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Malignant tumors of the upper extremity are uncommon, and their care should be referred to specialized facilities with experience treating these lesions. The Musculoskeletal Tumor Society (MSTS) staging system is used by the surgeon to determine appropriate surgical management, assess prognosis, and communicate with other healthcare providers. Magnetic resonance imaging (MRI) is employed pre-operatively to identify a lesion's compartment of origin, determine extent of spread, and plan biopsy and resection approaches. Involvement of neurovascular structures may result in devastating loss of upper extremity function, requiring amputation. Violation of high-resistance compartmental barriers necessitates more extensive surgical resection. Biopsy may be performed by the radiologist using imaging guidance. Knowledge of compartmental anatomy allows the radiologist or surgeon to use an easily excisable biopsy approach and prevent iatrogenic spread to unaffected compartments. Case examples are presented to illustrate the importance of compartmental anatomy in the management of benign and malignant upper extremity tumors. [References: 22]

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恶性肿瘤上肢是罕见的，他们的照顾，应提交专门设施与经验处理这些病变。在肌肉骨骼肿瘤学会（ MSTS ）分期系统所使用的外科医生，以确定适当的手术治疗，评估预后，并与其他医疗保健机构。磁共振成像（ MRI ）受雇于术前确定病变的舱室的原产地，确定范围蔓延，并计划活检和切除的办法。参与神经结构可能会导致灾难性的损失，上肢功能，需要截肢。违反高电阻房室障碍需要更广泛的手术切除。活检可由放射使用成像制导。知识房室允许放射解剖或外科医生使用一种易于excisable活检的方法，防止医源性传播到不受影响舱室。实例说明介绍的重要性室解剖管理的良性和恶性上肢肿瘤。 [参考文献： 22 ]

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OBJECTIVE: Fractures of the proximal femur are common sequelae of osteoporosis, and are responsible for significant morbidity and mortality in elderly patients worldwide. Plain film radiographic assessment methods to assess for fracture risk may be of particular value. DESIGN AND PATIENTS: The authors present the results of biomechanical testing, radiographic imaging, and histologic exam of 20 embalmed human bone specimens, with implications for clinical correlation of radiologic findings. Authors assessed bone architecture using the Singh Index, using a blinded 3-rater system to reduce bias and measure intra-observer reliability. After loading to failure with ultimate tensile strength (UTS), bone specimens were assessed by fracture location type and by trabecular bone volume (TBV). RESULTS: Singh scoring was performed with Inter-Class Correlation of 0.80 (F=0.24, by ICC Portney Model 2). A statistically-significant difference among the UTS distributions was noted for UTS by Fracture Site (F=4.49, p=0.026, by ANOVA). No significant association of Singh Index with TBV, or TBV with UTS, was observed, although a trend toward greater UTS with higher Singh grade was observed. CONCLUSIONS: The authors propose that the Singh Index is a valuable and reliable indicator which may reflect structural integrity in trabecular bone. Fracture site along the femur is associated with tensile strength. The authors, in the light of these findings, address the promise and potential impact of prophylactic hip augmentation in populations at risk for femoral neck pathology.

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目的：骨折股骨近端是常见的后遗症，骨质疏松症，并有责任重大的发病率和死亡率在全世界老年患者。平片影像学评价方法，以评估骨折风险可能具有特别的价值。设计与患者：作者们提出的结果，生物力学测试， X光成像，并组织考试， 20人骨标本的防腐，具有影响的临床相关性的影像学研究结果。作者分摊骨结构使用Singh指数，采用双盲3评分系统，以减少偏见和衡量内部观察员可靠性。装货后要失败的抗拉强度（悉尼科技大学），骨标本进行评估骨折位置类型和骨小梁体积（ TBV ）。结果：辛格得分是用类间的相关性0.80性（ F = 0.24 ，国际商会Portney模型2 ）。阿统计学显着差异，强度分布指出的悉尼科技大学的骨折性（ F = 4.49 ， p值= 0.026 ，通过方差分析）。无显着性协会Singh指数与TBV ，或TBV与悉尼科技大学，与会者指出，虽然更大的趋势强度等级较高的辛格进行了观察。结论：作者提出，在Singh指数是一种宝贵的和可靠的指标可以反映结构完整的骨小梁。骨折沿股骨与抗拉强度。作者根据这些调查结果，处理的承诺和预防可能产生的影响在增加髋关节的人口处于危险之中股骨颈病理学。

