跟骨侧位X线片在跟骨骨折临床中的应用及临床体会

目的：研究跟骨侧位X线片上跟骨交叉角（Gissane’s角）、跟距角（B?觟ehler’s角）和跟骰角（跟骰关节与跟骨下缘的夹角）在正常跟骨和跟骨骨折时数值改变,从而在跟骨侧位X线片上更多的了解跟骨骨折。方法：测量53例正常跟骨侧位X线片,其中右足25例,左足28例,男25例,女28例。分别得Gissane’s角、B?觟ehler’s角和跟骰角的数值。再测量16例跟骨骨折的跟骨侧位X线片,其中男16例,右足11例,左足5例。分别得Gissane’s角、B?觟ehler’s角和跟角的数值,最后进行统计学分析。结果：正常组,Gissane’s角、B?觟ehler’s角和跟骰角男女、左右（均P＞0.05）无明显差异,正常跟骨与骨折病例相比,跟骰角（P＞0.05）无明显差异。Gissane’s角和B?觟ehler’s角存在统计学差异（P＜0.05）。结论：正常情况下,Gissane’s角、B?觟ehler’s角和跟骰角无性别和左右侧差异。骨折情况下与正常情况下,跟骰角无统计学差异,Gissane’s角和B?觟ehler’s角有显著差异。跟骨关节内骨折时,Gissane’s和B?觟ehler’s两角的存在有利于跟骨的修复。虽然跟骰角无统计学意义,但它是足弓的一部分,说明跟骨骨折对足弓的影响是有限的。     

螺旋CT在跟骨骨折中的应用

近年来随着螺旋CT及影像后处理在工作中的广泛应用,对跟骨骨折的评价及对临床治疗的指导作用,显示了独特的优势,探讨如下。1　对象和方法1.1　对象　本组男10例,女6例,年龄17～6 3岁,共16例跟骨骨折。1.2　方法　CT检查前均行X线片检查。使用PHIL IPS SE-CURA螺旋CT机及固有工作站。患者坐于检查床上,足先进,小腿与床面呈15°倾斜。通过侧位定位像行跟骨轴位扫描。扫描条件:12 0 kv、14 0 m A、时间1s、层厚2 mm、螺距1、重建层厚1mm。以多平面重建(MPR)、表面覆盖法(SSD)重建获取图像,精确调节阈值,并应用SSD切割技术,去除距骨…     

跟骨骨炎临床X线分析

跟骨骨炎究竟系类风湿性病变,还是由强直性脊柱炎引起,既往文献大多支持前一说法。随着人们对二病的认识和区分,其归属问题也需商榷。笔者收集三家医院24例,从其临床和X线改变入手,分析如下: 临床资料 本组24例男19例,女5例,年龄10～37岁。病史9个月～5年。均因足跟肿痛就诊。双     

多层螺旋CT在跟骨骨折病变中的应用40例分析

目的讨论多层螺旋CT在跟骨骨折病变中的临床应用价值。方法收集40例跟骨骨折患者,应用东芝Asteion4多层螺旋CT扫描仪行薄层扫描并行三维和多平面重建进行观察。结果螺旋CT的三维和多平面重建可以更全面、立体地观察骨折全貌及伴随病变的特征,弥补了X线平片和轴位CT扫描的不足,给临床治疗方案的制定提供了可靠的依据。结论多层螺旋CT重建技术在跟骨骨折的诊断和手术方案制定中有很高的临床应用价值,可以提高跟骨骨折病变诊断的准确率和手术方案的设计提供准确的空间立体定位依据。     

骨斑点症X线表现2例报道

病例 例1,男,49岁,既往健康,因肩部外伤后疼痛而就诊,摄右肩正位片,显示右肱骨近端髓腔内多发斑点状及索条状高密度影,边界清楚、锐利,周围骨皮质无破坏.后经患者同意,拍摄双侧髋关节、双侧肩关节、双侧腕关节,均显示同样的X线表现.     

跟骨距骨桥X线特征及24例临床分析

目的：探讨跟距骨桥形成机制、解剖特点和临床表现。材料和方法：观察28足跟距骨桥正侧位X线片、4例CT横断扫描、10例行足部斜位X线点片。其中男10例，女14例，单侧20例，双侧4例。结果：不完全性跟距骨桥共18足，X线片上可见跟、距关节内侧的骨性突起，跟距两骨间有一间隙，跟、距骨的异常骨块表面光滑，距骨内结节增大，呈帽状扣在异常增大的载距突上面。CT见跟、距关节间隙变窄，边缘变尖、硬化、翘起，尤以跟、距后关节为著。完全性跟距骨桥10足，在X片及CT上可见跟、距关节间隙消失，骨桥影呈骨性连换，CT见跟、距两骨间有骨小梁沟通。结论：认识跟距骨桥的X线征象，有助于临床对疾病的诊断、治疗，避免误诊、漏诊。     

