胸壁厚度测定对战现场张力性气胸穿刺减压的意义研究

目的 对某部官兵胸壁厚度进行测量,以提高目前战现场胸腔穿刺减压救治张力性气胸成功率和降低意外损伤风险。方法 测量某部480名官兵身高和体重,通过胸部CT测量左右第2肋间锁骨中线、第4肋间腋前线和第5肋间腋前线6个部位的胸壁厚度。结果 第2肋间锁骨中线胸壁厚度为（3.48±0.83）cm,第4肋间腋前线胸壁厚度为（2.73±0.69）cm,第5肋间腋前线胸壁厚度为（2.39±0.64）cm。胸壁厚度超过5.0 cm的情况,左侧第2肋间锁骨中线占7.3%,右侧第2肋间锁骨中线占5.6%,右侧第4肋间腋前线占1.8%。女性较男性胸壁厚,差异有统计学意义（P<0.05）。胸壁厚度与体重指数呈正相关性（P<0.05）。结论 目前使用的套管针进行穿刺,成功率能够保证,但损伤风险也较大,特别是在左侧气胸时。本研究结果需要在出现张力性气胸的患者中得到验证。     

锁骨下静脉穿刺管胸腔穿刺留置治疗自发性张力性气胸疗效及可行性分析

目的 分析锁骨下静脉穿刺管胸腔穿刺留置治疗自发性张力性气胸的疗效和可行性.方法 本组68例患者设为治疗组,采用胸腔切开置硅胶管持续闭式引流治疗为主的68例类似患者作为对照组,观察两组疗效和分析不足.结果 两组治疗后症状缓解、患侧肺复张、拔管时间比较差异无统计学意义(P>0.05);两组出现的不良反应、并发症例数、总疗程比较差异有统计学意义(P<0.05).结论 临床中治疗自发性张力性气胸,可把锁骨下静脉穿刺针行胸腔穿刺并留置穿刺管行胸腔持续闭式引流作为首选的治疗方法,值得在临床中推广应用.     

腋下与锁骨中线入路胸腔闭式引流治疗气胸临床对照研究

目的 对比腋下与锁骨中线入路胸腔闭式引流治疗气胸的临床疗效.方法 选取2013年1月-2015年3月我院收治的100例创伤性或自发性气胸患者作为研究对象,按照随机数字表法将100例患者均分为试验组(经腋下置管)和对照组(经锁骨中线置管),分别选择腋中线第3,4肋间隙置管,锁骨中线第2肋间隙置管.观察2组患者手术时间、术后疼痛评分情况;引流管脱出、皮下气肿、血管或神经损伤发生情况.结果 2组患者手术时间比较,差异无统计学意义(P＞0.05);2组患者术后疼痛评分比较,试验组术后疼痛评分低于对照组,差异有统计学意义(P＜0.05).2组患者引流管脱出、血管或神经损伤发生情况比较,差异无统计学意义(P＞0.05);2组患者皮下气肿发生情况比较,试验组患者发生率低于对照组,差异有统计学意义(P＜0.05).结论 腋下入路胸腔闭式引流治疗气胸效果较好,患者术后疼痛轻,皮下气肿发生情况少,临床应用价值较高.     

延迟与即时胸腔穿刺治疗自发性气胸的对比研究

自发性气胸是呼吸科的常见病。治疗的近期目的是排尽胸腔内的气体使肺尽早复张恢复肺功能。具体治疗方法众多,其中胸腔穿刺抽气作为一个创伤小、简单易行的治疗手段临床应用最广泛,但胸穿抽气存在短期复发率高的缺陷。为了提高胸穿抽气的疗效,笔者设计延迟胸穿抽气与同期进行的常规即时胸穿抽气进行对比,观察住院期间的治疗成功率及出院3个月的复发情况。     

