中枢性眩晕飞行员全脑血管造影初步分析

目的 了解中枢性眩晕飞行员患者脑血管的形态结构.方法 利用数字减影血管造影技术对飞行员患者行主动脉弓及全脑血管造影,分析血管结构异常的类型.结果 7例患者中4例患者为一侧椎动脉纤细,其中2例发生了椎动脉闭塞,另有2例脑血管存在先天变异;1例患者有颈内动脉狭窄;2例患者造影未见异常.结论 飞行员中枢性眩晕的原因有可能是脑血管变异、脑血管闭塞和狭窄引起的. Abstract： Objective To investigate the morphological changes of cerebral blood vessels by digital subtraction angiography (DSA) in the hospitalized military pilots with central vertigo.Methods Seven pilots were examined by cerebral and aortic arch DSA through femoral artery puncture. Type and distribution of the cerebrovascular abnormalities were observed and analyzed.Results Four pilots out of 7 were thinner unilateral vertebral artery and 2 of them appeared vertebral artery occlusion and the rest 2 pilots showed congenital abnormalities of cerebral artery. One pilot was diagnosed as internal carotid artery stenosis. Only 2 pilots were not detected abnormalities by DSA.Conclusions Congenital abnormalities, stenosis and occlusion of cerebral artery would be the reasons of resulting in pilot's central vertigo.     

飞行人员恶性肿瘤术后安全放飞指征的临床研究

目的 研究和探讨我国飞行人员恶性肿瘤手术后放飞的安全标准. 方法 回顾分析38年间,经病理检查确诊为恶性肿瘤并进行外科手术的飞行人员病例资料,全组25例飞行人员恶性肿瘤术后放飞13例. 结果 本组13例恶性肿瘤术后放飞的飞行人员中,甲状腺癌4例、结肠癌3例、膀胱癌2例,胃癌、胰腺囊腺瘤、乳腺癌和耻骨软骨肉瘤各1例.经手术治疗及术后辅助治疗,13例病人机体状况恢复良好,鉴定结论 :飞行合格.术后随访3～38年,飞行时间30～2000 h,飞行状态良好. 结论 部分患恶性肿瘤的飞行人员,通过仔细认真的手术、正规的术后辅助治疗和护理、循序渐进的体能锻炼、定期严格的健康体检,可以达到飞行合格.作者提出了适合我国飞行人员恶性肿瘤术后恢复飞行的基本标准. Abstract： Objective To study and discuss the safety standard of flying qualification for the postoperative flying personnel with malignant tumor. Methods Related case history in past 38 years was retrospectively reviewed and sought 13 flying qualified cases out of 25 postoperative flying personnel with malignant tumor. Results Among 13 qualified cases there were 4 cases of thyroid carcinoma, 3 cases of colon carcinoma, 2 cases of bladder carcinoma and 4 cases respectively were gastric cancer, cystadenoma of pancreas, breast carcinoma and pubis osteochondrosarcoma. Those 13 cases were cured by operation and other adjuvant treatments and were diagnosed as well recovered. Since they were qualified for flying, the 3-38 years follow-up showed that they had fitted in flying for 30-2000 h. Conclusions Some flying personnel with malignant tumor would be qualified for flying by operation, proper adjuvant treatments and regular nursing, as well as the progressive physical exercise and under regular rigorous physical examination. The paper also puts forward a basic standard that suited for Chinese military flying personnel with malignant tumor.     

