脊髓纵裂的X线及CT诊断对比研究

脊髓纵裂为罕见先天性发育畸形 ,临床易误诊和漏诊。我院 1978～ 1998年共诊治脊髓纵裂 5 0例 ,现对其Ｘ线检查及ＣＴ诊断特点分析如下。1　材料与方法1 1　一般资料　 5 0例中 ,41例行手术治疗。男 13例 ,女 37例 ;年龄 2～ 34岁 ,平均 10 4岁 ,16岁以上者 8例。病程 5月～ 2 0年 ,平均 6 1年。其中腰骶部包块 10例 ,腰背部皮肤多毛症 18例 ,皮窦 4例 ,排尿困难和遗尿 9例 ,尿失禁 3例 ,大便失禁 2例 ,下肢神经功能障碍 40例 ,下肢发育不良与足畸形 2 7例。1 2　方法　所有病例伴有先天性脊柱畸形 ,均行全脊柱Ｘ线片和脊柱造影 ,部分病人…     

锥形束CT对下颌后牙区下颌管位置的三维测量研究

目的:通过锥形束CT(CBCT)检查对下颌管位置进行准确定位,为避免在外科手术中造成对下牙槽血管神经束的损伤提供统计学依据。方法:对50例(男28例,女22例)牙列部分缺损的种植患者(年龄19～76岁,x±s=39.76±14.07)进行颌骨CBCT检查并测量下颌后牙区下颌管的三维位置。结果:通过测量得到下颌管同以下指定区域的距离得出:下颌骨的高度从前往后逐渐降低,宽度逐渐增厚,磨牙区下颌管在下颌骨的舌侧行走,在前磨牙区逐渐向颊侧移行,下颌管到下颌骨下缘的距离为(8.45±2.29)mm,下颌管到牙槽嵴顶的距离为(14.90±2.95)mm。结论:通过CBCT测量得到下颌管及下颌骨的形态学数据,对种植术前确定下颌管的解剖位置有重要的临床指导意义。     

锥形束CT在埋伏牙拔除中的临床应用

目的:评价锥形束CT(CBCT)在颌骨埋伏牙诊断和治疗中的临床价值。方法:对常规口腔全景片和咬合片不能清楚定位的埋伏牙20例患者进行锥形束CT扫描获得高分辨率影像,并使用专用软件"i-Vi ew"进行任意断面的观察。结果:本组共23颗埋伏牙被精确定位,并根据"i-Vi ew"软件分析最佳手术入路后均顺利拔除埋伏牙。结论:锥形束CT是检查埋伏牙准确有效的方法,在埋伏牙拔除的方案制定中有重要的指导价值。     

应用锥形束CT评价阻生尖牙正畸牵引前后牙槽骨的状态

目的:应用锥形束CT(cone beam computed tomography,CBCT)研究60g和150g牵引上颌唇侧埋伏阻生尖牙过程中根尖及根周硬组织的变化,为临床治疗埋伏阻生尖牙提供参考.方法:选取20例采用直丝弓矫治技术进行正畸治疗的上颌唇侧埋伏阻生尖牙患者,随机分成2组,每组10人.从外科暴露手术开始,利用链状橡皮环分别对上颌埋伏尖牙施加60g和150g牙体长轴方向的力,到阻生牙完全排入牙弓结束,平均10个月.对牵引前、后上颌尖牙牙根长度及牙根周围骨密度的变化进行CBCT分析,采用SPSS 16.0软件对测量数据进行配对t检验.结果:阻生尖牙以60g的力向牙体长轴方向做整体移动时,牙根长度、牙根周围骨密度与移动前比较,差异无显著性(P＞0.05);以150g的力向牙体长轴方向做整体移动时,牙根长度、牙根周围骨密度与移动前比较,差异有显著性(P＜0.05).结论:临床上治疗埋伏阻生尖牙采用小于60g的牵引力向牙体长轴方向做整体移动是行之有效的而且是安全的.     

