BACKGROUND Femoral trochlear dysplasia(FTD)is an important risk factor for patellar instability.Dejour classification is widely used at present and relies on standard lateral X-rays,which are not common in clinical wo...BACKGROUND Femoral trochlear dysplasia(FTD)is an important risk factor for patellar instability.Dejour classification is widely used at present and relies on standard lateral X-rays,which are not common in clinical work.Therefore,magnetic resonance imaging(MRI)has become the first choice for the diagnosis of FTD.However,manually measuring is tedious,time-consuming,and easily produces great variability.AIM To use artificial intelligence(AI)to assist diagnosing FTD on MRI images and to evaluate its reliability.METHODS We searched 464 knee MRI cases between January 2019 and December 2020,including FTD(n=202)and normal trochlea(n=252).This paper adopts the heatmap regression method to detect the key points network.For the final evaluation,several metrics(accuracy,sensitivity,specificity,etc.)were calculated.RESULTS The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of the AI model ranged from 0.74-0.96.All values were superior to junior doctors and intermediate doctors,similar to senior doctors.However,diagnostic time was much lower than that of junior doctors and intermediate doctors.CONCLUSION The diagnosis of FTD on knee MRI can be aided by AI and can be achieved with a high level of accuracy.展开更多
Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent...Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.Results Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.Conclusions Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.展开更多
目的探讨面动脉鼻唇沟穿支皮瓣与额部滑车上动脉皮瓣在鼻尖缺损整形中的疗效比较。方法回顾性分析自2024年1月至2025年5月,中国人民解放军海军第九七一医院耳鼻喉科收治43例鼻尖缺损患者的临床资料,根据手术方法分为观察组(23例)和对照...目的探讨面动脉鼻唇沟穿支皮瓣与额部滑车上动脉皮瓣在鼻尖缺损整形中的疗效比较。方法回顾性分析自2024年1月至2025年5月,中国人民解放军海军第九七一医院耳鼻喉科收治43例鼻尖缺损患者的临床资料,根据手术方法分为观察组(23例)和对照组(20例),观察组给予面动脉鼻唇沟穿支皮瓣修复,对照组采用额部滑车上动脉皮瓣修复,观察两组患者手术相关指标、鼻部轮廓参数、瘢痕严重程度及满意率差异。结果观察组和对照组在手术时间、术中出血量和术后引流量比较,差异无统计学意义(P>0.05);观察组和对照组术后6个月鼻额角、鼻面角、鼻尖凸度和鼻唇角比较,差异无统计学意义(P>0.05);观察组瘢痕评估量表(patient and observers scar assessment,POSAS)评分中瘢痕面积、厚度、柔软度、色素沉着和总分分别为3(1~5)分、2(1~4)分、2(0~3)分、4(2~6)分和15(8~23)分,明显低于对照组(P<0.05);观察组患者满意度优于对照组(P<0.05)。结论相较于额部滑车上动脉皮瓣,面动脉鼻唇沟穿支皮瓣在鼻尖缺损整形中具有瘢痕程度较轻,患者满意度较高的优点。展开更多
Patellofemoral instability(PI)is the disruption of the patella’s relationship with the trochlear groove as a result of abnormal movement of the patella.To identify the presence of PI,conventional radiographs(anteropo...Patellofemoral instability(PI)is the disruption of the patella’s relationship with the trochlear groove as a result of abnormal movement of the patella.To identify the presence of PI,conventional radiographs(anteroposterior,lateral,and axial or skyline views),magnetic resonance imaging,and computed tomography are used.In this study,we examined four main instability factors:Trochlear dysplasia,patella alta,tibial tuberosity–trochlear groove distance,and patellar tilt.We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint,such as patellar size and shape,lateral trochlear inclination,trochlear depth,trochlear angle,and sulcus angle,in cases of PI.In addition,we reviewed the evaluation of coronal alignment,femoral anteversion,and tibial torsion.Possible causes of error that can be made when evaluating these factors are examined.PI is a multi-factorial problem.Many problems affecting bone structure and muscles morphologically and functionally can cause this condition.It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes.Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment.This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications.展开更多
Objective To study the neural, arterial and venous relationship in the middle incisural space in the region of the tentorial incisura and to determine the important clinical anatomical landmarks of these important neu...Objective To study the neural, arterial and venous relationship in the middle incisural space in the region of the tentorial incisura and to determine the important clinical anatomical landmarks of these important neurovascular structures. Methods Twenty adult cadaveric heads were examined using ×6 to ×40 magnification after perfusing the arteries and veins with colored latex and the relationship of the neural structures, arteries, veins were observed. The distances between the important neursovascular structures and landmarks were measured. Results The important cranial nerves related to the middle incisural space of the tentorial incisura are the oculomotor, the trochlear and the trigeminal nerves. And the important arteries related to the middle incisural space are posterior cerebral arteries and superior cerebellar arteries. The entrance site of oculomotor nerve to the roof of the cavernous sinus located at (11.2±4.3) mm posterior to the anterior clinoid process, (4.4±1.4) mm lateroposterior posterior to the posterior clinoid process. The entrance site of trochlear nerver located at (23.3 ± 3.0) mm posterior to anterior clinoid process, (14.5±3.9) mm lateroposterior posterior to the posterior clinoid process. The entrance site of oculomotor nerve located at (6.3±1.6) mm posterior to the supraclinoid portion of internal carotid artery, while that of the trochlear nerve at ((17.9±3.5)) mm to the supraclinoid portion of internal carotid artery. The entrance site of trochlear nerve located at (11.5±3.0) mm posterior to the entrance site of oculomotor nerve. Conclusions Anterior, posterior clinoid process and the supraclinoid portion of internal carotid artery are the important landmarks for the entrance site of the oculomotor and trochlear nerve. The superior cerebellar artery, the posterior cerebral artery and its important branches including the medial posterior choroidal artery and the long circumflex branch are all closely related to the middle incisural space, and should not be injured during operation.展开更多
文摘BACKGROUND Femoral trochlear dysplasia(FTD)is an important risk factor for patellar instability.Dejour classification is widely used at present and relies on standard lateral X-rays,which are not common in clinical work.Therefore,magnetic resonance imaging(MRI)has become the first choice for the diagnosis of FTD.However,manually measuring is tedious,time-consuming,and easily produces great variability.AIM To use artificial intelligence(AI)to assist diagnosing FTD on MRI images and to evaluate its reliability.METHODS We searched 464 knee MRI cases between January 2019 and December 2020,including FTD(n=202)and normal trochlea(n=252).This paper adopts the heatmap regression method to detect the key points network.For the final evaluation,several metrics(accuracy,sensitivity,specificity,etc.)were calculated.RESULTS The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of the AI model ranged from 0.74-0.96.All values were superior to junior doctors and intermediate doctors,similar to senior doctors.However,diagnostic time was much lower than that of junior doctors and intermediate doctors.CONCLUSION The diagnosis of FTD on knee MRI can be aided by AI and can be achieved with a high level of accuracy.
