Objective:To assess the short-term radiographic and clinical outcomes of total arthroscopic Latarjet procedure for young activated patients with habitual anterior shoulder dislocation and a marked glenoid bone defect.Methods:We retrospectively reviewed the radiographic and clinical outcomes of 37 patients who had undergone a total arthroscopic Latarjet procedure from January 2017 to June 2019 for habitual anterior shoulder dislocation and a marked glenoid bone defect. They were all males, with an average age of 25.4 years(from 18 to 36 years). A total of 18 left and 19 right shoulders were involved. 3D CT scans of bilateral shoulders were performed before surgery and the glenoid defects calculated before total arthroscopic Latarjet procedure and repair of anterior joint capsule. Comparisons were made between preoperation and the final follow-up in terms of active range of motion (AROM), Rowe score, Walch-Duplay score and Subjective Shoulder Value (SSV). 3D CT reconstruction was conducted at the final follow-up to evaluate the location and absorption of bone grafts.Results:The duration of follow-up ranged from 6 to 36 months (average, 12.5 months). No recurrent dislocation occurred before the final follow-up. No significant differences were found between preoperation and the final follow-up in anteflexion elevation, external rotation at lateral body, internal rotation or external rotation at abduction 90° ( P>0.05). The differences between preoperation and the final follow-up were statistically significant in Rowe score (42.2±5.6 versus 91.1±3.3), Walch-Duplay score (31.5±8.0 versus 92.6±3.7), and SSV score (63.9%±6.1% versus 79.3%±5.0%) ( P<0.05). 3D CT reconstruction at the final follow-up observed bone absorption in 29 patients; 23 patients recovered to their pre-injury sports level 6 to 12 months after surgery. Conclusion:In young activated patients with anterior shoulder dislocation and a marked glenoid bone defect, the total arthroscopic Latarjet procedure plus anterior capsular repair can produce excellent early functional and radiographic outcomes.

临床资料 上胫腓关节是由腓骨头胫骨关节面和胫骨外侧髁腓骨关节面组成的小关节,周围有较为强韧的支持韧带.Nelaton 于 1874 年首次报道了上胫腓关节脱位 [1],之后有部分病例报道.上胫腓关节脱位是一种较为罕见的下肢损伤 [2],常常伴随有同侧的胫骨骨折等其它损伤.因为脱位后没有特殊的临床症状,而且经常被其它严重损伤掩盖伤情,导致上胫腓关节脱位常常被忽视,临床漏诊率很 高 [3].笔者将报道 1 例上胫腓关节脱位合并胫骨干骨折的病例,并对上胫腓关节的解剖和力学特点、分类、诊断、治疗做一综述.

肩关节不稳定是肩关节常见疾病,该病诊断相对容易,复发率高,尤其是<20岁的患者,其复发率>90％.肩关节不稳定的病理包括前下盂唇损伤、伴关节盂骨损伤、肱骨后上方软骨损伤、前盂唇韧带骨膜袖撕脱等.Bankart损伤是指前下盂唇损伤和盂肱下韧带损伤引起的肩关节脱位.单纯的Bankart损伤临床少见,多合并其他损伤,如关节囊损伤、骨性Bankart损伤、SLAP损伤、Hillsachs损伤、关节盂侧骨缺损等.Bankart损伤常用的治疗方式包括切开修复、关节镜下肩修复术.Bankart损伤修复手术翻修常用的技术包括Bankart修复术、肌腱填塞、植骨术、Bristow-Latarjet手术等.Bankart损伤修复手术术后翻修的常见原因有术后疼痛、再次脱位、残存不稳.Bankart损伤手术出现疼痛的原因包括感染、缝合张力过大、前方缝合部分肩胛下肌、肌腱填塞时固定小圆肌等.术后复发和残留不稳定的原因包括再次受伤、手术技术、制动时间不足、内固定松动等.手术技术常见问题包括术中评估不足、并发损伤未处理、打结不牢固、缝合位置不准确等.Bankart损伤修复手术术后处理原则包括早期悬吊制动保护,早期被动活动度练习,中后期可进行主动关节活动度练习,早期以肌肉静力性收缩练习为主,中后期可改为肌肉抗阻力练习,练习后注意冰敷防止肿胀,同时应注意控制盂肱关节节律,增加肩胛骨的活动度练习及稳定性练习,避免形成异常运动模式.对于Bankart损伤术前应仔细评估,术中全面检查,明确损伤类型.处理并发损伤,充分松解、牢固缝合,加强术后康复.

