隐匿性骨折30例分析

目的：探讨隐匿性骨折的诊断与治疗。方法：对30例临床怀疑隐匿性骨折的患者行CT及MRI检查。结果：所选病例X线平片均未显示明显骨折线，27例行CT检查，其中20例CT显示有骨折线，余6例再行MRI检查，显示骨挫伤，3例直接行MRI检查，显示有骨挫伤。结论：X线未显示明显骨折，临床怀疑隐匿性骨折患者应行CT、MRI检查。     

隐匿性骨折30例临床诊治体会

目的探讨隐匿性骨折的诊断与治疗。方法对临床怀疑隐匿性骨折的患者行CT及MRI检查,确诊为隐匿性骨折30例。结果所选病例X线平片均未显示明显骨折线,27例行CT检查,其中20例CT显示有骨折线,余7例再行MRI检查,6例显示骨挫伤,5例直接行MRI检查,4例显示有骨挫伤。结论X线未显示明显骨折,临床怀疑隐匿性骨折患者应行CT、MRI检查。     

MSCT 和 MRI 对隐匿性骨折的诊断分析和临床价值

隐匿性骨折主要为骨外伤后骨小梁微骨折及其导致的骨髓充血、水肿,但无明显的骨皮质骨折［1］。也有文献认为是隐匿性骨创伤［2］。此类骨折是指 X线平片检查为阴性,但实际有骨折存在的骨创伤类型［3］。随着 MRI 和 MSCT 技术的不断发展,在骨关节系统的应用也日益普及。笔者回顾性分析56例 X 线平片表现正常,但临床症状明显,或疑有骨折的患者,经 MSCT 和 MRI 检查最终确诊的患者的影像学资料,分析 MSCT 及 MRI 在隐匿性骨折中的诊断价值。     

高频超声在撕脱性骨折与副骨鉴别诊断中的应用价值

目的探讨超声在撕脱性骨折与副骨鉴别诊断中的应用价值。方法 457例踝关节扭伤患者行超声检查,判断其腓骨表面的游离骨块性质并与X线和(或)CT检查结果对照。结果 457例踝关节扭伤患者均行X线,对疑似撕脱性骨折病例行CT检查。证实撕脱性骨折135例,腓骨下副骨49例。超声诊断撕脱性骨折117例,诊断副骨47例,其中超声漏诊撕脱骨折15例,漏诊副骨5例,将6例撕脱骨折误诊为副骨,3例副骨误诊为撕脱性骨折。超声检查与X线或CT检查具有一致性。结论超声能够清晰显示撕脱性骨折与副骨的形态及边缘状况,并且可显示局部软组织肿胀、积液或者积血等改变,可作为两者间鉴别的重要检查手段。     

小儿急性骨髓炎超声诊断和X-线、CT对照分析

目的探讨小儿急性骨髓炎的超声和X-线平片、CT表现及其诊断价值。方法23例小儿急性骨髓炎患者均经穿刺手术病理证实,术前全部患者行X-线平片、增强CT和超声检查。结果X-线对小儿急性骨髓炎的早期诊断灵敏性和特异性较低。CT特点:7d左右出现骨密度不均匀,10d左右显示骨膜反应,2周以内可见骨质破坏。超声特点:最早征象为深部软组织肿胀,4d左右可显示骨膜抬高及少量骨膜下积液。10天后可显示骨皮质破坏,粗糙不平,部分患者骨髓腔内可见不规则无回声区,骨质破坏周围软组织内可见丰富血流信号。结论超声检查对小儿急性骨髓炎有较高的应用价值,可作为小儿急性骨髓炎患者的首选检查方法。     

