肩胛骨Y位的摄影技巧及临床价值

目的 探讨肩胛骨Y位摄影技巧及临床价值.方法 110例肩关节外伤或者肩部疼痛患者,拍摄肩胛骨Y位.摄影方法:患者面向探测器前站立,被检侧肩关节贴近探测器,双手自然下垂,手心旋前并紧贴身体,冠状面与探测器呈55°~65°,患侧肱骨头置于探测器中心,球管向足侧倾斜15°,中心线对准肱骨头.结果 110例患者中,82例一次性拍摄成功;28例由于身体倾斜角度不合适,拍摄不成功,改变身体倾斜角度拍摄成功.显示肩峰骨折5例,弯曲型及钩型肩峰20例,肩峰 -肱骨头距离<1 cm 35例,喙突骨折2例.结论 肩胛骨Y位能够清晰显示肩袖出口骨性解剖结构,指导临床制订治疗方案,具有较高的临床价值.     

髋关节改良侧位摄影的实际应用

目的 设计一种既操作简便又与常规髋关节侧位同样拍摄效果的新体位.方法 采用不同摄影角度对骨骼模型进行X线摄影,测量股骨头、颈充分显示时中心线倾斜角度和骨骼模型倾斜角度,并对头、颈显示情况评分;对30例髋关节X线摄影患者加照新侧位,并与常规侧位的实际可操作性和图像质量进行对比.结果 模拟摄影得出中心线向头侧倾斜35°~45°,身体冠状面与探测器角度60°~70°,评分为3分;新侧位具有可行性,对关节面、间隙显示率均为96.7%,股骨头、颈均为100%,大粗隆为80%,小粗隆为100%.结论 改良髋关节侧位摄影方法同样可以显示股骨头、颈和其余诸组成骨情况.     

地震致骨关节多发骨折的DR、螺旋CT及CT重建诊断价值的比较

目的 比较地震所致多发骨关节骨折的X线平片(DR)、CT轴位扫描、CT重建,包括多平面重建(MPR)及3D的诊断价值.方法 对比分析汶川地震伤员中经临床治疗及手术证实的51例多发骨关节骨折DR 、CT、MPR及3D表现,应用Logistic多元回归方法 分析DR、CT、MPR及3D的诊断价值及统计学意义.结果 51例地震伤员共累及骨盆、下肢、上肢、肩关节、下颌骨、脊柱等部位共计130块骨并均为多骨多发骨折.其中DR有1例股骨外侧髁撕脱性骨折、1例胫骨平台骨折及1例跟骨骨折漏诊;1例下颌骨骨折CT第1次漏诊,第2次向足侧倾斜15°显示骨折线,而MPR及3D检查均显示清楚.Logistic多元回归分析结果 认为,此组DR检查结果 与临床诊断没有统计学意义.结论 地震所致骨关节骨折多为多骨粉碎性骨折,如果有条件,应首选CT轴位扫描并进行MPR、3D重建,四者联合应用可保证术前正确诊断.     

X线断层融合摄影对骶尾椎骨折的诊断价值

目的:比较X线断层融合摄影与常规DR对骶尾椎骨折的显示率。方法:选择临床怀疑骶尾椎骨折的36例患者,分别行X线断层融合矢状位摄影与常规DR侧位摄影,评价这2种成像技术所获得的骶尾椎骨图像质量及骨折诊断情况。结果:36例骶尾骨常规DR侧位摄影优质图像率为25.0%,阳性诊断率为23.7%;X线断层融合矢状位摄影优质图像率为83.3%,阳性诊断率为63.3%;2种成像技术的检查结果差异有统计学意义(P0.001)。结论:对骶尾骨骨质结构的显示和骨折的检出,X线断层融合矢状位摄影较常规DR侧位摄影具有更好的能力,可作为骶尾骨骨折的首选检查方法。     

髌骨轴位X线检查辅助装置的设计与临床应用

目的:设计一套髌骨轴位X线检查辅助装置,以满足膝关节不同程度屈曲受限患者髌骨轴位X线摄影及其临床应用价值.方法:髌骨轴位辅助装置制作材料均使用不锈钢材质,由膝部定位组件和探测器支撑组件两部分组成.本研究纳入100例膝关节髌股关节炎患者,膝关节均有不同程度屈曲受限,使用辅助装置进行髌骨轴位摄影,由2名擅长骨关节影像诊断的高年资影像医师观察髌骨轴位图像,并对其主要解剖结构显示能力及图像质量进行评价.结果:使用髌骨轴位辅助装置首次摄影成功率为98％,优级片率为93％,图像质量符合诊断要求;能够在膝关节屈曲不同角度(15°～90°)下拍摄髌骨轴位,并清晰显示髌骨运行轨迹情况以及准确测量髌骨沟角、适合角等相关参数.结论:使用髌骨轴位X线检查辅助装置简单、易行、摄影成功率高,图像质量符合影像诊断学要求.对于髌股关节炎、髌骨习惯性脱位、髌骨骨折的诊断有一定的临床价值.     

