ObjectiveTo study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone. Methods The lumbar MRI data of 107 patients with low back and leg pain who met the selection criteria between October 2019 and November 2022 were retrospectively analyzed. The vascular emanation angles, vascular travel angles, and the length of vessels in the lateral segments of the left vertebral body of L1-L5, as well as the distance between the segmental vessels in different Moro junctions of the vertebral body and their distances from the edges of the vertebrae in the same sequence (bottom marked as I, top as S) were measured. The gap between the large abdominal vessels and the lateral vessels of the vertebral body was set as the lateral vascular safe zones of the lumbar spine, and the extent of the safe zones (namely the area between the vessels) was measured. The anterior 1/3 of the lumbar intervertebral disc was taken as the simulated puncture center, and the area with a diameter of 22 mm around it as the simulated channel area. The proportion of vessels in the channel was further counted. In addition, the proportions of segmental vessels at L5 without a clear travel and with an emanation angel less than 90° were calculated. Results Except for the differences in the vascular emanation angles between L4 and L5, the vascular travel angles between L1, L2 and L4, L5, and the length of vessels in the lateral segments of the vertebral body among L1-L4 were not significant (P>0.05), the differences in the vascular emanation angles, vascular travel angles, and the length of vessels between the rest segments were all significant (P<0.05). There was no significant difference in the distance between vessels of L1, L2 and L2, L3 at Moro Ⅰ-Ⅳ junctions (P>0.05), in L3, L4 and L4, L5 at Ⅱ and Ⅲ junction (P>0.05). There was no significant difference in the vascular distance of L2, L3 between Ⅱ, Ⅲ junction and Ⅲ, Ⅳ junction, and the vascular distance of L3, L4 between Ⅰ, Ⅱ junction and Ⅲ, Ⅳ junction (P>0.05). The vascular distance of the other adjacent vertebral bodies was significant different between different Moro junctions (P<0.05). Except that there was no significant difference in the distance between L2I and L3S at Ⅰ, Ⅱ junction, L3I and L4S at Ⅱ, Ⅲ junction, and L2I and L3S at Ⅲ, Ⅳ junction (P>0.05), there was significant difference of the vascular distance between the bottom of one segment and the top of the next in the other segments (P<0.05). Comparison between junctions: Except for the L3S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ junction, and L5S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ and Ⅲ, Ⅳ junctions had no significant difference (P>0.05), there were significant differences in the distance between the other segmental vessels and the vertebral edge of the same sequence in different Moro junctions (P<0.05). The overall proportion of vessels in the simulated channels was 40.19% (43/107), and the proportion of vessels in L1 (41.12%, 44/107) and L5 (18.69%, 20/107) was higher than that in the other segments. The proportion of vessels in the channel of Moro zone Ⅰ (46.73%, 50/107) and zone Ⅱ (32.71%, 35/107) was higher than that in the zone Ⅲ, while no segmental vessels in L1 and L2 were found in the channel of zone Ⅲ (χ2=74.950, P<0.001). Moreover, 26.17% (28/107) of the segmental vessels of lateral L5 showed no movement, and 27.10% (29/107) vascular emanation angles of lateral L5 were less than 90°. Conclusion L1 and L5 segmental vessels are most likely to be injured in Moro zones Ⅰ and Ⅱ, and the placement of OLIF channels in L4, 5 at Ⅲ, Ⅳ junction should be avoided. It is usually safe to place fixation pins at the vertebral body edge on the cephalic side of the intervertebral space, but it is safer to place them on the caudal side in L1, 2 (Ⅰ, Ⅱ junction), L3, 4 (Ⅲ, Ⅳ junction), and L4, 5 (Ⅱ, Ⅲ, Ⅳ junctions).
Objective To review the research on different surgical approaches and MRI evaluation of total hip arthroplasty (THA), to clarify the possible muscle damage caused by different approaches, and to help clinicians avoid intraoperative muscle damage and identify the causes of certain muscle-related complications after operation. MethodsThe research literature on different surgical approaches and MRI evaluation of THA at home and abroad was extensively reviewed to summarize the MRI performance of the posterior approach, modified direct lateral approach, direct anterior approach, and minimally invasive anterolateral approach (also called Orthopadische Chirurgie Munchen approach). Results The traditional posterior approach mainly damages the short external rotator muscle group and increases the incidence of postoperative dislocation; the piriformis-keeping posterior approach significantly improves the quality of the pyriformis tendon in the postoperative period, but it may lead to damage to the intrapelvic portion of the piriformis muscle. The modified direct lateral approach mainly damages the gluteus medius muscle, which increases the risk of postoperative claudication. The direct anterior approach mainly damages the vastus tensoris muscle and may result in damage to the short external rotator muscle group and the muscles around the incision. The minimally invasive anterolateral approach primarily damages the superior gluteal nerve, which subsequently leads to denervation of the broad fascial tensor fasciae latae, and this approach may also result in injury to the gluteus medius and gluteus minimus muscles. The muscle damage status significantly affects prognosis, and the minimally invasive approach is more suitable for elderly patients. ConclusionMRI can clarify the different types of muscle damage caused by different surgical approaches. Minimally invasive approaches can reduce muscle damage and improve postoperative function compared with traditional approaches, and can benefit elderly patients more, but due to the small field, forcing to expand the surgical field will lead to unintended muscle damage and reduce postoperative function.
