Abstract:
:The introduction of new techniques to the magnetic resonance imaging (MRI) armamentarium is beginning to provide an MRI examination that overcomes many of the disadvantages noted in earlier reports. An analysis of the various advantages and disadvantages of MRI, plain film myelography, and computed tomographic myelography points to a potential revision of the sequence of diagnostic studies and the workup of cervical degenerative disease. MRI might now be the appropriate first test for the evaluation of the cervical spine in a patient with symptoms referable to degenerative disease when therapeutic intervention is considered. An initial T1-weighted sagittal image with a 3-mm slice thickness will provide excellent contrast evaluation of the vertebral body marrow, disc space height, neural canal, and spinal cord. Disc herniation, canal stenosis, subluxation, and malalignment can be appreciated. Next, a fast, variable flip angle, gradient-echo sequence can be performed to increase the signal density of the cerebrospinal fluid relative to the extradural elements and cord. This provides an increased conspicuousness of extradural disease. Axial gradient-echo fast sequences, with low flip angles, will provide a second orthogonal plane with increased conspicuousness of extradural changes relative to the neural foramen and thecal sac. If necessary, additional oblique views through the neural foramen can be obtained. Finally, if intramedullary disease is considered in the differential, a gated, refocused, T2-weighted examination in the sagittal plane will provide the necessary soft-tissue contrast to detect pathology without unwanted artifact. Thus, unlike plain film or computed tomographic myelography, an examination of the entire cervical region including the osseous structures, extradural cerebrospinal fluid interface, and the spinal cord can be obtained with a single modality in an outpatient setting and in a noninvasive fashion. MRI can certainly replace plain film myelography for the overwhelming majority of situations. If surface-coil MRI fails to demonstrate an abnormality responsible for the patient's clinical symptoms, then a high-resolution computed tomographic scan with or without intrathecal contrast can be obtained. While the cost at first may seem prohibitive, the additional information that MRI is capable of providing in a noninvasive outpatient setting more than compensates for the expense.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Modic MT,Ross JS,Masaryk TJsubject
Has Abstractpub_date
1989-02-01 00:00:00pages
109-20issue
239eissn
0009-921Xissn
1528-1132pub_type
杂志文章abstract:UNLABELLED:Compressive osseointegration technology, which provides immediate, mechanically compliant endoprosthetic fixation, has been adapted for massive proximal tibial reconstructions in an attempt to avoid aseptic failure encountered with conventional stems. A retrospective review of 16 patients with resected tumor...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-009-0986-4
更新日期:2009-11-01 00:00:00
abstract::One hundred eight patients with low-grade soft tissue sarcoma treated at the authors' institution from 1984 to 1999 were reviewed retrospectively. Low-grade sarcomas were defined as those designated as Grade I of III or Grade I or II of IV. Patients who presented with recurrent tumors or who had multiple procedures at...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200204000-00023
更新日期:2002-04-01 00:00:00
abstract:BACKGROUND:To prevent symptomatic heterotopic ossification (HO) and guide primary prophylaxis in patients with combat wounds, physicians require risk stratification methods that can be used early in the postinjury period. There are no validated models to help guide clinicians in the treatment for this common and potent...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-015-4302-1
更新日期:2015-09-01 00:00:00
abstract::Percutaneous fixation of hand fractures is a common technique that takes advantage of the subcutaneous nature of hand bones, their small size, and their limited loading potential for stress placed on hardware. Percutaneous wire fixation supplements cast fixation when plaster cannot hold particular reductions, and allo...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-200006000-00014
更新日期:2000-06-01 00:00:00
abstract::One thousand one hundred sixty-nine elderly Japanese patients who sustained a hip fracture were observed prospectively. Ninety-two percent had operative fracture treatment. Hospital length of stay averaged 67 days; 81% of patients were discharged to their place of residence where they resided before sustaining the fra...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1998-03-01 00:00:00
abstract::The case histories and gross and microscopic findings of two adolescent patients with Scheuermann's kyphosis demonstrate that the anterior longitudinal ligament is bowstrung across the apex of the hyphosis. The microscopic findings include markedly irregular end plates and end plate disruption with protrusion of disk ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1975-07-01 00:00:00
