Imaging measurement of circumferential cortical thickness of anterior entrance and anterior half of lower cervical pedicles and its application analysis / 第二军医大学学报

Objective To measure the circumferential cortical thickness of anterior entrance and anterior half of lower cervical pedicles on computed tomography (CT) images, providing a reference for accurate anterior cervical pedicle screws. Methods CT scanning was performed in 10 normal lower cervical vertebrae from fresh cadavers, and the coronal and sagittal reconstructed images were obtained. The images were then opened in AutoCAD-2007 software to perform quantitative measurement (accuracy was 0. 1 mm) using the “dimaligned function” of dimension menu, and measurement parameters included the thicknesses of superior, medial, inferior and lateral cortex of anterior entrance of pedicle (SAE. MAE. IAE and LAE. respectively), and thicknesses of superior, medial, inferior and lateral cortex of anterior half of pedicle (SPA, MPA, IPA and LPA, respectively). Results Average thicknesses of SAE. MAE. IAE. LAE, SPA, MPA. IPA, and LPA at left and right side from Q to C7 were (1. 9 + 0. 6) and (1. 9 + 0. 5) mm, (1. 9 + 0. 7) and (1.9+0. 4) mm. (2.4 + 0. 6) and (2. 4 + 0. 5) mm, (0. 9 + 0. 5) and (0. 9 + 0. 6) mm, (2. 3 + 0. 9) and (2. 3 +0. 7) mm, (2. 1 + 0. 5) and (2. 1 + 0. 6) mm, (2. 2+0. 8) and (2. 2+0. 7) mm, and (1. 0 + 0. 7) and (1. 0 + 0. 6) mm, respectively. There was no significant difference in same measurement parameter between left and right sides at same cervical level (P>0. 05). Single factor random block analysis of variance found LAE and LPA were significantly thinner than the other 6 parameters of the same side of same cervical vertebra (all P0. 05). Conclusion LAE and LPA are the thinnest among the 8 measurement parameters from C3 to C7, which suggests LAE and LPA have the weakest resistance to exotic force if resistance strength to exotic force is parallel to cortex thickness. We should avoid locating close to LAE when finding anterior entrance or close to LPA when inserting anterior cervical pedicle screws.

Correlation analysis between position of head, cervical curvature classification and balance of cervical spine through lateral plain radiograph measurement / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the relationship between position of head, cervical curvature type and associated cervical balance parameters in a neutral looking-forward posture.</p><p><b>METHODS</b>Cervical lateral X-rays of 60 patients with cervical spondylosis were selected from January to December 2015. There were 22 males and 38 females with an average age of (35.5±10.9) years old. The measured parameters included cervical curvature type, McGregor slope, C2 lower end plate slope, T1 slope, center of gravity to C7 sagittal vertical offset (CG-C7 SVA), and C2 to C7 sagittal vertical offset (C2-C7 SVA). The parameters were analyzed using Spearman correlation.</p><p><b>RESULTS</b>The cervical curvature type was significantly correlated with C2 lower endplate slope, C0-C2 angle (total degree of C2 lower endplate slope plus McGregor slope), CG-C7 SVA and T1 slope (<0.05), but it was not significantly correlated McGregor slope (>0.05). C2 lower endplate slope and C2-C7 SVA (r=0.87) were significantly (<0.05) correlated with CG-C7 SVA (<0.05).</p><p><b>CONCLUSIONS</b>There was certain some relationship among position of head, cervical curvature type and associated cervical balance parameters in a neutral looking-forward posture. The center of gravity of the head would backwards shift following faced upward. A position of extension with posterior-shifting of the head would suggest that it may be accompanied with a relatively normal lordosis of the cervical spine. Some patients with abnormal curvature showed slightly bended head in the natural posture. Health education toward these people would be meaningful to restore the balance of their neck.</p>

Radiographic study of the mental foramen in a Mongolian population / Шинэ санаа Шинэ нээлт

BACKGROUNDPurpose of this study was to investigate the most common position of the mental foramen in a selected Mongolian population. The study sample included two hundred and twenty two panoramic radiographs of selected Mongolian population taken in School of Dentistry, Health Sciences University of Mongolia.RESULTSThe patients’ age ranged from 16 to 66 years, with a mean age of 27.4 years. The most common position of the mental foramen was in line with the second premolar (58.8%). Ethnic and gender differences were also investigated and the symmetry of location within individuals analyzed. In 30.2%, it was between the first and second premolar, and in 2.5%, it was below the first premolar. It is important to know the position of the mental foramen for the placement of osseointegrated implants in the mandibular premolar region.CONCLUSIONClinicians and anthropologists should expect to find the position of the mental foramen to be symmetrical and in line with the second premolar teeth.