Objective To explore the effect of distal rearrangement and ligament arthrolysis combined with reconstruction in treatment of recurrent dislocation of the patella to provide certain reference basis for the clinical usage of ligament arthrolysis combined with reconstruction.Methods The distal rearrangement (distal rearrangement group) and ligament arthrolysis combined with reconstruction(ligament arthrolysis combined with reconstruction group) were used to treat 50 cases of recurrent dislocation of the patella respectively from January 2014 to January 2016.The Lysholm and HSS scores were used to evaluate knee joint function before and after surgery in 2 groups.The patella separately extrapolate experiment,fear experiment and number of dislocation were examined and number of positive cases was counted 1,3,6,12 months after surgery.Results The two groups were followed up for 12 months.Between two groups,there were no statistically significant differences in preoperative Lysholm,HSS evaluation and the positive rate of patella separately extrapolate experiment,fear experiment and number of dislocation(P ＞0.05).Lysholm score in the ligament arthrolysis combined with reconstruction group was higher than the distal rearrangement group (P ＜0.05).HSS score in the ligament arthrolysis combined with reconstruction group was higher than the distal rearrangement group(P ＜0.05).There were no significant differences between the two groups in the positive rate of patella separately extrapolate experiment and number of dislocation of the patella at 1,3,6,12 months after surgery (P ＞0.05).The positive ratio of fear experiment at 1,3 months after surgery was lower in the ligament arthrolysis combined with reconstruction group than the distal rearrangement group,the difference was statistically significant (P ＜0.05).Conclusion Treatment of recurrent dislocation of the patella with combined release of ligament and reconstruction is better than distal rearrangement,and it is worthy of clinical promotion.

Objective To explore the effect of high level tibial osteotomy combined arthroscopy in treatment of knee osteoarthritis.Methods Thirty-eight patients with knee osteoarthritis were treated by high level tibial osteotomy combined arthroscopic treatment and Tomofix internal fixation.All patients were followed-up for more than 3 years.The therapeutic effect was analyzed and compared by HSS knee function scores,femoral tibial angle (FTA) and lateral tibial dissection angle (aLPTA) analyses.Results The scores of HSS knee function (84.5±5.7) in 1 year after the operation were significantly higher than those of pre-operation (68.3±3.8).In 3 years follow-up period,the scores of HSS knee function (79.6±4.8) were significantly lower than those in 1 year after operation,but they were still significantly higher than those before operation.The results of FTA (173.52±1.09°) and aLPTA (88.01±1.09°) were significantly lower than those before operation (184.36±1.21° and 95.34±0.78°).In 3 years follow-up period,the results of FTA and aLPTA (174.42±0.98° and 89.15±0.98°) were increased,but they were still significantly lower than those before operation.Conclusion The therapeutic effect of knee osteoarthritis with high level of tibial osteotomy combined arthroscopic treatment is satisfactory without occurrence of any complication,and it has less influence on normal anatomy of the joint,hence it is worthy to be popularized.

