颈椎及其毗邻结构的超声检查与临床意义

目的探讨颈椎及其毗邻结构的超声检查方法与临床意义。方法对50例健康成人颈部进行超声检查,重点描述颈椎及其毗邻结构的扫查方法与声像图特点。结果 (1)颈椎棘突扫查图像:颈椎棘突呈"栅栏样"声像,寰椎有"拱桥形"的后弓与"山丘状"的后结节,枢椎棘突宽大且末端分叉,而隆椎拥有高大突出的棘突。(2)寰枕关节与寰枢外侧关节扫查图像:颈2背根神经节位于寰枢外侧关节后内侧,椎动脉在寰枢外侧关节后外侧上行,之后走行于寰枕关节下方侧块背侧。(3)颈椎小关节纵切扫查图像:后面观呈"叠瓦状"图像;侧面观呈"波浪线"图像,颈神经后内侧支走行于波谷处。(4)颈椎横突横切扫查图像:颈6横突前、后结节呈"驼峰征",颈6神经根位于两结节间的深沟内;颈7横突仅有一个巨大的后结节,颈7神经根位于后结节前方。(5)颈椎钩突与钩椎关节扫查图像:钩突外侧紧邻椎动脉,内侧为椎间盘;钩椎关节呈"裂缝样"图像。结论超声是检查颈椎及其毗邻结构的理想方法。     

《肌肉骨骼系统的超声检查》DVD光盘新片介绍

《肌肉骨骼系统的超声检查》由北京大学第三临床学院超声诊断科王金锐和崔立刚教授主讲。本教材根据肌肉骨骼系统超声检查临床适应证、检查方法、肌肉骨骼系统解剖结构、常见病变的声像图表现，系统阐述了超声在肩关节、肘关节、腕关节、髋关节、膝关节、踝关节及肌肉系统中的应用。由于肌肉骨骼系统超声检查尚未普及，本教材特别增加了相应关节规范超声扫查手法的演示，便于学员掌握和应用。其是医学影像专业医师、超声诊断医师、研究生及进修医师超声专业培训学习的实用性软件。     

喉部超声解剖及声像图研究

目的 探讨正常喉部的超声解剖声像,提供超声诊断喉部疾病的依据.方法 通过研究4具尸体标本的断面解剖及对40例正常对照组的超声断面声像图对比,分析正常喉的超声解剖声像图.结果通过尸体标本断层解剖和对照组超声声像图的对照,建立了正常喉部的超声解剖声像图.结论 超声检查对正常喉部解剖结构识别良好,能够运用于喉部一般疾病检查中,为临床提供重要的补充检查方法.     

高频超声对正常成人臂丛神经根和椎间孔的定位及其图像特征

目的探讨应用高频超声对正常成人臂丛神经根和椎间孔定位的准确性及影响因素。方法在高频超声引导下使用金属探针对成人尸体颈胸段双侧臂丛神经椎间孔及神经根行穿刺定位,并与正常成人臂丛神经声像图对照分析。结果声像图显示,颈椎椎体横突根部和椎动脉是辨认和定位椎间孔及其内神经根发出水平的重要解剖标志。50例受检者中,所有受检者均可观察到C5～C8水平的神经根,显示率为100%(100/100),T1和下干显示率为34%(34/100)。结论高频超声可准确区分和定位臂丛神经各个神经根及椎间孔位置,可为臂丛神经损伤及局部麻醉的定位诊断提供可靠的影像学依据和参考。     

超声扫查正常成人臂丛神经根

目的 探讨正常臂丛神经根的声像图特征及定位标志,以对神经根发出位置水平进行准确定位。方法 对40名正常人进行臂丛神经超声检查,以C7椎体横突前结节短小或缺如这一形态学特征为标志,以椎体长轴为轴线,于横断面判定各个神经根发出椎间孔的相应椎体水平,观察C5~T1各神经根的超声声像图的特征。结果 通过各颈椎椎体横突的超声表现可辨认和识别神经根发出水平,C7神经根出椎间孔段的超声声像图具有特征性。于40名受检者均可观察到C5~7水平的神经根,25名可见C8神经根,7名可见T1神经根。结论 高频超声能利用椎体横突的形态学的差别区分和定位各个神经根所对应的椎体水平,对臂丛神经损伤的定位诊断提供依据。     

