腕关节轴位像摄影架的制作原理及使用

临床上在拍摄腕关节轴位像时 ,放射人员使用传统方法进行投照 ,无任何辅助装置 ,存在着诸多缺陷。为解决这些问题 ,我们设计制作了腕关节轴位像摄影架 (以下简称摄影架 ) ,临床应用获得满意效果。1　制作结构和方法1 1　结构组成和材料　摄影架由手掌架、前臂架、前臂托板等 3部分组成 (见图 1)。可选用工程塑料一次性铸成 ,也可选用木材分别制作后连结而成。　　　 图 1　腕关节轴位像摄影架1 手掌架　　　　　　　 5 前臂托板2 手掌架下框　　　　　 6 前臂架底部3 前臂架　　　　　　　 7 前臂架台阶4 前臂托板凹形槽1 2　制作方法　…     

DR髌骨站立轴位的体位设计及临床应用

目的探讨数字X线摄影(DR)髌骨站立轴位的体位设计及其临床应用。方法患者取站立位,手扶机架单脚站立,被检侧膝关节屈曲30～60°,足尖尽量绷直,足背或小腿紧贴探测器边缘,然后调整中心线的入射点从头侧进行摄影。结果采用髌骨站立轴位摄影共100例,其中优质片79例,占79%;良质片18例,占18%;劣质片3例,占3%。结论髌骨站立轴位摄影操作简便,患者舒适易配合,可作为髌骨的补充摄影方法。     

髌骨稳定性与髌股关节炎MRI表现相关性研究

目的 研究髌骨位置四项描述指标与髌股关节炎(PFOA) MRI特征之间相关性.方法 搜集PFOA患者87例,正常人群35名.对膝关节进行MRI检查,评估髌骨长度率(PLR)、滑车沟(SA)、髌骨外侧倾斜角(LT-PA)、二等分处平移(BO)四项指标与髌股内外侧关节面软骨形态改变和骨髓水肿样病变(BML)的相关性.结果 (1)PLR与软骨缺损程度和外侧BML相关(r=0.674、0.734、0.675,P＜0.01),差异有统计学意义.(2)SA与软骨缺损和外侧BML相关(r=0.541、0.664、0.646,P＜0.05),差异有显著统计学意义.(3)最小LPTA(9°～14°)与外侧软骨缺损相关性大,OR(95％ CI)=1,但最大LPTA(23°～ 29°)与外侧软骨缺损相关性小,OR(95％ CI) =0.4(0.3 ～0.6).LPTA与外侧BML相关性也有同样的趋势.(4)BO值与内侧软骨丢失和外侧BML相关(r=0.544、0.459,P＜0.05),差异有显著统计学意义.结论 四项髌骨稳定性指标与髌股关节软骨缺损及外侧关节面骨髓水肿程度都存在着相关性,但对内测关节骨髓水肿程度影响不大.四项髌骨稳定性指标对于PFOA有一定的评估价值.     

髌股关节仰卧30°轴位CR成像中心线入射角度的探讨

我们在临床工作中,经过对大量的髌股关节疾病的研究、总结,采用了髌股关节仰卧30°轴位[1]CR成像技术,现就髌股关节30°轴位CR成像时的中心线入射角度探讨如下.     

上颌前部颌顶轴位摄影技术及其临床应用

随着人民生活水平和公民审美素质的迅速提高，牙列不齐对美观的影响已引起人们的高度重视，要求牙齿矫正者呈逐年上升趋势。笔者对来本院就诊的牙列不齐者统计发现，有10％左右是由上颌前部（321｜123）的埋伏牙所致。     

Distal realignment and patellar autologous chondrocyte implantation: mid-term results in a selected population

The aim of this prospective observational study was to assess the 3-year clinical outcome of distal realignment and membrane-seeded autologous chondrocyte implantation (MACI^®) in selected patients with patellofemoral malalignment and large, isolated, patellar cartilage lesions. Twelve patients (14 knees; 6 females, 6 males; mean age 31 years) with Fulkerson type II patellofemoral malalignment (lateralized and tilted patella) and Outerbridge grade III–IV isolated patellar cartilage lesions were treated. All had tibial tuberosity and trochlear sulcus >20 mm on a preoperative CT scan and a cartilage defect >3 cm². Patients with Outerbridge grade III–IV trochlear cartilage lesions, those with rheumatic, infective or neoplastic conditions, or ligament instability, diabetes or obesity and those aged >40 years were excluded. Follow-up was at 36 months. Patients were enrolled after diagnostic arthroscopy. Cartilage was harvested and sent for culture. After a mean period of 30 days (range 25–40) patients underwent transfer of the tibial tuberosity according to Fulkerson associated with a MACI procedure. Clinical assessment was performed with the Kujala, Lysholm, Tegner and Modified Cincinnati scores. The Patient Satisfaction Survey was administered at 36 months. Consistently improved knee function and activity levels were reflected by significantly increased Kujala, Lysholm, Tegner and Modified Cincinnati scores at 36 months. The significant clinical improvement support the value of associating distal realignment and autologous chondrocyte implantation in treating large, isolated, patellar cartilage lesions associated with patellofemoral malalignment.     

