在X线、CT导引下经皮椎弓根穿刺胸腰椎椎体活检术的价值

目的 探讨在X线、CT导引下经皮椎弓根穿刺胸腰椎椎体活检术在胸腰椎椎体疾病中的应用价值.资料与方法 选择2003年9月至2007年10月间在X线、CT导引下经皮椎弓根穿刺胸腰椎椎体活检术患者26例,其中在X线导引下穿刺腰椎6例,在CT导引下穿刺腰椎16例、胸椎4例.结果 26例全部穿刺成功,穿刺成功率100%,无严重并发症发生.结论 胸椎采用CT导引,腰椎采用X线或CT导引,行椎体经椎弓根穿刺活检术是一种简便、微创、有效的检查方法,可提高对椎体病变的确诊率,为椎体病变的进一步治疗提供有效的帮助,临床价值极大.     

CT模拟胸椎经皮椎体成形术相关测量参数分析

目的 CT模拟胸椎经皮椎体成形术(percutaneous vertebroplasty,PVP),测量和分析相关重要参数.资料与方法 随机选取40例患者行胸椎多层螺旋CT扫描,后处理工作站上模拟PVP,共480节椎体,测量项目为胸椎T1-12左右椎弓根的左右径,上下径,左右进针距离,左右旁开中心距离等数据,并用SPSS 13.0统计软件包进行统计分析.结果 T1-12椎弓根左右径为(3.92+1.60) mm,上下径为(12.15±2.73)mm,左右进针距离为(93.13±15.59) mm,左右旁开中心距离为(43.01±14.48)mm.结论 CT模拟PVP相关测量参数为胸椎PVP中穿刺针的选择及穿刺路径的规划提供基础的影像解剖学数据.     

旋转DSA的软组织断层重建技术在经皮椎体成形术后并发症诊断中的价值

目的探讨旋转DSA的软组织断层重建技术(DynaCT)在经皮椎体成形术后并发症诊断中的应用价值。方法对30例中36个胸椎和腰椎行经皮椎体成形术(PVP),术后经X线摄片、DynaCT和螺旋CT扫描,对聚甲基丙烯酸甲酯(PMMA)的椎体外渗漏和胸膜腔的图像和临床情况进行分析。结果所有病例的手术都获得成功。所有病例术中和术后未出现严重的并发症。在经PVP术后的36个椎体中,30个椎体的无椎体外渗漏,都经X线正侧位、DynaCT和CT确诊。6个椎体出现椎体外渗漏,经X线正侧位、DynaCT和CT检查确诊,其中2例中2个椎体出现椎间盘渗漏;2例2个椎体出现椎旁软组织渗漏;1例1个椎体出现静脉丛渗漏。1例椎弓根渗漏在侧位X线片怀疑为椎体后缘硬膜外渗漏,但在DynaCT重建图像和螺旋CT显示,PMMA位于两侧椎弓根内,椎管内并无PMMA。X线摄片和DynaCT、CT都未发现气胸和胸腔积液。结论DynaCT对PVP术后并发症的迅速判断提供了有益的信息。     

