高性能战斗机飞行员椎间盘退变危险因素研究进展

椎间盘退行性疾病是中老年人常见的退行性疾病之一,也是引起颈腰背痛的首要病种.高性能战斗机区别于普通战斗机及其他机型,具有高载荷、高载荷增长率和高角加速度等特点.流行病学调查表明,高性能战斗机飞行员椎间盘退变的发病率高于其他机型飞行员,椎间盘退变引起的脊柱相关症状极大影响了飞行员的睡眠和精神状态,甚至影响飞行任务的完成.为探究导致高性能战斗机飞行员椎间盘退变的危险因素,该文对国内外相关研究进展作一综述.     

35名高性能战斗机飞行员脊柱影像检查分析

随着高性能战斗机逐渐装备部队，飞行员脊柱健康标准有待进一步完善。我们对以往制定的低性能战斗机飞行员的脊柱健康标准认识已显不足。通过对35名高性能战斗机飞行员的脊柱影像检查分析，就高性能战斗机飞行员脊柱健康标准进行针对性的研究和重新认识。     

高性能战斗机飞行对飞行员脊柱影响的研究

随着各国空军不断发展和装备高性能战斗机,其高机动性和高加速度(+G_z)无疑对飞行员身体各个系统带来了明显影响,特别是飞行员的脊柱。可以说脊柱在飞行员的身体中是最容易受到高G影响的部分。美、俄、日和西欧各国空军等对此非常重视,并积极地进行了研究。由于我国空军开始装备高性能战斗机才是近几年的事,对此方面还没有更多的研究。重视对飞行员脊柱改变和损伤的研究,不仅对高性能战斗机飞行员的选拔有重要意义,同时对保护现有高性能战斗机飞行员的     

高G作用下飞行员脊柱的损伤及其防护

目的 综述飞行中高G作用下飞行员脊柱的损伤问题及其作用机制，分析提出防护对策。资料来源 与选择国内外近20年来的文献报道。资料引用国内外发表的相关文献36篇。资料综合论述了 Gz作用对飞行员脊柱的椎体、椎间盘、肌肉韧带的影响，分析了其损伤的作用机制，提出了防护对策。结论 Gz复合因素作用下脊柱过重负荷具有加速脊柱退变的作用，对飞行效能与飞行安全有不利影响，建议加强对其综合预防措施研究。     

“上工治未病”理念在高性能战斗机飞行员脊柱保健中的护理体会

目的探讨＂上工治未病＂理念在高性能战斗机飞行员脊柱保健中的护理体会。方法对110例高性能战斗机飞行员进行情志心神统一护理模式,饮食起居调护,辨证施护既病防变,加强身体锻炼指导,坚持防重于治的原则,同病异护,异病同护。结果 110例高性能战斗机飞行员在辨证观的理论指导下增强体质,预防疾病发生,较好地控制疾病复发达到未病先防的目的。结论中医＂治未病＂理念在高性能战斗机飞行员脊柱保健中的应用能够从飞行员生理、心理所处的社会环境出发,结合评估飞行员潜在问题,调养身心情志,加强锻炼机体来达到未病先防的目的。     

中医“治未病”理念在高性能战斗机飞行员脊柱保健中的应用体会（摘要）

目的探讨“上工治未病”理念在高性能战斗机飞行员脊柱保健中的应用体会。方法对110例高性能战斗机飞行员进行情志心神统一护理模式,饮食起居调护,辩证施护既病防变,加强身体锻炼指导,坚持防重干治的原则,同病异护,异病同护。结果110例高性能战斗机飞行员在辩证观的理论指导下增强体质,预防疾病发生,较好地控制疾病复发达到未病先防的目的。结论中医“冶未病”理念在高性能战斗机飞行员脊柱保健中的应用能够从飞行员生理、心理所处的社会环境出发,结合评估飞行员潜在问题,调养身心情志,加强锻炼机体来达到未病先防的目的。     

新型高性能战斗机飞行员前庭功能选拔鉴定训练方法研究中存在的问题及展望

目的 综述新型高性能战斗机飞行员前庭功能选拔鉴定训练方法研究中存在的问题并展望未来的发展方向.资料来源与选择国内该领域相关研究论文与综述.资料引用引用公开发表的论文共62篇.资料综合综合分析高性能战斗机对飞行员前庭功能的影响,明确飞行员前庭功能选拔、鉴定、训练等方面存在的问题,提出高性能战斗机飞行员前庭功能选拔鉴定训练未来的发展方向.结论 必须要建立快速、简便、易耐受的前庭功能筛选与全面的前庭功能评估方法、研究具有良好预测率的晕机病易感性预测方法、研制有效的前庭定向能力训练设备,以便更好地开展高性能战斗机飞行员前庭功能选拔鉴定训练工作.     

