成人颈椎枕环枢段X线观察

正确认识颈椎枕环枢段的X线解剖特征,对鉴别正常或病理改变十分重要。本文目的是通过70例成人颈椎正侧位照片的观察,提高对颈推枕环枢段X线解剖特征的认识能力。本文资料全部为成人。年龄19～55岁,临床上无任何枕环枢段疾病及其它症状。     

寰枢椎病变的治疗方法选择

目的探讨寰枢椎病变合理有效的内固定方法，最大限度地保护枕颈区域残存的运动功能。方法采用椎弓根螺钉技术对39例寰枢区病变患者，根据发病特点，病理解剖和CT三维重建分析：分别采用A：寰枢椎固定、B：寰枢椎固定＋寰枢椎融合、C：枕枢固定、D：枕枢固定＋枕枢融合、E：寰枢椎固定＋枕枢融合、F：枕枢固定＋寰枢融合、G：上颈椎前路手术＋后路枕枢（寰枢）固定融合术等七种方法治疗。随访手术疗效。结果本组患者采用A法15例，B法5例，C法4例。D法11例，E法2例，F法0例，G法2例。39例患者均完成手术，术中保留枕环关节21例，椎动脉破裂2例，环椎后弓断裂2例。术后X线片示寰枢椎完全复位36例，不完全复位2例，过度复位1例。术后3个月-2．6年，平均1．1年复查，枕颈部后方疼痛3例，活动受限21例，植骨融合失败1例。结论合理有限的内固定技术可使部分寰枢椎病变患者残存的上颈椎运动功能得到保护，尤其是枕环关节。部分患者取出内固定后可恢复枕环和寰枢椎的运动功能。     

1例枕颈CD内固定经口环枢椎减压的护理

枕颈CD内固定植骨融合,经口腔环枢椎减压术是目前国内治疗环枢椎脱位的一种先进的手术方法,这种新的手术方法给骨科护士提出了更高的专业素质要求.我科对1例枕颈CD内固定经口环枢椎减压病人进行精心护理,恢复快,无任何并发症,现将护理体会介绍如下.     

微粒植骨法结合头环背心治疗环枢椎不稳定围手术期护理体会

自2000年起,我院采用微粒植骨法结合头环背心治疗环枢椎不稳定8例,经精心护理,效果满意。现报告如下。1资料与方法1.1临床资料本组8例,男6例,女2例,24～53岁,平均36.8岁。导致环枢椎不稳定的原因分别为:先天性环枕融合合并环枢椎脱位1例,环椎横韧带断裂1例,枢椎齿状突骨折6例。除先天性环枕融合病1例外,其余7例均为外伤所致,车祸伤3例,矸石砸伤2例,高处坠落伤1例,他人拧伤颈部1例。除1例先天性环枕融合患者外,其余患者受伤距就诊时间为20d～3个月,平均38d。1.2方法本组均采用后入路术式。术前将环枢椎复位后安装头环背心,并使其牢固固定环枢…     

枕寰枢复合体后方静脉结构三维CT解剖

背景:颅、颈交界区解剖结构复杂,术前观察枕寰枢复合体后方静脉丛是非常必要的。利用三维CT血管成像技术显示这些结构具有明显的优势。目的:观察枕寰枢复合体后方静脉丛结构的解剖特点。方法:随机筛选60例患者头颈部CTA枕寰枢复合体无明确异常资料,回顾性分析其三维CT成像,测量枕寰枢复合体后方静脉结构,描述枕寰枢复合体的空间关系。结果与结论:统计学处理结果显示除寰枢关节后硬膜外静脉丛至中线距离左、右侧有显著性差异(P<0.05)外,枕下海绵窦体积、寰枢外侧关节后硬膜外静脉丛体积、枕下海绵窦与中线距离、颈深静脉C1段水平直径及至中线距离、C1后弓距离的测量值左、右侧,男、女性之间差异均无显著性意义(P>0.05)。提示枕寰枢复合体后方静脉、静脉丛血管丰富、其形态或结构变异复杂,存在不确定的变异。     