经皮穿刺髓核切除术的入路应用解剖学研究

对Ｌ４－Ｌ５，Ｌ５－Ｓ１椎间盘经皮穿刺髓核切除术有效无伤害进针的角度，度，距腹腔血管距离，与神经根途径关系及距离进行了解剖滂观察和测量。方法：在７具成人尸体进行Ｌ４－Ｌ５，Ｌ５－Ｓ１椎间切除Ｘ光芝为光屏临床观察。结论：上术结果在对５０例腰椎间盘突出症经皮穿刺髓核切除Ｘ光荧光屏临床观察观察为产儿无伤害的。     

腰硬联合麻醉中正中入路穿刺法与旁正中入路穿刺法对高龄髋部手术患者的影响

目的探讨腰硬联合麻醉(combined spinal epidural anesthesia, CSEA)中分别采用正中入路穿刺与旁正中入路穿刺在高龄患者髋部手术中的效果。方法选取2016年5月至2019年4月北京中医药大学房山医院采用CSEA接受髋部手术的60例高龄患者,根据入路穿刺方法的不同分为对照组(30例,正中入路穿刺法)与观察组(30例,旁正中入路穿刺法),观察患者手术情况、相关手术指标及术后腰背疼痛状况等。结果观察组硬膜外重复穿刺、脊麻成功置管失败、感觉异常以及置管出血比例依次为6.7%、93.3%、3.3%、6.7%、0.0%,明显优于对照组,差异均有统计学意义(P<0.05);观察组手术时间(135.58±10.41)min、术中出血量(486.12±11.05)ml、术后引流量(92.03±10.84)ml,显著少于对照组,差异有统计学意义(P<0.05);观察组术后7d腰背疼痛发生率为13.3%、疼痛持续时间为(2.10±0.25)d,均低于对照组,差异有统计学意义(P<0.05)。结论与正中入路穿刺法相比,旁正中入路穿刺法应用于高龄患者髋部手术C...     

腰-硬联合麻醉不同穿刺入路的临床观察

目的：比较腰-硬联合麻醉（combined spinal epidural anesthesia,CSEA）直入穿刺法与旁入穿刺法的穿刺成功率及术后腰背痛的发生率。方法：选择下肢、盆腔等手术120例,ASAⅠ～Ⅱ级,按随机数字表法分为直入法穿刺组与旁入法穿刺组,均采用一点法即针内针单间隙穿刺技术,观察腰麻针一次穿刺成功率、神经易感发生率、硬膜外置管困难发生率、术后腰背痛发生情况。结果：直入法穿刺组与旁入法穿刺组一次穿刺成功率分别为83.3%和93.3%（P〈0.05）;术后腰背痛发生率分别为75.0%和23.3%（P〈0.05）;硬膜外置管困难发生率分别为10.0%和8.3%（P〉0.05）;神经异感发生率分别为8.3%和8.3%（P〉0.05）。结论：CSEA旁入穿刺法腰麻针一次穿刺成功率高,同时术后腰背痛发生率低。     

输液港置入术的静脉穿刺方法和入路的选择

目的：比较输液港植入术后入路组与中央入路组以及Ｂ超引导下穿刺的效果。方法：输液港植入术患者180例分为后入路组与中央入路组各90例,两组患者均在局部麻醉后穿刺植入输液港,观察两组一次置管成功率及并发症的发生。将后入路组90例患者分为盲穿组和B超引导组各45例,观察两组一次置管成功率及并发症的发生。结果：后入路组置管成功率（94.4％）高于中央入路组（84.4％）,差异有统计学意义（P＜0.05）;后入路组无输液不畅,无血栓形成,中央入路组发生输液不畅4例,血栓形成4例,并发症发生率8.89%,两组远期并发症发生率比较,差异有统计学意义（P＜0.05）。盲穿组45例中首次穿刺置管成功40例（88.89%）,B超引导组45例（100%）首次穿刺置管均获成功,两组比较差异有统计学意义（P＜0.05）。盲穿组出现并发症8例（17.78%）,包括气胸1例,穿刺动脉2例,输液不畅1例,血肿3例,导管相关感染1例;B超引导组出现并发症2例（4.44%）,包括导管相关感染、导管异位各1例;两组并发症发生率比较,差异有统计学意义（P＜0.05）。结论：后入路组应作为植入式静脉输液港置管的首选路径,B超引导下穿刺准确率高,可明显减少相关并发症。     