基金ThisstudywassupportedbyagrantfromtheChineseNationalNaturalScienceFoundation (No .3 0 0 0 0 170 )
文摘Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.Results Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.Conclusions Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.
文摘目的探讨面动脉鼻唇沟穿支皮瓣与额部滑车上动脉皮瓣在鼻尖缺损整形中的疗效比较。方法回顾性分析自2024年1月至2025年5月,中国人民解放军海军第九七一医院耳鼻喉科收治43例鼻尖缺损患者的临床资料,根据手术方法分为观察组(23例)和对照组(20例),观察组给予面动脉鼻唇沟穿支皮瓣修复,对照组采用额部滑车上动脉皮瓣修复,观察两组患者手术相关指标、鼻部轮廓参数、瘢痕严重程度及满意率差异。结果观察组和对照组在手术时间、术中出血量和术后引流量比较,差异无统计学意义(P>0.05);观察组和对照组术后6个月鼻额角、鼻面角、鼻尖凸度和鼻唇角比较,差异无统计学意义(P>0.05);观察组瘢痕评估量表(patient and observers scar assessment,POSAS)评分中瘢痕面积、厚度、柔软度、色素沉着和总分分别为3(1~5)分、2(1~4)分、2(0~3)分、4(2~6)分和15(8~23)分,明显低于对照组(P<0.05);观察组患者满意度优于对照组(P<0.05)。结论相较于额部滑车上动脉皮瓣,面动脉鼻唇沟穿支皮瓣在鼻尖缺损整形中具有瘢痕程度较轻,患者满意度较高的优点。
文摘Patellofemoral instability(PI)is the disruption of the patella’s relationship with the trochlear groove as a result of abnormal movement of the patella.To identify the presence of PI,conventional radiographs(anteroposterior,lateral,and axial or skyline views),magnetic resonance imaging,and computed tomography are used.In this study,we examined four main instability factors:Trochlear dysplasia,patella alta,tibial tuberosity–trochlear groove distance,and patellar tilt.We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint,such as patellar size and shape,lateral trochlear inclination,trochlear depth,trochlear angle,and sulcus angle,in cases of PI.In addition,we reviewed the evaluation of coronal alignment,femoral anteversion,and tibial torsion.Possible causes of error that can be made when evaluating these factors are examined.PI is a multi-factorial problem.Many problems affecting bone structure and muscles morphologically and functionally can cause this condition.It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes.Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment.This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications.
文摘Objective To study the neural, arterial and venous relationship in the middle incisural space in the region of the tentorial incisura and to determine the important clinical anatomical landmarks of these important neurovascular structures. Methods Twenty adult cadaveric heads were examined using ×6 to ×40 magnification after perfusing the arteries and veins with colored latex and the relationship of the neural structures, arteries, veins were observed. The distances between the important neursovascular structures and landmarks were measured. Results The important cranial nerves related to the middle incisural space of the tentorial incisura are the oculomotor, the trochlear and the trigeminal nerves. And the important arteries related to the middle incisural space are posterior cerebral arteries and superior cerebellar arteries. The entrance site of oculomotor nerve to the roof of the cavernous sinus located at (11.2±4.3) mm posterior to the anterior clinoid process, (4.4±1.4) mm lateroposterior posterior to the posterior clinoid process. The entrance site of trochlear nerver located at (23.3 ± 3.0) mm posterior to anterior clinoid process, (14.5±3.9) mm lateroposterior posterior to the posterior clinoid process. The entrance site of oculomotor nerve located at (6.3±1.6) mm posterior to the supraclinoid portion of internal carotid artery, while that of the trochlear nerve at ((17.9±3.5)) mm to the supraclinoid portion of internal carotid artery. The entrance site of trochlear nerve located at (11.5±3.0) mm posterior to the entrance site of oculomotor nerve. Conclusions Anterior, posterior clinoid process and the supraclinoid portion of internal carotid artery are the important landmarks for the entrance site of the oculomotor and trochlear nerve. The superior cerebellar artery, the posterior cerebral artery and its important branches including the medial posterior choroidal artery and the long circumflex branch are all closely related to the middle incisural space, and should not be injured during operation.
