Reliability of the assessment of disc degeneration on the lateral DXA scans

IntroductionGiven the prevalence and costs induced by osteoarthritis (OA), it is necessary to find a cheap and safe technique to evaluate it reliably.ObjectiveTo assess the value of the lateral dual energy X-ray absorptiometry (DXA) spine scans for the diagnosis of disc degeneration.MethodSeventy-seven individuals aged 18 and over, with or without disc degeneration, had both lateral thoracolumbar spine radiographs and DXA spine scans (≤ 6 months between both exams). Disc degeneration was assessed using the Lane score. The images of 20 randomly selected individuals were assessed by two readers.ResultsAlmost 13% of the thoracic levels were not assessable on the DXA scans. For the identification of the intervertebral levels on the DXA scans as interpretable or not, the intra-reader agreement was good (κ = 0.81) and the inter-reader agreement was fair (κ = 0.27–0.36). For the diagnostic criteria (osteophytes, disc space narrowing, osteosclerosis, overall grade), the intra-reader agreement was excellent for the radiographs (κ = 0.89–0.92), good for the DXA scans (κ = 0.64–0.83) and fair to moderate for the between-method comparison (κ = 0.25–0.44). The inter-reader agreement was moderate to good for the radiographs (κ = 0.49–0.66) and fair to good for the DXA scans (κ = 0.32–0.74). In the per patient analysis (the most severe grade), the intra-reader agreement was excellent for the radiographs (κ = 0.85–0.94), moderate to excellent for the DXA scans (κ = 0.53–0.85) and poor to good for the between-methods comparison (κ = 0.17–0.63).ConclusionOur results do not support the use of DXA scans for the assessment of thoracolumbar disc degeneration.     

机器人手术系统在女性梗阻性生殖道畸形中的应用

目的:分析达芬奇机器人手术系统在女性梗阻性生殖道畸形中的临床应用效果.方法:回顾性分析空军军医大学第一附属医院2015年9月～2019年10月使用达芬奇机器人手术系统完成的梗阻性生殖道畸形手术患者7例的临床资料,统计分析不同生殖道畸形的分类、临床表现、手术方法、术后并发症、月经恢复情况和性生活满意度等.结果:7例患者中,宫颈发育异常者6例,阴道完全闭锁者4例,阴道下段闭锁者1例,合并子宫内膜异位症者6例,合并泌尿系统畸形者1例.所有患者均保留了有功能子宫,6例行宫颈成形术,5例行阴道成形术;所有患者均恢复规律月经,2例有性生活者性生活均满意.结论:对于梗阻性生殖道畸形的患者,达芬奇机器人手术系统能更好地重建生殖道解剖结构,保留有功能子宫.     

Vertebral level of the ending of the spinal cord and its relationship to the length of the vertebral column in Northern Turkish neonates

Summary Racial and sex differences in the level of ending of the spinal cord of the adult have been reported. It is lower in Africans and in females. Since such differences may affect even fetuses and newborns we aimed to study in Northern Turkish neonates. The study was made on 40 full-term newborn still-births (23 male, 17 female). In all cases, the length of the vertebral column, the length of the spinal cord and the body weight were measured and the vertebral level of ending of the spinal cord was noted. It was found that the termination of the spinal cord varied from the first lumbar to the second sacral vertebra, with a mean level between L2 and L3. In female neonates, it was observed that the spinal cord ended at a slightly lower level (0.2 vertebra) than in males. Our findings approximately agreed with those of Barson [2] who studied neonates in England and of Jit and Charnalia [5] in North India. However, we found that the spinal cord ended one and half vertebrae lower in Northern Turkish neonates than in South African and South Indian subjects. The correlations between body-weight and length of the spinal cord, weight and length of the vertebral column, length of the spinal cord and length of vertebral column, length of the vertebral column and level of ending of the cord were statistically highly significant for males, females and both sexes together (p<0.001). The longer the vertebral column, the higher the termination of the spinal cord.