大网膜恶性肿瘤的超声诊断研究

目的探讨超声诊断大网膜恶性肿瘤的价值。方法回顾性分析25例大网膜恶性肿瘤的超声表现,并与CT表现、病理结果对比分析。结果超声检查18/25例(72%)发现病变,6/25例(24%)未发现病变,误诊1/25例(4%);大网膜恶性肿瘤的超声表现分为三类:巨大实性、囊实性、多发实性小结节。结论超声对判断网膜恶性肿瘤的部位及内部结构具有重要价值,超声声像图复杂多变,判断性质需结合临床和CT等其他影像手段。     

从骨科医师角度看超声在骨科的应用

作为影像诊断学的一个重要组成部份,超声已在骨科临床应用近20余年.由于该方法无辐射损害、重复性强,对体液、软组织及软骨的显示有明显的特异性和准确性、故在骨科诊断学中占有不可忽视的重要地位.又因超声对骨科的研究起步较晚,且因骨结构的特点限制超声使用范围,故尚有许多课题得进一步研究.一、进行骨科超声检查的基本要求.1、熟悉检查局部的超声解剖这点虽然是一个普通常识,但往往不易做到.声像图的基础是断层解剖结构,四肢和脊柱的断层解剖极为复杂,而不同方向切面结构又大相径庭,即使是一位解剖学家也难以全面、准确地辩别.仅掌握脊柱、四肢及关节的横、纵两个标准切面的超声解剖,也需要付出很大的努力.2.了解临床拟诊疾病的基本病理变化组织或器官的病理变化是合理解释声像图上     

腰椎超声图像特征分析及椎体节段定位研究

目的应用超声观察腰椎骨性结构移行规律,以及腰椎横突数目正常及异常时腰椎节段的识别方法。方法对我科收治的200例腰痛患者均行超声扫查,重点观察并总结腰椎纵切面、横切面的声像图特点和骨性结构移行规律,当腰椎横突数目异常时参考第12肋骨、腰椎棘突、椎板、横突或髂嵴,采取联合应用多种节段确定的方法对腰椎节段进行定位,并与X线检查结果进行对比。结果总结本研究患者腰椎骨性结构的声像图特点和移行规律:(1)纵切面上大致分为5个切面,包括棘突切面、椎板切面、椎板与下关节突切面、上关节突与横突根部切面、横突切面;当连续动态扫查腰椎时可发现棘突向外移行为椎板,椎板向外移行为上下关节突及横突根部,横突根部向外移行为横突。(2)横切面上可分为3个切面,包括横突上关节突关节切面、横突间切面、横突下椎板切面;当连续动态扫查腰椎时可发现关节突关节向下移行为横突,横突向下移行为椎板,椎板向下移行为下一个关节突关节。本研究共12例患者出现腰椎横突数目异常,其中10出现双侧6个横突声影,考虑为胸椎、骶椎腰化(8例、2例);1例左侧出现6个横突声影、右侧出现5个横突声影,考虑为左侧胸12肋骨变短;1例左侧出现5个横突声影、右侧出现4个横突声影,考虑为右侧L1横突变长所致。12例患者经脊柱X线全长片证实,与超声结果一致。结论腰椎骨性结构在横切面及纵切面上均有一定的移行规律,超声是确定腰椎节段的理想方法。     

结节性甲状腺肿合并甲状腺癌的超声声像图特征

目的探讨结节性甲状腺肿合并甲状腺癌的超声声像图特征。方法回顾性分析经术后病理诊断为结节性甲状腺肿合并甲状腺癌的34例患者的甲状腺及颈部淋巴结声像图特征。结果34例患者中有26例（76．47％）声像图表现为结节形态不规则、边界模糊、内部砂粒样钙化、后方回声衰减，周围组织浸润，颈部淋巴结肿大等异常超声声像图表现中的一项或多项。结论结节性甲状腺肿合并甲状腺癌具有较为特征性的超声声像图表现，通过对结节性甲状腺肿患者甲状腺及颈部淋巴结超声声像图的详细分析，可以发现甲状腺内异常结节，对于指导此类患者的治疗具有重要的临床意义。     

甲状腺结节的超声诊断与鉴别诊断

本文报告105例甲状腺结节的声像图表现.对照临床与病理总结了腺瘤.结节性肿大、囊肿和癌的声像图特点.超声诊断正确率为92.4%.认为超声检查对正确诊断甲状腺结节有重要临床意义.     

