臀肌挛缩症的一种新X线征象--髂骨致密线

目的：明确髂骨致密线与臀肌挛缩症之间的关系，探讨髂骨致密线的形成机制。方法：分析103例臀肌挛缩症的骨盆平片及其中8例骨盆CT片，并与200例非臀肌挛缩症的骨盆平片及其中13例骨盆CT作对照。结果：臀肌挛缩组85例（82．5％）骨盆平片见骶髂关节旁髂骨致密线，对照组仅见5例（2．5％）。103例臀肌挛缩症中，髂骨致密线出现于5岁以上组和5岁以下组分别为81例（81／88）和4例（4／15）；出现于臀大肌挛缩为主组和臀中肌挛缩为主组分别为83例（83／94）和2例（2／9）。CT扫描示正常骨盆的髂骨骶髂关节部外缘皮质呈后内向前外走行的斜面，而在臀肌挛缩症患者，髂骨后部增厚、变形，外缘皮质斜面变小，近乎前后走行。结论：骨盆平片上髂关节旁髂骨致密线是臀肌挛缩症的1种征象；这一征象是由于挛缩的臀大肌长期、持续的牵拉作用，导致本呈后内向前外斜行的髂骨骶髂关节部外缘皮质变为前后走行使其形成轴位投影所致。     

臀肌挛缩症的MRI应用价值

目的 探讨臀肌挛缩症(GMC)的MRI表现及其临床价值。方法 经临床及手术证实的臀肌挛缩症11例，均行X线平片及MR检查，常规行MRT1WI及T2WI，所有患者均加扫轴面及冠状面快速梯度回波(FFE)T2WI；5例行CT检查。结果 T1WI及T2WI显示11例受累臀肌萎缩；8例臀中、小肌萎缩明显，3例臀中、小肌萎缩、消失。FFE-T2WI显示11例患侧从髂骨至股骨粗隆间的挛缩纤维索条影，呈条带状低信号；阔筋膜张肌萎缩，与臀中、小肌分界不清。4例受累髋关节囊明显增厚。X线显示7例骨盆左侧倾斜，1例右侧倾斜，1例左侧股骨大粗隆轻度不规则。5例CT扫描显示3例骨盆倾斜，2例双侧臀肌大小不对称。结论 MRI能直接显示臀肌挛缩纤维索条影，指导临床治疗；FFE-T2WI序列是GMC的特异检查序列。     

臀肌筋膜挛缩症影像学表现

目的探讨臀肌筋膜挛缩症(gluteal muscle contracture, GMC)影像学特点。方法回顾分析388例经临床确诊GMC患者的临床及影像学资料。388例术前行骨盆X线及CT检查,其中2例行双侧髋关节MRI检查。378例接受手术治疗,其中129例术后行CT检查,3例行MRI检查。结果患者主要临床表现为髋关节弹响、活动受限及并脚下蹲困难。X线:373例(96.1%)见骨盆致密线;CT:388例(100%)见臀肌"挛缩带"、臀肌萎缩;MRI:2例(100%)见双低信号臀肌"挛缩带"。70例(18.0%)见骨盆倾斜。臀大肌挛缩产生骨盆致密线,臀中肌挛缩导致髂骨外翻。术后CT及MRI见臀肌挛缩带中断。结论 GMC在CT或MRI检查可见特征性臀肌"挛缩带",指导临床治疗并进行术后影像学评估。     

髂胫束与臀大肌结合部超声图像特征在诊断臀肌挛缩症中的意义

目的：探讨髂胫束与臀大肌结合部的超声图像特征在臀肌挛缩症诊断中的意义。方法：对319例（569侧患肢）臀肌挛缩症患者行高频超声检查,观察髂胫束、髂胫束与臀大肌结合部及臀部肌肉的声像图特征,并与手术结果对照。结果：555例髂胫束与臀大肌结合部有挛缩改变（97.54%,555/569）,声像图表现为不规则的不均匀低回声结节;超声检出率为96.84%（551/569）,与手术结果比较差异无统计学意义（χ²=0.08,P>0.05）。结论：超声易于发现髂胫束与臀大肌结合部挛缩的声像改变,其声像特征可作为诊断臀肌挛缩症的重要依据。     

