ObjectiveTo assess the application and the effectiveness of a strategy of combining posterior occipitocervical angle (POCA) with occipital-C2 (O-C2) angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion.MethodsThe clinical data of 22 patients undergoing posterior instrumented occipitocervical fusions between March 2013 and January 2016 were retrospectively analysed, and all patients were performed by using a strategy combining with POCA and O-C2 angle for adjustment of occipitocervical fixation angle. All patients suffered from occipitocervical instability, including 7 males and 15 females with an average age of 44.4 years (range, 20-63 years). The patients were diagnosed as skull base depression with atlantoaxial dislocation in 20 cases and rheumatoid arthritis in 2 cases. The preoperative Japanese Orthopaedic Association (JOA) score was 13.2±2.0, and the visual analogue scale (VAS) score was 6.3±0.9. The POCA was first used to guide the pre-bending of the nail-rod system during the operation, so that POCA of 12 patients with abnormal preoperative POCA could be restored to the normal range; then intraoperative fluoroscopy was used to confirm whether the O-C2 angle was within the normal range (4 cases were abnormal and 2 cases needed intraoperative adjustment); finally, POCA and O-C2 angles were within normal range after adjustment. The postoperative complications were recorded, and the JOA and VAS scores were used to evaluate the recovery of spinal nerve function and the degree of pain relief after operation. The radiological data were collected to evaluate the bone graft fusion, the changes of postoperative POCA, O-C2 angle, and lower cervical curvature (Cobb angle).ResultsAll 22 patients were followed up 12-48 months, with an average of 24 months. No serious complications and reoperation occurred. At last follow-up, the VAS score and JOA score were 2.9±0.8 and 15.4±0.9 respectively, which were significantly improved when compared with preoperative ones (t=15.870, P=0.000; t=6.587, P=0.000). Imaging examination showed that 22 patients had occipitocervical osseous fusion, good position of internal fixator without loosening or fracture, and good occipitocervical stability. The POCA and O-C2 angles were within the normal range at 3 days after operation and at last follow-up, and there were significant differences when compared with preoperative ones (P<0.05); but no significant difference was found in POCA and O-C2 angles between at 3 days after operation and at last follow-up (P>0.05). There was no significant difference in Cobb angle of lower cervical spine between before and after operation (P>0.05).ConclusionThe strategy of combination POCA and O-C2 angle for adjustment of occipitocervical fixation angle during operation can ensure a better effectiveness.
Objective To observe the changes in peripapillary vessel perfusion after uncomplicated phacoemulsification surgery in patients with cataract and primary open-angle glaucoma (POAG). Methods A case-control study. From November 2017 to April 2019, 17 eyes of 17 cases of POAG complicated with cataract (observation group) and 17 eyes of 17 cases of simple senile cataract (control group) were included in the study. All the affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure (IOP), visual field, optical coherence tomography angiography (OCTA) examination, and measurement of axial length (AL) and central corneal thickness (CCT). All eyes underwent conventional phacoemulsification surgery for cataract. After the operation, the same equipment and methods as before the operation were used for related inspections. The VD, the thickness of the retinal nerve fiber layer (RNFL), and the IOP were observed before the operation, at the end of the operation, and 1 d, 1 week, 1 month and 3 months after the operation, mean visual field defect (MD) changes 3 months after surgery. Data comparisons within groups used repeated measures analysis of variance; data comparisons between groups used independent samples t test. Results The average age of patients in the observation group and control group was 68.18±6.13 and 65.82±6.95 years, respectively, and the difference was not statistically significant (t=1.912, P=0.072). There was no significant difference in AL (t=1.436), CCT (t=?1.557) and phacoemulsification (t=1.602) between the two groups (P>0.05). The difference