射频毁损脊神经后内侧支治疗腰椎小关节病变所致慢性腰痛的疗效

目的：评估射频毁损脊神经后内侧支治疗腰椎小关节病变所致慢性腰痛的疗效。方法：将腰痛时间长于3个月、腰椎小关节处有固定压痛以及影像学检查诊断为腰椎小关节病变的40例患者随机分为射频组（n=20）和消炎镇痛药组（n=20）。射频组患者在C型臂X线机引导下将射频穿刺针刺到脊神经后内侧支所对应小关节的上关节突与相应横突根部交界处,确认位置后行感觉测试和运动测试,如无异常进行射频热凝治疗。消炎镇痛药组患者口服双氯芬酸钠。腰痛程度采用视觉模拟评分法（visual analogue scale,VAS）评分。治疗前（T0）和治疗后3个月（T1）观察患者的生命体征和VAS评分。根据治疗过程中VAS改善程度统计疗效（分为显效、有效和无效）。结果：治疗后3个月总有效率射频组为87．6％,消炎镇痛药组为46．5％;显效率射频组为76．2％,消炎镇痛药组为26．4％。射频组的总有效率和显效率均显著高于消炎镇痛药组（P〈0．01）。结论：C型臂X线机引导射频毁损脊神经后内侧支治疗能有效缓解腰椎小关节病变所致慢性腰痛,疗效优于口服药物治疗。     

经皮空心螺钉治疗累及骨盆环骨折21例临床分析

目的:评价C型臂引导下经皮空心螺钉治疗累及骨盆环骨折的临床安全性及疗效。方法:回顾分析应用经皮空心螺钉治疗骨盆环骨折21例,空心螺钉直径均为6.5 mm。单纯前环单侧骨折4例、双侧骨折5例;前后环均破坏中,一侧骶骨骨折脱位合并同侧或对侧耻骨上下支骨折7例,合并耻骨联合分离2例,合并双侧耻骨上下支骨折3例。骶骨骨折脱位除1例用2枚螺钉外,其余均用1枚螺钉固定,耻骨上支用1枚螺钉,耻骨联合分离用1枚螺钉。结果:手术时间20~50 min,平均30 min,术后21例均获得随访,时间1~14个月,平均10个月。所有患者均无医源性神经损伤,除1例骶髂关节骨折脱位合并耻骨联合分离螺钉欠佳外,其余螺钉位置良好,未见螺钉移位现象。该例患者出现生理负荷下骶髂部疼痛,行走有跛行。结论:C型臂X线机引导下经皮空心螺钉治疗累及骨盆环骨折,是一种安全、有效、微创的方法。     

C臂CT在介入诊疗中的应用

C臂CT是平板探测器数字减影血管造影系统的一种新技术,在介入室同一工作床上能提供透视、摄影、DSA及容积CT成像,已在血管性及非血管介入诊疗中开始发挥其独特作用,本文介绍C臂CT在介入诊疗应用中的潜力、限度与前景.     

C臂CT在腹部介入诊疗中的初步应用

目的 探讨C臂CT在腹部介入诊疗中的应用价值.方法 42例行腹部介入诊疗患者在常规DSA基础上行C臂CT检查,评价C臂CT是否提供额外影像信息及其对介入治疗方案的影响;其中25例与近期多层螺旋CT(MSCT)比较,评价其图像质量.结果 在35例行介入治疗的患者中,68.6%(24/35)C臂CT在常规DSA基础上能提供...     

针刀治疗椎-基底动脉供血不足的临床观察

目的：观察C形臂x线机下针刀松解枕下三角对椎．基底动脉供血不足（VBI）的影响。方法：将131例VBI患者随机分为两组,治疗组68例采用C形臂x线机下针刀松解枕下三角、刺激风池穴治疗,对照组63例采用静脉滴注葛根素注射液治疗。观察治疗前后临床症状及经颅多普勒超声（TCD）检测左椎动脉、右椎动脉、基底动脉平均血流速度的变化。结果：治疗组总有效率为89．71％、对照组为85．71％。治疗组治疗后椎一基底动脉平均血流速度明显增加（P〈0．01）。结论：C形臂x线机下针刀松解枕后三角治疗VBI有效。     

