evaluation of spinal ligamentous injuries by steven p brownstein md in

7/24/2019 Evaluation of Spinal Ligamentous Injuries by Steven P Brownstein MD in

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Ertfep _fmunateh Epml Akkmss D 1(1)4 E_EAD.N[.J@.=====1 (?21=) 221

Aostrakt

Jltreùktjel4[pjlah Hjcanmlt jldury js wmhh ekunmltm` te om elm tfm nest kennel jldurjms jl a trauna. Jt js ahse wmhh ekunmltm` tfat,

`mpml`jlc upel tfm cra`m (smrjeuslmss) ei tfm jldury, tfmy kal tagm up te ? ymars te fmah al` favm `jiimrmlt trmatnmlt pretekehs. Zmt jt smmns

imw ekters attmnpt te akkuratmhy cra`m tfm jldury akker`jlc te nm`jkah cuj`mhjlms mvml wfmrm spmkjjk cuj`mhjlms mxjst. Pfm kru`m al` varyjlc

nmtfe`s te assmss tfm jldury prevj`m` hjtthm kelsmlsus. Pfjs stu`y sfews tfat prmkjsm akkuratm cra`jlc ei spjlah hjcanmlt jldury kal om omst

eotajlm` oy a`valkm` kenputmrjzm` nmtfe`s ier nmasurjlc x-rays, wfjhm keliernjlc te kurrmlt ANA jldury cuj`mhjlms. Elm Ful`rm` ralèn

kasms ei spjlah jldury wmrm assmssm` oy usuah vjsuah jlspmktjel ei strmss x-rays oy ra`jehecjsts, tfml rm-assmssm` oy kenputmr nmasurmnmlt.

_msuhts4 [jcljjkalt spjlah hjcanmlt jldury was akkuratmhy rmvmahm` oy kenputmr nmasurmnmlt tfat was njssm` oy tfm stalàr`

ra`jehecjkah rma`s.

Kelkhusjel4Assmssjlc spjlah hjcanmlt jldury oy kenputmr nmasurmnmlt sjcljjkalthy jnprevms jaclesjs al` cra`jlc ei hjcanmlt jldury.

Gmywer`s4 [pjlah Hjcanmlt Jldury7 Jltmrsmcnmltah Netjel [pjlah jlsstaojhjty7 Ahtmratjel ei netjel smcnmlt jltmcrjty (AEN[J)

Aoormvjatjels4ANA4 Anmrjkal Nm`jkah Assekjatjel7 AEN[J4 Ahtmratjel ei Netjel [mcnmlt Jltmcrjty7 K_NA4 Kenputmrjzm` _a`jecrapfjk

Nmlsuratjel Alahysjs

W3^. [pjlah hjcanmlt jldurjms wjhh rmnajl preohmnatjk ulhmss

jl`jlcs kal oetf om systmnjzm` al` qualtjjm` jl a kelsjstmlt,

hecjkah, al` akkuratm nallmr.

Pfm Anmrjkal Nm`jkah Assekjatjels (ANA) Cuj`ms te tfm

Mvahuatjel ei Rmrnalmlt Jnpajrnmlt W6^kal om usm` as a rmimrmlkm

oy prevj`jlc a stalàr`jzm`, eodmktjvm appreakf wfml mvahuatjlc

`jsaojhjty al` jnpajrnmlt W6^. Pfm [pjlah Jldury Ne`mh jlkhu`ms

a jaclesaohm kel`jtjel ei dejlt haxjty kahhm` ahtmratjel ei netjel

smcnmlt jltmcrjty (AEN[J) wfmrm mxakt spjlah ra`jecrapfjknmlsuratjel js usm` te j`mltjiy tfm smvmrjty ei dejlt jlstaojhjty.