枕大孔区畸形的MRI、CT及X线诊断评价

枕大孔区畸形是指发生于枕骨大孔及上颈椎畸形 ,伴或不伴神经系统的损害 ,或为该部位单独发生的神经系统畸形 ,它包括扁平颅底、颅底凹陷、环枕融合、颈椎融合、环枢椎脱位和小脑扁桃体下疝畸形 〔１〕 。本组疾病的诊断很大程度上需依靠影像学检查。以往主要是在Ｘ线上通过测量基底角、钱伯伦氏线、环齿关节间隙及直接观察椎体的形态等来诊断。ＣＴ在枕大孔区畸形的诊断上因其缺乏多方位扫描能力而帮助不大。ＭＲＩ能任意方位断层成像 ,同时又能直接显示神经组织受累情况 ,不但诊断准确 ,而且能给外科治疗方案的选择提供十分有用的信息。本…     

微粒植骨法结合头环背心治疗环枢椎不稳定围手术期护理体会

自2000年起,我院采用微粒植骨法结合头环背心治疗环枢椎不稳定8例,经精心护理,效果满意.现报告如下. 1资料与方法 1.1临床资料本组8例,男6例,女2例,24～53岁,平均36.8岁.导致环枢椎不稳定的原因分别为:先天性环枕融合合并环枢椎脱位1例,环椎横韧带断裂1例,枢椎齿状突骨折6例.除先天性环枕融合病1例外,其余7例均为外伤所致,车祸伤3例,矸石砸伤2例,高处坠落伤1例,他人拧伤颈部1例.除1例先天性环枕融合患者外,其余患者受伤距就诊时间为20d～3个月,平均38d.     

单纯性环枢关节半脱位的影像学诊断

目的:探讨单纯性环枢关节半脱位的发病机制及影像诊断。材料与方法:对15例单纯性环枢关节半脱位病例的临床及X线及CT表现作回顾性分析。结果:侧位X线片上齿前间距(AADI)增宽(成人>3mm,儿童>4mm)或咽后壁肿胀。结论:单纯性环枢关节前脱位最常见。伴有或不伴有损伤到齿突横韧带的单独撕裂都可引起环枢关节的破裂。侧位环齿前间距(AADI)测量是诊断孤立性环枢关节前-后脱位最有效和最简便的方法。在自动复位病例中,咽后壁肿胀可是唯一的X线征象。     

多层螺旋CT在寰枢关节脱位中的应用探讨(附19例检查病例分析)

目的 :探讨多层螺旋CT三维后重建技术在寰枢关节脱位中的应用价值。材料和方法 :对 19例寰枢关节脱位的患者进行标准体位的多层螺旋CT检查 ,在MPVR二维图像中测量齿状突与寰椎侧块距离差 (DO)、寰齿前间隙 (AO)、寰枕线与齿状突轴线的夹角 (α) ;在SSD模式 3D图像中 ,作枕骨大孔正后缘与硬腭正中的连线和寰枢椎双侧横突孔中心的连线 ,测量两者的夹角 ( β)。结果 :齿状突与寰椎侧块关系失常者 15例 ,AO间距增宽者 11例 ,α值小于正常值者 7例 ,β值失常者 7例。结论 :多层螺旋CT图像后处理技术能够直观、立体、多角度显示枕寰枢椎三者之间的关系 ;多数据测量更准确评估寰枢关节脱位的类型、受伤部位及程度 ,对临床的诊断与治疗具有重要意义     

1例枕颈CD内固定经口环枢椎减压的护理

枕颈ＣＤ内固定植骨融合 ,经口腔环枢椎减压术是目前国内治疗环枢椎脱位的一种先进的手术方法 ,这种新的手术方法给骨科护士提出了更高的专业素质要求。我科对 1例枕颈ＣＤ内固定经口环枢椎减压病人进行精心护理 ,恢复快 ,无任何并发症 ,现将护理体会介绍如下。1　病例介绍患者男性 ,43岁 ,因右侧肢体活动不便 3年入院。查体 ;头颈部伸屈活动受限 ,右侧肢体肌张力高 ,肌力 5级 ,右肱三头肌 ,肱二头肌肌腱反射、桡骨膜反射亢进 ,右膝腱反射亢进 ,霍夫曼试验 (+) ,踝阵挛 (+) ,ＭＲＩ示环椎前弓后缘齿状突前缘距离约为 5ｍｍ ,该部颈髓明显受…     

