小儿先天性肌性斜颈MR诊断

先天性肌性斜颈(congenital muscular torticollis,CMT)是由于一侧胸锁乳突肌(sternocleidomastoid,SCM)挛缩导致头部向患侧偏斜、颈部扭转、面部及下颌偏向健侧的疾病,病理特征是胸锁乳突肌间质增生及纤维化.本病是新生儿及婴幼儿最常见的肌肉骨骼系统先天性疾病之一,发病率约为0.3%～1.9%[1],右侧受累多见[2].若早期失治,可出现面部、颈椎的发育不对称,影响面部美观并导致头颈部的功能异常.本文总结7 例CMT患儿的MRI特征,现报告如下.     

胸锁乳突肌单纯切断术治疗先天性斜颈62例报告

<正> 肌性斜颈(简称斜颈)是一侧胸锁乳突肌挛缩而致头向侧方偏斜并旋转,久之造成患侧头颈部发育不良,面部不对称,头颈屈向患侧影响颈部正常功能及美观,一般需手术治疗,我院自1982年6月至1990年10月收治肌性斜颈62例,改变传统的胸锁乳突肌抽出手术方法,采用单纯切断胸锁乳突肌的胸骨头及锁骨头手术方法,采用单纯切断胸锁乳突肌的胸骨头及锁骨头手术方法,收到良好效果,本文仅就其手术方法及术后处理进行讨论。 一、临床资料     

超声在先天性肌性斜颈诊断及推拿治疗疗效评估中的应用

目的:探讨超声在先天性肌性斜颈诊断及推拿疗效评估中的应用价值。方法:35例先天性肌性斜颈患儿,其中男27例,女8例;年龄10d~14个月,平均(4.70±4.29)个月;根据超声表现分为四型。患儿年龄与分型之间的相关性分析使用Pearson检验;治疗前后,胸锁乳突肌厚度比率比较使用配对t检验。结果:不同分型阶段,超声表现各具特征性;患儿年龄与超声分型之间相关性分析:相关系数0.482,P=0.0030.05;治疗前后患侧胸锁乳突肌与健侧比例分别为2.10±0.55、1.40±0.33,两者之间差异有统计学意义(t=6.689,P=0.000)。结论:先天性肌性斜颈超声表现具有特征性,有助于临床诊断及疗效评估。     

推拿治疗小儿肌性斜颈200例

小儿肌性斜颈的主要因素是颈部的胸锁乳突肌发生纤维性挛缩及分娩损伤和胎位不正，导致头倾向患侧或伴有前屈、后仰，下颌及颜面旋向健侧，早期在患侧胸锁乳突肌可发现梭形肿块，逐渐挛缩突出如条索状。若不及时治疗可发生颜面不对称畸形和代偿性的胸椎侧凸。治疗原则是舒筋活血、软坚消肿和纠正斜颈。     

超声对先天性肌性斜颈伴发育性髋关节异常的诊断价值

目的 :探讨超声对先天性肌性斜颈(CMT)伴发育性髋关节异常(DDH)的诊断价值。方法 :回顾性分析176例CMT患儿超声检查时双侧胸锁乳突肌(SCM)厚度、髋关节Graf分型及临床相关资料,将其分为CMT+DDH组和CMT组进行对照分析。结果:CMT+DDH占11.4%(20/176);2组性别比、两者发病方向差异均无统计学意义(均P0.05);CMT+DDH组双侧SCM厚度差值和双侧SCM厚度比率均明显高于CMT组(均P0.05);分别以双侧SCM厚度差值≥0.74 cm和双侧SCM厚度比率≥0.24为临界值,预测DDH的敏感度分别为50.0%和45.0%,特异度分别为77.6%和83.3%。结论:CMT和DDH有一定共存比例,超声显示双侧SCM厚度差值和厚度比率对CMT伴DDH具有预测价值,是早期诊断CMT与DDH的重要依据。     