鼻骨改良轴位的体位设计及诊断鼻骨骨折的价值

目的通过对鼻骨轴位摄影方法的改良与设计,显示常规轴位摄影难以显示的鼻骨影像并讨论鼻骨轴位的诊断价值。方法对45例鼻骨受伤患者分别行常规鼻骨侧位、改良轴位摄影,分析改良轴位摄影显示鼻骨图像质量情况。结果应用鼻骨改良轴位摄影,清晰显示出鼻骨轴位图像并且对临床诊断非常有价值。结论鼻骨改良轴位摄影操作简单易行,成功率高,显示鼻骨轴位影像清晰。对鼻骨骨折的诊断有极大的帮助。     

女性腰椎侧位平片投照方法改进

通常女性患者拍摄腰椎侧位平片时，由于体形的原因，女性患者的骨盆部较宽，所以当患者侧卧于摄影平床上时，腰椎并不能平行于床面，而是与床面形成一定角度．越是靠近骶骨的椎体角度越大，因而如果采用常规拍摄腰椎平片的投照技术，则射线不能垂直射入椎体及椎间隙，从而得到的影像是倾斜的，出现失真的影像．影响了诊断。经过多年的试验，我们根据女性患者的体形特点，对女性腰椎侧化的投照方法进行了改进，得到了满意的效果，具体方法如下：     

实用投照角度在缺血性脑血管病介入检查及治疗中的应用

目的 探讨缺血性脑血管病DSA检查及介入治疗过程中能够清晰显示血管病变的最佳实用投照角度,为其影像诊断及介入治疗提供精确图像数据信息.方法 通过对随机抽取的1 000例缺血性脑血管病患者全脑血管造影或介入治疗图像进行分析,得出被选择血管的最佳实用投照角度.本组病例均对双侧锁骨下动脉、双侧椎动脉、双侧颈内动脉起始段及颅内段等相关血管进行常规正侧位DSA图像采集,有针对性地进行斜位投照.结果 基底动脉狭窄病变的最佳实用投照角度为向足侧斜(CAUD)28°±5°;椎动脉颅内段狭窄病变的最佳实用投照角度为右前斜位(RAO)25°±3°或者左前斜位(LAO)25°±3°;右椎动脉起始段狭窄病变的最佳实用投照角度为LAO 20°±5° 向头侧斜(CRAN)15°±5°;左椎动脉起始段狭窄病变的最佳实用投照角度为RAO 20°±5°;右侧锁骨下动脉起始段狭窄病变的最佳实用投照角度为RAO 40°±7° CAUD 20°±7;左侧锁骨下动脉狭窄病变的最佳实用投照角度为LAO 50°±6°;大脑中动脉M1段近端的最佳投照角度为RAO 15°±5°或者LAO 15°±5°;大脑中动脉M1段靠近分叉处狭窄病变的最佳实用投照角度为LAO 25°±5°或者RAO 25°±5°.结论 应用最佳实用投照角度,能够清晰显示目标血管狭窄病变的形态、程度等信息,为介入治疗提供最佳的工作位置,有助于缺血性脑血管病的影像诊断和介入治疗.     

小儿胸部摄影成像角度的应用

目的小儿胸部X线检查成像角度的应用与医学影像质量的关系。方法采取随机抽查来放射科拍胸片的未成年人100列并将其随意分成两个组，一组为常规组（对照组），另一组为适量将中心线向足侧倾斜一定角度（5～10度实验组），以此来对比两种方法之间的差异。结果实验组在影像显示范围及影像质量上明显好于对照组，尤其是在肺纹理显示分辨率上高于对照组。结论小儿胸部摄影球管向足侧倾斜一定角度（5～10度）的投照方法，可提高胸片的影像质量，从而提高影像诊断的准确性。     

小儿胸部摄影中成像角度的应用价值

目的 探讨小儿胸部摄影技术中成像角度的运用与影像质量的关系.方法 采用随机抽样方法将前来放射科摄片的300例小儿随机进行常规(对照组)和适度地将中心线向足侧倾斜一定角度(5°,实验组)的2种摄片方法摄影.分析2种方法的差异性.结果 2种不同的小儿胸部摄影方法在影像质量上存在显著性差异(P＜0.01).实验组肺野显示分率高于对照组,有利于肺纹理的连续追踪.结论 适度地将中心线向足侧倾斜一定角度(5°)的成像方法,可提高小儿胸片的影像质量.     

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）