直接前入路与外侧入路全髋关节置换术的临床对比研究

目的 对比分析直接前入路与外侧入路行全髋关节置换术的临床疗效.方法 回顾性分析2013年1月至2015年12月收集的120例行全髋关节置换患者的临床资料,其中60例采用直接前入路,60例采用外侧入路.记录两组手术时间、术中出血量及住院时间,术后随访时对两组患者行VAS评分和Harris评分.结果 两组一般资料比较,差异均无统计学意义(P＞0.05);直接前入路组手术时间较外侧入路组长,出血量较外侧入路组少,住院时间较外侧入路组短,两组相比,差异均有统计学意义(P＜0.05);末次随访时,直接前入路组Harris评分较外侧入路组高,且差异有统计学意义(P＜0.05);两组VAS评分相比,差异无统计学意义(P＞0.05).两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 直接前入路对软组织损伤少,患者围术期恢复较快,其治疗效果优于外侧入路.     

颈内动脉-眼动脉瘤手术入路的解剖研究

目的颈内动脉-眼动脉瘤的相关手术入路的解剖研究。方法采用国人成人头颅湿标本9例,模拟相关手术入路,对重要解剖结构进行测量。结果左侧视神经长6.12~14.32 mm,平均（10.22±2.64）mm,右侧视神经长6.10~14.30 mm,平均（10.12±2.52）mm;前床突（ACP）长7.36～13.82 mm,平均（9.17±1.23）mm、宽7.95~17.16 mm,平均（12.36±2.40）mm、厚3.15~7.80 mm,平均（5.47±1.32）mm;硬膜外切除ACP后,视神经长度的显露增加了2倍,视神经-颈内动脉间隙（OCT）长度增加了2倍,OCT的宽度增加了3~4倍。结论翼点硬膜下入路作为常规手术入路,具有相对安全性并便于对近端血流进行控制。硬膜外入路主要是强调硬膜外磨除前床突,增加显露,具有安全、简洁的优势,往往需要联合硬膜下入路。对侧入路只适合于小的、指向内侧的动脉瘤。     

成人腭部微种植体植入区域骨皮质密度的锥形束CT测量分析

目的：利用锥形束CT（cone beam computed tomography,CBCT）测量腭部骨皮质密度,分析腭部骨皮质密度的分布规律。方法：选取107例20～40岁成人（男51例、女56例）的CBCT影像数据,测量腭部28个点位的骨皮质密度,以亨斯菲尔德单位（Hounsfield units,HU）表示,重复测量方差分析比较不同部位间骨密度差异,t检验比较骨密度的性别差异。结果：腭部各测量点位中骨皮质密度最大值为（976.24±138.66） HU,最小值为（460.45±183.33） HU。除Y0X0、Y8X0、Y8X6、Y12X6、Y20X6、Y20X9、Y24X6和Y24X9外,其余20个测量点位的骨皮质密度值性别差异有统计学意义（P＜0.05）。腭部骨皮质密度有由前向后递减的趋势（P=0.000）。腭前部中缝旁3 mm区域的骨皮质密度高于腭前部中缝区（P＜0.05）。结论：经CBCT获取了成人腭部骨皮质密度的分布规律,为腭部微种植体植入部位的选择提供了参考。     

Measurement of cortical bone thickness in adults by cone-beam computerized tomography for orthodontic miniscrews placement

The purpose of this study was to investigate the cortical bone thickness of the inter-dental area of both jaws for orthodontic miniscrew placement. The cone-beam computerized tomography images of 32 non-orthodontic adults with normal occlusion were taken to measure the cortical bone thickness in both jaws. One-way analysis of variance (ANOVA) was used to analyze the differences in cortical bone thickness. Buccal cortical bone in the mandible was thicker than that in the maxilla. In the maxilla, cortical bone thickness was thicker in the buccal side than in the palatal side. Buccal cortical bone thickness in the mandible was thickest at the site distal to the first molar, and in the maxilla it was thickest at the site mesial to the first molar, while in the palatal side of maxilla it was thickest at the site mesial to the second premolar. The changing pattern of cortical bone thickness varies at different sites. In the buccal side of maxilla, the thinnest cortical bone thickness was found to be at 4 mm level from the alveolar crest, while the thickest was at 10 mm level (except for the site mesial to the first premolar). The buccal cortical bone thickness at the sites mesial or distal to the first molar in the mandible and palatal cortical bone thickness of maxilla tended to increase with increasing distance from the alveolar bone.     