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OBJECTIVE: To describe the patterns and note the evolution of edematous Schmorl's nodes. MATERIALS AND METHODS: In 47 patients (M:F=26:21, 24-86 years, average 60), 84 Schmorls nodes with T2 hyperintensity with serial MR exams were evaluated. Interval between MR exams was 2-72 months (average 17). Two observers noted size, location, margins, internal and surrounding T1/T2 signal, adjacent disc herniation or bulge, concentric ring, underlying fracture, malignancy, infection, or prior disc surgery, and serial MR changes in these characteristics over time. RESULTS: Node size averaged 7x9 mm. Most were located at L3 (29%, 24/84), L4 (19%, 16/84) and L2 (13%, 11/84), at the central (39%, 33/84) or outer (30%, 25/84) third of the endplate. 55% (39/71) had a bulging disc, 7% (5/71) had disc herniation. 10% (8/84) had evidence of associated fracture, 17% (14/84) tumor, 7% (6/84) infection. Most nodes had well-defined margins (82%, 69/84). The most common node internal signal was isointense to adjacent disc on T1/T2 (33%, 28/84); surrounding marrow was most commonly hypointense on T1 and hyperintense on T2 (54%, 38/71). A common finding was concentric rings (38%, 32/84) in the marrow surrounding the node, a finding which had 72% negative predictive value for absence of infection, tumor and fracture. On follow-up, there was no interval change in node size in 46%(39/84) of Schmorl's nodes. 26% (22/84) had increased size. Most (60%, 50/84) showed no temporal change in internal T2 signal. 21% (18/84) of nodes showed decreased internal T2 signal, 13% (11/84) showed increased T2 signal. Regarding the surrounding marrow, most (58%, 49/84) showed no temporal change in T2 signal; 21%(18/84) showed decreased T2 signal, 13% (11/84) showed increased T2 signal. In 13 Schmorl's nodes with intranodal enhancement, eight (62%) showed no interval change; among eight with enhancement in surrounding marrow, five (63%) showed no change on follow-up. CONCLUSION: Although most remain unchanged, a relatively large minority of edematous Schmorl's nodes evolve in size and signal over a relatively short time. Some evolve to form well-defined concentric rings in the surrounding marrow that appear to be analogous to degenerative changes of endplates. Concentric ring formation has a high negative predictive value for "idiopathic" Schmorl's nodes without underlying fracture, infection, or malignancy.

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目的：描述模式和说明的演变水肿许莫的节点。材料与方法： 47例（男：女= 26:21 ， 24-86岁，平均60岁）， 84 Schmorls节点时刻高串行磁共振考试进行了评价。问考试之间的间隔是2-72个月（平均17 ）。两名观察员指出大小，位置，边缘，内部和周围的T1/T2信号，邻近椎间盘突出或隆起，同心环，基本骨折，恶性肿瘤，感染，或事先椎间盘手术，和串行磁共振改变这些特征随着时间的推移。结果：节点大小平均7x9毫米。大多数人被安置在三级（ 29 ％，八十四分之二十四），腰椎（ 19 ％， 84分之16 ）和L2 （ 13 ％，八十四分之一十一），在中央（ 39 ％，八十四分之三十三）或外（ 30 ％，八十四分之二十五）三分之一的挡板。 55 ％（七十一分之三十九）有胀光盘， 7 ％（ 5 / 71 ）有椎间盘突出。 10 ％（ 8 / 84 ）有证据表明相关性骨折， 17 ％（ 84分之14 ）肿瘤， 7 ％（ 6 / 84 ）感染。多数节点已明确界定的利润率（ 82 ％， 84分之69 ）。最常见的节点内部信号isointense邻近光碟T1/T2 （ 33 ％， 84分之28 ） ;周边骨髓是最常见的低的T1和高在T2 （ 54 ％， 71分之38 ）。一个共同的结论是同心圆环（ 38 ％，八十四分之三十二）在骨髓周围的节点，发现其中72 ％的阴性预测值为没有感染，肿瘤和骨折。关于后续行动的，没有间隔的变化节点大小的46 ％（八十四分之三十九）的许莫的节点。 26 ％（八十四分之二十二）增加了规模。大多数（ 60 ％， 50/84 ）没有变化的内部时刻信号。 21 ％（八十四分之一十八）的节点显示减少内部时刻信号， 13 ％（八十四分之一十一）显示增加时刻信号。关于周边骨髓，大多数（ 58 ％， 84分之49 ）没有变化在T2信号; 21 ％（ 84分之18 ）显示减少时刻信号， 13 ％（ 84分之11 ）显示增加时刻信号。许莫在13日的节点intranodal增强， 8 （ 62 ％）无间隔变化;八之间加强周边骨髓， 5 （ 63 ％）没有变化的后续行动。结论：虽然大部分保持不变，一个比较大的少数水肿许莫的节点发展的规模和信号，在相对短的时间。一些发展，形成明确的同心圆环周围骨髓似乎类似于退行性改变的终板。同心环形成具有较高的阴性预测值为“特发性”许莫的节点，没有相应的骨折，感染，或恶性肿瘤。

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Migrating lumbar facet joint cysts.