飞行人员甲状腺疾病的特点、诊治及医学鉴定

目的 总结飞行人员甲状腺疾病的诊治和医学鉴定经验. 方法 收集我院2000年12月-2009年12月间住院飞行人员67例甲状腺疾病资料,将其归为:①无症状的良性甲状腺结节;②慢性淋巴细胞性甲状腺炎;③甲状腺功能异常类疾病(包括甲状腺机能亢进症和甲状腺机能减退症);④甲状腺恶性肿瘤.分析4类疾病的特点及飞行结论 情况. 结果 ①良性甲状腺结节36例(占53.73%),4例手术治疗(腺瘤3例,结节性甲状腺肿1例),除5例因其他原因停飞外,其余31例均飞行合格,定期复查;②慢性淋巴细胞性甲状腺炎5例(占7.46%),甲状腺功能正常,均飞行合格,定期复查;③甲状腺功能异常类疾病20例(占29.85%,甲状腺机能亢进18例,甲状腺机能减退2例),均行药物治疗,6例飞行合格,3例暂时飞行不合格,11例停飞;④甲状腺恶性肿瘤6例(占8.96%,4例为乳头状癌,2例为滤泡状癌),1例飞行合格,5例停飞.经统计学分析,甲状腺功能异常类疾病和甲状腺恶性肿瘤的停飞率均高于良性甲状腺结节和慢性淋巴细胞性甲状腺炎,且差异有统计学意义(P<0.01或P<0.05). 结论 飞行人员甲状腺疾病以无症状的良性结节常见,要重视功能异常类疾病和恶性肿瘤的早期诊断和治疗. Abstract： Objective To summarize the experiences of diagnosis,treatment and medical evaluation of thyroid disease in flying personnel. Methods Sixty-seven cases of thyroid diseases,that were hospitalized from December 2000 to December 2009,were collected and analyzed.They were concluded such categories as:①asymptomatic benign thyroid nodules;②Hashimoto's disease;③diseases of abnormal thyroid functions (including hyperthyroidism and hypothyroidism);and ④thyroid cancer.Their characteristics and the relationship between different categories were analyzed correspondingly to the evaluations for flying. Results ①Among 36 cases of diagnosed asymptomatic benign thyroid nodules (53.73%),4 (3 were adenoma and 1 was nodular goiter) were surgically treated.31 Cases were evaluated as qualified for flying but should be with regular medical check-up while the other 5 were permanently grounded.②There were 5 cases of Hashimoto's disease with normal thyroid functions (7.46%).They were qualified for flying but should be with regular medical check-up.③Thyroid dysfunction took 20 cases (29.85%),among which 18 were hyperthyroidism and 2 were hypothyroidism.Drug treatment was applied.Six cases were finally qualified for flying while the other 3 and 11 were respectively assessed as temporary and permanent grounding.④Six cases were thyroid cancer (8.96%),included 4 papillary carcinoma cases and 2 follicular thyroid carcinoma cases.Only 1 case was finally qualified for flying while the others were permanently grounded.Statistical analysis showed that thyroid dysfunction diseases and thyroid cancer caused significant higher disqualification rate than benign thyroid nodules and Hashimoto's diseases (P<0.01 or P<0.05). Conclusions Benign thyroid nodules are the common thyroid diseases in flying personnel.But the diagnosis of thyroid dysfunction diseases and thyroid malignant tumors should be cared in order to win the chance of treatment and further to reduce the rate of flying disqualification.     

飞行人员空晕病的诊治和医学鉴定

Objective To summarize the clinical features,diagnosis and treatment methods,prevention and control measures,and medical evaluation principles for airsickness in flying personnel. Methods Forty-nine cases of flying personnel with airsickness,who were hospitalized from September of 1976 to July of 2009,were retrospectively analyzed in respect of disease course,etiology or incentive,clinical diagnosis and medical evaluation of airsickness.The relationship between vestibular function status and medical evaluation was also statistically analyzed. Results ① Three of 49 picked cases were diagnosed as primary airsickness while the rest 46 were the secondary that were induced by different causes or incentives.Etiological treatment and vestibular habituation were the primarily treatments for such airsickness.② Among these cases,22 were normal in vestibular nystagmus electroretinogram (VNG) comparing to 27 abnormal cases.③ Sixteen and 33 cases were evaluated as normal and deficient Coriolis acceleration tolerance respectively.④ Eleven flying personnel Were finally qualified while 10 and 28 were temporarily and permanently grounded respectively.Flying personnel with abnormal VNG or with deficient Coriolis acceleration tolerance showed higher grounding rate than those with the normal (χ2=5.584,16.722,P<0.05). Conclusions Airsickness in active service flying personnel is mostly the secondary affection,which is caused by various primary disease or incentives.Such prevention and control measures as treating primary disease.eliminating incentives and implementing vestibular habituation are suggested.The effect of airsickness treatment and vestibular function should be emphasized in making medical evaluation.     

