数字胃肠机升级方案的选择与特殊运用

本文介绍了数字胃肠机升级方案的选择原则和需要考虑的主要因素及方法,并阐述了升级系统在胃肠造影以外的应用。合理选择数字胃肠机升级系统方案,可以让数字成像完全满足临床诊断的需求,同时又极大地节约医院的运行成本。     

Adapting the fluoroscope to image-guided surgery

Image-guided techniques have been well established in all surgical disciplines for years. To achieve an optimised work flow during image-guided surgery, the surgeon should be able to manipulate the visual feedback and therefore the imaging unit. C-arm fluoroscopy is the imaging modality routinely used for intraoperative imaging in orthopaedic surgery. The C-arm fluoroscope is positioned and handled by a radiographer on vocal commands, which means that the surgeon depends on external help to manipulate the visual feedback and the work flow is not optimised. The MEPUC interface adapts the C-arm fluoroscope to the needs of image-guided orthopaedic procedures. MEPUC is an acronym for Motorised Exact-Positioning Unit for C-arm. In the hardware component of the MEPUC a conventional C-arm fluoroscope is equipped with stepping motors. The software component allows the surgeon to control the motorised movements of the fluoroscope. The MEPUC interface enables the surgeon to position the C-arm fluoroscope independently in the operating room. Further advantages are achievable when the MEPUC interface is combined with surgical navigation, as this combination allows fully automatic reproduction of former projections. Clinical experience with the MEPUC interface suggests that the work flow for intraoperative imaging is improved and personal requirements reduced.     

职业健康检查中摄胸片取代胸透的探讨

目的探讨基层疾病预防控制中心在职业健康检查中用摄胸片取代胸部透视的利弊。方法分别从辐射危害、阳性检出率和各自优缺点3个角度进行分析比较。结果在职业健康检查中摄胸片机体所受的X射线有效剂量当量比胸部透视小11.92倍,阳性检出率是胸部透视的5倍,二者阳性检出率比较,差异有统计学意义(χ2=41.77,P0.01)。且胸片显影清晰,对比度高,能发现早期肺微小病变和客观记录图像等优点,比胸部透视更适合在职业健康检查中应用。结论为了保障劳动者合法健康权益,减少有害X射线辐射,提高职业病(尘肺病)的检出率,提倡在基层疾病预防控制中心的职业健康检查中用X射线胸部摄片取代常规胸部透视的做法。     

东芝KXO-15CX线发生器透视无图像故障分析

本文对我院东芝KX0-15CX线发生器出现过9次透视无图像故障进行了分析讨论，并论述了检修方法。     

Accuracy of Sonographically Guided Intra‐articular Injections in the Native Adult Hip

Objective. The purpose of this study was to determine the accuracy of sonographically guided intra‐articular injections performed in the native adult hip using contrast‐enhanced fluoroscopy as a reference standard. Methods. Twenty‐eight consecutive patients (ages 32–91 years; mean, 68 years) referred to the pain clinic for intra‐articular hip injections were recruited to participate. In each case, a 2‐ to 6‐MHz curvilinear array transducer was used to place the needle into the hip joint at the femoral head‐neck junction using an oblique sagittal approach. A contrast‐enhanced fluoroscopic examination was then completed and assessed by an independent observer to determine needle placement accuracy. Once accurate placement was confirmed, the therapeutic injection proceeded. Results. Thirty hip injections were completed in 15 women and 13 men (1 man and 1 woman received bilateral injections). The patients' body mass index (BMI) ranged from 20 to 39 kg/cm² (mean, 28 kg/cm²) and procedure time from initial scanning to injection averaged 112 seconds (range, 47–187 seconds). Overall, 97% of sonographically placed needles were accurate. The single inaccurate placement resulted from inadvertent needle withdrawal from the joint capsule during connection of the extension tubing for contrast agent injection in a young patient with a BMI of 28 kg/cm² and no hip effusion. Conclusions. Sonographic guidance can be used to inject the native adult hip joint with acceptable accuracy. When using the oblique sagittal approach, operators must be aware of the possibility of needle withdrawal from the joint due to the limited intra‐articular space within the target region, particularly in the absence of effusion.     

Axillary/subclavian vein puncture using navigation by parallax with an imaginary target

BACKGROUND: The parallax principles allow the relative positions of two overlapping objects with respect to the receiver of a two dimensional image to be determined, and can reliably navigate an object to a target in three dimensional space. Navigation by parallax can direct axillary/subclavian vein puncture under fluoroscopy with a guide wire inside the vein. The axillary/subclavian vein has a constant relationship with the first rib and an imaginary target just cranial and lateral to the middle part of the first rib may serve as a surrogate position marker for the vein adequate for guiding puncture. METHOD: Patients requiring axillary/subclavian vein puncture were considered for the new technique. In an appropriate postero-anterior (P-A) caudal projection such that the middle part of the first rib lay outside the second rib concavity, the needle was inserted into the body medial to the coracoid process and advanced dorsally and medially towards an imaginary target cranial and lateral to the middle part of the first rib. Once the needle tip had reached the imaginary target, it was moved ventro-dorsally while staying stationary in the fluoroscopic image until venous blood was aspirated. RESULT: Navigation by parallax was successful in 21/24 cases (88%) and 42/45 separate venous punctures (93%) with an imaginary target, and in the remaining three cases with a real guide wire target. There were four insignificant axillary arterial punctures. CONCLUSIONS: Navigation by parallax with an imaginary or a real target is effective, easy, and simple, and should facilitate axillary/subclavian vein puncture in multiple clinical scenarios.     

B超及X线检查对判定异常节育环的价值比较

目的 探讨超声、X线透视检查对判定节育环异常的价值。方法 本组对62例病人进行了B超及X线透视检查，其中至少有一种检查结果显示节育环异常。结果 B超检查节育环异常50例，X线透视检查节育环异常41例，B超诊断节育环异常准确率为80．64％，X线透视诊断节育环异常准确率为66．13％。结论 超声、X线透视对节育环异常的判定各有特点，B超检查对判断节育环异常价值更大。     

Bennett骨折闭合整复透视下克氏针内固定术的临床观察

目的:探讨闭合手法复位后透视下经皮克氏针内固定术治疗Bennett骨折的可行性,评价其对骨折修复的作用及后期功能恢复情况.方法:对12例Bennett骨折患者在X线透视下两助手牵引复位,用2枚克氏针固定大多角骨及第一、二掌骨,维持骨折块的解剖复位,观察疗效.结果:术中骨折均解剖复位,石膏外固定4～6周后去除内固定,12例患者随访9个月,骨折无错位,一期愈合,露在皮外克氏针未发生感染,拇指腕掌关节功能良好.结论:闭合整复透视下2枚克氏针内固定术治疗Bennett骨折固定可靠,疗效确切,能减轻患者痛苦及经济负担,适于基层医院推广应用.     

小儿肠套叠304例空气灌肠诊治体会

目的分析空气灌肠整复失败原因,提高小儿肠套叠空气灌肠诊断及治疗水平。方法总结304倒小儿肠套叠的临床表现和治疗情况。结果304例均以阵发性哭闹（或腹痛）、呕吐、血便、腹包块为主要症状。x线透视下行空气灌肠诊断和整复治疗,灌肠整复成功211例（69．0％）。结论小儿肠套叠早期诊断及治疗与预后相关。整复失败与患儿延误就诊、复杂型肠套叠、套叠肠袢器质性病变、合并其他先天性疾病等有关。