脊柱相关疾病X线片表现

颈椎相关疾病X线片表现 1.寰、枢椎错位的X线片表现:开位片中寰椎两侧的侧块不对称;寰齿侧间隙及寰、枢关节间隙左右不对称;寰、枢椎外侧缘或其关节面的内侧缘左右不对称;齿状突轴线与寰椎的中轴线不重叠,二轴线互成夹角或有分离;枢惟棘突偏离齿突中轴线.     

寰枢关节周围关系临床意义探讨

目的:2008年3月~2010年3月2年间共收治的寰枢关节不稳患者57例,结合临床对影像学诊断治疗进行了研究,对X线、CT和MRI检查在该病诊断的应用价值治疗提供基础参考意见。方法:对有颈部外伤史的病人常规行X线检查,然后根据寰齿间距(ADl)和齿突侧块间隙(LADS)的结果,行下一步CT检查或者MR/检查,指导临床治疗方法的选择。X线侧位片观察寰齿前间隙(为寰椎前弓后缘与齿突前缘距离),齿状突后倾角(齿突纵轴与枢椎体纵轴的夹角);开口正位片上测定齿突侧块间隙。结果:对ADI增宽(大于3mm)和LADS增大(大于6.9mm)的病例CT扫描,无骨性结构损伤和韧带断裂可行颈围固定等非手术治疗。骨性结构损伤和韧带断裂或脱位者,考虑行寰枢椎融合手术或者枕颈融合术,具体根据损伤程度和类型制定手术方案。结论:X线检查是颈部外伤的常规检查手段,结合CT(尤其是三维重建)和MRI,可以了解寰枢关节周围联系结构的损伤情况,以便制定合理的治疗方案。     

第1、2颈椎序列CT测量及其对寰枢脱位的诊断价值

①目的为临床提供寰枢脱位、半脱位的确诊依据.②方法行正常人第1、2颈椎序列的CT测量,得出正常数据.另对25例寰枢脱位、半脱位病人的CT影像进行回顾性分析.③结果正常组寰齿关节间隙、齿突与双侧侧块间距差、寰枕线与齿轴线的交角分别为(0.16±0.03)cm、(0.20±0.18)cm、(69.6±5.6)°.25例寰枢脱位、半脱位CT检查表现为寰齿关节间隙＞2.0mm,脊椎椎管前后缘连线相错,齿突与寰椎侧块关系双侧不对称,并有寰枢外侧关节位置改变.④结论第1、2颈椎序列的CT扫描对寰枢脱位、半脱位有明确的诊断价值.     

成人外伤后“寰枢椎半脱位”96例的诊治探讨

目的探讨成人外伤后表现为颈部疼痛、行相关影像学检查显示寰齿侧块间距(LADI)不对称与寰枢椎半脱位之间的关系。方法通过对所有96例急诊诊断为"寰枢椎半脱位"的患者行颈椎牵引、颈部支具固定等治疗方案,比较治疗前后影像学检查寰椎侧块与枢椎齿状突之间的关系。结论成人外伤后出现颈部疼痛,行相关影像学检查显示寰椎侧块与枢椎齿状突间距不对称不一定都诊断为"寰枢椎半脱位",须联合临床表现及影像学检查的精确测量综合诊断。     

30例寰枢关节半脱位的临床分析

临床上，我们将以眩晕、头痛或偏头痛以及耳呜、视物不清、夜间失眠多梦、后枕疼痛及皮肤感觉麻厚等为主要症状和寰枢椎开口位X线平片显示有寰枢轴线分离、寰齿间距左右宽窄不等，或颈椎侧位片示齿状突与寰椎前弓间距大于3ml，诊断为寰枢关节半脱位。我院于2005年3月～2007年3月间采取枕颌布带牵引与药物治疗相结合治疗寰枢关节半脱位30例，收到满意疗效，现报告如下：     

