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
BACKGROUND Trochlear dysplasia(TD)is the most prevalent risk factor of recurrent patellar dislocation(RPD).Surgeons remain hesitant to perform open trochleoplasty even in severe TD,due to high complication rates.A goa...BACKGROUND Trochlear dysplasia(TD)is the most prevalent risk factor of recurrent patellar dislocation(RPD).Surgeons remain hesitant to perform open trochleoplasty even in severe TD,due to high complication rates.A goal to reduce complications underlies the development of arthroscopic trochleoplasty.Our method,precise arthroscopic mini-trochleoplasty(PAM trochleoplasty),involves minimal osteotomy and damage to patellofemoral joint.Medial patellofemoral ligament reconstruction(MPFLR)is the most frequently selected safe procedure for RPD treatment.MPFLR is associated with low complication rates.No prior study has compared outcomes and complications between combined arthroscopic trochleoplasty with MPFLR and isolated MPFLR in RPD treatment.AIM To compare outcomes and complications,at 2-year follow-up in patients who underwent either combined PAM trochleoplasty with MPFLR or isolated MPFLR.METHODS Thirty patients who underwent PAM+MPFLR,and 20 patients isolated MPFLR were included.Clinical outcomes assessment consisted of patient-reported outcome measure scores(PROMs),including visual analog scale(VAS),International Knee Documentation Committee(IKDC)score,Knee Injury and Osteoarthritis Outcome Score(KOOS),Lysholm score,and Tegner activity score,and complications.Subgroups of cases with type B TD of Dejour classification were assessed.Radiological evaluation included tibial tubercletrochlear groove(TT-TG)distance,lateral trochlear inclination(LTI),and lateral patellar tilt(LPT).RESULTS PAM+MPFLR group demonstrated more severe multiple dysplasia compared to MPFLR group(P0.05).However,MPFLR group demonstrated significantly higher IKDC and Tegner scores(P0.05).CONCLUSION Both PAM+MPFLR and isolated MPFLR result in favorable clinical outcomes and comparable complication rates.These findings suggest PAM+MPFLR may be considered as an option for treating RPD with severe TD.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
目的基于MRI诊断探讨不同程度青少年膝关节运动损伤(knee sport injury,KSI)的相关因素。材料与方法回顾性收集2022年6月至2024年6月432例12~18岁青少年的影像学资料和临床信息,按膝关节损伤程度分为正常组(n=174,MRI无结构性损伤)、低...目的基于MRI诊断探讨不同程度青少年膝关节运动损伤(knee sport injury,KSI)的相关因素。材料与方法回顾性收集2022年6月至2024年6月432例12~18岁青少年的影像学资料和临床信息,按膝关节损伤程度分为正常组(n=174,MRI无结构性损伤)、低级别损伤组(n=146,软骨Ⅰ~Ⅱ级损伤、半月板Ⅰ~Ⅱ级损伤或韧带部分撕裂)和高级别损伤组(n=112,软骨Ⅲ~Ⅳ级损伤、半月板Ⅲ~Ⅳ级损伤、韧带完全断裂或骨折)。对年龄、性别、身体质量指数(body mass index,BMI)、运动习惯(佩戴护具及适宜鞋服、运动前热身、科学训练计划、运动后拉伸)、损伤史、盘状半月板、股骨滑车发育不良等影像及临床指标,采用Kruskall-Wallis H检验和χ2检验对临床及影像指标进行单因素分析,筛选差异有统计学意义的变量,再以多项logistic回归分析膝关节不同损伤程度的相关因素。结果高级别损伤组住院和手术比例高于低级别损伤组和正常组(P<0.05);高级别损伤组膝关节异常症状比例高于其他两组(P<0.05);多项logistic回归分析显示:运动中佩戴护具、穿适宜的运动鞋以及运动服和运动前热身是青少年膝关节运动中的保护因素(P<0.05),盘状半月板和有损伤史是青少年膝关节运动中的危险因素(P<0.05),而滑车发育不良更倾向于发生低级别的损伤(P<0.05)。结论本研究通过不同损伤程度分级,分析了青少年膝关节运动损伤的相关因素:佩戴护具、适宜运动鞋和充分热身是保护因素;盘状半月板、损伤史是危险因素;滑车发育不良则与低级别损伤相关。展开更多
Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehen...Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehensive measure of its severity. In this study, we designed the Ocular Motor Nerve Palsy Scale and investigated its validity and reliability. Six experts were invited to grade and evaluate the scale. The study recruited 106 patients with a definite diagnosis of unilateral isolated ocular motor nerve palsy. Three physicians evaluated the patients using the scale. One of the three physicians evaluated the patients again after 24 hours. The content validity index(CVI) and factor analysis were used to analyze the scale's construct validity. The intraclass correlation coefficient and Cronbach's alpha were used to evaluate the inter-rater and test-retest reliability and the internal consistency. The CVI results(I-CVI = 1.0, S-CVI = 0.9, Pc = 0.016, K* = 1) indicated good content validity. Factor analysis extracted two common factors that accounted for 85.2% of the variance. Furthermore, the load value of each component was above 0.8, indicating good construct validity. The Ocular Motor Nerve Palsy Scale was found to be highly reliable, with an inter-rater reliability intraclass correlation coefficient of 0.965(P 0.01), a test-retest reliability intraclass correlation coefficient of 0.976(P 0.01), and Cronbach's alpha values of 0.63–0.70. In conclusion, the Ocular Motor Nerve Palsy Scale with good validity and reliability can be used to quantify the severity of ocular motor nerve palsy. This study was registered at Chinese Clinical Trial Registry(registration number: Chi CTR-OOC-17010702).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
