基于深度学习的计算机辅助诊断系统检出DR胸部正位片中的骨折

目的 观察基于深度学习的计算机辅助诊断系统（DL-CAD）检出DR胸部正位片中骨折的效能及其对低年资放射科医师的辅助作用。方法 ①试验1：回顾性收集547例DR胸部正位片,其中361例存在胸部骨折（共983处骨折）、186例无胸部骨折,评估DL-CAD对骨折的预测性能。②试验2：随机选取试验1中的397例DR胸片,其中211例存在胸部骨折（共604处骨折）、186例无胸部骨折,记录并比较单独DL-CAD（1组）、单独低年资医师（2组）、DL-CAD辅助低年资医师（3组）、单独高年资医师（4组）的检出结果。结果 ①试验1：983处骨折中,DL-CAD识别出672处,正确识别641处,误诊31处,敏感度65.21%（641/983）,F值为77.46%;361例骨折患者中,DL-CAD识别出320例,正确识别314例,误诊6例,敏感度86.98%（314/361）,F值92.22%。②试验2：1、2、3、4组观察者检出骨折的敏感度分别为62.09%（375/604）、61.59%（372/604）、86.75%（524/604）和83.44%（504/604）,F值分别为75.38%、74.62%、90.74%及89.84%;3、4组检测效能均高于1、2组（P均<0.001）,而1组与2组间、3组与4组间差异均无统计学意义（P均>0.05）。结论 DL-CAD对DR胸部正位片中骨折的检出效果较好,且可有效提高低年资放射科医师对胸部骨折的检出效能。     

固定床架用于超声筛查婴儿发育性髋关节发育不良

目的 观察固定床架用于超声筛查婴儿发育性髋关节发育不良(DDH)的价值。方法 将400名接受DDH筛查且无髋关节异常婴儿分为低年资医师使用固定床架组(A组)、低年资医师不使用固定床架组(B组)、高年资医师使用固定床架组(C组)及高年资医师不使用固定床架组(D组)共4组,每组100名。比较4组婴儿一般资料、超声筛查DDH时间及髋关节超声图像质量;采用Bland-Altman一致性分析评估低年资医师与复核医师(与高年资医师工作年限相同的另外3名医师)复核α角和β角测值的一致性,评估固定床架的应用价值。结果 4组婴儿性别、年龄及体质量差异均无统计学意义(P均＞0.05); A组和B组超声检查时间均大于C组和D组(P均＜0.05)。4组合格图像数量差异有统计学意义(χ²=85.777,P＜0.001),B组与其他3组差异均有统计学意义(P均＜0.05)。不使用固定床架时,低年资医师与复核医师所测α角之差的最大绝对值为7°,所测β角之差的最大绝对值为2°;使用固定床架时,低年资医师与复核医师所测α角之差的最大绝对值为3°,所测β角之差的最大绝对值为2°。结论 固定床架对于辅助低年资医师超声筛查婴儿DHH具有较高价值,而对高年资医师检查结果无明显影响。     

柔性减影CE-Boost技术对CT肺动脉造影图像质量的影响

目的 观察柔性减影CE-Boost技术对CT肺动脉造影(CTPA)图像质量的影响。方法 回顾性分析66例疑诊肺栓塞(PE)患者的肺部CT平扫及CTPA资料,对平扫期和增强动脉期图像进行薄层重建,以Sure-Subtraction Lung软件行柔性减影,获得CE-Boost序列图像。将重建后增强动脉期图像(A组)与CE-Boost图像(B组)上传至Toshiba Vitrea后处理工作站,测量肺动脉及其分支CT值,计算信噪比(SNR)及对比噪声比(CNR);并由2名影像科医师采用5分法对图像质量进行主观评分。结果 B组肺动脉主干,左、右肺动脉干,左、右上肺动脉分支及左、右下肺动脉分支的CT值、SNR值及CNR值均高于A组(P均＜0.001)。B组图像主观评分5(4,5)分,高于A组的2(1,2)分(Z=－4.980,P＜0.001),且2名医师对A、B组图像质量评分的一致性较高(Kappa=0.896)。结论 柔性减影CE-Boost技术可提高CTPA图像质量。     