臀肌筋膜挛缩症

臀肌筋膜挛缩症又称为注射性臀大肌挛缩症[1]、臀肌纤维化[2]、儿童髋关节外展挛缩[3]、臀肌挛缩症[4]，是由于臀肌及其筋膜纤维性挛缩引起的髋关节外旋挛缩畸形和屈曲障碍，表现出姿式、步态的异常及特有的临床体征。本症好发于儿童，近年来有增加的趋势，由于病因尚有争论，加上认识不足，故常被误诊。1病因学1·1注射因素Peiro[2]、马承宣[1]、李承球[4]等均认为患儿在婴儿期反复接受肌肉注射，由于外头机械性损伤和药物的化学刺激，使肌肉筋膜组织发生纤维变性，继发髋关节功能障碍。马承宣还认为儿童好发与其组织代谢旺盛，对异物刺激…     

小细胞肺癌的螺旋CT表现特征

目的 明确未治疗小细胞肺癌的螺旋CT表现特征，以利于提高CT诊断的准确性。资料与方法 搜集未经治疗且行胸部螺旋CT增强扫描并经病理证实的小细胞肺癌32例，观察其胸部螺旋CT表现特征，结合其他临床资料进行分期。结果 32例小细胞肺癌中，局限性病变6例(18．8％)，广泛播散性病变26例(81．2％)；中心型27例(84．4％)，周围型5例(15．6％)。3l例(96．9％)表现为肺内肿块或结节，其中肿块密度均匀29例(90．6％)，钙化及空洞各1例。19例(59．4％)发现支气管狭窄，16例(50％)伴阻塞性肺炎，10例(31．3％)伴阻塞性肺不张。14例(43．8％)纵隔大血管被包埋或侵犯。31例(96．9％)肺门淋巴结增大，25例(78．1％)纵隔淋巴结增大。转移至对侧肺5例(15．6％)、神经系统5例(15．6％)、腹部脏器(肝、肾上腺)4例(12．5％)、骨骼3例(9．4％)。结论 小细胞肺癌以中心型为主，呈实体性生长，CT上肿块密度较均匀，易侵犯支气管及纵隔大血管，伴肺门、纵隔淋巴结转移。     

臀肌挛缩症的影像学诊断

臀肌挛缩症(gluteal muscle contracture．GMC)是多种原因引起臀肌及其筋膜纤维变性、挛缩，导致髋关节功能障碍，表现出一系列特有的症状、体征的临床症候群。有学者对臀肌挛缩症的X线表现进行了研究，包括颈干角、中心边缘角(CE)增大，及股骨头指数下降、髂骨高宽比和髋臼角变小等，     

CT和超声内镜诊断胃肠道间质瘤的价值分析

目的 探讨胃肠道间质瘤的CT和超声内镜诊断价值。方法 搜集经手术和病理证实的胃肠道间质瘤患者11例进行回顾性分析。11例均行螺旋CT平扫，10例行双期增强扫描，8例行超声内镜检查。结果肿瘤位于胃部8例，食管、十二指肠和直肠各1例。本组良性者，肿瘤直径≤5cm，边界清楚，密度均匀，可见单个坏死灶。恶性者，有如下特征：(1)肿块直径≥7cm；(2)肿瘤边缘有分叶；(3)瘤体内有多个小片状坏死或大块坏死；(4)肿瘤的溃疡大而深；(5)瘤旁常伴成簇状或线状排列的小血管；(6)瘤体内有散在分布的细小钙化点；(7)周围组织侵犯或远处转移。本组CT定位准确度为54．5％(6／11)，超声内镜定位准确度为87．5％(7／8)。病理学检查肿瘤为良性者3例，恶性者7例，增生活跃者1例。cT判定良恶性准确度为72．7％(8／11)，超声内镜判定良恶性准确度为62．5％(5／8)。结论CT和超声内镜结合有助于胃肠道间质瘤的定位和良恶性的判断，对指导临床治疗和估计预后有一定的价值。     

成人活动性肺结核的CT表现

目的分析成人活动性肺结核的CT表现，明确其CT特征。资料与方法肺结核组61例，肺炎组40例，均行常规螺旋CT扫描和HRCT扫描。分析各自的影像学表现，并进行统计学分析。结果肺结核组：肺实变影60例(98．4％)；合并空洞21例(34．4％)；小叶中心结节或直径2-4mm分支线样结构(春芽征)42例(68．9％)；直径5-8mm边缘模糊的结节50例(82．0％)；支气管扩张43例(70．5％)；不规则线影49例(80．3％)；疤痕性肺气肿21例(34．4％)；血管束变形40例(65．6％)。肺炎组：肺实变影32例(80．0％)；合并空洞5例(12．5％)；小叶中心结节或直径2—4mm分支线样结构(春芽征)16例(40．0％)；直径5-8mm边缘模糊的结节8例(20．0％)；支气管扩张2例(5．0％)；不规则线影20例(50．0％)；肺气肿4例(10．0％)；血管束变形14例(35．0％)。结论典型的活动性肺结核CT表现有其特点，发生在常见或非常见部位的肺实变影，伴有局限或广泛的支气管播散灶，在HRCT上观察到小叶中心结节或2—4mm分支线样结构(春芽征)和5-8mm边缘模糊的结节影，均应初诊为活动性肺结核；同时出现钙化或纤维化的征象，则强烈支持肺结核的诊断。     