高性能战斗机飞行员高+GZ综合防护进展

目的 概述国内外高性能战斗机飞行员高＋Gz综合防护的现状和发展趋势；提出我国相关技术，装备的改进建议。资料来源与选择 根据国内外的文献报道，主要介绍了高＋Gz防护措施的研究进展。资料引用 作者引用文献26篇。资料综合 重点论述了提高飞行员自身的抗荷能力，提高抗荷装备的抗荷性能，后倾座椅应用，＋Gz引起的意识丧失（G－LOC）监测与自动恢复系统，推拉效应等高＋Gz综合防护研究上的进展。结论 国内外在高性能战斗机飞行员高＋Gz综合防护的研究与应用上均取得很大进展，我国在该领域的工作与国外最先进水平相比尚有差距，应进一步改进提高相关技术，装备的研究与应用水平。     

飞行员脊柱健康评价--X线、CT、MRI所见及临床调查

目的 探讨歼击机飞行员脊柱健康的评价标准。方法 顺序采集46名歼击机飞行员特别设定的体检资料，包括脊柱临床评价，全脊柱立位X线前后位及侧位摄片，腰椎双斜位摄片，颈椎MRI，腰椎CT等资料。将脊柱的生理曲度及异常曲度情况，结构退变情况和脊柱临床评价都给予量化，并进行统计分析，比较各项指标之间关系。结果 ①飞行员的年龄和飞行时间与其颈椎和腰椎问题的大小都具有显著的相关性。②颈椎曲度异常和脊柱侧弯情况普遍存在，但与脊柱临床评价并无相关性。③脊柱退变的各项指标(包括椎间隙狭窄、椎间盘突出、椎体楔形变、椎体骨刺等)之间都有一定的相关性，但与脊柱的临床评价并不相关。结论 歼击机飞行员的脊柱健康的临床评价与其结构形态的退行性改变并不平行；单纯以脊柱结构的改变来确定飞行员脊柱健康的标准值得商榷。     

高性能战斗机飞行员左下肺叶腺癌切除术后放飞一例并文献复习

目的 本文旨在复习飞行员肺癌相关文献,并探讨高性能战斗机飞行员肺癌肺叶切除后的航空医学鉴定思路和标准. 方法结合1例高性能战斗机飞行员左下肺腺癌的临床诊断、手术治疗、康复情况及健康鉴定和康复后的飞行情况,复习相关文献,对高性能战斗机飞行员肺癌肺叶切除后的医学鉴定进行探讨. 结果该飞行员有左下肺孤立性结节病史10年,无主诉及临床症状,经肺CT检查提示结节影较前变大并伴毛刺状,正电子发射断层摄影检查呈异常放射性浓聚灶,临床诊断为肺癌.行左下肺叶切除术及淋巴结清扫术,术后病理结果为高分化腺癌,未进行放疗、化疗.飞行暂不合格,地面观察1年,经临床检查未见肿瘤复发及转移,心、肺功能检查大致正常,加速度耐力检查合格,飞行结论为合格.恢复飞行12个月,飞行时间65 h,来院复查未见异常. 结论肺癌肺叶切除的高性能战斗机飞行员,术后无复发、转移,心肺功能及加速度耐力良好者,可飞行合格.     

国外加速度肺不张研究概况

目的综述国外有关军事飞行中加速度肺不张的发生情况、发生机制和预防措施的研究。资料来源与选择国外该领域相关文献。资料引用期刊文献14篇，美国AD报告5篇。资料综合回顾了从20世纪60年代开始，国外军事飞行中加速度肺不张的发生情况和机载分子筛装机应用中对其预防措施的研究。结论加速度肺不张的发生主要与高G。作用时吸入纯氧和抗荷服充气有关。加入空气降低氧浓度、采用无代偿正压呼吸和抗荷动作能取得有效的预防效果。机载分子筛氧气浓缩器由于产氧浓度较高，对其应用后加速度肺不张发生的问题可通过分流出口流量降低氧浓度预防。对于有代偿正压呼吸的预防作用有待进一步研究。     

