超声三维斑点追踪成像评价心肌梗死患者左心室整体收缩功能的研究

目的 应用超声三维斑点追踪技术评价心肌梗死患者的左室整体应变特征及与左室整体收缩功能的相关性.方法 使用三维斑点追踪技术对24例心肌梗死患者及20例正常人进行心肌运动分析,测量左室射血分数(LVEF),左室整体纵向、圆周、径向及面积收缩期峰值应变,并比较心肌梗死组与正常组之间的各应变指标变化情况及与LVEF的相关性.结果 三维斑点追踪技术测得心肌梗死患者的LVEF及各整体心肌应变参数均较正常组减低(P＜0.05).心肌梗死组左室整体纵向、圆周、径向及面积收缩期峰值应变与LVEF的相关系数分别为-0.626、-0.770、0.772和-0.748(P＜0.01).Bland-Altman分析显示应变测值在心肌梗死组和正常组均有良好的一致性.结论 三维斑点追踪技术可通过测量心肌应变无创、客观地评价左室整体收缩功能,为评估左室收缩功能提供一种新方法.     

股骨小转子数字化三维重建与测量的临床意义

目的　探讨股骨小转子相关解剖数字化测量方法,为设计针对小转子骨折特点的股骨近端内固定系统提供解剖学依据。 方法　对80例完整成人股骨标本行CT扫描,应用Mimics 10.01软件,利用数字化三维重建技术重建股骨,标定相关解剖标志,测量指标包括股骨小转子相关解剖参数。 结果　小转子纵径为(27.01±1.72)mm,横径为(17.82±1.22)mm,应用后倾角为（22.42±9.08）°,应用上倾角为（17.02±2.02）°,拟固定小转子最短螺钉长度为(49.25±3.20) mm,小转子高为(8.59±1.44) mm,小转子体积为(755.91±150.14) mm3。所有测量参数,左、右侧均无统计学差异,P> 0.05。 结论　基于CT影像的股骨数字化三维重建图像具有良好的形态和清晰的边界,可精确识别股骨相应的解剖标志并进行三维测量,能较好地为设计用于小转子骨折固定的股骨近端内固定系统提供解剖学依据。     

基于数字化三维重建的跟骨关节内骨折分型的初步应用

目的　探讨数字化虚拟可视技术在跟骨关节内骨折分型的可行性与价值。 方法　17例跟骨关节内骨折患者CT扫描数据集导入相应软件,重建跟骨骨折三维可视模型。2名高年资骨科医师,在规定时间内完成对每例跟骨骨折的三维数字化分型和sander分型评估,使用Kapppa值计算相关度,比较两种分型的可信度差别。 结果　重建了15个跟骨骨折的数字化三维可视模型,准确地反映了跟骨骨折的解剖部位、骨折移位的方向和程度,数字分型的可信度Kapppa值为0.795(0.691~0.874),属于可信程度,　sander分型的Kapppa值为0.641（0.591~0.701）,属于基本可信程度。 结论　基于数字化三维重建的跟骨骨折的分型直观明了,具有较高的可信度、为临床诊治方式的选择提供了更为精准的影像学依据。     

Comparison of scapular kinematics between elevation and lowering of the arm in the scapular plane

Objective. To compare scapular orientation during both the concentric (elevation) and eccentric (lowering) phases of scapular plane abduction in subjects with and without shoulder impingement.

Design. Mixed model analysis of variance with one between-subjects factor (group) and within-subjects factors of phase, humeral angle, and trial.

Background. Abnormal scapular kinematics have been identified in shoulder impingement patients during the concentric phase of arm elevation, and under static conditions. Because abnormal scapular motion is observed clinically during the eccentric phase of arm elevation, analysis of this phase of motion is warranted.

Methods. Twenty-six symptomatic and 26 healthy subjects performed five repetitions of humeral scapular plane abduction. An electromagnetic tracking device described three-dimensional scapular kinematics during arm elevation and lowering. Angular values for scapular anterior/posterior tipping in the sagittal plane, upward/downward rotation in the scapular plane, and internal/external rotation in the transverse plane were calculated. Scapular orientation relative to the thorax at humeral angles of 40°, 60°, 80°, 100°, and 120° was statistically tested for effects of phase and trial, or for interactions of phase with group or humeral angle.