Objective To summarize the methods and applications for quantitative measurement of iron in human.Methods The methods and applications for quantitative measurement of iron in human were analyzed retrospectively via reviewing the literatures domesticly and abroad， and summarized the advantages and disadvantages respectively. Results The methods for quantitative measurement of iron included laboratory tests， pathology examinations， CT， superconducting quantum interference device investigation （SQUID）， and MRI. Conclusions Laboratory test is the most simple and economic method for quantitative measurement of iron in human. Percutaneous liver biopsy is the gold standardmethod. Radiologic examinations， especially MRI， may be main methods of measuring liver iron content in future.
Objective To evaluate the sensitivity and accuracy of SPIO-enhanced MR Imaging in the detection of focal hepatic lesions. Methods We searched MEDLINE (1966 to 2004), EMBSAE (1984 to 2004), The Cochrane Library (Issue 1, 2004), CBMdisc (Jan.1978 to Jul. 2004), CMCC (1994 to 2004), “Radiology”, “AJR” and “European Radiology” database. Data from pharmaceutical companies and our research were also added. Related journals published from 1985 to 2003 were handsearched. Participants were clinically suspected of focal hepatic lesions. The quality of studies was assessed, and descriptive systematic review was applied to evaluate the detection sensitivity and accuracy of the imaging modality. Results Ten studies (418 patients with 1 037 focal hepatic lesions) were included. Because the data of sensitivity and specificity could not be extracted from any of the 10 included studies, it was impossible to do the meta-analysis using SROC curve. The sensitivity of SPIO-enhanced MRI ranged from 66% to 100%; accuracy ranged from 76% to 97%. Conclusions At present, there is no evidence to ascertain that SPIO-enhanced MRI has a considerably high accuracy in the detection of focal hepatic lesions. More studies with good methodology are needed.
Objective Gunshot wound spreads to the surrounding tissues and organs, it is difficult to debride and easy to infect. The conventional treatment is thorough, extensive debridement, fully open drainage, which often causes normal tissue damage and compl ications. To evaluate the effectiveness of vacuum seal ing drainage (VSD) treating thepenetrating wound in porcine extremity by MRI and pathological methods so as to provide theoretical basis for future cl inical use. Methods Eight healthy adult pigs, weighing (45 ± 5) kg, were selected. Eight pairs of hind l imb penetrating wounds (16 wounds) were made by using Chinese-made 95-type rifle at 25 meters distance, which were randomly divided into experimental group (left side, n=8) and the control group (right side, n=8). After debriding and disinfecting the penetrating wounds at 6 hours after injury, wounds were treated with VSD in experimental group. The ball istics exports of the wounds were covered with single-layer gauze and imports were directly sutured and covered with sterile gauze in control group. The trajectory and the general condition of the adjacent skin were observed. MRI and histological observation were taken at 5, 24, 48, and 72 hours after injury, bacterial counting analysis was done at 0, 12, 24, 48, and 72 hours after injury. Results The aperture of the trajectory exit and entry were (5.00 ± 2.50) cm and (0.30 ± 0.15) cm immediately after injury. The wound surface was clean, rosy without leakage and swell ing after 72 hours in experimental group; wound and adjacent tissue were swell ing obviously, pus, muscle necrosis and exfol iative tissue was observed, and deep defect cavity at the trajectory exit could be seen in control group. MRI showed that pairs of l inear low signal in T1WI and T2WI was seen in trajector of experimental group at 5 hours after injury, and signal in T1WI gradually increased at disrupted area and tissue deformation area at 24, 48, and 72 hours; in control group, low signal in T1WI was observed at 5 hours after injury, and signal in T2WI gradually increased and a clear boundari between edema and surrounding tissue, and the increase of signal in T1WI was not obvious at 24, 48, and 72 hours. The histological observation showed that wound was dominated by effusion at 5 hours after injury, granulation tissue gradually increased, muscle tissue dissolved and inflammatory cell infiltration was not obvious at 24, 48, and 72 hours in experimental group; in control group, the gradual dissolution of muscle fibers and inflammatory cell infiltration were observed at 5, 24, and 48 hours, muscle tissue became swell ing, dissolving and degeneration and a large number of inflammatory cell infiltration gathered into the bacteria group at 72 hours. There was no significant difference in the number of bacteria per gram of tissue (P gt; 0.05) between experimental group and control group at 0 hour after injury; the numbers of bacteria in control group were significantly higher than those in experimental group at 12, 24, 48, and 72 hours (P lt; 0.05). Conclusion MRI combined with pathology show diagnostic meaning in treatment of gunshot wound with VSD. MRI can accurately reflect the scope of l imb gunshot wound 72 hours after injury. VSD may be an approach to delay infective time, shorten wound heal ing time, and promote the growth of healthy granulation tissue.
