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Objective:To evaluate the specialty of the clinical features, treatment procedure, clinical outcome, and prognosis in the patients with "sandwich" atlantoaxial dislocation (AAD).Methods:From 2008 to 2018, 160 cases with "sandwich" AAD were retrospectively selected from the case series of AAD in Peking University Third Hospital. The case series had 80 males and 80 females. The mean age at the initial visit was 35.5±14.6 years (range, 5-77). The clinical courses, treatment methodology and prognosis were reviewed. And the surgical approach, posterior fixation segment and the recovery of neurological function were mainly summarized. The atlantodental interval (ADI), the distance by which the odontoid exceeded the Chamberlain line and the cervical-medullary angle were analyzed.Results:The most common symptoms included weakness or numbness of the limbs (67.5%, 108/160), unstable gait (30%, 48/160) and vertigo (20%, 32/160). Among all, 130 cases (81.3%, 130/160) had myelopathy, with the Japanese Orthopaedic Association (JOA) scores from 4 to 16 (mean JOA scores 13.5±2.5). Cranial neuropathy was involved in 20 cases (12.5%). Radiological findings showed brainstem and/or cervical-medullar in 130 cases (81.3%), syringomyelia in 37 cases (23.1%) and Chiari malformation in 30 cases (18.8%). Computed tomography angiography (CTA) was performed in 90 cases, which showed vertebral artery anomalies in 55 cases (61.0%) and excessive medialized internal carotid artery in 5 cases (5.6%). All cases had no spinal cord or vertebral artery injury. The surgery included posterior occipito-cervical fusion (reducible dislocation, 145 cases), and transoral release followed by posterior fusion (irreducible dislocation, 15 cases). Fifty-seven cases were treated using alternative fixation technique. The average follow-up time was 50.5±22.4 months (range, 24 to 120 months). All of 152 cases (95.0%) achieved solid atlantoaxial fusion; there was no obvious osseous fusion formation on postoperative images in 6 cases (3.8%), but no atlantoaxial instability was found on dynamic radiographs; screw loosening happened in 2 patients (1.2%). Nine patients (5.6%) suffered complications, including 4 cases with recurrent dislocation, 2 screw loosening, 2 cases with bulbar paralysis and 1 wound infection. The mean postoperative JOA was 15.1±1.8 (range, 5-17), and the mean neurological improvement rate was 42.9%±33.3% in the patients with myelopathy.Conclusion:"Sandwich" AAD, a subgroup of AAD, has unique clinical features: earlier onset age and more severe myelopathy. The incidence of bone and vascular malformation is higher. So alternative surgical plan and hybrid fixation should be prepared for this subgroup of AAD.
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Objective To investigate the association between the osteogenic differentiation in the soft tissue lump and the clinicopathological characteristics of osteosarcoma patients. Methods We retrospectively reviewed the clinical data of conventional osteosarcoma patients with soft tissue lumps, including Enneking stages, chemotherapy sensitivity, overall survival and post-metastatic survival time. The ossification level in soft tissue lumps was assessed by imaging and the proportion of osteoid matrix was assessed by pathological examination. Results A total of 189 cases were included in this study. In patients with Enneking IIIB, non-osteoblastic, partially osteoblastic and osteoblastic types accounted for 30.2%, 9.6% and 6.3%, respectively. Non-osteoblastic osteosarcoma patients had a higher rate of initial metastasis (P < 0.05); Chemotherapy efficiency of non-osteoblastic, partially osteoblastic and osteoblastic types were 60.5%, 59.6% and 31.3%, respectively. The osteoblastic osteosarcoma held the worst rate of chemotherapy sensitivity (P < 0.05). The overall survival of non-osteoblastic osteosarcoma was shorter than those of partially osteoblastic and osteoblastic types (P < 0.05). Post-metastatic survival time of osteoblastic osteosarcoma was longer than that of non-osteoblastic osteosarcoma (P=0.078). Conclusion For conventional osteosarcoma, the osteogenesis level in soft tissue lumps is related to the surgical stage, chemotherapy sensitivity and prognosis of tumors, which may provide guidance for the individual decision regarding chemotherapy and surgery timing on patients.
