脊椎压缩性骨折的影像学诊断

脊椎压缩性骨折（ｃｏｍｐｒｅｓｉｏｎｆｒａｃｔｕｒｅｏｆｔｈｅｖｅｒｔｅｂｒａ）是相当常见的疾病，可引起背部疼痛以及神经症状。过去我们经常以Ｘ线平片来诊断压缩性骨折，临床上应用相当广泛，然而平片有其诊断的缺点，所以常需要其他检查，如脊髓造影、ＣＴ及Ｍ...     

术前MRI检查确定椎体压缩性骨折节段及数量价值分析

目的：探讨术前MRI检查确定急性骨质疏松性椎体压缩性骨折（OVCFs）节段及数量的价值。方法：选择临床拟诊的OVCFs121例,脊柱标准位平片和CT扫描检查均在入院时完成,脊柱薄层短翻转恢复（STIR）序列的MRI扫描在术前1周内完成;分为单节段骨折组（89例）和多节段骨折组（32例）,将每组患者最初通过标准位平片和CT检查确定的骨折节段和数量与MRI结果进行比对。结果：单节段组MRI与标准位平片和CT扫描检查诊断不一致率为25．8％（23／89）,多节段组诊断不一致率为62．5％（20／32）;多节段组标准位平片和CT扫描检查误诊率非常显著高于单节段组（P〈0．01）。结论：OVCFs（特别是多节段）,术前加行MRI检查能够显著降低误诊率。     

颞骨及颅底肿瘤

颞骨病变的影象诊断,过去主要靠平片和多轨迹体层摄影。近年来,由于CT扫描技术的改进,空间分辨力已达0.1mm的高水平,已成为诊断方面的重要检查方法。最近磁共振也正在应用于临床。本文论述一下颞骨及颅底肿瘤主要病变的影象特征(包括磁共振)。一、颞骨肿瘤 (一)胆脂瘤胆脂瘤是锥体内发生的肿瘤。原发性胆脂瘤少见,它是由误入锥体的类上皮细胞发生的,继发性胆脂瘤发病率高,它是由慢性中耳炎引起的。在此论述继发性胆脂瘤的X线的表现。胆脂瘤的诊断,除因先天畸形看不到鼓膜外,     

反射性交感神经营养不良的影像学诊断

目的探讨反射性交感神经营养不良(RSD)影像学诊断的意义。方法收集并分析5例反射性交感神经营养不良的临床和影像学特点。结果全部患者均在外伤后起病,均有错位疼痛、局部水肿和感觉过敏等临床表现。X线平片和CT检查均可发现病变部位的斑片状骨质疏松,CT检查优于平片。4例患者行骨扫描检查发现病变部位均有放射性异常浓集影。1例早期患者行MR I检查,能发现在平片中不易发现的骨侵蚀。结论平片和CT扫描显示的斑片状骨质疏松是本病最具特征性的影像学表现,骨扫描和MR I有助于本病的早期诊断。     

小儿支气管肺炎胸部平片X线分析

小儿支气管肺炎是婴幼儿最常见的急性肺部感染。本文通过80例小儿支气管肺炎的临床表现及胸部平片分析认为：由于小儿生长发育、营养状况及有无其它原发性疾病等，小儿支气管肺炎的临床表现及胸部平片X线表现各有不同。认为X线胸部平片检查是诊断小儿支气管肺炎的首选检查方法。     

磁共振成像在老年人髋关节创伤中的应用价值

老年人因骨质疏松、髋关节外伤所致骨折非常多见，一般多以平片进行诊断，但一些小骨折或轻微骨折X线平片及CT容易误诊、漏诊。磁共振是一种无创伤、安全的影像学检查方法，其特点是对所扫描的组织分辨力高，可进行多方位和多序列的断层成像，能极大提高髋关节创伤的正确诊断率。     

螺旋CT对急性胃肠道穿孔的早期诊断价值

胃肠道穿孔是临床常见的急腹症之一,既往多依赖腹部X线平片检查,但仍有部分患者平片未能显示膈下游离气体,尤其是在穿孔早期更是无法诊断。随着螺旋CT的应     

X线对颅骨多发性骨髓瘤的诊断价值

多发性骨髓瘤是一种较常见的恶性肿瘤，肿瘤起自骨髓，主要破坏骨髓结构，绝大多数为多发，偶有单发。X线平片可直接显示颅骨穿凿样骨破坏或骨质疏松样改变，病变大小不等。由于骨髓瘤多无明显特征性，早期诊断常较困难，X线平片作为常规检查手段，对该病的诊断具有较高的价值。1995年-2002年我们收集了17例显示为多发颅骨破坏的平片，经骨髓穿刺证实为多发骨髓瘤的患者，现讨论如下：     