Objective To evaluate the clinical application value in the diagnosis of malignant breast lesions by acoustic radiation force impulse (ARFI).Methods A total of 130 breast lesions in 127 patients were detected by normal ultrasound test and ARFI.The area ratio (AR) of the lesions in normal ultrasonography to virtual touch tissue imaging (VTI) and the shear wave velocities (SWV) of lesions were measured,and the results were correlated with the pathologic results,the ROC curve were produced to find the cut-off value point of AR and SWV to predict breast cancer.The difference between benign and malignant of breast lesions was analyzed.Results VTQ in diagnosis of malignant breast masses of ROC area was 0.90(95％CI:0.86-0.96).The cut-off point of SWV was 2.9 m/s,the sensitivity,specificity,consistent rate and positive predictive value was 93.2 ％,71.9 ％,83.8 ％,81％.AR in diagnosis of malignant breast masses of ROC area was 0.84(95％CI:0.78-0.91).The cut-off point of AR was 1.27,The sensitivity,specificity,consistent rate and positive predictive value of AR was 76.7％,82.5％,79.2％,84.8％.The sensitivity,specificity,consistent rate and positive predictive value of SWV(2.9 m/s as the cut-off point)combine with AR(1.27 as the cut-off point) in diagnosis malignant breast masses was 97.3％,61.4％,81.5％,76.3％.Conclusions ARFI can help to differentiate benign from malignant breast diseases.The sensitivity of SWV is better than AR,and the sensitivity is improved when VTQ combine with AR.

目的:探讨不同大小嗜铬细胞瘤的超声表现,通过与病理对照分析提高对本病的超声诊断水平.方法:分析手术后经病理证实的24例患者嗜铬细胞瘤的超声诊断资料.按嗜铬细胞瘤的最大直径分为3组,即直径＜4.0cm组,4.0～6.0cm组及＞6.0cm组,分析病灶内部回声、周边及内部血流和边界的情况.结果:24例患者中3例为双侧发病,嗜铬细胞瘤病灶共27个:其中5个病灶为异位嗜铬细胞瘤(3个位于肾门部,2个位于腹主动脉或下腔静脉前方),10病灶个位于右侧肾上腺,12个病灶位于左侧肾上腺.27个病灶中有2个为恶性.不同大小病灶组之间内部回声及病灶血流情况,均具有显著性差异(P＜0.05,P＜0.01).但病灶边界情况与病灶大小无关,3组之间无显著性差异(P＞0.05).术后病理大体标本多数肿瘤界限清楚有完整包膜,切面灰褐色或棕黄色,常有出血、坏死和囊性变.镜下肿瘤细胞排列呈巢状,有富含血管的纤维组织或薄壁血窦分隔,瘤细胞多数为多角形,胞浆丰富、嗜碱性.免疫组化瘤细胞CgA(+)、肿瘤巢周支持细胞均为S-100(+).结论:随嗜铬细胞瘤肿物大小不同超声图像有所不同,嗜铬细胞瘤病理结构决定超声图像有一定的特点.

OBJECTIVETo determine the best shear wave elastography (SWE) quantitative parameters including the maximum elasticity (Emax), mean elasticity(Emean), minimum elasticity, standard deviation and ratio of Emean (Eratio) in assessing benign and malignant breast lesions.METHODSTotally 302 breast lesions underwent conventional ultrasound and SWE. Each lesion was classified according to ultrasound Breast Imaging Reporting and Data System (BI-RADS). The receiver operating characteristic(ROC) curves were used to determine the cut-off values of SWE quantitative parameters and to suggest breast lesions as benign or malignant. The sensitivity,specificity and the Youden index (sum of sensitivity and specificity minus 1) of SWE quantitative parameters were compared,and then the sensitivity,specificity and the Youden index of the combinations of each SWE parameters in assessing breast lesions were compared.RESULTSThe sensitivity,specificity and the Youden index of the Emax were 0.87,0.97 and 0.84,which were higher than other SWE parameters (all P<0.01). The sensitivity, specificity and the Youden index of Emax combined with ultrasound BI-RADS were 0.86,0.97 and 0.83, which were higher than other combinations (all P<0.01).CONCLUSIONSCompared with other parameters, Emax has the best performance in assessing breast lesions. It can be used as an important quantitative indicator for the evaluation of benign and malignant breast lesions.