Correlation Analysis between Navigation and Radiographic Measurementfor Component Position of Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To examine the correlation between the Navigation and radiographic measurements for the postoperative mechanical axis and component position in total knee arthroplasty. MATERIALS AND METHODS: From December 2005 to May 2006, Navigation assisted MIS TKA was performed on 46 knees of 34 patients. After fixing the components, the mechanical axis (MA) of the lower extremity, femoral component position to the mechanical axis in the coronal plane (theta), tibial component position in the coronal (beta) and sagittal (sigma) planes was measured using the Navigation. Two observers measured the same angles using the postoperative follow-up radiographs. The measurements were compared and the correlation between the Navigation and radiographic measurement was analyzed. RESULTS: The average Navigation measurements were valgus 0.02+/-1.09 degrees for MA, varus 0.05+/-0.96 degrees for theta, valgus 0.02+/-0.86 degrees for beta and 4.03+/-1.25 degrees for sigma. The mean radiographic measurements of observer 1 were valgus 0.71+/-3.73 degrees for MA, valgus 1.14+/-1.72 degrees for theta, valgus 0.90+/-1.47 degrees for beta and 4.51+/-2.03 degrees for sigma. Those of observer 2 were valgus 0.12+/-3.39 degrees, valgus 0.16+/-1.96 degrees, valgus 0.30+/-1.65 degrees and 3.85+/-1.60 degrees, respectively. CONCLUSION: The average of measurement for the component position showed a statistically significant difference in the MA (p=0.001), theta (p=0.000) and beta (p=0.000) among three groups. There were a relatively high correlation between observer 1 and 2 for the radiographic measurements (r=0.67-0.96). However there was a very low correlation between the Navigation and radiographic measurements (r=0.10-0.39). Therefore, the possibility of a difference between the Navigation and radiographic measurement need to be considered when evaluating the component position.

Efficacy of Computer Assisted Surgery in Revision Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the accuracy of the mechanical axis and implant positions postoperatively and to evaluate the radiology results of computer assisted navigation surgery for bone cutting and ligament balancing in revision TKA. MATERIALS AND METHODS: 13 consecutive revision TKAs were performed by a single surgeon with use of computer assisted surgery (CAS) from July 2004 to August 2005. At the revision, the mean age was 64.7 years. The mean interval from the index arthroplasty was 9.8 years. The cause of the revision included 11 cases of polyethylene wear and 2 cases of loosening. Two observers measured the mechanical axis, position of the implants, and level of joint lines. RESULTS: By observer I, the mechanical axis improved from varus 11.9degrees to valgus 1.5degrees, and the mean alpha, bets, gamma and delta angles were 95.3, 90.8, 3.9 and 87.6degrees respectively. From observer II, the mechanical axis improved from varus 11.6degrees to valgus 1.6degrees, and mean alpha, beta, gamma and delta angles were 95.5, 90.5, 4.1 and 87.9degrees respectively. The measured angles from observers I and II showed a good correlation. CONCLUSION: Accurate bone cutting and verification in each step are possible using real time information provided by the CAS. The mechanical axis, component positions, joint line could be checked and adjusted with feedback of navigation system. Information about flexion and extension gap and ligament balancing could be verified during revision surgery.

Intraoperative versus Postoperative Measurement in Total Knee Arthroplasty using Computer-Assisted Orthopaedic Surgery (CAOS): Accuracy of CAOS / 대한정형외과학회잡지

PURPOSE: The purpose of this research was to compare the intra-operative and post-operative measured angle in total knee arthroplasty (TKA) and to evaluate the postoperative improvement in the mechanical axis. MATERIALS AND METHODS: Forty TKAs were performed using CAOS between February and May 2004. We measured the mechanical axis in the preoperative orthograms. After inserting the implant, we measured the femoral component angle (FCA), tibial component angle (TCA) and tibial component slope (TCS) using the verification tool in CAOS, on the post-operative orthogram and X-ray of the lateral tibial view, 2 observers measured the FCA, TCA, TCS and mechanical axis. RESULTS: The mean FCA, TCA and TCS using the verification tool in CAOS, were valgus 0.03+/-0.85degrees, valgus 0.49+/-1.02degrees, nd 4.26+/-1.64degrees. The mean FCA, TCA and TCS by observer 1 were valgus 0.67+/-1.24degrees, varus 0.54+/-1.54degrees, and 4.57+/-1.74degrees and those by observer 2 were valgus 0.48+/-1.17degrees, varus 0.52+/-1.44degrees, and 4.24+/-2.83degrees. There was a positive correlation between the measured angle by respective observers and the angle measured by the CAOS (p<0.05). The mechanical axis by observers 1 and 2 improved from varus 13.96degrees to valgus 0.04degrees and from varus 14.12degrees to valgus 0.08degrees respectively. CONCLUSION: CAOS affords the possibility of precisely placing the femoral and tibial components. The angles measured by the respective observers and in the CAOS were significantly correlated.

