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Objective:To evaluate the application values of small FOV surface coil and BLADE sequence in MR imaging on assessment of talar cartilage injury of ankle joint under traction.Methods:The clinical and imaging data of 53 patients with ankle cartilage injury in the Affiliated Suzhou Hospital of Nanjing Medical University from December 2018 to July 2020 were prospectively analyzed. All patients underwent the following MR sequences: sequence Ⅰ was fast spin echo proton density weighted (FSE-PD) BLADE sequence with surface coil small FOV, and sequence Ⅱ was FSE-PD-BLADE imaging of small FOV under horizontal load traction of ankle joint. Paired sample Wilcoxon rank sum test was used to compare the thickness of talus dome cartilage, cartilage space and subjective assessment score of image quality (including the outline of the upper surface of the cartilage at the injury, the thickness of the cartilage layer at the injury, the rupture of the cartilage at the injury, the relationship between cartilage and subchondral bone, subchondral bone collapse or trabecular fracture line) between sequence I and sequence Ⅱ.Results:There was significant difference in the thickness of central cartilage of talus between sequence Ⅰ and sequence Ⅱ [0.70 (0.60, 0.90) mm and 0.80 (0.70, 0.90) mm, Z=-2.900, P=0.004, respectively]. There was no significant difference in the thickness of medial and lateral talus cartilage between sequence Ⅰ and sequence Ⅱ (P>0.05). There were significant differences between sequence Ⅰ and sequence Ⅱ in the center [0.10 (0, 0.15), 0.89(0.63, 1.00) mm], medial [0.10(0, 0.31), 1.20(0.70, 1.25) mm] and lateral cartilage space [0.18(0.08, 0.23), 0.90(0.76, 0.94)mm] (all P<0.001). As for the subjective assessment score of talus cartilage injury, except for score in subchondral bone collapse or bone trabecular fracture line between sequence Ⅱ and sequence Ⅰ ( Z=-1.480, P=0.139), significant differences were found in all other scores ( P<0.05). Conclusion:MRI of the ankle under traction is safe and feasible. Under the condition of horizontal traction, small FOV surface coil combined with BLADE sequence can better display talus cartilage injury.
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Objective To investigate the effect of soft tissue on the posterior lumbar spine after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) for spinal osteoporotic fractures. Methods From January 2015 to December 2016, 52 patients with thoracolumbar osteoporotic fracture in our hospital underwent PKP or PVP. According to their fat suppression sequence (FSE) on Magnetic Resonance Imaging (MRI), they were divided into FSE positive and FSE negative groups. The FSE negative group had 38 patients, 9 males and 29 females with a mean age of 75.1 ± 6.0 years; the FSE positive group had 14 pa-tients, 4 males and 10 females with a mean age of 73.9 ± 5.8 years. The 2 groups were compared in terms of visual analogue scale (VAS) for lying on bed and standing at the 1, 3 and 7 days after surgery and painless ambulation at the 3 time points as well. Results There were no significant differences between the 2 groups in age, gender or responsible vertebrae distributions. When the patients were lying on bed, their VAS scores at the 1, 3 and 7 days after surgery were 4.1 ± 1.7, 3.0 ± 0.9 and 1.0 ± 0.8 for the FSE negative group, and 4.8 ± 1.0, 3.0 ± 0.7 and 1.3 ± 0.9 for the FSE positive group; when the patients were standing, their VAS scores at the 1, 3 and 7 days after surgery were 4.2 ± 1.1, 3.2 ± 0.7 and 1.9 ± 0.7 for the FSE negative group, and 5.4 ± 1.1, 4.0 ± 1.0 and 2.3 ± 0.5 for the FSE positive group. The VAS scores for standing at the 1 and 3 days after surgery for the FSE negative group were significantly lower than those for the FSE positive group (P <0.05). There were no significant differences between the 2 groups in the VAS scores for lying on bed at the 1, 3 or 7 days after surgery and for standing at the 7 days after surgery (P > 0.05). At the 1, 3 and 7 days after surgery, there were respectively 22, 37 and 38 patients in the FSE negative group who accomplished painless ambulation and there were respectively 3, 9 and 14 patients in the FSE positive group who accomplished painless ambulation. A significantly larger proportion of the patients in the FSE negative group accomplished painless ambulation than in the FSE positive group (P <0.05). At 7 days after surgery, all the patients in the 2 group accomplished painless ambulation. Conclusions The soft tissue of the lower back may play an important role after PKP and PVP, for fine soft tissue can reduce time for lying on bed and foster surgical efficiency. The VAS scores for standing may be more significant than those for lying on bed in prediction of ambulant time.
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Objective To compare the accuracy rate of talar osteochondral lesions between the small field of view (FOV) surface coil MR imaging and 2D FSE proton density weighted imaging (2D-FSE-PD),3D-SPACE sequences MR imaging with boot-shaped coil.Methods Totally 43 patients (45 ankles) underwent 3D-SPACE sequence after 2D-FSE-PD sequence scanning using the boot-shaped coil,then the PDWI sequence was scanning after the boot-shaped coil was replaced by the small FOV surface coil at 1.5T MRI.The results of the arthroscopic examinations was regarded as the standard for assessing the accuracy rate of the three methods.Results The accuracy rate of 2D-FSE-PD sequence with small FOV surface coil was 86.67％ (39/45),the accuracy rate of 2D-FSE-PD sequence with boot coil was 60.00％ (27/45),the accuracy rate of 3D-SPACE sequence with boot coil was 68.89％ (31/45).The accuracy rate of small FOV surface coil was higher than those of boot coil used 3D-SPACE sequence (x2 =4.114,P =0.002) and boot coil used 2D-FSE-PD sequence (x2 =8.182,P＜0.001).There was not significant difference between 3D-SPACE sequence using boot coil and 2D-FSE-PD sequence using boot coil (x2 =0.776,P=0.125).Conclusion Compared with the 2D-FSE-PD and 3D-SPACE sequences with boot-shaped coil,the small surface coil scanning with routine sequence can show talar osteochondral lesions better.