基于卷积神经网络经直肠超声模型预测前列腺癌Gleason分级

目的 观察基于卷积神经网络(CNN)的经直肠超声(TRUS)模型预测前列腺癌Gleason分级(GS)的价值。方法 前瞻性收集101例拟接受TRUS引导下前列腺穿刺活检的前列腺癌患者;采集568幅前列腺癌超声图像,根据病理结果将其分为低危(GS≤6,n=90)、中危(GS=7,n=185)及高危(GS≥8,n=293)。建立前列腺癌TRUS数据集,基于CNN构建TRUS预测前列腺癌GS模型;以穿刺活检病理结果为金标准,评估模型与超声医师的诊断效能。结果 基于CNN的TRUS模型预测前列腺癌GS≤6的精确率高于超声医师(P＜0.05),而二者召回率(Recall)和F1-score差异均无统计学意义(P均＞0.05);基于CNN的TRUS模型预测GS=7和GS≥8的精确率、Recall及F1-score均高于超声医师(P均＜0.05)。基于CNN的TRUS模型预测前列腺癌GS的总体准确率(76.75%)高于超声医师(51.75%,χ²=31.021,P＜0.001),其预测前列腺癌GS的曲线下面积(AUC)为0.72、特异度为47.22%、敏感度为96.88%,超声医师分别为0.67、52.78%及80.21%,二者AUC差异无统计学意义(Z=0.859,P=0.390)。结论 基于CNN的TRUS模型有助于预测前列腺癌、尤其需要积极治疗的中-高危前列腺癌的GS。     

零回波时间3.0T MRI用于检出肺癌结节

目的 观察零回波时间(ZTE)3.0T MRI检出肺癌结节的价值。方法 前瞻性纳入126例肺癌患者(共176个肺结节),以3.0T MR仪行肺部轴位ZTE成像和常规序列成像,包括T1容积内插屏气检查(VIBE)、T2刀锋序列(BLADE)及T2半傅里叶采集单次激发快速自旋回波(HASTE)序列扫描;分析ZTE MRI与CT显示肺结节特征的一致性,观察以不同MR序列检出肺结节的敏感度。结果 176个肺结节中,ZTE MRI检出140个、漏诊36个。ZTE MRI与CT显示肺结节最大径及其实性部分最大径的一致性均好(ICC=0.954、0.943,P均<0.001)且差异较小,显示气管血管束、胸膜凹陷及内部支气管充气征的一致性均好(Kappa=0.894、0.912、0.917),显示结节类型及形状的一致性中等(Kappa=0.661、0.501)。ZTE MRI检出肺结节的敏感度均高于其他单独MR序列(P均<0.05);ZTE与T2-BLADE组合的敏感度均高于其他序列组合(P均<0.05)。结论 ZTE 3.0T MRI检出肺癌结节的效能较好,优于常规MR序列;与T2-BLADE联合可进一步提高其敏感度。     

2017年美国放射学会甲状腺影像报告与数据系统鉴别甲状腺良恶性结节

目的 探讨2017年美国放射学会（ACR）推荐的甲状腺影像报告与数据系统（TI-RADS）对鉴别甲状腺良恶性结节的应用价值。方法 回顾性分析经手术病理确诊的497个甲状腺结节的超声资料,采用2017年ACR TI-RADS分类对结节评分和分类,与病理结果对照,采用ROC确定最佳临界评分,计算TI-RADS分类诊断良恶性结节的敏感度、特异度和准确率。评价高年资与低年资医师采用此最佳临界评分诊断甲状腺良恶性结节的效能和一致性。结果 采用2017年ACR TI-RADS分类诊断甲状腺恶性结节的ROC曲线下面积为0.883（P<0.001）,最佳临界评分为5分,敏感度86.22%,特异度78.68%。以TI-RADS评分> 5分归为恶性结节,高年资和低年资医师诊断的敏感度、特异度、准确率分别为78.22%（176/225）、76.47%（208/272）、77.26%（384/497）和77.33%（174/225）、74.26%（202/272）、75.65%（376/497）,二者诊断良恶性结节具有中等一致性（Kappa=0.581）。结论 2017年ACR TI-RADS具有较高临床应用价值,鉴别甲状腺良恶性结节的最佳界值为5分。     

