乳腺癌的高频超声特点及误漏诊原因分析

目的分析乳腺癌的高频超声像图特点,以期提高乳腺癌的超声诊断率。方法对经手术证实的术前做过超声检查的23例乳腺癌进行回顾性分析。结果23例乳腺癌的超声诊断符合率为82．6％,分析误漏诊因,如增生致结构紊乱、手术瘢痕后方回声衰减等影响了诊断等。结论高频超声对乳腺癌的诊断具有很高临床应用价值,对于声像图特征不典型的乳腺癌应对声像图进行综合分析。     

超声测量对正常胎儿胼胝体解剖观察的价值

目的:超声测量不同孕周正常胎儿胼胝体径线参考值,完善胎儿胼胝体解剖数据.方法:在断层解剖影像基础上对235例孕20～40周胎儿行胼胝体超声检查,测量胎儿胼胝体径线,分析其与孕周的关系,并与报道数据进行比较.结果:建立胎儿胼胝体长、宽、厚度正常参考值范围;在相关切面上扫查,胎儿胼胝体显示率为87.7％;各径线与孕周呈正相关,随妊娠月份增加而增长.结论:超声对胼胝体径线测量有其独特的优势,建立的参考值范围可为临床评价胎儿胼胝体发育状况提供便利.     

M型超声心动图的断面解剖

本文用60例成人心脏,作与M型超声心动图心尖波群、心室波群、二尖瓣波群、心底波群相应的断面,研究了四种波群超声束通过的层次结构;观测了右心室、室间隔、主动脉管、二尖瓣组合结构、左心房等M型超声心动图常用结构的特点。     

高频超声对正常正中神经显像及其临床意义

目的 通过高频超声探查上肢正中神经全程并熟练掌握正中神经的超声探查手法,选取超声易于辨识的解剖位点测量正中神经的横截面积（CSA）并探讨其与周围组织的关系,提供正常参考值范围并为临床诊断外周神经疾病提供依据。 方法 对240例健康志愿者沿正中神经走行进行高频超声探查,依次测量5个位点 ［腕管（腕横纹处）、前臂中点、正中神经穿出旋前圆肌处、肱骨髁上处及肱骨中点处］的CSA,每个位点重复测量３次取其均值,并进行CSA与身高、体重的相关性分析。 结果 高频超声显示,正常人正中神经横截面呈筛网状低回声图像,在不同部位分别显示为圆形、椭圆形或三角形,纵截面上成束状平行排列的低回声被断续的条带状高回声分割。探查得出,正中神经在上述5个位点的CSA均值以及双侧上肢之间同一位点处正中神经的CSA差异无统计学意义。 结论 正中神经在高频超声下全程可探及,显示率为100％;在不同部位的正常值及超声声像图略有差异,差异有统计学意义;正中神经的CSA在上臂段最粗,腕管处次之,前臂段最细。     

肘管的应用解剖研究

ObjectiveTo study the anatomic elements of the pathogeny of the cubital tunnel syndrome.Methods60 elbows of adult cadavers were dissected.The length and width of the arcuate ligament(AL),the depth of the cubital tunnel,the extension of the ulnar nerve(UE) and the distance from medial epicondyle to olecranon(OE) as the elbow flexed from neutral to 90 degrees were measured.ResultsVariations in the arcuate ligament were classified into four typesⅠ,the proximal 1/2 part of the arcuate ligament was absent;Ⅱ,the whole tunnel was covered by arcuate ligament;Ⅲ,A thickened fascial band was observed in the arcuate ligament;Ⅳ,the thickened facial band was replaced by muscle.The length and width of the arcuate ligament were 9.7±2.3 mm and 14.1±4.2 mm respectively.The depth of the cubital tunel was 5.2±1.1 mm,The extension of ulnar nerve and the distance from epicondyle to olecranon were 7.2%±0.5% and 4.7±1.5 mm.ConclusionsThe morphologic change of the cubital tunnel was the anatomical pathogeny of the cubital tunnel syndrome.     