口腔颌面锥形束CT在髁突骨折诊断及治疗中的应用

目的：探讨口腔颌面锥形束CT（CBCT）在髁突骨折诊断及治疗中的应用。方法：回顾分析西安交通大学口腔医院口腔颌面外科自201O年1月～2012年6月诊治的髁突骨折42例（59侧）,每例患者术前均行CBCT检查。其中有28例（32侧）在CBCT检查之前已行曲面断层全景片检查,17例（25侧）已行螺旋cT检查。结果：2侧骨折经曲面断层颌全景片检查后漏诊,漏诊率6．25％;螺旋cT和CBCT检查无误诊和漏诊,均可以确诊髁突骨折,并明确骨折部位及分型。42例（59侧）髁突骨折中,髁头（囊内）骨折13侧,髁颈骨折27侧,髁突下骨折19侧。13侧囊内骨折中,A型7侧,B型4侧,C型0例,M型2侧。PDA分类,Ⅰ型28侧,Ⅱ型11侧,Ⅲ型20例。结论：对于髁突骨折的诊断,CBCT是一种简单可靠的影像学技术,并可以明确骨折类型,对其治疗具有重要的指导意义。     

锥形束CT在口腔正畸埋伏阻生牙诊疗中的临床应用

目的 探讨锥形束CT（CBCT）在口腔正畸埋伏阻生牙诊疗中的临床应用及其效果.方法于2011年1月至2013年8月选择需正畸治疗伴埋伏阻生牙患者56例,均行普通X线片及CBCT,比较普通X线片、CBCT及术中肉眼所见情况,评价CBCT指导正畸治疗效果.结果 56例患者中,上颌埋伏牙50例,共计71颗牙.普通X线片可发现颌骨内埋伏阻生牙,但不能清晰显示埋伏牙具体定位情况;锥形束CT三维重建和矢状位、冠状位、轴位显像后,所有患者均清晰、直观地显示埋伏阻生牙的信息.所有患者均在CBCT引导下完成矫治,其中39例进行正畸牵引治疗,17例采用了拔除方法.普通X线片与CBCT术中符合率分别为80%、100%.结论锥形束CT可直观反映埋伏阻生牙的三维图像,为埋伏阻生牙的诊断和矫治方案设计提供了准确的参考依据,对提高矫治效果具有重要的临床作用,可用于指导埋伏阻生牙的临床诊断、制定矫治计划和评价矫治效果,在口腔正畸临床具有较高的应用价值.     

上颌窦底位置与上颌第一磨牙关系的锥形束CT研究

目的 利用锥形束CT研究上颌窦底位置与上颌第一磨牙的关系,为临床治疗中磨牙的移动提供参 考。方法 选取2022年1月-2024年1月在本院就诊的54例拟行正畸矫治的患者为研究对象,根据垂直骨面 型分类将其分为均角型组、高角型组及低角型组,每组18例。应用锥形束CT测量各组上颌第一磨牙与上 颌窦的距离,比较三组上颌第一磨牙根尖同上颌窦底间关系的分类情况、上颌第一磨牙至上颌窦底距离。 结果 三组上颌第一磨牙根尖同上颌窦底间的关系分类数据比较,差异有统计学意义（P ＜0.05）;高角型 组1+2+3类占比高于均角型组、低角型组,但差异无统计学意义（P ＞0.05）,均角型组、低角型组对比 1+2+3类占比一致;高角型组第一磨牙近中颊根、远中颊根、腭根到上颌窦底的距离优于均角型组、低角 型组（P ＜0.05）。结论 通过CBCT检查可以发现,高角型患者上颌窦底位置偏低,与上颌第一磨牙牙根 邻近,且上颌第一磨牙牙根尖多与上颌窦底接触。     

锥形束CT在上颌埋伏中切牙正畸治疗中的应用

目的:评价锥形束CT(CBCT)在上颌埋伏中切牙正畸治疗中的应用价值。方法:选择在我院就诊的上颌埋伏中切牙患者54例(男32例,女22例),应用CBCT进行扫描和图像三维重建,显示埋伏中切牙的形态、位置、牙根弯曲情况以及与邻牙的关系。结果:经CBCT三维重建后,54例病例均清晰的显示了埋伏中切牙的牙体形态、唇腭向位置、萌出方向、牙根弯曲情况以及与邻牙的关系。结论:CBCT检查能提供准确,直观的信息,对上颌埋伏阻生的诊断,治疗设计具有更好的指导意义。     

黑龙江省汉族人下颌第一磨牙远舌根发生率的锥形束CT研究

目的:研究黑龙江省汉族人下颌第一恒磨牙的远舌根发生率。方法:采用锥形束CT扫描成像技术拍摄下颌第一恒磨牙113颗,对扫描图像进行三维重建,并选择不同方向的断层观察研究远舌根发生率。结果:在113颗下颌第一恒磨牙中,远舌根的发生率为42.5%(48/113),其中男性发生率为43.8%(28/64),女性发生率为40.8%(20/49);左侧发生率为38.6%(17/44),右侧发生率为44.9%(31/69),性别与部位没有显著性差异。结论:黑龙江省汉族人下颌第一恒磨牙牙根形态变异较大,掌握其特点有助于提高根管治疗的成功率。     