经皮椎体成形术的临床应用

目的　探讨经皮椎体成形术 (PVP)治疗椎体病变引起的压缩骨折的技术操作和临床效果。资料与方法　对 30例共 4 6个椎体行PVP ,其中骨质疏松 2 0例 ,血管瘤 1例 ,多发性骨髓瘤 1例 ,转移瘤 8例。年龄 31～ 98岁 ,平均 5 8岁。穿刺方法为患者俯卧 ,影像增强器向矢状面足侧成角 10°～ 15° ,椎体上下缘没有双边影 ,使欲穿刺侧的椎弓根投影在椎体的中外 1/ 3处 ,将穿刺针、X线管、椎弓根成一直线进针 ,穿刺成功后将聚甲基丙烯酸甲酯 (PM MA ,骨水泥 )按粉液比 3∶2 (g/ml)混合成糊状 ,在透视下用 1ml注射器均匀缓慢注入病变椎体。如骨水泥弥散不良再行对侧穿刺。术后当天、7天、1个月、3个月CT检查注射椎体 ,随访病情变化。结果　所有病例均成功施行了PVP ,单侧穿刺 32个椎体 (胸椎 8个 ,腰椎 2 4个 ) ,双侧穿刺 14个椎体 (胸椎 8个 ,腰椎 6个 )。单侧穿刺胸椎骨水泥平均用量 2 .5ml,腰椎 3.7ml;双侧穿刺胸椎骨水泥平均用量 3.2ml,腰椎 4 .7ml。治疗效果同骨水泥的注射量无关 ,同单双侧穿刺无关。 2 1例良性病例疼痛完全缓解 (CR) 14例 ,部分缓解 (PR) 7例 ;9例恶性病例中PR 7例 ,2例无效(NR) ;随访 6个月良性病例止痛效果良好 ,恶性病例 3个月后止痛效果下降。CT、X线随访骨水泥术后形态无变化 ,未见椎体     

经皮椎体成形术治疗椎体恶性病变的临床应用

目的　探讨经皮椎体成形术(PVP)治疗椎体恶性病变的方法及临床效果。方法　对 13例共 15个椎体行PVP,其中椎体转移瘤 11例,原发瘤 2例;胸椎 6例,腰椎 7例,年龄 45~73岁,平均 59岁。在C型臂X线机或CT监视下,用 11~13G、长15cm骨穿针经椎弓根入路行椎体穿刺,穿刺成功后注入非离子型对比剂造影,了解椎体引流静脉情况,然后注入按 3 2 1配制的聚甲基丙烯酸甲脂(PMMA,简称骨水泥)3~7ml。患者随访 6~12个月。结果　穿刺成功率 100%。76. 9% (10 /13)患者术后3d内症状明显缓解,止痛效果 6个月内为 69. 2% (9 /13), 1年内为 54. 5% (6 /11)。术后CT随访显示PMMA分布良好,未见椎体压缩。患者无严重并发症发生。结论　PVP治疗椎体恶性病变所至疼痛、预防椎体压缩及继发性截瘫效果好,安全可行。     

CT图像模拟穿刺路径在经皮椎体成形术中的应用价值

目的:探讨CT图像模拟穿刺路径在单侧椎弓根入路经皮椎体成形术(PVP)中的应用价值。方法:45例(61个椎体)患者术前均行CT检查,在CT图像上测量模拟经皮椎体成形术穿刺角度及旁开棘突距离,并在此参数参考下,于X线透视下行经皮椎体成形术。采用视觉模拟评分法(VAS评分)和WHO评分法评价疼痛缓解情况。结果:不同节段椎体穿刺角度及棘突旁开距离差异有统计学意义(P<0.05),Th8～L5椎体穿刺角度及旁开距离逐渐增大。本组手术成功率100%,术后疼痛缓解率为100%。单侧椎弓根穿刺成功率为95.1%。结论:对于不同节段椎体,PVP手术穿刺角度及穿刺点选择是不同的,术前根据CT图像测量穿刺参数可有效提高单侧椎弓根穿刺成功率。     

经皮椎体成形术治疗老年骨质疏松性椎体骨折

目的 探讨经皮椎体成形术(PVP)治疗老年骨质疏松性椎体骨折的价值.方法 27例老年骨质疏松症患者共33节椎体骨折,均经MRI、CT及平片证实.在透视监视下经椎弓根行椎体穿刺,注入粉(g)GA955液(ml)GA955硫酸钡粉(g)为15GA95510GA9553的聚甲基丙烯酸甲酯(PMMA),术后即刻摄X线正侧位片,1 d后CT观察PMMA分布渗漏状况,定期观察疗效和椎体高度.结果 PVP技术成功率100%,PMMA平均注入量4.6 ml (2.3～7.5 ml),术后1 d CT证实椎体周围PMMA少量渗漏7节,但无临床症状.术后1 d,所有病例腰背部疼痛明显减轻,平均随访8个月,疼痛均无复发,椎体高度无进一步塌陷.结论 PVP对治疗老年骨质疏松性椎体骨折所致的腰背疼痛是有效的.     