abstract:BACKGROUND:The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN)--so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capita...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-012-2339-y
更新日期:2012-08-01 00:00:00
abstract::Pathologic fractures of the proximal femur secondary to benign bone tumors often are difficult to treat because of specific anatomic features of this region and the aggressiveness of the tumors. Between 1986 and 1996, 11 patients presented with a pathologic fracture of the proximal femur secondary to a benign bone tum...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200112000-00032
更新日期:2001-12-01 00:00:00
abstract:BACKGROUND:Limb salvage surgery has evolved to become the standard method of treating sarcomas of the extremities with acceptable oncologic results. However, little information exists relative to the activity level or ability to participate in sports after tumor reconstructions. QUESTIONS/PURPOSES:The aims of the stud...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-014-3622-x
更新日期:2015-03-01 00:00:00
abstract::Benign solitary schwannomas of the foot are a rare occurrence; only four cases have been previously reported. A schwannoma associated with the medial plantar nerve present for more than 40 years before the onset of symptoms was diagnosed in a 73-year-old man. Excision of the mass, with preservation of the involved ner...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-03-01 00:00:00
abstract::Use of the lowest possible cuff inflation pressure should minimize the pathogenic effects of compression beneath the pneumatic tourniquet. Curved tourniquets (designed to fit conically shaped limbs) and wider tourniquets were associated with significantly lower arterial occlusion pressure (AOP) than standard, straight...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-02-01 00:00:00
abstract::Proximal tibial osteotomy for degenerative genu varus and valgus has an excellent success rate with proper patient selection and technical proficiency. The following are some infrequently recognized pitfalls. Excessive bone loss prevents two plateau weight-bearing after osteotomy, introduces a "teeter effect," and is ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-197501000-00034
更新日期:1975-01-01 00:00:00
abstract::A consecutive series of 125 hybrid total hip arthroplasties were performed in 120 patients by a single surgeon and were observed for an average of 8.6 years (range, 7-11 years). There were 38 men and 82 women with an average age of 71 years (range, 25-87 years) at the time of surgery. The diagnoses included primary an...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1996-12-01 00:00:00
abstract::We report the case of an infected nonunion of the proximal femoral in an elderly patient. There was extensive involvement of the entire proximal femur precluding salvage. An impromptu use of a cephalomedullary nail coated with antibiotic-laden bone cement is described, followed by reimplantation with a revision-type p...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000238779.12069.e1
更新日期:2007-01-01 00:00:00
abstract::In 63 anatomic specimens of the shoulder, the coracohumeral ligament was found to be a clear, well-developed structure in 59 and absent or vestigial in four. The origin of the coracohumeral ligament was consistently found at the base of the coracoid process. The insertion was more variable, between the rotator interva...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-07-01 00:00:00
abstract::A study of skeletal development in X-linked hypophosphatemic (Hyp) mice revealed that radiographic characteristics of the disease appear as early as seven days after birth and that an unexpected transitory metaphyseal radio-opacity occurs in the long bones of the Hyp mice. Hyperostotic osteomalacia appears at the firs...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1981-11-01 00:00:00
abstract::Therapeutic radiation delivered to bone and the adjacent local tissues before allograft limb-salvage surgery has been associated with poor graft incorporation and higher numbers of clinical complications. Our objective was to determine the effect of preoperative radiation therapy on specific histologic, molecular and ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000165732.64757.bb
更新日期:2005-06-01 00:00:00
abstract::The regeneration of bone remains an elusive yet important goal in the field of orthopaedic surgery. Despite its limitations, autogenous cancellous bone grafting continues to the most effective means by which bone healing is enhanced clinically. Biosynthetic bone grafts currently are being developed as an alternative t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-199910001-00011
更新日期:1999-10-01 00:00:00