ObjectiveTo summarize the relationship between lateral femoral notch sign (LFNS) and anterior cruciate ligament (ACL) rupture. MethodsThe relevant literature of LFNS at home and abroad in recent years was retrospectively reviewed, and its mechanism, diagnostic criteria and influencing factors in diagnosis of ACL rupture were summarized and analyzed.ResultsThe LFNS is associated with rotational stability of the knee. As an indirect sign of ACL rupture, the LFNS has high clinical diagnostic value, especially the diagnosis of ACL rupture with lateral meniscus injury.ConclusionThe diagnostic criteria and influencing factors of LFNS in diagnosis of ACL rupture are still unclear and controversial, which needs further study.
Objective To investigate the diagnosis and effectiveness of surgical treatment for lumbar pyogenic spondyl itis. Methods Between February 2005 and June 2010, 15 cases of lumbar pyogenic spondyl itis were treated. There were 10 males and 5 females with an average age of 48.6 years (range, 26-72 years). Affected segments included L2, 3 in 3 cases,L3, 4 in 3 cases, L4, 5 in 8 cases, and L5, S1 in 1 case. All cases had cl inical manifestations of moderate or severe fever, local pain of lesion, and l imitation of the spinal movement; 10 patients had nerve root symptoms, and 8 patients had symptoms of lower limb paraplegia. Leukocyte, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) significantly increased in all cases. The preoperative X-ray and CT examinations showed no clear bone destruction; MRI showed decreased signal intensity on T1WI and increased signal intensity on T2WI, 7 cases had local ized abscess formation. The patients underwent focal cleaning and bone grafting and fusion combined with internal fixation, including anterior operation in 13 cases, posterior operation in 1 case, and combined anterior and posterior operation in 1 case. The results of bacterial culture were positive in 10 cases. According to the results of intraoperative bacterial cultures, sensitive antibiotics were selected. Results Healing of incision by first intention was achieved in 14 cases, healing by second intention in 1 case. After 2 weeks, 1 case recurred and symptoms was rel iefed after symptomatic treatment. Back pain and (or) lower limb pain were obviously improved in the other patients; body temperature recovered to normal after 3-4 days; leukocyte, ESR, and CRP significantly decreased. All the patients were followed up 12 to 70 months with an average of 35.4 months.The patients had no rejection, no fistula formation, no lumbar kyphosis, and no fixator loosening or breakage. The bony fusion time was 4-8 months. Conclusion Combination of cl inical manifestations, laboratory tests, and MRI can diagnose lumbar pyogenic spondyl itis, of which CRP is an important indicator to determine progression of the disease, and MRI is important for diagnosis. Debridement combined with interbody fusion and internal fixation is a safe and effective treatment method.
Objective
To develop a modified short time inversion recovery (STIR) sequence grading system for lumbar intervertebral disc degeneration based on MRI STIR sequences, and to test the validity and reproducibility of this grading system.
Methods
A modified 8-level grading system for lumbar intervertebral disc degeneration based on routine sagittal STIR sequences and modified Pfirrmann grading system was developed. Between April 2011 and February 2012, 60 patients with different degrees of lumbar intervertebral disc degeneration were selected as objects of study, including 32 males and 28 females with an average of 50 years (range, 17-85 years). T2 weighted and STIR sequence images were obtained from the lumbar discs of L1, 2-L5, S1 of each object (total, 300 discs). All examinations were analyzed independently by 3 observers and a consensus readout was performed after all data collected. The validity and reproducibility were analyzed by calculating consistent rate and Kappa value.