Automatic Midline Identification in Transverse 2-D Ultrasound Images of the Spine

Effective epidural needle placement and injection involves accurate identification of the midline of the spine. Ultrasound, as a safe pre-procedural imaging modality, is suitable for epidural guidance because it offers adequate visibility of the vertebral anatomy. However, image interpretation remains a key challenge, especially for novices. A deep neural network is proposed to automatically classify the transverse ultrasound images of the vertebrae and identify the midline. To distinguish midline images from off-center frames, the proposed network detects the left–right symmetric anatomic landmarks. To assess the feasibility of the proposed method for midline detection, a data set of ultrasound images was collected from 20 volunteers, whose body mass indices were less than 30. The data were split into two segments, for training and test. The performance of the proposed method was further evaluated using fourfold cross validation. Moreover, it was compared against a state-of-the-art deep neural network. Compared with the gold standard provided by an expert sonographer, the proposed trained network correctly classified 88% of the transverse planes from unseen test patients. This capability supports the first step of guiding the placement of an epidural needle.     

颈部三维CT血管成像在寰椎后路固定术中的应用

背景:寰枢椎后路内固定融合是治疗上颈椎病变的常用手术方式,此处解剖结构复杂多变,损伤椎动脉的案例时有报道。目的:观察正常人上颈椎三维CT血管图像,研究寰椎后弓的解剖结构及伴行椎动脉的走形特点,为寰椎后路置钉提供解剖学依据。方法:纳入椎动脉显影良好且寰枢椎无明显病变者400例,利用原始资料进行容积重建,同时配合分离、融合、透明和伪彩等图像处理技术,在三维图像上观察椎动脉寰枕段的走行及变异,测量寰椎与后路置钉相关的解剖数据。结果与结论:400例头颈部三维CT血管图像清晰,满足要求。椎动脉寰枕段的行程弯曲,走形典型者385例,变异15例,共18侧。固定第一阶段动脉11侧,窗式椎动脉6侧,异常起源的小脑后下动脉1侧;椎动脉沟环48例,其中10例为双侧,共58侧。椎动脉沟底的后弓是钉道最薄弱部分,左右侧比较差异无显著性意义(P>0.05)。说明寰椎后弓及其伴行椎动脉常存在变异,给寰椎后路置钉带来不确定因素,三维CT血管图像可以清楚地显示两者的解剖结构,置入前充分了解这些数据,可以制定准确的手术方案,提高手术的安全性。     

肾动脉分支异常伴或不伴肾动脉狭窄的超声漏误诊分析

目的探讨超声诊断肾动脉分支异常伴或不伴肾动脉狭窄的漏误诊原因。 方法选取2018年1月1日至2019年12月25日于北京协和医院经CT血管造影（CTA）检查诊断为肾动脉分支异常的80例患者共103个肾的超声检查结果,与CTA检查结果进行对比分析,重点讨论肾动脉分支异常伴或不伴肾动脉狭窄的漏误诊原因。 结果在CTA诊断的103个肾中,27个为肾动脉变异合并狭窄,76个仅为肾动脉分支异常不伴肾动脉狭窄。在肾动脉变异合并狭窄的27个肾中,2个超声正确诊断（检出率为7.4%）,均由高年资超声医师检查;25个超声诊断不全面或漏诊,其中15个由低年资超声医师检查,10个由高年资超声医师检查。仅肾动脉分支异常的76个肾中,9个超声正确诊断（检出率为11.8%）,其中8个高年资超声医师检查,1个由低年资超声医师检查;67个超声漏诊,其中24个由低年资超声医生检查,43个由高年资超声医师检查。 结论肾动脉分支变异伴或不伴肾动脉狭窄的超声检出率较低,超声检出水平与工作年限可能有一定关系,提示在超声医师临床实践及教学培训过程中,注意强化对肾动脉分支异常的全面认识,将有助于提高超声检查对肾动脉分支异常这类疾病的检出率及诊断水平。     