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Niveau vertébral de la terminaison de la moelle épinière et sa relation avec la longueur de la colonne vertébrale chez le nouveau-né en Turquie du Nord

Résumé Selon la race et le sexe, les différences de niveau de la terminaison de la moelle épinière ont été rapportées chez l'adulte. Elle est plus basse chez les Africains et chez les femmes. Dès lors il se peut qu'il existe déjà des différences raciales et selon le sexe, chez le foetus et le nouveau-né. Nous nous proposons d'étudier une population de nouveau-nés du Nord de la Turquie. Cette étude est faite à partir de 40 nouveau-nés à terme, décèdes (23 garçons et 17 filles). Chez tous ces nouveau-nés, la longueur de la colonne vertébrale, la longueur de la moelle épinière et le poids ont été mesurés. Le niveau vertébral de la terminaison de la moelle épinière variait entre la première vertèbre lombaire et la deuxième vertèbre sacrée. Le niveau moyen de cette terminaison était situé entre L2 et L3. Chez les filles nouveau-nés, il était observé que la moelle épinière se terminait légèrement plus bas (0,2 vertèbre) que chez les garçons nouveaunés. Nos observations rejoignent celles de Barson [2] qui étudia des nouveaunés d'Angleterre et celles de Jit et Charnalia [5] qui étudièrent des nouveau-nés du Nord de l'Inde. Cependant, nous avons trouvé que la moelle épinière se terminait une vertèbre et demie plus bas chez les nouveau-nés de la Turquie du Nord que chez les nouveau-nés d'Afrique du Sud et d'Inde du Sud. La corrélation entre le poids des spécimens et la longueur de la moelle épinière; le poids et la longueur de la colonne vertébrale, la longueur de la moelle épinière et la longueur de la colonne vertébrale, la longueur de la colonne vertébrale et le niveau vertébral de la terminaison de la moelle épinière parmi les garçons, les filles, et dans les deux sexes, étaient statistiquement très significatifs (p<0.001). Plus la colonne vertébrale était longue, plus haute était située la terminaison de la moelle épinière.

     

Resolution of spinal epidural vascular pseudotumor following balloon occlusion of a postoperative vertebral arteriovenous fistula

Summary We describe a case of a vascular mass arising secondary to a postoperative vertebral arteriovenous fistula mimicking recurrent cervical neurofibroma on CT in a patient with neurofibromatosis. Angiography was required for diagnosis. The recurrent tumor resolved following balloon embolization of the fistula.     

重睑成形术术前术后外眼的三维测量分析

目的 :揭示重睑成形术术后外眼形态的客观变化。方法 :通过对 50例施重睑成形术患者分别于术前、术后对外眼的形态进行三维测量分析。结果 :三维测量六项指标的变化以及经配对样本的 T检验结果表明 ,重睑术后外眼显著性变化是眼裂宽度、睫毛长度和睫毛角度术后值的增加。结论 :本研究肯定了重睑成形术的术后效果 ,并从解剖学角度分析了产生上述客观变化的原因 ,进一步讨论了重睑成形术的适应证和禁忌证。     

CT引导下经皮经椎弓根脊椎肿瘤穿刺活检

目的探讨在CT引导下经皮经椎弓根行脊椎肿瘤穿刺活检的价值。方法CT引导下选择最佳穿刺点、穿刺角度及深度并随时调整,以确保整个穿刺过程在病变的椎弓根内及椎体内完成。结果所有病例均未发生穿刺并发症。11例所取组织量可满足病理检查要求。1例取材量不足而未能得出满意诊断结果。结论CT引导下经椎弓根行脊椎肿瘤穿刺活检取材准确,操作安全可靠。     

