腰椎横突骨折及其并发伤的CT分析

目的:探讨腰椎横突骨折及其并发伤的CT表现特征和意义。方法:结合X线平片,对83例腰椎横突骨折及其并发伤的CT表现特征进行回顾性分析。结果:83例共计163个横突骨折中,常规X线平片漏诊112个(68.7%)。CT表现可分3种类型:横形骨折(Ⅰ型)33例65个,斜形骨折(Ⅱ型)31例60个,撕脱性骨折(Ⅲ型)19例38个;并发胸腹部脏器伤61例(73.5%);L1、L2高位横突骨折与胸部胸膜肺并发伤具有明显相关性(P<0.0001),多发性腰椎横突骨折组的脏器并发伤发生率明显高于单发性骨折组(P<0.0001)。结论:在腰椎横突骨折的显示上,CT优于常规X线平片,其胸腹脏器并发伤的发生率与腰椎横突骨折类型无关,而与骨折所在腰段的部位和多发性有关。腰椎横突骨折可作为胸腹脏器并发伤的重要提示性征象。     

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。     

一例飞行员弹射脊柱伤的调查分析

目的 调查1例飞行员弹射脊柱损伤的原因及影响因素,探讨损伤机制,以预防和减少此类损伤的发生.方法勘查飞行事故现场,调查事故发生经过,询访当事人和有关人员,查阅病案及有关资料,分析研究病因,提出预防方案.结果某部歼击机飞行员因飞机故障弹射跳伞后腰部疼痛入院.主要诊断为第1腰椎压缩性骨折、第1腰椎双侧横突和第2腰椎左侧横突骨折.结论 飞行员弹射脊柱损伤与弹射姿势有关,熟练地掌握弹射动作和保持正确弹射姿势可以有效地提高弹射成功率.     

螺旋CT诊断钝性肠管和肠系膜损伤的临床价值

目的 探讨螺旋CT对急性钝性大小肠和肠系膜损伤的诊断价值.方法 2004-02-2008-05, 急性腹部钝性损伤螺旋CT扫描300例.CT诊断大小肠或/和肠系膜损伤18例,其中16例剖腹手术.2例临床随访.CT表现与手术探查对照分析.结果 肠管和系膜损伤的CT各种表现的诊断准确率分别为:肠壁增厚63%,肠壁破裂100%,肠系膜血肿71%,肠系膜血管中断100%,系膜束带征56%及气腹或肠壁或系膜间积气50%.结论 综合分析肠和肠系膜损伤的直接和间接CT征象,可以较准确地评估肠和肠系膜损伤的程度及损伤部位.     

钝性损伤致下胸部肋骨骨折合并腹腔脏器损伤的危险因素分析

目的分析钝性损伤致下胸部肋骨骨折合并腹腔脏器损伤的危险因素和早期预测因子。方法回顾性分析2015年1月—2017年12月厦门大学附属东南医院收治的183例钝性损伤致下胸部肋骨(8~12肋)骨折患者,其中经CT影像学或剖腹探查诊断合并腹腔脏器损伤34例(腹腔脏器损伤组),无腹腔脏器损伤149例(无腹腔脏器损伤组),收集患者人口学特征(性别、年龄)、致伤原因(交通事故、高处坠落、意外跌倒、暴力击打)、肋骨骨折部位(单侧、双侧)和数目、入院时生命体征(收缩压、心率)、腹部体征、实验室指标(红细胞压积),通过单因素和多因素Logiistic回归分析合并腹腔脏器损伤的相关因素。结果本组183例钝性损伤致下胸部肋骨骨折患者中左侧肋骨骨折91例,右侧肋骨骨折79例,双侧肋骨骨折13例。本组合并腹腔脏器损伤比例为18.6%(34/183),共计发生57处脏器损伤,其中脾脏损伤27例、肝脏损伤18例、肾脏损伤6例、肾上腺损伤3例、胰腺损伤2例、十二指肠损伤1例。单因素分析发现,性别和肋骨骨折数目与合并腹腔脏器损伤无关联,而年龄(χ~2=6.349,P=0.012)、是否机动车事故(χ~2=7.133,P=0.008)、肋骨骨折部位(χ~2=11.506,P=0.001)、入院时收缩压(χ~2=18.531,P0.001)、心率(χ~2=5.932,P=0.015)、腹部体征(χ~2=6.416,P=0.011)和红细胞压积(χ~2=6.685,P=0.010)与合并腹腔脏器损伤存在关联。多因素Logistic回归分析发现,机动车事故(OR=5.64,95%CI:2.57~11.61,P=0.008)、双侧肋骨骨折(OR=4.25,95%CI:1.63~12.87,P=0.025)、入院时红细胞压积40%(OR=2.16,95%CI:1.98~5.29,P=0.017)是同时合并腹腔脏器损伤的独立危险因素。结论对于钝性损伤致下胸部肋骨骨折,尤其是机动车事故、双侧肋骨骨折、存在明显失血指征者,要高度警惕合并腹腔脏器损伤的可能。     