区域CT值在预测股骨近端骨折中的价值

目的:探讨60岁以上成人发生股骨近端骨折的股骨颈部松质骨CT值。方法:自2020年1月至2020年12月,回顾性分析行双髋关节CT检查的年龄＞60岁的280例研究对象,男85例,女195例;年龄75(66,82)岁;左侧120例,右侧160例。其中136例股骨近端骨折患者为研究组,144例无骨折者为对照组。采用GEOptima CT机扫描并分别重建出股骨近端水平位、冠状位和矢状位层面。测量并比较两组股骨颈部松质骨的CT值;采用Logistic回归分析股骨颈松质骨CT值与股骨颈骨折间的关系。结果:骨折组年龄79(73.3,85.0)岁,无骨折组年龄69.5(64.0,78.8)岁,两组年龄比较,差异有统计学意义(P＜0.05)。骨折组区域CT值8.62(-3.62,27.15) HU低于无骨折组34.31(-5.93,71.74) HU(P＜0.05)。冠状位平面内骨折组的区域CT值-8.48(-30.96,17.46) HU低于无骨折组40.49(5.55,80.71) HU(P＜0.05);矢状位平面内骨折组区域CT值-31.28(-54.91,-5.11) HU低于无骨折组7.74(-20.12,44.54) HU(P＜0.05);水平位平面内骨折组区域CT值0.17(-23.13,24.60) HU低于无骨折组46.40(10.42,85.18) HU(P＜0.05);骨折组股骨颈部区域CT值低于无骨折组(P＜0.05)。经Logistic回归分析,冠状位区域CT值是股骨近端骨折的影响因素,可以写入预测骨折概率的回归方程。结论:在60岁以上成人,随着年龄的不断增大,股骨颈部松质骨CT值呈下降趋势。股骨颈部松质骨CT值越小发生股骨近端骨折的风险越大。     

基于MRI自动化定量海马体积诊断颞叶癫痫患者海马硬化

目的 评估基于MRI自动化定量海马体积诊断颞叶癫痫患者海马硬化（HS）的效能。方法 回顾性分析经术后病理检查证实的64例存在HS的颞叶癫痫患者,采用AccuBrain软件对头部3D T1WI进行自动化定量分析,检测海马体积指数（HVI）;以病理结果为诊断金标准,统计2名医师目测诊断HS结果。采用受试者工作特征（ROC）曲线获得HVI诊断HS的截断值及曲线下面积（AUC）,计算HVI诊断HS的敏感度、特异度和准确率,评价2种诊断方式所获结果的一致性。结果 64例中,38例左侧HS、26例右侧HS。医师目测诊断HS的敏感度、特异度、准确率分别为90.63%（58/64）、100%（64/64）及95.31%（122/128）。ROC曲线结果显示,HVI诊断HS的最佳截断值为0.185,AUC为0.936。HVI诊断HS的敏感度、特异度、准确率分别为87.50%（56/64）、93.75%（60/64）及90.63%（116/128）。医师目测与HVI诊断HS的准确率一致性较强（Kappa=0.684,P<0.05）。结论 MRI自动化定量海马体积可用于诊断颞叶癫痫患者HS,其诊断效能较高。     