螺旋CT中多平面重建技术在诊断细微及隐匿性骨折中的临床应用

骨关节创伤性疾病在临床急诊工作中较为常见,X线平片检查对于细微、隐匿性骨折难以发现,我们搜集并整理了35例经多层螺旋CT矢状位多平面重建（MPR）图像显示并诊断的患者资料,探讨MPR技术在细微及隐匿性骨折中的临床应用价值。     

糖尿病足的X线诊断价值

目的：探讨糖尿病足的X线平片表现及其临床价值。方法：回顾分析13例临床确诊为糖尿病足的X线平片特征,加以总结。结果：糖尿病足的X线平片影像学改变为骨质疏松、骨质破坏、骨性关节炎和软组织肿胀为主要影像学改变。结论：X线平片检查简便、经济,可提供糖尿病足的骨质损害征象,能基本反映其病理改变,是指导糖尿病足诊疗的有效影像学方法之一,但诊断必须密切结合临床。     

游离骨折块移位距离对骨折愈合影响的实验研究

目的 探讨长骨干粉碎性骨折游离骨折块移位距离对骨折愈合的影响. 方法 在120只新西兰大白兔右桡骨中部截取楔形骨块,制成实验模型,用2枚克氏针将骨块复位固定并使之与主骨存有一定的间距,并分为五组:A组(原位固定)、B组(骨块与骨干间距为桡骨干直径1/5)、C组(桡骨干直径2/5)、D组(桡骨干直径3/5)、E组(桡骨干直径4/5).每组动物分别于术后2,4,6,8周分批处死,摄X线片观察各组骨折愈合情况,用改进Gary X线评分标准评分;取材HE染色,观察骨折愈合的组织形态学变化,免疫组化测定BMP-2的表达. 结果 (1)X线摄片显示:A、B组骨折愈合无差异,C、D组骨折愈合延迟,E组骨块吸收骨不连.(2)组织形态学观察:A、B组骨折局部形态学变化相同,而其他各组与A组相比,骨痂出现及改建的时间明显较晚,呈延迟愈合和不愈合的表现.(3)BMP-2表达:2周时BMP-2表达B组与A组差异无统计学意义(P＞0.05),C、D、E组与A组比较差异有统计学意义(P＜0.01),4周时只有E组与A组差异有统计学意义(P＜0.01);6周和8周时各组之间差异无统计学意义(P＞0.05). 结论游离骨折块移位距离会影响骨折的愈合,移位距离越大,对骨折愈合产生的影响越明显,当游离骨折块移位距离达到其骨干直径的2/5以上时,骨折将发生愈合障碍.     

MACHO fracture: distal fifth metacarpal fracture revisited

Background: The term “boxer's fracture” has been used to describe fractures to the fifth metacarpal. In fact, boxers do not fracture their fifth metacarpal but their second or third metacarpals. Methods: We reviewed demographic data for 51 patients with boxer's fractures. Sex, age, hand involved, hand dominance, method of injury, ethanol intoxication, and presence of anger at the time of injury were evaluated. Results: Only 18 % of our cases involved a patient hitting another person. Fifty-one percent of the cases occurred when the patient intentionally struck a hard object. Thirty-one percent of fractures were accidental or due to crush injury. Of those injured from an intentional blow, nearly all of the patients were male. Patients were commonly angry at the time of injury. Conclusions: Based on the characteristics of our patients with these fractures, we believe a more appropriate name for this injury is the MACHO fracture (Men Angrily Cuffing Hard Objects).     

