良性淋巴上皮病变MRI诊断1例

患者女性,58岁.自觉双侧上睑皮肤肿胀半年,以外侧明显,不伴有眼干、眼痛及眼部红肿,双眼视力正常,患者口干,舌尖麻木.触诊:双侧眼球突出,双侧泪腺区肿块质地较韧,可活动,边界清,无压痛,患者眼睑功能正常,泪点位置正常,泪道冲洗通畅.眼科初步诊断为泪腺脱垂,为进一步明确诊断行MRI检查.MRI表现为双侧泪腺明显肿大,呈等T1等T2信号,STIR为等信号,肿大泪腺向眶内外延伸,临近眶外壁骨质未见异常,双侧眼外肌形态信号未见异常,双侧眼球明显突出,双侧腮腺明显弥漫肿大.结合临床MRI考虑良性淋巴上皮病变,排除泪腺脱垂.后患者经糖皮质激素治疗后明显好转.随访半年证实诊断.     

双带线锚钉重建喙锁韧带治疗Tossy Ⅲ型肩锁关节脱位的生物力学研究与临床

[目的]为双锚钉固定修复新鲜肩锁关节脱位提供生物力学依据。[方法]10具成人肩部标本,将周围软组织剔除仅保留喙锁韧带连接喙突与锁骨,分别进行韧带破坏荷载、单枚带线锚钉固定力学测试及双枚带线锚钉固定力学测试。[结果]喙锁韧带断裂载荷(413.0±123.48)N,1枚锚钉组失效载荷(345.1±111.23)N,2枚锚钉组失效载荷(465.3±100.64)N。[结论]双枚带线锚钉固定修复肩锁关节脱位的力学强度与原喙锁韧带的力学强度相当。临床应用12例,均获满意效果。     

An applied research on precise sustentacular screw placement based on anatomical division of the anterior lateral wall of calcaneus and the sustentaculum tali北大核心CSCD

Objective To evaluate our novel path based on anatomical division of the anterior lateral wall of calcaneus and the sustentaculum tali for precise sustentacular screw placement in the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ. Methods The anterior lateral wall of the calcaneus was divided into the anterior-superior zone S1, the anterior-inferior zone S2, the posterior-superior zone S3 and the posterior-inferior zone S4 for demarcation of the screw insertion points by our method of Four Zones, and into the front, middle and rear sections by our method of Three Sections for demarcation of the screw target points. The specimens were scanned by CT and modeled by Mimics. On the 3D virtual model of the calcaneus, one screw was placed from each zone of the anterior lateral wall of the calcaneus to the sustentaculum tali body. The screw placement target for S1 and S2 was the medial intersection point P1 of the front and middle sections of the sustentaculum tali, and that for S3 and S4 was the medial intersection point P2 of the middle and rear sections of the sustentaculum tali. It was observed whether the screws were placed in the bone channel. A total of 72 patients were included who had been admitted to Department of Orthopaedics, Suqian Hospital Affiliated to Xuzhou Medical University for calcaneal fractures of Sanders types Ⅱ and Ⅲ from January 2017 to January 2021. They were divided into an anatomical division group and a 3D printing group according to their screw placement method for the sustentaculum tali. In the anatomical division group of 32 patients subjected to screw placement based on our anatomical division, there were 25 males and 7 females, aged from 24 to 60 years; in the 3D printing group of 40 patients subjected to screw placement assisted by 3D printing, there were 31 males and 9 females, aged from 25 to 58 years. The disparities between the parameters of sustentacular screw placement and the actual values were compared in the anatomical division group, and the total number of screws, screws on average, distribution of screws, and accuracy of screw placement were compared between the 2 groups. Results All the screws which were virtually placed in the specimens of the calcaneus from S1 and S2 to P1 and from S3 and S4 to P2 passed through the bony channel, with no perforation into the tarsal sinus. There was no significant difference in the general date between the anatomical division group and the 3D printing group, showing they were comparable (P > 0.05). In the anatomical division group, a total of 52 screws were placed to the sustentaculum tali with an average of (1.63 ± 0.48) screws per patient, and 2 screws were placed in 20 patients, yielding an accuracy rate of screw placement of 92.3% (48/52). There were no statistically significant differences between the parameters and the actual values of screw placement in the anatomical division group (P > 0.05). In the 3D printing group, a total of 63 screws were placed to the sustentaculum tali with an average of (1.58 ± 0.49) screws per patient, and 2 screws were placed in 23 patients, yielding an accuracy rate of screw placement of 93.7% (59/63). There were no significant differences in the above comparisons between the anatomical division group and the 3D printing group (P > 0.05). Conclusion In the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ, the sustentacular screw placement based on our anatomical division of the anterior lateral wall of the calcaneus and the sustentaculum tali can lead to similar clinical accuracy as 3D printing-assisted screw placement does. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