MRI影像组学及临床特征联合模型预测高强度聚焦超声治疗子宫肌瘤效果

目的 观察基于MRI影像组学及临床特征建立的联合模型预测高强度聚焦超声(HIFU)治疗子宫肌瘤效果的效能。方法 回顾性分析257例接受HIFU治疗的单发子宫肌瘤患者,基于治疗前盆腔轴位T2WI、T1WI、T1对比增强(T1C)及表观弥散系数(ADC)图提取病灶影像组学特征。分别以XGBoost特征选择算法及XGBoost分类器建立预测HIFU即刻消融率和随访肌瘤体积缩小率的影像组学联合临床特征模型A和B。按8∶2比例将数据集分为训练集(n=202)和测试集(n=52),采用受试者工作特征(ROC)曲线和混淆矩阵评估模型的预测效能。结果 经XGBoost算法选择后纳入10个影像组学特征,包括4个T1WI、2个T2WI、1个T1C及3个ADC图影像组学特征,结合肌瘤背侧距骶骨距离和T2WI信号强度构建模型A;纳入10个影像组学特征,含4个T1WI、3个TIC及3个ADC图影像组学特征,结合肌瘤T2WI信号强度构建模型B。ROC曲线结果显示,模型A预测训练集和测试集HIFU治疗肌瘤即刻消融率的曲线下面积(AUC)分别为0.94[95%CI(0.90,0.96)]和0.90[95%CI(0.81,0.97)],模型B预测训练集和测试集肌瘤体积缩小率的AUC分别为0.98[95%CI(0.97,0.99)]、0.91[95%CI(0.81,0.98)]。结论 MRI影像组学联合临床特征模型可有效预测HIFU治疗子宫肌瘤近期及远期效果。     

CT影像组学联合CT特征预测肺亚实性结节侵袭性

目的 观察CT影像组学联合CT特征预测肺亚实性结节侵袭性的价值。方法 回顾性分析170例肺亚实性结节患者资料,包括6例非典型腺瘤样增生(AAH)、12例原位腺癌(AIS)、58例微浸润性腺癌(MIA)及94例浸润性腺癌(IAC),将AAH、AIS和MIA归为非侵袭组、IAC归为侵袭组。按7∶3比例将患者分为训练集(n=119,含5例AAH、9例AIS、36例MIA及69例IAC)和验证集(n=51,含1例AAH、3例AIS、22例MIA及25例IAC)。采用单因素及logistic回归分析训练集患者一般资料及病灶CT表现,筛选预测肺亚实性结节侵袭性的独立危险因素并建立CT模型;基于训练集提取及筛选病灶最佳影像组学特征,以之构建影像组学模型。基于CT模型及影像组学模型构建联合模型,并以列线图将其可视化。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),基于验证集评估各模型诊断效能;以校准曲线评价联合模型的校准程度。结果 CT所示结节长径和最大CT值为预测肺亚实性结节为IAC的CT相关独立危险因素,以之构建CT模型。基于训练集筛选出6个最佳影像组学特征并构建影像组学模型。CT模型、影像组学模型及联合模型预测验证集肺亚实性结节侵袭性的AUC分别为0.772、0.785及0.869;联合模型的AUC高于CT模型(Z=2.336,P=0.019)而与影像组学模型差异无统计学意义(Z=1.925,P=0.054),其预测结果与实际结果的一致性较高。结论 CT影像组学联合CT特征可有效预测肺亚实性结节侵袭性。     

Correlation of rib fracture patterns with abdominal solid organ injury: A retrospective observational cohort study

PurposeRib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma.MethodsThis retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient.ResultsAltogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures.ConclusionThere is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.     

可吸收肋骨固定钉加涤纶补片治疗多发性肋骨骨折12例

目的：介绍加用涤纶补片外包裹固定治疗多发性肋骨骨折的方法及适应证,以减少骨折移位并发症的发生。方法：自2006年9月至2008年3月采用可吸收肋骨钉加涤纶补片治疗多发性肋骨骨折12例,男8例,女4例;年龄22～51岁,平均38.2岁;受伤至手术时间：2h～3d。均为闭合性损伤且伴有明显胸痛及胸闷气闭,其中伴呼吸困难、咳痰中带血、血氧饱合度下降4例。X线检查：单侧肋骨骨折3例,双侧肋骨骨折9例,均伴有血气胸。结果：12例患者均获得随访,时间2～26个月,平均8个月。所有病例骨折均愈合。依据评定标准,从疼痛、呼吸、肋骨对位情况等方面对疗效进行观察：优10例,良1例,可1例。结论：应用可吸收肋骨钉加涤纶补片治疗多发性肋骨骨折是安全有效的,特别适用于骨质疏松、粉碎性骨折及斜形骨折的患者。     

Cervical Spine CT Can Miss Fractures in American Football Players When Protective Equipment is in Place: A Cadaver Study

