128层螺旋CT诊断骨质疏松性椎体压缩骨折的优势

目的探讨128排螺旋CT多种重建方法对骨质疏松性椎体压缩骨折的诊断价值。方法收集临床诊断为原发性骨质疏松症患者56例进行128排螺旋CT腰椎容积扫描,对扫描图像采用三维重建、矢状位重建、曲面冠状位重建和薄层横断面重建等方法对椎体骨折情况进行评价,并与X线和MRI（磁共振成像）诊断结果对照,对骨质疏松程度进行初步分级。结果 56例72个椎体压缩骨折,有骨折线椎体65个,椎管狭窄4个,5个椎体附件骨折,1个椎体神经孔狭窄,5个椎体发生滑脱;128排螺旋CT多种重建方法联合应用,能准确全面诊断椎体骨折情况,对椎管狭窄及附件骨折显示准确度明显高于普通X线片及MRI;56例经过128排螺旋CT图像测量评估骨质疏松程度分别为轻度28例,中度19例,重度9例。结论 128层螺旋CT对椎体压缩骨折程度的判断较以往检查方法有明显优势,并能初步判断骨质疏松程度。     

64排128层螺旋CT冠脉成像对冠状动脉疾病的诊断价值探讨

目的：研究64排128层螺旋CT冠脉成像对冠状动脉疾病的诊断价值。方法选择我院在2015年4月-2015年10月收治的冠状动脉疾病65例作为研究对象,对患者行64排螺旋CT冠状动脉成像检查,全部病例均提供有冠状动脉造影检查（CAG）资料,对检查结果进行分析。结果64排128层螺旋CT冠状动脉成像检查冠状动脉狭窄诊断灵敏度为92.39%、特异度为93.75%、阳性预测值为88.54%、阴性预测值为95.93%。结论64排128层螺旋CT冠状动脉成像检查对冠状动脉疾病的诊断敏感度、特异度、阳性预测值、阴性预测值都比较高,有着显著的诊断冠状动脉狭窄应用价值,可作为CAG检查前的有效筛查方法。     

64排128层螺旋CT头颈部血管成像技术的临床运用

目的:探讨64排128层螺旋CT在头颈部血管成像技术中的临床运用。方法 :对148例疑似头颈部血管有病变的患者,通过西门子﹙SOMATOM Definition AS﹚64排128层螺旋CT机行头颈部CTA检查,应用MPR、CPR、VR、MIP等重建技术。结果 :148例患者中,127例明确诊断血管病变152处,21例阴性。结论 :64排128层螺旋CT头颈部CTA检查是一种有效的无创检查方法,对脑血管病变的显示及诊断具有较好的临床指导价值。     

螺旋CT诊断外伤性肩关节创伤中的应用

目的分析外伤性肩关节创伤临床诊断中64排128层螺旋CT的应用效果。方法选取广州市增城区人民医院2016年1月-2018年5月期间收治的疑似外伤性肩关节创伤患者37例,所有患者分别接受X线检查与64排128层螺旋CT检查,其中X线检查归为X线组,64排128层螺旋CT检查归为CT组,就两种检查结果进行对比。结果 X线组检查确诊阳性率为37.84%(14/37),确诊阴性率为27.03%(10/37),不确诊率为35.14%(13/37);CT组检查确诊阳性率为48.65%(18/37),确诊阴性率为占51.35%(19/37),不确诊率为0.00%(0/37),两组对比,CT组检查阳性率、阴性率、不确诊率均优于X线组,差异均有统计学意义(P0.05)。结论在外伤性肩关节创伤临床诊断中,对患者施以64排128层螺旋CT诊断,可以明显优化患者的临床诊断准确率,对于病情的早期治疗具有重要的影响意义,值得普及应用。     

骨水泥对椎体成形术后骨密度的影响分析

目的分析骨水泥对椎体成形术后骨密度的影响。方法对86例骨质疏松性椎体压缩性骨折（OVCFs）患者行单节段经皮椎体成形术（PVP）治疗。随机分组聚甲基丙烯酸甲酯（PMMA）骨水泥组及磷酸钙骨水泥（CPC）组,监测患者术前、术后（3月、12月）病椎、相邻椎体骨密度的变化以及相邻椎体骨折发生率。结果比较两组病椎非骨水泥注射区骨密度（BMD）的变化,无显著差异性（P〉0．05）;上下椎体BMD无显著差异性（P〉0．05）;对于相邻椎体再骨折与未发生组BMD比较,有显著差异性（P〈0．05）。结论椎体成形术后PMMA和CPC骨水泥对病椎及相邻椎体的骨密度影响不明显,骨密度降低是引起相邻椎体再骨折的重要因素：研发一种既能恢复生物力学强度、又有诱导成骨的骨水泥很有必要。     