abstract::In 20 patients, the torn posterior cruciate ligament (PCL) was repaired without reinforcement within two weeks after injury. Fourteen patients had a midsubstance tear, and in six the ligament was avulsed from the femur without bone. There were 11 isolated and nine combined injuries. The follow-up period ranged from tw...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Major disadvantages of antibiotic bone cements include limited drug release and reduced strength resulting from the addition of high doses of antibiotics. Bacterial cellulose, a three-dimensional hydrophilic mesh, may retain antibiotics and release them gradually. We hypothesized that the addition of cellulo...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1626-8
更新日期:2011-02-01 00:00:00
abstract::Sodium hyaluronate (HA) with a molecular weight of 202 x 10(4) (HA-202) was administered into the right knees of mature rabbits for the treatment of experimental osteoarthrosis induced by resection of the anterior cruciate ligament. At six and 12 weeks after the initiation of administration, the test group was compare...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1994-01-01 00:00:00
abstract::Seventy-five adults who sustained 76 tibial plateau fractures were treated according to a prospective protocol using instability in extension as the principal indication for operative fixation. Patients showing instability underwent closed manipulative reduction under fluoroscopic guidance. If significant joint depres...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199706000-00007
更新日期:1997-06-01 00:00:00
abstract::Sixteen porous polysulfone-coated canine femoral stems were inserted into 14 dogs. Coatings were approximately 40% porous, with an average pore size of 125 or 250 microns. Bone was formed within at least about 30% of the surface pores of the implants. The tissue ingrowths filling the pores included marrow and fibrous ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-06-01 00:00:00
abstract::Trauma remains a significant and persistent public health problem, accounting for 90,000 deaths and 20 million people disabled annually. Current concepts of appropriate triage and emergency treatment of gunshot wounds are addressed from a trauma surgeon's perspective. Recent studies regarding prehospital transport pol...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200303000-00006
更新日期:2003-03-01 00:00:00
abstract::Epiphyseal stapling is considered a safe, effective method of correcting angular deformities of the knee in growing children. A study of the underlying biochemical events would contribute to a better understanding of the control of longitudinal growth rate in epiphyseal growth plates and of the molecular pathology of ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-05-01 00:00:00
abstract::The annual wear rate in polyethylene articulations should be 0.1 mm or less to avoid future osteolysis. Highly cross-linked polyethylene shows an 80 to 90% wear reduction in hip simulator testing, but the clinical documentation of this new polyethylene is still inadequate. We evaluated the highly cross-linked polyethy...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验,评审
doi:
更新日期:2004-12-01 00:00:00
abstract::Despite the implication that mechanical overload is fundamental to the development of plantar fasciitis, gait analysis has revealed inconsistent findings regarding its effect on lower limb loading. The aim of the current study was to evaluate the regional vertical ground reaction force in patients with and without pla...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000057989.41099.d8
更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:Clinical research in orthopaedics typically reports the presence of an association after rejecting a null hypothesis of no association using an alpha threshold of 0.05 at which to evaluate a calculated p value. This arbitrary value is a factor that results in the current difficulties reproducing research fin...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/CORR.0000000000000843
更新日期:2019-10-01 00:00:00
abstract::A retrospective review was performed on 20 patients treated at the authors' hospital between 1961 and 1981 with noninfected nonunions following primary open reduction and internal fixation (ORIF) of intertrochanteric femoral fractures. All patients were available for follow-up examination. Each patient was interviewed...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-05-01 00:00:00
abstract::During the past 30 years, the orthopaedic oncology group at the Massachusetts General Hospital has treated 648 patients with osteosarcoma centrally located in the bone. Using records maintained in a specifically designed computer system, a study was done to assess the factors that seemed to influence the survival outc...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000145991.65770.e6
更新日期:2004-12-01 00:00:00