BackgroundIatrogenic worsening of spinal injury can result in significant harm to American football players and complicate management when equipment is removed in the acute setting by inexperienced personnel. Spine imaging before removal of protective equipment mitigates this risk. There is no consensus regarding the ideal timing of equipment removal or whether current diagnostic imaging modalities are effective to detect such injuries without equipment removal. Prior data suggest that CT is a diagnostic modality for this purpose; however, radiologists’ accuracy in detecting fractures in the presence of protective equipment requires additional study.Questions/purposes(1) Does the introduction of American football equipment result in a significant reduction in sensitivity for cervical spine fracture detection? (2) Absent specific guidance as to parameters needed to establish diagnostic quality, can a radiologist determine whether such CTs are of diagnostic quality by subjectively relying on the ability to identify anatomic landmarks?MethodsA pendulum device was engineered to deliver a measured axial load to the crown of cadavers to produce a variety of cervical spine fractures in 13 cadaver specimens. The cadavers were then imaged using a standardized CT protocol first without and then with protective football equipment. The images were presented to three board-certified, fellowship-trained radiologists to (1) identify all fractures from the occiput to T1 and (2) subjectively assess the diagnostic quality of the resulting CTs. A sensitivity analysis was performed against a reference standard of fractures produced by the consensus of all radiologists in this study to determine whether there was any reduction in radiologists’ ability to detect fractures once football equipment was in place.ResultsWe found that CT scans obtained with football protective equipment in place resulted in lower sensitivity in diagnosing cervical spine injuries than CT scans obtained without pads. A total of 42 fractures were identified in the reference standard, allowing for a combined 126 possible fracture identifications between the three interpreters. Without football equipment, a combined 98 fractures were identified, whereas a combined 65 fractures were identified once the equipment was introduced. Overall, the sensitivity was reduced by 26% (52% [65 of 126] versus 78% [98 of 126] [95% CI 14.8% to 37.5%]; p < 0.001). Of the 78 total CT series imaged with football equipment, 92% (72 of 78) were considered to be of diagnostic quality. However, the study radiologists failed to identify 50% (53 of 105) of fractures present in those CT images.ConclusionThe sensitivity of cervical spine fracture detection using CT is diminished in the setting of protective American football equipment. Future studies in live subjects with cervical spine fracture may be warranted to support these conclusions.Clinical RelevanceThese findings contradict previous studies that determined CT to be a diagnostic imaging modality to image the cervical spine through equipment. Although the interpreting radiologists consistently deemed CTs performed in the presence of helmets and shoulder pads to have subjectively diagnostic quality, numerous fractures that had been detected in the absence of equipment were missed in their presence. Furthermore, this study established that subjective approval of the appearance of an imaging study based on the ability to recognize anatomic landmarks is insufficient to reliably determine the diagnostic quality of a CT study.     

Far posterior rib plating: Preliminary results of a retrospective case series

IntroductionFar posterior, or paraspinal rib fractures, defined as fractures that are medial to the medial border of the scapula (and may involve the costovertebral articulation), are often treated nonoperatively. However, in certain cases, including severe displacement, persistent pain, nonunion, or persistent respiratory distress, stabilization with open reduction and internal fixation (ORIF) may be warranted. There is a paucity of literature regarding the surgical approach and clinical outcomes following ORIF for far posterior rib fractures and fracture-dislocations. The purpose of this paper is to describe the surgical approach and to report the first collection of clinical outcomes for patients undergoing paraspinal rib ORIF.Patients and methodsA retrospective case series was performed at a single urban level 1 trauma center. Patients 18 years of age or older who underwent ORIF of far posterior rib fractures were included in this study. Far posterior rib fractures were defined as fractures that occurred medial to the medial border of the scapula underneath the paraspinal musculature. Data collection including patient demographics, injury characteristics, operative variables, and postoperative outcomes were collected and analyzed.ResultsTwenty-six patients, with a mean age of 50.7 years, who underwent paraspinal rib ORIF were included in this study. The mean follow-up was 12.1 months. 80.8% of patients had a flail chest injury. On average, 3.4 ribs were instrumented posteriorly with 22.8% of patients requiring fixation spanning the costotransverse articulation. No intraoperative complications occurred. Only one patient required a repeat procedure. Total hospital length of stay averaged 17.3 days with an intensive care unit stay averaging 6.2 days. Total ventilator time averaged 4 days. 7 patients were diagnosed with postoperative pneumonia and 6 patients required tracheostomy.ConclusionOpen reduction and internal fixation for far posterior, or paraspinal rib fractures and fracture-dislocations is a safe procedure with low complications rates and favorable postoperative outcomes including hospital length of stay, ICU length of stay, need for tracheostomy, postoperative pneumonia, and mechanical ventilation time.     