基于深度学习测量X线片髋关节外侧中心边缘角和Sharp角评估髋关节发育不良

目的 探讨基于深度学习测量X线片髋关节外侧中心边缘(LCE)角和Sharp角评估髋关节发育不良的价值。方法 回顾性收集384例成人双髋关节正位数字化X线片。由2名影像科医师标注髋臼关键点和股骨轮廓用于模型训练,经十折交叉验证得到预测结果;以设定程序自动测量双侧髋关节LCE角和Sharp角,由上述医师于X线片中手动测量LCE角和Sharp角并诊断髋关节发育不良及交界性发育不良。对比手动测量与自动测量LCE角、Sharp角结果的差异;观察手动测量与自动测量的相关性;以组内相关系数(ICC)评估测量结果的一致性;采用受试者工作特征(ROC)曲线评估自动测量LCE角、Sharp角诊断髋关节发育不良的效能。结果 共测量768侧髋。手动测量与自动测量左侧LCE角、右侧LCE角、右侧Sharp角结果差异无统计学意义(P均>0.05),手动测量左侧Sharp角小于自动测量结果(P<0.05)。对左、右侧LCE角及左、右侧Sharp角,手动测量与自动测量结果的ICC分别为0.944、0.904、0.890及0.887,r值分别为0.948、0.924、0.910及0.887(P均<0....     

拇外翻术后拇外翻角和第1-2跖骨间角X射线测量方法评价

背景：拇外翻术后拇外翻角和第1-2跖骨间角的测量关键在于第1跖骨轴线的确定。第1跖骨轴线的不同确定方法,造成了这两个角度测量值的差异,使不同临床研究之间的数据不具有可比性。对于拇外翻术后角度测量,国内外尚未形成公认的标准方法。目的：回顾不同拇外翻术后拇外翻角和第1-2跖骨间角的测量方法的研究进展,为拇外翻的术后测量与评价研究提供参考。方法：由第一作者在2012年2月检索PubMed、中国期刊全文数据库以及万方数据库。其中,英文检索词为：＂hallux valgus＂、＂angles＂、＂radiographic measurements＂。中文检索词为＂拇外翻＂、＂角度＂、＂X射线测量＂。选取29篇文献进行归纳总结。结果与结论：最好的测量方法其标记点必须是易于确定,可重复性好,应尽量避免受到截骨部位及跖骨本身解剖变异的影响。拇外翻术后X射线测量方法目前多用头部中心/基底部中心测量方法。专业化的工具软件测量取代手工测量是未来拇外翻术后X射线测量的发展趋势。     

Assessing a Novel Method of Calculation of the Cobb Angle for Scoliosis: Interexaminer Reliability and Student Satisfaction

ObjectiveThe objectives of this pilot study were to compare the interexaminer reliability of 2 different methods of Cobb angle measurement and to determine whether the participants considered 1 of the 2 methods easier to learn, understand, and apply.MethodsEntry-level anatomy students who have familiarity with vertebral column anatomy but have not had previous radiology training were instructed on how to measure a Cobb angle. Each student measured 2 curves (thoracic and lumbar) on a single radiograph, first with the traditional method of Cobb angle measurement and second with a novel method of Cobb angle measurement using a digital level.ResultsThe variance of measurements decreased by using the novel method from thoracic to lumbar measurements and for the moderate and severe scoliosis films. All decreases in variance were statistically significant except for the lumbar measurement variance for the severe scoliosis film. The novel method of Cobb angle measurement with these same participants showed interexaminer reliability. More than 78% of naive participants considered the proposed method easier to learn, understand, and apply when compared with the traditional method.ConclusionIn this group of naive students, there was improved interrater reliability, greater satisfaction, and reduced measurement variances in some cases, with a novel method using a digital level to measure the Cobb angle compared with the traditional method of measurement.     

