率、诊断准确率、治疗安全性、碎石使用率上都存在较大差别,两种定位技术的结石检出率和碎石使用率均具有统计学差异（P〈0.05）。结论 B超定位技术比X线定位技术在许多方面具有明显优势,应引起足够的重视。     

Histological evaluation of allograft bone after acetabular revision arthroplasty: report of two cases

We recently had the opportunity to take histological sections from two patients who underwent acetabular reconstruction in which allograft and ME Müller acetabular roof reinforcement rings were used. In one patient (case 1), histological sections of the chipped allograft were taken on two separate occasions from the same area, at 7 months, and at 3 years and 11 months after the bone graft. The histology of the chipped allograft showed necrosis at 7 months, but almost normal morphology of trabecular bone formation at 3 years and 11 months after the bone graft. In the other patient (case 2) histological sections of the block allograft and chipped allograft were taken at 1 year and 8 months after the bone graft. The block allograft showed only a small amount of admixture of newly formed bone with the necrotic bone, while the chipped allograft showed a large amount of newly formed bone, with only a small amount of necrotic bone remaining. Therefore, we principally use chipped allograft for acetabular reconstruction, in order to achieve early and complete graft incorporation. If a block allograft is used in a weight-bearing area, it should be protected from excessive load by using an acetabular reinforcement device. Received: October 27, 1999 / Accepted: March 16, 2000     

Evaluation of acetabular dysplasia using a top view of the hip on three-dimensional CT

We assessed coverage over the femoral head, using three-dimensional computed tomography (CT) imaging on 20 hips in 18 patients before rotational acetabular osteotomy, and on 18 normal hips as control. In particular, we introduced a "top view of the hip" in three-dimensional CT evaluation in order to detect posterolateral deficiency, which needs special attention in regard to rotational transfer of the acetabular fragment. We determined the horizontal plane passing through 5 mm cranial to the top of the femoral head on the coronal view of a multiplanar reconstruction image. Then, we erased the images of the ilium that were more cranial than this horizontal plane from the conventional cranial view of the pelvis and the proximal femur, and defined this view as the "top view of the hip". This top view clearly showed any uncovered area on the femoral head. Of the 20 hips, 6 were deficient anterolaterally (anterolateral type), 9 were deficient laterally (lateral type), and 5 were deficient posterolaterally (posterolateral type). On plain anteroposterior radiographs, 7 of the 20 hips had the cross-over sign of Reynolds. Five of these 7 hips with the cross-over sign were the posterolateral type in top view, while none of the 13 hips without the cross-over sign was the posterolateral type. We recommend preoperative evaluation using a top-view on three-dimensional CT images in patients who have the cross-over sign on an anteroposterior radiograph. Received: December 16, 1999 / Accepted: June 28, 2000     

Optimizing femoral anteversion and offset after total hip arthroplasty, using a modular femoral neck system: an experimental study

To investigate the effectiveness of a modular femoral neck system, consisting of two neutral and four types of retroverted necks for the correction of femoral anteversion and offset in total hip arthroplasty, an experimental study was carried out, using sawbones with four different angles of femoral anteversion (16°, 34°, 47°, and 59°). With the neutral neck, reconstruction of the preoperative anteversion and offset in the normal femur was achieved. While the 15° retroverted long neck was effective for the mildly or moderately anteverted femur, this retroverted neck showed insufficient correction for the severely anteverted femur. This modular neck system proved to be useful for correction of the medial component of femoral offset in femora with anteversion of less than 47°. For patients with greater anteversion, a feature which is rarely seen in the clinical situation, femoral necks with a greater degree of retroversion may be useful. Received: September 3, 1999 / Accepted: March 29, 2000     

Long-term results of rotational acetabular osteotomy in young patients with advanced osteoarthrosis of the hip