歼击机飞行员腰椎退行性病变随访观察

目的评价歼击机飞行员腰椎退行性病变状况。方法对4年前作过CT检查的无症状歼击机飞行员（A组，平均年龄42岁，平均累计飞行时间2400h；B组，平均年龄27岁，平均累计飞行时间930h），和相应年龄无飞行经验的对照组人员（C组）进行复查。结果与4年前CT结果比较，各组的椎间盘突出数明显增加，而对照组的骨赘、A组老飞行员的椎管狭窄数明显增加。与4年前比较，老飞行人员与C组问的CT差别明显降低。结论歼击机飞行员腰椎退行性病变的发展较地面人员早。随着年龄的增加，与对照组的差别逐渐缩小。     

Spinal MRI in fighter pilots and controls: a 13-year longitudinal study

INTRODUCTION: Although it is known that some degenerative changes occur in the spines of fighter pilots, it is not clear whether their frequent exposure to high acceleration is associated with premature development of such changes. This case-control study was designed help answer that question. METHODS: There were 12 Finnish Air Force pilot cadets and their controls who were examined using cervical and lumbar magnetic resonance imaging (MRI) before the pilots started fighter training (baseline) and 13 yr later (follow-up) when the pilots had accumulated a total of 1200 +/- 470 h in fighter aircraft. RESULTS: No statistical differences were found between groups with respect to the frequency of degenerative changes in either the cervical or lumbar spine. Cervical changes in pilots were for the most part observed in the lower part of the neck, while controls showed more variability as to location. In the lumbar region, pilots showed a non-significant tendency toward more changes in disks L4-S1, including changes in signal intensity, height, protrusions, and end plates. CONCLUSION: Occupational exposure to acceleration in fighter aircraft did not cause significant radiological changes in the spinal column during the first 13 yr of a fighter pilot's flying career. Assessments for the need of a fighter pilot's follow-up imaging should be based on clinical outcome, not on periodic imaging.     

Cervical and lumbar MRI findings in aviators as a function of aircraft type

BACKGROUND & AIMS: Neck pain and lower back pain (LBP) are frequently reported by military helicopter pilots (HP) and fighter pilots. A small number of studies have used imaging methods to evaluate spinal cervical degenerative findings in pilots exposed to high +Gz, with results indicating an increase in cervical disk protrusions in this population. We evaluated the cervical and lumbar spine with magnetic resonance imaging (MRI) to assess the prevalence of degenerative changes in three subpopulations of pilots. METHODS: Fighter pilots (FP), transport pilots (TP), and HP (10 pilots in each group) underwent cervical and lumbar MRI. Degenerative pathologic changes (disk herniation, cord compression, foraminal stenosis, and the presence of osteophytes) were evaluated in each group by two independent experienced radiologists. RESULTS: Cervical spine degenerative changes seemed to be associated with older age rather then aircraft type, affecting the older group of TP (8/10 pilots) more than the younger FP group who were exposed to high +Gz (3/10 pilots). In contrast, for lumbar spine degenerative changes, we found an uncommon pattern of lumbar spine degeneration in HP, affecting the upper part of the lumbar spine (10/13 disks found at L1-L4). CONCLUSIONS: The results of this study suggest that HP may have detectable degenerative lumbar findings. More research is needed to validate these findings as well as to explore the possible pathophysiological link between occupational exposures and the specific involvement of the upper lumbar spine.     

+Gz associated stenosis of the cervical spinal canal in fighter pilots

Previous magnetic resonance imaging (MRI) studies have shown that repeated exposure to +Gz forces can cause premature degenerative changes of the cervical spine (i.e. a work-related disease). This paper reports on two clinical cases of +Gz-associated degenerative cervical spinal stenosis caused by dorsal osteophytes in fighter pilots. Conventional x-rays and MRI were used to demonstrate narrowing of the cervical spinal canal. The first case was complicated by a C6-7 intervertebral disk prolapse and a congenitally narrow spinal canal. The second case involved progressive degenerative spinal stenosis in the C5-6 disk space which required surgery. The findings in this case were confirmed by surgery which showed posterior osteophytes and thickened ligaments compressing the cervical medulla. These two cases suggest that +Gz forces can cause degenerative spinal stenosis of the cervical spine. Flight safety may be jeopardized if symptoms and signs of medullar compression occur during high +Gz stress. It is recommended that student fighter pilots undergo conventional x-rays and MRI studies in order to screen out and reject candidates with a congenitally narrow spinal canal. These examination methods might be useful in fighter pilots' periodic medical check-ups in order to reveal acquired degenerative spinal stenosis.     