Pfjs spjlah jnpajrnmlt kausm` oy spjlah hjcanmlt jldurjms js

j`mltjjm` let tfreucf pfysjkah mxanjlatjel out oy nmasurjlc

strmss V-ray jnacms (hmxjel al` mxtmlsjel). [jlkm tfjs mvahuatjel

usms stalàr`jzm`, eodmktjvm ra`jecrapfjk nmlsuratjel krjtmrja

al` prmkjsmhy nmasurm` strmss V-rays, jt preùkms al eppertuljty

te njljnjzm tfm a`vmrsarjah laturm ei tfm jldury tert armla wfml

attmnptjlc te ruhm jl er ruhm eut AEN[J. Sfml tfm prevj`mr immhs

tfat tfmrm nay favm omml a spjlah hjcanmlt jldury, AEN[J krjtmrja

arm usm` te ruhm jl er eut aly spjlah hjcanmlt jldury oy nmasurjlc

spjlah ra`jecrapfjk fypmrneojhjty al` arm krjtjkah jl`jlcs el ahh

spjlah jnpajrnmlt mxanjlatjels. Pfus, tfm nest prmkjsm jnacm

nmasurmnmlt prekmùrm js rmqujrm` te mlaohm pfysjkjals te nestakkuratmhy `jaclesm al` miimktjvmhy trmat patjmlts wjtf pajl iren

spjlah hjcanmlt jldurjms.

Jltreùktjel

Sfjhm senm patjmlts rmkevmr ulmvmltiuhhy iren a spjlm jldury,

a sjcljjkalt lunomr wjhh favm pajl wfjkf nay hast jl`mjljtmhy

W1,?^. Pfm rjsg ei `mvmhepjlc kfreljk pajl wjhh om jlkrmasm` ji

a pfysjkjal js ulaohm te jl` a pfysjkah kausm ei pajl jl tfmsm

patjmlts W;,0^. V-ray, KP, al` N_J skals arm reutjlmhy er`mrm`

te aj` pfysjkjals jl mvahuatjlc a patjmlt, out tfmsm jnacjlc

tmkfljqums arm eitml ulaohm te khmarhy sfew tfm rmah seurkm ei pajl

a``jlc ulkmrtajlty te wfat tfm kerrmkt `jaclesjs al` uhtjnatmhytfm prepmr keursm ei trmatnmlt js W?^.

Aitmr spjlah trauna, tfm hjcanmlts jl tfm spjlm nay om

ànacm` kausjlc hjcanmlteus jlstaojhjty rmsuhtjlc jl aolernah

jltmrsmcnmltah netjel. Mxkmssjvm dejlt netjel kausm` oy

spjlah hjcanmlt sprajls js a kausm ei akutm spjlm pajl al` js a

sjcljjkalt rjsg iakter ier `mvmhepjlc kfreljk pajl W=,9^. [mrjeus

jltmrsmcnmltah netjel preohmns arm reutjlmhy njssm` jl stalàr`

V-ray al` KP jltmrprmtatjels oy oear`-kmrtjjm ra`jehecjsts. Jl a

rmhatm` stu`y sfewjlc tfm lmm` te jnprevm akkuraky jl kurrmlt

ra`jehecjsts rma`s, Payher mt ah. W3^ kelkhu`m` tfat tfmrm js a lmm`

te rmùkm tfm suodmktjvjty ei rma`jlc nm`jkah jnacms al` jnprevm

acrmmnmlt ei tfm `jaclesjs omtwmml pfysjkjals W3^. Pfmy statm,Pfm stu`y rmjlierkms tfm lmm` ier ra`jehecjk spmkjahjsts te rmùkm

njssm` `jaclesms, njs`jaclesms, al` nm`jke-hmcah kenphjkatjels

[tmvml R Orewlstmjl N@*, Dmiirmy Krelg @K D@ al` Desmpf Kjeij OA

[pjlah Gjlmtjks al` @ylanjk Nm`jkah Jnacjlc, ][A

[uonjssjel4 Aucust 1:, ?21=7 Ruohjsfm`4 Aucust ?3, ?21=

*Kerrmspel`jlc autfer4[tmvml R Orewlstmjl, [pjlah Gjlmtjks, @ylanjk Nm`jkah Jnacjlc, :=2 Smst Kfmstlut [trmmt ]ljel, Lmw Dmrsmy 2326;,

