Management of cervical spinal lesions in rheumatoid arthritis

We review the management of cervical spinal lesions in rheumatoid arthritis. Surgical treatment for cervical lesions presents several potential problems, such as spinal cord injury during surgery, prolonged and painful postoperative immobilization, poor outcome incompatible with surgical invasiveness, and a high failure rate of arthrodesis. The introduction of spinal instrumentation techniques to surgery for cervical lesions has solved some of these problems. Rigid spinal fixation using screws, rods, and wires has made surgery more reliable, and has freed patients from painful postoperative immobilization methods such as the Halo vest. However, the effects of surgical treatment have not been clearly examined using methods of evidence-based medicine. There is a need for clinical studies of treatment for cervical lesions, in order to help establish better methods for the management of cervical spinal lesions.     

中药烫疗联合早期康复治疗脑卒中肩关节半脱位37例

目的探讨中药烫疗联合早期康复治疗脑卒中肩关节半脱位的临床疗效。方法采用随机方法将符合脑卒中肩关节半脱位标准的71例患者分为2组,治疗组37例,对照组34例。2组均给予早期康复治疗,包括良肢位摆放、纠正肩关节位置、运动与作业疗法等,治疗组同时联合中药烫疗治疗。2组疗程均为1月。治疗前后记录2组双侧肩关节X线片及肩关节指诊评价复位情况,采用运动功能评定量表（FMA）中上肢部分评定上肢功能恢复情况。结果治疗1月后治疗组复位率明显高于对照组,经统计学分析,差异有统计意义（P〈0.05）;治疗组和对照组FMA的分值均较治疗前明显提高（P〈0.05）,治疗后2组比较,治疗组高于对照组（P〈0.05）。结论中药烫疗联合早期康复治疗脑卒中肩关节半脱位疗效确切,使用安全,值得临床推广应用。     

早期康复介入对脑卒中后肩关节半脱位的影响

目的：观察康复早期介入对脑卒中偏瘫后肩关节半脱位的影响。方法采用随机分组的方法,将患者分为观察组和对照组,每组30例。两组均接受早期神经科常规药物治疗和针刺、功能电刺激,观察组在此基础上早期适时配合康复训练指导。结果经过1个月的肩关节保护治疗后,观察组显效18例（60.0%）,有效9例,无效3例,与对照组显效10例（33.3%）比较,差异有统计学意义（P〈0.05）。结论早期康复介入同时配合针刺、功能电刺激能从根本上降低脑卒中偏瘫后肩关节半脱位的发生率。     

高频超声快速诊断婴幼儿难复性桡骨小头半脱位

目的 探讨高频超声检查在快速诊断儿童难复性桡骨小头半脱位中的应用价值.方法 23例难复性单侧桡骨小头半脱位儿童,年龄1～5岁,行双侧肘关节多切面高频超声及X线检查,并与健侧对比,观察患侧桡骨小头相对于肱骨小头的位置变化.结果 X线均未检出桡骨小头半脱位,高频超声检出桡骨小头半脱位23例,伴有关节腔积液者10例,超声图像上表现为肘关节前区桡侧纵切面及外侧冠状面显示低回声的桡骨小头相对于高回声的肱骨小头有明显移位.结论 高频超声在儿童难复性桡骨小头半脱位诊断方面的敏感性明显高于X线片;高频超声通过连续扫查可观察肘关节周围解剖结构的连续性及毗邻关系,尤其双侧对比前区桡侧纵切面、外侧区冠状面可快速、准确地诊断儿童难复性桡骨小头半脱位.     

MRI在诊断寰枢关节半脱位的应用价值

目的 探讨MRI T2WI STIR序列在诊断寰枢关节半脱位中的价值.方法 对28例有头颈部外伤、X线或CT检查发现齿状突不居中患者应用MRI T2WI STIR序列对寰枢关节进行扫描,评价横韧带损伤情况,结合临床,对寰枢关节损伤情况进行评价,指导临床治疗.结果 所有患者寰枢关节骨质均未见骨折征象,脊髓均未见受压损伤征象;横韧带位于双侧侧块内侧和齿状突后方,显示清楚,T2WI STIR序列均呈均匀低信号影;均未见到齿状突断裂征象.结论 MRI T2WI STIR序列对寰枢关节横韧带显示良好,对齿状突不居中的头颈部外伤患者有鉴别诊断价值.     