飞行人员甲状腺疾病的特点、诊治及医学鉴定

Objective To summarize the experiences of diagnosis,treatment and medical evaluation of thyroid disease in flying personnel. Methods Sixty-seven cases of thyroid diseases,that were hospitalized from December 2000 to December 2009,were collected and analyzed.They were concluded such categories as:①asymptomatic benign thyroid nodules;②Hashimoto's disease;③diseases of abnormal thyroid functions (including hyperthyroidism and hypothyroidism);and ④thyroid cancer.Their characteristics and the relationship between different categories were analyzed correspondingly to the evaluations for flying. Results ①Among 36 cases of diagnosed asymptomatic benign thyroid nodules (53.73%),4 (3 were adenoma and 1 was nodular goiter) were surgically treated.31 Cases were evaluated as qualified for flying but should be with regular medical check-up while the other 5 were permanently grounded.②There were 5 cases of Hashimoto's disease with normal thyroid functions (7.46%).They were qualified for flying but should be with regular medical check-up.③Thyroid dysfunction took 20 cases (29.85%),among which 18 were hyperthyroidism and 2 were hypothyroidism.Drug treatment was applied.Six cases were finally qualified for flying while the other 3 and 11 were respectively assessed as temporary and permanent grounding.④Six cases were thyroid cancer (8.96%),included 4 papillary carcinoma cases and 2 follicular thyroid carcinoma cases.Only 1 case was finally qualified for flying while the others were permanently grounded.Statistical analysis showed that thyroid dysfunction diseases and thyroid cancer caused significant higher disqualification rate than benign thyroid nodules and Hashimoto's diseases (P<0.01 or P<0.05). Conclusions Benign thyroid nodules are the common thyroid diseases in flying personnel.But the diagnosis of thyroid dysfunction diseases and thyroid malignant tumors should be cared in order to win the chance of treatment and further to reduce the rate of flying disqualification.     

飞行人员空晕病的诊治和医学鉴定

目的 总结飞行人员空晕病的临床特征、诊治方法、防治措施及医学鉴定原则. 方法 回顾性分析1976年9月-2009年7月间住我院的49例飞行人员空晕病患者的病历资料,包括患者病史、病因与诱因、诊断分类、检查及医学鉴定结论 .对前庭功能检查结果与医学鉴定结论之间的关系进行统计学分析. 结果 ①本组病例原发性空晕病3例,继发性空晕病46例;继发性空晕病有其原发病因或诱因,其治疗主要为病因治疗和前庭功能脱敏习服训练;②前庭眼震电图检查正常者22例,异常者27例;③科里奥利加速度耐力正常者16例,不良者33例;④飞行合格11例,暂时飞行不合格10例,飞行不合格28例.前庭眼震电图异常者和科里奥利加速度耐力不良者飞行不合格率分别高于前庭眼震电图正常者和科里奥利加速度耐力正常者(χ2=5.584、16.722,P<0.05).结论 现役飞行人员空晕病多为继发性,防治措施包括治疗原发病因、消除诱因和加强前庭功能脱敏习服训练.其医学鉴定要兼顾原发病治疗效果、前庭功能状况及飞行机种情况. Abstract： Objective To summarize the clinical features,diagnosis and treatment methods,prevention and control measures,and medical evaluation principles for airsickness in flying personnel. Methods Forty-nine cases of flying personnel with airsickness,who were hospitalized from September of 1976 to July of 2009,were retrospectively analyzed in respect of disease course,etiology or incentive,clinical diagnosis and medical evaluation of airsickness.The relationship between vestibular function status and medical evaluation was also statistically analyzed. Results ① Three of 49 picked cases were diagnosed as primary airsickness while the rest 46 were the secondary that were induced by different causes or incentives.Etiological treatment and vestibular habituation were the primarily treatments for such airsickness.② Among these cases,22 were normal in vestibular nystagmus electroretinogram (VNG) comparing to 27 abnormal cases.③ Sixteen and 33 cases were evaluated as normal and deficient Coriolis acceleration tolerance respectively.④ Eleven flying personnel Were finally qualified while 10 and 28 were temporarily and permanently grounded respectively.Flying personnel with abnormal VNG or with deficient Coriolis acceleration tolerance showed higher grounding rate than those with the normal (χ2=5.584,16.722,P<0.05). Conclusions Airsickness in active service flying personnel is mostly the secondary affection,which is caused by various primary disease or incentives.Such prevention and control measures as treating primary disease.eliminating incentives and implementing vestibular habituation are suggested.The effect of airsickness treatment and vestibular function should be emphasized in making medical evaluation.     