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Objective To compare the imaging quality of articular cartilage of the knee with 3D-sampling perfection with applica-tion optimized contrast using different flip angle evolutions (3D-SPACE),3D-true fast imaging with steady-state precession (3D-True FISP)and 2D-fast-spin-echo-proto-density(2D-FSE-PD)sequences.Methods 40 healthy volunteers and 20 patients of knee joints were examined with 3D-SPACE,3D-True FISP and 2D-FSE-PD sequences at 1.5T MRI.Signal-noise ratio (SNR),contrast-to-noise ratio (CNR)and lesion visualization of articular cartilage were compared.Results 3D-SPACE showed the highest SNR of cartilage and CNR of fluid/cartilage among the three sequences (P <0.05).3D-SPACE had the better capability for showing the lev-el I 、level Ⅱcartilage injury comparing with 3D-True FISP,but no significant difference between the cartilage injury at level Ⅲ and level Ⅳ.For all levels of cartilage injury,3D sequence was better than the 2D sequence.Conclusion Compared with the 3D-True FISP sequence and 2D-FSE-PD sequence,3D-SPACE sequence can show the structure of knee and knee cartilage injury better.
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Objective To investigate the methods and effects of the double foliated anterolateral thigh flap in wound repair.Methods From March 2001 to January 2007,nine patients with adjacent soft tissue defects were treated by double foliated anterolateral thigh flap.Of all patients,three patients were with perforating injury.Results All the transplanted flaps survived,except for one patient with superficial necrosis in extremities,who got healed with dressings change and anti-infective therapy.All patients were followed up,which showed that all flaps had excellent appearance,with a normal color and consistency.Conclusion The double foliated anterolateral thigh flap has the advantages of foliated anterolateral thigh flap and is an optimal method for repairing adjacent soft tissue defects.
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Objective To study the effect of acute hypervolemic hemodilution on expression of serum chemokine interferon-inducible protein 10 in patients undergoing total hip replacement.Methods Twenty ASA Ⅰ or Ⅱ patients undergoing elective total hip replacement were randomly divided into 2 groups (n=10 each):HES group and LR group.The patients in HES group received 6% HES 20 ml/kg in rate of 30 ml/(kg·h) after anesthesia.The patients in LR group received Ringer's solution 20 ml/kg in rate of 30 ml(kg·h) after anesthesia.The blood loss,blood transfusion and the time of operation were recorded.Venous blood samples were taken before anesthesia (T0),at the begining of operation (T1),30 min after operation (T2),and at the end of operation (T3),in determination of serum chemokine interferon-inducible protein 10.Results The blood loss and the blood transfusion in HES group were (560±90)ml and (200±100) ml,those were significantly lower than that in LR group[(810±110)ml and (600±200)ml].The IP-10 concentrations were significantly increased at T2～T3 as compared to baseline value at T0 in both groups,but were higher in LP group[(77.3±13.8) ng/L and (89.9±15.1) ng/L]than those in HES group [(62.8±13.6) ng/L and (65.4±10.2) ng/L,P＜0.05].Conclusions Acute hypervolemic hemodilution can abate blood loss and blood transfusion during total hip replacement operation.Preoprative infusion with hydroxyethyl starch can attenuate the immunological depression during operation and anesthesia.
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Objective To summarize the early results of total hip replacement with a proximally hydroxyapatite-coated femoral component. Methods From February 2000 to October 2003, 65 cases (70 hips) underwent uncemented total hip replacement with a proximally hydroxyapatite-coated femoral component (U2, United Orthopedic Corporation, Taiwan, China). The diagnosis included femoral neck fractures in 30 cases, osteoarthritis in 15 cases, avascular necrosis of the femoral head in 9 cases, loosening of artificial femoral head in 8 cases, rheumatoid arthritis in 2 cases, and arthrodesis in 1 case. Clinical and radiographic evaluations were performed at 1 week, 3 and 6 months postoperatively, and yearly afterwards. Bone mineral density (BMD) of the proximal femur was measured with dual-energy X-ray Absorptiometry (DEXA) for 44 cases. Results Postoperative X-ray films showed that the initial fixation was excellent or good in all the stems. The follow-ups averaged 3 years (2 to 5.5 years). The mean preoperative Harris hip score was 32 (25 to 52) points, which were improved to 96 points at the latest follow-ups. There was no reported incidence of thigh pain at any time throughout our study. And no case needed revision. By the measurements on the X-ray films taken within 1 year postoperatively, 7 of the 70 stems had subsidence of less than 1.5 mm. No hip experienced extensive proximal end osteolysis, intramedullary osteolysis, or loosening. DEXA showed that the BMD values decreased after operation, and then returned rapidly to the normal or near normal ones 3 to 6 months after operation, especially in zones Ⅱand Ⅵwhere the increase was even more significant than at the control side. All the stems were radiographically stable with evidence of osseous ingrowth typically seen in HA-coated zones, according to the criteria proposed by Engh et al. Conclusions Since HA-coating on femoral implants can enhance the initial fixation of implants, accelerate bone ingrowth and osseous fixation of the femoral component, and seal the interface between the implant and bone to prevent ingress of polyethylene particles, it is helpful in improving clinical results of the cementless total hip replacement.