目的探讨双能量CT Bone Marrow Edema(骨髓水肿)定量评估肋骨骨折演变时间节点的价值。方法收集60例双能量CT扫描的胸部外伤患者,利用CT Bone Marrow Edema技术,标准化定量肋骨骨折处骨髓水肿区域及骨折两侧1 cm处正常区域骨髓CT值,得...目的探讨双能量CT Bone Marrow Edema(骨髓水肿)定量评估肋骨骨折演变时间节点的价值。方法收集60例双能量CT扫描的胸部外伤患者,利用CT Bone Marrow Edema技术,标准化定量肋骨骨折处骨髓水肿区域及骨折两侧1 cm处正常区域骨髓CT值,得到三期骨髓水肿标准化CT值增量与VNCa标准化CT值增量。对数值变量行统计学描述,并对三期骨髓水肿标准化CT值增量、VNCa标准化CT值增量进行各自组间比较及两两间比较,对有差异的组别行诊断效能比较,由接受者工作特征(ROC)曲线下面积(AUC)进行评估,并计算Cut-off值。结果三期骨髓水肿标准化CT值增量及VNCa标准化CT值增量组间均有统计学意义(H=10.788,p=0.005;F=115.787,p=0.000),其中,软骨痂期(纤维性骨痂期)与硬骨痂-重塑期骨髓水肿标准化CT值增量有统计学意义(H=54.958,p=0.003),其余两两间无统计学意义(分别为H=-25.603,p=0.183;H=29.354,p=0.113)。而三期VNCa标准化CT值增量两两间均有统计学意义(P均为0.000)。ROC曲线鉴别软骨痂期(纤维性骨痂期)与硬骨痂-重塑期骨髓水肿标准化CT值增量曲线下面积为0.652,Cut-off值为81.575 Hu,鉴别血肿炎症机化期与软骨痂期(纤维性骨痂期)VNCa标准化CT值增量曲线下面积为0.668,Cut-off值为55.700 Hu,鉴别软骨痂期(纤维性骨痂期)与硬骨痂-重塑期VNCa标准化CT值增量曲线下面积为0.905,Cut-off值为37.625 Hu。结论通过双能量CT Bone Marrow Edema可定量评估肋骨骨折演变时间节点,骨折时间演变的标准化CT值增量差异性可为法医鉴定骨折处于不同时间段提供理论依据。通过标准化CT值增量Cut-off值可一定程度上预测骨折所处时间阶段,为法医在鉴定肋骨骨折方面提供定量依据。展开更多
Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous ma...Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.展开更多
Objective:To explore the clinical value of dual energy CT(DECT)virtual noncalcium(VNCa)in the diagnosis of sacroiliac joint bone marrow edema(BME).Methods:A collection of 45 patients(21 males,24 females,and an average...Objective:To explore the clinical value of dual energy CT(DECT)virtual noncalcium(VNCa)in the diagnosis of sacroiliac joint bone marrow edema(BME).Methods:A collection of 45 patients(21 males,24 females,and an average age of 34 years)who underwent MRI and DECT(Siemens Somatom definition force)examinations for the sacroiliac joints in our hospital from January 2019 to August 2020.After the DECT scan,the bone marrow pseudo-color map was obtained after VNCa processing.The bone marrow pseudo-color map was evaluated by two physicians.Take MRI test results as the gold standard,the application value of DECT VNCa technology in the diagnosis of sacroiliac joint BME was analyzed.Results:The positive predictive value(PPV),negative predictive value(NPV),sensitivity(Sen),specificity(Spe)and accuracy(Acc)of the qualitative diagnosis of iliac bone and sacral BME with DECT VNCa technology was:80.6%,85.2%,78.4%,86.8%,83.3%and 100%,64.9%,32.5%,100%,70.0%,respectively.The area of edema displayed by quantitative measurement of DECT VNCa image is smaller than the area measured by MRI image.The VNCa CT value(-71.66±72.97Hu)of the iliac edema area was higher than that of the non-edema area(-90.27±65.85Hu),and the VNCa CT value of the sacral edema area(-62.90±46.87Hu)was higher than that of the non-edema area(-101.08±134.02Hu),the