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OBJECTIVE: The majority of lumbar facet joint cysts (LFJCs) are located in the spinal canal, on the medial aspect of the facet joint with characteristic diagnostic features. When they migrate away from the joint of origin, they cause diagnostic problems. MATERIALS AND METHODS: In a 7-year period we examined by computed tomography (CT) and magnetic resonance (MR) imaging five unusual cases of facet joint cysts which migrated from the facet joint of origin. RESULTS: Three LFJCs were identified in the right S1 foramen, one in the right L5-S1 neural foramen and one in the left erector spinae and multifidus muscles between the levels of L2-L4 spinous process. CONCLUSIONS: Awareness that spinal lesions identified at MRI and CT could be due to migrating facet joint cyst requires a high level of suspicion. The identification of the appositional contact of the cyst and the facet joint needs to be actively sought in the presence of degenerative facet joints.

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目的：大多数腰椎小关节囊肿（ LFJCs ）位于椎管，对内侧的关节诊断功能与特点。当他们迁移远离联合的原籍国，它们所造成的诊断问题。材料与方法： 7年期间，我们审查了计算机断层扫描（ CT ）和核磁共振（先生）成像五个不寻常的案件关节囊肿而迁移的小关节的原产地。结果： LFJCs确定了正确的一孔，一个正确的腰5 S1蛋白神经孔，一个在左边竖spinae和肌肉之间的multifidus水平的L2 -腰椎棘突。结论：认识到，确定脊髓病变MRI和CT可能是由于候鸟关节囊肿需要高度的怀疑。确定沉积联系囊肿和关节需要积极寻求存在退行性关节。

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OBJECTIVE: To describe the technique of obturator nerve block under CT guidance via the posterior approach, and to evaluate the efficacy of the procedure in the short-term and mid-term relief of chronic hip pain. DESIGN AND PATIENTS: Consecutive patients referred for obturator nerve block were prospectively enrolled in this study. Under CT-guidance, via a posterior approach through the pelvis, local anaesthetic and steroid were infiltrated around the obturator nerve using a 22G spinal needle. Fifty-one patients (19 male, 32 female), mean age 54 years, with hip pain refractory to conventional therapy underwent the procedure. Visual Analogue Scale pain scores were recorded before the procedure and at 30 minutes, 24 hours, 1 week and 3 months thereafter. RESULTS: Pain scores within 30 minutes showed a decrease from a mean +/- SD score of 8.41+/-1.22 pre-procedure to 2.86+/-2.1, p<0.001. At 24 hours, the mean pain score was 2.06+/-1.76, a decrease of 76% from pre-procedural score, p<0.001. Sustained pain relief at 1 week and 3 months was attained in 92% (mean pain score 2.41+/-2.2, p<0.001) and 82% (mean pain score 3.80+/-2.94, p<0.001) of cases respectively. Follow-up data was complete for all 51 patients. No serious side-effects were reported. CONCLUSIONS: In patients with hip pain refractory to conventional pain control measures, CT-guided obturator nerve block can provide relief from pain in the short to medium term. The posterior approach offers safe, reliable and effective access to the nerve, in a procedure which is well-tolerated by the patient.

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目的：描述技术闭孔神经阻滞CT引导下经后路和评价的程序，在短期和中期救济慢性髋关节疼痛。设计与患者：例提到的闭孔神经阻滞前瞻性参加这项研究。在CT引导，通过后路通过骨盆，局部麻醉和类固醇是渗透在闭孔神经脊髓使用22G针。 51名患者（ 19男， 32女），平均年龄54岁，髋部疼痛难治接受常规治疗的程序。视觉模拟评分疼痛分数都记录的程序和30分钟， 24小时， 1周和3个月以后。结果：疼痛分数在30分钟内显示出下降，平均+ / -的SD评分的8.41 + / -1.22预审程序2.86 + / -2.1 ，磷“ 0.001 。在24小时内，平均疼痛评分为2.06 + / -1.76 ，下降了76 ％，由学前教育程序评分，磷“ 0.001 。持续疼痛1周和3个月达到92 ％（平均疼痛评分2.41 + / -2.2 ，磷“ 0.001 ）和82 ％（平均疼痛评分3.80 + / -2.94 ，磷” 0.001 ）例。随访资料已经完成对所有51例。无严重副作用的报告。结论：在患者的髋关节疼痛难治常规疼痛控制措施， CT引导下闭孔神经阻滞可以提供救济疼痛短期到中期。后方法提供安全，可靠，有效地利用神经，在这种程序是耐受性良好的耐心。