原发性骨质疏松患者骨密度与骨代谢指标的关系

目的 :探讨原发性骨质疏松症患者骨密度 (BMD)与绝经年限 ,骨代谢生化指标的关系及骨质疏松症患者中骨折组与非骨折组骨代谢生化指标的变化。为防止骨质疏松提供科学依据。方法 :对成都地区 5 0～ 75岁女性原发性骨质疏松症患者 185例询问其绝经年限 ,测定 T4 - L5椎体侧位摄片 ,并计算出楔形指数 ,检测其骨代谢生化指标。结果 :原发性骨质疏松症患者各年龄组骨密度与骨代谢各项生化指标比较差异无显著性。骨折率随绝经年限的增加而增加。骨密度与绝经年限和骨钙素 (BGP)成负相关。骨折年龄与非骨折年龄差异无显著性。骨折组与非骨折组的 BMD比较差异有显著性。两组骨代谢各项生化指标比较显示尿磷 /肌酐比 ,骨折组与非骨折组比较差异有显著性 (P<0 .0 5 )。其它生化指标两组比较差异无显著性。结论 :BMD对预测原发性骨质疏松脊椎压缩性骨折有一定价值。BGP对骨质疏松症临床诊断是一项较敏感的生化指标。绝经年限对原发性骨质疏松骨折预测和防治有指导意义。     

128排螺旋CT冠状动脉成像在冠心病诊断中的应用价值

目的:探究128排螺旋CT冠状动脉成像在冠心病诊断中的应用价值。方法:对64例冠心病患者进行分析,分别采用128排螺旋CT冠状动脉成像检查与选择冠状动脉造影常规检查,对比两种检查方法的效果。结果:64例冠心病患者采用128排螺旋CT诊断准确率为95.3%(61/64),特异度为80.0%(4/5),敏感度为96.6%(57/59),与金标准对比差异不显著,P0.05,无统计学意义。两种诊断方法在冠状动脉狭窄程度对比中,差异不显著,P0.05,无统计学意义。结论:在冠心病诊断中采用128排螺旋CT冠状动脉成像检查,可以显著提高诊断准确率,其特异度与敏感度较高,具有较高的临床应用价值。     

64排螺旋CT三维重建对隐匿型肋骨骨折的诊断与应用价值

目的:探讨隐匿型肋骨骨折在64排螺旋CT三维重建的检查与应用价值,为临床诊疗及司法鉴定提供准确的影像诊断依据。方法:收集本院从2015年1月~2016年12月因胸部外伤入院,怀疑肋骨骨折的患者96例进行检查分析,患者入院后均行DR检查、CT常规扫描,部分患者行64排螺旋CT三维重建。结果:阳性病例82例;其中62例患者可见明确的骨折,20例患者行DR及CT常规平扫均未见明显骨折,后行64排螺旋CT三维重建并经工作站后处理获得MPR、VR图像后,发现隐匿型肋骨骨折16例。结论:64排螺旋CT三维重建方法能够快速检查骨折患者,可以完整地多方位多角度地显示出肋骨骨折情况,大大减少漏诊、误诊的发生,提高影像诊断的准确率。     

急性脑出血应用64排128层螺旋CT的临床分析

目的 讨论急性脑出血应用64排128层螺旋CT的临床诊断价值研究。方法 选择30例在2019年3月—2020年3月治疗的急性脑出血的患者作为试验组,选择30例同期的急性非脑出血的患者作为对照组。两组患者均使用64排128层的螺旋CT检测。结果 选取30例急性脑出血的患者,其中有20例患者发生基底节出血,有3例患者发生脑叶出血的情况,有2例患者为小脑出血,有2例患者为脑干出血,有3例患者为丘脑出血。有2例患者死亡。两组脑出血量相比,差异有统计学意义（P <0.05）。两组中线位移发生率以及病死率差异无统计学意义（P> 0.05）。结论 在急性脑出血患者中使用64排128层螺旋CT检测,能够明确患者脑出血的准确位置,提高治疗提供可靠的依据,从而减少脑出血发生率。     