Magnetic resonance imaging of the lumbar spine with axial loading: a review of 120 cases

Purpose

To evaluate the imaging findings of patients with clinical symptoms of lower back pain who underwent magnetic resonance imaging (MRI) of the lumbar spine with axial loading.

Materials and methods

We examined 120 patients by MRI, before and after axial loading, using a compression device that applied 50% of their body weight for a load time of 5 min. The dural sac cross area (DSCA) was examined by two experienced radiologists before and after axial load, and their findings were compared. Degenerative abnormalities within and adjacent to the spinal canal were also analyzed.

Results

A reduction in DSCA greater than 15 mm² after axial load was defined as significant, and was found in 81 patients (67.5%) and 138 disc spaces (38.3%). Reduction was most frequent at L4-L5 (n = 55). For other disorders, a 9% increase in cases of bulging disc was seen during axial loading, and seven disc spaces showed protrusion/extrusion only after load. Facet joint synovial cysts, foraminal stenosis, and hypertrophy of the flavum ligaments showed almost no differences, pre- and post-load.

Conclusion

For adequate evaluation of lumbar symptoms, examination should be performed with axial loading, especially in cases of suspected spinal stenosis.     

膝关节骨关节炎软骨下水肿与MRI及临床表现的相关性研究

目的 探讨膝关节骨关节炎(OA)软骨下骨髓水肿与一般临床指标及股四头肌面积、半月板分级的相关性.方法 收集在本院就诊的膝关节OA 患者72例,行膝关节正侧位X线及常规MRI检查,并在12个月后不同时间点复查X线平片和MRI.对各膝关节进行K-L分级、骨髓水肿评分、半月板分级及VAS评分.采用t检验和秩和检验对2组一般资料进行比较,采用Spearman进行双变量相关性分析.结果 初次随访中有骨髓水肿组的年龄及VAS评分明显低于无骨髓水肿组(P<0.05),骨髓水肿的程度与年龄及VAS评分中度相关,与其他指标相关性不大.12个月后随访中,骨髓水肿组的体质量指数(BMI)及股四头肌面积与无骨髓水肿组出现差异(P<0.05).骨髓水肿程度与年龄、股四头肌面积及VAS评分中度相关.结论 关节炎进展中骨髓水肿范围与年龄、股四头肌面积、BMI及VAS评分相关,MRI测量指标较X线更能反映膝关节OA进展,同时也揭示了与膝关节OA进展相关的部分因素.     

短暂性脑缺血发作的磁共振弥散加权成像表现与临床因素的关系

目的 评价磁共振弥散加权成像(DWI)对短暂性脑缺血发作(TIA)患者的应用价值,以及DWI异常与临床因素的关系.方法 研究2006年3～7月在发病后7天内进行常规MRI和DWI检查的59例TIA患者的临床资料.对TIA患者DWI表现和临床因素的关系进行分析.结果 59例TIA患者中,22例(37%)有DWI异常(阳性组),37例(63%)无DWI异常(阴性组).有DWI异常者更多见于TIA持续时间较长(≥30min)、发作频繁、有运动障碍、失语、脑卒中或TIA史、糖尿病和房颤患者.22例DWI异常者中9例在常规MRI上未显示病灶,13例在常规MRI(T2和FLAIR)上也显示异常.结论 在临床诊断的TIA患者中,症状持续时间较长、发作频繁、有运动障碍、失语、脑卒中或TIA史、糖尿病和房颤史与DWI异常显著相关.     

Correlation between occult bone lesions and meniscoligamentous injuries in patients with traumatic knee joint disease

To identify any correlation between the distribution of occult bone lesions and meniscoligamentous injuries, magnetic resonance images of 333 patients with traumatic knee joint disease were reviewed. Bone lesions of the knee were commonly associated with medial meniscal injuries and/or anterior cruciate ligament injuries. While knees with bone lesions showed a higher incidence (P < 0.05) of anterior cruciate ligament injury than knees without bone lesions, the presence of a lateral femoral condylar lesion resulted in a significantly higher incidence of anterior cruciate ligament injuries (P < 0.01). However, no significant positive correlation was found between other occult bone lesions and meniscoligamentous injuries.     

Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging

It may be very difficult to diagnose the pathology in patients with anterior knee pain. Patients with chronic anterior knee pain have been reviewed for the study. Our aim was to delineate the presence of subtle trochlear dysplasia by measuring lateral trochlear inclination (LTI) in axial magnetic resonance imaging (MRI) scans. While there were 109 knees in the study group with anterior knee pain (AKP), control group consisted of 74 knees without AKP. The LTI measurements were performed at the level of proximal cartilaginous area of trochlear groove in axial scans. The condition was termed to be trochlear dysplasia when LTI was below 11o. Parameters in both groups were statistically analyzed and compared for their association with LTI. There was no significant difference between LTI values of male and female subjects in each group. The mean LTI values in anterior knee pain and control groups were 17.32o and 21.5o, respectively, and the difference was statistically significant (P < 0.05). The ratio of knees with trochlear dysplasia was 16.5% in AKP group, which was only 2.7% in control. In the AKP group, the ratio of trochlear dysplasia was significantly high (P < 0.05). Although trochlear dysplasia has been generally detected in cases with patellar instability, this study revealed that the frequency of this finding in patients with other causes of anterior knee pain was also considerably high. Measurement of lateral trochlear inclination in axial MRI scans with radiologic assessment seems to be a valuable diagnostic criterion, especially in patients in whom etiology of anterior knee pain could not be identified.     

Correlation between diffusion in lumbar intervertebral disks and lumbar artery status: evaluation with fresh blood imaging technique

PURPOSE: To evaluate the correlation of the lumbar artery status with the diffusion values in lumbar vertebral disks in patients with low back problems using a fresh blood imaging (FBI) technique. MATERIALS AND METHODS: First, both digital subtraction angiography (DSA) and MR angiography (MRA) was performed, and the weighted kappa value between DSA and MR angiography in evaluating the status of lumbar arteries was calculated. Then, The sagittal diffusion-weighted MR images in 260 intervertebral disks (L1-2 to L4-5) and MR angiographic images using FBI technique in the corresponding 260 lumbar artery pairs (total of 520 arteries) of the 65 patients with low back problems were separately evaluated by two radiologists. RESULTS: The weighted kappa value between DSA and MRA in evaluating the status of lumbar arteries in both observes indicated good agreement. There were significant correlations between the status of lumbar arteries and the ADC values of the lumbar disks in all orthogonal directions (x, y, and z) at all intervertebral levels except L4-5 by both observers (P < 0.001). CONCLUSION: There is a strong association between the diminished flow in lumbar arteries and the decreased diffusion of lumbar intervertebral disks at all intervertebral levels except at L4-5.     

脊髓型颈椎病患者3 T MR扩散张量成像测量参数值与临床表现的相关性研究

目的 探讨3 T MR DTI各测量值与脊髓型颈椎病临床症状的相关性.方法 选取颈椎病患者104例,根据日本骨科学会17分法脊髓损害功能评定标准(JOA评分)将其分为轻(31例、13～16分),中(27例、9～12分),重度(25例、5～8分)及严重(21例、0～4分)4组.按病变部位脊髓信号特征分为3组:A组33例,T1WI、T2WI均未见异常信号;B组30例,T1WI无异常信号,T2WI呈高信号;C组41例,T1WI呈低信号,T2WI呈高信号.所有患者均行DTI,测量受压严重节段脊髓的各向异性分数(FA)、ADC值及本征值(λ1、λ2、λ3),并行颈髓纤维束成像.采用Spearman相关性分析法分析各测量参数值与JOA评分的相关性,采用单因素方差分析比较各组间测量参数.结果 所有受检者DTI显示满意.轻、中、重度及严重4组FA值分别为0.69±0.13、0.58±0.03、0.46±0.08、0.37 ±0.11,组间比较差异有统计学意义(F=100.59,P＜0.05).JOA评分与FA值呈正相关(r=0.883,P＜0.05).JOA评分与ADC及入1、λ2、λ3值无相关性(r值分别为0.232、0.217、0.113、0.127,P值均＞0.05).A、B、C3组FA值分别为0.67±0.33、0.51±0.21、0.38±0.03,组间比较差异有统计学意义(F=50.05,P＜0.05).随着临床症状加重,即JOA评分降低,FA值呈降低趋势;且随着T2高信号的出现,其FA值也呈降低趋势,FA值越低,其纤维束损害越明显.ADC、λ2、λ3值在轻、中、重度及严重4组间及在A、B、C3组间比较,差异均有统计学意义,λ1在各组间比较差异均无统计学意义.结论 FA值的改变与临床症状呈正相关,且FA值越低,其纤维束损害越明显.DyTI可以反映病变的严重程度及脊髓纤维束受压损伤的范围.