][A, Pmh4 :26-963-?==?7 Mnajh4 spjlah-gjlmtjks.ken

Mvahuatjel ei [pjlah Hjcanmlteus Jldurjms

usjlc Kenputmrjzm` V-ray Jltmrprmtatjel

_msmarkf ArtjkhmYehunm 1 Jssum 1 - Aucust ?21=

Ertfep _fmunateh Epml Akkmss D

Kepyrjcft Ahh rjcfts arm rmsmrvm` oy [tmvml R Orewlstmjl


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Ertfepm`jks al` _fmunatehecy Epml Akkmss Deurlah

Few te kjtm tfjs artjkhm4Orewlstmjl [R, Dmiimrmy Krelg @K, Desmpf Kjei OA. Mvahuatjel ei [pjlah Hjcanmlteus Jldurjms usjlc Kenputmrjzm` V-ray

Jltmrprmtatjel. Ertfep _fmunateh Epml Akkmss D. ?21=71(1)4 =====1.22?

Kenputmrjzm` _a`jecrapfjk Nmlsuratjel Alahysjs (K_NA) js

al akkmptm` prekmùrm jl tfm Latjelah Cuj`mhjlms Khmarjlcfeusm

tfat kal prevj`m tfm nest usmiuh khjljkah jliernatjel al` kal om

masjhy utjhjzm` te nerm akkuratmhy j`mltjiy khjljkahhy sjcljjkalt

hjcanmlt jlstaojhjtjms. Jliernatjel prevj`m` oy K_NA kal assjst

èkters jl `mtmrnjljlc nerm iekusm` al` miimktjvm trmatnmlt

phals oy jnprevjlc tfm ul`mrstal`jlc ei tfm pajl seurkm jl tfm

patjmlt omjlc trmatm` al` kal sjcljjkalthy rmùkm tfm njssm`

`jaclesjs, njs`jaclesms, al` nm`jke-hmcah kenphjkatjels

assekjatm` wjtf tfjs jldury. Jl tfm stu`y kelùktm` oy Payher

mt ah. W:^ tfmy sfewm` tfm miimktjvmlmss al` rmhjaojhjty ei al

jltmrsmcnmltah netjel mxan usjlc phajl ra`jecrapfs wfml

kenojlm` wjtf K_NA tmkflehecy W:^. Pfm pfysjkjals hmvmh ei

acrmmnmlt el tfm prmsmlkm ei spjlah jlstaojhjty jlkrmasm` iren

13% te 33% iehhewjlc njljnah trajljlc wjtf K_NA omkausm jt

`ranatjkahhy jlkrmasm` tfmjr aojhjty te hekatm aolernah spjlah

netjel W:^.

Pfm iekus ei tfm kurrmlt mxpmrjnmlt was te tmst a oear`-

kmrtjjm` ra`jehecjsts aojhjty te j`mltjiy tfm nest smrjeus hmvmhs ei

hjcanmlt jlstaojhjty (dejlt haxjty) jl stalàr` kmrvjkah al` hunomr

wmjcft-omarjlc strmss V-ray stu`jms wjtfeut tfm usm ei K_NA.

Kasm [mhmktjel

Pfm purpesm ei tfjs kasm smhmktjel prekmss was te prevj`m

trauna kasms tfat weuh` lernahhy om rma` oy a ra`jehecjst. Pfm

kasms ei 122 patjmlts wfe wmrm prmvjeushy smlt te al eutpatjmlt

jnacjlc kmltmr ier a rmqumstm` K_NA jltmrsmcnmltah netjel

stu`y wmrm ralènhy smhmktm` iren twe eutpatjmlt nm`jkah

jnacjlc kmltmrs. Jl tfjs mxpmrjnmlt, =; kmrvjkah al` 03 hunoar

kasms wmrm usm`. Omsj`ms favjlc spjlm pajl assekjatm` wjtf akar akkj`mlt, tfmrm was le etfmr krjtmrja rmqujrm` ier a patjmlt

te om jlkhu`m` jl tfjs stu`y. Pfmrm was le kjrkunstalkm wfmrm a

patjmlt was ruhm` jlmhjcjohm te om jl tfjs mxpmrjnmlt.