先天性早发型骨梅毒X线表现

目的:探讨先天性骨梅毒X线表现及特点,评价X线平片检查在本病诊断中的价值。材料和方法:回顾性分析最近5年25例早发型骨梅毒的临床资料和X线表现。结果:25例四肢长骨均有骨骼异常改变,按照病变累及的部位分为干骺端炎、骨膜炎、骨干炎(或骨髓炎)。全部病例均有干骺端炎,主要表现是先期钙化带增厚,部分呈锯齿状改变,钙化带下方出现横行透亮带。骨膜炎20例,表现单层或数层骨膜增生。骨干炎13例,部分骨干呈虫噬状骨质破坏,骨皮质内层增生,一般骨干不增粗,尺桡骨受累较多见。结论:本病四肢长骨具有病变多发、广泛、对称的特点,凡疑有先天性早发型骨梅毒患儿,应及早进行四肢长骨X线照片检查。     

俯卧与坐姿下籽骨轴位的X线影像质量的比较

目的：评估在坐姿下行籽骨轴位X线投照的影像质量。方法：收集2023年3—6月由于足部不适前来就诊的50例患者,对同一患者进行俯卧与坐姿两种姿势下籽骨轴位的DR检查,将获取的两组影像进行质量评估与比较。结果：俯卧与坐姿两种姿势下的影像合格率、EI、DAP在统计学上均不存在显著差异。结论：在拍摄籽骨轴位X线时,对于不能进行传统体位（俯卧）投照的患者,可在坐姿下进行投照,所获取的X线影像也能满足影像医生诊断需求。     

胫骨结节骨软骨炎的X线诊断

目的：探讨X线检查在胫骨结节骨软骨炎诊断中的价值。方法：回顾性分析52个（42例患者）胫骨结节骨软骨炎的膝关节X线摄影图像，观察胫骨结节骨及其周围软组织的改变。结果：所有患病的胫骨结节均示其邻近软组织肿胀，胫骨结节二次骨化中心异常改变有局部骨隆起10个、轮廓不规则8个、密度不均匀15个、碎裂状11个、前方见碎骨片4个和胫骨结节向前上方移位12个。结论：X线检查是诊断胫骨结节骨软骨炎有价值的方法。     

Glycogenic acanthosis of the esophagus: Radiographic and pathologic features

Diagnostic features of glycogenic acanthosis of the esophagus on air-contrast radiography, endoscopy, and histopathologic studies in 10 selected cases are presented.Glycogenic acanthosis of the esophagus is a common benign entity, characterized by multifocal plaques of hyperplastic squamous epithelium with abundant intracellular glycogen deposits. At esophagoscopy or on autopsy specimens these lesions appear as slightly raised grey-white plaques which are usually 2–10 mm in diameter and may be confluent. They cause a finely nodular or cobblestone mucosal pattern demonstrable on doublecontrast views of the well-distended eosphagus. The findings are not associated with mucosal ulcerations, luminal narrowing, or mobility disturbance, although some patients may have coexistent hiatal hernia and gastroesophageal reflux.     

Amyloidosis of the gastric stump: Radiographic and CT findings

An unusual case of amyloid deposition in the wall of gastric pouch 15 years after surgery for peptic ulcer is presented. The radiographic and computed tomographic (CT) findings included marked thickening of the gastric wall associated with clusters of calcifications and ulcerated mucosa. These features are illustrated and the pertinent literature is briefly reviewed.     

先天性骨梅毒的X线表现分析

目的 :探讨先天性骨梅毒X线表现及其特点。方法 :收集 10例先天性骨梅毒婴儿骨骼X线平片分析其表现。结果 :10例中 8例有骨骼异常改变。骨梅毒的X线表现为 :骨骺端炎 8例 ,主要表现为先期钙化带致密、增厚 ,其下方有不规则的透亮带和不规则硬化。骨膜炎 7例 ,显示葱皮状骨膜增厚。骨干炎 5例。骨骼改变呈多发、对称、广泛性 ,侵犯长骨为主 ,也可以累及不规则骨。结论 :X线检查对发现婴儿骨梅毒病变的诊断非常重要 ,能够明确诊断并确定病变范围。摄片还应包括骨盆等不规则骨     

影响口腔曲面体层摄影质量的相关因素

目的：探讨121腔曲面断层摄影的影响因素，提高摄影质量。材料与方法：对295例121腔曲面断层摄影质量进行评估。结果：甲级片152张(51．5％)，乙级片101张(34．2％)，丙级片25张98．5％)，废片17张(5．8％)。结论：标准的摄影体位、正确的操作程序、恰当的摄影条件有助于摄影质量的提高，完善的管理制度至关重要。     

迟发性外伤性颅内血肿113例临床特点及影像学特征分析

目的：对外伤性迟发性颅内血肿113例临床特点及其影像学特征进行分析。方法：对1995-01～2003-03期间住院治疗的外伤性迟发性颅内血肿患病历资料进行回顾性分析。结果：在同期住院治疗的1574例颅脑损伤患中，有113例(7.2％)患出现迟发性颅内血肿或因迟发性颅内血肿入院手术治疗．术后恢复良好18例(15．9％)．中残29例(25．7％)，重残25例(22．1％)，植物生存17例(15．1％)，死亡24例(21．2％)。结论：外伤性迟发性颅内血肿有其明确的临床特点和典型的影像学特征，及早发现，及时手术抢救治疗，能显改善外伤性迟发性颅内血肿的预后。     