of the mean IOP was statistically significant between the two groups (t=4.139, P<0.05). Before surgery, the VD (t=?6.560) and RNFL thickness (t=?7.320) of the observation group were lower than those of the control group, and the difference was statistically significant (P＜0.05). Compared with before the operation, the VD around the disc of the eye in both groups increased at the end of the operation and at different time points after the operation. Among them, the observation group had a statistically significant difference at 1 month after the operation of the eye (F=3.108, P=0.042); the control group had no significant difference at different time points after the operation (F=1.981, P＞0.05). The results of each quadrant analysis showed that only the observation group had a statistically significant difference in the temporal side of the eye one month after surgery (F=5.414, P=0.017). After surgery, the observation group and the control group had thicker RNFL thickness around the disc of the eye, and the difference was statistically significant (F=22.670, 23.080; P=0.002, 0.001). Before the operation and 3 months after the operation, the average MD of the eyes of the observation group and the control group were 14.90±7.15, 1.12±0.93 dB and 12.10±7.70, 0.88±0.66 dB, respectively. The average MD before and 3 months after the operation was compared, and the difference was statistically significant (t=14.414, 13.225; P=0.000, 0.000). Compared with before surgery, there was no statistically significant difference in the average MD of the two groups of eyes at 3 months after surgery (t=0.938, 0.817; P=0.082, 0.103). At the end of the operation, the intraocular pressure of the observation group and the control group were 10.84±3.39 and 11.46±3.79 mm Hg (1 mm Hg=0.133 kPa), respectively; they were both lower than before the operation, and the difference was statistically significant (t=?2.211, ?2.310; P＜0.05). Conclusions The thickness of VD and RNFL in eyes with POAG combined with cataract is lower than that in patients with senile cataract alone. The high perfusion pressure during conventional phacoemulsification surgery can cause a transient increase in VD, but it will not cause further damage to the visual field of POAG patients.
ObjectiveTo study the difference of femoral condylar twist angle (CTA) measurement in three dimensional (3-D) reconstruction digital models of human knee joint based on the two dimensional (2-D) images of MRI and CT so as to provide a reference for selecting the best method of CTA measurement in preoperative design for the femoral prosthesis rotational position.
MethodsThe CTA of 10 human cadaveric knee joint was measured in 3-D digital models based on MRI (group A), in 3-D digital models based on CT (group B), in the cadaveric knee joint with cartilage (group C), and in the cadaveric knee joint without cartilage (group D), respectively. The statistical analysis of the differences was made among the measurements of the CTA.
ResultsThe CTA values measured in 3-D digital models were (6.43±0.53)° in group A and (3.31±1.07)° in group B, showing significant difference (t=10.235, P=0.000). The CTA values measured in the cadaveric knee joint were (5.21±1.28)° in group C and (3.33±1.12)° in group D, showing significant difference (t=5.770, P=0.000). There was significant difference in the CTA values between group B and group C (t=5.779, P=0.000), but no significant difference was found between group A and group C (t=3.219, P=0.110).
ConclusionThe CTA values measured in the 3-D digital models based on MRI are closer to the actual values measured in the knee joint with cartilage, and benefit for preoperative plan.
摘要:目的: 探討磁共振波譜(MRS)對鑒別橋小腦角神經鞘瘤與腦膜瘤的價值。 方法 :對8例神經鞘瘤和8例腦膜瘤病例進行MRI平掃和增強掃描,并采用點分辨波譜序列(PRESS,TR/TE=2000/136ms)進行單體素波譜分析。從事磁共振診斷專業的醫師根據腫瘤的MRI及MRS表現特征進行鑒別診斷。 結果 :盡管多數神經鞘瘤(5/8)和腦膜瘤(6/8)具有典型的MRI表現特征并僅經MRI即可得到正確鑒別,但部分病例(5/16)為不典型表現者,如腦膜瘤呈長T1長T2信號并伴有囊變,以及神經鞘瘤呈等信號、均勻強化且不伴有囊變或內聽道擴大者,鑒別診斷困難。MRS顯示腦膜瘤的膽堿/肌酸比值(Cho/Cr)(2.74±1.47)略高于神經鞘瘤(2.70±1.21),但差異無統計學意義。丙氨酸(Ala)在腦膜瘤中的出現率(4/8)顯著高于神經鞘瘤(0/8)(Plt;0.05),谷氨酸鹽/谷氨酰胺(Glx)在腦膜瘤中的出現率(5/8)也高于神經鞘瘤(2/8);而肌醇(Ins)在神經鞘瘤中的出現率(4/8)高于腦膜瘤(2/8)。結合MRS表現,在MRI上尚難鑒別的病例可被明確診斷,并與最終病理結果相符。 結論 : MRI有助于多數橋小腦角神經鞘瘤與腦膜瘤的鑒別診斷,但對不典型病例有一定局限性;MRS對不典型病例的鑒別具有重要的參考價值。