Mxpmrjnmltah Nmtfe`s

Pe assmss a pfysjkjals aojhjty te j`mltjiy rataohm aneults

ei jltmrsmcnmltah netjel jl V-ray stu`jms, tfm kasms ei trauna

patjmlts wmrm rmvjmwm` oy a oear`-kmrtjjm` ra`jehecjst. Pfm

V-ray stu`jms prevj`m` keltajlm` tfm alahysjs ei jvm vjmw

kmrvjkah smrjms er jvm vjmw hunoar V-rays, wfjkf jlkhu`m` oetf

hmxjel al` mxtmlsjel jhns. Pfm jlvehvmnmlt jl a neter vmfjkhm

akkj`mlt al` assekjatm` pajl was tfm elhy fjstery supphjm` te tfm

ra`jehecjst. Sjtf tfjs fjstery, tfm ra`jehecjst was asgm` te usm

ahh lernahhy usm` nmtfe`s te fmhp `mtmrnjlm aolernah spjlm

nevmnmlts.

Pfm nmasurmnmlts eotajlm` oy K_NA `mtmrnjlm` tfm

smvmrjty ei tfm spjlah uljts netjel akker`jlc te tfm jnpajrnmlt

krjtmrja mstaohjsfm` jl tfm ANA =tfM`jtjel cuj`mhjlms. Akker`jlc

te tfm ANA =tf M`jtjel cuj`mhjlms, spjlah jlstaojhjty js rataohm

jl tfm kmrvjkah spjlm wfml tralshatjel jl elm vmrtmora js harcmr

tfal ;.=nn er fas alcuhar netjel crmatmr tfal 11. _ataohm

jnpajrnmlt ei tfm hunoar spjlm ekkurs wfml tfmrm js a tralshatjel

crmatmr tfal 0.=nn jl elm vmrtmora el aletfmr er wfml alcuhar

netjel mxkmm`s 1= at H1-?, H?;, er H;-0 hmvmhs, js crmatmr tfal

?2 at tfm H0-= hmvmh, er js crmatmr tfal ?= at tfm H=-[1 hmvmh.

Pfm jl`jlcs `mtmrnjlm` oy K_NA weuh` mvmltuahhy om usm`

te `mtmrnjlm tfm akkuraky ei tfm pfysjkjals aojhjty te `jaclesm

spjlah hjcanmlt jldurjms jl strmss V-rays.

_msuhts

Pfm oear`-kmrtjjm` ra`jehecjsts rmperts ei tfm smhmktm` V-ray

stu`jms sfewm` le stu`jms favjlc sjcljjkalt aneults ei spjlah

jlstaojhjty jl`jkatjvm ei spjlah hjcanmlt jldurjms. Le jl`jlcs ei

aolernah dejlt phay wmrm ieul` al` le uljts ei quahjjm` AEN[J

jltmcrjty wmrm rmpertm`.

Fewmvmr, K_NA `mtmrnjlm` iren tfm sanm V-ray smrjms

tfat tfmrm wmrm a kenojlm` 1:: netjel uljts tfat sfewm`

aolernah dejlt haxjty jl ahh 122 patjmlts. Jl ?0 patjmlts, tfmrm was

a tetah ei ?: jl`jlcs, ?? kmrvjkah al` 3 hunoar, ei rataohm spjlah

netjel aolernahjtjms tfat mxkmm`m` tfm nmlsuratjel tfrmsfeh`

ier AEN[J akker`jlc te tfm wj`mhy akkmptm` ANA = tf M`jtjel

cuj`mhjlms. Ei tfm rataohm kmrvjkah spjlm jl`jlcs, 1? rmsuhtm` iren

mxkmssjvm tralshatjel al` 12 wmrm ùm te alcuhatjel. Pfmrm was1 patjmlt wjtf ? rataohm kmrvjkah spjlm tralshatjel jl`jlcs. Pfmrm

wmrm ? patjmlts wjtf aolernah alcuhar netjel al` tralshatjel

jl tfm kmrvjkah spjlm. Pfmrm wmrm ? rataohm hunoar jl`jlcs ùm

te tralshatjel al` tfm etfmr = wmrm iren mxkmssjvm alcuhatjel.

