颈动脉蹼与缺血性脑卒中:从病理影像到治疗

颈动脉蹼(carotid web,CaW)是位于颈动脉分叉部后壁向血管腔内突起的薄层样结构.近年来,对CaW在缺血性脑卒中尤其是隐源性脑卒中发生及复发中的作用有较多的研究,但临床对其认识尚不够深入.     

能谱CT成像与颈部血管超声评价颈动脉狭窄的对比研究

目的 探讨能谱CT成像与颈部血管超声在颈动脉狭窄评价中的应用价值。方法 纳入2016年6月—2021年6月河南省驻马店市中心医院数字减影血管造影（DSA）确诊为颈动脉狭窄的缺血性脑卒中（IS）患者289例,其中男159例、女130例,年龄43~82（61.7±8.0）岁。患者均行能谱CT和颈部血管超声检查,以DSA诊断结果为金标准,比较能谱CT及颈部血管超声诊断颈动脉狭窄程度的一致性;比较2种检查方法对不同程度颈动脉狭窄的诊断效能;比较2种检查方法对颈总动脉易损斑块的检出率。结果 以DSA诊断结果为金标准,能谱CT及超声检测颈动脉狭窄程度Kappa值分别为0.844、0.882,均具有较好的一致性;除了颈部血管超声诊断颈动脉轻度狭窄的灵敏度较低、能谱CT诊断颈动脉轻度狭窄的阳性预测值较低外,能谱CT及颈部血管超声对不同程度颈动脉狭窄的诊断均具有较高的准确率、灵敏度、特异度、阳性预测值及阴性预测值。在颈总动脉上,DSA共检出易损斑块1 672个;颈部血管超声检出876个,其中软斑块384个、表面不规则斑块80个、溃疡斑412个,易损斑块检出率为52.39%（876/1 672）;能谱CT检出367个,均为软斑块,易损斑块检出率为21.95%（367/1 672）。血管超声易损斑块检出率高于能谱CT,差异有统计学意义（χ²=509.00,P<0.001）。结论 能谱CT成像与颈部血管超声均能准确判断颈动脉狭窄程度,超声可能在颈总动脉易损斑块评估中更具价值,临床应用时可将两种方式联合使用。     

原发性脾脏血管肉瘤一例

患者女，50岁。以左上腹疼痛1年余，加重4d就诊。1年前无明显诱因出现左上腹部针刺样痛，近4d左上腹痛在吸气及右侧卧时加重。同时出现左肩部疼痛。体检：一般情况尚可，皮肤黏膜无出血及黄染。     

磁共振成像在颈动脉狭窄中的诊断价值

目的探讨磁共振成像在颈动脉狭窄诊断中的价值。方法对30例患者行磁共振检查（MRA和MRI）,其中23例行数字减影血管造影（DSA）,以颈总动脉法（CC法）计算狭窄率。结果以DSA检查结果为金标准,磁共振诊断颈动脉狭窄及闭塞的敏感性、特异性、假阴性率及假阳性率分别为97.06%、70.59%、2.94%、29.41%。结论MRA结合MRI可作为诊断颈动脉狭窄的筛选检查。     

糖尿病患者颈动脉血管超声检测

目的应用彩色多普勒超声检测糖尿病患者颈动脉结构改变。方法应用高频探头对54例糖尿病患者，40例非糖尿痛患者的颈动脉进行超声检测，并对比分析相关内容。结果糖尿病组颈动脉内膜厚度较非糖尿病组增加，斑块发生率增加。结论高频超声可以早期发现糖尿病患者颈动脉粥样硬化，其发病率及发生率均高于正常组。     

脑梗死病人的颈动脉超声分析

目的 探讨颈部血管病变与脑梗死的相关性。方法 自颈总动脉近心端开始,分别取其短轴和长轴切面,由近而远逐渐向远心端扫查,观察颈总动脉及其分又处、颈内动脉和椎动脉内-中膜厚度和形态、斑块及血流情况。结果 129例脑梗死患者中有110例共329支颈部动脉患有不同程度的硬化,100例共178支动脉有硬化斑块。13例14支动脉为中度至严重狭窄;3例3支颈内动脉为完全闭塞,不能引出血流频谱和血流色彩。结论 颈动脉粥样硬化所形成的颈动脉狭窄和斑块是缺血性脑病的病理基础,颈动脉粥样硬化附壁血栓脱落、斑块的破裂出血可以成为大片脑梗死或腔隙性脑梗死的主要原因。     

基于超声超高帧率时空滤波图像的颈动脉血管壁运动追踪

本研究提出一种超声超高帧率时空滤波图像联合块匹配方法,以实现对颈动脉血管壁的运动追踪.超高帧率平面波超声图像以其高时间分辨率反映细节的运动信息.时空滤波方法滤除图像中相关性较低的随机噪声信号,从而使得联合块匹配算法中相关性的计算更加准确.通过对比,高帧率成像相对于低帧率反映出更加细致的运动信息,时空滤除处理减少了追踪结...     