睾丸肿瘤的高频超声诊断

目的：分析采用高频超声诊断睾丸肿瘤的具体诊断的方法和疗效。方法选择我院2008年1月~2012年12月泌尿外科住院患者,共35例进行研究。结果本组睾丸肿瘤具有共同声像特征：睾丸肿大,睾丸纵隔声像扭曲或消失,有占位病灶。睾丸精原细胞瘤、畸胎瘤、睾丸囊肿和表皮样囊肿具有较为特征性的声像图。GE P6型彩色多普勒成像系统显示33例睾丸恶性肿瘤内部及周边血流信号丰富,杂乱,并呈条带状、树枝状及网状分布,2例睾丸肿瘤为少血供。睾丸良性肿瘤内部无或稀少的血流信号。结论高频超声诊断睾丸肿瘤具有良好的效果,不仅能够提高声像图的质量,而且,CDFI显示睾丸内局灶性多血管改变且血管形态不规则,有助于睾丸肿瘤的诊断和鉴别诊断。     

高频超声对乳腺肿块的声像图分析

目的 探讨乳腺肿块的各种声像学特征,评价高频超声在乳腺癌诊断中的重要价值.方法 观察120例乳腺肿块,对比分析了乳腺癌与良性结节的声像图差异.结果 120例乳腺肿块均行手术或活检,病理证实结果为,恶性23例,良性97例;其中无明显肿块以片状低回声区伴微钙化为主要表现者1例.乳腺癌与良性结节在肿块的形态、边界、纵横比值是否>1、微钙化点、恶性环、血流信号、阻力指数>0.7、峰值流速PSV>20cm/s,两者比较有显著性差异(P<0.05),其准确性为89.2%.结论 高频超声诊断乳腺肿块良恶性符合率高,对乳腺肿块良恶性的诊断及鉴别诊断具有重要的临床应用价值.     

高频超声成像中的编码激励研究

本论文实现了基于编码激励的高频超声成像实验系统并对编码激励在实际应用中的性质进行了定量实验研究.以中心频率为10 MHz的眼科B超为实验平台,实现了一个适用于各种二进制编码激励的超声成像系统.系统使用FPGA实现了编码激励实时成像处理,并通过数据采集卡获得射频回波数据.实验表明,采用编码激励可以显著增加系统信噪比,降低发射电压.在单反射面情况下,15 V发射电压的编码激励回波的信噪比与70 V发射电压的单脉冲激励回波的信噪比相当,脉冲压缩的旁瓣水平在-30 dB以下.在超声体模实验中,20 V发射电压的编码激励回波的信噪比水平及穿透深度与60 V发射电压的单脉冲激励系统相当.编码激励实验结果为实现低发射电压的便携式超声诊断系统提供了实验基础.     

踝管内胫后神经松解有关的应用解剖

目的：为踝管内胫后神经松解治疗踝管综合征,跟痛症等提供解剖学基础,方法：在15例成人尸体标本,对胫后神经在踝管内的分支部位及其走行进行了解剖观察研究,测量了胫后神经的滑动距离,结果：胫后神经多在内踝水平下3cm内分出足底内,外侧神经支配足底部皮肤感觉及内在肌,少部分在内踝上分支,从胫神经主干内踝上1厘米内发出1－2支神经（跟内侧支）在皮下或深筋膜下行走达足跟脂肪垫内及跟骨内,沿途呈树枝状分支,被动活动关节时,踝管内胫神经可滑动8．2mm(5.0-12.5mm,),结论：踝管内胫神经松解应充分 解胫神经的主干及主要分支,足跟分支卡压可能与足跟痛有关,故对顽固性足跟痛患者可考虑封闭,松解或切断有关神经支。     

Dimensions of the anterior tarsal tunnel and features of the deep peroneal nerve in relation to clinical application