3-D measurement of body tissues based on ultrasound images with 3-D spatial information

In this study, we developed a new method to perform 3-D measurements between the recorded B-scans using the corresponding spatial location and orientation of each B-scan, without the need to create a 3-D volume. A portable ultrasound (US) scanner and an electromagnetic spatial locator attached to the US probe were used. During data collection, the US probe was moved over the region-of-interest. A small number of B-scans containing interesting anatomical information were captured from different body parts and displayed in a 3-D space with their corresponding locations recorded by the spatial locator. In the B-scan planes, the distance between any two points, as well as the angle between any two lines, could be calculated. In validation experiments, three distances and three angles of a custom-designed phantom were measured using this method. In comparison with the results measured by a micrometer, the mean error of distance measurement was −0.8 ± 1.7 mm (−2.3 ± 3.6%) and that of angle measurement was −0.3 ± 2.9° (−0.1 ± 4.1%). The lengths of the first metatarsals and the angles between the first metatarsals and the middle part of the tibias of three subjects were measured in vivo using magnetic resonance imaging (MRI) and the US method by two operators before and after MRI scanning. The overall percentage differences of the length and angle measurements were 0.8 ± 2.2% and 2.5 ± 3.6%, respectively. The results showed that this US method had good repeatability and reproducibility (interclass correlation coefficient values > 0.75). We expect that this new method could potentially provide a quick and effective approach for the 3-D measurement of soft tissues and bones in the musculoskeletal system.     

Reliability and criterion validity of measurements using a smart phone-based measurement tool for the transverse rotation angle of the pelvis during single-leg lifting

Objective: The purposes of this study were to determine the intra-rater test–retest reliability of a smart phone-based measurement tool (SBMT) and a three-dimensional (3D) motion analysis system for measuring the transverse rotation angle of the pelvis during single-leg lifting (SLL) and the criterion validity of the transverse rotation angle of the pelvis measurement using SBMT compared with a 3D motion analysis system (3DMAS). Method: Seventeen healthy volunteers performed SLL with their dominant leg without bending the knee until they reached a target placed 20 cm above the table. This study used a 3DMAS, considered the gold standard, to measure the transverse rotation angle of the pelvis to assess the criterion validity of the SBMT measurement. Intra-rater test–retest reliability was determined using the SBMT and 3DMAS using intra-class correlation coefficient (ICC) [3,1] values. The criterion validity of the SBMT was assessed with ICC [3,1] values. Result: Both the 3DMAS (ICC = 0.77) and SBMT (ICC = 0.83) showed excellent intra-rater test–retest reliability in the measurement of the transverse rotation angle of the pelvis during SLL in a supine position. Moreover, the SBMT showed an excellent correlation with the 3DMAS (ICC = 0.99). Conclusion: Measurement of the transverse rotation angle of the pelvis using the SBMT showed excellent reliability and criterion validity compared with the 3DMAS.     

Prenatal diagnosis of horseshoe kidney by measurement of the renal pelvic angle.

OBJECTIVE: The aim of this study was to evaluate the usefulness of measurement of the angle between bilateral renal pelves on axial views in the prenatal ultrasonographic diagnosis of horseshoe kidney. METHODS: We retrospectively measured the renal pelvic angle in 19 fetuses with horseshoe and 20 fetuses with normal kidneys in the second and third trimesters. Renal pelvic angle was defined as the angle between the long axis of the renal pelves on the axial view of the abdomen. We compared the renal pelvic angles of horseshoe and normal kidneys with unpaired t-test. Taking 140 degrees as a cut-off value, we calculated the sensitivity, specificity and accuracy of pelvic angle measurement for the prenatal diagnosis of horseshoe kidney. RESULTS: The mean pelvic angles in the fetuses with horseshoe kidney were 116 degrees and 110 degrees in the second and third trimester, respectively. In the normal fetuses, the equivalent angles were 172 degrees and 161 degrees. The difference between the two groups was statistically significant (P < 0.01). Using 140 degrees as the discriminating criterion, the sensitivity, specificity and accuracy of renal pelvic angle measurement for the prenatal diagnosis of horseshoe kidney were all 100%. Fifteen of 19 fetuses with horseshoe kidney had no other abnormality. Four (21%) fetuses had severe complex abnormalities which were associated with trisomy 18 in three cases. CONCLUSION: Observation and measurement of the renal pelvic angle is a simple and useful method in the prenatal diagnosis of the horseshoe kidney.     

