正常股骨头骨骺及生长板随年龄变化MRI研究

目的 探讨股骨头骨骺软骨及生长板软骨生长、发育过程中的MRI特点及骨骺闭合的MRI表现.方法 对40例正常人股骨头进行MRI扫描,按年龄分为4组,6个月以内5例,6个月～8岁13例,8～20岁12例,20～30岁10例.MRI扫描包括常规SE T1WI、FSE T2WI序列和STIR-PDWI.结果 MRI 可以显示5种软骨结构,骨骺软骨在T1WI及T2WI均呈中等信号;生长板和二次骨化中心的生长板软骨T1WI呈稍高信号、T2WI呈高信号;临时钙化带及二次骨化中心临时钙化带在T1WI及T2WI均呈低信号.骨骺闭合后骺板STIR-PDWI像上由闭合前的高信号转变为低信号.结论 MRI可以显示、区分生长发育期股骨头各种正常软骨结构;骺板在STIR-PDWI像上转变为低信号可以作为股骨头骨骺闭合的标准.     

骨发育中软骨组织MRI与组织学微血管摄影对照

目的 为了解骨发育中MRI能显示哪些软骨组织结构进行组织学对照。材料与方法 2－14岁儿童膝关节MRI共30例。采用冠状、矢状T1WI、T2WI和FFE序列,常规扫描与骨骺软骨、生长板软骨、关节软骨以及关节内脂肪垫、滑膜等组织大切片、微血管摄影对照。结果 MRI能显示股骨髁及胫骨髁的关节软骨、骺软骨两层成软骨细胞带和骨化中心周边的肥大软骨细胞带。亦能显示骺软骨内的主要血管。生长板的先期钙化带呈低信号线,初级骨小梁区的毛细血管区在T2WI／FFE序列呈狭窄的高信号带。6－8岁儿童生长板内的骺、干血管交通支,因其血管周围有纤维组织呈纵行线样中等信号强度。MRI还能显示关节内脂肪垫的间质和血管以及滑膜肥厚等。结论 MRI能显示骨发育中软骨组织的细微结构,有助于今后研究婴幼儿和儿童的软骨疾患。     

长骨生长板损伤MRI成像技术及诊断

目的研究长骨生长板的MRI成像序列及信号特点，并分析生长板损伤的MRI表现。方法前瞻性对3l例少儿（正常关节11例，外伤关节20例）骨关节长骨生长板行冠状位、矢状位Turbospin echoo（TSE）序列与Dual echo steady state（DESS）序列MR成像，观察生长板在两个序列上的MRI信号表现，对骨骺损伤采用Salter—Harris5型分类法，分别观察骨骺、干骺端及生长板的MRI表现。结果sE序列T1WI生长板软骨及骺软骨表现为等信号。T2WI生长板软骨表现为稍高信号，骺软骨呈低信号影，DESS序列T2WI生长板软骨与骺软骨表现为高信号，生长板信号稍高于骺软骨信号。长骨生长板依年龄不同其形态表现有所差异。骨骺和生长板损伤18例，干骺端骨折2例。Salter-Harris分类：Ⅱ型见于2例，Ⅲ型8例，Ⅳ型6例，Ⅴ型2例。结论DESS序列具有高空间分辨率与高信号对比，能很好地显示正常生长板及其损伤。     

幼儿发育性髋关节发育不良的MRI检查

目的根据幼儿发育性髋关节发育不良(DDH)的病理改变及MRI表现,探寻MRI快速检查方案。资料与方法回顾性分析10例(11个髋关节)术前接受MRI检查的DDH患儿的MRI表现。扫描方案包括AX T1WI、COR Tirm和COR 3D T1WI VIBE。总结不同加权像反映的DDH的病理改变。结果 COR上均可显示10例DDH(11个髋关节)股骨头不同程度向外上移位,髋臼上缘直立、变短。COR Tirm上5个髋关节上盂唇水平走行,4个髋关节上盂唇内翻,1个上盂唇无法辨认,1个上盂唇走行正常。COR 3D T1WI VIBE上6个股骨头骨化中心未出现,3个患侧股骨头骨化中心较对侧小,2个DDH股骨头骨化中心发育正常。AX T1WI上9个髋臼窝内可见增生的脂肪组织。结论合理的MRI扫描方案(AX T1WI、COR Tirm和COR 3D T1WI Vibe)能够快速、全面地显示DDH的病理改变。     

儿童髋关节一过性滑膜炎的MRI表现

目的探讨儿童一过性髋关节滑膜炎的磁共振诊断价值。方法分析23例儿童一过性髋关节滑膜炎的磁共振影像资料,所有患儿行横断位T2WI+FS、T1WI,冠状位用T2WI+FS、T1WI,采用常规自旋及快速自旋回波序列。结果23例患儿共28侧髋关节发病,18例为单侧发病,5例为双侧,所有病变髋关节不同程度关节积液,T2WI上表现为关节腔内片状、带状高信号影,T1WI上呈低信号,6侧关节滑膜增厚,4侧关节周围软组织肿胀,所有患侧股骨头骨骺、干骺端及髋臼骨质正常。6例治疗2~5周后复查,基本恢复正常。结论磁共振对儿童一过性髋关节滑膜炎的诊断安全、可靠,在诊断与鉴别诊断上具有很高的价值。     

