腰椎间盘突出症伴骶髂关节错位的治疗

目的:观察不同治疗方法对腰椎间盘突出症伴骶髂关节错位的效果。方法:135例患者随机分为3组。对照组45例,以治疗腰椎间盘突出症为主,用手法整复偏歪棘突及腰椎小关节紊乱,给予水平牵引等治疗。治疗1组45例,治疗骶髂关节错位为主,以正骨推拿手法治疗。治疗2组45例,腰椎间盘突出症与骶髂关节错位同时治疗,以三维牵引为主,并综合应用上面的治疗方法。结果:治疗1组治疗后骶髂关节错位的整复效果好,但腰曲值改善率低。治疗2组治疗后骶髂关节错位的整复效果好,腰曲的改善率高。对照组对骶髂关节错位无整复效果,腰曲值改善率明显。结论:治疗腰椎间盘突出症伴骶髂关节错位要分清主次,筋骨并重,而三维牵引是一种有效的治疗方法。     

股骨头缺血性坏死误诊为腰椎间盘突出症的成因和预防对策

目的分析股骨头缺血性坏死误诊为腰椎间盘突出症的形成原因,提出预防对策。方法回顾性分析我院2006年1月～2010年12月收治并误诊为腰椎间盘突出症的17例股骨头缺血性坏死的临床资料。结果 17例中单侧股骨头坏死12例,双侧5例,共22个股骨头坏死延误诊断,发病到确诊时间5～18个月,平均10个月。按Ficat及Arlet分期,Ⅰ期2个,Ⅱa期5个,Ⅱb期5个,Ⅲ期6个,Ⅳ期4个。6例误行腰椎间盘手术,2例行髋部X线、CT检查不能确诊股骨头缺血性坏死,后经MRI、放射性核素扫描(ECT)检查明确诊断。17例确诊后根据分期的不同13个股骨头实施了全髋关节置换术,6个实施了髓内减压钽棒置入,3个实施了髓内减压植骨,症状均明显减轻。结论对可疑股骨头缺血性坏死病例应及早行ECT、MRI检查,且影像学检查与临床检查要密切结合,严格执行腰椎间盘手术指征,制定合理的临床路径是防止股骨头缺血性坏死误诊的重要措施。     

Displacement of the heart by diaphragm: is this heart alternating?

A-64-year-old man was admitted to the emergency department because of dyspnea. Twelve-lead ECG revealed alternating QRS complexes. In consequence of diagnostic tests, i.e., chest tomography showed eventration of the left diaphragm. In this case, we present an unusual case of electrical alternans due to diaphragmatic eventration.     

Visual motion detection in hierarchical spatial frames of reference

Neurophysiological and neuroimaging work has uncovered modulatory influence of long-range lateral connections from outside of the classical receptive field on neuronal and behavioral responses to localized targets. We report two psychophysical experiments investigating visual detection of real and apparent motion in central vision with and without remote and immediate stationary references. At a particular temporal frequency (0.1–12.8 Hz), participants adjusted the amplitude of either triangle-wave (real) or square-wave (stroboscopic/apparent) oscillatory motion of a vertical bar along a straight, horizontal trajectory for the first impression of the target’s stationarity/nonstationarity (the displacement threshold). In the relative motion conditions, a stationary reference bar was positioned 23′ apart from the target; in the absolute motion conditions, the bar was absent. The thresholds were measured with a dimly-lit uniform background (13 × 13°) and either in the darkness (experiment 1) or moving-background conditions (experiment 2). For both real and apparent motion, varying the observation conditions yields three sensitivity levels: irrespective of the background, the lowest thresholds occur in the presence of an immediate reference, followed by the moderately increased thresholds obtained with a dimly-lit background alone. The equally high thresholds occur in the darkness and moving-background conditions without any visible stationary references. The results suggest that the spatial frames of reference for visual motion detection are hierarchically nested, yet independent. The findings provide support for the view that absolute motion perception should be considered relative, extending neurophysiological evidence for the existence of long-range lateral connections across the visual field.     

近10年推拿治疗腰椎间盘突出症临床进展

Lumbar intervertebral disc herniation (LIDH) is a commonly encountered clinical disease.Tuina therapy is one of the important conservative treatments for it.In order to understand the clinical status of tuina therapy for this disease,now the literature in recent 10 years is reviewed as follows.     

牵张方向对下颌骨体部牵张成骨应力分布与位移的影响

目的:研究牵张方向对下颌骨体部牵张成骨的影响。方法:建立下颌骨牵张成骨三维有限元模型,在下颌骨体部模拟牵张成骨,测量不同加载条件下,下颌骨的VonMises应力、颏顶点和右侧下颌角点的位移。结果:应力、位移量与加载力值成线性关系。应力集中在加载部位,双侧加载、与牙合平面平行方向加载时,VonMises应力更大,颏顶点、下颌角点表现为X、Z轴向的正位移和Y轴向的负位移;与下颌骨下缘平行方向的加载应力小,颏顶点、下颌角点表现为X、Y轴向的正位移和Z轴向的负位移。结论:单侧加载时下颌骨向对侧偏斜多,双侧加载时矢状向位移趋势大。与上颌牙合平面平行的加载较与下颌骨体下缘平行的加载应力大,但不会造成前牙开牙合。     

Characterization of implant displacement and deformation in gynecologic interstitial brachytherapy

