儿童发育性髋关节脱位MRI表现与病理对照研究

目的:探讨MRI对儿童发育性髋关节脱位(DDH)的诊断价值。方法:回顾性分析63例经手术证实的DDH的MRI表现。根据Dunn标准将63例DDH分为三型(Ⅰ型、Ⅱ型、Ⅲ型),观察影响DDH复位的因素(关节积液、关节内脂肪增生、盂唇、圆韧带、髂腰肌)。结果:正常髋关节数共为53个,脱位髋关节数共为73个,其中Ⅰ型30个、Ⅱ型20个、Ⅲ型23个。Ⅱ型和Ⅲ型脱位髋关节中观察到盂唇内翻外翻、圆韧带粗大、髂腰肌挛缩、关节积液、脂肪增生等病理变化。MRI对病变盂唇显示的敏感度、特异度、阳性预测值、阴性预测值、符合率分别为70.9%、75.0%、88.0%、50.0%、72.1%(Kappa值为0.3986);对圆韧带显示的敏感度、特异度、阳性预测值、阴性预测值、符合率分别为60.0%、66.7%、71.4%、54.5%、62.7%(Kappa值为0.2586);对髂腰肌挛缩的显示敏感度、特异度、阳性预测值、阴性预测值、符合率分别为80.0%、91.3%、88.9%、84.0、86.0%(Kappa值为0.7177),对关节积液及脂肪增生显示的符合率为100%。结论:MRI能较准确地显示关节积液、关节内脂肪增生、盂唇病变、髂腰肌挛缩,能为外科手术提供有价值的信息。     

高频超声Graf法与Terjesen法对发育性髋关节发育不良诊断一致性研究

目的 探讨Graf超声检查法和Terjesen超声检查法在发育性髋关节发育不良(DDH)诊断中的诊断一致性.方法 回顾性分析2019年1月至6月,在我院超声科行DDH检查的婴幼儿共108例,其中男孩41例,女孩67例,共216个髋关节.每位进行DDH检查患儿均进行双侧髋关节扫查.参照Graf方法,测量α角度及β角度,再...     

兰州市0～6月龄婴儿髋关节发育不良筛查现状分析

目的 :了解本地区0~6月龄婴幼儿髋关节发病情况,明确早期超声筛查在发育性髋关节发育不良(DDH)诊断中的重要意义。方法:选取0~6月龄的婴儿共10 139例,行髋关节超声检查。采用Graf标准作为诊断分型标准。结果:10 139例中DDH 1 372例(1 576侧髋),男579例(42.2%),女793例(57.8%),其中Ⅱ型1 527侧髋(96.9%),Ⅲ型31侧髋(2.0%),Ⅳ型18侧髋(1.1%)。Logistic多因素回归分析显示,DDH患病率无明显性别差异(P0.05),羊水过少、剖宫产及臀位均为DDH的危险因素(均P0.05)。结论 :婴儿出生后42 d~3个月行髋关节超声检查,有利于DDH的早期诊断和治疗。     

三维CT在发育性髋关节脱位骨性病理形态评价中的应用

目的 评价螺旋CT三维重建(3D-CT)技术在研究发育性髋关节脱位(developmental dislocation of hip,DDH)的应用价值.方法 选择41例3岁以下单侧DDH患儿,所有患儿均行CT检查,获取3D-CT图像,并对双侧髋关节股骨头颈前倾角(femoral neck anteversion,FNA)、三维中心边缘角(three-dimensional center-edge angle,3D-CE)、髋臼前倾角(acetabular ateversion,AA)及股骨头骨骺核球形指数进行测量.结果 DDH患儿脱位侧的AA、FNA、3D-CE及股骨头骨骺核球形指数等参数均较正常侧存在显著性差异,而且脱位侧的FNA及AA在<18个月组与≥18个月组之间存在显著性差异.结论 3D-CT测量对显示DDH时髋关节的病理改变及程度具有重要价值.     

梨状肌综合征的超声表现分析

目的:探讨超声在梨状肌综合征(PS)诊断中的应用价值。方法:选取45例PS患者作为观察组,另取同期健康体检者44例作为对照组,均行超声检查,比较2组双侧坐骨神经及梨状肌厚度,并统计超声诊断结果 (准确率、敏感度、特异度、误诊及漏诊率)。结果:观察组双侧坐骨神经厚度及梨状肌厚度均高于对照组(均P0.05);超声对PS诊断准确率、敏感度、特异度、误诊率、漏诊率分别为89.89%(80/89)、88.89%(40/45)、90.91%(40/44)、9.09%(4/44)、11.11%(5/45)。结论:超声对PS具有较高的诊断准确率、敏感度及特异度,误诊、漏诊率低,可有效显示双侧坐骨神经及梨状肌厚度,值得临床推广应用。     