Objective To explore the diagnostic value of shear wave elastography(SWE) combined with breast imaging reporting and data system(BI-RADS) in quantitative differential diagnosis of breast tumors.Methods A total of 120 patients with breast lesions were classified by BI-RADS,and were detected by quantitative SWE examination.The average value of young modulus and standard deviation(Std) were collected.The regression equation was built with average value of young modulus,Std and BI-RADS as independent variables.The P value calculated with regression equation was defined as prediction probability value,and the optimal diagnostic boundary value was found.Results Area under curve(AUC) of the receiver operating characteristic(ROC) was 0.9330 in the simple BI-RADS classification,the diagnostic sensitivity,specificity,accuracy and the Youden index were 0.95652,0.78378,0.85000 and 0.74031 respectively.AUC of ROC was 0.9900 in the combine group.The 0.685 of prediction probability value was diagnosis point,when pathological diagnosis result,accuracy and Youden index were maximum,and the diagnostic sensitivity,specificity,accuracy and the Youden index were 0.91304,0.98649,0.95833 and 0.89953 respectively.Conclusion The combination of BI-RADS and shear wave elasticity could improve the specificity and accuracy of diagnosis.

目的 探讨实时剪切波弹性模量定量参数鉴别乳腺小结节良恶性的临床价值.方法 定量检测93例女性患者101个乳腺小结节的组织整体弹性模量值和弹性模量分布情况量化指标(Std),应用ROC曲线分别计算两种数据的诊断界值.结果 对照组织病理,良、恶性小结节的整体弹性模量值和Std值差异均具有统计学意义；ROC曲线分析,整体弹性诊断界值取28.15 kPa时,约登指数最大为0.555,诊断实验的灵敏度82.4％,特异度73.1％；Std诊断界值取11.9 kPa时,约登指数最大为0.72,诊断实验的灵敏度82％,特异度89.6％.整体弹性值的阳性预测值60.8％,阴性预测值89.0％；Std值的阳性预测值87.5％,阴性预测值91.3％.结论 从整体与局部分析乳腺小结节的弹性模量特征和分布规律,有助于乳腺小结节的良、恶性诊断.

Objective To evaluate the value of supersonic shear wave elastrography(SWE) in the diagnosis of benign and malignant breast lesions.Methods SWE was performed on 134 breast lesions of 123 female patients and 74 normal breast glands to determine the values of overall elastic modulus and dispersion,and ROC curves were used to assess the diagnosis boundary value of two kinds of data respectively.Results According to the diagnostic gold standard-histopathology,the values of overall elastic modulus and dispersion were statistically significant when comparing benign lesions and malignant lesions with normal glands.ROC curve displayed that,when the Youden index reached to maximum,the diagnosis boundary value of overall elastic modulus was 41.01 kPa,the sensitivity and specificity of the value were 68.5％ and 83.8％ respectively; the diagnosis boundary value of dispersion was 12.25 kPa,the sensitivity and specificity of the value were 87.0％ and 88.7％ respectively.Conclusions The values of overall elastic modulus and dispersion for solid breast lesions can be used to reflect the elastic characteristics of lesions quantificationally,which is useful to diagnose benign and malignant breast lesions in clinical.

Objective To assess the value of ultrasound combined with thermal texture maps in diagnosis of breast neoplasms.Methods Totally 114patients(114lesions) were examined with ultrasound and thermal texture maps,the results were compared with pathology.Results Of all the 114patients,43patients were malignant and 71benign diagnosed by pathology.Ultrasound correctly diagnosed 32malignant and 53benign lesions,thermal texture maps correctly diagnosed 35 malignant and 45benign lesions.The sensitivity,accuracy of ultrasound and thermal texture maps was 74.42%(32/43),74.56%(85/114) and 81.40%(35/43),70.18%(80/114),respectively,and of combining two methods was 95.35%(41/43) and 86.84%(99/114).Conclusion Combining ultrasound and thermal texture maps can increase the diagnostic sensitivity and accuracy of breast cancer.