Between 1974 and 1987, we performed 38 rotational acetabular osteotomies to treat advanced coxarthrosis caused by acetabular dysplasia in 38 patients who were aged 40 years old or less at the time of surgery. Of these patients, 28 were followed-up for more than 10 years after surgery. The preoperative severity of coxarthrosis was graded as stage III in 21 hips and as stage IV in 7 hips, according to our modification of the classification of coxarthrosis advocated by the Japanese Orthopaedic Association. At the time of follow-up, 27 patients retained their own hip joints on the operated side 10 to 18 years (average, 13 years) after surgery, and the remaining patient had had a secondary total hip replacement 7 years after the surgery. Of the 27 patients who retained their own hip joints on the operated side, 20 had little or no pain and none suffered from severe pain in the operated hip; the severity of coxarthrosis was graded as stage II in 4 hips, as stage III in 9 hips, and as stage IV in 14 hips. We conclude that rotational acetabular osteotomy can be a useful procedure in young patients who have advanced coxarthrosis secondary to acetabular dysplasia. Received: September 22, 1999 / Accepted: February 7, 2000     

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.     

定位教育在中医骨伤专业学生培养中的运用实践

目的 了解传统教育模式与“定位教育”模式在中医骨伤专业学生培养过程中运用的差异性.方法 根据中医骨伤专业人才培养目标、《中医筋伤》课程的教学目标以及骨伤筋伤临床常见病的发病情况,确定颈椎病、膝骨关节病,腰椎间盘突出症,肩关节周围炎作为重点“定位”学习内容,根据该四类疾病的解剖、生理病理、病因病机、诊断要点、辨证治疗、预防调护等方面设计考核问卷,对2010级中医骨伤班学生（对照组）进行传统教育模式教学,学习结束后,发放、回收、分析考核问卷;对2011级骨伤班学生（实验组）进行定位教育模式教学,学习结束后发放、回收、分析考核问卷,将实验组与对照组学生的成绩进行统计分析,比较两个组别的平均分,比较各分数段人数占总人数的百分比.结果 实验组平均分数为67.05分,对照组平均分数为51 58分;对照组60分以下分数段人数百分比高于实验组,对照组60分以上各分数段人数的百分比均少于实验组,二者具有差异性.结论 定位教育模式教学效果优于传统教学模式,定位教育模式更有利于中医骨伤专业学生培养目标的完成.     

发育性髋关节发育不良：影像检查新观点

目前,发育性髋关节发育不良（DDH）的诊断主要依靠超声及X线平片。超声的敏感性虽高,但观察者依赖性强,容易造成过度诊断;X线平片仅能观察骨性髋关节的形态,不能显示软骨部分,然而髋臼软骨对髋关节的稳定具有重要作用。由于MRI软组织分辨力高,可清晰显示髋臼软骨并进行定量测量,还可显示影响髋关节复位的软组织成分,因此MRI在DDH的诊断和治疗的应用越来越广泛。综述影像检查在DDH诊断中的新观点和思路,特别是MRI在评估髋关节发育中的应用价值。     

Dosimetric effects of residual uncertainties in carbon ion treatment of head chordoma

PurposeTo investigate dose distribution variations due to setup errors and range uncertainties in image-guided carbon ion radiotherapy of head chordoma.Materials and methodsTen treatment plans were retrospectively tested with TRiP98 against ±1.0 mm and ±1.0° setup errors, as observed in clinical routine, and 2.6% range uncertainty when 2 mm CTV-to-PTV margins were applied. Single-fraction simulations were compared with the total treatment dose in terms of DVH bands, conformity and inhomogeneity. The contribution of image processing artifacts on reported results was also discussed, as a function of the imaging dataset resolution.ResultsResults showed that safety margins grant the conformal target coverage in presence of setup errors with D95_CTV variations below 10% in 7 patients out of 10. Instead, the inclusion of range uncertainty yielded to appreciable dose degradation, reporting larger effects for CTV and dose conformity, whereas reduced impact is found on the organ-at-risk. The fractionation scheme positively affects dose conformity and inhomogeneity; conversely its influence on DVH bands is strongly related to the patient anatomy.ConclusionBesides safety margins, setup and range uncertainties lead to non-negligible combined contribution. Systematical treatment plan robustness assessment against expected uncertainties is thus encouraged, selecting beam settings and fractionation schemes where homogeneity is preserved.