Results
According to the grading system, there were 0 grade 1, 83 (27.7%) grade 2, 87 (29.0%) grade 3, 66 (22.0%) grade 4, 31 (10.3%) grade 5, 15 (5.0%) grade 6, 12 (4.0%) grade 7, and 6 (2.0%) grade 8. Intra-observer consistency was b (Kappa value range, 0.822-0.952), and inter-observer consistency was high to b (Kappa value range, 0.749-0.843). According to the consensus analysis, the total consistent rate was 82.7%-92.7% (mean, 85.6%). A difference of one grade occurred in 13.9% and a difference of two or more grades in 0.5% of all the cases.
Conclusion Disc degeneration can be graded by using modified STIR sequence grading system, which can improve the accuracy of grading different degrees of lumbar intervertebral disc degeneration.
Objective To evaluate the value of MRI in diagnosis of obstetrical brachial plexus palsy pre-gangl ionic injury. Methods From November 2006 to February 2008, 10 patients with obstetrical brachial plexus palsy were treated, 8 males and 2 females, aged from 2 months to 3 years (11.4 months on average). There were 7 cases of left side and 3 of right side.According to Tassin classification, 2 cases were type II, 6 type III and 2 type IV. All patients were performed MRI examinations before the operation, whose results were compared with those of exploration during the operation. Results MRI examinations showed 1 patient was normal and 9 patients had post-traumatic spinalmeningolcele. The 6 patients had displacement of spinal cord (4 towards the healthy side and 2 towards the sick side), 6 had deformity of spinal cord, and 2 had avulsed nerve root thickening. MRI detected 19 nerve roots were positive, 16 were true positive and 3 false positive in surgical exploration. MRI detected 6 nerve roots were negative, 4 were true negative and 2 false negative in surgical exploration. The sensitivity, specificity and accuracy of MRI in diagnosis of obstetrical brachial plexus palsy pre-gangl ionic injury were 84.2%, 80.0% and 83.3%, respectively. There were significant differences in the results by preoperative MRI examinations and by exploration during the operation (P lt; 0.05). Conclusion MRI can show pre-gangl ionic injury of brachial plexus of the patients with obstetrical brachial plexus palsy and can supply references for early diagnosis and operation time. MRI can be routinely conducted as a preoperative examination.
Objective
To investigate whether preoperative T1 slope (T1S) in MRI can predict the changes of cervical curvature after expansive open-door laminoplasty (EOLP) in patients with cervical spondylotic myelopathy, so as to make up for the shortcomings of difficult measurement in X-ray film.
Methods
The clinical data of 36 patients with cervical spondylotic myelopathy who underwent EOLP were retrospectively analysed. There were 21 males and 15 females with an average age of 55.8 years (range, 37-73 years) and an average follow-up time of 14.3 months (range, 12-24 months). The preoperative X-ray films at dynamic position, CT, and MRI of cervical spine before operation, and the anteroposterior and lateral X-ray films at last follow-up were taken out to measure the following sagittal parameters. The parameters included C2-C7 Cobb angle and C2-C7 sagittal vertical axis (C2-C7 SVA) in all patients before operation and at last follow-up; preoperative T1S were measured in MRI, and the patients were divided into larger T1S group (T1S>19°, group A) and small T1S group (T1S≤19°, group B) according to the median of T1S, and the preoperative T1S, C2-C7 Cobb angle, C2-C7 SVA, and the C2-C7 Cobb angle and C2-C7 SVA at last follow-up, difference in axial distance (the difference of C2-C7 SVA before and after operation), postoperative curvature loss (the difference of C2-C7 Cobb angle before and after operation), the number of patients whose curvature loss was more than 5° after operation, and the number of patients whose kyphosis changed (C2-C7 Cobb angle was less than 0° after operation).
Results
The C2-C7 Cobb angle at last follow-up was significantly decreased when compared with preoperative value (t=8.000, P=0.000), but there was no significant difference in C2-C7 SVA between pre- and post-operation (t=–1.842, P=0.074). The preoperative T1S was (19.69±3.39)°; there were 17 cases in group A and 19 cases in group B with no significant difference in gender and age between 2 groups (P>0.05). The preoperative C2-C7 Cobb angle in group B was significantly lower than that in group A (t=–2.150, P=0.039), while there was no significant difference in preoperative C2-C7 SVA between 2 groups (t=0.206, P=0.838). At last follow-up, except for the curvature loss after operation in group B was significantly lower than that in group A (t=–2.723, P=0.010), there was no significant difference in the other indicators between 2 groups (P>0.05).
Conclusion
Preoperative larger T1S (T1S>19°) in MRI had a larger preoperative lordosis angle, but more postoperative physiological curvature was lost; preoperative T1S in MRI can not predict postoperative curvature loss, but preoperative larger T1S may be more prone to kyphosis.