Utility of skull radiographs in infants undergoing 3D head CT during evaluation for physical abuse

BackgroundClinical practice guidelines recommend performing head CT and skull radiographs (SR) when evaluating infants for physical abuse. We compared the accuracy of 3-dimensional CT (3DCT) and SR for detecting skull fractures.MethodsWe reviewed children <12 months evaluated for physical abuse undergoing 3DCT and SR between January 2017 and December 2018. 3DCT and SR images were blindly read by 2 radiologists. Interrater reliability (IRR) was calculated. Diagnostic accuracy was compared using McNemar's test.Results158 infants with a mean age of 5.0 months underwent 3DCT and SR. Consensus reading identified 46 fractures (29.1%) on 3DCT and 40 fractures (25.3%) on SR. IRR was higher for 3DCT (κ = 0.95) than for SR (=0.65). 11 fractures were identified on 3DCT but not SR. 5 fractures were identified on SR but not 3DCT. There was no difference in the diagnostic accuracy of 3DCT and SR (χ² = 1.56, p = 0.211).ConclusionsWe found no difference in the accuracy of 3DCT and SR for detecting skull fractures in infants. Because 3DCT has better IRR and evaluates for both bony and intracranial injuries it is superior to SR. Omitting SRs may be acceptable if a 3DCT is performed, and would reduce radiation exposure without compromising diagnostic accuracy.     

人工智能辅助低年资放射科医师检出乳腺病变

目的观察人工智能(AI)辅助对低年资放射科医师检出乳腺X线片中乳腺病灶的价值。方法回顾性分析73例接受乳腺X线摄影检查的女性患者。由3名低年资放射科医师首先分别阅片,之后于AI辅助下再次阅片,勾画乳腺病灶区域;统计检出病灶数,记录病灶类型及乳腺影像报告和数据系统(BI-RADS)分类。以病理结果或随访最终临床诊断为标准,对比医师单独阅片与AI辅助阅片检出乳腺病灶的敏感度和准确率及对不同类型、不同BI-RADS分类病灶的诊断效能。结果 73例共121个乳腺病灶,其中软组织病灶(包括肿块、结构扭曲与不对称病灶)88个、钙化病灶33个;BI-RADS 2类17个,3类66个,4类及以上38个。与医师单独阅片相比,AI辅助阅片对全部乳腺病灶、特别是软组织病灶的诊断敏感度和准确率均显著提升(P均0.01),而对乳腺钙化病灶的敏感度和准确率差异均无统计学意义(P均0.05)。结论 AI辅助有助于提高低年资放射科医师检出乳腺X线片中乳腺病灶、尤其软组织病灶的效能。     

