Toward an Improved Wrist View: Qualitative and Quantitative Investigation of the 20° Axial Lateral Wrist X-Ray

AimIn standard lateral wrist radiographs, the radiocarpal joint is often obscured because of the angulation of the radial styloid process. A modified lateral projection at a 20° angle has been shown to demonstrate the distal radius in profile in postoperative patients without superimposing of the orthopedic hardware used in open reduction and internal fixation procedures over the wrist joint. We assessed whether this 20° axial-lateral view is advantageous in a wider patient group.Materials and MethodsConsenting adults receiving wrist radiographs in a tertiary hospital radiology department for any indication underwent posteroanterior, posteroanterior-oblique, 0° lateral, and 20° lateral views. A musculoskeletal radiologist and a radiology technologist, blinded to clinical data and to which view was 0°/20°, both evaluated 0°/20° images in random order for whether the radiocarpal joint was obscured by radial styloid, radiocarpal articular margins, or ulnar styloid process, and which view was preferred.ResultsIn 124 cases, the radiocarpal joint was shown clearly on more 20° than 0° views (75/124 vs. 23/124, P < .001). Orthopedic hardware obscured joint lines in fewer 20° than 0° views (12/124 vs. 28/124, P < .001). There was a trend to the ulnar styloid process obscuring part of the radiocarpal joint less in 0° view (28/124 vs. 78/124 in 20°; P = .088), primarily in 20° laterals of wrists with positive ulnar variance. The 20° view was preferred by the radiologist in 76% (95/124) and preferred by the technologist in 83% (104/124).ConclusionThe 20° lateral view was superior to the current 0° lateral view in a wide range of patients, with the radiocarpal joint obscured significantly less by hardware or adjacent anatomy, and preferred by both the blinded radiologist and technologist.     

COA: New variables for measuring joint space width to evaluate knee osteoarthritis

Background: Assessing the radiographic features of knee osteoarthritis, especially joint space narrowing, is important for evaluating disease progression. The purpose of this study was to quantitatively analyze joint space narrowing by measuring 2 new variables: the average joint space width (aJSW) and the articulate angle (AA) on X-ray films, and to evaluate the relationship between the 2 variables, knee function and OA symptoms. Methods: Using the web-based radiology viewer (Cedara I-Reach™ 4.1.1) we measured the 2 variables in 50 knees of 41 patients with knee OA participating in the Shanghai OA Study. We also evaluated the Kellgren-Lawrence (K-L) grade, the Western Ontario and McMaster Universities OA Index (WOMAC), and additional questionnaire in OA knees. Results: The aJSW correlated with the K-L grade (r = -0.57, P < 0.001), kneeling (r = -0.29, P = 0.04), sitting cross-legged on the floor (r = -0.31, P = 0.03), WOMAC pain (r = -0.31, P = 0.03), WOMAC disability (r = -0.35, P = 0.01), pain while squatting (r = -0.37, P = 0.01), and defecating in a squatting position (r = -0.39, P = 0.01). The AA correlated with defecating in a squatting position (r = 0.29, P = 0.05), WOMAC disability (r = 0.30, P = 0.04) and K-L grade (r = 0.44, P = 0.003). The K-L grade also correlated with pain while squatting (r = -0.40, P = 0.005) and defecating in a squatting position (r = -0.34, P = 0.02), WOMAC pain (r = 0.30, P = 0.04), and WOMAC disability (r = 0.30, P = 0.04). Conclusion: The aJSW closely correlated with knee OA symptoms and function scores, and was more sensitive to knee OA related disabilities than K-L grade and the AA. The aJSW could be used as a new variable for knee OA evaluation.     

Prevalence of Spirometrically-defined Restrictive Ventilatory Defect in Korea: The Fourth-2, 3, and Fifth Korean National Health and Nutrition Examination Survey, 2008-2012

The aim of the study was to evaluate the prevalence of restrictive ventilatory defect and to determine the risk factors in subjects with spirometrically-defined restrictive ventilatory defect. We used the population-based, fourth-2, 3 (2008, 2009) and fifth (2010-2012) Korea National Health and Nutrition Examination Survey (KNHANES) to analyze 15,073 subjects, aged ≥40 yr who underwent spirometry. Chest radiographs were also analyzed to identify restrictive lung disease. Spirometrically-defined restrictive ventilatory defect (FEV₁/FVC≥70% and FVC<80% of mean predicted value) was detected in 11.3% (n= 1,709) of subjects aged ≥40 yr. The prevalence increased to 12.3% on using the lower limit of normal (LLN) criteria. Approximately 99.4% of subjects were classified as mild restrictive. Among these, 11.3% had inactive tuberculosis (TB) lesion, 2.2% cardiac disease, 2.0% previous operation scar or radiation injury and/or mediastinal disease, and 7.4% other pulmonary disease suggestive of restrictive lung diseases on chest radiograph. Evidence of previous TB history was independently associated with restrictive ventilatory defect (odds ratios [OR], 1.78; 95% confidence interval, 1.45-2.18) after adjustment for gender, age, smoking, area for residence and body mass index. The prevalence of restrictive ventilatory defect among the nationwide population in Korea was 11.3% with fixed ratio criterion and 12.3% with LLN criterion. Most cases were of the mild restrictive category and previous TB history is the independent risk factor for restrictive ventilatory defect.