飞行人员多系统萎缩二例并文献复习

目的 探讨2例飞行人员患罕见病多系统萎缩(multiple system atrophy,MSA)的临床特征、鉴别诊断、治疗、与飞行的关系及健康鉴定. 方法 分析2例飞行人员的临床资料及复习相关文献. 结果 2例起始表现均不典型,晚期1例表现较典型.因是罕见病,都有一定时期误诊.最终确诊主要根据临床表现,结合电生理及影像学检查.确诊后飞行结论 为飞行不合格. 结论 神经系统变性疾病起始表现隐袭,病程较长.飞行人员身体素质较好,发病后表现更加隐蔽.要求航空医生要更加仔细地观察临床表现及分析相关检查,尽早做出诊断,避免误诊.对此类神经系统变性疾病的飞行结论 要根据病情轻重、飞行机种及飞行任务综合评定. Abstract： Objective To investigate the clinical features by analyzing two flying personnel cases of multiple system atrophy (MSA) for the references to diagnosis, treatment, as well as the influence to flying and the criteria of individual aeromedical evaluation. Methods The clinical data of 2 cases of aircrew with MSA were analyzed and related literatures were reviewed. Results The clinical MSA features of both cases were not typical in their early stage but 1 case appeared typical features in late stage. These 2 cases were misdiagnosed in a certain time because of MSA's rare occurrence, but finally the definite diagnosis was made by judging clinical features, electrophysiology and imageology examinations. These 2 pilots were finally disqualified for flying. Conclusions The clinical features of degeneration diseases of neurologic system in early stage were obscure and had relative longer course of disease, especially for those physical fitness pilots. So it raised higher requirements to the aviation physician in early recognizing the features of MSA for preventing misdiagnosis. Aeromedical assessment of flying personnel with degeneration diseases of neurologic system should be synthetically evaluated according to clinical features, aircraft type and mission.     

脉搏波传导速度和踝臂指数在飞行人员动脉硬化早期检测中的应用

目的 探讨脉搏波传导速度(pulse wave velocity,PWV)和踝臂指数(ankle brachial pressure index,ABI)在飞行人员动脉硬化早期检测中的应用价值.方法 应用动脉硬化检测仪,检测107例飞行人员的PWV和ABI,并与107例地方体检人员进行对比分析.结果 飞行人员组发现PWV异常10例(9.3%),对照组发现36例(33.6%);对照组发现1例ABI异常,而飞行人员组未见ABI异常;两组人群PWV均值随着年龄的增长而增大(F=3.314～13.819,P＜0.05),但飞行人员PWV均值显著低于同年龄组一般人群(t=2.187～4.208,P＜0.05).线性回归分析结果表明,飞行人员PWV与年龄、血压、腰围和体重指数显著相关(β=0.439～0.634,P＜0.01).结论 年龄、血压、腰围或体重指数的增加是飞行人员大动脉弹性降低的主要危险因素,PWV可以作为飞行人员血管早期病变检测与评价的功能指标. Abstract： Objective To explore the value of using pulse wave velocity (PWV) and ankle brachial pressure index (ABI) to detect the early arteriosclerosis in flying personnel. Methods PWV and ABI were detected in 107 cases of flying personnel by arteriosclerosis detector and 107 civil personnel were examined as control group. Results 10 cases (9.3%) of abnormal PWV were found in flying personnel group while 36 cases (33.6%) found in control group. Only one abnormal ABI case was in control group but in flying personnel group. The mean PWV of both groups' showed significant increase with the age growing (F= 3. 314-13. 819, P＜0. 05). The mean PWV of flying personnel group was significantly lower than that of the control group in same age segment (t= 2. 187-4. 208,P＜0.05). Linear regression analysis showed that PWV was closely related to the age, blood pressure, waist circumference (WC) and body mass index (BMI) in flying personnel group (β=0. 439-0. 634, P＜0. 05). Conclusions The increases of age, blood pressure and WC or BMI are the major risk factors of causing aorta elasticity decreased in flying personnel. It is suggested that the PWV would be an applicable functional index in early diagnosis of vascular pathological changes and in medical evaluation.     

