Application of three-dimensional fast gradient echo sequence in observation of craniocervical junctional ligament / 中南大学学报(医学版)

OBJECTIVES@#To explore the value of three-dimensional fast gradient echo sequence (3D-GRE) in observation of the craniocervical junctional ligament.@*METHODS@#A total of 21 healthy volunteers underwent 3D-GRE imaging. The imaging data was imported into the post-processing workstation. The structures of the ligaments in the craniocervical junctional area were observed and evaluated by multiplanar reconstruction technique.@*RESULTS@#The features of ligaments in the craniocervical junction were shown clearly for all the 21 cases of volunteers. The scan time was 267-294 s. After the treatment with the three-dimensional reconstruction technique, the signal characteristics and the running structure of the transverse ligament, the alar ligament, the serrated ligament and the lamina could be effectively displayed.@*CONCLUSIONS@#The 3D-GRE can evaluate the three-dimensional data of craniocervical junctional ligament in a short period of time. Post-processing reconstruction technique can clearly evaluate the structure characteristics of each ligament, which can lay a foundation for further application in craniocerebral trauma patients.

Ultrasonography and magnetic resonance imaging of elbow ligaments: a comparative study / Ultrassonografia na avaliação de ligamentos de cotovelo: estudo comparativo com imagem de ressonância magnética

ABSTRACT Objective: To determine the value of ultrasonography in elbow ligament assessment compared to magnetic resonance imaging. Methods: A prospective single-center study involving 30 volunteers with no elbow joint changes. Two experienced ultrasound specialists evaluated both elbows of each volunteer, resulting in 60 evaluations per physician and totaling up 120 evaluations. Magnetic resonance images were obtained using a 3-Tesla machine and evaluated by two experienced radiologists, totaling up 120 exams. Each examiner assigned subjective, zero-to-5 scores to ligaments imaged, where zero corresponded to non-identified ligament and 5 to visualization of the entire ligament. The level of significance was set at 5%. Bland-Altman dispersions and plots were prepared for each pair of measurements obtained. Results: All ligaments were amenable to sonographic identification; scores of 4 or 5 were assigned by examiners based on ligament visibility. Ligaments could also be identified using magnetic resonance imaging and were assigned scores of 5 by examiners. All ligaments were described as intact and healthy by all four examiners. Comparative analysis of elbow ligament sonographic and magnetic resonance imaging findings did not differ significantly. Conclusion: Ultrasonography and magnetic resonance imaging can be considered equivalent modalities for elbow ligament assessment in the hands of experienced examiners.

RESUMO Objetivo: Avaliar o desempenho da ultrassonografia na avaliação dos ligamentos do cotovelo, comparando os achados com ressonância magnética. Métodos: Estudo prospectivo unicêntrico envolvendo 30 pacientes, sem alterações articulares nos cotovelos. Dois ultrassonografistas experientes avaliaram ambos os cotovelos de cada um dos pacientes, com 60 avaliações cada médico e 120 avaliações no total. As imagens de ressonância magnética foram obtidas em aparelhos 3 Tesla. Dois radiologistas experientes avaliaram as imagens, com total de 120 exames. Cada examinador deu uma nota subjetiva, de zero a 5, para os ligamentos avaliados; zero correspondeu a ligamento não identificado, e 5 a ligamento visualizado integralmente. Foi considerado nível de significância de 5%. Para cada par de medidas obtidas, construíram-se dispersões e parcelas de Bland-Altman. Resultados: Todos os ligamentos foram identificados pelos examinadores de ultrassonografia, recebendo pontuação 4 ou 5, em relação à sua visibilidade, e foram identificados pelos examinadores de ressonância magnética, com pontuação 5. Foram considerados intactos e saudáveis pelos quatro examinadores. As comparações entre ultrassonografia e ressonância magnética na avaliação dos ligamentos do cotovelo não demostraram diferenças significativas. Conclusão: Quando realizada por examinadores experientes, a ultrassonografia pode ser considerada semelhante à ressonância magnética na avaliação de ligamentos do cotovelo.

Influência do posicionamento radiográfico no cálculo interobservador do ângulo do platô tibial em cães / Influence of radiographic positioning in the interobserver measuring of the tibial plateau angle in dogs

O objetivo deste trabalho foi demonstrar que o posicionamento radiográfico inadequado do membro pélvico de cães (imagens obliquadas) afeta a mensuração do ângulo do platô tibial (APT), levando à maior variação entre observadores. Foram realizadas duas projeções radiográficas nos membros pélvicos direito e esquerdo, uma em perfil verdadeiro e a outra com o membro obliquado em 21 cães provenientes do atendimento clínico cirúrgico do Hospital Veterinário da Universidade de Cuiabá, em Cuiabá-MT. Os critérios de inclusão foram cães livres de histórico ou afecção ortopédica nos membros pélvicos, pesando entre 15 e 40 quilos, sem predileção por raça ou sexo, entre dois e sete anos de idade. Foram obtidas 42 imagens radiográficas em perfil verdadeiro e 42 imagens radiográficas obliquadas. Três observadores com experiência em cálculo do APT fizeram as mensurações. Nos cálculos das imagens em perfil verdadeiro, o observador 1 obteve uma média de 23,35º ± 2,82; o observador 2, média de 23,88º ± 4,83; e o observador 3, média de 24,54º ± 4,01, não sendo encontrada diferença significativa entre o cálculo dos três avaliadores, P=0,944 (P > 0,05), nas imagens em perfil verdadeiro. Nos cálculos das imagens obliquadas, o observador 1 obteve uma média de 21,69º ± 4,22; o observador 2, média de 19,42º ± 5,92; e o observador 3, média de 22,64º ± 5,23, e foi encontrada diferença significativa entre o cálculo dos três observadores, P=0,016 (P < 0,05). Com esses dados, pôde-se demonstrar que a imagem radiográfica obliquada compromete o valor final do cálculo do ângulo do platô tibial em cães, levando à variação numérica estatisticamente significativa entre observadores. Conclui-se, assim, que um posicionamento correto do membro pélvico, em perfil verdadeiro, deve ser sempre utilizado para a obtenção de imagens, com o objetivo de mensurar o valor do APT.(AU)