Objective To evaluate the value of quantitative elastography with shear wave elastography (SWE) in the tissue characterization for patients with breast tissue and lesions.Methods SWE quantitative elastography were performed in 178 mammary glands,108 women with fatty tissue and 168 women with 215 breast lesions.The breast lesions were taken with pathologic results as reference,quantitative elasticity value of the lesions were measured.Results Pathological tests in 47 lesions showed were malignant and 167 lesions were benign.Malignant lesions exhibited a maximum,mean and minimum elasticity value of 113.92±61.05 kPa,55.68±31.65 kPa,23.45±16.13 kPa,respectively,while benign ones had elasticity value of 37.26±24.10 kPa,23.45±14.73 kPa and 13.61±9.49 kPa,individually (P<0.01).The elasticity values of mastopathy (n=61) were higher than those of fibroadenoma (n=69,P<0.05).The elasticity values of fibroadenoma were higher than those of mammary gland and fatty tissue (P<0.01).Conclusion SWE can reflect the elasticity modulus in different breast tissue,which can provide real-time quantitative elasticity measurements in tissue characterization and support differential diagnosis of breast lesion.

Purpose To evaluate the application of blood-oxygen functional imaging system (BOFIS) combined with high-frequency Doppler ultrasound(US) in the diagnosis of early breast cancer and identification of benign or malignant tumors. Materials and Methods 226 patients with 231 lesions confirmed by surgical/pathological findings were analyzed by BOFIS and US. US breast image and report data system (BI-RADS) classification is according to two-dimensional and Doppler ultrasound signs. Malignant lesions were diagnosed if BI-RADS grade was Ⅳb or above.Benign lesions were diagnosed if BI-RADS grade was Ⅳa or below. For BOFIS, margin character, internal structure, the numbers of micrangium, the changes of blood flow and blood oxygen content of tumors were used to detect benign or malignant.Results Pathological examination showed that 149 lesions were benign and 82 were malignant.①The sensitivity of US and BOFIS were 84.2% and 78.1%, respectively. The negative predictive value (NPV) of US and BOFIS were 91% and 87.1%, respectively. For BOFIS combined with US, the sensitivity (95.1%) was higher than that of BOFIS or US (P 0.05), and the NPV (96.5%) was higher than that of BOFIS (P 0.05).②For the lesions of BI-RADS gradeⅢ,Ⅳ andⅤ, the coincidence of US were 98.7%, 71.5% and 96.9%, respectively and those of BOFIS were 86.8%, 76.4% and 75%, respectively.③The sensitivity of US and BOFIS to detecting the lesions2cm were 73% and 67.7%, respectively. The sensitivity was improved to 89.2% if BOFIS combined with US (P0.05).Conclusion BOFIS combined with US can improve the accuracy in the detection and diagnosis of breast cancer.

Objective To determine the appearance of thyroid nodules by using supersonic shear imaging(SSI),which were used as the reference standard and to evaluate the value of quantitative elastography with SSI in diagnosis of thyroid nodules.Methods The SSI quantitative elastography were performed in 75 patients with 105 thyroid nodules with the available pathologic results in all cases.Receiver operating characteristic(ROC)curves were used to assess diagnostic performance.Results The malignant thyroid nodules exhibited a mean,a maximun and a minimum elasticity value of 45.84±19.41 kPa、79.73±40.58 kPa and 23.22±12.61 kPa,respectively,while the benign ones had elasticity value of 20.65±6.35 kPa、31.28±13.03 kPa and 13.61±5.63 kPa,respectively(P<0.01).The areas under the ROC curve(Az)of the three modalities were 0.938(max),0.910(mean)and 0.771(min),respectively.When the max elasticity value was 45 kPa,the sensitiveness was 83.3%,and the specificity was 91.4%;the mean elasticity value was 30 kPa,the sensitivenes was 79.0%,the specificity was 95.1%;the minimum elasticity value was 18 kPa,the sensitiveness was 62.5%,and the specificity was 86.4%.Conclusion The SSI provides quantitative elasticity measurements and complementary information that potentially could be helpful for diagnosis of thyroid nodules.