MRI诊断阔韧带平滑肌瘤1例

患者女性,38岁。腹部逐渐隆起1年,增长较快2个月,伴下腹痛1月。近半年出现尿频伴尿痛1月,偶伴有腰痛,月经正常。妇科检查：阴道后壁前凸,窥器暴露困难,触诊未触及宫颈。盆腹腔巨大包块下缘距阴道口约3cm,偏于阴道左后方,直肠粘膜柔软,与包块分界清．无出血。     

腹腔血管变异伴脾动脉瘤1例

患者男.32岁.近1周因腹胀不适入院.查体:体温36.8℃.腹平软.中腹部轻度压痛,无反跳痛,肠鸣音略亢进.CTA:显示腹腔干分支为脾动脉和胃左动脉,脾动脉中部呈囊状扩张,约10.6 mm×5.7mm(图1).肝总动脉起自于肠图1脾动脉起自于腹主动脉,中部呈囊样扩张图2 肝总动脉起自于肠系膜上动脉根部系膜上动脉根部,由近至远分支为肝固有动脉和肝左、右动脉,胃右动脉起自于肝固有动脉(图2).CT诊断:①腹腔动脉变异;②脾动脉瘤.     

颈椎管内囊性畸胎瘤1例

女性,31岁。因颈部疼痛活动受限伴右侧肢体麻木1月入院。查体颈椎活动受限,C2～6棘间压痛,双侧岗下肌及肩峰压痛。行磁共振检查,颈椎曲度稍变直,序列正常,颈椎体及附件未见异常,颈2水平椎管内见囊状改变,大小约28mm×12mm×20mm,下部见短T1长T2高信号,STIR压脂序列为低信号,囊壁后部见壁结节,增强检查囊壁环形强化,结节未见明显强化,脊髓明显受压(图1～4)。颈3/4、4/5、5/6     

膈肌运动及血流动力学与下腔静脉膜性阻塞关系的研究

目的 探讨膈肌运动及血流冲击(右房反流血液与肝静脉血流)与下腔静脉膜性阻塞(MOVC)发病机制的关系.方法 通过20例尸体解剖,测量腔静脉膈肌裂孔横径与胸廓横径,并取膈肌腔静脉孔处下方肝静脉上方下腔静脉(A组)行组织学检查,观察该处下腔静脉(IVC)内膜厚度及I型胶原的沉积情况,并与肾静脉汇合处上方0.5 cm处下腔静脉(B组)的检查结果 进行对照分析,同时分析裂孔横径相对大小与A组结果 的相关性.结果 A组IVC内膜厚度及I型胶原面积均大于B组,两组间差异有统计学意义(P＜0.05),膈肌裂孔横径相对大小与A组结果 无明显相关性.结论 膈肌运动、血流冲击在MOVC发病过程中可能起重要作用,其中膈肌运动可能起关键作用.     

尾状叶外生型肝癌1例

患者 女,56岁.乙型肝炎病史多年,无明显不适,未经系统治疗,甲胎蛋白AFP 358.60(0～13.6)ng/ml,癌胚抗原未见异常.彩超查体发现肝门区占位,为明确诊断进行磁共振检查. MRI所见:肝脏形态规整,实质信号欠均匀,正反相位对比较大,门静脉主干及左右支未见充盈缺损.肝内外胆管无扩张,总胆管不宽,腔内未见充盈缺损.肝门区(与尾状叶相连)见类圆形稍长T1、稍长T2肿块影,最大径约3.0cm×3.2cm.增强扫描动脉期呈均质明显强化,静脉期及延迟后肿块内呈不均质低信号,延迟期边缘仍见强化.     

非功能性胰腺神经内分泌瘤的CT表现

目的分析非功能性胰腺神经内分泌肿瘤的多排螺旋CT表现。 方法收集2003年5月至2015年6月解放军第404医院经临床和手术病理确诊为非功能性胰腺神经内分泌肿瘤且术前在本院行上腹部增强CT检查的患者15例。回顾性分析其多排螺旋CT图像,主要观察肿瘤的数目、位置、形状、大小、密度及强化方式等。 结果15例均为胰腺单发肿瘤,发生于胰体部7例、头部5例、尾部3例。肿瘤呈圆形或类圆形,平均直径3.8 cm。CT平扫11例表现为稍低密度影,2例表现为等密度,2例表现为囊性病灶。增强后3例表现为等密度强化,6例为低密度强化,5例为高密度强化,1例囊性病灶无强化。5例可见胰管扩张,肝转移瘤见于1例患者,增强后呈环形强化。 结论非功能性胰腺神经内分泌肿瘤的多排螺旋CT表现具有一定特点,但其鉴别诊断较难,需结合影像学表现和临床信息判断。     

翼点入路显微手术治疗前交通动脉瘤疗效观察

目的观察翼点入路显微手术治疗前交通动脉瘤的效果。方法前交通动脉瘤患者21例,采用翼点入路显微手术夹闭前交通动脉瘤瘤颈。结果显微手术成功夹闭动脉瘤20例,术后COS评定恢复良好17例,中度残疾2例,重度残疾1例,死亡1例。结论翼点入路显微手术治疗前交通动脉瘤安全有效。