飞行人员耳气压伤的诊治和医学鉴定

目的 通过对40年间住我院飞行人员耳气压伤资料分析,了解耳气压伤的发病情况,并进一步探讨其临床诊治和医学鉴定. 方法 对1967年8月-2007年7月住我院的235例(375耳)耳气压伤飞行人员的资料进行分析:①统计患病年龄、住院年代、飞行机种、飞行职务和飞行时间等与飞行结论 的关系;②按原发性耳气压伤(由咽鼓管周围鼻咽科疾病所致)和继发性耳气压伤(由咽鼓管本身疾病所致)进行分类,并统计其疗效和飞行结论 的关系. 结果 ①耳气压伤在35岁以下占77.0%;在1997年8月-2007年7月仅占14.0%;歼击机飞行员占43.0%,飞行员占70.6%;飞行时间少于1000 h的占51.3%.②继发性耳气压伤治愈率68.9%(164耳/238耳)、停飞率11.2%(18例/160例),原发性耳气压伤治愈率29.2%(40耳/137耳)、停飞率57.3%(43例/75例),差异均有统计学意义(x2=53.8、73.5,P＜0.01). 结论 飞行人员耳气压伤常见,近10年耳气压伤的发生率呈下降趋势,多发生于年轻的歼击机飞行员,且继发性耳气压伤治愈率高于原发性,停飞率低于原发性耳气压伤. Abstract： Objective To summarize the clinical diagnosis, treatment and medical evaluation of barotraumas of ear (BE) by analyzing the inpatients' medical data in past 40 years. Methods The BE cases of 375 ears from 235 aircrews who were hospitalized from August of 1967 to July of 2007,hospitalization, duty, as well as the served aircraft type and flying hours, was respectively analyzed.(induced by the diseases of Eustachian tube itself) were classified and their curative effects were also was younger than 35 yrs. Only 14.0% BE occurred during the period from August of 1997 to July of 2007. In all BE cases, pilots took 70. 6% and the pilots with the flying hours less than 1000 h accounted for 51.3%. 43.0% (101 out of 235) fighter pilots appeared BE and 32.7% of them were permanently grounded, and this percentage was significantly higher than that on other types of aircraft caused 11.2% grounding rate (18 cases out of 160). The primary BE caused 57.3% pilots grounded while its healing rate was 29.2%. The differences were significantly (P＜0. 01). Conclusions BE is common in aircrew, especially in young fighter pilots. It shows a decreased trend in recent 10 year.Secondary BE has higher healing rate than primary BE's and causes lower grounding rate.     

320层CT心电门控双期心脏功能扫描一站式检查的初步研究

目的 初步探讨应用320层CT心电门控双期心功能扫描模式(DPCFA)一站式评价心脏、冠状动脉、肺动脉形态及左、右心室功能的能力.方法 回顾性分析40例经临床确诊患者的320层CT DPCFA扫描数据,分别以肺动脉期重建并观察肺动脉分支,以主动脉期重建并观察冠状动脉.分别以两期数据进行MPR重组并分析左、右心室功能,结果与超声心动图相对照.5例因图像质量欠佳排除组外,35例图像质量达到2级以上,可用作诊断,扫描平均心率(71.2±11.2)次/min,全部患者扫描期间未出现心律失常.应用Pearson检验进行相关性分析,应用配对t检验分析二者测量左心室射血分数(LVEF)的一致性.结果 (1)35例最终入组患者中,诊断单发肺动脉栓塞l1例,冠心病支架术后7例,单发冠心病5例,先天性心脏病房间隔缺损3例,特发性肺动脉高压3例,左房黏液瘤l例,肺动脉栓塞合并冠心病5例,全部符合临床诊断.(2)CT与超声心动图对照,35例患者的左、右心室舒张末期最大径分别为(36.7±3.3)、(43.3±3.4)mm,左、右心室收缩末期最大径分别为(31.6 ±5.1)、(41.3±5.1)mm,LVEF为47.1±15.1.超声心动图测得左、右心室舒张末期最大径分别为(40.3±3.1)、(47.3±4.2)mm,左、右心室收缩末期最大径分别为(37.3±5.6)、(45.3±3.3)mm,LVEF为46.0±14.8.CT与超声测量结果有显著的相关性(r=0.886～0.988,P值均＜0.01),LVEF的测量结果差异无统计学意义(t=0.692,P＞0.05).(3)应用DPCFA技术,平均射线剂量(5.4 ±0.5)mSv.结论 320层CT心电门控双期心功能扫描模式,可以用于心血管疾病一站式影像检查,可为临床心血管疾病的诊断、鉴别诊断、治疗方案的确定提供丰富的影像学信息,对左、右心功能不全相关临床问题的处理具有指导作用.