经皮椎体成形术后影像学评价

目的 探讨影像学检查在经皮椎体成形术(PVP)后诊断的应用价值.资料与方法 回顾分析85例因骨质疏松性压缩骨折行PVP患者的临床和影像学资料,所有患者术后均行X线和CT检查,25例术后再发疼痛的患者行MRI检查.结果 40个椎体发生骨水泥渗漏,26个椎体出现椎旁静脉渗漏,10个椎体出现椎旁软组织渗漏,10个椎体出现椎管内渗漏,5个椎体出现椎间盘渗漏,2个椎体出现椎间孔渗漏,2个椎体出现穿刺针道渗漏.新发骨折12例共15个椎体,6个椎体骨折发生在相邻椎体,9个发生在不相邻椎体.结论 CT应作为PVP后观察骨水泥渗漏必要的影像学检查方法,MRI在诊断新发骨折方面具有优势.     

国产骨水泥行经皮椎体成形术治疗椎体压缩性骨折的临床应用

目的 探讨应用国产骨水泥行经皮椎体成形术(PVP)治疗椎体压缩性骨折的临床应用价值.资料与方法 在大型C臂X线机或CT机导引下,应用国产骨水泥采用经单侧椎弓根注射法行PVP治疗骨质疏松性椎体压缩性骨折患者60例,观察其临床疗效及并发症.结果 60例骨质疏松性椎体压缩性骨折患者共106个椎体行PVP治疗,技术成功率100%,其中52例患者疼痛完全缓解(CR);8例患者疼痛部分缓解(PR);总有效率100%.2例出现骨水泥外溢至椎间盘,未出现临床症状,全部病例未出现严重并发症.结论 应用国产骨水泥行PVP术治疗外伤和骨质疏松性椎体压缩性骨折安全有效,能明显地缓解疼痛和加固椎体,是一种值得临床推广应用的治疗方法.     

C形臂X线机与CT联合导向在经皮椎体成形术中的应用

目的探讨在移动式C形臂X线机与16排CT联合导向下,经皮椎体成形术中在治疗骨质疏松性椎体压缩骨折的操作方法及优势。方法将移动式C形臂X线机与16排CT置于同一机房,组成组合机。16排CT扫描病变椎体及相邻椎体,确定穿刺点及穿刺路径,评价术后椎体情况;移动式C形臂X线机实时透视监视注射聚乙烯吡咯烷酮(骨水泥)。结果在组合机引导下对12例单椎体压缩骨折的患者行经皮椎体成形术成功率100%,无并发症发生。结论移动式C形臂X线机与16排CT联合导向在经皮椎体成形术中的操作简便、定位准确、监视实时、导向安全,特别提高了L4椎体平面以上各椎体行椎体成形术的安全性。     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.     

Extension du modèle puissance–temps limite pour estimer la production d’énergie aérobie et anaérobie lors de l’exercice intense

Aim

Examine how the modelling of the relation between power and time to exhaustion can provide an estimation of the production of aerobic and anaerobic energy during intense exercise.

Current knowledge

The hyperbolic model made it possible to define the critical power corresponding to the maximal rate of energy renewed by aerobic metabolism. A new model distinguishing the critical power from the maximal aerobic power has been built to estimate more precisely the anaerobic contribution. Data from middle distance runners and subjects tested on cycle ergometer showed a relative contribution of anaerobic metabolism arising from critical power and increasing until around 10 % of total power when aerobic energy production reaches its maximum.

Prospects

Considering the slow component of oxygen uptake would provide a more precise analysis of energy production and transformation during exercise at high intensity.     