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Synovial sarcoma (SS) arises in soft tissues but may invade adjacent bone. We describe a case of SS presenting as aggressive lysis of the proximal ulna, the imaging of which suggested a primary bone lesion. Needle biopsy showed a "small round blue cell tumour", and a primitive neuroectodermal tumour (PNET)/Ewing sarcoma was suggested on the basis of the imaging appearances. The definitive diagnosis of synovial sarcoma was made following molecular genetic studies, which demonstrated a fusion product incorporating the genes SYT and SSX1. The importance of correct diagnosis to guide appropriate management, and, therefore, the necessity for molecular genetic studies, is discussed.

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滑膜肉瘤（不锈钢）中出现软组织，但可能侵入邻近骨。我们描述一个案件的SS提出咄咄逼人溶解近端尺骨，成像其中提出了原发性骨病变。穿刺活检显示， “小轮蓝细胞瘤” ，并且原始神经外胚层肿瘤（原始神经外胚层肿瘤） / Ewing肉瘤建议为基础的影像学表现。最终诊断为滑膜肉瘤后作出的分子遗传学研究，该产品表现出了融合基因SYT纳入和SSX1 。的重要性，正确的诊断，以指导适当的管理，因此，有必要的分子遗传学研究，进行了讨论。

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Lipoma arborescens is a rare entity of the synovium and frequently occurs in the joints. Lipoma arborescens involving the synovial sheaths of the tendons is exceedingly rare. We report a case of a 12-year-old girl with lipoma arborescence affecting the synovial sheaths of the peroneal, posterior tibialis, and flexor tendons. Identification of the typical features of fat tissues in the proliferative synovium on MRI may help in making a correct diagnosis. The clinical presentation and MRI findings are described, and the entity is briefly reviewed.

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脂肪瘤是一种罕见的乔木实体的滑膜和经常发生的关节。脂肪瘤立涉及滑膜鞘的肌腱是极其罕见的。我们报告一例12岁的女孩与脂肪树状影响滑液鞘的腓骨，胫骨后，和屈肌腱。鉴定典型特征的脂肪组织的增生滑膜的MRI可能有助于作出正确的诊断。临床表现及MRI表现说明，并简要回顾实体。

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We present a case of giant atypical ossifying fibromyxoid tumour (OFMT) of soft tissue, occurring in the calf, in a 77-year-old woman. The patient presented with a history of bleeding ulcer over a calf lump that had been present for over 4 years. Clinical presentation, radiological features and histopathologic findings are described, and the relevant literature is reviewed.

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本病例的巨大非典型骨化纤维瘤（ OFMT ）的软组织，发生在小腿，在一个77岁的女子。病人与历史的出血性溃疡超过小腿肿块目前已超过4年。临床表现，影像学特点和病理结果说明，以及有关的文献回顾。

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Patients who present with slowly growing extremity masses are often imaged with MRI to be examined for possible tumors. In addition to cysts and neoplasms, chronic expanding hematomas should be considered in the differential diagnosis if the patient has a history of remote trauma. The presence or absence of internal contrast enhancement is often used to distinguish between hematomas and hemorrhagic neoplasms on MRI and CT. We present the unusual case of a patient who had a chronic expanding hematoma of the calf that demonstrated nodular internal enhancement on gadolinium-enhanced MRI, simulating a neoplasm.

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谁与患者目前缓慢增长的肢体群众往往成像与MRI进行审查可能肿瘤。此外，囊肿和肿瘤，慢性血肿扩大，应考虑的鉴别诊断如果病人在偏远的历史创伤。是否存在内部对比增强通常用来区分血肿和出血性肿瘤的MRI和CT 。我们本不寻常的情况下谁的病人有慢性扩展血肿小腿表明结节内部加强对钆增强MRI ，模拟肿瘤。

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