PurposeTo determine the uncertainties in implant position during multifraction gynecologic interstitial brachytherapy, we analyzed the interfraction displacements and deformations of gynecologic interstitial implants.Methods and MaterialsFourteen gynecologic patients treated with multifraction high-dose-rate interstitial brachytherapy received two CT scans each at the time of implantation and 48–72 h later. Rigid fusions on the pubic symphysis were performed. This analysis included catheter shifts in the cranial (CR), caudal (CA), anterior, posterior, left, and right directions; template shifts; the change in the catheter length measured along the path from catheter tip to catheter connector (offset); the change in relative distances between catheters (deformations); and changes in rectum and bladder D_2cc and tumor D₉₀.ResultsOf the 198 catheters analyzed, the number of catheter shifts (%) and mean ± standard deviation were 43% CA (5.0 ± 2.0 mm), 22% CR (7.9 ± 4.0 mm), 14% anterior (6.3 ± 2.1 mm), 48% posterior (8.7 ± 3.1 mm), 7% left (4.8 ± 0.4 mm), and 9% right (5.4 ± 0.9 mm). Catheter offsets were 3% CA (7.2 ± 6.3 mm) and 11% CR (6.1 ± 2.6 mm). Template shifts were 43% CA (5.2 ± 1.6 mm) and 14% CR (6.6 ± 4.0 mm). Deformations were 10 shrinkages (4.7 ± 0.9 mm) and 32 expansions (4.7 ± 0.5 mm). Dosimetric changes were 5.2% ± 10.8% for rectum D_2cc, −1.1% ± 18.5% for bladder D_2cc, and −5.1% ± 6.7% for tumor D₉₀.ConclusionsOn average, less than 1 cm displacements and deformations of the implant occurred over the course of treatment. Proper quality assurance methodologies should be in place to detect shifts that can potentially result in inadvertent insertion into normal tissue.     

Effects of Various Parameters on Lateral Displacement Estimation in Ultrasound Elastography

Complementary to axial, lateral displacement and strain can provide important information on the biological soft tissues. In this paper, the effects of key parameters (i.e., lateral displacement, pitch, beamwidth, beam overlap and interpolation) on lateral displacement estimation were investigated, in simulations and homogeneous phantom experiments, using lateral rigid motion only to study its fundamentals separately from the effects of axial motion and 2-D deformation on lateral displacement estimation. The performance of the lateral motion estimator was evaluated by measuring its associated bias, jitter and correlation coefficient. Simulation results showed that the bias and jitter of the lateral displacement estimation and correlation coefficient of RF signals undergo periodic variations depending on the lateral displacement, with a period equal to the pitch. The performance of the lateral estimation was improved when a smaller pitch or a larger beamwidth, was used. The effect of the pitch on the lateral estimation on lateral displacement estimation was found to be greater than the beamwidth effect. Therefore, a smaller pitch is preferred when the beam overlap remains the same. The use of cubic spline, instead of linear interpolation, increases the correlation coefficient, and decreases the jitter, with the trade-off of increased bias. The results of the phantom experiments were shown in good agreement with the simulation findings, including the periodic variation of the performance with lateral displacement and effects of pitch, beamwidth and interpolation method on lateral displacement estimation. In conclusion, smaller pitch, wider beamwidth and spline interpolation were shown to be key in reducing the jitter error in the lateral displacement estimation. (E-mail: ek2191@columbia.edu)     

犬急性心肌缺血左心室起搏跨壁径向位移的超声研究

目的 观察比格犬急性心肌缺血后左心室不同起搏位点节段整体和节段跨壁心肌峰值径向位移(RD)的变化,量化评价不同起搏位点左室跨壁心肌力学状态特征.方法 10只健康比格犬开胸模型,结扎冠状动脉左前降支诱导产生急性心肌缺血.随机进行缺血后左心室侧壁起搏(LVI/P)、左心室心尖起搏(LVA-P)、左心室缺血与非缺血交界区起搏(LVB-P),分别采集三个心动周期标准二尖辦口、乳头肌及心尖短轴切面动态组织多普勒(TDI)速度二维图像.分析评价左室不同起搏位点节段整体和节段跨壁心肌(RD、达峰时间(RD-Tc)、达峰时间标准差(RD-TSD)等力学参数变化.结果 ①急性心肌缺血后LVL-P、LVA-P和LVB-P状态组内节段跨壁三层心肌间RD差异无统计学意义;LVL-P、LVA-P和LVB-P状态组间节段整体和节段跨壁三层心肌RD差异无统计学意义.②急性心肌缺血后LVL-P和LVB-P状态节段跨壁和相应节段整体的RD相关性高于LVA-P状态.③急性心肌缺血后左室不同起搏位点节段整体和跨壁心肌大部分节段RD-Tc延迟于T波之后,不同起搏位点间大部分节段RD-Tc差异无统计学意义.④急性心肌缺血后LVL-P、LVA-P、LVB-P心内膜下和中层心肌以及LVDP节段整体的RD-TSD.均比缺血非起搏状态相应节段降低,差异有统计学意义(P相似文献   

B超动态观察针灸推拿治疗腰椎间盘突出症240例

采用B超动态观察经针灸推拿治疗的腰椎间盘突出症患者的腰椎管内径动态变化与临床疗效的关系。结果表明：针灸、推拿、针灸与推拿结合3种治疗方法均能使椎管内径增宽,均能改变突出椎间盘与受刺激的神经根之间的位置关系。针灸与推拿结合能提高疗效。缩短疗程,减少后遗症状。