正常成人寰枢关节齿突偏移及关节间隙的螺旋CT测量研究

目的通过CT图像测量正常成人寰枢关节齿突偏移及关节间隙数据获取其正常参数,为临床判断有无寰枢关节异常提供参考标准。方法对正常成人146例无寰枢关节病变的健康志愿者分A组(18～29岁),B组(30～49岁),C组(≥50岁)3个年龄组,男70例女76例,均行常规中立位螺旋CT扫描寰枢椎体,对原始图像应用图像后处理工作站的多平面重组(MPR)软件功能进行处理后,测量齿状突齿突生长性偏移值(DO)、寰齿前间隙(ADI)、寰齿侧块间隙(LADI)、双侧齿突侧块间距差(VBLADI)、齿突侧块间隙差值比(RVBLADI)。结果正常成人齿状突生长性偏移平均为0.256±0.444,偏移62人,偏移率:42.5%,最大偏移值:2mm;寰齿前间隙(ADI)平均值为(1.70±0.47)mm,齿侧间隙差值(VBLADI)平均为(0.707±0.742),齿侧间隙差值比率(RVBLADI)平均为(0.045±0.0457)。ADI值A组>B组>C组,A组中96%的ADI为1.2～3mm,B岁组中98%的为ADI为1.2～2.5mm,C组中98%的为ADI0.5～2mm;双侧LADI不对称发生率77.39%,其VBLADI及RVBLADI值A组>B组>C组,不对称组中18-29岁组92%的VBLADI值范围是0.2～3mm、RVBLADI的范围是1.1%～18%,30-49岁组95%的VBLADI值的范围是0.1～2mm、RVBLADI的范围是1.2%～14.2%,≥50岁组97%的VBLADI的范围是0.2～1.5mm、RVBLADI的范围是1.2%～9%。结论标准中立位寰枢关节CT扫描及多平面重组能够全面观察寰枢椎影像解剖的结构,提供正常成人CT影像学DO及各年龄段的ADI、VBLADI、RVBLADI的正常参考值数据,为寰枢关节脱位或半脱位提供依据。     

寰枢关节影像学研究

目的 测量环枢关节间隙、环齿关节间隙的正常值.讨论其环齿关节不对称性的临床意义,提高环枢椎脱位的影像学诊断作用.方法 随机抽取200名成人进行测量.不分性别且均无外伤、感染、先天性畸形等病史,使用德国西门子数字胃肠机,测量其环齿关节间隙、环枢关节间隙.结果 环齿关节（正位开口位）,齿状突与环椎两侧间隙为：右侧最宽4mm、最窄2mm,左侧最宽5mm,最窄2mm.200例中两侧不对称者占30%,不对称差值最大达3mm.环枢关节（颈椎侧位）环椎前弓后缘与齿状突前缘之间隙为1～2mm,平均1.48mm.结论 正常的环齿关节两侧间隙可以不对称,其差值最大达3mm.因此,不能单纯依据环枢关节不对称对环枢关节脱位定性诊断.     

小儿寰枢关节半脱位的X线诊断价值

目的：通过对38例临床怀疑小儿寰枢关节半脱位X线影像资料的分析,结合文献资料,分析误诊的原因,预防的措施。方法：回顾性总结分析2010年3月至2014年4月前来我院就诊的15例和外院提供的23例临床怀疑寰枢关节脱位的患儿,将其分成两组。一组查体时临床症状不典型者有24例,另一组临床症状典型者有14例。两组患儿均摄颈椎侧位＋张口位,测量及比较ADI、VBLADS及偏离齿状突距离,观察寰枢椎外侧关节面是否对齐例数。结果：两组ADI测量值及寰枢椎外侧关节面不对齐的例数有统计学差异（P〈0.05）,两组BVLADS值及偏离齿状突距离未见统计学差异。结论：准确测量ADI,观察寰枢椎外侧关节面是否错位是X线诊断小儿寰枢关节半脱位较可行的方法。齿状突与寰椎两侧块间距离的差值（VBLADS）和寰底线中点垂线偏离齿状突轴线的距离作为诊断的参考指标。     

64排CT多平面重建对正常人群寰枢关节间隙的研究

目的：测量正常人群颈椎寰枢关节间隙正常值及双侧寰枢关节齿突侧块间隙（LADI）不对称值,并探讨其临床意义。方法：200例无寰枢关节病变成人,在中立位下用64排CT扫描C1-2椎体,对原始图像进行多平面重建成像后,测量寰齿前间隙（AADI）,双侧LADI及双侧齿突侧块间隙不对称值（VBLADI）。结果：男性AADI明显大于女性（P〈0.05）;AADI 95%正常值男性1.2-2.7 mm,女性1.1-2.3 mm。男女性双侧LADI（不对称发生率高达92.0%）及VBLADI均无统计学意义。结论：正常人群中双侧LADI不对称者常见,当有颈部外伤且影像学提示双侧LADI不对称时,诊断寰枢关节脱位或半脱位应慎重,须结合临床及进一步检查以明确诊断。     

颈椎旋转的影像学诊断

目的 总结分析颈椎旋转的影像学表现,寻找其正确的诊断及治疗方法.方法 收集75名患者的X线平片及CT片,分别观察颈椎棘突、横突的连线,寰-齿关节间隙,齿状突与棘突平分线的变化.结果 在所有患者的颈椎正位像及侧位像上棘突及横突的连线均不在同一直线上;39例存在寰-齿关节间隙不等宽;51例枢椎齿状突与棘突平分线存在偏转.结论 颈椎旋转的影像学表现典型,熟悉其表现有助于该病的诊断.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.