Abstract：

Objective To explore the feasibility of evaluating cardiac structure, coronary artery,pulmonary artery and cardiac function in one single scan by 320-row CT ECG-gated double phase cardiac function scan mode. MethodsForty patients underwent the 320-detector row CT double phase cardiovascular angiography. The pulmonary phase and aortic phase were reconstructed in order to evaluate the pulmonary and coronary artery. MPR reconstructions of both pulmonary and aortic phase were used to analyze the function of the two ventricles. And the results of the cardiac function were compared with those of transthoracic echocardiography. Thirty-five cases could be analyzed and diagnosed, while the other 5 cases had to be given up because of the poor imaging quality. The mean heart rate was (71.2 ± 11.2) beat per min (bpm). No arrhythmia case included. Results ( 1 ) Pulmonary embolism were diagnosed in 11 cases,coronary artery disease (CAD) were found in 5 cases, while post-stent implantation were observed in 7 cases. Six cases of congenital heart disease were diagnosed with 3 ASD and 3 primary pulmonary hypertension. Another one was diagnosed with left atrial myxoma, and 5 cases were pulmonary embolism associated with CAD. All of above cases were verified by final clinical diagnosis. (2) The heart function parameters including LVEDd , RVEDd, LVESd, RVESd and LVEF were (36.7 ±3.3), (43.3 ± 3.4) mm,(31.6±5.1), (41.3 ±5.1) mm and (47.1 ±15.1) for CT, while those were (40.3 ±3.1), (47.3 ±4.2) mm,(37.3 ±5.6), (45.3 ±3.3) mm,and (46.0 ± 14.8) for ultrasound, respectively. The CT results were correlated with the ultrasound ( n = 35, r = 0.886-0.988, P ＜ 0.01 ). (3) The average radiation exposure was ( 5.4 ± 0.5 ) mSv. Conclusions 320-row CT ECG-gated double phase cardiac function scan mode is feasible for the "one-stop-shop" examination of the cardiovascular disease. This noninvasive method is recommended for the diagnosis, differential diagnosis, treatment and prognosis of cardiovascular disease.     

飞行员颈性眩晕与椎动脉先天发育异常的关系

目的探讨飞行员颈性眩晕与椎动脉先天发育异常之间的关系。方法利用二维超声及彩色多普勒超声回顾性分析71例颈性眩晕飞行员患者的椎动脉走行、内径及血流动力学变化等,总结颈性眩晕飞行员患者中椎动脉先天发育异常的比例。结果根据椎动脉异常的超声诊断标准,本组71例患者142条椎动脉中,85条椎动脉起始段清晰显示,显示率为59.9%(85/142),椎间段均清楚显示,显示率为100%;椎动脉纤细者20例,占28.2%(20/71),共包括21条椎动脉(左侧8条,右侧13条),其中1例为双侧椎动脉纤细,均为均匀性纤细;椎动脉走形变异22例,占31.0%(22/71),共包括椎动脉37条;同时存在椎动脉纤细和椎动脉走行异常者12例,占16.9%(12/71)。血流动力学参数异常者13例,28例患者合并颈椎X线片改变;椎动脉纤细者左右侧椎动脉内径、收缩期峰值流速(Vmax)及血流量之间差异无统计学意义。结论椎动脉发育异常是飞行员颈性眩晕的主要原因之一,椎动脉超声检查可作为招飞检查项目。     

