动态DR多角度扫描技术在膝关节负重位检查中的临床应用价值

【摘要】目的：探讨动态DR多角度扫描技术在膝关节负重位检查中的临床应用价值。方法：搜集行膝关节负重位下动态DR多角度扫描的105例患者,105例患者均常规摄膝关节正侧位DR片。由2位副主任医师、1位主治医师、2位主管技师及1位工程师共同阅片,对图像进行评价。结果：105例患者的检查图像均能满足临床诊断要求。与常规DR片相比,负重位动态DR多角度扫描可获得三维影像,骨性关节面下囊性改变较常规DR片多显示5例,关节间隙变窄多显示32例,骨性关节面改变多显示28例,两者均显示正常14例。29.5%病例的动态DR多角度扫描检出了常规DR未能检出的病灶,57.1%病例的多角度动态DR扫描显示的病损情况较常规DR严重,能更真实地反映关节病情变化,常规DR与负重位多角度动态DR对病变的显示情况差异有统计学意义（P＜0.05）。结论：负重位动态多角度扫描技术将DR图像由二维扩展到三维,明显提高了病变检出率,能更真实反映关节病损情况,特别是关节骨性关节面与间隙改变及关节面下小囊状病损情况,有较好的临床应用前景。     

先天性尺桡骨融合伴桡骨头脱位1例

病例女,37岁,因＂自幼左前臂功能障碍＂入院。骨科查体：左肘关节呈直肘,肘、腕关节活动受限,软组织无肿胀。临床诊断：左肘关节、腕关节先天性畸形。CR检查：侧位片示左侧尺桡骨近端骨性联合,呈交叉畸形,无关节面。正位片示肘关节成角畸形,关节间隙清晰,左腕部尺桡关节分离错位,尺骨向远端背侧突出,骨质均未见异常改变。影像诊断：左侧先天性尺桡骨融合伴桡骨头脱位。     

关节骨软骨瘤病2例报告

例1,女,36岁,左膝关节肿物四年,逐渐增大,近半年来经常出现关节的酸痛,偶尔出现关节的纹锁现象。 X线平片检查：正位、左膝关节内侧明显窄于外则,关节下缘模糊、关节内形状不一,大小不等的骨性块影,具周围密度高于中心密度。侧位：左膝关节前方可见一枚骨性块影,其大者约2.5×2.5cm,小者为0.5×0.5cm,关节内并见有数小块大小不等、形态不规则边缘尖滑的小骨性块影。X线诊断：左膝关节骨软骨瘤病。     

髁间窝后前位DR诊断膝关节骨关节炎价值研究

目的：探讨股骨髁间窝后前位直接数字X线摄影（DR）在膝关节骨关节炎诊断中的价值。方法：选择经临床确诊膝关节骨关节炎156例,分别进行股骨髁间窝后前位结合膝关节正侧位DR摄片（观察组）及单纯膝关节正侧位DR摄片（对照组）,比较两组检出率。结果：观察组检出膝关节骨关节炎142例,占91.0%;未见明显异常7例,占4.5%;可疑7例,占4.5%。对照组检出膝关节骨关节炎98例,占62.8%;未见明显异常25例,占16.0%;可疑33例,占21.2%。两组检出率比较,差异显著（P〈0.05）。结论：股骨髁间窝后前位结合膝关节正侧位DR,对诊断膝关节骨关节炎具有重要参考价值。     

关节骨软骨瘤病2例报告

例1,女,36岁,左膝关节肿物四年,逐渐增大,近半年来经常出现关节的酸痛,偶尔出现关节的纹锁现象。 X线平片检查：正位、左膝关节内侧明显窄于外则,关节下缘模糊、关节内形状不一,大小不等的骨性块影,具周围密度高于中心密度。侧位：左膝关节前方可见一枚骨性块影,其大者约2.5×2.5cm,小者为0.5×0.5cm,关节内并见有数小块大小不等、形态不规则边缘尖滑的小骨性块影。X线诊断：左膝关节骨软骨瘤病。     

DR数字成像在膝关节摄影中的应用价值

目的：探讨DR（digital Radiography,DR）数字成像在膝关节摄影中的的临床应用价值。方法：回顾分析400例DR数字成像膝关节摄影的X线照片质量,并加以总结。结果：400例膝关节DR照片中,甲级片378例,占94．50％,乙级片22例,占5．50％。膝关节退行性改变48例,占12．00％,髌骨骨折65例,占16．25％,股骨下段骨折32例,占8．00％,胫腓骨上段骨折37例,占9．25％,胫骨上段骨折35例,占8．75％,腓骨上段骨折22例,占5．50％,其余病例正常。结论：DR系统在骨与关节、软组织的X线诊断中已广泛应用,检查简便、经济,是有效影像学检查方法之一。     