胸腰椎压缩骨折中后方韧带复合体损伤与CT骨性影像学参数及生物力学的相关性分析

目的 :探讨CT骨性影像学参数[椎体楔变角(SIEA)、局部后凸角(LK)、棘突间距增加值(IISD)]在后方韧带复合体(PLC)损伤诊断中的可靠性,并从生物力学角度探讨压缩骨折后PLC的损伤机制。方法:选择胸腰椎(T11～L2)骨折外伤患者68例,测量CT骨性参数,并按MRI对PLC损伤状态的判断,分为损伤组36例和无损伤组32例,先将各项骨性参数行t检验,有意义的参数纳入二元Logistic回归分析,并根据ROC曲线分析参数预测PLC损伤的诊断效能。35例行生物力学分析,并对不同程度骨折患者给予垂直及前屈工况,判断不同工况与棘突间位移值改变的相关性。结果:2组CT骨性参数差异均有统计学意义(均P0.05)。Logistic回归分析,表明SIEA与PLC损伤无相关性(P 0.05),LK、IISD与PLC损伤均有相关性(均P0.05)。LK的ROC曲线下面积为0.760,IISD为0.834。生物力学t检验结果示:不同工况在Ⅰ度、Ⅱ度骨折患者的棘突间位移值改变中差异有统计学意义,且垂直力显著性大(P0.05)。结论:在骨性参数中,LK及IISD是诊断PLC最有效的预测参数。垂直力对胸腰椎压缩骨折患者的棘突间位移值改变起主要作用。     

腰椎椎体CT值与骨密度值的相关性研究

骨质疏松症(osteoporosis,OP)是一种以骨量低下,骨微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病[1].由于骨质疏松所引起的骨折给患者带来极大的痛苦,也给社会造成了很大的负担.因此,如何早期预测骨质疏松、预防骨折、提高人们的生活质量,已成为目前亟待解决的重大课题.双能X线骨密度仪(DXA)是一种二维的测量方法,腰椎测量值受到骨质增生和附件的影响而不够精确;定量CT (QCT)需要专门的软件而无法普及;上述2种方法使得骨质疏松的检出率难以提高.MSCT是临床最常用的一种检查方法,影像科医师可方便快捷地测量每1例接受腰椎或腹部CT检查的患者腰椎椎体CT值.本文通过对腰椎椎体CT值与骨密度值进行相关性分析,从而评估椎体CT值对骨质疏松的诊断价值.     

腹部内脏动脉瘤双源CT血管造影表现

目的探讨腹部内脏动脉瘤双源CT血管造影(CTA)的表现。方法回顾性分析30例腹部内脏动脉瘤患者CT原始及后处理图像,主要应用容积显示(VR)、最大密度投影(MIP)、曲面重组(CPR)、多平面重组(MPR)等后处理技术,进行图像重建观察动脉瘤情况,并结合横断面图像对疾病进行诊断。结果 30例腹部内脏动脉血管造影成功,图像清晰。CTA能清晰显示腹部内脏动脉瘤,包括3例结节性多动脉炎患者,均可见多发内脏动脉瘤,此外单发动脉瘤中包括:脾动脉瘤12例、肝动脉瘤3例、肾动脉瘤8例(1例患者双肾均可见一单发动脉瘤)、腹腔干动脉瘤1例、腹腔干假性动脉瘤1例、肠系膜上动脉瘤3例。结论双源CT及其后处理技术对腹部内脏动脉瘤及相关疾病有很好的诊断价值,为临床治疗提供了依据。     

脾创伤:CT随访的价值

在腹部钝性创伤中,脾是最常见的损伤器官,诊断脾损伤CT是可靠的。作者对临床情况稳定的钝性脾创伤患者,经预期治疗后行CT随访的价值予以评估。作者回顾本院1988年1月～1993年4月间出院诊断为脾创伤的所有患者的医疗记录。其中的42例CT诊断为脾损伤并得到保守治疗及随访,将这42例患者分成3组。Ⅰ组(n=14)包括只预约了初期CT检查的稳定患者;Ⅱ组(n=22)包括为随访脾创     

钝性腹部空腔脏器及肠系膜损伤的 CT 诊断

目的：通过对照分析腹部钝性空腔脏器及肠系膜损伤患者术中发现及术前CT征象,寻找判断空腔脏器及肠系膜损伤的特征性CT表现,以助于提高诊断率。方法回顾性分析2011～2013年我院100例钝性腹部创伤患者,其中男性82例,女性18例;年龄11个月～77岁,平均37岁。将其分为A、B两组,A组为经手术证实的有钝性肠道及肠系膜损伤患者（50例）,B组为经手术证实的只有钝性实质性脏器损伤而没有空腔脏器及肠系膜损伤患者（50例）,分析两组中与空腔脏器及肠系膜损伤相关的CT征象,采用单因素分析方法,进一步得出有助于判断是否有空腔脏器及肠系膜损伤的CT征象。结果通过分析发现具有统计学意义的征象有：腹腔或腹膜后积气（P＜0.01,敏感度50％,特异度98％）,肠管壁增厚（P＜0.01,敏感度40％,特异度98％）,系膜增厚（P＜0.01,敏感度42％,特异度88％）,系膜密度增高（P＜0.05,敏感度16％,特异度98％）,腹腔脂肪间隙密度增高模糊（P＜0.05,敏感度18％,特异度96％）,腹膜增厚（P＜0.05,敏感度26％,特异度90％）。结论通过分析发现腹腔或腹膜后积气、肠管壁增厚、系膜增厚、系膜密度增高、腹腔脂肪间隙密度增高模糊等征象有助于判断空腔脏器及肠系膜损伤。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）