飞行员腰椎椎弓根峡部裂的医学鉴定

目的总结飞行员腰椎椎弓根峡部裂的医学鉴定经验。方法对62名腰椎椎弓根峡部裂飞行员的资料进行分析，对其中14名高性能歼击机飞行员进行了1～4年的随访。结果62例中：27例改装合格，21例原机种合格，10例暂不合格，4例停飞。其中10例暂不合格中，有6例因腰椎峡部裂或伴滑脱，并有长期腰腿痛症状暂不合格，4例因其他疾病而暂不合格。停飞4例中：有2例因腰椎峡部滑脱合并长期腰腿痛症状或伴有腰椎间盘突出停飞，2例因其他疾病而停飞。结论在飞行员腰椎椎弓根峡部裂的医学鉴定时应考虑身体状况、飞行任务等各种因素的影响。     

俄罗斯航空医学发展概况

目的 介绍俄国航空医学发展概况。资料来源与选择 俄罗斯公开发表的论文及综述。资料引用 引用了文献12篇。资科综合 从航空医学经验的总结和理论发展，飞行人员卫生保障的科学同题，高机动飞行的卫生保障，高空飞行安全的卫生保障等4个方面作了介绍。     

歼击机飞行员颈椎X线表现调查

目的　探讨高 G加速度对飞行员颈椎可能产生的影响及其临床意义。　方法　对一组正常歼击机飞行员的颈椎 X线摄片分析 ,同样对一组正常地面人员的摄片 ,就常见的异常 X线征像结合临床情况进行讨论分析比较。　结果　飞行员组颈椎“切凹征”的出现率较对照组明显增高 ;颈曲变直、反向或侧弯程度都比对照组要显著 ;颈椎椎间隙狭窄情况两组无明显差异。对照组颈椎既往症状发生率显著增高于飞行员组。　结论　加速度负荷可能是加速颈椎退变主要因素之一 ,但 X线所示的颈椎退行性改变并不一定意味着临床症状的出现 ;飞行员常规保持体育运动对颈椎临床症状的预防具有重要的临床意义。     

303例歼击机飞行员骨科病症谱分析

目的 探讨歼-5、歼-6,歼-7、歼-8和高性能战斗机飞行员骨科病症谱的分布规律.方法 对303例歼击机飞行员均进行常规颈、胸、腰椎正侧位及腰椎双斜位计算机X线摄影检查、腰椎CT或MRI扫描,然后进行分类.将303例飞行员按机种分为3组,分析其骨科病症谱,并进行统计学检验. 结果位于前10位的骨科病症分别为椎间盘突出、腰椎峡部裂、骶椎隐形裂、半月板损伤、肌腱损伤或断裂、关节炎、腰肌劳损、骨折、许莫结节和腰椎楔形变.3组飞行员骨科病症构成比比较,差异无统计学上的显著性意义(x2=-0.202～2.115,P>0.05). 结论歼击机飞行员的骨科病症以脊柱和运动系统病变为主,对其原因进行分析有助于提高航卫保障质量.     

Surgical correction of disc pathology in fighter pilots: a review of 14 cases

BACKGROUND: Disorders of the spine are common in fighter crewmembers. The high cost of training and experience for pilots makes it important to use all reasonable clinical means to restore grounded pilots to their flying duties, provided that all safety standards are maintained. To date, there has been limited research into specific surgical treatment of spine injury in pilots. This study was designed to examine the efficacy of surgical procedures in Spanish Air Force fighter pilots with injuries to the spine, as well as the aeromedical disposition of such pilots. METHODS: A retrospective study was conducted using the medical records of 14 fighter pilots with symptomatic spinal disorders treated by surgery. RESULTS: The 14 pilots underwent surgery: 12 cases involved fusion of vertebral structures (arthrodesis), while 2 pilots underwent discectomy. All pilots were subsequently given waivers to resume flying duties. DISCUSSION: The successful return to flight status of these pilots indicates the practical application of surgical techniques that safely stabilize the spine. However, due the sample limited size of the sample, further studies are needed.