基于冠状动脉 CTA 图像对冠状动脉空间扭曲程度的量化测量

目的：提出对冠状动脉的扭曲程度进行准确的测量评价的新方法,为明确冠状动脉扭曲的所造成的影响提供有利条件。方法连续录入72例临床拟诊冠心病且均接受256排冠状动脉电子计算机断层扫描血管造影(CTA)检查患者的图像,经后处理后,提取心外膜下3支主要冠状动脉血管中轴,获取其在3维空间中的坐标,并对扭曲系数进行量化测量。结果心外膜下3支主要冠状动脉的三维空间扭曲系数分别为：左前降支6.66±7.54,左回旋支13.43±12.85,右冠状动脉17.61±7.67。通过对冠状动脉扭曲的建模检验证明该方法对扭曲评价的效果良好。结论此方法能对冠状动脉在三维空间的扭曲程度进行准确的定量化分析,且结果不受造影投射面、人为测量误差及血管长度的影响。     

The accuracy and optimal slice thickness of multislice helical computed tomography for right and left ventricular volume measurement

Background Multislice helical computed tomography (MSCT) has been used to depict coronary anatomy noninvasively, and proved useful for evaluating ventricular function. The aim of our study was to assess the accuracy of ventricular volume as measured by MSCT.Methods Fourteen human left ventricular (LV) and 15 right ventricular (RV) casts were scanned by MSCT. A series of LV and RV short-axis images were reconstructed later with slice thickness of 2.0 mm, 3.5 mm, 5.0 mm, 7.0 mm, and 10.0 mm. Ventricular volume was calculated by the multislice tomographic Simpson’s method. True LV and RV cast volumes were determined by water displacement. Results Both calculated LV and RV volumes correlated highly with the corresponding true volumes (all r&gt;0.95, P&lt;0.01). But with slice thickness from 2.0 mm to 10.0 mm, MSCT scanning overestimated the corresponding true volume by (3.21±5.95) ml to (12.58±8.56) ml for LV and (10.22±8.45) ml to (23.91±12.24) ml for RV (all P&lt;0.01). There was a very high correlation between the overestimation and the selected slice thickness for both LV and RV volume measurements (r=0.998 and 0.996, P&lt;0.01, respectively). However, when slice thickness was reduced to 5.0 mm, the overestimation for both LV and RV volume measurements became nonsignificant for slice thickness from 2.0 mm to 5.0 mm. Conclusions Both LV and RV volumes can be accurately estimated by MSCT. Thinner slice has more accurate calculated volume. However, 5.0 mm slice thickness is thin enough for an accurate measurement of LV or RV volume.     

基于锥形束计算机体层摄影术测量牙龈厚度

目的：探索一种应用锥形束计算机体层摄影术(cone-beam computed tomography, CBCT)对牙龈稳定显影的方法,并应用CBCT测量分析牙龈厚度与其覆盖骨厚度间的关系,进一步验证牙周探诊法判断牙龈生物型的可行性。方法：对受试者的上前牙区进行CBCT拍摄前准备：硅橡胶取初印,藻酸盐与造影剂按一定比例混合均匀取终印;拍摄CBCT后应用配套软件对影像资料进行三维重建处理,获得清晰牙龈图像,并测量目标位置的牙龈厚度,应用以上方法对15名研究对象的60颗上前牙进行CBCT拍摄,CBCT测量釉牙骨质界处的牙龈厚度,牙齿中央骨嵴顶下方2 mm处唇侧牙龈厚度及骨厚度,综合临床判断牙龈生物型,进行数据统计分析。结果：应用CBCT显示牙龈外形并可结合软件测量目标位置的牙龈厚度,薄型、中间型与厚型3组间的牙龈平均厚度比较,差异有统计学意义（F=7.206,P=0.002）;牙龈生物型与釉牙骨质界处牙龈厚度相关（r=0.449,P＜0.05）;上前牙唇侧中央骨嵴顶下2 mm处的牙龈厚度与骨厚度负相关（r=-0.31）。结论：通过印模技术结合造影使牙龈表面间接显影的方式,应用CBCT拍摄获得了清晰的上前牙区牙龈三维图像;CBCT测量牙龈厚度的结果与牙周探诊法判断牙龈生物型的结果较为一致,牙龈生物型与釉牙骨质界处牙龈厚度呈正相关,上前牙唇侧中央骨嵴顶下2 mm处的牙龈厚度与骨厚度呈轻度负相关。     