锥形束CT检查在口腔正畸治疗中的运用价值

目的 研究锥形束CT检查在口腔正畸治疗中的运用价值。方法 选择2023年3月-2024年1月在陆军 第八十集团军医院接受治疗的69例口腔正畸患者为研究对象,按照随机数字表法分为对照组（n =34）与研 究组（n =35）。对照组口腔正畸治疗中行X射线检查,研究组口腔正畸治疗中行锥形束CT检查,比较两 组颌面改善情况、牙齿功能及口腔相关指标评分。结果 研究组治疗后SNB、SNA、ANB指标均优于对照 组,差异有统计学意义（P＜0.05）;研究组治疗后吞咽、咀嚼、语言功能评分高于对照组,差异有统计学 意义（P＜0.05）;研究组治疗后牙齿整齐、咬合接触、前牙覆合覆盖评分高于对照组,差异有统计学意义 （P＜0.05）。结论 口腔正畸治疗中运用锥形束CT检查辅助可有效改善患者牙齿功能,明确上下颌骨头影 指标,利于改善治疗口腔相关指标。     

Accuracy of cone-beam computed tomography for syndesmosis injury diagnosis compared to conventional computed tomography

BackgroundSyndesmosis injury can lead to ankle mortise instability and early osteoarthritis. Several multiple detector computed tomography (MDCT) methods for measurement have been developed. Weight-bearing cone beam CT (WB CBCT) is an emerging technique that offers the possibility of upright-position scanning and lower doses. This study sought to assess the diagnostic accuracy of WB CBCT in syndesmose injury compared to MDCT, with instability confirmed via manual testing upon arthroscopic examination.MethodsThree musculoskeletal radiologists with different levels of expertise prospectively analyzed 11 MDCT and eight WB CBCT scans of the same trauma-afflicted ankles with clinical suspicion of syndesmosis lesion over a period of 5 months. They evaluated 10 methods of measurement in both sides. Syndesmosis was considered pathological on arthroscopic examination in four patients. Correlation between readers was evaluated with intra-class correlation testing (p < 0.05 was considered significant). Capacity of discrimination was assessed by area under the curve (AUC) for all methods.ResultsInter-observer agreement was near excellent for both WB CBCT and MDCT for the anterior tibio-fibular (TF) distance (ICC = 0.781 and 0.831, respectively), posterior TF distance (ICC = 0.841 and 0.826), minimal TF distance (ICC = 0.899 and 0.875), and TF surface (ICC = 0.93 and 0.84). AUC were better for MDCT than WB CBCT in assessing syndesmosis instability for: anterior TF distance (ROC = 0.869 vs. 0.555, p = 0.01), minimal TF distance (ROC = 0.883 vs. 0.608, p = 0.02) and antero-posterior fibular translation (ROC = 0.894 vs. 0.467, p = 0.006).ConclusionsMDCT demonstrated better ability to distinguish pathological syndesmosis than WB CBCT, with the antero-posterior fibular translation the best discriminating measurement. The physiological widening of the contralateral syndesmosis occurring with the WB CBCT upright position may explain these results.     

CT三维重建在髋臼骨折诊断治疗中的作用

目的 探讨CT三维重建在髋臼骨折诊断治疗中的意义，以提高髋臼骨折的诊疗水平。方法 对57例有移位的髋臼骨折进行术前CT三维重建，明确骨折的类型，然后制定手术方案和选择最佳的手术入路。结果 57例患者均获得12个月～6年9个月的随访，平均26个月。按Matta的疗效评定标准，临床标准：优43例，良6例，可8例，优良率85．96％；X线标准：优44例，良6例，可7例，优良率87．72％。结论 CT三维重建逼真地显示了损伤的髋臼立体表面形态，有助于判断髋臼骨折的部位、类型和损伤程度，对手术入路的选择和手术复位固定的方法具有指导作用。     

Value of high-resolution computed tomography in diagnosis of petrous bone fracture

High-resolution computed tomography (CT) was performed on 31 patients clinically suspected of having petrous bone fracture. The location of the fracture was demonstrated accurately in 28 patients (90.3%), whereas it could be diagnosed by plain skull film in only 17 patients (54.8%). The anatomic location of fractures demonstrated by high-resolution CT clearly corresponded to the clinical symptoms and signs. We have classified petrous bone fracture into five types according to the anatomic levels demonstrated on CT images. The findings indicate that highresolution CT is extremely useful for diagnosing petrous bone fracture.     

