超声在髋关节穿刺导向中的应用

目的 探讨超声在髋关节穿刺导向的应用价值,以及关节间隙作为穿刺点在无关节腔积液患者穿刺中的优势.方法 对确诊为强直性脊柱炎或骨性关节炎累及髋关节的43例患者共计82个关节,以髋臼与股骨头之间的关节间隙为穿刺靶点,进行超声引导下关节穿刺注药.记录穿刺次数、穿刺深度、所用时间、副作用及并发症.结果 82个髋关节腔均能在超声图像上清晰显示,左、右髋关节穿刺深度分别为(3.4±0.9)cm和(3.1 ±0.8)cm.95.1％的关节穿刺1次即进入关节腔,所有关节最后均穿刺成功,穿刺成功率为100％.操作所用时间为(287.9±45.8)s.术后未发现与操作相关的并发症.结论 超声可作为位置深在的髋关节穿刺治疗时的首选引导方法,而关节腔无积液患者可首选关节间隙作为穿刺靶点.     

活动性强直性骶髂关节炎的彩色多普勒超声表现

Objective To evaluate the color Doppler ultrasonographic findings of active ankylosing sacroiliitis.Methods Thirty three patients (66 sacroiliac joints in total) with active ankylosing sacroiliitis identified by MRI and twenty eight healthy volunteers (56 sacroiliac joints) underwent color Doppler ultrasound examinations of sacroiliac joints.Degree of blood flow within and around the sacroiliac joints was evaluated by semi-quantitative scale (0 - 4 grade).For arteries, resistive index was also measured.Statistical analyses were performed to compare blood flow demonstration rate, blood flow signal scale distribution,degree of blow flow and RI value between the two groups.Results Higher blood flow demonstration rate was found in patients with active ankylosing sacroiliitis(60/66,90.1%) than control group (25/56,44.6%)( P = 0.000).The scale distribution and degree of blow flow between these two groups were statistically different (all P = 0.000) ,with mainly 2～3 grade for the patients and 0～1 grade for the control.Mean value of RI in the patients was 0.57 ± 0.07, which was lower than the control (0.66 ± 0.04, P = 0.000).Conclusions Patients with active ankylosing sacroiliitis tend to have higher degree of blood flow in sacroiliac joints and lower RI values of artery.Color Doppler ultrasound may help to evaluate the activity of ankylosing sacroiliitis.     

活动性强直性骶髂关节炎的彩色多普勒超声表现

目的 探讨活动性强直性骶髂关节炎的彩色多普勒超声表现.方法 使用彩色多普勒超声检查33例经MRI确诊为活动性强直性骶髂关节炎患者的66个骶髂关节和28例健康对照者的56个骶髂关节,了解骶髂关节内部和周边血流信号的显示情况,并对血流信号的丰富程度进行半定量分级,同时测量动脉血流阻力指数,分析两组间血流显示率、血流级别分布、血流的丰富程度和动脉血流阻力指数的差异.结果 病例组骶髂关节内部或周边血流显示率(60/66,90.1%)高于健康对照组(25/56,44.6%),两组间差异具有显著统计学意义(P=0.000);病例组以2～3级多血流为主,而健康对照组以0～1级少血流为主,两组间血流级别分布及血流丰富程度差异均具有显著统计学意义(均P=0.000);病例组的平均动脉血流阻力指数(0.57±0.07)低于健康对照组(0.66±0.04),两组间差异亦具有显著统计学意义(P=0.000).结论 活动性强直性骶髂关节炎患者骶髂关节内部或周边以丰富偏低阻力血流为主,彩色多普勒超声有助于评价强直性骶髂关节炎的炎性活动度.     

超声引导联合电刺激定位注射肉毒毒素治疗脑卒中后上肢痉挛

目的评价超声引导联合电刺激定位注射肉毒毒素(BTX-A)治疗脑卒中后上肢肌痉挛的效果。方法选择脑卒中上肢痉挛患者23例,在超声引导联合电刺激定位引导下,多点注射法将BTX-A注入靶肌。注射后进行常规康复训练。注射前、注射后1、2、4、12周分别采用改良Ashworth评分、腕指关节主动活动度测量、Fug1-Meyer评估表对上肢部分进行疗效评价。结果注射BTX-A后,患者肌张力、腕指关节主动活动度、Fug1-Meyer评估表上肢部分评分均较注射前明显改善(P均<0.05)。结论超声引导联合电刺激定位注射BTX-A治疗脑卒中后上肢肌痉挛,定位准确,治疗效果明显。     

康复医学科住院医师超声医学培训初探

本文对康复医学科住院医师超声医学培训实践进行了探讨.在教学内容上,结合本专业特点以针对性肌骨系统影像训练为重点;在教学方法上,实施有针对性的教学指导并调动住院医师自学积极性,同时配合超声专科医师的指导.实践证明,近几年的住院医师临床培训取得了良好的效果.     