Abstract: Objective: To explore the value of magnetic resonance spectroscopy (MRS) in the differentiation of neurinoma and meningioma in the cerebellopontine angle. Methods : 16 cases, including 8 cases of meningiomas and 8 cases of neurinomas, underwent MRI (plan and gadoliniumenhanced scan) and singlevoxel proton MRS (PRESS series, TR/TE=2000/136ms). MRI and MRS results were reviewed and differential diagnoses were made by professional radiologists. Results : Although most cases (11/16) were typical and clearly classified on MRI, atypical cases were also observed, such as meningioma of long T1/T2 signal intensity with small cystic foci, and neurinoma of isointensity and homogenous enhancement without cystic change or enlargement of internal acoustic meatus. The choline to creatine ratio (Cho/Cr) of meningioma (2.74±1.47) was higher than that of neurinoma (2.70±1.21), however the difference was not significant (Pgt;0.05). Alanine was observed in 4/8 meningiomas but none of neurinomas (Plt;0.05), and glutamine/glutamate was more frequently visualized in meningiomas (5/8) than in neurinomas (2/8), whilemyoinositol was more frequently observed in neurinomas (4/8) than in meningiomas (2/8). With MRS, cases difficult to differentiate were clearly and correctly classified. Conclusion : Although most CPA neurinomas and meningiomas can be diagnosed by MRI, MRS is useful for the differential diagnosis of atypical cases.
Objective To study the feasibil ity and rel iabil ity of the multi-plannar reformation (MPR) of multispiral CT (MSCT) in measuring the kyphosis angle (KA) after thoracolumbar fracture. Methods From December 2007 to December 2009, 45 thoracolumbar fracture patients who underwent computed radiology (CR) and MSCT were recruited. There were 32 males and 13 females with a mean age of 48 years (range, 24-63 years), including 36 simple compression fractures and 9 burst fractures. The fracture locations were T11 in 6 cases , T12 in 11 cases, L1 in 20 cases, and L2 in 8 cases. Fracture was caused by trafffic accident in 25 cases, by fall ing from height in 12 cases, and by others in 8 cases. The imaging examination was performed after 2 hours to 7 days of injury in 22 cases and after more than 7 days in 23 cases. The KA was measured on the lateral X-ray films of CR and MPR by two observers, then the measurements were done again after three weeks. The data were statistically analyzed. Results The average KA values on CR by two observers were (20.75 ± 8.31)° and (22.49 ± 9.07)°, respectively; showing significant difference (P lt; 0.05), and the correlation was good (r=0.882, P lt; 0.05). The average KA values on MPR by two observers were (16.65 ± 8.62)° and (17.08 ± 7.88)°, respectively, showing no significant difference (P gt; 0.05), the correlation was excellent (r=0.976, P lt; 0.05). The average KA values on CR and MPR were (21.61 ± 8.43)° and (16.87 ± 8.20)°, respectively; showing significant difference (P lt; 0.05), the correlation was good (r=0.852, P lt; 0.05). Conclusion It is more feasible and rel iable in measuring the KA on MRP of MSCT than CR, but the value is larger on CR.
ObjectiveTo systematically review the diagnostic value of optical coherence tomography angiography (OCTA) for primary open-angle glaucoma (POAG). MethodsThe CNKI, WanFang Data, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library databases were electronically searched to collect diagnostic test on OCTA for POAG from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 15.0 software. ResultsA total of 12 diagnostic tests involving 993 subjects were included. Meta-analysis results showed that the sensitivity/specificity of OCTA for diagnosing peripapillary vessel density, retinal vessel density, and optic nerve fiber changes in patients with POAG were 0.77/0.92, 0.56/0.92, and 0.85/0.91, respectively, and the AUC of the SROC curve was 0.94, 0.92 and 0.95, respectively. ConclusionOCTA has high diagnostic accuracy for POAG. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the association between myopia and open-angle glaucoma (OAG).
MethodsForeign and domestic articles published from January 2000 to May 2013 were searched in PubMed, EMbase, WanFang Data, VIP and CNKI for observational studies on the association between myopia and OAG. According to the inclusion and exclusion criteria, the studies were screened, the data were extracted, and the method quality of included studies was assessed. Then meta-analysis was performed using Stata 12.0 software.