Beziehungen zwischen Aufprallgeschwindigkeit,Fahrzeugbeschädigungen,Frakturen und „Wurfweite” bei 50 tödlichen Fußgänger-PKW-Unfällen

Zusammenfassung Aus 160 Obduktionen von Fußgängern, die durch PKW getötet worden waren, sind 50 nach folgenden Gesichtspunkten ausgewählt worden:Auffahrunfälle Erwachsener mit gesicherten Angaben in den Gerichtsakten über Fahrzeugbeschädigungen, Zusammenstoßstellen, Endlage der Fußgänger und Bremsspuren. Aus diesen Daten wurden Ausgangs- und Aufprallgeschwindigkeiten berechnet sowie die Wurfweite der Fußgänger gemessen.Die Ausgangsgeschwindigkeiten, nach der Berechnung zwischen 32 und 95 km/h, lagen meistens etwas höher als die angegebenen Geschwindigkeiten. Zwischen Ausgangs- und Aufprallgeschwindigkeiten waren die Differenzen größer. Ab 12 km/h Aufprallgeschwindigkeit kam es bereits zu tödlichen Verletzungen. Auffallend ist die zweigipfelige Verteilung der Häufigkeit sowohl bei der Einteilung nach den Aufprallgeschwindigkeiten als auch nach den Deformationsarbeiten (Aufprallgeschwindigkeit: 26% bei 51–60 km/h und 22% bei 21 bis 30 km/h; Deformationsarbeit: 34% bei 39–200 kpm und 30% bei 701–1000 kpm).Bei Aufprallgeschwindigkeiten über 50 km/h wurden doppelt so viel Knochenbrüche an der Wirbelsäule und am Becken als bei Aufprallgeschwindigkeiten unter 50 km/h festgestellt.Bei 44 Fußgängerunfällen lag ein Drittel innerhalb der Erwartungsgrenze der Wurfweite nach Fiala, je ein Drittel aber darüber bzw, darunter.Das Beschädigungsbild und die Anstoßverletzungen geben Hinweise zur Ermittlung der Aufprallgeschwindigkeit, vor allem wenn weitere Berechnungsgrundlagen fehlen.

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Summary Fifty cases were selected from 160 autopsies performed on pedestrians who were accidentally killed by private motorcars; the cases were selected according to the following criteria:The cases were confined to impact accidents involving adults in which reliable evidence could be gathered from the Court records in relation to damage to the car, the place of collision, the final position of the injured pedestrian and the extent of skidmarks. The initial and collision speeds of the cars were calculated from these facts and the distance of projection of the pedestrians were measured.The initial speeds, calculated between 32 and 95 km/h, were, in most cases, higher than the declared speeds. The differences between initial and collision speeds were larger. Fatal injuries could arise from a collision velocity of only 12 km/h. A striking feature of the analysis was the distribution of two peaks of frequency whether these were classified according to the collision speeds or according to the deformation of the vehicle (collision speed: 26% at the speed of 51 to 60 km/h and 22% at the speed of 21 to 30 km/h; deformation work: 34% at the deformation work of 39 to 200 kpm and 30% at the deformation work of 701 to 1,000 kpm).Twice as many fractures of the vertebral column and pelvis were sustained at collision speeds over 50 km/h as were sustained under 50 km/h.In one third of 44 pedestrian accidents, the distance of projection was within the expected range described by Fiala; in one third the distance was above and in one third below the expected range.If additional data for calculation were lacking, the patterns in injury arising from the impacts gave indications from which it was possible to estimate the collision speed.

Stipendiat der Alexander v. Humboldt-Stiftung, Dozent Dr. med. S. Kamiyama, Dept. of Legal Medicine, School of Medicine, Chiba University, 313 Inohanacho, Chiba, Japan.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Hip and pelvic injuries in the elderly

Fractures of the hip and pelvis are frequent and serious injuries in elderly patients. Due to the aging population, their incidence should double by 2050. Therefore, the social and economical implications of these fractures are significant. Delay in diagnosis increases the associated morbidity and mortality. The purpose is to review the imaging features of these fractures, the imaging techniques (projections, CT) to depict them and their classification based on severity.