64层螺旋CT血管成像在后循环缺血的应用

目的探讨64层螺旋CT血管成像(CTA)在后循环缺血诊断中的价值。方法收集临床拟诊为后循环缺血的患者94例,行头颈部CTA,观察椎基底动脉和颈内动脉系统的形态,有无异常分支,有无狭窄。并评价横突孔有无狭窄以及钩椎关节有无增生。结果94例患者中,51例存在椎基底动脉及颈内动脉系统的各种类型血管结构异常,横突孔狭窄或钩椎关节增生而不伴有血管病变20例,另有椎动脉内支架2例。血管及颈椎骨质情况均未见明显异常的21例。结论64层螺旋CTA能够同时显示椎基底动脉和颈内动脉的形态、走行、小分支及其侧支循环情况,以及横突孔和钩椎关节等结构的改变。可以更全面的评价后循环缺血的病因及评估支架成型术后的改变。     

Peer review of third trimester abdominal circumference measurements

BackgroundThird trimester growth scans represent a significant proportion of the workload in obstetric ultrasound departments. The objective of these serial growth scans is to improve the antenatal detection of babies with fetal growth restriction. The aim of this paper is to describe a method of peer review for third trimester abdominal circumference measurements which is realistic within busy obstetric ultrasound departments in the UK.MethodTwenty-two, third trimester, measured abdominal circumference images were randomly selected. Images were assessed subjectively by 12 sonographers using the image Criteria Achieved Score. For quantitative assessment, termed the Inter-operator Variability Score, three of the abdominal circumference (AC) images were blindly remeasured. Following this, a questionnaire was used to ascertain which image criteria sonographers considered most important and to reach an agreement on correct caliper placement.ResultsThe least frequently met image criteria with the lowest Criteria Achieved Score related to an oblique abdominal circumference section. These included fetal kidney present (Criteria Achieved Score 24.6%), multiple oblique ribs (Criteria Achieved Score 39.4%) and oblique spine (Criteria Achieved Score 37.5%). Caliper placement was also identified as inconsistent.DiscussionThis study demonstrates that the perfect AC section is not always possible and sonographers use their professional judgement to determine whether an image is acceptable. Seventy-three percent of the images reviewed were of an acceptable standard. There can be inconsistencies in sonographer opinion regarding what is an acceptable third trimester abdominal circumference image. These differences need to be addressed to maximise the effectiveness of the third trimester ultrasound examination.ConclusionPeer review can be used to monitor scan quality and identify areas of inconsistency.     

Use of endo-vaginal ultrasound to optimize visualization of the distal fetal spine in breech presentations

Endovaginal ultrasound was used to evaluate the spine of 13 second-trimester fetuses in which transbdominal images were considered equivocal due to suboptimal visualization of the distal spine and where the fetus was in a breech presentation. Endovaginal sonography demonstrated a small defect in the distal spine and a meningomyelocele in one of the 13 cases. In all of the remaining 12 cases, endovaginal sonography resulted in improved visualization of morphologic detail, providing sufficient information regarding bony anatomy to exclude splaying of the posterior elements. Additionally, in 10 cases the intact skin surface overlying the distal spine, which was not seen by transbdominal sonography, was well demonstrated by endovaginal ultrasound. The authors recommend that endovaginal ultrasound be considered to optimize visualization of the distal fetal spine when transbdominal images are inconclusive and the fetus is in a breech presentation.     