超声引导下注药治疗难治性急性跟腱附着端炎的初步研究

目的初步探讨超声引导下局部跟腱内注射得宝松治疗难治性急性跟腱附着端炎的有效性及安全性。方法 9例患者进行超声引导下跟腱内得宝松注射治疗。记录注射前、注射后第2、4周和第8周患者VAS疼痛评分、超声急性炎症评分以及8周内有无并发症发生。结果超声均能清晰显示所有跟腱附着部及其急性炎症区域,急性炎症区注射成功率100%。注射后第2、4周及第8周,疼痛VAS评分及超声急性炎症评分与治疗前相比,均显著降低(P0.05)。随访8周内仅1例出现局部皮肤轻微萎缩,无其他并发症发生。结论超声引导下跟腱注药是一种准确、安全的引导方法,可短期内有效缓解难治性跟腱附着点炎所致疼痛,但是对于远期效果仍有待研究。     

不同时点A型肉毒毒素干预对脊髓损伤大鼠腓肠肌病理特征影响的研究

目的:探讨在不同时间点进行A型肉毒毒素(BoNT-A)注射干预对脊髓损伤(SCI)大鼠肌张力(MAS)、运动功能状态(BBB)及腓肠肌(GM)病理特征的影响,进而寻找BoNT-A干预痉挛最佳时间的理论依据。方法:48只SD雄性大鼠被随机分配至Nor-Contrl组、12周-Contrl组、NS干预组和BT干预组。NS/BT干预组按干预时间又分设3个亚组(2周-NS亚组、2周-BT亚组、4周-NS亚组、4周-BT亚组、8周-NS亚组、8周-BT亚组)。Nor-Contrl组和12周-Contrl组大鼠不予注射药物;BT/NS干预组,按上述时间点分别给予BoNT-A/生理盐水注射大鼠右GM。肌张力评估采用MAS评估,运动功能采用BBB评分。GM标本进行肌重测量及蛋白电泳分析(MyHC)。结果:与12周-Contrl组相比,BT干预组大鼠GM肌重明显下降(P≤0.05)。与12周-Contrl组相比,干预组大鼠MAS及BBB结果差异无显著性意义(P0.05)。BT干预组中不同亚组大鼠GM的MyHC分型占比较Nor-Contrl组及12周-Contrl组间的差异均有显著性意义(P≤0.05);且随着干预时间点不同,BT干预组大鼠GM的MyHC分型占比亦不同。结论:BoNT-A注射干预导致受注射的GM肌重及肌重/体质量比显著下降,萎缩明显;对受试大鼠MAS及BBB无明显影响;早期注射较后期注射更易引起GM发生MyHC构型改变。     

活动性强直性骶髂关节炎的彩色多普勒超声表现

Objective To evaluate the color Doppler ultrasonographic findings of active ankylosing sacroiliitis.Methods Thirty three patients (66 sacroiliac joints in total) with active ankylosing sacroiliitis identified by MRI and twenty eight healthy volunteers (56 sacroiliac joints) underwent color Doppler ultrasound examinations of sacroiliac joints.Degree of blood flow within and around the sacroiliac joints was evaluated by semi-quantitative scale (0 - 4 grade).For arteries, resistive index was also measured.Statistical analyses were performed to compare blood flow demonstration rate, blood flow signal scale distribution,degree of blow flow and RI value between the two groups.Results Higher blood flow demonstration rate was found in patients with active ankylosing sacroiliitis(60/66,90.1%) than control group (25/56,44.6%)( P = 0.000).The scale distribution and degree of blow flow between these two groups were statistically different (all P = 0.000) ,with mainly 2～3 grade for the patients and 0～1 grade for the control.Mean value of RI in the patients was 0.57 ± 0.07, which was lower than the control (0.66 ± 0.04, P = 0.000).Conclusions Patients with active ankylosing sacroiliitis tend to have higher degree of blood flow in sacroiliac joints and lower RI values of artery.Color Doppler ultrasound may help to evaluate the activity of ankylosing sacroiliitis.     

脊髓损伤大鼠痉挛腓肠肌超声弹性成像特征与其病理学特征的相关性

目的 观察大鼠脊髓损伤(SCI)前后痉挛腓肠肌(GM)的病理特征、超声弹性特征及两者的相关性。方法 将24只SD雄性大鼠分为对照组(n=6)和SCI组(2、4、12周亚组,每组6只)。各组大鼠在上述各时间点完成踝关节肌张力改良Ashworth量表(MAS)评分、BBB运动功能评分、超声弹性成像评估GM硬度(Young's模量)、肌ATP酶染色及MyHC电泳分析。相关性采用Pearson相关分析。结果 踝跖屈时,对照组GM的Young's模量与体质量呈正相关(r=0.89,P=0.02),与MyHC-Ⅰ占比呈负相关(r=-0.83,P=0.04);2周亚组GM的Young's模量与其MyHC-Ⅰ型肌纤维占比呈正相关(r=0.85,P=0.03)。踝背曲时,对照组GM的Young's模量与其Ⅰ型纤维占比呈负相关(r=-0.91,P=0.01),4周亚组GM的Young's模量与体质量呈负相关(r=-0.92,P=0.01)。结论 SCI后大鼠GM的硬度特征与其早期病理改变相关;而后期发生的GM硬度改变可能与其肌纤维外结构改变有关。