Results. Internal rotation was significantly increased in the eccentric phase for both groups at the 100° angle (P<0.05) and for the symptomatic group only at the 120° angle (P<0.05). Scapular anterior tipping was significantly decreased during the eccentric phase in both groups at the 80° (P<0.001), 100° (P<0.0001), and 120° (P<0.0001) angles.

Conclusions. Small but statistically significant differences in scapular tipping and internal rotation during the eccentric phase of arm elevation were identified at higher humeral angles in both subject groups, while no significant phase differences for scapular upward rotation or for scapular variables at lower humeral angles were found. Averaged across phases, the symptomatic group demonstrated significant reductions in upward rotation at lower humeral elevation angles, and significant increases in anterior tipping at higher elevation angles as compared to the healthy group.

Relevance Normal and abnormal scapular kinematics during varying types of motion need to be understood in order to optimally design rehabilitation programs for individuals with impingement syndrome.     

CT三维重建在孤立性肺结节鉴别诊断中的价值

目的:探讨CT三维重建在孤立性肺结节(SPN)良恶性鉴别诊断中的价值。方法:收集就诊于我院门诊SPN患者29例,64排螺旋CT胸部平扫后三维重建,并与常规胸部CT平扫对比分析。结果:29例患者中良性结节11例,恶性16例,排除诊断2例。毛刺和血管集束征的检出率在胸部CT三维重建中均高于普通胸部CT平扫(均P<0.05)。结论:胸部CT三维重建在观察SPN形态学方面优于普通胸部CT平扫,对SPN的良恶性鉴别有重要价值。     

An MRI based average macaque monkey stereotaxic atlas and space (MNI monkey space)

In studies of the human brain, a standard stereotaxic space such as the Montreal Neurological Institute (MNI space) is widely used to provide a common reference for the three-dimensional localization of functional activation foci and anatomical structures, enabling the comparison of results obtained across different studies. Here we present a standard macaque monkey brain MRI template that offers a common stereotaxic reference frame to localize anatomical and functional information in an organized and reliable way for comparison across individual monkeys and studies. We have used MRI volumes from a group of 25 normal adult macaque monkeys (18 cynomolgus and 7 rhesus) to create a common standard macaque monkey brain as well as atlases for each of these species separately. In addition, the digital macaque monkey volume was subjected to 3D volumetric analysis and comparison of brain structures between the individual brains and the average atlas. Furthermore, we provide a means of transforming any macaque MRI volume into MNI monkey space coordinates in 3D using simple web based tools. Coordinates in MNI monkey space can also be transformed into the coordinate system of a detailed neuroanatomical paper atlas (Paxinos et al., 2008), enabling researchers to identify and delineate cortical and subcortical structures in their individual macaque monkey brains.     

三维适形放射治疗联合药物治疗肺癌的临床疗效分析

目的探讨三维适形放射治疗(3D-CRT)联合化疗治疗肺癌的临床效果及安全性。方法选取2010年1月至2012年1月行3D-CRT联合化疗的40例肺癌患者为观察组,另选取同期行化疗的40例肺癌患者为对照组,观察两组患者治疗后的临床效果和不良反应。结果观察组和对照组的总有效率分别为95.0%和65.0%,差异有统计学意义(P<0.001)。观察组和对照组的2年生存率分别为55.0%和30.0%,差异有统计学意义(P=0.001)。观察组发生放射性食管炎患者10例,放射性肺炎12例。结论 3D-CRT联合化疗治疗肺癌临床效果确切,同时可提高患者的生存率,安全有效,值得临床推广应用。     

Three-Dimensional CT Evaluation for Endovascular Abdominal Aortic Aneurysm Repair. Quantitative Assessment of the Infrarenal Aortic Neck

Endovascular grafting of abdominal aortic aneurysms should be offered only to those patients with suitable anatomy. This is especially true at the level of the proximal aortic neck in order to secure long-term proximal fixation. Aortoiliac anatomy is easy to understand conceptually, however, it is difficult to define and measure quantitatively. In this article, we discuss the use of three dimensional computed tomographic angiography to determine aneurysm morphology and select patients for endovascular repair. Specifically, we apply our methods to define and measure angulation of the aorta and iliac arteries. The anatomic definition of the angulation of the proximal aortic neck is emphasized.