超声诊断婴儿肌性斜颈1例

患儿　男 ,出生 12天 ,第一胎臀位产。因发现患儿头始终偏向右侧与右颈部肿块就诊。查体 :患儿发育正常 ,一般情况好 ,头向右侧偏斜 ,下颌转向左侧 ,颜面部不对称 ,右侧胸锁乳突肌中下部可触及一红枣大小硬性肿块 ,无红肿、压痛 ,颈部活动受限。超声检查 :显示患儿两侧胸锁乳突肌明显不对称 ,右侧胸锁乳突肌中下位局部肌肉挛缩 ,呈梭形改变 ,范围大小约 1 3cm×2 2cm ,内部回声较周围的正常肌肉回声水平增强 ,光点分布欠均匀 (图 1)。超声诊断 :右侧肌性斜颈。临床随访证实。　　讨论 :斜颈 (torticollis)是婴幼儿一种常见疾病 ,它是由于一…     

飞行学员胸锁乳突肌发育畸形1例

胸锁乳突肌发育畸形罕见。笔者从事招飞体检20多年仅遇到1例,现报道如下: 1 临床资料 患者,男性,18岁,湖北汉川人,1999年高中毕业生,同年9月入飞行预备学院。查体发现胸锁乳突肌的两个头,即胸乳突肌和锁乳突肌明显分离,各自独立,不像正常人那样向上合并成一组肌肉。而且锁乳突肌下端不是止于锁骨的胸骨端,而是止于锁骨的中     

鳃裂囊肿和瘘管的影像诊断

目的:认识鳃裂囊肿影像学表现和提高诊断准确率.材料和方法:回顾分析了经临床诊治,以及手术、病理证实的鳃裂囊肿和瘘管21例的超声、CT、MRI表现.结果:①12例超声检查表现为颈中、上部两侧与胸锁乳突肌、颌下腺、腮腺、颈鞘血管关系密切的低回声囊肿或囊实性病灶.②10例CT检查表现为位于颈前三角区、胸锁乳突肌前缘的囊性肿块;合并感染时,病灶边界模糊,囊内密度增高,囊壁强化.③1例MRI检查表现为颈侧部、胸锁乳突肌深面、下颌角后下方、颈动静脉外侧的囊性肿物,为短T1长T2信号,边缘异常对比增强,与周围组织界限清.仅有1例第一鳃裂瘘管未能显示.结论:超声的诊断价值有限,CT和MRI显示病变的位置、范围、形态、密度和信号较佳,多断面成像和信号变化使M RI在诊断中更有价值.     

成人肌性斜颈病100例手术治疗体会

1991～ 1 999年 ,我们对成人肌性斜颈病 1 0 0例行手术治疗 ,效果满意。1　临床资料1 1　一般情况　男 4 6例 ,女 54例 ;1 5～ 2 0岁 52例 ,2 1～ 2 5岁 2 3例 ,2 6～ 30岁 1 3例 ,31～ 35岁 6例 ,36～ 4 0岁 5例 ,4 1岁以上 1例。左侧 36例 ,右侧 64例。其中复发性 1 8例 ,先天性蹼颈 6例。1 2　临床症状及病理改变　斜颈畸形 ,头偏向患侧 ,面部及下颌转向健侧 ,面部不对称 ,眼、耳低于健侧 ,患侧项肌萎缩。头、颈转动受限 ,脊柱呈代偿性弯曲。病侧胸锁乳突肌短缩、硬化并成条索状。胸锁乳突肌标本镜下检查 ,见细胞结构改变或消失 ,可发…     

按摩治疗颈部软组织损伤96例

颈部软组织损伤属于常见病,笔者采用推拿按摩手法治疗效果满意,现报告如下: 1 临床资料 本组男90例,女6例,年龄16～68岁。病程2 h～3 d。一侧夹肌损伤36例,一侧两块以上颈肌损伤60例。病人呈强迫体位,头向患侧偏斜。检查时损伤的肌肉有明显压痛,肌张力增高,功能受限。门诊采用先点揉风池穴,后弹拨,捋顺,捏拿患侧损伤肌肉,颈部旋转、侧扳等推拿按摩手法治     

Magnetic resonance imaging of primary skeletal muscle diseases: patterns of distribution and severity of involvement

Magnetic resonance imaging of the lower extremities was performed with a low field system in 51 patients representing three different categories of biopsy-proven primary skeletal muscle disease; muscular dystrophies, congenital myopathies and polymyositis. The intermuscular distribution of abnormal signal intensity and the grade of involvement of individual muscles were assessed. Large differences in the degree of pathological signal intensity between individual muscles were found in all categories. In the muscular dystrophy and polymyositis patients, the overall involvement was significantly more severe than in patients with congenital myopathy. Definite patterns of selective involvement were seen. Statistical evidence of selective muscle sparing was found; the gracilis muscle was significantly less affected than the other muscles in all three disease groups. Other muscles with significant sparing include the rectus femoris and sartorius muscles of the thigh and the tibialis posterior muscle of the leg. Common anatomical and functional characteristics of muscles may be related to the distribution of muscular disease.     