髋臼盂唇损伤的特点及修复方法的研究进展

随着髋关节镜的应用以及影像学技术的提高,髋臼盂唇损伤逐渐得到国内外学者的重视。髋臼盂唇为附着于髋臼边缘的纤维软骨环,具有调节滑液平衡,增加髋关节稳定性等功能。手术治疗是修复髋臼盂唇损伤的重要手段,包括髋臼盂唇切除术、髋臼盂唇修补术、髋臼盂唇重建术等术式。三种手术方式都取得了较好的早、中期临床效果,尤以髋臼盂唇修补术、髋臼盂唇重建术效果明显,但是具体的机制尚不明确。近年来新兴的髋臼盂唇重建术是否优于髋臼盂唇切除术还需要进一步的探究。本文就髋臼盂唇的解剖结构和功能、盂唇损伤的原因及诊治方法进行详细的综述,并指出尚需进一步探索的问题。     

外伤性骺早闭MRI的诊断价值

目的 评估MRI对外伤后骺早闭的诊断价值。方法 对21例外伤后骺早闭患儿分别行X线及MRI检查,除常规T1WI和T2WI外,其中8例还行脂肪抑制序列（SPIR）检查;分析MRI在骺早闭的诊断及部位、范围的显示,以及预后方面的应用价值。结果 21例骺早闭位于股骨远端6例、胫骨近端6例,胫骨远端9例;19例成角畸形,2例短缩并成角畸形;21例骺板软骨在T1WI中呈均匀偏低信号,在T2WI中呈均匀高信号,骺早闭表现为线状、条状低信号穿过骺板软骨;8例脂肪抑制序列较常规SE、快速梯度回波（FFE）序列图像更清晰。结论 MRI能清晰显示骺板软骨,明确诊断骺早闭,准确显示骺早闭的部位、程度及范围,为临床手术治疗提供重要依据。     

髋臼盂唇重建研究进展

髋臼盂唇是附着在骨性髋臼缘的三角形状的纤维软骨环,具有稳定关节和调节关节滑液平衡的功能。创伤、退变、发育不良和髋关节撞击综合征是造成髋臼盂唇损伤的主要原因。髋臼盂唇损伤后将改变髋关节的生物力学机制,引起关节不稳,增加关节应力,最终导致骨性关节炎的发生。手术治疗是修复损伤髋臼盂唇的主要手段,术中应尽量修补和保留尽可能多的盂唇组织。当髋臼盂唇严重损伤或髋臼盂唇功能不良而无法进行缝合修复时,髋臼盂唇重建是另一种可选择的手术方式,以达到恢复髋臼盂唇解剖结构和生物力学功能的目的,避免髋臼盂唇切除后造成髋关节早期退变。髋臼盂唇重建是近年来新兴的手术方式,本文就其适应症、移植物的选择、手术技术和临床疗效等方面进行详细综述,以期进一步指导临床实践。     

髋关节镜清理治疗髋臼盂唇损伤10例报告

目的:探讨髋关节镜在髋臼盂唇损伤中的诊疗价值.方法:对10例髋臼盂唇损伤的患者采用髋关节镜技术进行诊断和治疗,男性7例,女性3例.平均年龄43岁(17～63岁).左侧6例,右侧4例.髋臼发育不良4例,髋关节骨性关节炎3例,运动伤3例.关节镜检查髋臼盂唇放射瓣状损伤3例,退行性变3例,桶柄状损伤2例,横形裂2例.撕裂发生在前盂唇4例,后盂唇3例,上盂唇3例.射频气化清理增生肥厚的滑膜组织和软骨损伤的创面,切除并修整损伤的盂唇组织.结果:术后随访10例,平均11个月(6个月～31个月),髋关节症状完全解除7例,明显改善2例,1例因骨性关节炎较重于术后15个月行人工关节置换术.本组患者无血管神经损伤和感染病例.结论:髋关节镜对髋臼盂唇损伤具有重要的诊断和治疗价值,其疗效取决于关节软骨退变的程度和治疗时机.     

髋关节撞击综合征影像表现的初步探讨

目的 探讨髋关节撞击综合征(FAI)的影像表现.方法 回顾性分析经手术证实的9例FAI患者的影像资料,9例患者均行髋关节正侧位X线检查及患髋MR检查,其中1例还接受了患髋关节MR关节造影检查,探讨其影像特征性改变.结果 9例患者X线表现均出现股骨头颈交界处骨性突起或髋臼过度覆盖.MR检查显示9例患者均出现不同程度的髋臼盂唇损伤,均出现在前上盂唇,ⅠA期损伤2例,ⅠB期损伤3例,ⅡA期损伤2例,ⅡB期损伤2例;1例患髋关节MR造影检查显示髋臼前上盂唇内线样裂隙,可见对比剂进入裂隙.2例的股骨头负重区软骨下骨内出现硬化囊变区,手术证实相应部位出现直径2 cm大小的软骨剥脱.结论 MRI可以显示FAI患者髋臼盂唇及关节软骨损伤,有助于早期诊断FAI.     

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.