膝关节半月板放射状撕裂的MRI表现

目的 探讨MRI对膝关节半月板放射状撕裂的检出能力.方法 回顾性分析1085例经关节镜证实的膝关节半月板损伤中的半月板放射状撕裂107例(9.9%)患者的MRI资料,同时按住院号顺序采用等足巨抽样方法 ,抽取100例经关节镜证实的非放射状撕裂的半月板损伤患者作为对照组.所有患者均经MR检查,观察裂隙征及裂隙行走征、半月板分离征、半月板消失征及小半月板征4种征象,与关节镜结果 比较.结果 (1)107例半月板放射状撕裂患者中,最常见的发生部位是外侧半月板体部(71例,66.4%)和前体交界部(25例,23.4%).(2)107例半月板放射状撕裂中,MRI诊断放射状撕裂102例.100例半月板非放射状撕裂的半月板损伤中,MRI诊断11例为放射状撕裂,MRI诊断半月板放射状撕裂的敏感度、特异度、阳性预测值、阴性预测值分别为95.3%(102/107)、89.0%(89/100)、90.3%(102/113)、94.7%(89/94).(3)裂隙征和半月板分离征出现频率最高,102例中分别出现59例(57.8%)和43例(42.2%),是诊断放射状撕裂最重要的MRI征象.结论 MRI诊断半月板放射状撕裂的准确率较高,是目前术前无创诊断的最佳方法 .     

膝关节MRI平扫与直接法造影诊断半月板损伤准确性分析

目的:比较分析MRI平扫与造影MRI对半月板损伤诊断的准确性。方法:100例疑似半月板损伤患者,行MRI矢状位T1WI、T2WI GRE、STIR、PD+Fatsat,冠状位T2WI GRE,平扫后立即在直接关节腔内注射对比剂行矢状位、冠状位、轴位T1WI,层厚4mm、层距1mm。结果:94例经关节镜或手术确诊为半月板撕裂,其中,MRI GRE序列诊断撕裂84例,膝关节MRI造影诊断83例。6例经关节镜或手术确诊为正常或变性,MR GRE序列和膝关节MRI造影也为正常或变性。结论:MRI平扫与MRI造影对半月板损伤的诊断准确性差异无统计学意义(P>0.05)。     

探讨半月板边缘部垂直撕裂与前交叉韧带损伤的关系

目的 探讨半月板边缘部垂直撕裂对诊断前交叉韧带(ACL)损伤的价值.方法 回顾性分析经关节镜证实的149例半月板撕裂的膝关节MRI结果,判断半月板撕裂的形态、位置以及前交叉韧带的情况.结果 149例半月板撕裂膝关节中,34个膝关节共36个半月板撕裂(其中2个膝关节内、外侧半月板同时撕裂),MRI显示为半月板边缘部垂直撕裂类型,其中29个膝关节同时伴有前交叉韧带损伤.其余115个膝关节,MRI显示为其他半月板撕裂类型,其中49例膝关节同时伴有前交叉韧带损伤.膝关节半月板边缘部垂直撕裂类型与其他的半月板撕裂类型比较,其合并前交叉韧带损伤的发生率分别为85.3%及42.6%,两者间具有显著性差异(χ2=19.2,P＜0.01).半月板边缘部垂直撕裂提示膝关节前交叉韧带损伤的敏感性、特异性和阳性似然比分别为37.2%、93.0%和5.3.结论半月板边缘部垂直撕裂大部分合并有ACL损伤.     

MRI与关节镜诊断半月板损伤临床表现的对比分析

目的 探讨MRI和关节镜检查半月板损伤的诊断价值。方法 收集40例我院接受诊断与治疗的膝关节损伤患者的MRI图像,以关节镜诊断为标准,计算MRI诊断的敏感性、特异性、准确性。结果 本组40例膝关节,左膝18例,右膝22例,共80个半月板。MRI表现为Ⅰ度损伤9个,Ⅱ度损伤15个,Ⅲ度损伤56个。MRI诊断半月板撕裂56个,其中外侧半月板35,内侧半月板21个,关节镜证实半月板撕裂50个,其中外侧半月板32,内侧半月板18个,其余6个半月板关节镜下肉眼未见明显撕裂。24个半月板MRI诊断无撕裂者中,关节镜下证实有3个半月板撕裂并进行部分切除。以关节镜检查为标准,MRI对半月板撕裂诊断的敏感性为94.3%,特异性为77.8%,准确性为88.8%,MRI诊断与关节镜结果差异无统计学意义（x^2=0.44,P〉0.05）。结论 MRI对半月板撕裂具有较高的诊断价值。而关节镜检查为最终确诊半月板损伤提供了清晰的镜像和依据,两者相互补充才能得到更好的临床效果。     

半月板损伤的MRI诊断与关节镜对照研究

目的：评价MRI对半月板损伤的诊断价值,为临床诊断和治疗半月板损伤提供可靠的影像学依据。方法：对138例拟行关节镜术的膝关节疼痛患者进行术前MRI检查,并于MRI检查后2周内行关节镜术。结果：符合纳入标准的84例患者中,与关节镜结果对照,MRI诊断半月板Ⅰ级损伤、Ⅱ级损伤的符合率分别为100%和91.1%;诊断半月板撕裂的敏感度、特异度、符合率、Kappa值分别为91.5%、90.7%、91.1%和0.82;对半月板撕裂类型诊断的敏感度、特异度、符合率和Kappa值分别为90.9%、85.7%、88.1%和0.76。结论：与关节镜比较,MRI显示半月板Ⅰ、Ⅱ级损伤时的内部信号改变更敏感。MRI诊断半月板撕裂,与关节镜结果具有极好的一致性,并能准确评价半月板撕裂类型。MRI检查可作为评价半月板损伤的首选方法,对半月板损伤临床治疗方案的选择具有重要指导意义。     

