Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1990
New aspects of lumbar disc disease. MR imaging and histological findings.
Magnetic resonance imaging (MRI) and plain X-ray and CT studies were performed in patients with a history of lumbar back pain due to spinal disc disease. Spin-echo pulse sequences (SE), phase-contrast techniques (partial saturation sequences with delayed readout, PS), and fat-suppressing inversion recovery sequences (STIR) were employed. In 74 of 325 patients, PS and STIR images displayed vertebral marrow changes adjacent to the end-plates of the affected segments. ⋯ In six patients histological diagnosis showed substitution of hematopoietic marrow by fatty tissue, cartilaginous particles, degeneration of fat cells, and an increase in extracellular fluid with different components. The etiology is still unclear, but a correlation with lumbar disc disease is demonstrated. These vertebral marrow changes were best displayed with STIR and phase-contrast MR sequences, both providing contrast changes superior to T2-weighted SE techniques.
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Twenty cases of aneurysmal bone cyst were reviewed, with an average follow-up of 10.3 years. Twelve patients still had open growth plates at diagnosis, but all of them were fully grown at follow-up. The treatments performed were: resection of the cyst or of the whole affected bone, curettage, and curettage and bone grafting. ⋯ Two patients relapsed, one that had been treated by curettage alone and one by curettage and bone grafting. Five patients showed skeletal deformities at follow-up. Two had lesions of the growth plate, most likely caused by radiation therapy, whereas in the other three growth had probably been impaired by surgical trauma.
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The growing propagation of hip-joint sonography and its increasing use as a screening method make it important to point out some potential mistakes. Good image quality, three-dimensional evaluation with real-time technique, consideration of form variants, correct estimation of angle parameters, consideration of medical history, and clinical evaluation as well as the necessity of follow-up examinations are inevitable requirements for reliable diagnostic sonography of the hip joint.
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Arch Orthop Trauma Surg · Jan 1990
The importance of functional magnetic resonance imaging (MRI) in the planning of stabilizing operations on the cervical spine in rheumatoid patients.
Chronic inflammatory diseases, such as chronic polyarthritis or spondylarthritis ankylopoietica, can occasionally lead to vertebral instabilities of the occipitoatlantal or atlantoaxial level, requiring some form of stabilizing operation. By means of functional magnetic resonance imaging, i.e., with the cervical spine at its maximal range of flexion and extension, performed on 11 patients suffering from an instability at the above level, it was possible to demonstrate not only the extent of synovial tissue, but also how this sometimes excessive soft-tissue growth hinders an adequate reduction of the subluxated vertebrae. The importance of this investigation lies in the fact that the necessary operation can be planned appropriately. As such, three patients required a decompressing operation entailing resection of the posterior arch of the atlas, widening of the foremen magnum, or both.
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The present authors analyzed the pathological alterations of 1966 tendons examined in the National Institute of Traumatology, Budapest, during the past 18 years. The majority of cases proved to be tendinopathies (hypoxic-degenerative tendinopathy or calcific tendinitis, tendolipomatosis and mucoid degeneration) leading to tendon rupture. The incidence of tendon tumors, foreign bodies, infectious tendon diseases, and other pathological conditions was clearly lower. ⋯ In degenerative tendinopathies and alterations due to hereditary disease, electron microscopy was necessary. Polarization microscopy had a key role in examination of collagen structure and architecture, and identification of foreign bodies in the tendons. Enzyme histochemical and immunohistochemical examination were reliable but not absolutely necessary in the diagnosis of tendon pathology.