Involvement of the proximal tibiofibular joint in osteoarthritis of the knee

This study was performed to evaluate the possible involvement of the proximal tibiofibular joint in primary osteoarthritis of the knee. A total of 40 patients with primary osteoarthritis of the knee who had magnetic resonance imaging scans were reexamined for proximal tibiofibular joint involvement. The patient was questioned if pain was present in the proximal tibiofibular joint while at rest, when walking and climbing stairs. Symptoms were evaluated by applying moderate compression over the proximal tibiofibular joint during active ankle and knee motions. Magnetic resonance imaging scans were reexamined by two radiologists. Three of the 40 patients had minimal or moderate pain in the proximal tibiofibular joint during stair-climbing and on clinical examination. Magnetic resonance imaging scans of these three patients revealed osteophyte or subchondral cyst formation, or both. Degenerative changes in the proximal tibiofibular joint may be evident in association with osteoarthritis of the knee and may result in lateral-sided pain at the knee.     

Clinical evaluation of the proximal tibiofibular joint in knees with severe tibiofemoral primary osteoarthritis

Despite the coexistence of primary arthritic involvement of the tibiofemoral and proximal tibiofibular joints (PTFJ), clinical features of the PTFJ in knees with severe femorotibial arthritis have not been described to date. The PTFJ in knees with primary osteoarthritis may be a source of lateral knee pain after total knee arthroplasty operations. This study seeks to address whether there is a relationship between the clinical findings and degeneration of the PTFJ in knees with severe tibiofemoral primary osteoarthritis. Sixty knees in 34 consecutive patients (31 females and 3 males; mean age 71 years; range 61–86 years) with Kellgren–Lawrence grades III–IV primary femorotibial arthritis were enrolled in this study in order to collect clinical data regarding the PTFJ. Radiographs showed 23 PTFJs were grade IV, 14 were grade III, and 23 were grade II. With regard to the type of PTFJ, 13 joints were horizontal and 47 were oblique. Pain and tenderness were observed in 13 PTFJs upon clinical exam (two horizontal and 11 oblique PTFJ types; grade II in five, grade III in two, and grade IV in six). Lateral hamstring tightness was found in 28 knees (24 oblique and four horizontal PTFJ types; grade II in 10, grade III in two, and grade IV in 16). Ten of the 28 PTFJs in knees with lateral hamstring tightness were painful during the physical examination. No significant relationship was found between PTFJ exam findings and PTFJ type (Fisher's Exact test, p = 0.713), PTFJ grade of arthritis (χ² test, p = 0.700), or between hamstring tightness and PTFJ type (χ² test, p = 0.194). However, hamstring tightness was significantly correlated with the grade of arthritis in the PTFJ (χ² test, p = 0.004). Although degenerative disease of the PTFJ is commonly associated with degenerative disease of the knee joint, radiographic findings of the PTFJ in patients with severe degenerative knee osteoarthritis and varus malalignment do not correlate with clinical findings.     

The effect of tibiofemoral loading on proximal tibiofibular joint motion

The human proximal tibiofibular joint (PTFJ) and its relationship to overall knee joint mechanics have been largely unexplored. This study describes force/displacement data from experiments done on four human cadaveric knee specimens and general conclusions obtained with the help of a statistical modeling technique. Specimens were rigidly affixed at the tibia to a force plate and the femur was attached to a custom made device allowing for manual load application. Motion of the fibular head was tracked relative to the tibial plateau by means of reflective markers and a high speed digital camera synchronized with the force plate data stream. Each specimen was subjected to a range of loading conditions and a quadratic regression model was created and then used to predict the specimen's response to standardized loading conditions and compare these across specimens. Statistical analysis was performed with a three-factor analysis of variance with repeated measures. Proximal tibiofibular joint motion was largest in the anterior-posterior direction with translations of 1-3 mm observed during a range of physiological loading conditions. The applied internal-external rotation moment had a significant effect on proximal tibiofibular joint translation (P < 0.05). Effects of varus-valgus loading and flexion angle were seen in some specimens. This study demonstrates that substantial proximal tibiofibular joint motion can occur in physiologic loading states. Preservation of proximal tibiofibular joint function, and anatomical variations which affect this function, may need to be considered when designing surgical procedures for the knee joint.     

The effect of common carotid artery occlusion on blood pressure in the barodenervated cat

A 12% blood pressure elevation was found during common carotid occlusion in the barodenervated, thoracotomised cat under Nembutal anaesthesia. This rise in blood pressure appeared to be the net result of an 18% increase of total peripheral resistance and a concomitant 5% decrease of mean aortic flow.When the occlusions were repeated after ganglionic blockade similar values were found, indicating that the increase in resistance had not resulted from reflex vasoconstriction. To test if this increase of total peripheral resistance was caused by a mechanical exclusion, Ohm's law for parallel resistances was applied to the systemic tree to calculate the rise in resistance due to obstruction of the carotid flow. The results thus obtained matched the observed increase of peripheral resistance.It is concluded that common carotid artery occlusion can be used to test completeness of barodenervation in the cat, if an increase in blood pressure of about 12% is allowed for.     