Background The aim of this study was to demonstrate anatomical features of the anterior tarsal tunnel and the deep peroneal nerve and to discuss the importance of these structures for the anterior tarsal tunnel syndrome and some other surgical approaches to minimize the injury risk. Methods Lower limbs of 18 formalin fixed cadavers were examined. The limbs showed no evidence of pathology or trauma. Results The lateral length of the tunnel was 21.7 ± 4.3 mm and the medial length of the tunnel was 55.0 ± 9.0 mm. The width of the tunnel at the inferior border between the extensor hallucis longus and extensor digitorum longus tendons was 12.6 ± 2.1 mm. The location of the deep peroneal nerve bifurcation was in the anterior tarsal tunnel in 31 specimens (86.1%) and distal to the tunnel in two specimens (5.6%). In three specimens (8.3%) there was no bifurcation because of the absence of the medial terminal branch of the deep peroneal nerve. In these three specimens, the superficial peroneal nerve distributed to the adjacent sides of the great and second toes. Bifurcation above the tunnel was not observed in our specimens. There was connection between the deep peroneal nerve and the superficial peroneal nerve in 10 specimens (27.8%) in the first interdigital space. During the observations, the presence of a fibrous band over the nerve and vessel was noted in 22 specimens (61.1%). Conclusions We believe that a detailed anatomic knowledge of the anterior tarsal tunnel and the deep peroneal nerve will be of help during surgical approaches to this area and the diagnosis of the problems related to the peripheral nerves on the dorsum of the foot. This study was presented on the 4th Asian-Pacific International Congress of Anatomists (APICA 2005) in Kusadasi, Turkey on 7-10 September 2005.     

肘管的解剖特点对原位松解术治疗肘管综合征的疗效影响

目的　探讨肘管的解剖特点,为肘管综合征的手术方式的选择提供参考意义。 方法　选取81例肘管综合征患者,依据其肘管的解剖构造特点分为A、B两组,A 组：肘管支持带的厚度≥1.4 mm者,或者肘管支持带被滑车上肘肌取代者,共39例,B组：肘管支持带的厚度＜1.4 mm者,共42例,均实施尺神经原位松解术,术后随访12个月,我们将两组的有效率进行比较。 结果　两组的有效率具有显著差异（P＜0.05）, A组的有效率为92.31%, B组的有效率为76.19%。 结论　对于肘管支持带较厚者,或者直接被滑车上肘肌的患者,引发肘管综合征的病因考虑为被增厚的弓状韧带或者被滑车上肘肌卡压,故实施尺神经原位松解术的效果好,而肘管支持带相对较薄者,实施尺神经原位松解术治疗效果较差,考虑这类肘管综合征患者为尺神经完全屈肘时遭到牵拉引起,而非卡压造成。     

高频超声在带状疱疹诊断中的应用

目的应用高频超声观察各期带状疱疹患者的皮肤和皮神经的声像图改变，为临床早期诊断寻求影像学依据。方法75例拟诊断为带状疱疹患者，其中男性31例，女性44例，年龄22～79岁。病变位于躯干54例，四肢近端21例。采用直接扫查法，用10MHz彩色多普勒超声检测患者病变处皮肤层及皮下组织层厚度、皮神经直径和各层回声情况，以患者健侧对应部位为对照。结果67例确诊为带状疱疹，高频超声显示出疹前期及红斑丘疹期患者病变处与健侧比较皮肤层及皮下组织层明显增厚（P＜0．01），皮神经直径明显增大（P＜0．01），回声均减低；水疱期患者病变处皮肤层及皮下组织层未见明显增厚（P＞0．1），回声未见明显减低；但皮神经直径仍可见增大（P＜0．01），回声减低。结论高频超声检测带状疱疹患者（特别对早期不典型患者）皮肤和皮神经声像图表现异常，为临床早期诊断、减少误诊提供了影像学依据。     

Potential sites of compression of tibial nerve branches in foot: A cadaveric and imaging study

Hypertrophy of abductor hallucis muscle is one of the reported causes of compression of tibial nerve branches in foot, resulting in tarsal tunnel syndrome. In this study, we dissected the foot (including the sole) of 120 lower limbs in 60 human cadavers (45 males and 15 females), aged between 45 and 70 years to analyze the possible impact of abductor hallucis muscle in compression neuropathy of tibial nerve branches. We identified five areas in foot, where tibial nerve branches could be compressed by abductor hallucis. Our findings regarding three of these areas were substantiated by clinical evidence from ultrasonography of ankle and sole region, conducted in the affected foot of 120 patients (82 males and 38 females), aged between 42 and 75 years, who were referred for evaluation of pain and/or swelling in medial side of ankle joint with or without associated heel and/or sole pain. We also assessed whether estimation of parameters for the muscle size could identify patients at risk of having nerve compression due to abductor hallucis muscle hypertrophy. The interclass correlation coefficient for dorso‐planter thickness of abductor hallucis muscle was 0.84 (95% CI, 0.63–0.92) and that of medio‐lateral width was 0.78 (95% CI, 0.62–0.88) in the imaging study, suggesting both are reliable parameters of the muscle size. Receiver operating characteristic curve analysis showed, if ultrasonographic estimation of dorso‐plantar thickness is >12.8 mm and medio‐lateral width > 30.66 mm in patients with symptoms of nerve compression in foot, abductor hallucis muscle hypertrophy associated compression neuropathy may be suspected. Clin. Anat. 26:768–779, 2013. © 2012 Wiley Periodicals, Inc.     

