腰骶角与退变性脊柱滑脱的相关性分析

目的 探讨腰骶角与腰椎稳定性、退变性脊柱滑脱之间的关系。方法 对114例退变性脊柱滑脱患者进行腰椎动力位X线摄片，测量每例患者不同体位的腰骶角度和椎体滑脱程度并进行相关性分析。结果 腰骶角与前向椎间位移不稳及退变性脊柱滑脱之间存在显著正相关；立位、过伸位的腰骶角度及椎体滑脱程度明显大于卧位。结论 腰骶角的大小与退变性脊柱滑脱的发生及椎体滑脱程度有直接的关系，腰椎动力位摄片更有利于脊柱滑脱的显示。     

站立前屈位X线片联合仰卧位MRI评估退变性腰椎滑脱节段的稳定性

目的:探讨站立前屈位X线片联合仰卧位MRI评估退变性腰椎滑脱节段稳定性的可靠性及可行性。方法:回顾性分析2016年1月1日～2018年6月30日在山东大学齐鲁医院(青岛)脊柱外科住院治疗的87例退变性腰椎滑脱症患者的临床资料。男20例,女67例;年龄47～87岁(65.9±9.0岁)。滑脱节段:L3 10例,L4 66例,L5 11例;依据Meyerding分类,Ⅰ度滑脱82例,Ⅱ度滑脱5例。所有患者均在站立位获得前屈、后伸侧位X线片及仰卧位MRI片,利用图像存档通信系统(PACS系统)对影像数据进行回顾性分析,包括站立位前屈(F)、后伸(E)X线片和仰卧位MRI(S),MRI图像选取T1加权正中矢状面图像。将滑脱距离与椎体宽度的百分比定义为滑脱百分比并用于最后分析。计算出F与E、F与S之间滑脱百分比的差值定义为滑移率。滑移率≥8%定义为节段不稳定。结果:三种体位平均滑脱百分比F位最大[(16.97±5.93)%],其后依次为E位[(14.04±6.38)%]和S位[(9.89±5.34)%],三种体位之间有统计学差异(F-E:P0.01;F-S:P=0.00;E-S:P=0.00)。F-S、F-E之间平均滑移率分别为(7.08±4.60)%(-0.49%～24.32%)、(2.93±3.29)%(-3.46%～11.24%),两者之间有统计学差异(P=0.00)。以滑移率≥8%为标准,诊断为节段不稳的患者共40例,其中F-S发现37例(92.5%),F-E发现7例(17.5%);F-E显示滑脱节段不稳的7例中,4例F-S也显示不稳,另3例(7.5%)F-S未显示不稳。结论:对于退变性腰椎滑脱节段稳定性的评估,应用站立前屈侧位X线片结合平卧位MRI比站立前屈后伸位X线片能更好地显示滑脱节段的不稳定;站立前屈位X线片联合仰卧位MRI片可明显提高诊断的准确性,降低漏诊率。     

后路腰椎椎体间融合术后cage移位的危险因素分析及处理策略

目的:探讨开放后路腰椎椎体间融合术后cage移位的发生率、相关危险因素及其处理对策.方法:回顾性分析2016年1月～2017年12月在我院骨科腰椎专业组行开放后路腰椎椎体间融合手术的970例患者,男423例,女547例;年龄14～87岁(56.8±12.5岁).随访时腰椎侧位X线片上cage后缘标记线位置较术后首次测量...     

脊柱压缩性、爆裂性骨折的X线平片及CT的诊断价值

目的探讨X线平片、CT检查对脊柱压缩性缩性、爆裂性骨折的诊断价值。方法收集我院2005年2月-2008年11月间136例胸腰椎压缩性、爆裂性骨折病例,观察分析X线平片及CT上的脊柱骨性结构、椎管损伤情况。结果X线平片上136例患者127例显示胸腰椎压缩性、爆裂骨折,其中14例椎管内见明确小骨片（10％）;9例未见明确骨折征象。CT上全部病例可见椎体粉碎骨折。40例前柱骨折;22例椎体中柱骨折;25例后柱骨折;脊柱前、中两柱同时骨折23例：前、中、后三柱同时骨折26例。结论CT检查更能显示脊柱压缩性、爆裂性骨折中骨折碎片、脊椎前,中,后柱损伤的详情,临床上要重视X线平片及cT检查的互补作用。     