颈部血管彩超对缺血性脑血管病患者颈部动脉血管病变的诊断价值

目的探讨颈部血管彩超对缺血性脑血管病患者颈部动脉血管病变的诊断价值。方法 51例经头部CT或MRI及临床确诊的缺血性脑血管病患者,均进行了多层螺旋CT血管成像（CTA）和颈部血管超声（CVUS）检查,以CTA为对照,评价颈部血管彩超的诊断价值。结果 CTA和CVUS发现颈动脉狭窄及闭塞分别为20例、17例,椎动脉狭窄或发育异常分别为29例、15例。结论对于颈动脉狭窄的评价,颈部血管彩超和CTA具有很好的一致性,但颈部血管彩超对椎动脉病变的评价不足,联合使用CVUS和CTA可以更全面地评价缺血性脑血管病患者的颈部动脉病变。     

颈椎创伤继发椎动脉损伤核磁共振血管成像诊断及实验研究

目的 探讨二维时间飞逝效应核磁共振血管成像（2D TOF MRA）对闭合性椎动脉损伤的诊断价值。方法 319例闭合性颈椎创伤患者，采用2D TOF MRA技术进行椎动脉前瞻性检查。14只犬建立颈椎屈曲损伤的撞击伤模型，撞击后摄X线片，24～36h后行椎动脉2D TOF MRA检查及椎动脉血管造影。结果 319例颈椎创伤患者中，52例伴有椎动脉损伤。单侧椎动脉损伤51例，左侧22例，右侧29例；双侧椎动脉损伤1例。14只犬均造成颈椎小关节脱位，MRA检查7只犬一侧椎动脉损伤；2只犬一侧椎动脉成像不完整，MRA诊断为可疑阳性；5只犬双侧椎动脉正常。血管造影显示，8只犬一侧椎动脉损伤，6只犬正常。MRA诊断为阳性的7只犬和阴性的5只犬，血管造影与之一致。MRA诊断为可疑阳性的2只犬，血管造影证实1只为阳性，另1只为阴性。结论 2D TOF MRA检查是诊断闭合性椎动脉损伤可靠、首选的方法，对血管痉挛和小面积内膜损伤尚难以准确鉴别。     

空军招飞体检颈椎X线检查异常情况分析及建议

目的 异常中,曲度反向占颈椎异常的30.6%,合并其他异常占43.3%.序列异常占20.5%,发育异常占34.7%,骨质增生占6.8%. 结论 颈椎异常常引发颈肩不适、头痛、眩晕和晕厥等诸多临床症状,对飞行人员健康造成危害,甚至危及飞行安全.在招飞体检时,颈椎异常除单纯颈椎曲度直外,其他颈椎曲度反向、序列异常、骨质增生、寰椎沟环、颈椎融合、颈肋及颅底凹陷均应确定为不合格.     

闭合性颈椎创伤伴椎动脉损伤的临床研究

目的　研究椎动脉损伤在闭合性颈椎创伤中的发病率及其与颈椎损伤机制、类型、损伤程度的相关性 ,观察椎动脉损伤后的临床症状、体征 ,探讨早期正确诊断的方法。　方法　于2 0 0 0年 8月～ 2 0 0 2年 2月间 ,利用颈部动脉磁共振血管造影 (MRA)技术 ,连续观察 4 6例闭合性颈椎创伤患者 ,结合颈椎X线、MRI、CT检查及患者的临床症状、体征综合分析。　结果 4 6例闭合性颈椎创伤中 ,12例 (2 6 % )伴椎动脉损伤。其中 7例为双侧损伤 (4例一侧未显影、一侧狭窄 ,3例双侧狭窄 ) ,5例为单侧损伤 (均为一侧狭窄 ) ;10例椎动脉损伤患者无任何症状 ,2例出现眩晕、恶心呕吐、面部麻木、偏盲等症状。椎动脉损伤与屈曲型损伤及颈椎严重不稳定相关 (P <0 .0 5 ) ,与小关节绞锁、横突孔骨折及脊髓完全性损伤明显相关 (P <0 .0 1)。　结论　椎动脉损伤是闭合性颈椎创伤的较常见并发症 ,其临床症状体征缺乏特异性。颈椎创伤中的颈椎严重不稳定、屈曲型损伤、伴有脊髓完全性损伤、小关节绞锁和 (或 )横突孔骨折应高度怀疑椎动脉损伤。临床医师应对此类损伤有较高的警惕性 ,常规进行颈部动脉MRA检查是最有效的早期正确辅助诊断方法。     