Pfmrm was 1 patjmlt tfat fa` mxkmssjvm hunoar tralshatjel al`

alcuhar netjel prmsmlt.

@jskussjel

Pfjs stu`y was msjclm` te tmst a ra`jehecjsts aojhjty te hekatm

spjlah hjcanmlt jldurjms jl trauna kasms. [pjlah hjcanmlt jldurjms

arm al eitml evmrheegm` pfysjkah kausm ei teàys wmhh puohjkjzm`

kfreljk spjlah pajl al` jnpajrnmlt preohmn. Akker`jlc te

rmsmarkf, naly patjmlts wjtf kfreljk spjlah pajl è let favma patfealatenjk `jaclesjs, out ratfmr favm a `jaclesjs ei lel-

spmkjjk nmkfaljkah lmkg er oakg pajl W12^.

Mvml wjtf a`valkm` al` jnprevm` jnacjlc tmkflehecy, tfm

nest preohmnatjk arma jl `jaclesjlc hjcanmlteus jldurjms js

tfm suodmktjvjty ei tfm jnacjlc stu`y preimssjelah rma`. Payher

mt ah.s W:^ stu`y sfewm` tfat tfm suodmktjvjty js se harcm tfat

elm preimssjelah ra`jehecjst irmqumlthy says tfmrm js sjcljjkalt

patfehecy el tfm stu`y wfjhm aletfmr rmpert succmsts tfat tfmrm js

letfjlc ei aly sjcljjkalkm at ahh W:^. Sjtfeut a smparatm spmkjahty

alahysjs pmriernm` tfreucf K_LJA tmkflehecy, tfmsm kel`jtjels

weuh` favm celm njs`jaclesm` er ul`jskevmrm`.

Ahh tfm `jiimrmlt typms ei nm`jkah jnacjlc tmkfljqums arm

kennelhy akkmptm` `jaclestjk prekmùrms tfat favm omml

utjhjzm` ier `mka`ms. [enm favm khajnm` tfat V-ray, KP, al` N_J

skals arm cmlmrahhy let usmiuh jl tfm mvahuatjel ei kfreljk hew

oakg pajl W?,11^. Out tfjs js omkausm spjlah hjcanmlt jldurjms arm

nesthy njssm` ùm te jla`mquatm ra`jecrapfjk jltmrprmtatjel

W1?,1;^. Sfml mvahuatjlc kel`jtjels kausjlc spjlm pajl, tfmjr

miimktjvmlmss js hjnjtm` oy few tfm jnacm js assmssm`. Pfmsm

jnacjlc tmkfljqums eitml iajh te j`mltjiy aly petmltjah seurkm ei

pajl er kausm senm cress aolernahjty, wfjkf js let aktuahhy tfm

kausm ei tfm patjmlts pajl, te om keliusm` wjtf tfm rmah seurkm

ei pajl W10^. Jltmrsmcnmltah netjel preohmns arm njssm` oy

ra`jehecjsts omkausm tfmrm js le way te akkuratmhy qualtjiy

aolernah spjlah netjel jl tfmsm kasms oy sjnphy heegjlc at jhns


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Ertfepm`jks al` _fmunatehecy Epml Akkmss Deurlah

Few te kjtm tfjs artjkhm4Orewlstmjl [R, Dmiimrmy Krelg @K, Desmpf Kjei OA. Mvahuatjel ei [pjlah Hjcanmlteus Jldurjms usjlc Kenputmrjzm` V-ray

Jltmrprmtatjel. Ertfep _fmunateh Epml Akkmss D. ?21=71(1)4 =====1.22;

wjtf tfm funal mym wfjkf js a kennel praktjkm teày. Sjtfeut

al jltmrsmcnmltah netjel stu`y vja K_NA, phajl ra`jecrapfs

armlt omjlc usm` te tfmjr iuhhmst petmltjah wfml jaclesjlc spjlm

jldurjms.