best cut-off values(Cut-off values)for the quantitative diagnosis of iliac bone and sacral BME by VNCa are-66.40Hu and-50.60Hu,respectively.The curve of the receiver operating characteristic(ROC)of the iliac bone and sacrum area under the cure(AUC)is 0.720 and 0.706 respectively.There is a moderate negative correlation between the VNCa CT values of the ilium and sacrum in the edema area and the conventional CT values.Conclusion:The DECT VNCa technique has certain effectiveness in the diagnosis of sacroiliac joint BME,and its effectiveness in the diagnosis of ilium BME is better than sacrum.展开更多
Objective:To observe the curative effect of release with needle knife combined with microporous decompression in bone marrow edema area of subchndral bone for treatment of knee osteoarthritis.Method:From March 2019 to...Objective:To observe the curative effect of release with needle knife combined with microporous decompression in bone marrow edema area of subchndral bone for treatment of knee osteoarthritis.Method:From March 2019 to March 2020,66 patients with knee osteoarthritis were selected as the research objects,and divided into treatment group and control group according to random nuber table.The treatment group was treated with release with needle knife combined with microporous decompression in bone marrow edema area,while the control group was treated with release with needle knife.Visual analogue scale(VAS),the Western Ontario and Mc Master University composite index(WOMCA)and inflammatory factors were used to evaluate the curative effect of patients before treatment and after treatment.Results:The VAS scores of knee pain in both groups decreased after treatment.The treatment group was lower than the control group.The WOMAC scores of both groups were decreased significantly after treatment,and then gradually decreased with time.The WOMAC scroes of the treatment group were lower than those of the control group after treatment,and there was an interactive effect on time factor.Conclusion:Release with needle knife combined with microporous decompression in bone marrow edema area of subchondral bone has good curative effect in the treatment of knee osteoarthritis;it can relieve the pain of patients,improve the function of joint,reduce inlfammatory reaction,and then delay the pathological progress of KOA,which is worthy of clinical promotion.展开更多