探讨老年人股骨颈隐匿性骨折采用螺旋CT轴位扫描联合MRI诊断的临床效果

目的:探讨老年人股骨颈隐匿性骨折采用螺旋CT轴位扫描联合MRI诊断的效果。方法:选取单县中医医院2021年1月—2022年6月期间收治的98例疑似老年人股骨颈隐匿性骨折患者作为研究对象,患者均接受螺旋CT轴位扫描、MRI检查,将关节镜检查结果作为金标准,对比分析检查螺旋CT轴位扫描联合MRI检查的准确率。结果:98例疑似老年股骨颈隐匿性骨折患者经关节镜检查确诊89例,螺旋CT轴位扫描联合MRI检查准确率94.90%、灵敏度98.88%高于螺旋CT轴位扫描的89.80%、94.38%和MRI检查的88.78%、93.26%,差异有统计学意义(P<0.05)。98例疑似老年股骨颈隐匿性骨折患者接受螺旋CT轴位扫描检查,轴位平扫对骨折端移位、碎骨片、骨折线显示良好,清晰显示出并发损伤和附近软组织,也可显示椎管变窄。但无法满意显示出骨折三维立体状况和水平方面骨折线。MRI检查主要表现为不规则、稍长/短T2线形异常信号或长T₁,附近出现不规则形长T2骨髓挫伤水肿信号异常,合并髋附近软组织存在程度不同的水肿信号异常。此次MRI确诊的83例患者,包含4例CT轴位扫描大转子...     

61例隐匿性骨折的螺旋CT诊断结果分析

回顾性分析我院2011~2014年诊治的61例隐匿性骨折患者相关资料,患者入院后经过DR平片检查未显示骨折,患者行16层螺旋CT扫描,并行多平面重组和容积重建后处理技术,分析螺旋CT在隐匿性骨折中的诊断效果。结果 61例患者均经过X光照片(DR)和16层螺旋CT扫描,CT诊断符合率为100%,与X线照片对比,差异具有统计学意义(P〈0.05);61患者均为骨皮质断裂或骨皮质皱褶,其中25例(40.98%)肋骨骨折;13例(21.3%)脊椎骨折;12例(19.7%)颅面骨骨折;4例(6.6%)髌骨纵斜型骨折;3例(4.9%)跟骨骨折;2例(3.3%)跖骨骨折;1例(1.6%)股骨颈骨折;1例(1.6%)肩胛骨骨折。隐匿性骨折发病率较高,临床上采用螺旋CT诊断效果理想,能够对骨折患者做出明确诊断,检出率较高,值得推广使用。     

跟骨骨折的X线平片、CT及三维CT对比研究

18例跟骨外伤患者均行X线平片、常规CT及三维CT成像检查,X线平片包括侧位及轴位.结果 18例中X线平片阳性16例,可疑2例;CT及三维CT全部阳性.在跟骨骨折的X线检查中,平片占有重要地位,CT对隐匿性骨折、细微骨折的显示优于平片,三维CT是平片和CT不可替代的补充,并可为治疗的选择提供更多信息.     

超声显像在小儿骨折牵引治疗中的应用

目的探讨超声显像在小儿骨折牵引治疗中对骨折诊断及愈合监测的临床价值.方法对37例采用牵引术治疗的闭合性骨折的X-线和超声特点进行对比分析.结果超声诊断骨折结果与X-线片吻合;可清晰显像X-线难以显示的血肿机化期,对原始骨痂的显像时间亦较X-线早 2～7 d.结论超声观察骨折及骨折愈合是切实可行的,可为临床诊断和治疗决策提供一种有价值的信息.     

髋臼隐匿性骨折CT与X线平片检查对比分析

目的探讨CT平扫与X线平片检查在髋臼隐匿性骨折诊断和治疗中的临床应用价值。方法回顾性分析50例髋臼隐匿性骨折患者的一般资料,所有患者均经CT平扫与X线平片检查,观察和比较两种检查方法的检出结果。结果本组50例患者中,经CT平扫后49例患者可见骨折,骨折检出率为98.0%,经X线平片检查后40例患者可见骨折,骨折检出率为80.0%,二者比较,CT平扫检出符合率明显高于X线平片,差异具有统计学意义(χ2=8.27,P<0.05);经CT平扫后,清楚显示患者的骨折部位与移位情况,分型符合率为100%,经X线平片检查后,分型符合率为92.0%,二者比较,差异无统计学意义(P>0.05)。结论临床采用CT平扫对髋臼隐匿性骨折患者进行诊断和治疗效果较好,能够对不同的病情进行分型,为制定合理、有效的治疗方案提供了可靠的临床依据,有助于改善患者的疾病及预后,促进患者康复。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.