人体全长X线片的构建及其评价整体矢状面平衡的可靠性和准确性

目的 :应用数字化X线摄影(digital radiography,DR)系统构建新型人体全长X线片,并分析其评价人体整体矢状面平衡的可靠性和准确性。方法:2018年10月～2019年10月,采用DR系统对30例志愿患者一次性连续曝光采集影像数据,运用医学图像处理软件全自动拼接获取人体全长X线片,其中男13例,女17例,年龄45～65岁(56.5±6.1岁)。同时接受全脊柱和下肢X线片检查。利用Surgimap软件由两名脊柱外科医师和一名影像科医师分别在人体矢状面全长X线片、全脊柱和下肢侧位X线片上分别独立测量:胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis, LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slop,SS)、矢状面垂直轴偏距(sagittal vertical axis,SVA)、骶股角(sacrofemoral angle,KFA)、膝关节角(knee angle,KA)、踝关节角(ankle angle,AA)、骨盆位移(pelvic shift,P.Shift)。通过独立样本t检验验证相关参数在不同摄片方式中的一致性,通过组内相关系数(ICC)分析观察者内以及观察者间参数值的一致性。结果:人体矢状面全长X线片与全脊柱和下肢侧位X线片上测量的脊柱-骨盆-下肢参数比较的P值为0.782～0.969,均无统计学差异,具有一致性。人体矢状面全长X线片测量的TK、LL、PI、PT、SS、SVA值与全脊柱侧位X线片上测量值的观察者内ICCs分别为0.696～0.857、0.724～0.873、0.672～0.943、0.691～0.851、0.648～0.852、0.645～0.867;观察者间的ICCs为0.678～0.822、0.704～0.872、0.772～0.904、0.763～0.936、0.665～0.824、0.541～0.665;人体矢状面全长X线片上测量的PI、PT、SS、KFA、KA、AA、P.shift值与下肢侧位X线片上测量值的观察者内ICCs分别为0.673～0.932、0.623～0.828、0.634～0.861、0.701～0.873、0.645～0.867、0.679～0.855、0.592～0.827;观察者间的ICCs为0.665～0.914、0.631～0.811、0.625～0.843、0.541～0.765、0.591～0.753、0.613～0.798、0.543～0.762。结论:采用DR系统一次性连续曝光成像构建人体全长X线片可行,脊柱-骨盆-下肢矢状面参数与全脊柱和下肢侧位X线片上测量结果一致率高,且具有良好的可靠性和准确性。     

棘突不共线在颈椎"骨错缝、筋出槽"诊断中的临床应用

目的:研究X线平片对椎体旋转诊断的应用价值。方法:自2010年5月至2011年6月收集颈椎病患者129例,行颈椎X线正位平片检查,其中119例存在棘突不共线纳入测量,另10例棘突均共线不纳入测量。纳入测量病例中男28例,女91例,年龄24～65岁,平均(48.53±14.32)岁。纳入病例行CT检查,记录X线平片中观察到的棘突不居中的椎体节段及个数,再对棘突不居中的椎体节段行CT后多平面重建,观测相应节段椎体旋转及棘突偏歪的情况,统计分析X线平片检查中观测到的不居中的棘突个数与椎体旋转之间的关系。结果:不共线棘突个数为1～6个时,椎体旋转率分别为45.45%,46.67%,56.86%,62.07%,77.14%,85.19%。结论:不共线棘突数越多,相应椎体旋转可能性越大。     