超声评价异常体征合并发育性髋关节发育不良高危因素婴儿的髋关节发育状况

目的 :应用Graf髋关节超声诊断技术评价有异常体征合并发育性髋关节发育不良(DDH)高危因素婴儿髋关节的发育状况。方法:对我院488例临床体检提示有臀纹或大腿纹不对称、下肢长度差异、髋外展受限等异常体征同时合并其他DDH高危因素(女性、胎位为臀位、家族史或伴有其他骨骼肌肉畸形等)的婴儿行髋关节超声检查。采用Graf法和Graf髋关节病理分型对筛查结果进行统计和分析。结果:976个受检髋关节中,Ⅰ型髋关节914个,占93.6%;Ⅱ型49个,占5.0%,其中ⅡA型25个,ⅡB型13个,ⅡC型11个;D型4个,占0.4%;Ⅲ型7个,占0.7%;Ⅳ型2个,占0.2%。其中不成熟髋和DDH髋62个,检出率6.4%。结论 :超声能对有异常体征合并DDH高危因素婴儿髋关节的发育状况进行准确的定性评价,并能比较不同高危因素婴儿之间DDH发病率的差异性。     

发育性髋关节发育不良：影像检查新观点

目前,发育性髋关节发育不良（DDH）的诊断主要依靠超声及X线平片。超声的敏感性虽高,但观察者依赖性强,容易造成过度诊断;X线平片仅能观察骨性髋关节的形态,不能显示软骨部分,然而髋臼软骨对髋关节的稳定具有重要作用。由于MRI软组织分辨力高,可清晰显示髋臼软骨并进行定量测量,还可显示影响髋关节复位的软组织成分,因此MRI在DDH的诊断和治疗的应用越来越广泛。综述影像检查在DDH诊断中的新观点和思路,特别是MRI在评估髋关节发育中的应用价值。     

优秀击剑运动员下肢三关节等速肌力测试分析

目的:研究我国优秀击剑运动员下肢髋、膝、踝三关节肌群等速肌力表现,找出薄弱肌群。方法:国家击剑队备战2008年奥运会重点队员26名,男女各13名,年龄23.1±2.36岁。在60°/s、240°/s速度下测定运动员双侧下肢髋、膝、踝屈伸肌群等速向心峰力矩。结果发现:(1)髋关节:在240°/s下双侧伸肌峰力矩均明显低于60°/s(P<0.05),60°/s和240°/s下双侧髋关节屈肌峰力矩无显著差异(P>0.05);男运动员两个速度下前腿伸肌峰力矩均显著高于后腿(P<0.05),女运动员无显著差异(P>0.05);两个速度下,运动员双腿屈伸肌峰力矩比值低于正常。(2)膝关节:60°/s时男运动员双腿屈伸肌峰力矩有显著差异(P<0.05),240°/s时双侧伸肌峰力矩有显著差异(P<0.05),女运动员两个速度下均无显著差异(P>0.05);60°/s时,女运动员前后腿屈伸肌峰力矩比值分别为0.56和0.54,男运动员分别为0.63和0.67;240/°s时男女前后腿屈伸肌峰力矩比值均在正常范围。(3)踝关节:60°/s时男运动员前腿踝关节屈伸肌峰力矩显著大于后腿(P<0.05),240°/s时无显著差异(P>0.05);两个速度下,女运动员踝关节屈伸肌峰力矩均无显著性差异(P>0.05);运动员踝关节屈伸峰力矩比值在两个速度下均低于正常。结论:优秀男子击剑运动员下肢关节等速肌力双侧不对称,女运动员不对称表现不明显;击剑运动员下肢薄弱肌群为后腿髋关节伸肌群、股后肌群、前腿股后肌群及踝关节背伸肌群。     

婴儿发育性髋关节发育不良早期筛查的情况分析

目的分析临床结合超声检查对婴儿发育性髋关节发育不良(developmental dysplasia of the hip,DDH)进行早期筛查的结果,为DDH早期干预提供科学依据,降低DDH的致残率。方法对我院筛选DDH体征阳性4896例患儿行超声进一步检查。结果体格检查可疑阳性婴儿4896例,经过超声检查,正常髋关节3591例,占73.3%(3591/4896),可疑异常髋关节1196例,占24.5%(1196/4896),异常髋关节109例,占2.2%(109/4896),其中脱位型髋关节7例,占0.14%(7/4896)。对确诊患儿进行临床治疗,106例异常髋关节转为Graf I型髋关节,治愈率达97.2%(106/109)。结论对婴儿髋关节进行早期筛查对提高婴儿DDH检出率有重要意义,对确诊患儿给予早期干预可促使发育异常的髋关节结构向正常的髋关节转化,改善婴儿髋关节功能,具有重要的经济意义与社会意义。     

5227例婴儿发育性髋关节发育异常筛查结果的回顾性分析

目的 :评估产次、胎位、分娩方式对婴儿发育性髋关节发育异常(DDH)发病的影响。方法 :回顾性分析于我院行DDH超声筛查婴儿5 227例(10 454个髋关节),记录其性别、年龄、胎次、胎位、分娩方式,依据Graf分类法将超声筛查结果分为正常和异常髋关节(发育不良、半脱位、脱位),并行统计分析。结果:5 227例,共10 454个髋关节,其中第1胎DDH的检出率为4.47%(284/6 350)高于第2胎(3.05%,125/4 104)(χ~2=15.08,P0.01);臀位DDH检出率9.05%(42/464)较头位(3.67%,366/9 968)明显高(χ~2=34.15,P0.01);剖宫产DDH检出率5.33%(196/3 678)高于自然分娩(3.14%,213/6 776)(χ~2=27.51,P0.01)。结论 :产次、胎位、分娩方式均是影响DDH的因素,而臀位的影响更显著,可提示DDH的超声筛查。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.