糖尿病足3例报告

糖尿病近年来有明显增高趋势 ,其并发骨关节病的发生率约 0 .1% [1] ,其中使足部骨关节及软组织坏死与感染的糖尿病足发生率最高 ,现报道 3例患者足部表现 :例 1:男 ,6 4岁。糖尿病 8年 ,右足溃疡 5个月 ,治疗不愈。Ｘ线表现 :右足普遍骨质稀疏 ,第 5趾骨破坏 ,隐约可见少许骨性关节面影 ,第 35骨远端不同程度破坏 (图 1)。例 2 :男 ,75岁。糖尿病 2 5年 ,左足趾皮肤挫伤、感染 ,多种抗生素治疗效果不佳 ,皮肤破溃蔓延至一、二足趾 ,痛疼消失 ,第三趾皮肤大量脓性分泌物 ,经糖尿病综合治疗 ,Ｘ线表现 :左足第二趾、远端二节趾骨已脱落 ,…     

皮肌炎和多发性肌炎的胸部X线表现(附61例临床X线分析)

本文报告61例皮肌炎和多发性肌炎的胸部X线表现。胸片示异常者共29例占47.5％,包括(1)肺间质纤维化19例;(2)胸膜改变包括胸膜肥厚、胸水、气胸及皮下和纵隔气肿共11例;(3)肺实质炎性浸润4例;(4)盘状肺不张1例,(5)横膈抬高6例;(6)并发肺癌2例;(7)心脏增大8例。笔者发现本病胸部X线改变具有多样性,胸膜改变并不十分少见。文章最后讨论了本病X线改变的病理基础及我们的体会。     

系统性硬皮病手的X线分析(附8例报告)

本文回顾性分析了8例系统性硬皮病(Progressive Systemic Sclerosis 简称PSS)手的临床X线表现。X线改变为:(1)末节指骨骨吸收;(2)软组织钙化;(3)骨质疏松;(4)手指软组织萎缩和/或硬化;(5)指间关节畸形;(6)关节病。结合文献简要讨论了其发病机理和鉴别诊断。     

足分枝菌病的临床及X线诊断

目的：探讨足分枝菌病的临床及X线特点。方法：对48例经病理证实的足分枝菌病患者的临床及X线表现进行回顾性分析。结果：48例均有不同程度足软组织肿胀、皮肤结节,其中22例有2～4个结节突起伴多处皮肤溃疡;26例有5～10个结节及3～8cm大小肿块,周围皮肤感染;窦道形成：有2～4个窦道18例,5～8个窦道30例,30例有深色脓液流出,18例有黑色“颗粒”物流出。X线征象：16例局限性软组织肿胀,32例弥漫性软组织肿胀;骨质破坏累及多个骨者38例,单骨者10例;17例骨皮质毛糙、呈侵蚀性骨质破坏,22例呈溶骨性骨质破坏,5例囊状或轻度膨胀性骨破坏,4例骨质破坏与骨质增生并存;在溶骨性骨质破坏中3例（6．27％）有0．8～1．3cm死骨形成;同侧胫骨或股骨扩散感染4例（8．33％）。结论：本病的临床及影像学表现有一定特征性,综合分析可提高对本病的诊断准确性。     

糖尿病性足病的X线诊断（附15例报告）

糖尿病系全身性疾病,当其并发骨关节改变时,称为糖尿病性骨关节病,为糖尿病的晚期并发症。因糖尿病血管病变而使肢端缺血和因神经病变而失去感觉,合并感染的足称为糖尿病性足病。在糖尿病性骨关节病中,糖尿病性足病发生率最高,约占91．9％。为提高对本病的认识,现将笔者搜集的15例糖尿病性足病的临床及X线表现总结分析如下。     