低场强MRI对膝关节半月板损伤的诊断价值探讨

目的评价低场强MRI对半月板损伤的诊断价值。方法对我院90例临床高度怀疑半月板损伤的患者行低场强MRI扫描和关节镜检查,并对其结果进行比较。结果本组90例患者的98个膝关节共累及103个半月板,经MRI诊断为真性撕裂者55个半月板．经父节镜证实为53个半月板;经MRI检查阴性而关节镜下见撕裂者2个半月板,MRI和父节镜检查均为阴性者30个半月板,其中有3个为盘状半月板。低场强MRI对半月板损伤的敏感性为9375％,特异性94．37％,准确性94．17％。结论低场强MRI是诊断半月板损伤无创性的极有价值的诊断疗法．是膝关节镜术前的重要榆查。     

3.0 T MRI 3D-SPACE序列对膝关节半月板损伤的诊断价值

目的：探讨3.0 T MRI三维快速自旋回波序列（3D-SPACE）对膝关节半月板损伤的诊断价值。方法：收集经关节镜确诊的膝关节半月板损伤60例为研究对象，均行3.0 T MRI 3D-SPACE序列与2D-SPACE序列扫描。对2种检查方法诊断半月板损伤准确率及半月板和各种组织的对比噪声比进行比较。结果：3D-SPACE序列图像半月板与韧带的对比噪声比明显高于2D-SPACE序列（P<0.05）。3D-SPACE序列诊断半月板斜行撕裂的准确率明显高于2D-SPACE序列（P<0.05）。结论：3.0 T MRI3D-SPACE序列应用于膝关节半月板损伤的诊断中可有效提高半月板损伤的诊断准确性，具有一定的临床诊断价值。     

MRI和关节镜诊断膝半月板损伤的比较研究

目的 :探讨膝关节半月板损伤MRI和关节镜下的不同表现及其对半月板损伤的诊断意义。方法 :回顾性分析 10 2个半月板损伤的MRI表现和关节镜下图像。根据MRI信号改变将半月板损伤分为Ⅰ级、Ⅱ级、Ⅲ级 ,并与关节镜下所见对比 ,分别加以研究。结果 :根据MRI信号强度改变 ,10 2个膝关节中Ⅰ级损伤 3 4个 ,Ⅱ级损伤 2 7个 ,Ⅲ级损伤 41个。与关节镜检结果对比 ,MRI诊断半月板撕裂的敏感度 90 .0 % ,特异度 91.9% ,符合率 91.2 %。结论 :MRI在半月板损伤的诊断中具有极高价值 ,对指导患者的治疗具有重要的临床意义。     

MR与关节镜诊断半月板损伤的临床价值研究

目的探讨MR与关节镜诊断半月板损伤的临床价值。方法本组72例患者检查86个膝关节,共172例半月板,入院后进行MRI检查评价半月板损伤情况,2周内进行膝关节镜检查,MRI检查结果按Fischer分级标准分I级信号、II级信号、III级信号,关节镜检查结果分正常、退变、撕裂。结果 MRI与关节镜检查诊断半月板损伤结果比较,X~2=1.432,P=0.698,κ=0.694;MRI与关节镜检查诊断半月板撕裂结果比较,X~2=0.529,P=0.629,κ=0.767,MRI诊断半月板撕裂的敏感度86.27%、特异度91.73%、阳性预测值81.48%、阴性预测值94.07%、阳性似然比10.43、阴性似然比0.15、准确度90.12%、假阳性率8.27%、假阴性率13.73%。结论 MRI能够较好的诊断半月板损伤的程度,特别是对半月板撕裂的诊断,MRI的Ⅲ级信号可作为临床选择关节镜检查和手术治疗的一个重要指征。     

半月板缝合术后:MRI诊断的价值

目的 评价常规MRI对缝合后半月板的诊断价值.资料与方法 对29例膝关节的32个缝合半月板(内侧半月板22个,外侧半月板10个)进行MRI检查,采用短回波时间序列(SE T.WI,TSE PDW和快速小角度激发的T2*WI)及长回波时间序列(TSE T2WI)扫描.以半月板3级信号作为MRI诊断不愈合或再撕裂的标准.二次关节镜的探查结果作为评价的金标准.然后用Fisher精确概率法和配对X2检验做统计学处理.结果 所有32个缝合后的半月板在二次关节镜中均表现为完全愈合.22个缝合后的内侧半月板中,SE T1WI、TSE PDW和T2*WI误诊为半月板撕裂(假阳性率)分别为36%、27%和36%,TSE T2WI则为5%;10个缝合后的外侧半月板中,SET1WI、TSE PDW和T2*WI的假阳性率均为20%,而TSE T2WI为0%.各序列对内、外侧半月板的假阳性率差异无统计学意义.结论 对缝合后的半月板进行MRI诊断时,采用半月板3级信号的诊断标准有可能导致较高的假阳性率,短回波时间的序列更为严重.     

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.