The effect of arm position on the ultrasonographic measurements of the acromion-greater tuberosity distance

Abstract

Ultrasonographic measurements of acromion-greater tuberosity (AGT) distance have shown to be reliable and valid in the assessment of glenohumeral subluxation (GHS) in patients with stroke. The primary aim of this study was to investigate the effect of arm positions on ultrasonographic measurements of AGT distance. The secondary aim was to assess the intra-rater reliability of AGT distance in different arm positions. Sixteen healthy individuals with a mean age 28 standard deviation 11 years who gave informed written consent were recruited. Four clinically relevant arm positions for patients with stroke were selected: (1) arm hanging freely by the side; (2) forearm on a pillow placed on participants lap with the elbows at 90° flexion and the forearms in pronation; (3) as in position 2, but with the elbow supported and (4) shoulder in 10° of abduction and 60° of flexion with the arm resting on a pillow placed on a table. Repeated measures analysis of variance showed a statistically significant effect of arm positions on mean AGT measurements for the right (F (3, 45)?=?51.2666, p?<?0.001, effect size?=?0.774) and left (F (3, 45)?=?51.883, p?<?0.001, effect size?=?0.776) shoulders. AGT distance was significantly reduced in positions 3 and 4. Within-session intra-class correlation coefficients and the minimum detectable change values ranged from 0.94 to 0.97 and 0.1 to 0.2?cm, respectively, for all four positions. This preliminary study corroborates that supported arm position does reduce the AGT distance in healthy people suggesting ultrasonographic technique has potential to provide objective measurements in clinical management of patients with GHS.     

Radiology of postnatal skeletal development

Composites of C1 and C2 were analyzed in various roentgenographic projections to elucidate osseous interrelationships and the effect of overlap of different portions of these two vertebrae in standard radiographic projections during differing stages of postnatal chondro-osseous transformation. In anteroposterior projections the dentocentral synchrondrosis of C2 normally was located below the inferior rim of the C1 anterior ossification center. The upper extent of the dens ossification center was behind this anterior C1 center. The overlap made visualization of the ossiculum terminale difficult. The spinous process of C1 could be confused with the ossiculum. In tranverse projections, the normal laxity characteristic of young children allowed considerable variation in rotational interrelationships. Various degrees of such instability are illustrated. In lateral views variation of the anterior contour of the dens was significant. Such variation must be considered developmental due to the location and direction of growth of the chondrum terminale and interactive modeling between C1 and C2 to allow extension at this particular joint.     

Computer-assisted Magerl's transarticular screw fixation for atlantoaxial subluxation

We report two patients with rheumatoid arthritis in whom posterior atlantoaxial fixation was carried out using transarticular screws with computer assistance. Two bilateral transarticular screws were inserted in one patient; however, in the other patient, only a unilateral screw was used, because computerized images showed that the vertebral artery at the other side was placed too medially to allow insertion of the screw. Neither of these patients had any neurovascular complications after surgery. Computer-assisted surgery is useful for avoiding neurovascular complications with transarticular screw fixation of C1-2. Received: January 26, 2001 / Accepted: August 13, 2001     

拇掌指关节背侧半脱位的X线表现

目的: 探讨拇掌指关节背侧半脱位的X线表现.材料和方法: 7例拇掌指关节背侧半脱位的X线表现进行回顾性分析.并与随机抽取30例正常拇指正侧位X线片对照.结果: 30例正常拇掌指关节X线表现包括: (1)拇指指间关节曲屈≤18°;(2)无拇指背伸;(3)籽骨指侧缘位于掌骨头腕侧1.0～3.2mm或相同水平;(4)拇掌指关节间隙均匀.拇掌指关节背侧半脱位的X线表现包括: (1)拇指指间关节曲屈;(2)拇指近节指骨背伸;(3)籽骨位置异常;(4)拇掌指关节间隙不均匀.结论: 标准拇掌指关节正侧位片对诊断拇掌指关节背侧半脱位非常重要,熟悉其正常X线表现是正确诊断拇掌指关节背侧半脱位的关键.     

牵引和手法治疗环枢椎侧方半脱位100例

本文报道了用牵引、手法治疗环枢椎侧方半脱位100例,其中显效75例,有效24例,无效221例。作者认为椎体退变,软组织劳损,关节囊及韧带松驰,颈椎失稳也是引起环椎半脱位原因之一。牵引和手法对纠正椎体脱位均有疗效,手法治疗则有其独特的作用,只要纠正了C2 的半脱位、症状和体征即可缓解或消失。