Clinical research of features of magnetic resonance imaging of high-voltage electrical burns in limbs at early stage / 中华烧伤杂志

Objective@#To analyze the features of magnetic resonance imaging (MRI) of patients with high-voltage electrical burns in limbs at early stage.@*Methods@#Thirty-eight patients with high-voltage electrical burns, conforming to the study criteria, were hospitalized in our unit from March 2013 to August 2016. T1 weighted imaging (T1WI), T2WI, fat-suppression T2WI plain scan, and fat-suppression T1WI enhanced scan of MRI were performed in 78 limbs, including 56 upper limbs and 22 lower limbs at post injury hour 72. The MRI signal characteristics of electrical burns in skin and subcutaneous tissue, skeletal muscle, tendon, joint ligament, and skeleton of limbs were analyzed. " Sandwich-like" necrosis and injury in skeletal muscle, injuries of tendon, joint ligament, and skeleton were observed. MRI signal characteristics of amputated upper limbs and salvaged limbs were also analyzed. All patients underwent surgery within 24 h after MRI examination, and the muscle vitality was judged during operation. Muscle tissue without reaction to electrical stimulation which was completely necrotic as shown by MRI, muscle tissue with weak reaction to electrical stimulation which was injured with blood supply as shown by MRI, and muscle tissue with edema as shown by MRI were collected, and then the pathological characteristics of muscle tissue were observed with HE staining.@*Results@#(1) The defect area of patients at entrance of current was bigger than that at exit. The skin and subcutaneous tissue extensively unevenly thickened. T2WI manifested hyperintensity, and T1WI manifested isointensity, while fat-suppression enhanced T1WI manifested uneven enhancement. Zonal effusion was seen in the region of serious subcutaneous edema. (2) For complete necrosis of skeletal muscle, T2WI manifested hypointense, isointensity, or slight hyperintensity, and T1WI manifested isointensity, slight hyperintensity, or mixed signal of isointensity and slight hyperintensity, while fat-suppression enhanced T1WI manifested most no enhancement area with clear boundary. The MRI signals of injured skeletal muscle could be divided into two types. Type Ⅰ signal was for partial necrotic muscle adjacent to the completely necrotic zone. T2WI manifested uneven hyperintensity or slight hyperintensity, with unclear boundary. T1WI manifested isointensity or slight hyperintensity. Fat-suppression enhanced T1WI manifested significant banding or laciness enhancement. Type Ⅱ signal was for deep muscle tissue far from the complete necrotic zone. T2WI manifested hyperintensity, and T1WI manifested isointensity or main isointensity mixed with hyperintensity, while fat-suppression enhanced T1WI manifested uneven moderate or slight enhancement. Normal muscle signal, type Ⅰ signal, and type Ⅱ signal were all mixed with necrotic signal, showing " sandwich-like" change. For skeletal muscle edema, T2WI manifested slight hyperintensity and unclear boundary, and T1WI manifested hypointense, while fat-suppression enhanced T1WI manifested no obvious enhancement. (3) For complete necrosis of tendon, T2WI manifested isointensity or slight hyperintensity, and T1WI manifested isointensity, while fat-suppression enhanced T1WI manifested no enhancement. For tendon injury, T2WI manifested isointensity, and T1WI manifested isointensity or hypointense, while fat-suppression enhanced T1WI manifested slight enhancement. (4) Severe injury of wrist joint were manifested as complete necrosis of soft tissue around joint. T2WI manifested slight hyperintensity or isointensity, and T1WI manifested isointensity, while fat-suppression enhanced T1WI manifested no enhancement or slightly uneven enhancement. For completely destroyed wrist joints, the structures were not clear from outside to inside. T2WI manifested slight hyperintensity or isointensity, and T1WI manifested hypointense or isointensity, while fat-suppression enhanced T1WI manifested no enhancement. For elbow injury, T2WI manifested hyperintensity, and T1WI manifested isointensity or hypointense, while fat-suppression enhanced T1WI manifested uneven enhancement. For knee injury, T2WI manifested hyperintensity, and T1WI manifested hypointense, while fat-suppression enhanced T1WI manifested slight enhancement. (5) For bone edema, T2WI manifested isointensity, while fat-suppression T2WI manifested slight hyperintensity. T1WI manifested isointensity, and fat-suppression enhanced T1WI manifested patchy enhancement. (6) MRI of amputated upper limbs showed necrosis signals, type Ⅰ signals, type Ⅱ signals, and mixed signals of type Ⅰ and type Ⅱ in skeletal muscle. The necrosis signal and type Ⅰ signal area of the distal end were more than 50% greater than those of the lesion. The scope of the ecological tissue was large and the boundary was not clear. There were diffuse injuries in both anterior and posterior muscles, and the ulnar and radial artery pulsation disappeared in the upper limbs. The MRI of salvaged limbs were type Ⅰ signal, type Ⅱ signal, mixed signals of type Ⅰ and type Ⅱ, and local necrosis signals of skeletal muscle. The type Ⅰ signal was the main type, and the distal end showed type Ⅱ signal. (7) For completely necrotic skeletal muscle as shown by MRI, surgical exploration showed loss of muscle viability, and pathological examination showed complete necrosis of striated muscle tissue. For injury area of skeletal muscle as shown by MRI, surgical exploration showed interecological muscle with activity worse than mormal muscle, and pathological examination showed normal muscle cells and muscle fiber mixed with necrotic striated muscle cells having karyopyknosis, with different degree of injury. For edema area of skeletal muscle as shown by MRI, surgical exploration showed swelling skeletal muscle and normal muscle vitality, and pathological examination showed striated muscle interstitial edema with a large number of inflammatory cells infiltration. The manifestions of MRI were consistent with the results of surgical exploration and pathological examination.@*Conclusions@#Skeletal muscle complete necrosis, injury, and edema could be preferably differentiated by MRI, and the definite scope and depth of electrical injury, the injury of skin, tendon, joint ligament, and bone could also be displayed well on MRI. It can provide objective imaging basis for the diagnosis of high-voltage electrical burns in limbs at early stage, the establishment of clinical operation plan, and the judgment of intraoperative tissue vitality.

