腕骨脱位影像诊断中若干问题探讨

目的 探讨腕骨脱位的分型及命名、骨折与脱位的关系及其影像学检查方法.方法 56例腕骨脱位患者均摄有腕关节正侧位片,其中16例行64排CT扫描及重组;综合分析影像表现并进行诊断分型.结果 月骨脱位9例,月骨周围脱位19例,经舟骨月骨周围脱位16例,月骨和半舟骨脱位2例,舟骨-月骨周围脱位1例,其他腕骨脱位9例.其中34例伴有至少一处撕脱骨折.16例行平片及CT检查,平片显示撕脱骨折8例12处,未明确骨折部位2处,漏诊豆状骨脱位l例;CT示撕脱骨折11例21处,对骨折部位及脱位诊断均正确.结论 腕骨脱位类型多而复杂,应根据脱位及骨折具体情况进行分型及命名.除脱位外应注意骨折的诊断及骨折与脱位的关系.对于较复杂的骨折脱位CT扫描及重组应作为常规检查.     

腕骨脱位的X线平片及40层螺旋CT诊断比较

目的 探讨腕骨脱位X线平片及多层螺旋CT的影像学表现,并对两者的检出情况进行比较,以提高对腕骨脱位的诊断水平,减少漏诊误诊.资料与方法对2006年8月-2009年11月共21例腕骨脱位病人的X线平片、多层螺旋CT薄层扫描及容积再现(VR)三维重组和多平面重组(MPR)影像进行回顾性分析.其中男19例,女2例,年龄19~45岁,平均(31±7)岁.腕骨脱位位于左侧14例,右侧7例.结果 月骨脱位8例;月骨周围型脱位13例,其中,单纯月骨周围型脱位3例,经舟状骨月骨周围脱位4例,经舟状骨、三角骨月骨周围脱位1例,经三角骨月骨周围脱位3例,经桡骨茎突月骨周围性脱位2例.在伴有其他腕骨骨折的病例中,桡骨茎突及舟骨骨折于X线平片均得到确诊,而3例合并三角骨骨折的病例在X线平片上或不能显示骨折,或显示骨折片但不能确定具体部位.运用螺旋CT薄层扫描及重组后均做出了正确诊断.结论 X线平片对于腕骨脱位大多可以做出正确诊断,但当合并腕骨骨折,特别是细微骨折时,漏诊率较高,多层螺旋CT的MPR、VR技术可全面、准确地显示腕骨脱位及合并骨折情况,具有较高的临床应用价值.     

不典型月骨周围脱位的影像表现及鉴别

目的：总结不典型月骨周围脱位影像特点及与相关骨折脱位的鉴别要点。方法本组16例不典型月骨周围脱位均摄有腕关节正侧位片,5例同时行64排CT扫描及重建,仔细观察分析每一病例的影像表现及特点。结果本组16例均为不典型月骨周围后脱位,伴不同程度月骨向前半脱位。单纯不典型月骨周围后脱位10例,其中同时伴舟骨后脱位3例,半脱位2例,无脱位5例,舟骨无脱位病例中,1例正位头舟间隙明显增宽;经舟骨不典型月骨周围脱位6例,除月骨向前半脱位外,舟骨骨折近段亦随月骨向前半脱位。结论单纯不典型月骨周围后脱位均伴有不同程度月骨向前半脱位,可伴或不伴舟骨后脱位;经舟骨不典型月骨周围后脱位,月骨及骨折近段同时向前半脱位。     

经舟骨月骨周围脱位的诊断与治疗

经舟骨月骨周围脱位的诊断与治疗１００８５３北京解放军总医院肖嵩华，张伯勋中国图书资料分类号Ｒ６８４．７经舟骨月骨周围脱位是较为少见的腕部严重损伤，约占所有腕骨骨折脱位的３％。由于腕骨的排列复杂，在Ｘ线片上的影像不易辩认，故常因漏诊而延误治疗。本文着重...     

多排螺旋CT多平面重建在足踝隐匿性骨折诊断中的应用

目的 探讨多排螺旋CT多平面重建对足踝隐匿性骨折的诊断价值.方法 回顾性分析50例X线平片漏诊,而后经多排螺旋CT薄层扫描并多平面重建的足踝隐匿性骨折患者资料.结果 CT扫描显示本组50例骨折部位包括外踝15例,距骨7例,跟骨6例,骰状骨4例,舟骨5例,跖骨4例,内踝6例,第一楔骨2例及趾骨1例.多排螺旋CT多平面重建能准确显示足踝部骨折碎块大小、骨折线方向、移位程度及关节受累范围.结论 多排螺旋CT多平面重建能对足踝隐匿性骨折作出准确诊断,并对治疗方案的选择及预后的评估有重要价值.     