直接摄影检查患者的照射剂量分析

目的 通过对不同部位直接摄影(DR)检查的医学数字成像和传输(DICOM)文件信息中的患者剂量信息的统计,调查不同投照部位DR摄片的照射剂量分布范围,分析影响DR检查照射剂量的因素。方法 随机选取浙江省某三甲医院2009年1月至4月5160次DR摄片,包括胸部、胸椎及腰椎正、侧位、腹部前后位及骨盆正位。应用软件自动提取每例患者检查中DICOM信息文件中的剂量面积乘积(DAP),并结合照射野的范围,计算各部位DR检查的入射表面剂量(ESD)。结果 腹部前后位、腰椎侧位、胸椎正侧位的变异系数在60%以下;胸部正侧位、腰椎正位、骨盆正位的变异系数为60%~80%。各个部位的DAP最大值与最小值比值,除腹部前后位较小为3倍,其余部位差异较大。其中,腰椎正位最大差别为46倍、腰椎侧位30倍,胸椎侧位、胸部正位、侧位、骨盆正位、胸椎正位分别为23、23、18、16、11倍。通过计算得到ESD值选择75%分位点与现行普通摄片诊断参考水平(DRL)比较后发现,胸部正、侧位分别下降75%和73%;腰椎正侧位下降66%和77%;胸椎正侧位下降85%和84%;骨盆正位下降88%;腹部前后位下降88%。结论 DR检查中各个部位的DAP与ESD值存在较大变动,ESD值与现行的常规摄片的DRL相比有较大下降;有必要回顾分析DR摄片的患者照射剂量,对患者照射剂量与图像质量进行质量管理。     

正常颈部钩椎关节X线分析

颈钩椎关节邻近重要的血管和神经,钩突的病变可出现一系列有关的血管和神经症状,钩突的改变在Ｘ线平片可清晰显示,因此对钩突关节Ｘ线表现有必要进行研究。资料与方法本组４０例患者中男２６例,女１４例,年龄为１８～７０岁。４０例正常成人颈椎,皆无任何颈部症状,无颈部外伤史。各拍颈椎正侧及斜位照片。机器：使用日本岛津１０００ＭＡ,ＲＳＺ—２００型Ｘ光机。距离：用点片摄影,１１０ｃｍ距离投照。摄片用正位,侧位及斜位,立位摄影。测量方法;（１）位置的选择：正、侧及斜位照片对比观察,正位像由于斜射线的关系,中心（…     

艾-洛骨折一例

患者 男，40岁。因外伤致肘部及腕部肿痛，功能障碍就诊。体检：左肘部及腕部肿胀，并见瘀斑，肘外侧与腕部压痛明显，肘外翻活动加大，可触及骨折块，前臂旋转功能受限。X线检查：左肘关节正侧位片示左桡骨头骨折，骨折块旋转并向外移位，对位不良（图1）；左腕关节正侧位片示左侧尺桡关节关系失常，关节间隙增宽，桡骨向上移位（图2）。     

跟骨双45°斜轴位DR摄片在跟骨骨折中的诊断价值

目的：探讨跟骨双45°斜轴位DR摄片在跟骨骨折中的诊断价值。方法：对52例跟踝部外伤患者分别行足部正位和斜位、跟骨侧位和轴位DR摄片及跟骨双45°斜轴位DR片,取得跟骨不同部位骨质图像,进行对比分析。结果：52例跟踝部外伤患者经X线片或CT检查发现证实跟骨骨折46例,其中足部正斜位发现跟骨骨折21例;跟骨侧轴位片共发现骨折30例;跟骨侧轴位加双45°斜轴位摄片发现跟骨骨折42例,与跟骨侧轴位片相比,分别多发现跟骨前突骨折3例及跟骨结节内外侧突骨折6例。各个摄片方法对跟骨骨折的显示率分别为45%、65%和91%。结论：跟骨侧轴位加拍双侧45°斜轴位DR摄片能明显提高跟骨骨折诊断率,尤其是对跟骨结节内外侧突及跟骨前部近跟距关节处骨折具有较高的诊断价值。     

(99m)Tc-dextran scintigraphy to detect disease activity in patients with rheumatoid arthritis