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Background

The objectives of the study were to estimate the following in adults of Indian origin: a) Gender and side differences in the skin-to-muscle (SM) and muscle-to-bone thickness (MB) at the deltoid intramuscular injection site; b) Correlation of SM thickness with the BMI, age and gender; c) The prevalence of under and over-penetration assuming a standard needle length of 25 mm and following prescribed guidelines for IM injection.

Methods

The SM, MB and skin-to-bone (SB) thicknesses were bilaterally estimated in two hundred adult Indian subjects (100 male and 100 female) using an ultrasound probe at a pre-determined point on the upper arms of the subjects. The BMI of each subject was calculated. The unpaired sample ‘t’ test and paired ‘t’ test were used to analyse differences between groups. Pearson''s correlation coefficient was used in correlation analysis and suitable linear regression equations were generated.

Results

Females had a significantly higher SM thickness and lower MB thickness. The SM thickness was significantly greater on the left side, while the SB and MB thickness were significantly greater on the right. Multiple linear regression equations for both the dominant and non-dominant arms had good model fit properties. Under-penetration would have occurred in 2 (1%) subjects while over-penetration would have occurred in 50% of the subjects.

Conclusion

Over-penetration of deltoid IM injections is likely to be more prevalent as compared to under-penetration. Therefore, the technique of IM injection needs to be modified based on the body type of the individual patient.     

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Background

The objectives of the study were to estimate the following in adults of Indian origin: a) Gender and side differences in the skin-to-muscle (SM) and muscle-to-bone thickness (MB) at the deltoid intramuscular injection site; b) Correlation of SM thickness with the BMI, age and gender; c) The prevalence of under and over-penetration assuming a standard needle length of 25 mm and following prescribed guidelines for IM injection.

Methods

The SM, MB and skin-to-bone (SB) thicknesses were bilaterally estimated in two hundred adult Indian subjects (100 male and 100 female) using an ultrasound probe at a pre-determined point on the upper arms of the subjects. The BMI of each subject was calculated. The unpaired sample ‘t’ test and paired ‘t’ test were used to analyse differences between groups. Pearson's correlation coefficient was used in correlation analysis and suitable linear regression equations were generated.

Results

Females had a significantly higher SM thickness and lower MB thickness. The SM thickness was significantly greater on the left side, while the SB and MB thickness were significantly greater on the right. Multiple linear regression equations for both the dominant and non-dominant arms had good model fit properties. Under-penetration would have occurred in 2 (1%) subjects while over-penetration would have occurred in 50% of the subjects.

Conclusion

Over-penetration of deltoid IM injections is likely to be more prevalent as compared to under-penetration. Therefore, the technique of IM injection needs to be modified based on the body type of the individual patient.     