Effects of hip and head position on ankle range of motion,ankle passive torque,and passive gastrocnemius tension

Ankle joint range of motion (ROM) is notably influenced by the position of the hip joint. However, this result remains unexplained. Thus, the aim of this study was to test if the ankle passive torque and gastrocnemius muscle tension are affected by the hip and the head positions. The torque and the muscle shear elastic modulus (measured by elastography to estimate muscle tension) were collected in nine participants during passive ankle dorsiflexions performed in four conditions (by combining hip flexion at 90 or 150°, and head flexed or neutral). Ankle maximum dorsiflexion angle significantly decreased by flexing the hip from 150 to 90° (P < 0.001; mean difference 17.7 ± 2.5°), but no effect of the head position was observed (P > 0.05). Maximal passive torque and shear elastic modulus were higher with the hip flexed at 90° (P < 0.001). During submaximal ROM, no effects of the head and hip positioning (P > 0.05) were found for both torque and shear elastic modulus at a given common ankle angle among conditions. Shifts in maximal ankle angle due to hip angle manipulation are not related neither to changes in passive torque nor tension of the gastrocnemius. Further studies should be addressed to better understand the functional role of peripheral nerves and fasciae in the ankle ROM limits.     

Great potential of ultrasound elastography for the assessment of the masseter muscle in patients with temporomandibular disorders. A systematic review

Objective:To summarize the available evidence on the use of elastography in the assessment of the masseter muscle in healthy individuals and patients with masseter muscle disorders.Methods:Systematic literature review has been performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Results:16 of 142 studies identified were analyzed. Elastography was used in seven studies. Heterogeneity was observed in terms of study protocols, devices, patients, units of measure, and results. Elasticity values showed a correlation between the left and right masseter muscle side in healthy people, but not in patients with temporomandibular disorders (TMDs). Elasticity values increased in TMD and were correlated with the severity of TMD symptoms. Phantom studies proved the high reliability of elastography.Conclusion:Elastography is a promising tool for the assessment of the masseter muscle elasticity, but the evidence is insufficient. Studies on larger groups are needed to determine the accuracy of elastography to characterize masticatory muscle disorders.     

MR imaging findings in children with merosin-deficient congenital muscular dystrophy

BACKGROUND AND PURPOSE: Our purpose was to determine the brain MR imaging characteristics of merosin-deficient congenital muscular dystrophy in children. METHODS: We reviewed the MR imaging findings of the brain in three children with known merosin-deficient congenital muscular dystrophy to determine the presence of any cerebral or cerebellar abnormalities of development or abnormalities of the white matter. RESULTS: In all three patients, there was normal formation of the cerebrum, the cerebellum, and no evidence of neuronal migration anomalies. All three patients had abnormal white matter in the cerebrum, with sparing of the corpus callosum, internal capsule, cerebellum, and brain stem. CONCLUSION: MR imaging of the brain in children with merosin-deficient congenital muscular dystrophy reveals a consistent pattern of white matter abnormality. We postulate that disruption of the blood-brain barrier associated with merosin deficiency leads to increased water content, resulting in abnormal white matter signal intensity.     

超声多参数回归模型评估乳腺癌腋窝淋巴结转移的价值

目的：建立以乳腺癌腋窝淋巴结超声诊断特征为变量的Logistic回归模型,评价常规超声及实时弹性成像技术对乳腺癌腋窝淋巴结有无转移鉴别诊断的价值。方法对病理证实的112例乳腺癌患者的113个腋窝淋巴结的常规超声及弹性成像各因素进行综合分析,建立二分类Logistic回归模型,通过绘制ROC曲线评价模型的诊断效能。结果在纳入的113个淋巴结中,术后病理证实28个无转移,85个有转移。经过前进法Logistic回归分析,筛选出弹性应变率比值（ SR）、弹性评分及形态等3个指标对乳腺癌腋窝淋巴结转移诊断有统计学意义的特征变量。 Logistic回归模型对乳腺癌腋窝淋巴结转移预报的正确率为93．8％, ROC曲线下面积为0．962。结论二分类Logistic回归模型对腋窝淋巴结性质有较好的诊断效能,弹性成像提高了常规超声诊断腋窝淋巴结的准确度。     