C型臂图像拼接技术在下肢复杂骨折微创术中的临床应用效果分析

目的探讨移动式c型臂实时图像拼接技术在临床骨科微创手术中的应用效果。方法对43例下肢复杂性骨折均采用微创手术治疗,术中对下肢进行c型臂透视并采集2～4幅图像,经过图像拼接技术处理后得到骨折复位后内固定手术部位的1张全景图像,对术中拼接图像进行评价;术后行DR或CR摄片检查并进行相关角度测量。结果术后43例均获随访,随访时间6—16个月,平均8个月,术后及术后3月复查X线片示骨折对位、对线佳,骨折均愈合,无钢板断裂和螺钉松动,其术中拼接图像的评定结果为全组43例中,优27例,良15例,可1例,差0例,优良率为97．67％。43例患者测量的角度均在正常范围以内,拼接完整图像和术后DR或CR图像的比较差异无统计学意义（P〉0．05）。结论移动式c型臂拼接技术的全景成像能够及时、有效地满足了骨科医生在术中重构股骨和胫骨骨折部位全景图像的需要,避免了临床对术中骨折的复位整体效果判断有误和内固定物不适当等现象,为进一步提高临床骨科微创手术质量提供强有力的支持和保障。     

A Language for Effective Communication between Surgeons and Radiographers in Trauma Theatre

INTRODUCTION

The advent of the image intensifier has revolutionised trauma surgery since its development in 1955. The manufacturers have given names to various movements of the machine in the operating manual but it has not been popular among orthopaedic surgeons or radiographers. Lack of knowledge of names of various movements and ambiguity in command often leads to confusion between the surgeon and the radiographer regarding which way to move the image intensifier. A questionnaire-based study was conducted to assess the efficacy of communication between orthopaedic surgeons and radiographers while using the image intensifier intra-operatively.

SUBJECTS AND METHODS

Diagrams depicting the movements of the image intensifier were used in the questionnaire. Fifty questionnaires were given to orthopaedic surgeons and 50 to radiographers to name the various movements.

RESULTS

Ninety questionnaires were returned, 45 from surgeons and 45 from radiographers. Five questionnaires from surgeons and five from radiographers were returned blank. Of those responding, 97% could name the vertical movement, 68% the horizontal movement, 12% the swivel and 29% the angulation movement. None could name the orbital movement.

CONCLUSIONS

Even though orthopaedic surgeons do not operate the image intensifier themselves, knowledge of the movements of the image intensifier and their names can improve the efficacy of communication between surgeons and radiographers. A common language and precision in command can avoid confusion and has the potential to improve theatre time utilisation. The nomenclature of various movements of the image intensifier has been described and possible precise commands for various movements have been postulated.     

Flat-detector computed tomography (FD-CT)

Flat-panel detectors or, synonymously, flat detectors (FDs) have been developed for use in radiography and fluoroscopy with the defined goal to replace standard X-ray film, film-screen combinations and image intensifiers by an advanced sensor system. FD technology in comparison to X-ray film and image intensifiers offers higher dynamic range, dose reduction, fast digital readout and the possibility for dynamic acquisitions of image series, yet keeping to a compact design. It appeared logical to employ FD designs also for computed tomography (CT) imaging. Respective efforts date back a few years only, but FD-CT has meanwhile become widely accepted for interventional and intra-operative imaging using C-arm systems. FD-CT provides a very efficient way of combining two-dimensional (2D) radiographic or fluoroscopic and 3D CT imaging. In addition, FD technology made its way into a number of dedicated CT scanner developments, such as scanners for the maxillo-facial region or for micro-CT applications. This review focuses on technical and performance issues of FD technology and its full range of applications for CT imaging. A comparison with standard clinical CT is of primary interest. It reveals that FD-CT provides higher spatial resolution, but encompasses a number of disadvantages, such as lower dose efficiency, smaller field of view and lower temporal resolution. FD-CT is not aimed at challenging standard clinical CT as regards to the typical diagnostic examinations; but it has already proven unique for a number of dedicated CT applications, offering distinct practical advantages, above all the availability of immediate CT imaging in the interventional suite or the operating room.     

Balloon sinuplasty — the first Indian experience

The surgical management of sinusitis was revolutionized worldwide with the advent of the rigid Hopkins rod nasal endoscopes three decades ago. The traditional Messerklinger technique, was thus propagated worldwide by Prof. Stammberger, from the University of Graz in Austria and has come into vogue as functional endoscopic sinus surgery (FESS). The principal aim behind this procedure was the maximal preservation of the nasal mucosal integrity, while providing optimal disease clearance. Today, the introduction of a new technological innovation called ‘balloon sinuplasty’, has taken the field of sinus surgery a step further. This new technology is very similar to the principles of balloon angioplasty and today, this system has added an efficient, non-invasive tool in the armamentarium of the innovative endoscopic rhinologist. This FDA approved technique, in recent times has provided excellent results in various centers across the western world. We share our first surgical experience with the introduction of this cutting-edge technology in India.