3种生成大视野锥形束CT数据正中矢状面方法的比较

目的：比较迭代最近点法（interactive closet point,ICP）、普氏分析法（Procrustes analysis,PA）和点构法在确定大视野锥形束CT（cone beam computed tomography,CBCT）数据正中矢状面（mid-sagittal plane,MSP）的准确性,为大视野锥形束CT空间坐标系的建立和对称性分析提供理论依据。方法： 10名面部基本对称正畸患者进行大视野锥形束CT扫描,数据以DICOM格式保存输出,在Mimics10.0下完成数据分割获取数字化三维头颅,将所生成数字化头颅数据导入逆向工程软件geomagic studio 2012,对原始数据进行左右镜像,将原始和镜像后的三维头颅数据分别以ICP和PA进行配准,分别求得颅面结构正中矢状参考平面S1、S2。点构法是在InVivoDental 5.0软件下以蝶鞍点（sella, S）、鼻根点（nasion, N）、颅底点（basion, Ba）3点确定正中矢状参考平面S3,分别测量计算9对对称解剖标志点到上述3个参考平面的距离差值的绝对值,使用单因素方差分析比较3种方法生成正中矢状面的差异,并以LSD进行组间两两比较。结果： 在正位截图下观察,3种方法生成的正中矢状参考平面均可用于临床分析,单因素方差分析显示3种生成正中矢状参考平面的方法差异有统计学意义（F=10.932,P=0.001）,LSD检验显示迭代最近点算法与点构法生成MSP差异无统计学意义（P=0.11）,普氏分析算法与点构法生成MSP差异有统计学意义（P=0.01）。结论： 对于大视野锥形束CT数据,基于迭代最近点算法和普式分析算法计算可构建三维头颅的正中矢状参考平面,对于面部基本对称个体,迭代最近点算法与传统点构法所生成正中矢状参考平面无明显差异,具有临床可行性。     

Combination of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging is an optimal way to evaluate rheumatoid arthritis in rats dynamically

Background Rheumatoid arthritis （RA） is a chronic,systemic autoimmune inflammatory disorder.Many methods have been used to observe the progress of RA.The purpose of this study was to observe the progress of RA in rats with 18F-fluorodeoxyglucose （FDG） positron emission tomography/computed tomography （PET/CT）,magnetic resonance （MR） imaging and arthritis score,and analyze the relationships among different methods in evaluation of RA.Methods Sixteen healthy Sprague Dawley （SD） rats about 8-week old were randomly assigned to a RA group and a control group.Bovine type Ⅱ emulsified incomplete Freud＇s adjuvant was used to induce arthritis in the RA group.Arthritis score of the rats in two groups were recorded,and 18F-FDG PET/CT,MR imaging were performed both on the corresponding rats every 3 days.All the rats were sacrificed at week 5,and histopathological examination was performed on rat knees stained with haematoxylin and eosin.Results The arthritis score and the standard uptake value （SUV） of knee joints in RA rats increased with the progression of arthritis gradually.Both peaks of arthritis score and SUV appeared at 21 days after the first immune injection,then the arthritis score and SUV of knee joints decreased slowly.The arthritis scores of knee joints in RA rats were positively correlated with their SUV changes.The MR images were confirmed by the histopathological studies.Conclusion PET/CT can detect the earliest molecular metabolism changes of RA,and MR imaging can follow up the dynamical anatomical changes of RA,all of which indicated that PET/CT and MR imaging may be applied as useful tools to monitor the progress of RA.     

PET/CT图像融合对骨转移瘤放射治疗肿瘤区勾画的影响

目的 评价PET/CT图像融合在三维适形放射治疗骨转移瘤肿瘤靶区勾画中的作用。方法 选取3例病理证实原发灶为肺癌、肝癌和肾癌且合并全身多发性骨转移瘤患者,选择腰椎、胸椎、肋骨、髂骨、肩胛骨、股骨转移病灶各1处,标记为BM1~6,由8位放射肿瘤学医师分别在治疗计划CT上勾画6处骨转移瘤的肿瘤区体积(GTV),比较依据CT和PET/CT图像融合资料勾画GTV的差异。结果 有骨皮质破坏的病灶BM1~5,依据CT勾画的GTV较依据PET/CT勾画的GTV大(P<0.05),而无明显骨皮质破坏的病灶BM6则相反(P<0.05)。依据PET/CT勾画GTV时,不同观察者之间的差异小于依据CT勾画GTV时的差异。结论 PET/CT图像融合能提高骨转移瘤GTV勾画的精确性和重复性,从而减少对周围正常组织损伤而增加放射治疗的增益比。