预成型肋骨锁定钛板联合超声引导下胸椎旁神经阻滞治疗老年多发性肋骨骨折

目的:探讨预成型肋骨锁定钛板内固定手术与超声引导下胸椎旁神经阻滞联合应用对于老年多发性肋骨骨折患者的疗效。方法:回顾性分析2016年2月至2020年11月收治的221例老年多发性肋骨骨折患者,根据是否手术治疗,分为预成型肋骨锁定钛板联合超声引导下胸椎旁神经阻滞组(手术组)102例,保守治疗组(非手术组)119 例。手术组中男58 例,女44 例;年龄60~85(67.2±3.6)岁;肋骨骨折3~12(5.3±2.1)处。非手术组中男66 例,女53 例;年龄60~84 (66.8±3.2)岁;肋骨骨折2~11 (6.1±2.3)处。比较分析两组患者的临床资料、治疗效果及并发症情况。结果:两组患者术前临床资料比较,差异无统计学意义(P>0.05),所有患者顺利出院。手术组患者肺部感染(P=0.028),肺不张(P=0.032),呼吸衰竭(P=0.026),主动下床时间(P=0.040),骨折愈合时间(P=0.035),住院时间(P=0.043),治疗后3 d疼痛视觉模拟评分(visual analogue scale,VAS)(P=0.028),治疗后5 d VAS (P=0.032),治疗后7 d VAS (P=0.019),术后3个月最大自主通气量(maximal voluntary ventilation,MVV)(P=0.042),1 s用力呼气容积(forced expiratory volume in one second,FEV1)(P=0.035)以及术后6个月MVV(P=0.021),FEV1(P=0.026)均优于非手术治疗组。结论:对于老年严重多发肋骨骨折的患者,预成型肋骨锁定钛板与超声引导下胸椎旁神经阻滞的联合应用与非手术治疗相比较,能够及时有效镇痛,恢复胸廓稳定性,缩短住院时间,减少肺部感染及急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS) 等并发症的发生率。预成型肋骨锁定钛板治疗老年多发性肋骨骨折具有较好的临床效果。     

Platelet concentrate injection improves Achilles tendon repair in rats

Background and purpose We have previously shown that early fracture callus of rat rib has viscoelastic and contractile properties resembling those of smooth muscle. The cells responsible for this contractility have been hypothesized to be myofibroblast-like in nature. In soft-tissue healing, force generated by contraction of myofibroblasts promotes healing. Accordingly, we tried to identify myofibroblast-like cells in early fibrous callus.

Animals and methods Calluses from rat rib fractures were removed 7, 14, and 21 days after fracture and unfractured ribs acted as controls. All tissues were analyzed using qPCR and immunohistochemistry. We analyzed expression of smooth muscle- and myofibroblast-associated genes and proteins including alpha smooth muscle actin (αSMA), non-muscle myosin, fibronectin extra domain A variant (EDA-fibronectin), OB-cadherin, connexin-43, basic calponin (h1CaP), and h-caldesmon.

Results In calluses at 7 days post-fracture, there were statistically significant increases in expression of αSMA mRNA (2.5 fold), h1CaP mRNA (2.1 fold), EDA-fibronectin mRNA (14 fold), and connexin-43 mRNA (1.8 fold) compared to unfractured ribs, and by 21 days post-fracture mRNA expression in calluses had decreased to levels approaching those in unfractured rib. Immunohistochemistry of 7 day fibrous callus localized calponin, EDA-fibronectin and co-immunolabeling of OB-cadherin and αSMA (thus confirming a myofibroblastic phenotype) within various cell populations.

Interpretation This study provides further evidence that early rat rib callus is not only smooth muscle-like in nature but also contains a notable population of cells that have a distinct myofibroblastic phenotype. The presence of these cells indicates that in vivo contraction of early callus is a mechanism that may occur in fractures so as to facilitate healing, as it does in soft tissue wound repair.     

基于腰椎螺旋CT图像以卷积神经网络技术全自动识别并重建椎间盘的可行性

目的观察基于腰椎螺旋CT图像以卷积神经网络技术全自动识别及重建椎间盘的可行性。方法回顾性分析400例腰痛患者的腰椎CT资料,以其中320例为训练集、40例为验证集、40例为测试集。以人工智能(AI)系统进行学习训练和测试。以深度学习(DL)卷积神经网络3D V-Net技术分割腰椎轴位CT图像中的椎体与椎间盘,并轴位重建椎间盘;以Dice系数评估分割精度。由2名放射科医师分别对AI重建图像及人工重建图像进行图像质量评分并进行对比。结果AI分割骶椎椎体、L5椎体、L1~L4椎体及椎间盘的Dice系数分别为0.953、0.940、0.940及0.926,平均为0.940。针对测试集40例,采用腰椎螺旋CT数据经卷积神经网络技术完成197个椎间盘重建。2名放射科医师对197幅AI重建图像及人工重建图像的中位评分均为4分,差异无统计学意义(P均>0.05);评分一致性加权Kappa值为0.862[95%CI(0.778,0.946),P<0.001]。结论基于腰椎螺旋CT图像卷积神经网络全自动识别及重建椎间盘的可行性令人满意。