痛点封闭治疗第3腰椎横突综合征68例

自 1994年～ 1999年 ,我们采用痛点封闭的方法治疗第3腰椎横突综合征 ,收到良好效果 ,现总结报告如下。1　临床资料1.1　一般资料　本组 6 8例 ,均为门诊患者 ,男性 36例 ,女性 32例。年龄最小 16岁 ,最大 6 0岁。病程最短 3d,最长约10 a。有腰部扭伤病史 6例 ,腰部过度活动史 16例 ,余无明显诱因。左侧 2 1例 ,右侧 18例 ,双侧为 2 9例。影像学检查 :本组病例均要求拍 X线片 ,伴有臀腿疼痛者需拍 CT片 ,以排除腰椎间盘突出症及其它骨科疾病。 X线片显示 ,腰椎无畸形 ,2 4例椎体前缘有唇样增生或骨刺 ,11例脊柱轻度侧弯 ,18例腰椎生理曲度…     

强直性脊柱炎骶髂关节病变的X线平片和CT诊断及鉴别诊断

目的探讨强直性脊柱炎(AS)骶髂关节病变的X线平片、CT表现,以提高其诊断及鉴别诊断水平。方法对70例AS骶髂关节病变的X线平片、CT表现进行回顾性分析,并根据纽约标准分级。结果70例中,0级0例;l级X线平片4例,CT 11例;Ⅱ级X线平片10例,CT 15例;Ⅲ级28例;Ⅳ级16例(Ⅲ、Ⅳ级病变X线平片和CT分级相同)。结论X线平片、CT在AS骶髂关节病变诊断中具有重要价值。CT在早期病变发现、分级和疗效判断方面优于X线平片。     

中国汉族正常成人心骶角的测定及意义

目的 :测量脊柱与内脏的测量参数心骶角在脊柱全长正侧位X线片上的数据,比较心骶角在不同性别和不同年龄组间差异,并探索其临床应用价值。方法:纳入正常成人108例,男53例,女55例,年龄18~60岁,按照性别和年龄(18~44为青年,45~60为中年)分成四组:第一组为青年男性组(21例);第二组为中年男性组(32例);第三组为青年女性组(26例);第四组为中年女性组(29例)。将脊柱全长正位X线片上S1上终板中点和心脏冠状位最外侧点连线与重垂线之间的夹角定义为冠状位心骶角;将脊柱全长侧位X线片上S1上终板中点和心脏矢状位最前点连线与重垂线之间的夹角定义为矢状位心骶角。采用单因素方差分析比较各组间角度差异。采用独立样本t检验比较男女性别间角度差异,采用组内相关系数评估观测者间信度、观测者内信度以及测量的可重复性。结果:冠状位心骶角测值:青年男性组19.6°±2.8°,中年男性组20.6°±3.5°,青年女性组19.5°±3.6°,中年女性组20.8°±2.3°。矢状位心骶角测值:青年男性组17.0°±4.4°,中年男性组16.7°±4.3°,青年女性组14.7°±3.5°,中年女性组16.3°±4.8°。冠状位和矢状位心骶角在各组间的差异无显著性(P0.05)。冠状位和矢状位心骶角在男女性别间无显著性差异(P0.05)。评估观测者间客观信度、观测者内精确信度和测量的可重复性的组内相关系数在0.89~0.98之间(P0.05)。结论:中国汉族正常成人心骶角是一个解剖常数,具有良好的信度和可重复性,可以作为脊柱-内脏指标参与评估脊柱在冠状位和矢状位的平衡。     

退行性腰椎侧凸与骨质疏松症的相关性研究

目的:分析成人退行性腰椎侧凸与骨质疏松的相关性。方法:2004年1月至2009年6月门诊及病房共收治退行性腰椎侧凸患者69例,男6例,女63例;年龄51～82岁,平均69.3岁;所有患者均行X线、MRI检查,确诊并记录患者侧凸Cobb角;对照组50例,男9例,女41例,均为非腰椎侧凸患者,其中腰椎管狭窄症37例,腰间盘突出症8例,腰椎滑脱症4例,腰椎管内占位1例,平均年龄62.6岁。应用双能X线吸收法测定腰椎(L2～L4)及股骨颈、股骨粗隆和Ward′s三角骨密度值及T值,分析患者年龄、Cobb角与对应T值的相关性。结果:在69例退行性腰椎侧凸患者中,平均T值为-2.8±1.9,分布在-0.9～-4.7之间,合并骨质疏松52例,骨量减少14例;对照组平均T值-1.2±1.6,分布在0.4～-2.8之间;两组比较差异有显著性(P0.05)。骨质疏松程度与年龄呈明显正相关,而与Cobb角无相关。结论:骨质疏松症是退行性腰椎侧凸发病的危险因素,同时骨质疏松程度随着年龄的增大而增加,但与侧凸程度无明显相关。     