基于深度学习的人工智能测量婴儿非偏心型髋关节的研究

目的 评估人工智能模型自动测量婴儿髋关节发育指标的临床应用价值.方法 选取2019年1月至11月于广东省妇幼保健院超声科进行髋关节超声检查的婴儿231例(共462张标准髋关节图片),使用组内相关系数(ICC)、Deming回归对高年资医师与人工智能测量髋关节数据进行一致性分析,使用ICC对高年资医师、低年资医师、人工智...     

Effect of Skin Resection on the Improvement of Joint Contractures in Rats

The effect of skin resection on joint contracture was determined by comparing the first measurement of range of motion after cast removal and the second measurement after the skin resection. This study aimed to verify that both the joint movement during the measurement and skin affect range of motion. [Subjects] Twelve female Wistar rats were used. [Methods] The right hind limb ankle of each rat was immobilized in complete plantar flexion in a cast. In the resection group (n = 6), the skin of the right hind limb ankle was removed surgically, but not in the non-resection group (n = 6). In the resection group, the first measurement of the dorsiflexion angle was obtained after the cast was removed, and the second measurement was obtained after skin resection. In the non-resection group, both measurements of the dorsiflexion angle were obtained soon after the cast was removed. [Results] Compared with the non-resection group, the resection group showed a significant increase between the first and second measurements of range of motion. [Conclusion] These results show that range of motion is substantially affected by skin, in addition to joint movement, during measurement.Key words: Joint contracture, Skin, Rat     

基于深度学习构建模型识别下肢全长正位X线片中的下肢力线关键点及自动测量关键角度

目的 基于深度学习（DL）方法构建自动测量下肢全长正位X线片关键角度模型,评估其临床应用价值。方法 回顾性选取634幅下肢全长正位X线片,由5名骨科医师分别标注下肢力线关键点,包括髋关节中心、股骨髁间窝顶点、胫骨髁间嵴中点、股骨内侧和外侧髁最低点、胫骨内侧和外侧平台最低点、距骨宽度中点,并建立数据集。采用高分辨率网络（HRNet）进行迁移学习,构建自动检测关键点模型,以5折交叉验证筛选最优模型,确定关键点坐标后,通过余弦定律计算关键角度机械股骨远端外侧角（mLDFA）、胫骨近端内侧角（MPTA）、股骨胫骨关节线夹角（JLCA）及髋-膝-踝角（HKA）,实现自动测量关键角度,并以关键点自动检测模型和通过余弦定律计算所得关键角度共同构建自动测量关键角度模型。随机选取50幅图像,由另3名骨科医师手动测量上述关键角度,评估自动测量关键角度模型与医师测量结果的一致性。结果 3名骨科医师所测mLDFA、MPTA、JLCA及HKA的均值分别为（88.50±2.59）°、（86.41±2.25）°、（2.90±2.27）°及（174.62±3.97）°;自动测量关键角度模型所获结果分别为（88.48±2.60）°、（86.52±2.57）°、（3.11±2.41）°及（174.53±3.99）°,与医师测量结果的一致性较好（ICC=0.897、0.888、0.826、0.996）。结论 所构建的自动测量下肢全长正位X线片关键角度模型有助于识别骨科关键点和测量关键角度。     

抬高机械通气患者床头医嘱执行情况的调查

目的调查抬高机械通气患者床头医嘱的执行情况,了解护理人员落实患者床头抬高30°～45°的准确性。方法由专门培训的护士在观察日的9:00、15:00、21:00、3:00四个时点,使用自制量角器,对29例机械通气患者共测量1894例次床头抬高的角度,并按0°、1°～19°、20°～29°、30°～45°进行分类统计,同时将护士自查估计角度与研究人员所测结果进行比较。结果在总计1894例次的测量中,床头抬高大于0°的共662例次,占测量总次数的34.95%;日间(9:00,15:00)床头抬高402次,夜间(21:00,3:00)床头抬高260次,两时段相比差异有统计学意义。床头准确抬高30°～45°的共311例次,占测量总次数的16.42%,但护士自查评估认为床头准确抬高30°～45°的有581例次,两者比较差异有统计学意义(P0.01)。结论机械通气患者的床头抬高现状未能达到美国疾病预防与控制中心预防指南的推荐要求,护士对抬高床头30°～45°的重要性认识不足及对实际抬高角度判断有偏差是其主要原因。