ResultsEleven cross-sectional studies including 45 996 participants were finally included. The results of meta-analysis showed that, myopia increased the risk of OAG. Besides, the results of subgroup analysis by the severity of myopia showed that, low-degree myopia (more than-3.00 D) increased 1.52 times the risk (OR=1.52, 95%CI 1.23 to 1.88) while middle/high-degree myopia (no more than-3.00 D) increased 2.41 times (OR=2.41, 95%CI 1.91 to 3.03).
ConclusionIndividuals with myopia have increased risk of OAG.
ObjectiveTo systematically review the efficacy and safety of phacoemulsification combined with trabeculectomy versus simple phacoemulsification for primary angle closure glaucoma with cataract.MethodsDatabases including PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about phacoemulsification combined with trabeculectomy vs. simple phacoemulsification for primary angle closure glaucoma with cataract from inception to May 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software.ResultsA total of eight studies involving 679 patients were included. The results of meta-analysis showed that: there were no significant differences between two groups in postoperative visual acuity (MD=0.00, 95%CI –0.10 to 0.09, P=0.98), postoperative anterior chamber depth (MD=0.14, 95%CI –0.17 to 0.45, P=0.37) and adverse reactions rates (optic nerve injury: RR=1.56, 95%CI 0.70 to 3.47, P=0.28; visual field defect: RR=1.43, 95%CI 0.70 to 2.92, P=0.33; corneal edema: RR=0.57, 95%CI 0.25 to 1.32, P=0.19).ConclusionCurrent evidence shows that phacoemulsification combined with trabeculectomy and simple phacoemulsification has the similar efficacy and safety for primary angle closure glaucoma with cataract. Due to limited quantity and quality of the included studies, the above conclusions still need to be verified by more high quality studies.
Objective To explore the effect of the collateral ligaments and the plantar plate on the flexion of the metatarsophalangeal(MP) joints. Methods Twenty-four preserved human No.2-4 digits were obtained from embalmed cadaver feet, which were divided into 2 groups at random. In group A, the bilateral collateral ligaments were cut first, and then the plantar plate was sectioned. They were cut inopposite sequence in group B. Angle of the flexion of MP joint was observed in the same load after the bilateral collateral ligaments and the plantar plate were sectioned in different sequence.From 1994 to 2000,11 cases were used with this technic, including plantar section in 2 cases and both plantar section and bilateral collateral ligamentscut in 9 cases. Results The angle of flexion of the MP joint before operation in group A is 37.30±5.42°, it increased 11.29±2.36° and to 48.60±2.98° when the bilateral collateral ligaments were cut, and there was significant difference. Later the cut of the plantar plate increased another 5.30±1.59° and to 53.35±2.76°. Both have an increasing trend for the angle of flexion of the MP joint (Plt;0.01). While in group B, the angle of flexion of the MP joint before operation is 34.59±5.32°, it increased 6.29±2.98° and to 40.89±2.36° when the plantar plate were cut, laterthe cut of the bilateral collateral ligaments increased another 9.71±1.94° and to 50.60±2.01°. Both had an increasing trend for the angle of flexion ofthe MP joint (Plt;0.01). The bilateral collateral ligaments had more influence than the plantar plate (Plt;0.01). There was the same effect in different sequence (Pgt;0.05). In 2 cases with plantar section, the flexion angle of MP joint could achieve 15° to 45° in 2 monthes. The other 9 cases with both plantar section and bilateral collateral ligaments cut, the MP joint flexion achieved 10.3° to 58.4° in 26.3 months. Conclusion The flexion angle of the MP joint can be increasedby cutting the bilateral collateral ligaments and the plantar plate.