This work aimed at demonstrating that an inadequate radiographic position of pelvic limbs of dogs, from a strict lateral radiographic view, resulted in oblique images, affecting the measurement of the tibial plateau angle (TPA). There were two radiographic projections of the right and the left pelvic limb, one in strict lateral radiographic view and another with inclined hind limb in 21 dogs from the clinical surgical assistance at Hospital Veterinário of Universidade de Cuiabá in Cuiabá-MT. Inclusion criteria were dogs free from pelvic hind limbs orthopedic affection records, weighing between 15 and 40 kilos, without a preference for breed or gender and ageing between two and seven years old. A total of 42 radiographic images in strict lateral radiographic view and 42 inclined limb radiographic views were obtained. Three observers with TPA calculation experience made measurements. In the calculus for the strict lateral radiographic view the first observer has reached an average of 23,35º ± 2,82, the second observer 23,88º ± 4,83 and the third observer 24,54º ± 4,01. No significant statistic differences among the calculus of the three evaluators p=0,944 (P>0,05) was found. In the calculus of the inclined limbs radiographic views the first observer reached an average of 21,69º ± 4,22, the second observer 19,42º ± 5,92 and the third observer 22,64º ±. 5,23. Significant statistic difference in the calculus of the three observers, p=0,016, that is to say, P<0,05 was found. The data indicated that the inclined limb radiographic image compromises the final value of the calculation of tibial plateau angle in dogs. Thus, correct positioning of the pelvic limb, in a strict lateral radiographic view, must be always used for obtaining images aiming at measuring the value of TPA.(AU)

Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Using a Gracilis Autograft without Bone Tunnel

BACKGROUND: Several tendon graft and fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation. The purpose of this study was to evaluate the results of MPFL reconstruction using a gracilis autograft fixation without bone tunnel in patients with recurrent patellar instability. METHODS: Nine patients (four males and five females) diagnosed with recurrent patellar instability from July 2009 to January 2013 and had MPFL reconstruction using a gracilis autograft were included. The average age of the patients was 24.6 years (range, 13 to 48 years), and the average follow-up period was 19.3 months (range, 12 to 30 months). For every patient, femoral attachment was fixed using suture anchors securing the patella by suturing the periosteum and surrounding soft tissue. Clinical evaluation included the Kujala, Lysholm, and Tegner scores; in addition, patients were examined for any complication including recurrent dislocation. The congruence angle and patella alta were assessed radiologically before and after surgery. RESULTS: The Kujala score improved from an average of 42.7 ± 8.4 before surgery to 79.6 ± 13.6 (p = 0.008) at final follow-up; the Lysholm score improved from 45.8 ± 5.7 to 82.0 ± 10.5 (p = 0.008); and the Tegner score improved from 2.8 ± 0.8 to 5.6 ± 1.5 (p = 0.007). The Insall-Salvati ratio changed from 1.16 ± 0.1 (range, 0.94 to 1.35) before surgery to 1.14 ± 0.1 (range, 0.96 to 1.29; p = 0.233) at the final follow-up without significance. The congruence angle significantly improved from 26.5°± 10.6° (range, 12° to 43°) before surgery to -4.0°± 4.3° (range, -12° to 5°; p = 0.008) at final follow-up. Subluxation was observed in one patient and hemarthrosis occurred in another patient 2 years after surgery, but these patients were asymptomatic. CONCLUSIONS: We achieved good results with a patellar fixation technique in MPFL reconstruction using a gracilis autograft employing soft tissue suturing in patients with recurrent patellar dislocation.

Utility of Preoperative Distractive Stress Radiograph for Beginners to Extent of Medial Release in Total Knee Arthroplasty

BACKGROUND: This study evaluated the preoperative distractive stress radiographs in order to quantify and predict the extent of medial release according to the degree of varus deformity in primary total knee arthroplasty. METHODS: We evaluated 120 varus, osteoarthritic knee joints (75 patients). The association of the angle on the distractive stress radiograph with extent of medial release was analyzed. The extent of medial release was classified into the following 4 groups according to the stage: release of the deep medial collateral ligament (group 1), release of the posterior oblique ligament and/or semimembranous tendon (group 2), release of the posterior capsule (group 3) and release of the superficial medial collateral ligament (group 4). RESULTS: The mean femorotibial angle on the preoperative distractive stress radiograph was valgus 2.4degrees (group 1), valgus 0.8degrees (group 2), varus 2.1degrees (group 3) and varus 2.7degrees (group 4). The extent of medial release increased with increasing degree of varus deformity seen on the preoperative distractive stress radiograph. CONCLUSIONS: The preoperative distractive stress radiograph was useful for predicting the extent of medial release when performing primary total knee arthroplaty.