Bone marrow edema is a self-limiting, under-recognized condition. It mainly involves the lower limbs. It is characterized by pain and inability to bear weight. Diagnosis is most often based on imaging and by excluding...Bone marrow edema is a self-limiting, under-recognized condition. It mainly involves the lower limbs. It is characterized by pain and inability to bear weight. Diagnosis is most often based on imaging and by excluding other causes. Its exact pathogenesis is still debated and various theories are postulated. Treatment ranges from anti-inflammatories to restricted weight bearing. This overview has tried to revisit this rare and perhaps forgotten clinical-radiological condition.展开更多
目的与单纯髓芯减压(core decompression,CD)治疗相比,探讨双通道CD联合髓腔冲洗技术对非创伤性股骨头坏死(osteonecrosis of the femoral head,ONFH)塌陷进展以及临床结果的影响。方法回顾性分析2024年1月—10月因ONFH行双通道CD联合...目的与单纯髓芯减压(core decompression,CD)治疗相比,探讨双通道CD联合髓腔冲洗技术对非创伤性股骨头坏死(osteonecrosis of the femoral head,ONFH)塌陷进展以及临床结果的影响。方法回顾性分析2024年1月—10月因ONFH行双通道CD联合髓腔冲洗治疗且符合选择标准的19例(30髋)患者(CD+冲洗组)临床资料,按照1∶2比例纳入年龄、性别、身体质量指数(body mass index,BMI)匹配的54例(60髋)单纯CD患者作为对照(CD组)。两组患者性别、年龄、BMI、手术侧别、ONFH类型以及术前国际骨循环协会(ARCO)分期、骨髓水肿分期、疼痛视觉模拟评分(VAS)、Harris评分等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组患者术后住院时间以及并发症发生情况;术前及术后出院时VAS评分,计算手术前后差值(变化值);术前及术后出院、3个月时Harris评分。随访期间行X线片、CT和双髋MRI复查,术后3个月行ARCO分期和骨髓水肿分期,并与术前比较确定是否存在影像学进展或缓解。结果术后两组患者切口均Ⅰ期愈合,无感染、股骨颈骨折等手术相关并发症发生。两组患者均获随访,CD+冲洗组随访时间为(146.8±27.7)d,CD组为(164.3±48.2)d,组间差异无统计学意义(t=1.840,P=0.069)。两组术后住院时间差异无统计学意义(P>0.05)。术后出院时CD+冲洗组VAS评分低于CD组,变化值高于CD组,差异均有统计学意义(P<0.05)。CD+冲洗组术后出院时、3个月时Harris评分均高于CD组,差异均有统计学意义(P<0.05);组内随时间延长,Harris评分逐渐增高,各时间点间差异均有统计学意义(P<0.05)。影像学复查示,术后3个月两组ARCO分期以及影像学进展差异均无统计学意义(P>0.05);而CD+冲洗组骨髓水肿分期以及骨髓水肿缓解均优于CD组,差异有统计学意义(P<0.05)。结论双通道CD联合髓腔冲洗技术能明显减轻ONFH患者髋关节疼痛和改善关节功能,缓解股骨头骨髓水肿程度,延缓ONFH进展。展开更多
目的:探讨三期中药外治方案治疗急性踝关节扭伤致距骨骨挫伤的早期临床疗效。方法:回顾性分析2021年9月至2024年7月收治的360例初次外踝关节扭伤患者,根据MRI检查选取距骨骨挫伤的患者,最终纳入73例距骨骨挫伤患者。根据治疗方法不同分...目的:探讨三期中药外治方案治疗急性踝关节扭伤致距骨骨挫伤的早期临床疗效。方法:回顾性分析2021年9月至2024年7月收治的360例初次外踝关节扭伤患者,根据MRI检查选取距骨骨挫伤的患者,最终纳入73例距骨骨挫伤患者。根据治疗方法不同分为观察组和对照组,观察组35例,男16例,女19例;年龄24~37(30.34±2.68)岁;采用三期中药外治方案联合“保护(protection)、适当负重(optimal loading,OL)、冰敷(ice)、加压(compression)、抬高(elevation)-POLICE”治疗方案。对照组38例,男18例,女20例;年龄24~35(29.87±2.57)岁;采用“POLICE”治疗方案。通过3D Slicer软件测量治疗前及治疗6周MRI所示骨髓水肿(bone marrow edema,BME)区域体积,计算BME改善率。分别于治疗前和治疗第1、3周采用“Figure of 8”测量法评估踝关节肿胀程度;治疗前和治疗第1、6周采用疼痛视觉模拟评分(visual analog scale,VAS)评价踝关节疼痛程度;治疗6周采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分和Karlsson踝关节功能评分系统评价踝关节功能改善情况。结果:共73例踝关节扭伤致距骨骨挫伤患者完成6周随访。治疗6周,观察组BME改善率(39.18±0.06)%高于对照组(26.75±0.03)%,差异有统计学意义(P<0.05)。治疗1周后,观察组VAS(2.89±0.72)分,低于对照组(3.37±0.79)分,差异有统计学意义(P<0.05)。踝关节肿胀程度观察组(50.20±3.19)cm,低于对照组(52.00±3.60)cm,差异有统计学意义(P<0.05)。治疗3周后,两组间踝关节肿胀程度比较,差异无统计学意义(P>0.05)。治疗6周后,两组间VAS比较,差异无统计学意义(P>0.05)。观察组治疗6周AOFAS踝-后足评分、Karlsson评分分别为(87.43±4.18)、(82.77±5.93)分,高于对照组(82.92±4.87)、(76.45±6.85)分,差异均有统计学意义(P<0.05)。根据AOFAS踝-后足评分,观察组优8例,良27例;对照组优2例,良33例,可3例;两组比较差异有统计学意义(χ^(2)=7.089,P=0.029)。结论:三期中药外治联合“POLICE”治疗方案早期临床疗效显著,能够明显减轻急性外踝扭伤致骨挫伤患者踝关节疼痛和肿胀程度,促进骨髓水肿吸收,促进患者踝关节功能恢复。展开更多
