Résumé
PURPOSE: To determine the accuracy of MRI on postoperative pain syndrome (POPS), including early complications such as hematoma or infection. MATERIALS AND METHODS: Of the 54 patients with the POPS, we analyzed pre-operative MRI findings compared with operative findings on 39 patients, excluding nonunion, instability, metal failure and pseudarthrosis, who underwent an operation for POPS from December 1994 to June 1997. There were 25 men (64.1%) and 14 women (35.9%), aged from 16 to 68 years (average 44.5 years). They were divided into 5 subgroups and calculated for sensitivity, specificity and positive predictability. RESULTS: MRI accuracy in recurred disc was 84%, scar adhesion, recurred or developed stenosis, infection and hematoma was 100% for each overall accuracy of MRI was 93%. Average interval of reoperation in POPS was 3.2 years. In 21 cases (53.8%), symptoms persisted without pain-free interval after first operation. CONCLUSIONS: Early complications, including hematoma and infection, are easily detected with MRI. Especially if patient complains of severe leg pain or neurologic deficit, MRI is a good diagnostic tool. MRI is a useful method for evaluation of most cases of POPS, but it is limited in evaluating recurred disc or scar adhesion only in T1, T2 weighted image. Therefore, Gd-DTPA enhancement is necessary for an accurate diagnosis.
Sujets)
Femelle , Humains , Mâle , Cicatrice , Sténose pathologique , Diagnostic , Acide gadopentétique , Hématome , Jambe , Imagerie par résonance magnétique , Manifestations neurologiques , Douleur postopératoire , Pseudarthrose , Réintervention , Sensibilité et spécificitéRésumé
Median nerve injury after elbow dislocation is uncommon. The diagnosis of median nerve entrapment is often delayed. Median nerve paralysis is caused by entrapment within the elbow joint. If median nerve paralysis occurs following elbow dislocation or if it occurs following closed reduction, entrapment should be suspected. Optimal management of this problem consists of early surgical exploration and decompression. We report a case of a child who had entrapment of the median nerve in the elbow joint after closed reduction of posterior dislocation with fracture of the medial epicondyle. The diagnosis was made ten weeks after injury at surgical exploration. This case showed a characteristic radiologic sign in the anteroposterior radiograph. We released the entrapped median nerve with a successful result.
Sujets)
Enfant , Humains , Décompression , Diagnostic , Luxations , Articulation du coude , Coude , Nerf médian , ParalysieRésumé
No abstract available.