飞行学员椎动脉二维及彩色多普勒超声检测分析

目的 了解2010年度招收的飞行学员椎动脉发育情况,为椎动脉超声检查列入招飞体检提供依据.方法 利用二维及彩色多普勒超声回顾性分析722名飞行学员的椎动脉起始位置、内径、走行及血流动力学变化等,总结飞行学员中椎动脉先天发育异常的比例.结果 722名飞行学员左侧椎动脉起始段(Dl)与椎动脉椎间段(D2)内径(分别为3.624±0.017、3.623±0.018mm)宽于右侧(分别为3.489±0.018、3.438±0.019mm,P＜0.05),左侧椎动脉椎间段收缩期峰值流速(53.547±0.412cm/s)高于右侧(48.463±0.405cm/s,P＜0.05).椎动脉直径在2.5 ～3.0mm的比例较大,为17.5％,而小于2.5mm比例稍低,为6.9％;右侧椎动脉窄细者(16.0％,116/722)多于左侧(8.3％,60/722),差异有统计学意义(P＜0.05).双侧椎动脉走行异常者24例(占3.3％),其中双侧椎动脉起始位置正常,仅走行异常者19例,起始部伴走行异常者5例.19例仅走行异常者左右侧之间无明显差异(P＞0.05),5例起始部伴走行异常者中2例伴有同侧椎动脉窄细.结论 飞行学员中存在多种椎动脉先天发育异常,应早日将椎动脉的超声检查列入招飞体检项目中.     

Dual origin of the vertebral artery mimicking dissection.

Vertebral artery injury may occur at the time of cervical fracture or dislocation. Congenital vertebral artery variations, especially a double vertebral artery origin, may be responsible for angiographic findings that mimic vertebral artery dissection. Two cases of cervical spine fracture with ipsilateral double vertebral artery are presented. Conventional cerebral angiography is the easiest and best way to make this diagnosis and to exclude vertebral artery dissection.     

海军飞行人员住院疾病谱及停飞疾病谱分析

目的 分析2001-2006年海军飞行人员住院和医学停飞的主要疾病构成及其变迁特点,并对突出问题提出对策建议.方法 对2001-2006年海军总医院收治的飞行人员全部病例和2001-2006年海军飞行人员医学停飞的全部资料进行统计分析,并同以往不同时期海军飞行人员主要疾病和医学停飞疾病资料进行对比研究.结果 ①飞行人员颈椎腰椎疾病明显增多,其疾病构成比达19.1%,医学停飞构成比达140.0%,均位居第1位;②头痛、自主神经功能紊乱等功能性疾病仍然是飞行人员住院和医学停飞的主要原因之一,疾病构成比分别为18.3%与11.3%,医学停飞构成比分别为11.0%与10.0%;③晕厥(包括加速度耐力性晕厥),在住院疾病构成比仅为4.2%,但其医学停飞构成比达13.0%;④消化系统疾病和传染性疾病无论是住院还是医学停飞构成比均逐渐降低,排序亦逐渐靠后,但出现个别性传播性疾病值得重视.结论 飞行人员住院和医学停飞主要疾病与飞行职业因素密切相关,针对飞行人员的职业特点采取合理锻炼和有效装备防护,积极心理学干预和心血管疾病预防等措施,对降低飞行人员患病率和医学停飞率具有重要意义.     

飞行员环椎椎动脉沟环与颈性眩晕的关系

目的 探讨飞行员椎动脉沟环与颈性眩晕的关系,以期改进飞行员选拔方法。方法 分析１９７５￣１９９９年间因眩晕或疑诊颈椎疾病飞行员的颈椎Ｘ线片。结果 在３４６例飞行员中发现５６例有椎动脉沟环存在,其与眩晕的临床症状,体征有密切的关系。结论 有环椎椎动脉沟环者在飞行学员选拔中应作为一种负性因素。