腱鞘巨细胞瘤:放射学表现的范围

腱鞘巨细胞瘤是最常见的实性软组织肿瘤,且仅次于腱鞘囊肿为第二位常见的手部肿瘤。次常见于足、踝、膝和髋。70%以上的病变X线显示为软组织肿物和/或侵蚀,但亦可有其他表现。作者复习了90例的病理和临床病史后发现:大部分发生于手指和手部(87.8%),膝部为5.5%,踝和足部为5.5%,髋部为1.1%,并报道了其中36例的放射学表现。18例(50%)仅表现为软组织肿物,5例(13.9%)为软组织肿物伴压迫性骨侵蚀,7例(19.4%)X线表现阴性,6例(16.7%)为非典型的X线表现包括骨膜反应、病变内钙化、以及渗透性的骨内侵犯。病变大部发生于指骨,示指和中     

免疫损害患者肺结核的影像诊断

目的　探讨几种免疫损害疾病并发肺结核患者的X线和CT所见 ,包括糖尿病、肾移植术后及获得性免疫缺陷综合征 (AIDS)。方法　回顾分析合并有肺结核的 2 0例糖尿病患者的胸部CT所见、10例肾移植术后患者的胸部X线片及 2例AIDS患者的CT片。结果　糖尿病并发肺结核的CT表现为 :大片融合性肺实变 (10例 ) ,在单一病变区内有多发小空洞 (9例 ) ,病变不按肺段分布(2例 ) ,多数病变具有卫星灶。肾移植术后并发肺结核的胸部X线表现为 :斑片及大片融合实变(6例 )和粟粒型肺结核 (4例 )。AIDS病合并肺结核的CT表现为 :纵隔淋巴结肿大 (1例 ) ,肺内浸润(1例 )及胸部以外的结核病变 (2例 ) ,包括颈部及腹膜后淋巴结肿大。结论　 3种免疫损害病变患者并发肺结核的主要CT及X线表现为大片融合病变、单一病变内的多发小空洞、粟粒型肺结核、纵隔淋巴结肿大及胸部以外的淋巴结肿大     

超激光疼痛治疗仪治疗足底筋膜炎87例

超激光疼痛治疗仪治疗各种慢性软组织痛 ,周围神经痛疗效显著 ,操作方便 ,非侵入无创伤 ,易被患者接受。我们自 2 0 0 1年 1月起采用超激光疼痛治疗仪治疗足底筋膜炎 87例 ,取得满意的疗效 ,现报告如下。1　临床资料1.1　一般情况　本组 87例 ,男 85例 ,女 2例。年龄 174 3岁 ,平均年龄 2 4岁 ;病程 2d3个月 ;左足 4 4例 ,右足 39例 ,双足 4例 :11例经理疗 ,封闭等复发或效果不佳 ,76例未作任何处理。临床表现 :足底中部和足跟部疼痛 ,以足尖或足跟行走时加重 ,局部有压痛。本病诊断比较容易 ,4 2例行足部X线检查未发现异常征象。1.2　治疗…     

血友病性骨关节病：附30例临床X线分析

本文报告30例血友病性骨关节病,其中1例为女性(血友病丙),X线片上可有以下10种改变:(1)关节囊、软组织肿胀;(2)关节间隙增宽或变窄;(3)骨性关节凹凸不整;(4)股骨髁间凹或鹰咀窝加深;(5)骨骺或骨端过度发育增大变方;(6)方形膑骨;(7)骨骺线或骨骺不规则;(8)关节骨性僵直;(9)骨内囊肿样变;(10)软组织内钙化。文中对上述表现进行了评价并对病理改变与X 线表现的关系进行了讨论。     