肝包虫病CT诊断

目的：探讨肝包虫病的CT表现。材料与方法：对28例肝包虫病人(其中2例合并肾包虫病，1例合并胰包虫病，6例合并肺包虫病)分析其CT表现。结果：单纯型10例，多子囊型2例，实变钙化型16例。CT表现为实性低密度，无强化效应，伴随各种各样之钙化影。液化坏死，腔内容物CT值接近水。结论：肝包虫病多合并其它部分包虫病，伴有钙化者较常见(本组占57．1％)CT表现有其特征。     

髂胫束松解治疗臀肌挛缩症

目的为了寻求治疗臀肌挛缩症更加简单、安全、有效的手术方法,了解该病的发病因素和股骨大转子部髂胫束的病变情况。背景目前大部分作者认为臀肌挛缩症是臀部肌肉注射引起并与患者遗传因素有关的一种疾病,治疗方法多采用臀部切口,对臀大肌、臀中肌、臀小肌中的挛缩组织进行松解,以改善患侧髋关节的内收与内旋。此方法切口大、出血多、创伤大,有损伤坐骨神经和术后引起髋外展肌无力的危险。方法作者采取于股骨大转子部“Z”字形切断髂胫束的方法,使臀部紧张组织松弛,缓解患者症状。术后随访了连续治疗的33例患者,随访时间1～6年半,平均2.6年。结果本文所采取的手术方法操作简单、出血少,无严重合并症,所有病人手术效果均满意,是治疗该症较理想的方法之一,并发现创伤也是造成该症的另一因素。强调手术时彻底松解紧张的髂胫束和部分紧张的臀大肌止点是手术成功的关键。     

臀肌挛缩症与髂骨致密性骨炎的关系

目的：探讨臀肌挛缩症（GMC）与髂骨致密性骨炎（OCI）的关系。方法：搜集我院手术确诊的符合本研究纳入标准的GMC患者共315例,非GMC对照组251例,由2位高年资的放射诊断医师阅读两组的术前CT影像资料,分别统计OCI的发生率。随机选取不对称性OCI的GMC患者资料19例,共累及23侧骶髂关节,测量OCI髂骨硬化区与臀大肌,并进行相关性分析。结果：GMC组中OCI 81例（25.7%）,其中男16例（16/315）,女65例（65/315）;对照组251例中有2例OCI（0.7%）。GMC组与对照组之间及GMC组内男女患者之间,OCI的发生率差异均有显著性意义,U值分别为7.42,4.52,P〈0.05。OCI髂骨硬化程度与臀大肌的相关分析表明二者呈正相关r=0.61,P〈0.01。结论：GMC与OCI有密切关系。     

Hip abductor muscle activity during walking in individuals with gluteal tendinopathy

The external hip adduction moment during walking is greater in individuals with gluteal tendinopathy (GT ) than pain‐free controls. Although this likely represents a greater demand on the hip abductor muscles implicated in GT , no study has investigated activation of these muscles in GT . For this purpose, fine wire electrodes were inserted into the segments of the gluteus minimus and medius muscles, and surface electrodes placed on the tensor fascia lata, upper gluteus maximus, and vastus lateralis muscles of eight individuals with, and eight without, GT . Participants underwent six walking trials. Individual muscle patterns were compared between groups using a wavelet‐based linear effects model and muscle synergy analysis performed using non‐negative matrix factorization to evaluate muscle activation patterns, within‐ and between‐participant variability. Compared to controls, individuals with GT exhibited a more sustained initial burst of the posterior gluteus minimus and middle gluteus medius muscle segments. Two muscle synergies were identified; Synergy‐1 activated in early‐mid stance and Synergy‐2 in early stance. In GT participants, posterior gluteus minimus and posterior gluteus medius and tensor fascia lata contributed more to Synergy‐1 active during the period of single leg support. Participants with GT exhibited reduced within‐participant variability of posterior gluteus medius and reduced between‐participant variability of anterior gluteus minimus and medius and upper gluteus maximus. In conclusion, individuals with GT exhibit modified muscle activation patterns of the hip abductor muscles during walking, with potential relevance for gluteal tendon loading.     