Clinical Utility of Radiographic Measurements of Insertional Achilles Tendinitis with Haglund's Deformity / 대한족부족관절학회지

PURPOSE: It is to analyze the clinical utility of radiograhpic measurements for the insertional Achilles tendinitis patients who have Haglund's deformity and to evaluate the radiographic values related to Haglund's deformity in normal Korean population. MATERIALS AND METHODS: We used the angle of Fowler and Philip, parallel pitch lines (PPL) and Chauveaux-Liet (CL) angle as radiographic measurements. We examined 50 cases of insertional Achilles tendinits patients and another 50 cases of normal foot as a control. RESULTS: In normal feet, the mean value of angle of Fowler and Philip was 53.22 degrees, CL angle was -33.14 degrees and the PPL showed positive in 48%. In case of insertional Achilles tendinitis, the mean values were 55.39 degrees, -33.63 degrees, positive in 56% respectively. There were not statistically significant differences (p>0.05). CONCLUSION: The radiographic values for Haglund's deformity between insertional Achilles tendinitis feet and the normal feet did not show significant difference. Therefore, it seems that the clinical utility of radiographic measurements for the insertional Achilles tendinitis with Haglund's deformity is not useful and the development of new diagnostic methods as MRI and ultrasonography is required.

Clinical Utility of Radiographic Measurements of Insertional Achilles Tendinitis with Haglund's Deformity / 대한족부족관절학회지

PURPOSE: It is to analyze the clinical utility of radiograhpic measurements for the insertional Achilles tendinitis patients who have Haglund's deformity and to evaluate the radiographic values related to Haglund's deformity in normal Korean population. MATERIALS AND METHODS: We used the angle of Fowler and Philip, parallel pitch lines (PPL) and Chauveaux-Liet (CL) angle as radiographic measurements. We examined 50 cases of insertional Achilles tendinits patients and another 50 cases of normal foot as a control. RESULTS: In normal feet, the mean value of angle of Fowler and Philip was 53.22 degrees, CL angle was -33.14 degrees and the PPL showed positive in 48%. In case of insertional Achilles tendinitis, the mean values were 55.39 degrees, -33.63 degrees, positive in 56% respectively. There were not statistically significant differences (p>0.05). CONCLUSION: The radiographic values for Haglund's deformity between insertional Achilles tendinitis feet and the normal feet did not show significant difference. Therefore, it seems that the clinical utility of radiographic measurements for the insertional Achilles tendinitis with Haglund's deformity is not useful and the development of new diagnostic methods as MRI and ultrasonography is required.

Reproducibility of panoramic radiography in patients / 대한구강악안면방사선학회지

PURPOSE: To evaluate the magnification error percentage in repeatedly taken panoramic radiographs of same patient and machine. MATERIALS AND METHODS: 92 panoramic radiographs from 46 patients were traced and 30 horizontal and vertical measurements were made with digital sliding caliper. The results were compared with paired t-test. RESULTS: There was no statistically significant difference between the two measurements. The overall difference as percentage error was 6.19+/-5.60%. The largest error as 14.61+/-12.44% was found at condylar height 1, and smallest as 1.86+/-1.61% at mandibular height. Overall vertical error excluding condylar height 1 was 3.76+/-3.97%, and the horizontal error 6.88+/-5.92%. CONCLUSION: Repeatedly taken panoramic radiographs of the same patient and machine was reliable since there was no significant percentage error difference but the percentage error ranged from 1.86+/-1.61% to 14.61+/-12.44% indicating the error depends on the measuring site.

The correlation of bone probing, radiographic and histometric measurements / 대한치주과학회지

The most accurate method to assess bone level is the histometric measurement. However it causes discomfort in patients and damage to the regenerated tissues. in the present study, we used 4 type regenerative therapies. The present study evaluated the clinical reliability and accuracy of bone probing measurements and radiographic bone level in the assessment of bone level by comparing those results with histometric confirmed bone level. Twentyfour(24) intrabony defects(4x4mm 1-wall intrabony defects) were surgically created in the mandibular second and fourth premolars of 6 beagle dogs. The control group underwent a conventional flap operation. Experimental group 1 was treated with calcium phosphate glass only, and while experimental group 2 was treated with GTR and experimental group 3 was treated with calcium phosphate glass and GTR. The subjects were sacrificed 8 weeks after the operation and a bone probing measurements, radiographic measurement and histometric measurement was performed. The correlation between bone probing measurements(BP) and histometric measurement(HL), and radiographic measurement(RL) and histometric measurement(HL) were analyzed with Spearman's rank correlation analysis and the statistical significance with respect to the type of regenerative therapies was analyzed with the Kruskal Wallis test. The coefficeint of correlation to HL was 0.73 for RL and 0.90 for BP. The type of regenerative therapies had no significant effect on the difference between HL and other measurements. The results of this study suggests that bone probing measurements most closely represents actual bone level. So bone probing measurements may be a good clinical method for assessing the bone level following any type of periodontal regenerative therapies.