X线平片及MRI诊断动脉瘤样骨囊肿的价值

目的评价X线平片与MRI检查对动脉瘤样骨囊肿(ABC)的诊断价值。方法回顾性分析15例经手术病理证实的ABC的影像学表现,15例均行X线检查,5例行MRI检查。结果(1)15中例ABC发生于长骨13例,肋骨及骨盆各1例;(2)皂泡状或吹气球样膨胀性骨质破坏:X线15例,MR5例;(3)病灶内骨小梁间隔或骨嵴:X线11例,MR4例;(4)局限性骨质硬化:X线10例,MR4例;(5)骨壳边缘不全病理骨折:X线3例,MR1例;(6)骨膜反应:X线1例;(7)软组织肿块:无;(8)病灶内单发或多发囊肿:MR4例;(9)液-液平面:MR1例。结论X线平片显示病变的整体形态有优势,结合MRI显示病变组织成分综合分析有利于提高ABC的诊断符合率。     

糖尿病足的X线诊断

目的：探讨糖尿病足的X线特征。方法：回顾性分析31例糖尿病足患者的临床及X线表现。结果：骨质疏松23例,骨质破坏27例,神经营养性关节病2例,软组织肿胀31例,气性坏疽17例,足背动脉或跖骨间动脉钙化9例。结论：糖尿病足的X线表现具有一定的特征性,对临床诊断与治疗具有一定意义。     

Potential role of FDG PET in the setting of diabetic neuro-osteoarthropathy: can it differentiate uncomplicated Charcot's neuroarthropathy from osteomyelitis and soft-tissue infection?

BACKGROUND: This paper is based on the results from an ongoing prospective trial designed to investigate the usefulness of FDG PET in the complicated diabetic foot. AIM: To investigate the potential utility of FDG PET imaging in the setting of acute neuropathic osteoarthropathy (Charcot's foot). PATIENTS AND METHODS: A total of 63 patients, in four groups, were evaluated. The groups were: (A) 17 patients with a clinical diagnosis of Charcot's neuroarthropathy (11 men, six women; mean age: 59.4+/-8.6 years); (B) 21 patients with uncomplicated diabetic foot (16 men, five women; mean age: 63+/-10 years); (C) 20 non-diabetic patients with normal lower extremities (12 men, eight women; mean age 54+/-19 years); and (D) five patients with proven osteomyelitis secondary to complicated diabetic foot (three men, two women; mean age: 61.2+/-13.9 years). Five patients in group A had foot ulcer and intermediate to high degree of suspicion for superimposed osteomyelitis. Each subject underwent FDG PET imaging of the lower extremities in addition to MRI and the findings were compared with the final diagnostic outcome based on histopathology and clinical follow-up. The images were examined visually for focal abnormalities. Regions of interest were assigned to the sites of abnormal FDG uptake for calculating maximum standardized uptake value (SUVmax). Two important clinical decision-making issues were explored: (1) whether FDG PET shows a definitive uptake pattern in Charcot's neuroarthropathy and if so whether that could be utilized to differentiate it from other complicated forms of diabetic foot like osteomyelitis and cellulitis, which is frequently a diagnostic challenge in this clinical setting; and (2) how accurate FDG PET is in detection soft tissue infection in patients with Charcot's foot. These issues were examined by utilizing FDG PET findings along with MRI results in the same patient. RESULTS: We observed a low degree of diffuse FDG uptake in the Charcot's joints. This was clearly distinguishable from the normal joints. The SUVmax in the Charcot's lesions varied from 0.7 to 2.4 (mean, 1.3+/-0.4) while those of midfoot of the normal control subjects and the uncomplicated diabetic foot ranged from 0.2 to 0.7 (mean 0.42+/-0.12) and from 0.2 to 0.8 (mean 0.5+/-0.16), respectively. The only patient with Charcot's foot with superimposed osteomyelitis had an SUVmax of 6.5. The SUVmax of the sites of osteomyelitis as a complication of diabetic foot was 2.9-6.2 (mean: 4.38+/-1.39). Unifactorial analysis of variance test yielded a statistical significance in the SUVmax between the four groups (P<0.01). The SUVmax between the normal control groups and the uncomplicated diabetic foot was not statistically significant by the Student's t-test (P>0.05). In the setting of concomitant foot ulcer FDG PET accurately ruled out osteomyelitis. Overall sensitivity and accuracy of FDG PET in the diagnosis of Charcot's foot was 100 and 93.8%, respectively; and for MRI were 76.9 and 75%, respectively. FDG PET showed foci of abnormally enhanced uptake in the soft tissue which was suggestive of inflammation in seven cases (43.75%) which were proven pathologically to be secondary to infection. In only two of these cases the features of soft tissue infection were noted on the magnetic resonance images. CONCLUSION: The results support a valuable role of FDG PET in the setting of Charcot's neuroarthropathy by reliably differentiating it from osteomyelitis both in general and when foot ulcer is present.     