AIM: To investigate a possible trigeminal proprioceptive- oculomotor neural pathway and explore possible synaptic connections between neurons in this pathway. Attempt to bring a new insight to mechanism of Marcus Gun...AIM: To investigate a possible trigeminal proprioceptive- oculomotor neural pathway and explore possible synaptic connections between neurons in this pathway. Attempt to bring a new insight to mechanism of Marcus Gunn syndrome (MGS). METHODS: Anterograde and retrograde tract tracing was applied and combined with immunofluorescent stain in rats. After electrophysiological identifying mesencephalic trigeminal nucleus (Vine) neurons, intracellular injection of tracer was performed to trace axon trajectory. RESULTS: Following injections of anterograde tracers into the Vine, labeled terminals were observed ipsilateral in oculomotor and trochlear nuclei (Ill/IV), as well as in their premotor neurons in interstitial nucleus of Cajal and Darkschewitsch nucleus (INC/DN). Combining with choline acetyltransferase (CHAT) immunofluorescent stain, it showed that Vme projecting terminals contact upon ChAT positive Ill/IV motoneurons under confocal microscope. By retrograde labeling premotor neurons of the III, it showed that Vme neuronal terminals contact with retrogradely labeled pre-oculomotor neurons in the INCIDN. Axons of intraceiiularly labeled Vme neurons that respond to electric stimuli of the masseter nerve traveled into the ipsilateral III. CONCLUSION: There may exist a trigeminal propdoceptive- oculomotor system neural circuit in the rat, which is probably related to vertical-torsional eye movements. Possible association of this pathway with MGS etiology was discussed.展开更多
摘要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.
摘要BACKGROUND Trochlear dysplasia(TD)is the most prevalent risk factor of recurrent patellar dislocation(RPD).Surgeons remain hesitant to perform open trochleoplasty even in severe TD,due to high complication rates.A goal to reduce complications underlies the development of arthroscopic trochleoplasty.Our method,precise arthroscopic mini-trochleoplasty(PAM trochleoplasty),involves minimal osteotomy and damage to patellofemoral joint.Medial patellofemoral ligament reconstruction(MPFLR)is the most frequently selected safe procedure for RPD treatment.MPFLR is associated with low complication rates.No prior study has compared outcomes and complications between combined arthroscopic trochleoplasty with MPFLR and isolated MPFLR in RPD treatment.AIM To compare outcomes and complications,at 2-year follow-up in patients who underwent either combined PAM trochleoplasty with MPFLR or isolated MPFLR.METHODS Thirty patients who underwent PAM+MPFLR,and 20 patients isolated MPFLR were included.Clinical outcomes assessment consisted of patient-reported outcome measure scores(PROMs),including visual analog scale(VAS),International Knee Documentation Committee(IKDC)score,Knee Injury and Osteoarthritis Outcome Score(KOOS),Lysholm score,and Tegner activity score,and complications.Subgroups of cases with type B TD of Dejour classification were assessed.Radiological evaluation included tibial tubercletrochlear groove(TT-TG)distance,lateral trochlear inclination(LTI),and lateral patellar tilt(LPT).RESULTS PAM+MPFLR group demonstrated more severe multiple dysplasia compared to MPFLR group(P0.05).However,MPFLR group demonstrated significantly higher IKDC and Tegner scores(P0.05).CONCLUSION Both PAM+MPFLR and isolated MPFLR result in favorable clinical outcomes and comparable complication rates.These findings suggest PAM+MPFLR may be considered as an option for treating RPD with severe TD.
基金ThisstudywassupportedbyagrantfromtheChineseNationalNaturalScienceFoundation (No .3 0 0 0 0 170 )
摘要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.