目的观察温针灸联合补肾生骨方对股骨头坏死患者骨髓水肿、骨代谢及疼痛的影响。方法纳入股骨头坏死患者60例,采用随机数字表法分为对照组和观察组,每组30例,对照组采用口服补肾生骨方治疗,观察组给予补肾生骨方联合温针灸治疗。观察两...目的观察温针灸联合补肾生骨方对股骨头坏死患者骨髓水肿、骨代谢及疼痛的影响。方法纳入股骨头坏死患者60例,采用随机数字表法分为对照组和观察组,每组30例,对照组采用口服补肾生骨方治疗,观察组给予补肾生骨方联合温针灸治疗。观察两组治疗前后骨髓水肿等级、骨代谢指标、疼痛视觉模拟评分法(visual analog scale,VAS)评分和中医证候积分,并比较两组临床疗效和不良反应发生情况。结果治疗后两组骨髓水肿等级、血清Ⅰ型胶原羧基端肽β特殊序列(βisomer of C-terminal telopeptide of typeⅠcollagen,β-CTX)水平、VAS评分和中医证候积分较治疗前均下降(P<0.05),且观察组均低于对照组(P<0.05);治疗后两组血清骨钙素(bone-γ-carboxyglutamic acid-containing protein,BGP)、血清Ⅰ型前胶原氨基端前肽(typeⅠprocollagen N-terminal peptide,PINP)水平较治疗前均上升(P<0.05),且观察组高于对照组(P<0.05);观察组总有效率93.3%,显著高于对照组的83.3%(P<0.05)。两组均无明显不良反应发生。结论温针灸联合补肾生骨方治疗股骨头坏死临床疗效确切,能明显缓解患者疼痛,减轻骨髓水肿,改善骨代谢情况,优于单纯补肾生骨方治疗,具有较好安全性。展开更多
Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the...Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We evaluated the effects of vertebral bone drilling for the pain due to occults VFs. Materials and Methods: Eighteen patients with painful osteoporotic occult VFs underwent the vertebral bone drilling. We evaluated the clinical outcome by comparing numerical rating scale (NRS) and activity of daily life (ADL) values between before and after the vertebral bone drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and ADL score, and the mean NRS and ALD score after the bone drilling were 8.4 ± 0.8, 2.2 ± 0.6, 2.4 ± 1.0, 4.6 ± 0.5, respectively. Among the patients, we detected significant improvements in NRS pain score and ADL score after the drilling compared with baseline score (p < 0.0002). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic occult VFs.展开更多
文摘目的探讨双能量CT Bone Marrow Edema(骨髓水肿)定量评估肋骨骨折演变时间节点的价值。方法收集60例双能量CT扫描的胸部外伤患者,利用CT Bone Marrow Edema技术,标准化定量肋骨骨折处骨髓水肿区域及骨折两侧1 cm处正常区域骨髓CT值,得到三期骨髓水肿标准化CT值增量与VNCa标准化CT值增量。对数值变量行统计学描述,并对三期骨髓水肿标准化CT值增量、VNCa标准化CT值增量进行各自组间比较及两两间比较,对有差异的组别行诊断效能比较,由接受者工作特征(ROC)曲线下面积(AUC)进行评估,并计算Cut-off值。结果三期骨髓水肿标准化CT值增量及VNCa标准化CT值增量组间均有统计学意义(H=10.788,p=0.005;F=115.787,p=0.000),其中,软骨痂期(纤维性骨痂期)与硬骨痂-重塑期骨髓水肿标准化CT值增量有统计学意义(H=54.958,p=0.003),其余两两间无统计学意义(分别为H=-25.603,p=0.183;H=29.354,p=0.113)。而三期VNCa标准化CT值增量两两间均有统计学意义(P均为0.000)。ROC曲线鉴别软骨痂期(纤维性骨痂期)与硬骨痂-重塑期骨髓水肿标准化CT值增量曲线下面积为0.652,Cut-off值为81.575 Hu,鉴别血肿炎症机化期与软骨痂期(纤维性骨痂期)VNCa标准化CT值增量曲线下面积为0.668,Cut-off值为55.700 Hu,鉴别软骨痂期(纤维性骨痂期)与硬骨痂-重塑期VNCa标准化CT值增量曲线下面积为0.905,Cut-off值为37.625 Hu。结论通过双能量CT Bone Marrow Edema可定量评估肋骨骨折演变时间节点,骨折时间演变的标准化CT值增量差异性可为法医鉴定骨折处于不同时间段提供理论依据。通过标准化CT值增量Cut-off值可一定程度上预测骨折所处时间阶段,为法医在鉴定肋骨骨折方面提供定量依据。
文摘Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.