Objective To obtain the elasticity value of solid breast lesions with supersonic shear wave elastrography(SWE),in order to observe the value of quantitative elastography with SWE in differential diagnosis of breast tumors.Methods SWE quantitative elastography was performed in 108 female patients with 124 breast lesions.Taking pathologic results as reference,quantitative elasticity value of the lesions were measured,and ROC curves were used to assess diagnostic performance.Results There were 103 benign lesions in 87 patients and 21 malignant lesions in 21 patients.The mean elasticity value of malignant lesions was(47.92±32.54)kPa,and the maximum value was(113.18±47.48)kPa,whereas of benign ones was(25.87±12.50)kPa and(39.50±17.98)kPa,respectively(P0.01).The area under the ROC curve(Az) of the maximum and mean elasticity value was 0.944 and 0.756(P0.05),respectively.Taking 60.12 kPa as the threshold of the maximum elasticity value,the sensitivity was 90.50% and the specificity was 88.30%.Taking 42.08 kPa as the threshold of the mean elasticity value,the sensitivity was 57.10% and the specificity was 92.20%.Conclusion SWE provides quantitative elasticity measurements,thus adding complementary information that can potentially help in differential diagnosis of breast lesions.

Objective To investigate the value of breast imaging reporting and data reporting and data system(BI-RADS)assessment category based on the scores of sonographic features in the breast lesions.Methods The ultrasonic images for 1005 breast lesions confirmed by pathology were retrospectively reviewed.The age and the features of sonographic images including lesion shape,margin,halo,taller-than-wider,posterior attenuation,microcalcification,flow,lymph node were analyzed,then the scores were obtained due to the features.And the lesions were classified according to the scores.In each group,the malignant predicted value was compared with theorized risk degree of malignancy by BI-RADS to obtain the relationship between score and BI-RADS.Results The proportion of malignant lesions in score ≤3,4,5,6,7,8,9,10,11,12,13 14 and ≥15 were 0,1.6%,4.3%,8.8%,29.5%,42.1%,55.3%,69.7%,79.2%,73.0%,77.8%,95.7% and 94.5%,respectively.The 2,3,4a,4b,4c and 5 by BI-RADS were corresponded to score≤3,4,5～7,8～9,10～13 and ≥14,respectively.Score 6 or BI-RADS 4b was the best cut-off value by ultrasonography for differentiating malignant and begin breast lesions.The sensitivity,specificity,accuracy,negative predictive value and positive predictive value were 90.2%,90.1%,90.2%,95.3% and 80.7%,respectively.Conclusion BI-RADS assessment category according to sonographic feature scores can partly standardize ultrasonic report and offer reliable guiding information for clinical diagnosis and treatment of breast disease.

目的:探讨四肢骨结核的发病、诊断和治疗.方法:收集四肢骨结核31例进行分析.结果:男性明显多于女性(男64.52%,女35.48%);21～30岁多发,占29.03%;足骨发病最高,占35.48%;骨结核的漏诊、误诊较高.结论:四肢骨结核的发病率与以往报道不符;必须重视骨结核的诊断,加强全身抗痨治疗.

目的探讨边远少数民族地区脊柱结核的发病情况,为脊柱结核的防治提供依据.方法对335例脊柱结核患者进行回顾分析.结果发病年龄以21～30岁最多(98例,占29.25%);腰椎是胸椎的2.33倍;维族患者的发病年龄、发病部位较分散;维族女性明显高于男性.结论维族脊柱结核病情较重.

目的探讨边远少数民族地区脊柱结核手术治疗复发原因,总结手术治疗经验.方法收集手术治疗脊柱结核111例,对13例术后复发患者进行归类分析.结果手术时机掌握不当4例(3.6%);手术清除病灶不彻底3例(2.7%);术后切口处理欠妥3例(2.7%);术后抗结核治疗不规范11例(9.9%);忽视其它部位结核12例(10.81%);与生活环境有关.结论脊柱结核手术应注意手术时机选择,彻底清除病灶,妥善处理术后切口,坚持规范抗结核治疗,进行综合防治.