Oasm` el tfm kurrmlt hmvmh ei glewhm`cm usm` jl `jaclesjlc

spjlah hjcanmlt jldurjms teày, tfmrm arm le jl`jkatjels tfat aly

etfmr ra`jehecjst weuh` favm cettml aly sjcljjkalthy `jiimrmlt

rmsuhts tfal tfm pfysjkjal tfat was a part ei tfjs stu`y. Jl

acrmmnmlt wjtf tfm rmsuhts ei Payher mt ah.s W:^ stu`y, tfmrm js

le mvj`mlkm suppertjlc tfat nerm er `jiimrmlt ra`jehecjsts

weuh` favm omml aohm te akkuratmhy al` kelsjstmlthy j`mltjiy

spjlah hjcanmlt jldurjms. Pfm akkuraky jl `jaclesjlc spjlah

hjcanmlt jldurjms js dust let imasjohm wjtfeut tfm hmvmh ei

prmkjsjel kenputmrs kal eotajl jl jts nmasurmnmlts. Payher mt

ah. W:^ sfewm` jl tfmjr stu`y tfat jltmrsmcnmltah dejlt haxjty js

nest akkuratmhy nmasurm` wjtf tfm usm ei kenputmr assjstm`tmkflehecy W:^. Fewmvmr, nest ra`jehecjsts è let favm akkmss te

K_NA tmkflehecy tfat kal assjst tfmn jl `jaclesm smvmrm hmvmhs

ei dejlt haxjty nest akkuratmhy al` kelsjstmlthy.

Kelkhusjel

Mvml wjtf cuj`mhjlms ahrma`y mstaohjsfm`, tfmrm js stjhh le

rmsehutjel ei `mtmrnjljlc wfe js jldurm` al` te wfat hmvmh ei

smvmrjty. Pfm eovjeus patf te nerm miimktjvm trmatnmlt ei spjlah

pajl hjms wjtf jnprevjlc tfm akkuraky ei `jaclestjk tmkfljqums.

Pfm ul`mrstal`jlc ei AEN[J js ei hjtthm vahum ji tfm jl`jlcs arm

jlfmrmlthy omjlc njssm` jl nest ji let ahh ra`jecrapfjk rma`s. Pfm

K_NA prekmùrm eiimrs a stalàr`jzm` spjlah njsahjclnmlt al`

jltmrsmcnmltah netjel krjtmrja ier rmpertjlc AEN[J al` etfmraolernah statms ei tfm spjlah netjel uljt. K_NA ahse mlaohms

spjlah hjcanmlt jldurjms te om rmpertm` jl a nallmr tfat ahh

preimssjels kal utjhjzm ier nerm akkuratm `jaclesjs al` omttmr

trmatnmlt ratjelahms. Pfm narcjl ei mrrer jl jltmrsmcnmltah

netjel nmasurmnmlt al` tfm wj`m ralcm ei `jsacrmmnmlt

weuh` om sjcljjkalthy rmùkm`, ahhewjlc ier a nukf nerm

akkuratm assmssnmlt ei tfm `mcrmm ei spjlah hjcanmlt jldurjms.

Pfmrmierm, K_NA sfeuh` om a krjtjkah teeh usm` te ruhm jl er ruhm

eut aly patjmlt suspmktm` ei favjlc a spjlah hjcanmlt jldury

tfat js kausjlc jnpajrnmlt al` mjtfmr akutm er kfreljk pajl.

Pfjs stu`y sfews tfm jlkrm`johm lmm` ier a smparatm al` `jstjlkt

jltmrsmcnmltah netjel stu`y te om pmriernm` oy al mùkatm`

al` trajlm` oear`-kmrtjjm` ra`jehecjst usjlc K_NA tmkflehecy.A hecjkah al` systmnatjk appreakf te a stalàr`jzm` spjlah

hjcanmlt mvahuatjel prekmùrm sfeuh` jlkhu`m a smparatm K_NA

prekmùrm. Le prevj`mr sfeuh` om wjtfeut tfjs assmssnmlt. Pfjs

hjlm ei stu`y wjhh rmqujrm nerm rmsmarkf jl tfm iuturm, out K_NA

tmkflehecy kal om usm` te rmùkm tfm lunomr ei patjmlts wjtf

spjlah hjcanmlt jldurjms tfat arm ul`jaclesm` er njs`jaclesm`.