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Objective TodiscusstheevaluationeffectivenessofADCofMR DWIinneoadjuvantchemotherapy (NAC).Methods ThirtyGninepatientswithlocallyadvancedbreastcancerwereenrolledinthisstudy.Allthesepatientswerediagnosedbypuncture biopsyandtreatedwithNAC.DWIwasperformedbeforechemotherapyandafter4cyclesofchemotherapyrespectively.Radicalresectionof breastcancerwasperformedwithinoneweekaftertheendof4cyclesofNAC.Accordingtotheclinicalefficacyorpathologicalresponse,the changesoftumorvolumeandtumorcelldensitybeforeandafterchemotherapyweremeasured.Theresponseoftumorwasdividedas clinicallyeffective,completeremission (CR)+partialremission(PR)andclinicalineffectiveness,stabilizationdisease(SD)+progression disease(PD)ormajorhistologicalresponse (MHR)andnonGmajorhistologicalresponse (NMHR),respectively.Toevaluatethe practicalutilityofneoadjuvantchemotherapy,theADCvaluesweremeasuredinallgroupsandanalyzedstatistically.Results Before NAC,therewasnosignificantdifferenceinADCvaluebetweenCR+PR (0.96±0.22)andSD+PD (0.93±0.14)orMHR (1.05±0.22), NMHR (0.99±0.14).TheratiosofCR+PRand MHR were56.4%and66.7%respectivelyattheendoftreatment,andtheADC valuesinallpatientswerehigherthanthatbeforechemotherapy.However,Therewasnosignificantdifferencebeforeandafterchemotherapy intheSD+PD (1.02±0.19)andNMHR (1.08±0.20)groups (P＞0.05),whileCR+PR (1.47±0.16)and MHR (1.62+0.13) groupsweresignificantlydifferentbeforeandafterchemotherapy(P＜0.05).Therateoftumorvolumechangewaspositivelycorrelated withΔADC (r＝0.539,P＜0.05).Conclusion TheADCvalue canbeusedtoevaluatethevolumeandpathologicalgradeof tumorafterNACbasedon MRIplainscananddynamicscan, whichishelpfulfortimelyandeffectivepredictiveevaluationof chemotherapyeffect.ADCvaluecanbeusedasearlyevaluationofNACforbreastcancerandprognosticindicators.
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Objective: To evaluate the clinical result of atlantoaxial reduction and fixation guided by the intraoperative CT.Methods: Sixteen cases were retrospectively studied, including seven males and nine females, with the mean age of 49.9 years.Twelve cases were diagnosed as chronic atlantoaxial instability or dislocation, while four cases as acute odontoid fracture and dislocation.Among the sixteen cases, fourteen underwent atlantoaxial fusion, while two underwent temporary atlantoaxial fixation without fusion.The intraoperative CT was used in the setting of: 1.Evaluating the atlantoaxial reduction before the screw insertion;2.Guiding the C1 and C2 pedicle drilling (two cases using additional three-dimensional printing drilling template);3.Evaluating the position of the screws and reduction after the atlantoaxial fixation.In addition, three-dimensional drilling template combined with intraoperative CT was used in two cases.CT scanning frequency was calculated.To evaluate the accuracy rate of screw fixation under the intraoperative CT, 19 cases without the intraoperative CT were studied as the control group.Results: Averaged CT scanning frequency was 1.4 times (Once in eleven cases, twice in four and three times in one).Among the sixteen cases, mal-positioned C1 screws were found and revised in two cases.No spinal cord injury or vertebral artery injury occurred.The follow-up ranged from three to ten months, with the mean of 6.7 months.Fourteen cases achieved solid osseous fusion, and two with temporary fixation had odontoid fracture union.Anatomic reduction was achieved in all the cases.Eleven cases with preoperative myelopathy had postoperative improvement and their mean JOA scores improved from 12.1 to 14.4.To the last follow-up, no hardware complications were found including screw broken, rod broken or fixation loosening.All the screws of intraoperative CT group had good positions.For 19 cases of the control group, there were two cases of mal-positioned screws (10.5%).Conclusion: Advantages of atlantoaxial reduction and fixation guided by the intraoperative CT included: improving the accuracy of the atlantoaxial screws, exactly evaluating the reduction of the atlantoaxial joint, immediately discovering the mal-positioned screws and avoiding the revision surgery.A good clinical result was found in the preliminary study.
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Purpose To explore the diagnostic value of quantitative measurements of magnetic resonance images (MRI) in transverse and coronary sections in patients with ischiofemoral impingement (IFI) syndrome.Materials and Methods The data of 70 patients (127 hips) in the Affiliated Hospital of Chengde Medical College from 2013 June to 2016 April who were performed hip MRI examination was analyzed retrospectively.39 patients (67 hips) with clinical diagnosis of IFI syndrome were selected as case group,while the other 31 patients (58 hips) with clinical exclusion of IFI syndrome were selected as control group.Ischiofemoral space (IFS),quadratusfemoris space (QFS),ischial angle,femoral neck angle (FNA) and lesser trochanter angle (LTA) were measured on axial MR image with PDWI FS sequence.The cervicodiaphyseal angle (CCD) was measured on coronary section MR image with T2WI TIRM sequence.The above measurements of two groups were analyzed.Results IFS,QFS and LTA in patients of case group were 12.2 (10.2-13.9) mm,8.5 (6.9-10.4) mm and (13.8±0.7) °,while these measurements were 26.3 (22.9-30.4) mm,21.6 (19.5-25.4) mm and (19.9± 1.0) ° in patients of control group.Compared with control group,these measurements were significantly lower in case group (P＜0.01).Ischial angel,FNA were significantly higher in case group compared with control group [(131.2±0.4) ° vs.(127.1±0.6) °,29.2 (22.8-34.1) ° vs.22.7 (19-28.3) °,P＜0.01].CCD showed no significant difference between the two groups (P＞0.05).QFS,LTA have positive correlation with IFS in case group (r=0.870 and 0.653,P＜0.05),while FNA,ischial angel have significant negative correlation with IFS in case group (r=-0.623 and-0.655,P＜0.05).The cut-offvalues ofQFS,FNA,ischial angel and LTA were ≤ 12.7 mm,≥ 21.75 °,≥ 131.65 °,≤ 9.3°,respectively.Conclusion The reduction ofIFS and QFS is the main imaging signs of IFI syndrome.