椎体后凸成形术与保守治疗骨质疏松性脊柱骨折的对比研究

目的:对比骨质疏松性脊柱骨折患者分别采用椎体后凸成形术与保守治疗的效果。方法:选择医院2013年11月~2015年4月收治的骨质疏松性脊柱骨折患者128例,随机选择其中64例作为A组,给予椎体后凸成形术治疗,剩余64例作为B组,给予保守治疗,观察治疗前后A组与B组患者的背部疼痛程度、伤椎前中柱椎体高度及后凸Cobb角。结果:治疗前,两组患者各项观察指标差异无统计学意义(P0.05);治疗后,A组患者背部疼痛程度评分、后凸Cobb角低于B组,椎体高度高于B组,差异具有统计学意义(P0.05)。结论:临床治疗骨质疏松性脊柱骨折患者,椎体后凸成形术具有更好的治疗效果。     

Efficient and improved diagnosis of osteoporosis by simultaneous bone density measurement and spinal morphometry

OBJECTIVE: As the vertebral fracture status is an important and independent parameter for the prediction of future fractures, we aimed to determine the added value of spinal morphometry performed in combination with bone density measurement in the determination of vertebral fracture status in patients referred for conventional bone density measurement. DESIGN: Prospective, observational. METHOD: Consecutive patients referred to our university medical centre department for bone mineral density measurement also underwent spinal morphometry at the same session. The primary outcome parameter was the prevalence of vertebral fractures. RESULTS: A total of 958 patients were included. In 28% the indication was primary osteoporosis, and in 72% it was secondary osteoporosis. In 98% spinal morphometry was technically successful. In 681 patients (71%) Lvi-Tiv and in 826 (86%) Liv-Tv were visualized. One or more fractures were found in 25% of patients; a mean of 1.8 vertebral fractures per patient. In 68% of these patients this fracture was previously unknown. Most fractures (76%) were wedge shaped. The degree of severity of the fracture was mild in 43%, moderate in 44%, and severe in 13%. Even after excluding mild fractures, the prevalence of vertebral fractures was 17%. Bone density classification was normal in 28% of patients. There was osteopenia in 43% and osteoporosis in 29%. The prevalence of vertebral fractures in these subgroups was 18%, 23% and 36% respectively. CONCLUSION: Including spinal morphometry in bone mineral density measurement is of added value as this method detected previously unknown vertebral fractures in a great number of patients.     

Bisphosphonate treatment prevents hip fractures in 70-79 year old women with osteoporotic vertebral fractures

According to the data of a fracture intervention trial, in women aged 55-80 years with vertebral fractures or osteoporosis diagnosed by bone mineral density measurement, treatment with the bisphosphonate alendronate prevented hip fractures with numbers-needed-to-treat within 5 years of treatment of 46 and 66, respectively. In a large risedronate hip fracture study, this new bisphosphonate only showed a beneficial effect in women aged 70-79 years with moderately severe osteoporosis as judged by femoral neck T-score, when one or more vertebral fractures were present at the start of the treatment. The number-needed-to-treat was 29. However, in women aged over 80 years and who were selected predominantly on the basis of clinical risk factors for hip fracture, no effect was found with this drug on hip fracture rate, suggesting that most were not osteoporotic and/or that the clinical risk factors used did not have the clinical utility in identifying hip fracture risk. Other factors besides osteoporosis may play a more important role in causing hip fracture in this elderly group. Diagnosis of osteoporotic vertebral fractures in women aged 70-79 years is predictive of not only new vertebral fractures but also of hip fractures, and could therefore form an indication for drug treatment.     

64层螺旋CT三维重建和多平面重建诊断鼻骨骨折应用价值探讨

目的：探讨64层螺旋CT三维重建（3D）和多平面重建（MPR）技术在鼻骨骨折中的应用。方法：对医院近期102例鼻区骨折患者采用64排螺旋CT轴位薄层螺旋扫描,在工作站上使用三维重建（3D）和多平面重建（MPR）技术观察鼻区骨折影像表现。结果：鼻骨骨折102例,错位性骨折47例,非错位性骨折55例,双侧鼻骨骨折46例,单侧22例（左侧13例右侧9例）,鼻中隔骨折15例,鼻骨骨折伴发上颌骨额突骨折13例,单纯缝合分离6例（鼻上颌缝分离3例、鼻额缝分离2例、两侧鼻骨间缝分离1例）。所有鼻骨骨折经3D及MPR成像后均能立体显示骨折的部位、形态、类型、塌陷程度及三维空间信息。结论：64层螺旋CT3D及MPR技术可以提高鼻骨骨折诊断的准确性,并为临床医师选择治疗方案提供更有价值的信息。     