AIM: To test the applicability of Tc-dextran joint scintigraphy in the assessment of disease activity in patients with rheumatoid arthritis (RA), and to compare it with the clinical disease activity scores and laboratory parameters. METHODS: Twenty-seven patients with RA were investigated using Tc-dextran joint scintigraphy. The images were evaluated semi-quantitatively and the regional uptakes of the radiopharmaceutical were calculated for the knee, wrist and ankle joints. The clinical and laboratory parameters were collected and fully analysed. An articular Ritchie index (a tender joint score), the number of swollen joints (Sw), the number of tender joints, the morning stiffness (h), the total Ritchie articular index (R), the visual analogue scale (VAS) and the Disease Activity Score (DAS) were determined for all patients. RESULTS: Compared with controls, patients with RA had significantly higher regional Tc-dextran uptake in the knee, wrist and ankle joints (P=0.001). The regional Tc-dextran uptake showed no correlation with the patient's age, gender, duration of disease, number of swollen joints (Sw), number of tender joints, morning stiffness (h), VAS, total Ritchie articular index and DAS, or any laboratory parameters. There was a significant correlation between the regional Tc-dextran uptake for individual joints and the articular Ritchie index of the right and left wrist (r=0.42, P=0.03; r=0.45, P=0.02), right and left knee (r=0.66, P<0.0001; r=0.80, P<0.0001) and right and left ankle (r=0.47, P=0.014; r=0.76, P<0.0001), respectively. CONCLUSIONS: This study demonstrates that Tc-dextran scintigraphy is a sensitive method to detect active joint inflammation and could be useful in the management of patients with RA.     

Kashin-Beck disease in children: radiographic findings in the wrist

OBJECTIVE: To characterize the features and prevalence of radiographic abnormalities of the wrist in children with Kashin-Beck disease (KBD) and to determine whether the presence of radiographic abnormalities in the wrist correlates with the severity of KBD. DESIGN AND PATIENTS: Two hundred and eight posteroanterior radiographs of the right hand (including wrist) in children with KBD, ranging in age from 4 to 11 years (mean age 7.7 years), from endemic areas of China were reviewed. Carpal bony margins were evaluated for blurring, thinning, irregularity with and without sclerosis, interruption, depression or destruction. The radiocarpal, intercarpal and carpometacarpal joints were assessed for widening or narrowing. The severity of the disease was graded using the hand criteria from the Chinese Radiographic Criteria of KBD Diagnosis, which classifies the following five types according to the location of the hand involved: I, metaphysis; II, diaphysis; III, I+II; IV, metaphysis and epiphysis; V, II+IV. RESULTS: Of the 208 children, 95 had abnormalities in the hand but not in the wrist; 108 had both hand and wrist abnormalities; only five had abnormal wrist findings without any hand abnormalities. Of the 108 cases with wrist abnormalities, all the carpal bones were involved in 33 cases, of which the hand types were either IV or V. However, any individual carpal bone, or combination of bones, may become involved. The carpal bones most likely to show abnormalities were the capitate and the hamate (93%), followed by the triquetrum (31%), the lunate (9%), the scaphoid (6%), and the trapezoid and the trapezium (5%). The pisiform bones were not evaluated because they cannot be seen on the overlapping posteroanterior radiographs. The most commonly involved carpal joint was the midcarpal joint (42%). CONCLUSIONS: Recognizing carpal abnormalities on radiographs is helpful for the diagnosis of KBD and the evaluation of the severity of the disease. The more severe the KBD, the more likely that the carpal bones will be involved. The capitate and hamate are frequently affected if the disease involves the carpal bones.     

Real-time MRI of joint movement with trueFISP

PURPOSE: To develop a technique for dynamic magnetic resonance imaging (MRI) of joint motion based on a combination of real-time TrueFISP (fast imaging with steady state precession) imaging with surface radiofrequency (RF) coils.MATERIALS AND METHODS: The metacarpal, elbow, tarsal, and knee joint of five volunteers and the knees of four patients were examined with a real-time TrueFISP sequence during movement of the joints.RESULTS: All examined joints could be assessed under dynamic conditions with high image contrast and high temporal resolution.CONCLUSION: Dynamic MRI of joints with TrueFISP is feasible and can provide information supplemental to static joint examinations.     

