Axial and tangential views of the acromioclavicular joint: the introduction of new projections / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Routine anteroposterior radiographs of the acromioclavicular (AC) joint with or without weight bearing have limitations in demonstrating the AC joint. Transarticular fixation with Kirschner wire is a treatment choice for AC dislocations. However, percutaneous fixation of the AC joint is technically demanding. The C-arm fluoroscopy can be used as routine intraoperative guidance to facilitate this procedure. The current study aims to introduce new projections, the axial and tangential views of AC joint, to help evaluate the severity of the injury and facilitate the percutaneous procedure.</p><p><b>METHODS</b>Three shoulder specimens were used to find the projection directions of the axial and tangential views of the AC joint by using the digital radiography (DR) unit. The axial and tangential views were taken of 20 adult volunteers by referencing the projection directions determined in the shoulder specimens. The angles showed on the DR system and the angles between the coronal plane of the body and the vertical plane of the flat panel detector (FPD) during taking these radiographs were recorded. The C-arm fluoroscopy unit was used to take the axial and tangential views referencing the angles measured on the DR system. Routine anteroposterior radiographs of the AC joint were taken on the volunteers. The minimal distances from the distal clavicle to the acromion were measured on both tangential and anteroposterior radiographs. The data was statistically analyzed.</p><p><b>RESULTS</b>The clear axial and tangential radiographs of AC joints of the volunteers were obtained using both DR and C-arm fluoroscopy units. The angles demonstrated on the DR window are (20.8 ± 2.4)° for male and (18.3 ± 2.3)° for female. During taking the axial views, the angles between the coronal plane of the body and vertical plane of FPD are (23.3 ± 3.2)° for male and (20.1 ± 2.4)° for female. During taking tangential views, the corresponding angles are (117.5 ± 3.7)° for male and (113.1 ± 3.3)° for female. On the tangential radiographs, the minimal distance from the distal clavicle to the acromion is (6.1 ± 1.2) mm, wider than the same measurement on the anteroposterior radiographs (P < 0.05). Statistical analyses showed no significant differences in the above-mentioned angles and the minimal distances between the left and right AC joints (P > 0.05). There were no significant differences in the above-mentioned angles between DR and C-arm fluoroscopy units (P > 0.05).</p><p><b>CONCLUSIONS</b>The axial and tangential radiographs of the AC joint can demonstrate the joint clearly and they can be easily obtained with both DR system and C-arm fluoroscopy unit in similar projection directions.</p>

Application of labeled radioimmunoimaging tracing in detecting pulmonary embolism in rabbits after bone cement perfusion and relevant treatment effects / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>During the process of bone cement joint replacement, some patients show a series of complications, such as a sudden drop in blood pressure or dyspnea. The cause of the complication is considered to be due to emboli caused by the femur prosthesis insertion. The purpose of the present study was to detect the pulmonary embolism in rabbits after bone cement perfusion by radioimmunoimaging, and to explore its protective measures.</p><p><b>METHODS</b>Forty rabbits, 2.5 - 3.0 kg weight, were randomly assigned to four groups, with ten rabbits in each group. Group I (no intervention): Bone cement perfusion was done after medullary cavity reaming and pressurizing. Group II (epinephrine hydrochloride intervention): The medullary cavity was rinsed with a 1:10 000 normal saline-diluted epinephrine hydrochloride solution followed by bone cement perfusion after medullary cavity reaming and pressurizing. Group III (fibrin sealant intervention): The medullary cavity was precoated with fibrin sealant followed by bone cement perfusion after medullary cavity reaming and pressurizing. Group IV (blank control group): The medullary cavity was not perfused with bone cement after reaming. In each group, the rabbits underwent femoral head resection and medullary cavity reaming. Before bone cement perfusion, 2 ml of developing tracer was injected through the ear vein. Radionuclide imaging was performed at 60, 120, and 180 minutes after bone cement perfusion, and the pulmonary radioactivity in vivo was measured. The rabbits were immediately sacrificed, and the pulmonary tissue was removed and its radioactivity was measured in vitro. Pulmonary tissue was then fixed and the pulmonary embolism and the associated pathological changes were observed.</p><p><b>RESULTS</b>The pulmonary radioactivity in vivo was measured at 60, 120, and 180 minutes after bone cement perfusion. The radioactivities of the four groups were 11.67 ± 2.16, 14.59 ± 2.92 and 18.43 ± 4.83 in group I; 8.37 ± 3.05, 10.35 ± 2.24 and 11.48 ± 2.96 in group II; 3.91 ± 1.19, 5.53 ± 2.95 and 7.25 ± 1.26 in group III; 1.04 ± 0.35, 1.14 ± 0.87 and 1.43 ± 0.97 in group IV. The radioactivities of groups I, II, III at 60, 120 and 180 minutes were significantly higher than group IV (P < 0.05). The pulmonary embolism could be detected. Pretreatment with epinephrine hydrochloride and fibrin sealant significantly decreased the pulmonary radioactivity in group II and group III, but it was still higher than in the group IV.</p><p><b>CONCLUSIONS</b>Radioimmunoimaging is an alternative method for the dynamic observation of rabbit pulmonary embolism after bone cement perfusion. Radioimmunoimaging is the optional way to evaluate the effect of pretreatment with epinephrine hydrochloride or fibrin sealant on pulmonary embolism after bone cement perfusion.</p>

Imageologic study and clinical treatment of pelvic fractures combined with artery injuries / 中华创伤杂志

Objective To explore the imageologic characteristics of pelvic fractures with artery injuries and the treatment methods for embolization of arteries.Methods From January 1999 to June 2005,60 cases(42 males and 18 females)aged 21-52 years(average 34.5 years)with pelvic fractures and unsteady blood dynamics were admitted into our hospital.There were 32 cases with traffic injury,13 with crushing injury,nine with fall injury and six with other injuries.The mean injury severity score was 39?16(16-66).All cases were hypetensive with systolic blood pressure less than 90 mm Hg on the arrival.Routine X-ray examination of dorsaventral,debouch and porch of pelvis was performed.The aver- age amount of blood transfusion was 2 886 ml.All cases underwent iliac artery angiography and pelvic ar- teriography.Results X-ray examination of pelvic fractures showed posterior pelvic fracture in 25 ca- ses,with 64 branches of blood vessels injured;anterior pelvic fracture in 13,with 17 branches of blood vessels injured;acetabular fracture in six,with 12 branches of blood vessels injured;and combined pel- vic fracture in 16,with 36 branches of blood vessels injured.Three cases died,with mortality rate of 5%.One case with common arterial thrombosis was treated with artificial blood vessel transplantation, four cases with external iliac artery injuries including one with artery rupture were treated with prosthesis, and among the three cases with external iliac artery thrombosis,one was treated with dislodgment of thrombosis,one treated with recanalization of thrombolysis and one did not give any treatment.Fifty cases with injury and bleeding of internal iliac artery and its branches were treated with arterial embolization. Five cases showed no obvious injury.Conclusions The types of artery injuries can be predicted through X-ray of pelvic fracture.Posterior pelvic fracture may easily cause injury to superior gluteal arter- ies,iliac lumber arteries,and lateral sacral arteries.While anterior pelvic fracture will cause injury to obturator arteries.Superior gluteal artery is susceptible to injury.Embolization of injured arteries and an- astomosis are preferred treatment for pelvic arterial disruptions.