Proper Depth of Placement of Oral Endotracheal Tubes in Adults Prior to Radiographic Confirmation

Objective: To determine whether a certain distance measurement on the oral endotracheal tube (ETT) at the corner of the mouth could reasonably ensure proper depth of placement in critically ill patients, without the immediate need for a confirming chest x-ray (CXR).
Methods: A prospective observational cross-sectional design was used to compare ETT mark distance and radiographic location of the ETT tip. The measurement marking on the ETT at the level of the corner of the mouth was noted at the time of intubation. The relationship of the tip of the ETT to the tracheal carina on the postintubation CXR was then determined. The ETT placement was deemed correct if the tip was at least 2 cm cephalad to the carina on the CXR.
Results: Of 83 intubated patients assessed, 52 were men and 31 women. The mean measurement on the ETT at the corner of the mouth was 22.2 cm for the women and 23.1 cm for the men. The mean distance from the tip of the ETT to the carina was 3.45 cm for the women and 4.13 cm for the men. Seventy-five of the 83 patients (90.4%; 95% CI 81.9–95.7%) had correct ETT positions on the initial CXR. If the ETT position had been adjusted at the corner of the mouth to 21 cm for the women and 23 cm for the men, the ETT would have been in correct position for 81 of the 83 patients (97.6%; 95% CI 89.6–99.7%). This represents a significant improvement in tube placement (p < 0.025; the McNemar chi-square).
Conclusion: Proper depth of ETT placement in the critically ill adult patient can be estimated by the technique of this study. In this adult patient population, corner-of-the-mouth placement of the ETT using the 21-cm tube mark for the women and the 23-cm mark for the men would have led to proper placement for most patients.     

计算机X线摄影(CR)特性曲线的研讨

目的:计算机X线摄影(CR)以数字化成像发展了常规X线摄影,使其影像质量跨入了崭新的阶段。但对图像处理方式之一的谐调功能的掌握、开发及科学的运用乃是技术的核心。方法:谐调功能的四个层次决定着非线性转换曲线的基本类型、形状、斜率。在调试中采用固定曝光条件测试光楔片及变换不同调节内容,固定部位的摄影,论证特性曲线的特性。结果:掌握特性曲线调节的规律、特性,达到理想地提供丰富的诊断信息、完整的影像资料,准确诊断依据的目的。结论:计算机X线摄影对特性曲线调节的后处理功能进行实验、测试、研讨、论证、充分体现出数字化医学影像的优势及潜力。     

Radiographic detection of intrabronchial malpositions of nasogastric tubes and subsequent complications in intensive care unit patients

Objective: The aim of our study was to illustrate the radiographic spectrum of the intrabronchial malposition of nasogastric tubes and subsequent complications, and to discuss the role of radiography in the detection of such malpositions. Design: Retrospective clinical investigation. Setting: Tertiary care university teaching hospital. Patients and methods: We reviewed chest radiographs of 14 intensive care patients with nasogastric tubes malpositioned in the tracheobronchial tree. The site and anatomic location of the malposition were recorded. Complications due to tube malpositioning were monitored on follow-up radiographs and on computed tomographic examinations, which were available in 4 patients. Results: Nine of 14 nasogastric tubes were inserted in the right and 5 in the left tracheobronchial tree. Tube tips were malpositioned in the lower lobe bronchi (50 %), the intermediate bronchus (36 %), and the main bronchi (14 %). There was perforation of the bronchial system with subsequent pneumothorax in 4 patients. In 4 other patients, pneumonia developed at the former site of the malpositioned tube tip. Radiographic detection of nasogastric tube malpositioning was prompt in 9 patients and delayed in 5 patients. Conclusions: Whereas clinical signs of nasogastric tube malpositioning in intensive care patients may be absent or misleading, chest radiography can accurately detect nasogastric tube malpositions in the tracheobronchial tree, may prevent complications, and avoid the use of further costly or invasive diagnostic techniques. Received: 29 November 1995 Accepted: 6 December 1996     

Gastric interposition following transhiatal esophagectomy: Radiographic evaluation

Gastric interposition was achieved in 138 patients following transhiatal esophagectomy without thoracotomy. Among these, 33 had benign and 105 malignant lesions. All patients were evaluated on the 10th postoperative day with a barium swallow examination. However, if an anastomotic leak was suspected clinically before this time, a water-soluble contrast study was initially obtained. Early postoperative complications included anastomotic leaks (15), cricopharyngeal incoordination with aspiration (6), and gastric perforation (2). Late postoperative complications included anastomotic strictures (12), pyloric stenosis (4), recurrence of tumor (3), and transhiatal visceral herniation (2). Our technique of postoperative radiographic evaluation, particularly when a leak is suspected clinically, is discussed.