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OBJECTIVE@#To explore the MRI findings of os acromiale and to analyze the relationship between os acromiale and the supraspinatus and infraspinatus injury.@*METHODS@#From January 2010 to August 2020, 21 patients with os acromiale (os arcomiale group) were compared with 21 subjects with no evidence of os acromiale (no os arcomiale group). There were 14 males and 7 females in the os arcomiate group, aged from 29 to 77 years old, mean aged (55.5±11.5) years old. While in the control group, there were 10 males and 11 females in no os arcomiale group, aged from 31 to 70 years old, mean aged (51.1±10.0) years old. The os acromiales were classified as edematous os acromiale or non-edematous os acromiale based on whether the presence of marrow edema, and as displaced os acromiale or non-displaced os acromiale based on whether the presence of displacement of the os acromiale. The MRI features of os acromiale were analyzed. Statistical analyses were performed to identify the differences between the os arcomiale group and no os arcomiale group regarding rotator cuff tear, supraspinatus and infraspinatus injury. Differences in the supraspinatus and infraspinatus tear between the edematous and non-edematous os acromiale group, the displaced and non-displaced os acromiale group, the displaced os acromiale and no os arcomiale group were also assessed.@*RESULTS@#On MRI, all the 21 os acromiales appeared as a triangular or irregular bone fragment of the distal acromion, and forms a pseudo-acromioclavicular joint with the acromion. Eleven cases were edematous os acromiale, 11 cases were displaced os acromiale. In the os arcomiale group, 17 had supraspinatus tear, 1 had supraspinatus tendinitis, 11 had infraspinatus tear, and 4 had infraspinatus tendinitis. In the no os arcomiale group, 11 had supraspinatus tear, 2 had supraspinatus tendinitis, 5 had infraspinatus tear, and 1 had infraspinatus tendinitis. No statistically significant difference between the os arcomiale group and no os arcomiale group regarding the rotator cuff tear, supraspinatus and infraspinatus injury (P>0.05). In the 11 cases of edematous os arcomiale, 10 had supraspinatus tear and 7 had infraspinatus tear. In the 10 cases of non-edematous os acromiale, 7 had supraspinatus tear and 4 had infraspinatus tear. No statistically significant difference was noted between the edematous os acromiale and non-edematous os acromiale in terms of supraspinatus and infraspinatus tear (P>0.05). In the 11 cases of displaced os acromiale, 11 had supraspinatus tear and 9 had infraspinatus tear. In the 10 cases of non-displaced os acromiale, 6 had supraspinatus tear and 2 had infraspinatus tear. In the no os arcomiale group, 11 had supraspinatus tear and 5 had infraspinatus tear. There was a statistically significant increases in the prevalence of supraspinatus and infraspinatus tear in the displaced os acromiale group compared with non-displaced os acromiale group, the displaced os acromiale group and no os arcomiale group(P<0.05).@*CONCLUSION@#Shoulder MRI can very well depict os acromiale and can reveal associated abnormalities such as adjacent bone marrow edema, displaced deformity, and rotator cuff tear, and it can be used to assess the stability of the os acromiale. The presence of os acromiale may not increase the risk of supraspinatus and infraspinatus tear significantly. However, the presence of displaced os acromiale is at greater risk of supraspinatus and infraspinatus tear.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Acromion/diagnostic imaging , Magnetic Resonance Imaging , Rotator Cuff , Rotator Cuff Injuries/diagnostic imaging , ShoulderABSTRACT
Objective To investigate the influence of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood in patients with hepatocellular carcinoma (HCC) before argon-helium cryoablation on the patient's prognosis.Methods The related clinical and pathological data of 72 HCC patients,who had received percutaneous argon-helium cryoablation,were retrospectively analyzed.Based on the preoperative NLR value,the patients were divided into low NLR group (NLR＜3.5) and high NLR group (NLR ＞ 3.5).The postoperative overall survival time of the patients in the two groups were statistically analyzed,and the risk factors that might affect the prognosis were evaluated by using univariate and multivariate analysis.Results Argon-helium cryoablation was carried out in all patients.The median overall survival time was 22.4 months;the median overall survival time of the high NLR group and the low NLR group was 13.2 months and 24.2 months respectively,the difference in the overall survival time between the two groups was statistically significant (P=0.003).Univariate analysis showed that the primary tumor size,liver function Child-Pugh classification,albumin,total bilirubin,cholinesterase and NLR value were the related factors that affected the postoperative overall survival time of HCC after argon-helium cryoablation (P＜0.05).Multivariate analysis revealed that the primary tumor size and NLR value were the independent prognostic factors that affected the postoperative overall survival time of HCC after argon-helium cryoablation (P＜0.05).Conclusion Preoperative NLR value in peripheral blood can be used as a prognostic indicator for patients with HCC undergoing argonhelium cryoablation;the larger the primary hepatic lesion is and/or the higher the NLR value is,the worse the prognosis of the patient will be.