Calcific tendinitis of the gluteus maximus tendon: CT findings

Two cases of calcific tendinitis of gluteus maximus muscle are presented. The CT findings, including amorphous calcification without soft tissue mass and possible cortical erosion at the femoral enthesis of the gluteus maximus muscle, are highly suggestive of calcific tendinitis at this unusual but classical location. Ossifying entheses with well-defined cortical defect are frequent at the femoral insertion of the gluteus maximus muscle in asymptomatic subjects and must be differentiated from a real cortical erosion sometimes associated with these calcific tendinitis. Received: 16 July 1998; Revision received: 14 September 1998; Accepted: 13 October 1998     

MRI diagnosis of contracture of the gluteus maximus muscle

OBJECTIVE: The objective of our study was to describe MRI features of contracture of the gluteus maximus muscle after providing a retrospective review of the MRI studies of 21 patients. CONCLUSION: Gluteal contracture manifests characteristic features on MRI, including an intramuscular fibrotic cord extending to the thickened distal tendon with atrophy of the gluteus maximus muscle and posteromedial displacement of the iliotibial tract. In advanced cases, medial retraction of the muscle and its tendon results in a depressed groove at the muscle-tendon junction and external rotation of the proximal femur. Clinical correlation and meticulous physical examination may confirm the MR diagnosis.     

The influence of gluteus maximus on transverse plane tibial rotation

There is a common clinical belief that transverse plane tibial rotation is controlled by the rearfoot. Although distal structures may influence the motion of the tibia, transverse plane tibial rotation could be determined by the proximal hip musculature. Cadaver studies have identified gluteus maximus as having the largest capacity for external rotation of the hip. This study was therefore undertaken to investigate the effect of gluteus maximus on tibial motion. Kinematic data were collected from the foot and tibia along with EMG data from gluteus maximus for 17 male subjects during normal walking. A number of kinematic parameters were derived to characterise early stance phase. Gluteus maximus function was characterised using RMS EMG and EMG on/off times. No differences in muscle timing were found to be associated with any of the kinematic parameters. In addition, no differences in gluteal activation levels were found between groups of subjects who had different amounts of tibial rotation. However, there was a significant difference (p < 0.001) in gluteus maximus activation when groups were defined by the time taken to decelerate the tibia (time to peak internal velocity). Specifically, subjects with greater gluteus maximus activity had a lower time to decelerate the tibia. We suggest that a high level of gluteus maximus activity results in a larger external torque being applied to the femur, which ultimately leads to a more rapid deceleration of the tibia.     

应用CT感兴趣体积法测量臀中肌体积

目的:探讨CT感兴趣体积(VOI)法测量臀中肌体积的可行性。方法:回顾性搜集自2017年1月至2018年12月于南京大学医学院附属鼓楼医院共128例行128层CT扫描患者的临床及影像资料,纳人标准为图像清晰,包括两侧臀肌群上下起止点。其中女性31例,男性97例,平均65.8岁。以45岁和65岁为界将患者分为ABC三组,由两名操作者分别应用后处理工作站VOI软件进行三维重建并自动测量两侧臀中肌及臀肌群体积,一周后由操作者1和操作者2重复测量,应用组内相关系数评价组内及组间测量值的可靠性。比较臀中肌和臀肌群的性别及左右体积差异、臀中肌不同年龄的体积差异,以及不同性别患者臀中肌占臀肌群体积比例的差异。结果:臀中肌及臀肌群边界勾画准确,三维形态显示良好,与骨骼关系清晰可见。不同操作者及相同操作者不同时间测量值之间可重复性良好。臀中肌体积存在性别及年龄的差异,男性臀中肌体积大于女性,随着年龄的增长臀中肌体积缩小。男性两侧臀中肌占同侧肌群百分比较女性稍小,差异无统计学意义。结论:臀中肌体积存在性别及年龄差异,CT VOI法可较为清晰地测量臀中肌体积,且可重复性强,可作为评价臀中肌体积的影像学手段。     

多发性肌炎的CT应用价值

目的研究多发性肌炎(PM)的肌肉CT表现特点及应用价值。方法经肌肉活检证实的多发性肌炎20例。所有病例均完成腰背肌、臀肌、大腿肌以及小腿肌的CT轴位扫描,其中大腿肌和小腿肌分肌群组观察。观察内容包括:肌肉的密度;肌肉的体积;肌筋膜的改变;肌肉组织的清晰度;皮下脂肪层厚度。结果CT发现肌肉体积缩小15个部位;肌肉密度减低,脂肪样变53个部位;筋膜增厚18个部位;皮下脂肪层增厚23个部位;肌肉组织模糊3个部位。结论CT能够清楚显示PM肌肉病损程度、判断肌肉萎缩和病变分布情况,为肌肉活检明确定位。