MR study of normal joint function using a low field strength system

A functional MR study was performed using a 0.064 T permanent magnet MR system. The shoulder joints, elbow joints, hip joints, and knee joints of three volunteers (mean height and weight, 176 cm and 71 kg, respectively) were examined at incremental joint angles in three to eight stages during flexion-extension, abduction-adduction, or pronation-supination movement. Each set of 16 images was obtained in 4 min, 49 s using three-dimensional Fourier transformation methods with gradient echo pulse sequences. The images were evaluated in static mode and sometimes in cine mode. The findings obtained about the physiology of these normal joints was generally compatible with findings previously accumulated in the field of kinesiology. The study suggests that this method can be useful for in vivo study of kinesiology and pathogenesis of diseases and that patients with most types of contracture or deformity can be examined by MR imaging.     

Usefulness of radionuclide bone and joint imaging in vibration disease

Bone and joint imaging with 99mTc-MDP was carried out in 17 patients with vibration disease. A comparison was made between bone scintigraphy and radiography in the regions frequently involved: cervical spine, elbow joint, wrist joint, and bone of hand. These results suggested that radiography was superior to scintigraphy in the detection of osseous changes of cervical spine, while scintigraphy was superior to radiography in the case of wrist joint and bone of hand. 99mTc-MDP joint imaging was found to be more sensitive in the detection of involvement in peripheral joints (especially metacarpal, proximal, and distal interphalangeal joints) than radiography, but it is nonspecific. Therefore, regions of increased uptake should be radiographed to determine whether other causative factors exist.     

Usefulness of radionuclide bone and joint imaging in vibration disease

Bone and joint imaging with ^99mTc-MDP was carried out in 17 patients with vibration disease. A comparison was made between bone scintigraphy and radiography in the regions frequently involved: cervical spine, elbow joint, wrist joint, and bone of hand. These results suggested that radiography was superior to scintigraphy in the detection of osseous changes of cervical spine, while scintigraphy was superior to radiography in the case of wrist joint and bone of hand. ^99mTc-MDP joint imaging was found to be more sensitive in the detection of involvement in peripheral joints (especially metacarpal, proximal, and distal interphalangeal joints) than radiography, but it is nonspecific. Therefore, regions of increased uptake should be radiographed to determine whether other causative factors exist.     

膝关节自发性软骨下骨坏死的MRI诊断

目的:探讨MRI对膝关节自发性软骨下骨坏死的诊断价值.方法:回顾性分析22例(31个膝关节)膝关节自发性软骨下骨坏死患者的病例资料.所有病例均行X平片和MRI检查,其中8个膝关节同时进行CT检查.结果:X线平片显示无病灶膝关节28个,病灶膝关节3个,显示率9.7%.CT扫描8个膝关节中,显示6个病变膝关节,显示率75%.MRI检查出所有膝关节病灶,检出率100%.结论:MRI是膝关节自发性软骨下骨坏死最佳的影像学检查方法,发现骨坏死的敏感性极高,有助于临床诊断和及时治疗.     

螺旋CT多平面和三维重建在肘关节骨折中的诊断价值

目的探讨螺旋CT多平面重建(MPR)和三维重建(3D)在肘关节骨折诊断中的价值。方法对24例肘关节损伤患者行多层螺旋CT扫描并进行多平面和三维重建。结果24例中检出22例42处骨折,4例关节脱位。轴位平扫CT(2D CT)发现29处骨折,MPR显示骨折39处,3D发现骨折35处。结论MPR在发现小的骨折方面及显示骨折内部情况较好,而3D能直观、立体、多角度地显示肘关节的损伤。MPR和3D在诊断肘关节骨折中有重要价值。     

33例全关节结核的关节镜治疗经验总结

目的:探讨应用关节镜治疗全关节结核的方法和疗效. 方法:收集1995年2月至2006年5月经关节镜治疗的33例全关节结核病例,其中肩关节结核4例,肘关节结核3例,髋关节结核5例,膝关节结核18例,踝关节结核3例.镜下对关节彻底清理,对干酪样坏死组织或脓液进行结核杆菌培养和药物敏感性试验,术毕置管冲洗.术后关节腔用抗结核药物冲洗1～2周,肩、肘关节绷带固定3周后活动,髋、膝、踝关节石膏固定12周(22例)或外固定架固定3～6个月(2例).根据药敏试验结果进行抗结核治疗,持续1年.结果:本组33例均获3个月以上随访,根据Ikeuchi膝关节评分标准,疗效优25例,良8例.髋、膝、踝关节全部融合,所有关节伤口均一期愈合.结论:对于早、中、晚期,甚至合并窦道形成的全关节结核,均可考虑行关节镜下关节清理术.对全关节结核的镜下清理可以彻底清创,减轻创伤,降低伤口不愈合率,保持非负重关节的功能,提高负重关节的融合率.在药敏试验指导下的有针对性的抗结核治疗非常重要.