Graphical Abstract

相似文献   

H／G非骨水泥人工全髋关节置换术后髋臼侧的X线观察

目的：观察Ｈ／Ｇ非骨水泥人工全髋关节置换术后髋臼假体周围的骨反应。方法：根据Ａｍｓｔｕｔｚ的分区方法对２５例２８个Ｈ／Ｇ人工全髋关节进行髋臼侧Ｘ线随访观察。随访时间３６～７６个月，平均４８个月。结果：髋臼侧出现各种骨反应２３个关节，占关节总数的８２．１％。其中髋臼假体周围成骨２２个关节，占关节总数７８．５％；透亮带出现４个关节，占关节总数的１４．３％；骨硬化２个关节，占关节总数的７．１％；骨吸收２个关节，占关节总数的７．１％；无髋臼松动病例。发生时间以９～１２个月为主，发生部位以１～３区为多见。结论：假体周围成骨是骨小梁长入髋臼表面微孔区域，受力后逐渐增粗变大的现象，对长期稳定假体十分重要。但对于吸收类骨反应和透亮带的出现，作者通过改良手术操作，以期避免或减少发生。     

腺样体肥大患儿鼻声反射联合上气道气流场生物力学数值模型的特征分析

目的　探讨鼻声反射对腺样体肥大患儿的临床应用价值,联合建立上气道气流场生物力学数值模型,定性分析患儿鼻腔、鼻咽腔形态特征及气流场分布情况。方法　对35例腺样体肥大患儿行鼻咽侧位片及鼻声反射检查,根据腺样体/鼻咽腔（adenoid/nasopharynx,A/N比率）分为三组（A/N≤0.60,0.60＜A/N≤0.70,A/N＞0.70）,分析三组间鼻腔最小横截面积（minimal cross-sectional area,MCSA）、鼻腔最小横截面积距离前鼻孔的距离（distance of the minimal cross-sectional area from the nostril,DMCA）、鼻腔阻力（nasal airway resistance,NR）、鼻腔容积（nasal volume,NV）及鼻咽腔容积（nasopharyngeal volume,NPV）的参数有无显著性差异。据其中9例受试者上气道CT影像,三维重建上气道生物力学数值模型,分析气流流场特征。结果　35例受试者鼻声反射曲线特点为后段低平。随A/N比率增大NR逐渐增大,NV、NPV下降,各组间MCSA、DMCA、NR、NV无显著性差异（P＞0.05）,NPV有显著性差异（P =0.000）。患儿鼻咽部气流形态紊乱,压强变化梯度主要集中在鼻阈及腺样体与扁桃体交界区域,呼吸道的高流速区主要集中在鼻阈、中鼻道和鼻咽部。结论　鼻声反射可用于腺样体肥大患儿鼻咽腔容积的定量分析,可验证患儿上气道计算机仿真模型的真实及可靠性,二者结合可从三维立体角度考虑患儿上气道的阻塞因素,不仅能应用于腺样体肥大患儿的筛查工作,也可为临床因人制宜采取不同的手术方案及术后评估提供参考。     

光辅助X射线体表定位在骨科植入物内固定中的骨折定位作用

BACKGROUND: The traditional orthopedic fixation by C-arm positioning surface is completed, but the large C-arm injury on the human body and the long fixed time increase the suffering of patients.     

腹部术后并发ARDS临床研究

目的：探讨腹部术后并发症ARDS的早期诊断及治疗。方法：对1993年-2002年的22例术后并发ARDS的诊治进行回顾性分析。结果：22例中12例好转，7例死亡，3例自行出院。结论：PaCO2呈渐进性下降对本病诊断十分重要，急诊床边胸片亦有一定价值，呼吸支持原发病治疗，预防性治疗在本病的治疗中具有很重要的意义。     

结节病胸部X线和CT所见与支气管肺泡灌洗液细胞学变化的相关性

鉴于结节病胸部表现的多样性和多变性，对２５例结节病的胸部Ｘ线和ＣＴ所见与支气管肺泡灌洗液（ＢＡＬＦ）细胞学变化的相关性进行了研究。结果表明：ＣＴ对胸片０～Ｉ期患者能发现纵隔区更多组肿大淋巴结和多处肺实质病变；肺内病变多沿支气管肺纹理分布；ＣＴ肺扫描所见与ＢＡＬＦ细胞总数呈直线相关，ＣＴ表现有纤维化病变者多伴有ＢＡＬＦ中性粒细胞增多。提示ＣＴ对于结节病患者作为重要的补充检查手段，能对纵隔和肺部病变作出更精确的评价。     

山东汉族正常(牙合)少年儿童软组织侧貌的研究

目的:建立山东汉族正常少年儿童X线头影测量软组织的正常值和标准差,分析其侧貌特征。方法:对156名山东汉族正常少年儿童拍摄X线头颅侧位片,并进行图像处理和定点测量,用SAS 9.0统计软件对得出的数据进行统计学处理。男女之间,替牙期与恒牙期之间两样本进行t检验的比较分析。结果:建立了山东汉族正常少年儿童X线头影测量软组织的正常值数据库;替牙期男性上唇相对前突,女性下唇后缩;从替牙期到恒牙期男性软组织面高及上唇有较大生长,女性下唇生长明显。结论:山东汉族正常少年儿童软组织侧貌有一定的地域特征。     

医用X射线工作者回顾性剂量估算进展

随着X射线的广泛应用,其对医用工作者的辐射致癌效应越来越受到人们关注。准确的辐射致癌危险评价应建立在完整的个人剂量信息的基础之上。然而在X射线应用的早期并没有医用X射线工作者的个人剂量信息,因此需要通过进行剂量重建来估算早期的个人剂量信息。笔者对国内外早期医用诊断X射线工作者的剂量估算的现状和进展进行了综述。