马杜拉足的临床X线病理对照研究(附100例分析)

目的:分析马杜拉足的临床X线特点及某些征象的病理基础,并对致病菌加以探讨。方法:收集经手术证实的马杜拉足100例进行临床X线分析,其中选有窦道形成的30例做病理及细菌学检查。结果:临床特点:1病程长;2软组织肿胀;3多发窦道形成,可经窦道排出黑褐色颗粒。X线表现:1软组织肿胀,可见软组织内结节样改变;2溶骨性骨破坏,死骨少见,足骨间关节及多骨受累,溶骨破坏较骨修复占优势。病理特点:1霉菌性肉芽肿形成;2霉菌颗粒;3溶骨性骨破坏。结论:马杜拉足在X线上具有持征性表现,X线平片是诊断本病的主要影像学方法。     

胸背穿支皮瓣游离移植修复足踝部软组织缺损的手术方法及效果

目的探讨显微外科技术下采用胸背穿支皮瓣游离移植修复足踝部软组织缺损的手术方法及效果。方法回顾性分析2011年5月—2015年12月三亚市人民医院骨科收治的80例足踝部软组织缺损患者的临床资料,男性57例,女性23例,年龄18~67岁,平均39.4岁。软组织缺损部位:足背部14例,足踝部40例(内踝15例、外踝20例、后踝5例),足跟部26例。创伤缺损面积8.2cm×4.9cm~11.6cm×11.7 cm,合并创面感染30例。所有患者均在显微外科技术下采用胸背穿支皮瓣游离移植修复治疗,观察术后患者的皮瓣存活率、足踝部功能、移植皮瓣的感觉功能。结果 80例患者均成功完成手术,其中72例患者术后皮瓣完全存活,创面达到I级愈合标准;8例患者出现皮瓣移植术后青紫、皮温过低(26℃),其中7例经手术医生及时处理静脉危象后皮瓣存活,1例移植失败,出现皮瓣广泛性坏死。79例存活皮瓣中有76例获得随访,3例因各种原因未能得到随访。随访时间6~9个月,平均7.8个月。术后3个月感觉功能评价:S1级11例(14.47%),S2级18例(23.69%),S3级40例(52.63%),S4级7例(9.21%);美国足与踝关节协会(AOFAS)踝与后足功能评分67~92分,其中优23例(30.26%),良37例(48.69%),可11例(14.47%),差5例(6.58%)。结论显微外科技术下采用胸背穿支皮瓣游离移植修复足踝部软组织缺损术后皮瓣存活率高、踝关节功能恢复良好。     

Soft tissue enhancement on time-resolved peripheral magnetic resonance angiography

PURPOSE: To evaluate the incidence and locations of soft tissue enhancement on time-resolved two-dimensional projection magnetic resonance angiography (MRA) of the calf and foot. MATERIALS AND METHODS: Time-resolved two-dimensional projection MRA of the knee, calf, and foot, performed at 1.5 Tesla using the head coil, was retrospectively reviewed in 326 patients. Soft tissue enhancement of the foot was identified and graded by blinded review. Subsequently, patient medical records were reviewed to determine the presence or absence of diabetes, cellulitis, gangrene, and ulceration of the foot and presence of neuropathic joints. RESULTS: Enhancing spots were identified in 228 patients. For those feet without clinical abnormalities, diabetic patients had an average of 1.2 enhancing spots per foot, while nondiabetics had only 0.6 (P < 0.001). Higher-grade lesions were more prevalent in diabetics and in heavier patients. Of 64 patients with follow-up, 8 (13%) developed cellulitis (N = 4) or ulceration (N = 4) at the location of an enhancing spot, including 5 diabetic and 3 nondiabetic patients. CONCLUSION: Pedal soft tissue enhancement frequently occurs on time-resolved gadolinium (Gd):MRA of the feet. The etiology is uncertain, but the high frequency in diabetic patients and observation of progression to cellulitis/ulceration suggest this soft tissue enhancement may identify sites of subclinical pedal soft tissue injury.     