Evaluation of acetabular coverage of the femoral head with anteroposterior and false profile radiographs of hip joint

To assess the three-dimensional acetabular coverage of the femoral head, we focused on Wiberg's center-edge (CE) angle on anteroposterior radiographs and Lequesne's vertical-center-anterior margin (VCA) angle on false profile radiographs of the hip joint. The study analyzed 566 hip joints of 283 subjects with coxarthrosis (mean age, 34 years). We examined three-dimensional coverage using a calculation program for determining acetabular coverage from anteroposterior radiographs of the hip. There was a significant correlation between acetabular coverage, the CE angle, and the VCA angle (P<0.001). The relationship between the VCA angle (X₁), the CE angle (X₂), and the acetabular coverage (Y) on multiple regression analysis was: Y=47.8+0.06 X₁+1.03 X₂ (r=0.97;P<0.001) We investigated patients showing normal CE and Sharp angles, despite having clinical symptoms, but abnormal VCA angles. This was the finding for 11 joints (10.9%). Therefore, to assess acetabular coverage, it is important to examine not only the CE angle but also the VCA angle. The VCA angle reflects both anterior coverage and pelvic tilt in the standing position. This technique makes it possible to estimate acetabular coverage without special facilities and may be useful for the mass screening of hip joints for detecting acetabular dysplasia. No benefits in any form have been received or will be received from a commercial party related, directly or indirectly, to the subject of this article. No funds were received in support of this study.     

髋关节发育异常超声波检查和X线检查的比较

[目的]评价超声波检查在小婴儿发育性髋关节发育异常(DDH)中应用的意义。[方法]50个髋关节同时接受超声波检查和骨盆平片检查,获得α角和髋臼指数。根据各自的诊断标准进行判断,并将结果进行比较,判断2种检查方式有无差异。[结果]X线检查阳性患儿为42髋,超声波检查阳性患儿仅为13髋,诊断一致率42%,Kappa值为0.13(<0.4),通过配对资料的卡方检验,x2=27.034(P<0.01),2种诊断方法的结果有明显差异。随着患儿年龄的增加,诊断一致率升高。髋臼指数和α角经相关分析显示两者呈负相关,相关指数为-0.377,显示α角越大,髋臼指数越小。[结论]在小婴儿中由于超声波能够显示髋关节的软骨部分,因此相比X线片来说,超声波检查能够更加真实地反映小婴儿髋关节的发育情况,可以提高相对准确率。同时超声波检查操作起来比较方便,可以多次重复检查而不会给患儿带来伤害,对于有高危因素的婴儿可以在不同时间予以追踪检查及时给予必要的干预。因此小婴儿的髋关节评价提倡超声波检查。     

Symptoms Associated With Compartmental Radiographic Disease in Hip Arthroplasty Patients

We compared symptoms to radiographic disease in the medial (less weight bearing) and axial and superolateral (greater weight bearing) compartments in total hip arthroplasty patients. Western Ontario and McMaster Universities Osteoarthritis Index scores (0 [best] to 100 [worst]) were better for patients with more medial than axial radiographic disease for pain (41 vs 53; P =.002), stiffness (43 vs 56; P =.003), and function (49 vs 58; P =.03). Similarly, patients with more medial than superolateral disease had fewer symptoms. Patients with disease principally in the less weight-bearing medial compartment had milder symptoms than their radiographs suggested. Patients with disease principally in the greater weight-bearing axial and superolateral compartments had more severe symptoms than their radiographs suggested. The association between symptoms and radiographic disease depended on which compartment of the hip was most affected.     