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Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS). Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV fracture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotating around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the broken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixation was easily finished. The patient had an uneventful recovery without avascular necrosis of femoral head or non-union of the fracture at one year's follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful.
Subject(s)
Humans , Male , Middle Aged , Bone Wires , Device Removal , Femoral Neck Fractures , Diagnostic Imaging , General Surgery , Fracture Fixation, Internal , Methods , RadiographyABSTRACT
Objective: To establish an animal model for anterior cervical-adjustable fusion fixator (AC-AFF), and to compare the operation time, blood loss, and recovery time of food intake and movement between AC-AFF group and other groups with different cervical reconstruction fixators. Methods: Eighteen goats were evenly randomized into 3 groups: AC-AFF, steel plate+ titanium mesh, and steel plate+autogenous iliac bone group. The 3 fixtors were implanted after corpectomy. The operation time, blood loss during operation, and recovery time of food intake and movement were recorded in each animal and were compared. Results: All experiment animals survived after operation; one animal of steel plate+titanium mesh group suffered from incision infection and recovered 5 days after intramuscular penicillin therapy. Two animals in steel plate+autogenous iliac bone group could not stand on forehoof, but food intake was not influenced; the animals could stand 1 week later without treatment and walked with difficulty, and they recovered normal walk 2 weeks later. Four animals received C3 corpectomy (2 received AC-AFF and 2 received steel plate+titanium mesh) and the rest received C4 corpectomy. It was found that AC-AFF group had the shortest operation time (P<0.01), and there was no difference between the other 2 groups. The intra-operation blood loss in the steel plate+autogenous iliac bone group was significantly higher than that in the other 2 groups (P<0.01), with no significant difference found between the latter 2 groups. Conclusion: AC-AFF is easier to manage than the other 2 fixators; besides, AC-AFF has less blood loss, short operation time, less post-operation complication, and early recovery of food intake and movement.
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Objective: To observe the bone graft fusion of goat cervical model implanted with anterior cervical-adjustable fusion fixator(AC-AFF), laying a foundation for future studies. Methods: Eighteen experiment goats were implanted with AC-AFF, titanium mesh and autogenous iliac bone combined cervical plate after corpectomy. Six months later, the fused cervical spine vertebrae were collected, prepared, and observed grossly, under microscope, by X-ray photographs and CT scan; the fusion of the graft was evaluated. Meanwhile, the fusion of AC-AFF with the adjacent vertebral surface was observed. Results: All the experiment animals survived after operation; all the implants were stable, without displace or loosening. The interface where the titanium or AC-AFF contacts the vertebral body surface was bulged and ossified. All iliac bone graft fused well and a great deal of bony callus was found covering the vertebral body surface. Lucency area was not seen surrounding the bone graft, titanium and AC-AFF on the X-ray films, and there was new bone formation in the interface of internal fixation and bone. The central region of titanium and AC-AFF became vague and new bone formation was found in the intracavitary area of implants by CT scan. And part of the new bone transited the parietal reticulation and connected with normal ossea at titanium and AC-AFF. A large number of phoroblasts and chondrocytes were found microscopically in the bone fusion sites in all cases; however, the region without bony callus still existed in the titanium mesh lateral wall. Conclusion: There are no differences in bone fusion between AC-AFF with titanium mesh and autogenous iliac bone combined cervical plate. New phoroblasts and chondrocytes can be generated in the bone graft interface. AC-AFF has been proven as an important method for cervical stability reconstruction after decompression operation.
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<p><b>OBJECTIVE</b>To investigate the clinical characteristics and results of cervical spinal cord injury (SCI) in the patients with ossification of the posterior longitudinal ligament (OPLL).</p><p><b>METHODS</b>Nineteen patients with cervical SCI associated with OPLL were retrospectively analyzed. Data collection included: pre- and postoperative neurological function, OPLL-type, MRI signal changes and surgical approaches.</p><p><b>RESULTS</b>Spinal cord associated with OPLL was injured severely by mild trauma. Methylprednisolone sodium succinate was used within 8 h after trauma in 12 cases. Two of them died of complications. The neurological functions were markedly improved in the other 10 cases. Seventeen cases had surgical treatment. The neurological functions (Frankel grade) were improved significantly in the operated patients except for one, who died 27 d after operation.</p><p><b>CONCLUSIONS</b>The patients with OPLL are prone to have severe SCI, which directly associates with the preexisting OPLL-type and hyper-intensity signal change in the spinal cord on MRI. Both of using methylprednisolone sodium succinate administration within 8 h after trauma and surgical decompression may improve the neurological outcomes.</p>