MRI spectrum of bone changes in the diabetic foot

Purposes

(1) To assess the prevalence of bone marrow changes in the diabetic foot and (2) to discuss the clinical significance of these changes.

Methods

85 patients with radiographic and magnetic resonance imaging (MRI) foot examinations were selected. Inclusion criteria were clinical diagnosis of diabetes and bone changes on radiographs and MRI. The material was selected from the image storage (PACS) system. We searched for vascular (infarct and necrosis), traumatic (bruise and occult fractures), destruction and debris, dislocation, osteochondritis, osteomyelitis. Five patients had bilateral examinations. A total of 90 feet were evaluated.

Results

From 90 feet, 17 (18.9%) presented with vascular changes, from them, 11 feet had infarct and 6 feet had necrosis. Twenty (22.2%) feet had traumatic changes; of them, 10 (50%) had edema on MRI. Five (25%) cases had occult fracture on MRI; and 5 (25%) had visible fracture on both X-ray and MRI. Bone destruction was detected in 8 (8.9%) feet. Bony debris was visualized in three of them. Bone dislocation was visualized in 11 (12.2%) feet. There was evidence of osteochondritis in twenty-four (26.7%) feet. Osteomyelitis was diagnosed in ten (11.1%) feet.

Conclusion

Diabetic foot is a challenge for both clinicians and radiologists due to its complexity. The bone derangements inherent to the diabetic foot can be evaluated with high accuracy with MRI.     

基于free-style理念探讨穿支螺旋桨皮瓣在修复踝关节周围软组织缺损的应用

目的 运用free-style理念设计穿支螺旋桨皮瓣修复踝关节周围软组织缺损,探讨其可靠性与临床疗效.方法 回顾性分析2017年9月—2019年6月陕西中医药大学附属医院创伤二科收治的踝关节周围软组织缺损患者34例,男性21例,女性13例;年龄21～69岁,平均47.3岁;道路交通伤10例,重物砸伤6例,高处跌落伤7例...     

动态增强MRI评估糖尿病足足底软组织血流灌注情况

目的：初步探讨动态增强MRI评估糖尿病足病患者足底软组织血流灌注的技术方法及应用价值,并分析糖尿病足软组织微循环的病变特征。方法：26例单侧足发病(湿性坏疽12例,干性坏疽4例,混合性坏疽6例,缺血高危足4例)的糖尿病足患者,运用2D FLASH序列行双侧足底软组织单层动态增强MRI检查,对比分析双足动态增强曲线类型及...     

X线平片阴性足部外伤的MRI分析

目的 探讨MRI对X线平片阴性的距骨远侧足部损伤的诊断价值.方法 77只X线平片检查阴性的伤足做MRI检查,采用SE/T1WI、TSE/SPIR/T2WI、3D-water sel.-FFE 3种序列.结果 共54例有阳性发现.伤后30 d以内者47例,骨挫伤20例,肌肉损伤12例,骨挫伤并肌肉损伤6例,骨挫伤并软组织间隙损伤2例,软组织间隙损伤3例,细小骨折3例,骨挫伤并骨折1例.伤后30 d以上者7例,主要表现骨松质硬化、轻微骨骼形态改变.结论 MRI对X线片阴性但症状明显的足外伤具有重要诊断价值.