Comparison of different radiographic films in predicting the three-dimensional correction and fusion of adolescent idiopathic scoliosis / 中国组织工程研究

BACKGROUND:Standing bending, supine bending, lateral pressing, pronation compression films and traction radiography are indeed effective to predict the correction outcome of surgeries by Harrington's method and Lugue's method,however, they are discontented for the correction of three-dimensional pedicle screw of vertebral arch.OBJECTIVE: To evaluate the role of preoperative X-ray films of gravity-suspending traction, supine bending and fulcrum bending in patients undergoing spinal three-dimensional correction and fusion for adolescent idiopathic scoliosis (AIS).DESIGN: Contrast observation.SETTING: Department of Orthopaedics, the 211 Hospital of Chinese PLA (Military Orthopaedics Center).PARTICIPANTS: From January 2003 to December 2005, 63 cases aged 10-21 years were recruited from Department of Orthopaedics in the 211 Hospital of Chinese PLA, including 18 males and 45 females. They were diagnosed as AIS by clinical examinations and X-ray film, with Cobb angle≥40°. Informed consents were obtained from all the subjects.METHODS: All of the 63 AIS cases with 79 structural curves were studied by preoperative X-ray films of standing,gravity-suspending traction, supine bending and fulcrum bending, which were compared with standing X-ray films one week postoperatively.MAIN OUTCOME MEASURES: Cobb angles of preoperative fulcrum bending film and postoperative standing film.RESULTS: All of the 63 cases were involved in the result analysis. There was no significant difference in the Cobb angle between preoperative fulcrum bending X-ray film and postoperative standing X-ray film (P ＞ 0.05). Gravity-suspending traction and supine bending films were significantly different from postoperative standing film (P ＜ 0.05).CONCLUSION: The fulcrum bending X-ray films are superior to gravity-suspending traction and supine bending films in predicting the postoperative correction of AIS patients.

Clinical analysis of fresh cervical spinal cord injury without radiographic abnormality in children / 中国康复理论与实践

@#ObjectiveTo investigate the clinical characteristics and therapy of fresh cervical spinal cord injury without radiographic abnormality (SCIWORA) in children.MethodsThe materials of fourteen SCIWORA children (13 cases treated with non operative menthod, 1 case treated by atlantoocciptal fusion) were analyzed retrospectively.ResultsOne child was dead, and the other 13 cases had a 3-year follow up. Three children's symptoms had no change. According to ASIA criterion, there were 3 cases with grade A, 5 cases with grade B, 5 cases with grade C and 1 case with grade D before treatment. After treatment, there were 1 case recovered to grade B, 2 cases recovered to grade C, 5 cases recovered to grade D, 2 cases recovered to grade E.ConclusionSpinal cord injury caused by a short time dislocation of cervical vertebrae is the main reason of SCIWORA in children. The degree of the injury of spinal cord is related directly with the recovery of function of nervous system. Most patients can get satisfactory results by non operative methods. Operations are useful to the cases with obvious instability of cervical spine.