椎弓根定位方法与置钉技术探要

目的 通过Ｘ线平片分析关节突、横突及椎弓根间的相互关系,探讨上关节突作定位标志的临床价值。方法 常规Ｘ线正位片,测量Ｌ１～Ｌ５横突中轴线ＴＡ、两侧上关节突下缘连线ＡＡ与椎弓根中心点连线ＰＣ间的距离,〈１ｍｍ视为重叠。用ＡＡ组与上关节突外缘垂线的交点为进钉点,临床手术３０例。结果 ２１２例Ｘ线片共１０６０个腰椎,ＴＡ、ＡＡ与ＰＣ的重叠率分别为９２．３％和９０．２％（Ｐ〉０．０５）。男女两组间ＴＡ（Ｐ     

Pax-1 in the development of the cervico-occipital transitional zone

The Pax-1 gene has been found to play an important role in the development of the vertebral column. The cervico-occipital transitional zone is a specialized region of the vertebral column, and malformations of this region have frequently been described in humans. The exact embryonic border between head and trunk is a matter of controversy. In order to determine a possible role of Pax-1 in the development of the cervico-occipital transitional zone we studied the expression of this gene in a series of quail embryos and murine fetuses with in situ hybridization and immunohistochemistry. Pax-1 is expressed in all somites of the embryo, including the first five occipital ones. During embryonic days 3–5 the gene is down-regulated in the caudal direction within the first five somites, whereas more caudally Pax-1 is strongly expressed in the cells of the perinotochordal tube. In 5-day-old quail embryos, the cartilaginous anlage of the basioccipital bone has developed and there is no more expression of Pax-1 in this region. The fusion of the dens axis with the body of the axis also coincides with switching off of the Pax-1 gene. More caudally, the gene is continuously expressed in the intervertebral discs of murine embryos and therefore seems to be important for the process of resegmentation. Quail embryos do not possess permanent intervertebral discs. Hyper- or hyposegmentation defects may be explained by an over- or under-expression of Pax-1 during development. We also reinvestigated the border between the head and trunk in chick embryos by performing homotopical grafting experiments of the 5^th somite between chick and quail embryos. Grafted quail cells formed mainly the caudal end of the basioccipital bone. They were also located in the cranial half of the ventral atlantic arch, and only a few cells were found in the tip of the dens axis.     

Quantitative Ultrasound and Symptomatic Vertebral Fracture Risk in Chinese Women

Quantitative ultrasound (QUS) is emerging as a simple, inexpensive and noninvasive method for assessing bone quality and assessing fracture risk. We assessed the usefulness of a contact calcaneal ultrasonometer by studying normal premenopausal women (group I, n= 53), normal postmenopausal women (group II, n= 198), and osteoporotic women without (group III, n= 141) and with vertebral fractures (group IV, n= 53). The osteoporotic subjects had a T-score of the spine or hip neck bone mineral density (BMD) <−2.5 based on the local Chinese peak young mean values. When compared with postmenopausal controls, mean broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound index (QUI) were 26%, 2.1% and 25% lower in women with vertebral fractures (p all <0.005). The correlation coefficients between QUS parameters and BMD of the spine and hip ranged between 0.4 and 0.5. The ability of the QUS to discriminate between patients groups was determined based on the mean value of normal premenopausal women in group I. The mean T-score for women with fractures was −2.87 ± 1.02 for BUA, −2.54 ± 0.79 for SOS, −3.17 ± 0.70 for QUI, −2.65 ± 0.86 for L2–4 BMD and −2.53 ± 0.66 for hip neck BMD. After adjustment for age and body mass index, the odds ratio of vertebral fracture was 1.71 (95% CI 1.2–2.6) for each 1 SD reduction in BUA, 2.72 (1.3–5.3) for SOS, 2.58 (1.4–4.6) for QUI, 2.33 (1.6–3.3) for L2–4 BMD, 2.09 (1.37–3.20) for femoral neck BMD and 1.88 (1.34–2.92) for total hip BMD. The association between the QUS parameters and vertebral fracture risk persisted even adjustment for BMD. The area under the receiver operating characteristic curve for BUA for vertebral fracture was 0.92, for SOS, QUI, L2–4 BMD and femoral neck BMD was 0.95, and for total hip was 0.91. Received: 7 January 1999 / Accepted: 18 May 1999