Erect chest radiography in the setting of the acute abdomen: essential tool or an unnecessary waste of resources?

INTRODUCTION

It has been suggested that changes to the training schemes of junior doctors and the increased pressure on emergency departments to manage their patients within a limited time might increase the number of unnecessary investigations performed on emergency admission patients. This, in turn, may lead to an increased number of investigations with normal results. In this study we try to analyse the role of the chest X-ray (CXR) as a diagnostic tool in patients presenting with acute abdominal pain.

PATIENTS AND METHODS

A retrospective study was performed of the request forms and results of all chest radiography performed on patients admitted on the emergency surgical intake with acute abdominal pain through utilisation of the prospec-tively maintained electronic radiology database. The indications were compared to the guidelines published by the Royal College of Radiologists (RCR) which have been adopted as the standard of care.

RESULTS

A total of 334 chest X-rays were identified of which only 23 (7%) had new findings. Four (1%) patients had free gas under the diaphragm. Of the CXRs, 258 (77%) were reported normal whilst 53 (16%) had old changes which were described in their hospital records and previous radiographs. Of the CXRs with new findings, only 20 were clinically significant and, of these, four (1%) were surgically significant.

CONCLUSIONS

The majority of CXRs performed on emergency surgical admissions with abdominal pain are unnecessary. By obtaining a clear history, performing a thorough clinical examination and following the RCR guidelines most of the CXRs could be avoided. This would lead to less radiation exposure, reduce delays to diagnosis, and provide significant financial savings.     

Diagnostic performance of bilateral false profile radiographs in early hip osteoarthritis

Objectives

1. To show that the anterior hip joint space is profiled only on the contralateral false profile radiograph. 2. To provide normal values of hip joint space width on anteroposterior and false profile radiographs. 3. To identify the best sites for joint space radiographic measurements to depict early hip osteoarthritis.

前后椎间隙比判断腰椎不稳的可行性分析

目的探讨动力位摄X线片前后椎间隙比判断腰椎不稳的可行性。方法采用前后椎间隙比法对经传统方法诊断为腰椎不稳(18例)和无腰椎不稳患者(18例)的动力位X线片张口状改变角度进行测量。结果腰椎不稳病例中有16例阳性,2例阴性;正常者中有3例阳性,15例阴性。结论前后椎间隙测量比方法可用于腰椎节段不稳的判断。     

不同X线方法计算髋臼杯前倾角的准确性和可靠性研究

[目的]本文研究了文献上7种X线片测量髋臼前倾角的可靠性和准确性,以总结出适合临床应用的测量方法.[方法]对2011年9月20日～10月20在积水潭医院矫形骨科进行初次全髋关节置换的60个病人60例髋关节进行了CT和X线片测量髋臼假体前倾角研究.以CT测量结果为金标准,三位独立的测量者使用7种X线测量方法测量的前倾角结果与CT测量的结果进行了比较以评估各种方法的准确性,并评估了各种测量方法的组内和组间测量的可靠性.[结果]所有7种X线测量方法均有很高的组内和组间测量可靠性.与CT测量结果相比较,Widmer方法和Visser方法是不准确的,其他方法均是准确的.Visser方法与解剖学前倾角有正向强相关性.[结论]7种X线测量髋臼假体前倾角的方法中Lewinneck、Hassan、Ackland、Liaw、和Pradhan方法是可靠和准确的,Wid-mer方法和Visser方法是不准确的,但Visser方法可以用于测量髋臼假体的解剖学前倾角.考虑到测量的准确和计算的简便性,建议临床上采用Lewinneck方法和Liaw方法测量髋臼假体的前倾角.     

An analysis of radiographic parameters comparison between lumbar spine latericumbent and full-length lateral standing radiographs

Background Context

The lumbar spine latericumbent and full-length lateral standing radiographs are most commonly used to assess lumbar disorder. However, there are few literatures on the difference and correlation of the sagittal parameters between the two shooting positions.