Syringomyelia associated with spinal cord type cervical spondylopathy treated by expansive open-door laminectomy and drainage / 中国康复理论与实践

@#ObjectiveTo investigate the effect of surgery treatment for syringomyelia associated with spinal cord type cervical spondylopathy.MethodsExpansive open-door laminectomy and spinal cavity-subarachnoid drainage were performed in 11 cases.ResultsThe extremity function of 11 cases were all recoverd to varied extent in the following 1-5 years(average follow-up:30 months).ConclusionsExpansive open-door laminectomy and spinal cavity-subarachnoid drainage is an effective method for syringomyelia associated with spinal cord type cervical spondylopathy.

GAIT ANALYSIS OF SPASTIC LIMBS AFTER TREATMENT WITH SELECTIVE POSTERIOR RHIZOTOMY OF L5-S1 COMBINED WITH SEVERANCE OF ADDUCTOR MUSCLE / 解放军医学杂志

The adductor tendon was partially divided. The posterior roots of L 2-S 1 were separated from anterior roots and they were split into fasciculi. The fasciculi showing low threshold to electric stimulation were sectioned. Gait analysis was conducted both preoperatively and postoperatively. This operative strategy was carried out in 16 cases. The result of the treatment was satisfactory after being followed-up for 4 years. Spasticity was reduced by 90 percent and the rate of functional improvement was 80 percent. The results indicated that selective posterior rhizotomy of L 5-S 1, combined with division of addactor muscle was effective in the treatment of spastic lower limbs as a result of brain injury, cerebral palsy, and spinal cord injury.

SELECTIVE POSTERIOR RHIZOTOMY (SPR) AND PROGRAMMED TREATMENT FOR SPASTIC LIMBS AFTER SPINAL CORD INJURY / 解放军医学杂志

To evaluate the effect of selective posterior rhizotomy and programmed treatment on the relief of limb spasm secondary to the spinal cord injury. The posterior roots of L 2～S 1 were separated from anterior roots and split into funiculi. The funiculi sensitive to lower threshold of electrical stimulation were sectioned. The selective posterior rhizotomy and programmed treatment had been performed on 36 cases, and followed up for 3 years. The results of the treatment were satisfactory. The rate of spasticity relief was 90%, and the rate of functional improvement was 75%. Selective posterior rhizotomy and programmed treatment could be considerered to be the optimal treatment for spasticity of limbs subsequent to spinal cord injury.

TREATMENT OF SPASTIC LIMBS AFTER SPINAL CORD INJURY AND THE HISTOCHEMISTRY OF NERVE ROOTS / 解放军医学杂志

To study the curative effect of selective posterior rhizotomy for spastic limbs after spinal cord injury, and to study the histochemistry of nerve roots. The posterior nerve roots of L 2～S 1 were separated from anterion roots and splited into rootlets. The lower threshold rootlets were sectioned after electrical stimulation. The sectioned rootlets were studied with histochemistry. The resalt showed that the selective posterior rhizotomy was performed on 29 cases who were followed up for 3 years. The treatment was satisfactory. The rate of reducing spasticity was 90% and the rate of functional improvement was 80%. The Ache reaction of sectioned rootlets was positive. The result suggest that it is a successful way to treat spastic limbs after spinal cord injury with selective posterior rhizotomy. Electrical stimulation is necessary in selective posterior rhizotomy.

A STUDY OF EVOKED POTENTIAL AND GAIT ANALYSIS OF SPASTIC LIMBS SELECTIVE POSTERIOR RHIZOTOMY IN PATIENTS WITH CEREBRAL INJURY / 解放军医学杂志

Selective posterior rhizotomy was performed for the treatment of spastic limbs in patients with brain injury, and evoked potential and gait analysis were used to study its effect. The posterior roots of L 2～S 1 were separated from anterior roots and they were split into funiculi. Electric stimulation of the fumiculi was done.Those with low threshold were sectioned. Evoked potential and gait analysis were performed preoperatively and postoperatively. Selective posterior rhizotomy had been performed in 16 cases.They were followed up for 4 years. The result of the treatment was satisfactory.The rate of reduction in spasticity was 90 percent, and the rate of functional improvement was 80 percent.The study of evoked potential and gait analysis also showed that the effect of the operation was satisfactory.The results of selective posterior rhizotomy in the treatment of spastic limbs as a sequela of brain injury is promising,as judged by evoked potential and gait analysis.