膝屈伸肌群等速肌力训练改善膝骨性关节炎患者步态的效果分析

目的探讨膝屈伸肌群等速肌力训练改善膝骨性关节炎(KOA)患者步态的效果。方法采用前瞻性研究方法,为保证研究的安全性和科学性,选择2013年2月~2015年10月在我院诊治的KOA患者98例,根据入院顺序分为观察组与对照组各49例,两组都给予玻璃酸钠关节腔内注射和关节松动治疗,对照组给予积极康复训练,观察组给予膝屈伸肌群等速肌力训练,治疗观察时间都为4周。结果观察组与对照组的疗效优良率分别为93.9%和75.5%,观察组明显高于对照组(0.05)。治疗后观察组与对照组的Lysholm膝关节功能评分分别为(86.33±11.31)分和(75.84±10.71)分,都明显高于治疗前的(56.24±12.55)分和(56.24±11.12)分,组内与组间对比差异都有统计学意义(0.05)。观察组治疗后的屈肌PT与AOPT值分别为(21.87±3.67)N·m和(99.23±11.48)°,而对照组分别为(18.34±4.11)N·m和(89.02±10.45)°,都明显高于治疗前(0.05),且组间对比差异有统计学意义(0.05)。两组在治疗期间都无严重并发症,但观察组的恶心、呕吐、腹痛、腹胀等并发症发生率明显少于对照组(0.05)。结论膝屈伸肌群等速肌力训练在KOA患者中的应用能显著缓解疼痛、增强膝关节功能,具有很好的安全性,从而促进步态改善,具有重要的推广价值。     

腓骨近端截骨与膝关节表面置换治疗膝关节骨关节炎早期疗效的自身对照研究

目的 探讨腓骨近端截骨术和膝关节表面置换术治疗老年膝关节骨关节炎伴膝内翻畸形的早期临床疗效。方法 采用前瞻性自身对照研究方法 ,对2014年11月—2015年2月蚌埠医学院第一附属医院骨科收治的10例双侧膝关节骨关节炎伴膝内翻畸形患者,采用数字表法随机选择术式,每例患者两侧膝分别行腓骨近端截骨术(截骨组)和膝关节表面置换术(置换组)治疗,并对比观察其早期疗效。其中男2例,女8例,年龄55~75岁。应用VAS评分、美国特种外科医院(HSS)膝关节评分、美国膝关节外科协会评分(KSS)评价患者手术前后膝关节疼痛及功能情况,采用SPSS 21.0统计软件进行统计学分析。结果 所有患者顺利完成手术,术后获得随访6~9个月。术前截骨组和置换组在膝关节疼痛与功能评分方面差异均无统计学意义(P值均>0.05)。术后截骨组与置换组的膝关节疼痛及功能均明显改善,至末次随访时双侧VAS评分、HSS评分及KSS临床、功能评分均较术前明显改善,差异均有统计学意义(P值均<0.01);2组术后末次随访各评分差异均无统计学意义(P值均>0.05)。截骨组1例患者术中损伤胫腓间软组织,出现典型的腓总神经麻痹症状,术后6个月恢复正常,其余均无手术相关并发症发生。结论 腓骨近端截骨术可以明显改善膝关节骨关节炎伴膝内翻畸形患者的疼痛及功能情况,与膝关节表面置换术取得同样早期疗效,是一种安全的微创外科手术技术。     

The effects of antagonist moment on the resultant knee joint moment during isokinetic testing of the knee extensors

The purpose of this study was to examine the effects of moment of antagonistic muscle on the resultant joint moment during isokinetic eccentric and concentric efforts of the knee extensors. Ten males performed maximum eccentric and concentric knee extension and flexion efforts on a Biodex dynamometer at 0.52 rad · s⁻¹ (30° · s⁻¹). Electromyographic (EMG) activity of vastus medialis and biceps femoris (hamstrings) was also recorded. The antagonistic moment of the hamstrings was determined by recording the integrated EMG (iEMG)/moment relationship at different levels of muscle effort. The iEMG/moment curves were fitted using second-degree polynomials. The polynomials were then used to predict the antagonistic moment exerted by the hamstrings from the antagonist iEMG. The antagonistic moment had a maximum of 42.92 Nm and 28.97 Nm under concentric and eccentric conditions respectively; paired t-tests indicated that this was a significant difference (P < 0.05). These results indicate that the resultant joint moment of knee extensors is the result of both agonist and antagonist muscle activation. The greater antagonist muscle activity under concentric activation conditions may be partly responsible for the lower resultant joint concentric moment of knee extensors compared with the corresponding eccentric activation. The antagonist moment significantly affects comparisons between the isokinetic moments and agonist EMG and in vitro force measurements under different testing (muscle action and angular velocity) conditions. Accepted: 25 February 1997