Ⅰ期前后路联合重建不稳定下颈椎骨折脱位的临床观察

目的 分析Ⅰ期前后路联合手术重建不稳定下颈椎骨折脱位的近期临床疗效.方法 我院2006年3月至2009年7月对37例下颈椎严重骨折脱位患者,行Ⅰ期前路减压植骨融合钛板内固定,同期后路复位椎弓根螺钉内固定术.术前应用X线及64排CT明确骨折脱位下位颈椎的稳定程度,指导术前术式选择,同时测量椎弓根的宽度、高度,指导术中螺钉的选择.定期复查观察损伤节段的稳定性和融合率,采用ASIA分级判定脊髓功能的恢复情况.结果 28例患者获得随访,随访时间16.00～38.00个月,平均(22.37±6.93)个月.获得随访的患者,损伤节段稳定,颈椎椎体高度和生理曲度维持良好,融合率为100%,内固定位置良好.无椎动脉及脊髓损伤,无植骨决脱出或钢板、螺钉松动、断裂等并发症,脊髓功能评价平均提高1.30级,患者术后神经症状无一例加重.结论 Ⅰ期前后路联合重建治疗下颈椎骨折脱位,临床疗效满意,是一种可行的方法.     

Lumbar Ultrasound Image Feature Extraction and Classification with Support Vector Machine

Needle entry site localization remains a challenge for procedures that involve lumbar puncture, for example, epidural anesthesia. To solve the problem, we have developed an image classification algorithm that can automatically identify the bone/interspinous region for ultrasound images obtained from lumbar spine of pregnant patients in the transverse plane. The proposed algorithm consists of feature extraction, feature selection and machine learning procedures. A set of features, including matching values, positions and the appearance of black pixels within pre-defined windows along the midline, were extracted from the ultrasound images using template matching and midline detection methods. A support vector machine was then used to classify the bone images and interspinous images. The support vector machine model was trained with 1,040 images from 26 pregnant subjects and tested on 800 images from a separate set of 20 pregnant patients. A success rate of 95.0% on training set and 93.2% on test set was achieved with the proposed method. The trained support vector machine model was further tested on 46 off-line collected videos, and successfully identified the proper needle insertion site (interspinous region) in 45 of the cases. Therefore, the proposed method is able to process the ultrasound images of lumbar spine in an automatic manner, so as to facilitate the anesthetists' work of identifying the needle entry site.     

亚运志愿者创伤急救培训反馈调查

目的:了解对亚运志愿者进行创伤急救培训的效果.方法:随机抽取354名亚运医疗志愿者,在进行创伤急救的理论和操作培训后进行问卷调查和操作考试.结果:总体评分71.55%,对局部解剖的认知为59.04%,而对于颈椎损伤的正确处理率只有17.8%,其他培训内容基本及格甚至优秀.结论:经培训基本达到培训的目的和要求,但基本理论较欠缺,特别是对局部解剖和颈椎损伤的实际操作不熟练.     

Effect of the transverse ligament rupture on the biomechanics of the cervical spine under a compressive loading

Background

In order to diagnosis a transverse ligament rupture in the cervical spine, clinicians normally measure the atlas–dens interval by using CT scan images. However, the impact of this tear on the head and neck complex biomechanics is not widely studied. The transverse ligament plays a very important role in stabilizing the joint and its alteration may have a substantial effect on the whole head and neck complex.

Methods

A finite element model consisting of bony structures along with cartilage, intervertebral discs and all ligaments was developed based on CT and MRI images. The effect of head weights (compressive load) of 30 N to 57 N was investigated in the cases of intact and ruptured transverse ligament joints. The model was validated based on experimental studies investigating the response of the cervical spine under the extension–flexion moment.

Findings

The predictions indicate a significant alteration of the kinematics and load distribution at the facet joints of the cervical spine with a transverse ligament tear. The vertebrae flexion, the contact force at the facets joints and the atlas–dens interval increase with the rupture of the transverse ligament and are dependent to the head weight.

Interpretation

A transverse ligament tear increases the flexion angle of the head and the vertebrae as well as the atlas–dens interval. The atlas–dens interval reaches a critical value when the compressive loading exceeds 40 N. Supporting the head after an injury should be considered to avoid compression of the spinal cord and permanent neurologic damage.