以跗外侧动脉为蒂骰骨瓣转位修复距骨颈骨折的应用解剖

在30侧下肢标本上解剖观测了骰骨背侧面血管的来源、走行、分支和分布。骰骨背侧面的动脉主要来自跗外侧动脉。该动脉穿趾短伸肌深面,紧贴骰骨背侧面中份行走。行经骨面时,发出5～12支管径在0.3～1.0mm 至骰骨。以跗外侧动脉为蒂的骰骨瓣大小约为2×1cm。经临床应用证明,本骨瓣是修复距骨颈骨折距骨体缺血性坏死简易可行的一种新术式。     

Anatomical Variation of the Tarsus in Common Inbred Mouse Strains

Rodent models are used for a variety of orthopedic research applications; however, anatomy references include mostly artistic representations. Advanced imaging techniques, including micro‐computed tomography (microCT), can provide more accurate representations of subtle anatomical characteristics. A recent microCT atlas of laboratory mouse (Mus musculus) anatomy depicts the central and tarsal bone III (T3) as a single bone, differing from previous references. Fusion of tarsal bones is generally characterized as pathological secondary to mutations associated with growth factors, and normal variation has not been documented in the mouse tarsus. Therefore, it is unclear if this fusion is a normal or a pathological characteristic. The aim of this study is to characterize the tarsus of the laboratory mouse and compare it to the rat and selected outgroup species (i.e., white‐footed mouse) via microCT and histology to determine if the central and T3 are separate or fused into a single bone. Laboratory mice (C57/Bl6 [n = 17] and BalbC [n = 2]) and rats (n = 5) were scanned with microCT. A representative laboratory mouse from each strain was evaluated histologically via serial sagittal sections through the mid‐tarsus. General pedal anatomy was similar between all species; however, the central and T3 bones were fused in all laboratory mice but not the rat or white‐footed mouse. A band of hyaline cartilage was identified within the fused bone of the laboratory mice. We conclude that the fusion found is a normal characteristic in laboratory mice, but timing of the fusion remains ambiguous. Anat Rec, 300:450–459, 2017. © 2016 Wiley Periodicals, Inc.     

掌部小切口腕管松解术的应用解剖

目的：为掌部小切口腕管松解术提供解剖学基础。方法：在１６侧（男４,女１２）成人新鲜上肢标本上,对屈肌支持带、正中神经及其分支、掌浅弓、尺神经和尺动脉在腕掌部的位置和走行进行了观察与定位。结果：发现手掌部第三指蹼与掌长肌腱尺侧缘的连线上,掌浅弓与屈肌支持带下缘之间存在一个能避开重要结构进入腕管的安全区域,设计了掌部小切口腕管松解术,临床应用５２例,效果满意。结论：掌部小切口腕管松解术安全、简单、有效     

踝管动脉穿支小腿皮瓣修复足部软组织缺损

目的 总结踝管动脉穿支皮瓣修复足部的软组织缺损效果。 方法 在踝管动脉穿支解剖学研究的基础上,2005年6月至2013年6月间临床采用踝管动脉穿支皮瓣修复足部的软组织缺损36例,致伤原因：车祸伤24例,砸伤12例。损伤部位：足背14例,足内侧22例,软组织缺损范围为5 cm×3 cm~16.5 cm×10.0 cm。皮瓣切取面积最小为6.0 cm×4.0 cm,最大为本组皮瓣切取范围为7 cm×5 cm~18 cm ×12 cm,远端蒂旋转点位于平内踝。 结果 临床修复36例,创面Ⅰ期愈合33例,Ⅱ期愈合3例。所有病例经5~15个月随访,皮瓣色泽正常,外形与功能改善满意,供区创面植皮愈合良好,对功能无不良影响。 结论 踝管动脉穿支皮瓣,可以修复足部远侧创面,效果好。