_mimrmlkms

1. [kfeiimrnal D, Oecùg L, [hesar R (?223) Kfreljk Sfjphasf al`

Sfjphasf-Assekjatm` @jser`mrs4 Al Mvj`mlkm-Oasm` Appreakf. D An

Aka` Ertfep [urc 1=(12)4 =:9-929.

?. Kewal R, Gmhhy L, Kfeu _ (?226) Kelsunmrs Cuj`m Rraktjkm Cuj`mhjlms

ier Hew Oakg Rajl. Anmrjkal Kfreljk Rajl Assekjatjel, Kahjierlja,

][A, p4 =-3.

;. Kfeu _, Fuiinal HF (?22:) Khjljkah Cuj`mhjlm ier tfm Mvahuatjel al

Nalacmnmlt ei Hew Oakg Rajl. Anmrjkal Rajl [ekjmty, Chmlvjmw,

Jhhjlejs, ][A.

0. Darvjg DC, @mye _A (?22?) @jaclestjk mvahuatjel ei hew oakg pajl wjtf

mnpfasjs el jnacjlc. All Jltmrl Nm` 1;3(3)4 =69-=:3.

=. Raldaoj NN (?229) A fypetfmsjs ei kfreljk oakg pajl4 Hjcanmlt

suoiajhurm jldurjms hma` te nuskhm keltreh `ysiulktjel. Mur [pjlm D

1=(=)4 996-939.

9. Cjhms HCI, Nuhhmr _, Sjltmr CD (?229) Hunoesakrah `jsk ouhcm

er pretrusjel succmstm` oy hatmrah hunoesakrah phajl x-ray jhn-

prmhjnjlary rmsuhts. D Oelm Dejlt [urc Or 66-O4 0=2.

3. Payher DA, Kheptel R, Oeskf M, Njhhmr GA, Narkmhjs [ (1::=)

Jltmrprmtatjel ei aolernah hunoesakrah spjlm ra`jecrapfs. A tmst

kenparjlc stu`mlts, khjljkjals, ra`jehecy rmsj`mlts, al` ra`jehecjsts

jl nm`jkjlm al` kfjrepraktjk. [pjlm (Rfjha Ra 1:39) ?2(12)4 1103-

11=;.

6. Anmrjkal Nm`jkah Assekjatjel (?222) Cuj`ms te tfm Mvahuatjel ei

Rmrnalmlt Jnpajrnmlt (9tf

m`l), pc. ;3:.

:. Payher N, Fjpp DA, Cmrtsomjl [@, Cepjlatf [, _mjtnal K (?223)

Eosmrvmr acrmmnmlt jl assmssjlc hmxjel-mxtmlsjel x-rays ei tfm

kmrvjkah spjlah wjtf al` wjtfeut tfm usm ei qualtjtatjvm nmasurmnmlts

ei jltmrvmrtmorah netjel. [pjlm D 3(9)4 9=0-9=6.

12.Narras S[ (?223) Pfm Sergjlc Oakg4 A [ystmns Yjmw. Gjl`hm M`jtjel.

Sjhmy-Jltmrskjmlkm 16(0)4 021.

11._ekgmy RF, Penpgjls _G, See` _S, Sehkett OS (1:36) Pfm

usmiuhlmss ei x-ray mxanjlatjels jl tfm mvahuatjel ei patjmlts wjtf

oakg pajl. D Ian Rrakt 3(;)4 0==-09=.

1?.Perrmttj DA, [mlcupta @G (?223) Kmrvjkah [pjlm Prauna. Jl`jal D

Ertfep 01(0)4 ?==-?93.

1;._mj` @K, Fml`mrsel _, [aoem H, Njhhmr D@ (1:63) Mtjehecy al` khjljkahkeursm ei njssm` spjlm irakturms. D Prauna ?3(:)4 :62-:69.

10.@mye _A, Njrza [G, Purlmr DA, Nartjl OJ (?22:) Evmrtrmatjlc Kfreljk

Oakg Rajl4 Pjnm te Oakg eii5 D An Oear` Ian Nm` ??(1)4 9?-96.
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