螺旋CT重建在胸腰椎骨折诊断和治疗中的应用价值

目的 探讨螺旋CT重建在胸腰椎骨折患者诊断和治疗中的应用价值。方法 前瞻性分析了2001年6月至2002年3月对25例胸腰椎骨折患者进行三维CT扫描重建情况。其中男16例，女9例。年龄19—86岁，平均35．6岁。车祸伤10例，高处坠落15例。25例均行X线平片、普通CT、二维及三维CT重建检查。结果 单纯性压缩骨折12例，爆裂性骨折13例，其中合并椎管轻度狭窄3例，中度狭窄6例，重度狭窄4例，脊椎滑脱3例。结论 螺旋CT重建有利于胸腰椎骨折分型、早期诊断、手术治疗和治疗效果评价。     

A comparison of aortic root measurements by echocardiography and computed tomography

Objectives

The aim of the study is to evaluate an optimal way to assess the dimensions of the aortic root and each of the sinuses of Valsalva and examine how a single measurement in 1 plane (echocardiography or 2-dimensional computed tomography) can underestimate the maximum dimension of the aortic root.

Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias

Background  The objective of this study is to determine the reliability and validity of ultrasonography (US) in diagnosing incisional hernias in comparison with computed tomography (CT). The CT scans were assessed by two radiologists in order to estimate the inter-observer variation and twice by one radiologist to estimate the intra-observer variation. Patients were evaluated after reconstruction for an abdominal aortic aneurysm or an aortoiliac occlusion. Methods  Patients with a midline incision after undergoing reconstruction of an abdominal aortic aneurysm or aortoiliac occlusion were examined by CT scanning and US. Two radiologists evaluated the CT scans independently. One radiologist examined the CT scans twice. Discrepancies between the CT observations were resolved in a common evaluation session between the two radiologists. Results  After a mean follow-up of 3.4 years, 40 patients were imaged after a reconstructed abdominal aortic aneurysm (80% of the patients) or aortoiliac occlusion. The prevalence of incisional hernias was 24/40 = 60.0% with CT scanning as the diagnostic modality and 17/40 = 42.5% with US. The measure of agreement between CT scanning and US expressed as a Kappa statistic was 0.66 (95% confidence interval [CI] 0.45–0.88). The sensitivity of US examination when using CT as a comparison was 70.8%, the specificity was 100%, the predictive value of a positive US was 100%, and the predictive value of a negative US was 69.6%. The likelihood ratio of a positive US was infinite and that of a negative US was 0.29. The inter- and intra-observer Kappa statistics were 0.74 (CI 0.54–0.95) and 0.80 (CI 0.62–0.99), respectively. Conclusions  US imaging has a moderate sensitivity and negative predictive value, and a very good specificity and positive predictive value. Consistency of diagnosis, as determined by calculating the inter- and intra-observer Kappa statistics, was good. The incidence of incisional hernias is high after aortic reconstructions.     

X线平片与三维CT重建对先天性脊柱侧凸患者半椎体畸形的诊断价值

目的评价术前X线平片、三维CT重建对于先天性脊柱侧凸患者半椎体周围解剖结构的分辨能力,以完善手术计划,提高手术治疗的目的性。方法对16例先天性脊柱侧凸患者实施后路(6例)或前路(5例)或前后路联合半椎体切除(2例)、软组织松解、器械矫形植骨内固定术,或单纯后路器械矫形植骨融合术(3例)。比较患者术前X线平片、三维CT重建与术中所见关于半椎体周围解剖结构描述的符合率。结果16例患者术前三维CT重建与术中所见关于半椎体畸形前或后面解剖结构特点的描述符合率为16/16。而术前X线平片半椎体前侧和后侧观察结果与术中所见的符合率分别为5/7和1/11。结论先天性脊柱侧凸患者术前X线平片仅能大致了解半椎体前侧的分节情况,而不能准确反映后侧结构的异常情况。三维CT重建可更准确显示半椎体畸形的位置与结构,为完善手术计划提供依据。