超声弹性成像技术评估急性脑梗死颈动脉粥样硬化斑块稳定性

 目的 探讨应用超声弹性成像技术评估急性脑梗死患者颈动脉粥样硬化斑块稳定性,并进行早期预测。方法 选取2016年1-9月医院行颈动脉超声检查的急性脑梗死住院患者60例为急性脑梗死组,另选取门诊非急性脑梗死患者55例为对照组,采集两组患者基线资料,探查并测量颈动脉内膜厚度(intima media thickness,IMT)及斑块回声,采集相关的弹性参数(如弹性评分、弹性面积比值等)的数据并进行统计学分析。结果 急性脑梗死组IMT明显厚于对照组(1.71±0.20 vs 1.34±0.27,P<0.05);二维灰阶超声低回声斑块、等回声斑块、混合回声斑块、强回声斑块数量两组之间未出现统计学差异(P>0.05);超声弹性评分低回声斑块和混合回声斑块急性脑梗死组明显低于对照组(1.22±0.43 vs 1.73±0.78,P=0.033;2.95±0.51 vs 3.38±0.59,P=0.036);超声斑块弹性面积比值低回声斑块与混合回声斑块急性脑梗死组明显低于对照组 (1.15±0.09 vs 1.23±0.10,P=0.029;1.44±0.12 vs 1.55±0.09,P=0.010)。结论 应用超声弹性成像技术可以区别出颈动脉斑块的稳定性,为急性脑梗死提供预测价值。     

Tall vertebrae at birth: a radiographic finding in flaccid infants

It has been well documented that children with severe neuromuscular disorders have tall vertebrae, presumably a consequence of altered mechanical forces. This finding was present in four neonates who were born with severe "floppy" hypotonia due to Werdnig-Hoffmann disease (two cases), nonspecific neonatal myopathy, and congenital muscular dystrophy. Fetal vertebral development is normally modified by intrauterine muscle tension and fetal activity.     

骨骼肌急性拉伤后牵张训练对其材料力学性能影响的实验研究

目的:探讨牵张训练对骨骼肌急性拉伤后恢复期材料力学性能影响的规律.方法:92只SD大鼠为实验对象,选取10只为空白对照组,其余82只在同等条件下对其小腿三头肌实施急性拉伤后,随机分为实验对照组、牵张组和跑动组.于不同恢复期取腓肠肌进行拉伸测试,获取试样的拉伸极限张力-时间曲线,计算其应力、应变及弹性模量.结果:(1)极限应力:伤后第10天,牵张组和跑动组小腿三头肌的极限应力明显高于实验对照组(P<0.05);伤后第17天,牵张组小腿三头肌的极限应力恢复值最高(PPT-EC<0.05).(2)极限应变:肌肉伤后第30天实验对照组小腿三头肌极限应变仅为正常肌肉的85.93%(P<0.01);伤后第10天牵张组肌肉极限应变为正常肌肉的98.19%,第17天则明显高于正常肌肉(P<0.01);跑动组伤后第10天也明显恢复(P<0.01).(3)杨氏模量:牵张对肌肉的模量的影响较自然修复及跑动训练均更明显.结论:急性拉伤肌肉抗拉性能基本恢复约需3周,应变恢复相对较慢.牵张对肌肉伤后的材料力学性能有积极的影响,但以影响应变性能和优化模量为主.肌肉急性拉伤后进行适量的跑动对肌肉的材料力学性能有积极作用,大强度跑动致重复性损伤的可能性加大.     

Lytic clavicular lesions in fibromatosis colli

Two patients with fibromatosis colli (congenital torticollis) presented with lytic lesions in the clavicle at the insertion of the fibrosed clavicular head of the sternocleidomastoid muscle. Biopsy of one lesion showed intraosseous fibrosis. These lesions are probably not uncommon but radiographs are rarely performed in uncomplicated cases.