基金Project:Outstanding Youth Startup Foundation of Shanxi Province(No.2019YJ08)。
文摘Objective:To explore the clinical value of dual energy CT(DECT)virtual noncalcium(VNCa)in the diagnosis of sacroiliac joint bone marrow edema(BME).Methods:A collection of 45 patients(21 males,24 females,and an average age of 34 years)who underwent MRI and DECT(Siemens Somatom definition force)examinations for the sacroiliac joints in our hospital from January 2019 to August 2020.After the DECT scan,the bone marrow pseudo-color map was obtained after VNCa processing.The bone marrow pseudo-color map was evaluated by two physicians.Take MRI test results as the gold standard,the application value of DECT VNCa technology in the diagnosis of sacroiliac joint BME was analyzed.Results:The positive predictive value(PPV),negative predictive value(NPV),sensitivity(Sen),specificity(Spe)and accuracy(Acc)of the qualitative diagnosis of iliac bone and sacral BME with DECT VNCa technology was:80.6%,85.2%,78.4%,86.8%,83.3%and 100%,64.9%,32.5%,100%,70.0%,respectively.The area of edema displayed by quantitative measurement of DECT VNCa image is smaller than the area measured by MRI image.The VNCa CT value(-71.66±72.97Hu)of the iliac edema area was higher than that of the non-edema area(-90.27±65.85Hu),and the VNCa CT value of the sacral edema area(-62.90±46.87Hu)was higher than that of the non-edema area(-101.08±134.02Hu),the best cut-off values(Cut-off values)for the quantitative diagnosis of iliac bone and sacral BME by VNCa are-66.40Hu and-50.60Hu,respectively.The curve of the receiver operating characteristic(ROC)of the iliac bone and sacrum area under the cure(AUC)is 0.720 and 0.706 respectively.There is a moderate negative correlation between the VNCa CT values of the ilium and sacrum in the edema area and the conventional CT values.Conclusion:The DECT VNCa technique has certain effectiveness in the diagnosis of sacroiliac joint BME,and its effectiveness in the diagnosis of ilium BME is better than sacrum.
基金Science and Technology Research Project in Kaifeng City,Henan Province Project approval:Science and Technology Research Project in Kaifeng City,Henan Province(1503005)。
文摘Objective:To observe the curative effect of release with needle knife combined with microporous decompression in bone marrow edema area of subchndral bone for treatment of knee osteoarthritis.Method:From March 2019 to March 2020,66 patients with knee osteoarthritis were selected as the research objects,and divided into treatment group and control group according to random nuber table.The treatment group was treated with release with needle knife combined with microporous decompression in bone marrow edema area,while the control group was treated with release with needle knife.Visual analogue scale(VAS),the Western Ontario and Mc Master University composite index(WOMCA)and inflammatory factors were used to evaluate the curative effect of patients before treatment and after treatment.Results:The VAS scores of knee pain in both groups decreased after treatment.The treatment group was lower than the control group.The WOMAC scores of both groups were decreased significantly after treatment,and then gradually decreased with time.The WOMAC scroes of the treatment group were lower than those of the control group after treatment,and there was an interactive effect on time factor.Conclusion:Release with needle knife combined with microporous decompression in bone marrow edema area of subchondral bone has good curative effect in the treatment of knee osteoarthritis;it can relieve the pain of patients,improve the function of joint,reduce inlfammatory reaction,and then delay the pathological progress of KOA,which is worthy of clinical promotion.