ObjectiveTo observe and analyze the structural characteristics of the optic discs in high myopia (HM) combined with primary open-angle glaucoma (POAG) and the optic disc parameters with diagnostic efficacy. MethodsA cross-sectional study. From August 2020 to March 2021, a total of 114 eyes of 68 patients with POAG, HM and healthy volunteers who were diagnosed by Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University were included in the study. Among them, 21 POAG patients (39 eyes) were divided into H+P group (9 patients, 18 eyes) and non-H+P group (12 patients, 21 eyes) according to whether or not HM was combined; 26 HM patients (37 eyes) were selected as HM group; 21 healthy volunteers (38 eyes) were selected as normal control group. The subjects included 31 males (51 eyes) and 37 females (63 eyes), whose average age was 36.93±12.60 years old. Diopter, central corneal thickness (CCT) and axial length (AL) were measured. There was no significant difference in age (F=8.333), sex composition ratio (χ2=0.863), and CCT (F=1.425) among the four groups (P＞0.05); while, there were significant differences in AL (F=69.956), diopter (F=37.711), visual field index (VFI) (F=43.254) and mean defect (MD) (F=49.793) among the four groups (P＜0.01). Enhanced depth imaging using optical coherence tomography was used to obtain the tilt parameters, the disc rim parameters, the lamina cribrosa parameters and the retinal nerve fiber layer (RNFL) thickness. The tilt parameters included optic disc horizontal diameter, optic disc vertical diameter, optic disc ellipse index (horizontal diameter/vertical diameter); the disc rim parameters included Bruch’s membrane opening-minimal rim width (BMO), optic cup area, optic disc area, disc rim area, cup-disc area ratio; the lamina cribrosa parameters included anterior laminar insertion depth (ALID), prelaminar neural tissue (PLNT), and lamina cribrosa thickness. The pairwise comparison between groups were performed by ANOVA test. Pearson correlation analysis was used to analyze the correlation between disc tilt parameters, disc rim parameters, lamina cribrosa parameters and visual field parameters, as well as between disc rim parameters and RNFL thickness. According to receiver operating characteristic (ROC) curve and area under the curve (AUC), the predictive value of those above related factors for HM combined with POAG was evaluated. ResultsTilt parameters: compared with the optic disc horizontal diameter of non-H+P group, those of normal control group, HM group and H+P group were significantly decreased (P＜0.05), the ellipse indices of HM group and H+P group were significantly lower than those of normal control group and non-H+P group (P＜0.05). The results of correlation analysis showed that the optic disc horizontal and vertical diameters were negatively correlated with MD (r=－0.302, －0.235; P=0.002, 0.017), and negatively correlated with VFI (r=－0.291, －0.246; P=0.003, 0.013). Disc rim parameters: the disc cup area and cup-disc area ratio of non-H+P group and H+P group were significantly larger than those of normal control group and HM group (P＜0.05). The disc rim area and the average BMO of HM group, non-H+P group and H+P group were significantly smaller than those of normal control group (P＜0.05). The results of correlation analysis showed that the cup-disc area ratio (r=－0.584), the average BMO (r=0.650) had the highest correlation with the average RNFL thickness (P＜0.001). The superior, inferior, nasal and temporal BMO were all positively correlated with the corresponding quadrant RNFL thicknesses (r=0.431, 0.656, 0.362, 0.375; P＜0.05); the optic disc rim area, the average BMO were positively correlated with MD (r=0.449, 0.618) and VFI (r=0.449, 0.605) (P＜0.05), among which the correlation of the average BMO was the highest; the optic cup area and cup-disc area ratio were negatively correlated with MD (r=－0.346,－0.559) and VFI (r=－0.312,－0.548) (P＜0.001), among which the correlation of the cup-disc area ratio was the highest. Lamina cribrosa parameters: ALID of non-H+P group and H+P group were significantly deeper than those of normal control group and HM group (P＜0.05). LC of non-H+P group and H+P group were significantly thinner than those of normal control group and HM group (P＜0.05). The results of correlation analysis showed that ALID was negatively correlated with MD and VFI (r=－0.402, P＜0.001), VFI (r=－0.405, P=0.001); LC was positively correlated with MD and VFI (r=0.403, P＜0.001), VFI (r=－0.401, P=0.015). Comparison of diagnostic efficiency between various optic disc parameters: the results of ROC analysis showed that the cup-disc area ratio had the highest diagnostic performance (AUC=0.847, P=0.007), the maximum Youden index was 0.563, the sensitivity and specificity were 0.833 and 0.730, respectively, and the best critical value was 0.340. ConclusionsOptic disc tilt is more pronounced in HM combined with POAG; BMO in each quadrant could objectively reflect the disc rim defect of HM combined with POAG; the thinning and the backward shift of the lamina cribrosa were consistent with the aggravation of the visual field defect. Among them, the cup-disc area ratio had better diagnostic performance．