Low bone mass and postfall fracture risk among elderly nursing home men

OBJECTIVE: To study postfall fracture risk in relation to bone mineral density. SETTING: The study was conducted in men residing in nursing homes. PARTICIPANTS: A total of 212 men above the age of 65 years were recruited, and of these, 172 satisfied the inclusion criteria of the study. Among them, 82 were less than 85 years old, and 90 were at least 85 years old. INTERVENTION: Bone mineral density (BMD) of the calcaneus was measured, using the Lunar PIXI Bone Densitometer (version 1.43) and charts were reviewed for age, falls, and fractures. MEASUREMENTS: The values of BMD were expressed as T-scores, and the Lunar criteria equivalents of T-scores were used (T-scores more than -0.6 for normal BMD, -0.6 to -1.6 for osteopenia, and below -1.6 for osteoporosis). RESULTS: The median age of all participants was 84 years (range 65 to 102 years), and their mean T-score at the calcaneus was -1.51. In about 51% of them, the T-score was in the osteoporotic range. For subjects less than 85 years old, the mean T-score was -1.19, and for those 85 years and older, the mean T-score was -1.81; the mean bone density of those in the older old group was significantly lower than those in the younger old group if there was a history of a fracture. Analysis by age quartiles showed a progressive decline in BMD with advancing age. About 53% of the subjects who fell (37.2%) sustained a nontraumatic fracture. Among them, 67.6% had osteoporosis. CONCLUSION: At any given age after age 65, men who sustained a postfall fracture had a significantly lower BMD than those who did not sustain a postfall fracture.     

64层螺旋CT在胸骨骨折诊断中的应用

目的:探讨64层螺旋CT容积扫描三维重建图像在诊断胸骨骨折中的应用价值.方法:回顾性分析经64层螺旋CT容积扫描的胸骨骨折病例25例,分别对横断面图像、矢状面图像、容积再现(VRT)图像进行观察分析.结果:本组25例患者均确诊胸骨骨折,横断面图像显示胸骨骨折23例,检出率为92%;矢状面显示胸骨骨折25例,检出率为100%.容积再现(VRT)图像显示骨折22例,检出率为88%.同时发现肋骨骨折23例,气胸19例,胸腔积液20例,肺挫裂伤18例,肩胛骨骨折2例,锁骨骨折1例.结论:64层螺旋CT容积扫描三维重建图像在诊断胸骨骨折中具有较高价值,是诊断胸骨骨折的首选检查方法     

64层螺旋CT容积数据结合MPR在隐匿性骨折中的应用

目的讨论64层螺旋CT容积数据在胸外伤肋骨轻微骨折中的诊断价值。方法回顾性分析我院2009年1月至2010年10月资料完整的胸外伤肋骨骨折的患者共53例,经容积数据结合MPR诊断与64层螺旋CT后处理图像资料SSD技术对照分析。结果 64层螺旋CT容积数据结合MPR在发现轻微骨折、不全性骨折方面较好,而64层螺旋CT后处理图像SSD显示骨折的位置、范围、移位方向方面较好。结论 64层螺旋CT容积数据结合MPR在隐匿性骨折诊断中有确定性价值。     

16层螺旋CT重建技术在平战骨骼创伤中的应用价值

目的：探讨16层螺旋CT多平面重建及三维重建技术在平战骨骼创伤中的应用价值。方法：对2148例军地伤病员的2859个部位应用16层螺旋CT进行扫描,采集原始轴面图像数据,层厚采用0.625～1.25mm,利用工作站软件行多平面重建法（MPR）、容积再现法（VR）重建,最佳角度显示病变。结果：2859个部位中,骨折2175个,脱位684个,其中2834个三维图像可清晰显示骨折及脱位的整体情况,对10个肋骨及15个鼻骨裂隙骨折三维图像不能完全明确,需结合MPR图像后确诊。结论：16层螺旋CT多平面重建与三维重建技术相结合可以明显提高平战创伤中骨折及脱位诊断的准确率,为临床判断伤情及手术治疗提供更多有用的信息。