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Objective To investigate the performances and characteristics of femoro-acetabular impingement (FAI)on MSCT. Methods Hips jointed MSCT scans of 109 cases (as case group)and the other 120 cases (as control group)were analyzed retrospec-tively,to analyze the anatomy and osseous abnomality of FAI.Alpha angle,offset,CE angle were measured.The data were tested by using t test and ANOVA test.Results There were 57 cases of osseous protuberance at the femoral head and neck joint,26 cases of the offset reduction,17 cases of over-coverage acetabulum,41 cases of over-deep acetabulum,20 cases of acetabular retroversion,57 cases of subcortical cystic degeneration at the femoral head and neck joint and 22 cases of subchondral cystic degeneration at the ace-tabulum margin.Significant statistical differences were found between case group and control group in alpha angle value,offset and CE angle (P<0.05).Multiple comparisons demonstrated that except results between the value of alpha angle of Cam-type and Mixed-type(P=0.071),Pincer-type and the control group(P=0.083)with no statistical significance,the differences between any other two groups reached statistical significance (P<0.05).Multiple comparisons demonstrated that except result between the value of offset of Cam-type and Mixed-type(P=0.561)with no statistical significance,the differences between any other two groups reached statistical significance (P<0.05).Multiple comparisons demonstrate that except results between the value of CE angle Pin-cer-type and Mixed-type (P=0.444),Cam-type and the control group (P=0.236)with no statistical significance,the differences be-tween any other two groups reached statistical significance (P<0.05).Conclusion Different type of FAI has its unique anatomical features.Alpha angle,offsetand CE angle for the diagnosis of FAI have important reference values.
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Objective To evaluate the value and limitation of primary MSCT examination for rib fractures in a short interval. Methods Seventy-two cases with rib fractures were analyzed retrospectively.All of them underwent primary MSCT examination within the three days after trauma,and MSCT examination of chest,epigastria,rib or X-ray examination of rib for 1-6 times in the following 8 weeks.41 cases underwent X-ray examination firstly before MSCT examination.The total number of rib fractures was determined according to the compositive results of every examination.Diagnosis rate of the primary MSCT and X-ray examination were compared with each other.Results Among 72 cases,404 fractures in 325 ribs were diagnosed.Primary MSCT diagnosed 305 confirmed fractures and 28 doubtful fractures,and 84 fractures were not detected with diagnosis rate of 75.5%.13 of 28 suspected fractures were ruled out by the following re-examinations.The MSCT and X-ray diagnostic rates were 72.1%、50.3%,respectively for 41 cases who underwent X-ray examination firstly.Four fractures showed by X-ray plain film were not shown by primary MSCT.Conclusion There is a certain proportion of cases diagnosed as obscure or doubtful rib fracture by the primary MSCT. Therefore,diagnosis should be closely combined with the re-examination results of MSCT and X-ray plain film,especially MSCT ex-amination between the fourth and eighth weeks after trauma.
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Objective To study the effects of different temporal resolution of spiral computed tomography (CT)on perfusion parameters and perfusion curve of cervical cervical cancer.Methods Ten cases of cervical cancer were clinically confirmed with CT perfusion scanning.The original data were acquired using temporal resolution of 0.75 s.Then the original data were grouped according to different temporal resolution,namely,1.5 s group,2.25 s group,3 s group,3.75 s group,4.5 s group,5.25 s group,and 6 s group (experiment group). According to the same mathematical model and ROI of the same part,perfusion parameters (BF,BV,MTT,and PS)in each group were calculated respectively and compared with the original data.Results BF and MTT were relatively sensitive to the change of temporal resolution.When the temporal resolution was 3 s,it had a significant impact.PS and BV were not so sensitive to the change of temporal resolution.Temporal resolution of 4.5 s had a significant effect on PS. There was a significant effect on BV until the temporal resolution was 5.25 s. Conclusion Changing the temporal resolution will lead to corresponding changes of perfusion curve and perfusion parameters.Under the premise that it does not affect the diagnosis,properly decreasing temporal resolution (circu-lar scanning temporal ≤2.25 s)of CT perfusion scanning of cervical cancer can reduce the radiation dose effectively.
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Objective To find a better method to reconstruct total ear in one stage. Methods In the procedure, a compound framework was formed, in which Medpor acted as ear framework and homogenous rib cartilage as helix-framework after being sculptured, then they were vamped together. The formed framework was covered with adjacent skin flap and homogenous skin graft after it had been covered with superficial temporal fascia flap. Results From January 2001 to Augest 2003, 8 cases of congenital microtia or antotia were treated in this way, and all of them obtained satisfactory appearance in auricle. Conclusion The reconstructed ear has a delicate structure and good appearance, and looks and feels as a real one by this new procedure.