文摘Bone marrow edema is a self-limiting, under-recognized condition. It mainly involves the lower limbs. It is characterized by pain and inability to bear weight. Diagnosis is most often based on imaging and by excluding other causes. Its exact pathogenesis is still debated and various theories are postulated. Treatment ranges from anti-inflammatories to restricted weight bearing. This overview has tried to revisit this rare and perhaps forgotten clinical-radiological condition.
文摘目的与单纯髓芯减压(core decompression,CD)治疗相比,探讨双通道CD联合髓腔冲洗技术对非创伤性股骨头坏死(osteonecrosis of the femoral head,ONFH)塌陷进展以及临床结果的影响。方法回顾性分析2024年1月—10月因ONFH行双通道CD联合髓腔冲洗治疗且符合选择标准的19例(30髋)患者(CD+冲洗组)临床资料,按照1∶2比例纳入年龄、性别、身体质量指数(body mass index,BMI)匹配的54例(60髋)单纯CD患者作为对照(CD组)。两组患者性别、年龄、BMI、手术侧别、ONFH类型以及术前国际骨循环协会(ARCO)分期、骨髓水肿分期、疼痛视觉模拟评分(VAS)、Harris评分等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组患者术后住院时间以及并发症发生情况;术前及术后出院时VAS评分,计算手术前后差值(变化值);术前及术后出院、3个月时Harris评分。随访期间行X线片、CT和双髋MRI复查,术后3个月行ARCO分期和骨髓水肿分期,并与术前比较确定是否存在影像学进展或缓解。结果术后两组患者切口均Ⅰ期愈合,无感染、股骨颈骨折等手术相关并发症发生。两组患者均获随访,CD+冲洗组随访时间为(146.8±27.7)d,CD组为(164.3±48.2)d,组间差异无统计学意义(t=1.840,P=0.069)。两组术后住院时间差异无统计学意义(P>0.05)。术后出院时CD+冲洗组VAS评分低于CD组,变化值高于CD组,差异均有统计学意义(P<0.05)。CD+冲洗组术后出院时、3个月时Harris评分均高于CD组,差异均有统计学意义(P<0.05);组内随时间延长,Harris评分逐渐增高,各时间点间差异均有统计学意义(P<0.05)。影像学复查示,术后3个月两组ARCO分期以及影像学进展差异均无统计学意义(P>0.05);而CD+冲洗组骨髓水肿分期以及骨髓水肿缓解均优于CD组,差异有统计学意义(P<0.05)。结论双通道CD联合髓腔冲洗技术能明显减轻ONFH患者髋关节疼痛和改善关节功能,缓解股骨头骨髓水肿程度,延缓ONFH进展。
文摘目的:探讨三期中药外治方案治疗急性踝关节扭伤致距骨骨挫伤的早期临床疗效。方法:回顾性分析2021年9月至2024年7月收治的360例初次外踝关节扭伤患者,根据MRI检查选取距骨骨挫伤的患者,最终纳入73例距骨骨挫伤患者。根据治疗方法不同分为观察组和对照组,观察组35例,男16例,女19例;年龄24~37(30.34±2.68)岁;采用三期中药外治方案联合“保护(protection)、适当负重(optimal loading,OL)、冰敷(ice)、加压(compression)、抬高(elevation)-POLICE”治疗方案。对照组38例,男18例,女20例;年龄24~35(29.87±2.57)岁;采用“POLICE”治疗方案。通过3D Slicer软件测量治疗前及治疗6周MRI所示骨髓水肿(bone marrow edema,BME)区域体积,计算BME改善率。分别于治疗前和治疗第1、3周采用“Figure of 8”测量法评估踝关节肿胀程度;治疗前和治疗第1、6周采用疼痛视觉模拟评分(visual analog scale,VAS)评价踝关节疼痛程度;治疗6周采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分和Karlsson踝关节功能评分系统评价踝关节功能改善情况。