摘要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。
摘要目的基于MRI诊断探讨不同程度青少年膝关节运动损伤(knee sport injury,KSI)的相关因素。材料与方法回顾性收集2022年6月至2024年6月432例12~18岁青少年的影像学资料和临床信息,按膝关节损伤程度分为正常组(n=174,MRI无结构性损伤)、低级别损伤组(n=146,软骨Ⅰ~Ⅱ级损伤、半月板Ⅰ~Ⅱ级损伤或韧带部分撕裂)和高级别损伤组(n=112,软骨Ⅲ~Ⅳ级损伤、半月板Ⅲ~Ⅳ级损伤、韧带完全断裂或骨折)。对年龄、性别、身体质量指数(body mass index,BMI)、运动习惯(佩戴护具及适宜鞋服、运动前热身、科学训练计划、运动后拉伸)、损伤史、盘状半月板、股骨滑车发育不良等影像及临床指标,采用Kruskall-Wallis H检验和χ2检验对临床及影像指标进行单因素分析,筛选差异有统计学意义的变量,再以多项logistic回归分析膝关节不同损伤程度的相关因素。结果高级别损伤组住院和手术比例高于低级别损伤组和正常组(P<0.05);高级别损伤组膝关节异常症状比例高于其他两组(P<0.05);多项logistic回归分析显示:运动中佩戴护具、穿适宜的运动鞋以及运动服和运动前热身是青少年膝关节运动中的保护因素(P<0.05),盘状半月板和有损伤史是青少年膝关节运动中的危险因素(P<0.05),而滑车发育不良更倾向于发生低级别的损伤(P<0.05)。结论本研究通过不同损伤程度分级,分析了青少年膝关节运动损伤的相关因素:佩戴护具、适宜运动鞋和充分热身是保护因素;盘状半月板、损伤史是危险因素;滑车发育不良则与低级别损伤相关。
基金supported by the National Natural Science Foundation of China,No.81674052
摘要Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehensive measure of its severity. In this study, we designed the Ocular Motor Nerve Palsy Scale and investigated its validity and reliability. Six experts were invited to grade and evaluate the scale. The study recruited 106 patients with a definite diagnosis of unilateral isolated ocular motor nerve palsy. Three physicians evaluated the patients using the scale. One of the three physicians evaluated the patients again after 24 hours. The content validity index(CVI) and factor analysis were used to analyze the scale's construct validity. The intraclass correlation coefficient and Cronbach's alpha were used to evaluate the inter-rater and test-retest reliability and the internal consistency. The CVI results(I-CVI = 1.0, S-CVI = 0.9, Pc = 0.016, K* = 1) indicated good content validity. Factor analysis extracted two common factors that accounted for 85.2% of the variance. Furthermore, the load value of each component was above 0.8, indicating good construct validity. The Ocular Motor Nerve Palsy Scale was found to be highly reliable, with an inter-rater reliability intraclass correlation coefficient of 0.965(P 0.01), a test-retest reliability intraclass correlation coefficient of 0.976(P 0.01), and Cronbach's alpha values of 0.63–0.70. In conclusion, the Ocular Motor Nerve Palsy Scale with good validity and reliability can be used to quantify the severity of ocular motor nerve palsy. This study was registered at Chinese Clinical Trial Registry(registration number: Chi CTR-OOC-17010702).
摘要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.
摘要AIM: To investigate a possible trigeminal proprioceptive- oculomotor neural pathway and explore possible synaptic connections between neurons in this pathway. Attempt to bring a new insight to mechanism of Marcus Gunn syndrome (MGS). METHODS: Anterograde and retrograde tract tracing was applied and combined with immunofluorescent stain in rats. After electrophysiological identifying mesencephalic trigeminal nucleus (Vine) neurons, intracellular injection of tracer was performed to trace axon trajectory. RESULTS: Following injections of anterograde tracers into the Vine, labeled terminals were observed ipsilateral in oculomotor and trochlear nuclei (Ill/IV), as well as in their premotor neurons in interstitial nucleus of Cajal and Darkschewitsch nucleus (INC/DN). Combining with choline acetyltransferase (CHAT) immunofluorescent stain, it showed that Vme projecting terminals contact upon ChAT positive Ill/IV motoneurons under confocal microscope. By retrograde labeling premotor neurons of the III, it showed that Vme neuronal terminals contact with retrogradely labeled pre-oculomotor neurons in the INCIDN. Axons of intraceiiularly labeled Vme neurons that respond to electric stimuli of the masseter nerve traveled into the ipsilateral III. CONCLUSION: There may exist a trigeminal propdoceptive- oculomotor system neural circuit in the rat, which is probably related to vertical-torsional eye movements. Possible association of this pathway with MGS etiology was discussed.