Experimental fracture investigations concerning the hyoid bone fracture

IntroductionExtensive literature exists concerning the etiology and morphology of fractures of the hyoid bone (h.b.) in cases of fatal strangulation. There is an agreement to the effect that fractures are mostly located within the distal third of the cornua majora (c.m.). Although several predictors have been described very accurately, the fracture analysis has neither been based on the osseous construction nor on the stress distribution of the c.m. under strangulation resulting from the configuration and its details. This especially applies to the apex of the distal ends of the big horns, the bulbi. The objective of the experimental break tests that were performed was to contribute to elucidating the biomechanics of the horizontal and vertical fractures and to fractures of the bulbi.Materials and methodsBreak tests in the a.p. direction line were carried out on 28 unfixed h.b. of adults on a specially constructed test bench by continuously increasing the tension until a fracture/dislocation occurred. The test arrangement followed the constellation of typical-symmetrical hanging. The selection criteria were the symmetry of the h.b. and the gender. Before and after the experiments, a radiological depiction (DIMA system 20 kV, 10 sec; Institute for Diagnostic Radiology, University-Hospital Goettingen) was carried out, followed by a preparative depiction under magnifying glass control. The h.b. configuration was classified according to the following types: hyperbole-, parabola-, and horseshoe-type. Following this classification, the results were related to the findings achieved by the photo-elastic model experiments. By this, the results of the experimental fracture tests could be specifically compared to the tension distribution within the model.ResultsA total of 70 % of the experimentally-produced fractures were located within the distal third of the c.m. This matches with the frequency distribution in real typical symmetrical hanging. Following the radiological and preparative investigations that were carried out, the c.m. have to be viewed as tubular bones. The transition regions of different osseous strength/elasticity are thus to be considered as areas of increased vulnerability. For the distal third of the c.m., it is the level at which the dense spongiosa/compacta of the shaft part turn into wide-meshed spongiosa and tender compacta of the bulbi. Additionally, the bulbi themselves represent a locus of reduced strength in which the fractures were located basally and/or apically in the transition. It was not only in the whole c.m. that the direction in which the fragment was snapped off or fractured was not random, as all fractures were located on the broad side of the horn, following the applied force.ConclusionsThe experimental fracture tests explained the known accumulation of fractures in the distal third of the c.m. in cases of hanging with the knot of the rope located against the neck. It could be demonstrated radiologically and preparatively that, anatomically, the big horn of the h.b. is a tubular bone. From this, a new approach to the forensic reconstruction of trauma can be derived. The transitional area from the shaft into the bulbus represents a locus minoris resistentiae. In case of pressing the h.b. towards the cervical spine under ventral application of force, one could expect a point load of the bulbi. Two different types of bulbus fractures showed that this load is diagnostically relevant.The fracture direction is also of diagnostic value. It depends on the angle that is formed by the c.m. with their broad side towards the horizontal. This angle may even change for about 90° for the c.m. in the course from proximal to distal movement.By adjustment of the alignment of the broad side with the stress distribution within the different types of the h.b., a mechanically justified answer can be given to the question of why a horizontal fracture appears in the one case and a vertical fracture in the other.     

尺骨茎突骨折并发桡骨骨折发病机制X线分析

尺骨茎突骨折常为腕关节部骨折、脱位的合并损伤,尺骨茎突骨折合并桡骨骨折在临床较为常见.本文收集132例尺骨茎突骨折X线片资料进行总结分析,意在探讨尺骨茎突骨折与桡骨骨折的相互关系及机制,以便提高对尺桡骨骨折的诊断水平.     

Tillaux's fracture

Tillaux fracture or fracture of the antero-lateral portion of the distal tibia has a vertical fracture line either at the middle of the epiphysis or close to the external malleolus. It is seen around 13-14 years. Distance from the fracture line to the external malleolus depends of the degree of closure of the epiphyseal plate. When the medial aspect of the physis is open, the fracture line is more medial. The location of the fracture line in the epiphysis therefore depends on the maturity of the physis as shown by closure of its medial portion. Tomography is frequently necessary to see the fracture line and mainly to appreciate the fracture gap. If the gap is less than two millimeters non operative treatment with plaster cast is sufficient.     

Superior blowout fracture of the orbit: the blowup fracture.

We describe a patient who sustained a blowout fracture of the superior orbital roof without an orbital rim fracture. The initial CT study (obtained with 10-mm-thick sections) did not show herniation of the intraorbital fat into the anterior cranial fossa; however, thin (3-mm-thick) direct orbital sections showed a fracture of the midportion of the superomedial orbital roof with displacement of the fracture fragment into the anterior cranial fossa.     

Avulsion fracture of the medial collateral ligament association with Segond fracture

The Segond fracture is a tibial avulsion injury of the insertion of the middle third of the lateral capsular ligament that is typically associated with anterior cruciate ligament and meniscal tears. The classically assigned mechanism of injury is a combination of internal rotation and varus stress. We report two cases of Segond fractures that presented with a variant pattern including osseous avulsion injuries of the medial collateral ligament at the femoral origin, anterior cruciate ligament tear, and pivot shift-type osseous contusion pattern, suggesting an alternative mechanism of injury that includes dominant valgus stress and external rotation components. Awareness of this pattern may aid radiologists, surgeons, and sport medicine physicians in the accurate diagnosis of this injury complex and initiation of appropriate treatment in a timely fashion.