结果:共73例踝关节扭伤致距骨骨挫伤患者完成6周随访。治疗6周,观察组BME改善率(39.18±0.06)%高于对照组(26.75±0.03)%,差异有统计学意义(P<0.05)。治疗1周后,观察组VAS(2.89±0.72)分,低于对照组(3.37±0.79)分,差异有统计学意义(P<0.05)。踝关节肿胀程度观察组(50.20±3.19)cm,低于对照组(52.00±3.60)cm,差异有统计学意义(P<0.05)。治疗3周后,两组间踝关节肿胀程度比较,差异无统计学意义(P>0.05)。治疗6周后,两组间VAS比较,差异无统计学意义(P>0.05)。观察组治疗6周AOFAS踝-后足评分、Karlsson评分分别为(87.43±4.18)、(82.77±5.93)分,高于对照组(82.92±4.87)、(76.45±6.85)分,差异均有统计学意义(P<0.05)。根据AOFAS踝-后足评分,观察组优8例,良27例;对照组优2例,良33例,可3例;两组比较差异有统计学意义(χ^(2)=7.089,P=0.029)。结论:三期中药外治联合“POLICE”治疗方案早期临床疗效显著,能够明显减轻急性外踝扭伤致骨挫伤患者踝关节疼痛和肿胀程度,促进骨髓水肿吸收,促进患者踝关节功能恢复。
文摘目的观察温针灸联合补肾生骨方对股骨头坏死患者骨髓水肿、骨代谢及疼痛的影响。方法纳入股骨头坏死患者60例,采用随机数字表法分为对照组和观察组,每组30例,对照组采用口服补肾生骨方治疗,观察组给予补肾生骨方联合温针灸治疗。观察两组治疗前后骨髓水肿等级、骨代谢指标、疼痛视觉模拟评分法(visual analog scale,VAS)评分和中医证候积分,并比较两组临床疗效和不良反应发生情况。结果治疗后两组骨髓水肿等级、血清Ⅰ型胶原羧基端肽β特殊序列(βisomer of C-terminal telopeptide of typeⅠcollagen,β-CTX)水平、VAS评分和中医证候积分较治疗前均下降(P<0.05),且观察组均低于对照组(P<0.05);治疗后两组血清骨钙素(bone-γ-carboxyglutamic acid-containing protein,BGP)、血清Ⅰ型前胶原氨基端前肽(typeⅠprocollagen N-terminal peptide,PINP)水平较治疗前均上升(P<0.05),且观察组高于对照组(P<0.05);观察组总有效率93.3%,显著高于对照组的83.3%(P<0.05)。两组均无明显不良反应发生。结论温针灸联合补肾生骨方治疗股骨头坏死临床疗效确切,能明显缓解患者疼痛,减轻骨髓水肿,改善骨代谢情况,优于单纯补肾生骨方治疗,具有较好安全性。
文摘Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We evaluated the effects of vertebral bone drilling for the pain due to occults VFs. Materials and Methods: Eighteen patients with painful osteoporotic occult VFs underwent the vertebral bone drilling. We evaluated the clinical outcome by comparing numerical rating scale (NRS) and activity of daily life (ADL) values between before and after the vertebral bone drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and ADL score, and the mean NRS and ALD score after the bone drilling were 8.4 ± 0.8, 2.2 ± 0.6, 2.4 ± 1.0, 4.6 ± 0.5, respectively. Among the patients, we detected significant improvements in NRS pain score and ADL score after the drilling compared with baseline score (p < 0.0002). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic occult VFs.