The radiographic measurement of the foot in normal Thai children.

To find the normal values of the foot x-ray in Thai children. Materials & Methods: Thirty-one Thai children, 17 bys, 14 girls with the age ranged from 3 months to 5 years old without any foot deformities had the x-ray of the foot taken in AP and lateral view in maximum correction according to Simon’s technique and were measured the talo calceneal (TCAP), Talo first metatarsal (T-F), calcaneo-fifth metatarsal (C-F) in AP view, talo calcaneal (TClat), tibio-talar (TIT), tibiocalcaneal (TIC) in lateral view and talo calcaneal index (TI). Results: No statistical significant difference in the angles between boys and girls, left and right foot (P>0.05). The normal values of foot x-ray were 29.4o, 6.16o, 2.36o for the mean angles of talocalcaneal, talofirst metatarsal and calcaneofifth metatarsal in AP view and 44.47o, 92.97o, 48.67o for the mean angles of talocalcaneal, tibiotalar and tibiocalcaneal in the lateral view. The mean talocalcaneal index was 76.92o. Conclusion: This normal values can be useful as the standard to compare and evaluate the foot after treatment.

Prediction of Risk Factors in Hip Fractures from Simple Radiographic Measurements of the Proximal Femur / 대한정형외과학회잡지

PURPOSE: To investigate whether simple measurements made on conventional pelvis plain film could predict hip fractures independently of bone mineral density. MATERIALS AND METHODS: The authors analyzed the simple radiographs and dual x-ray absorptiometry scan of women over the age of 60 years who had sustained a neck fracture (n=40), trochanteric fracture (n=40) and non-fracture volunteers (n=40). RESULTS: In an age-adjusted univariate logistic regression model, the most reliable risk factor of hip fracture in bone mass was bone mineral density of the femoral neck. In the measurements of bone architecture, the most important risk factor was Singh index and in bone geometric measurements, it was hip axis length. There were no statistical differences in the measurements between neck fractures and trochanteric fractures. In a multivariate model, these three variables were shown to be significant improvements in the assessment of hip fracture risks. CONCLUSIONS: The authors concluded that simple measurements of proximal femoral geometry made on pelvic radiographs could predict hip fracture as well as bone density of the hip.

Radiographic parameters of acetabulum for dysplasia in Korean adults

We analyzed plain radiographs of 591 normal adult hips of various parameters to evaluate the radiological characteristics of the hip joint including the center-edge (CE) angle, acetabular angle, acetabular depth, acetabular roof obliquity and roof angle, and also to verify the rate of acetabular dysplasia. The CE angle was negatively correlated with acetabular angle and acetabular obliquity, but it was positively correlated with acetabular depth and roof angle. The rate of acetabular dysplasia (CE angle<20 degrees) was 1.8%. We concluded that the CE angle and acetabular angle are more useful parameters for the diagnosis of acetabular dysplasia because there was no significant difference with advancing age and gender, as well as relatively small standard deviations.

Tibial tunnel Placement in Arthroscopic ACL Reconstruction using Preoperative Radiographic Measurement / 대한정형외과학회잡지

A major cause of less than ideal results following intraarticular anterior cruciate ligament (ACL) reconstruction has been imprecise nonanatomic tunnel position for graft placement either in the femur, the tibia, or both. Lack of defined constant reference landmarks for reproducible tunnel placement has contributed to this problem on both sides of the joint. The purpose of this study was to define constant anatomic intraarticular and extraarticular landmarks that can be used as definitive reference points to reproducibly create a tibial tunnel for ACL reconstruction that (1) results in an impingement-free graft in full extension; (2) positions the tibial tunnel such that the sagittal tunnel-plateau angle is parallel with the sagittal intercondylar roof-plateau angle in full extension to minimize shear seen by the graft at the tibial tunnel inlet. Preoperative full extension and 90degrees flexion lateral radiographs were obtained. Preoperative measurements of the tibial tunnel-tibial shaft angle and distance from inferior pole of patella to entry point of tibial tunnel were useful tool for impingement free, Blumensaats line paralleling ACL reconstruction with autogenous bone patella tendon bone graft. The average tibial tunnel-tibial shaft angle was 34+/-4.59degrees (male), 33.5+/-3.37degrees (female). The mean distance between patella inferior pole and tibial tunnel entry point was 6.62+/-0.61cm (male), 6.21+/-0.89cm (female). This study sought to define constant anatomic landmarks extraarticularly as well as intraarticularly that can be used to reliably create an ideal tibial tunnel for ACL reconstruction.