第一掌骨连同大多角骨与近排腕骨脱位的有关问题

《中华创伤杂志》编辑部 :我是贵刊的忠实读者。现在临床工作中遇一问题 ,自己未能找到相关答案 ,特向有关老师请教 ,烦请在百忙中回信。患者因制砖机挤压致伤 ,X线片示左侧第 2～ 5腕掌关节脱位 ,同时第一掌骨连同大多角骨与近排腕骨脱位 ,在腕关节脱位中有月骨周围脱位、经舟骨的月骨周围骨折脱位等多种形式。此腕掌关节脱位是否极为少见 ?能不能叫做大多角骨周围腕掌关节脱位 ?张贵春医师 :您好 !编辑部将此信转给我 ,因您未附X线片 ,只能就您对伤情的描述和提出的问题作一些解答 ,供您参考。您说第一掌骨连同大多角骨与近排腕骨脱位 ,…     

多层螺旋CT在异形骨创伤性骨折中的应用价值

目的探讨多层螺旋CT不同重建方法在异形骨创伤性骨折中的应用价值。方法23例创伤性骨折病例经常规X线平片检查后，行多层螺旋CT扫描，在工作站进行容积再现及多平面重组，并与CT轴位图像、X线平片比较。由两位有经验的放射科医师共同阅片，以共同意见为准。结果23例创伤性骨折，依据CT轴位扫描及MPR、容积重建技术图像资料共发现骨折35处：常规CT轴位扫描检出34处，检出率97．1％；MPR检出35处；VR检出34处，检出率97．1％；X线平片检出骨折19处，检出率54．3％。结论多层螺旋CT能够显示X线平片难以诊断的异形骨创伤性骨折。     

螺旋CT骨三维重建在汶川大地震关节内及其它部位骨折诊断中的应用

目的 探讨螺旋CT骨三维重建在汶川大地震关节内及其它部位骨折诊断中应用价值.方法 对25例汶川地震中关节内及其它部位骨折患者行多层螺旋CT容积扫描,在工作站上对图像进行包括多平面重建及表面遮盖骨三维重建处理,观察重建图像对骨折的显示.结果 25例患者共36处骨折,采用骨三维重建方法均清楚显示.膝关节骨折6处,显示X线平片漏诊胫骨后交叉韧带止点撕脱性骨折1处;踝关节骨折3处,其中1例为Pilon骨折;肩关节骨折5处,发现X线漏诊肩关节盂前唇骨折1处;肘关节骨折3处;颈椎骨折2处,胸椎骨折4处,腰椎骨折5处,其中2例为爆裂性骨折,均伴关节突关节骨折,1例伴椎体滑脱;骨盆骨折8处,其中1处为骶髂关节骨折伴骶髂关节分离.本组中开放性骨折4例,骨折伴脱位6例,25例骨折病例周围软组织均不同程度肿胀.结论 螺旋CT骨三维重建能直观、逼真地显示骨折情况,为临床诊断及治疗提供更加充分的资料.     

X线透视结合切线位点片诊断腕舟骨骨折的符合率

目的探讨X线透视结合切线位点片诊断腕舟骨骨折的应用价值。方法选择120例腕骨骨折患者为研究对象,所有患者入院后均摄取腕骨正侧位片,透视结合切线位点片及螺旋CT检查。记录腕骨骨折的部位及数量,以螺旋CT检查结果为标准,比较X线平片正位、正侧位及X线透视结合切线位点片对腕舟骨骨折诊断符合率。结果 120例中,舟骨骨折比例最高,为67.5%;其次为月骨骨折,占13.3%。X线透视结合切线位点片对腕舟骨骨折检出率为93.8%,显著高于正侧位的78.8%和正位片的61.7%(P<0.05);与单纯正位片比较,正侧位片对腕舟骨骨折检出率更高(P<0.05)。结论 X线透视结合切线位点片对腕舟骨骨折诊断符合率高,是常规X线正侧位片的有力补充。     

髋臼骨折CT与X线平片检查比较

目的探讨CT与X线平片检查在髋臼骨折诊断中的临床应用价值。方法对照分析18例髋臼骨折CT、X线平片及临床治疗随访资料。结果18例髋臼骨折中前壁骨折4例,前柱骨折4例,后壁骨折2例,后柱骨折2例,复杂骨折6例。伴有盆腔内软组织肿胀11例。其中X线平片误漏诊4例。CT检出骨碎片27块,X线平片检出12块,其中关节腔内游离骨碎片CT检出17块,X线平片检出4块。股骨头脱位7例,伴股骨头骨折3例,其中X线平片漏诊1例。结论CT显示关节腔内碎骨片,确定骨折分型及了解盆腔软组织受损情况优于X线平片检查。     

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.