超声检测类风湿关节炎膝关节滑膜改变及其血流的临床应用价值

目的：通过观察类风湿关节炎（rheumatoid arthritis ,RA ）膝关节滑膜病变的超声声像图表现,分析滑膜病变超声检查结果与RA活动度的相关性,探讨超声检查RA膝关节滑膜病变的临床应用价值。方法对38例RA患者患侧膝关节和20例正常对照者双侧膝关节行超声检查,根据DAS28评分结果将RA患者分组,分别对比各组与对照组的滑膜厚度,髌上囊积液;分析RA组超声检测结果与DAS28评分之间的相关性。结果 RA组滑膜厚度较对照组明显增厚,髌上囊积液明显增多（ P ＜0．05）。RA组膝关节滑膜厚度、关节积液及滑膜内血流信号分级与RA患者DAS28评分之间存在一定的相关性（ P ＜0．05）。结论超声检查对RA膝关节滑膜病变具有一定的的诊断价值,与DAS28评分的相关性较好,可以作为评估RA膝关节滑膜病变常规检查方法之一。     

军事训练致膝关节滑膜炎的高频超声诊断

目的评价高频超声对创伤性膝关节滑膜炎诊断及观察疗效的价值。方法回顾性分析42例创伤性膝关节滑膜炎患者的临床资料,分析其高频超声（超声组）声像图表现,并将患者滑膜厚度、关节积液测量值与X线平片（X线组）及磁共振（MRI组）做比较。结果创伤性滑膜炎急性期滑膜厚度、关节腔积液的数值,超声组为（4．1±1．4）mm、（15．8±3．7）mm,X线组为（1．9±0．5）mm、（9．4±2．0）mm,MRI组为（4．2±1．2）mm、（16．2±4．1）mm。超声组与X线组比较均有统计学差异（P〈0．05）,与MRI组比较均无统计学差异。治疗前后滑膜厚度、关节腔积液及滑膜内血流信号高频超声测值比较有统计学差异（P〈0．05）。结论高频超声在诊断创伤性膝关节滑膜炎、判断病情和随访中有较高的应用价值。     

超声激励脉冲编码技术对膝关节疾病的诊断价值

目的探讨超声激励脉冲编码技术对类风湿性关节炎(rheumatoidarthritis,RA)和骨关节炎(osteoarthritis ,OA)中膝关节病变的诊断价值。方法对5 6例类风湿性关节炎患者112个膝关节和4 1例骨关节炎82个膝关节进行了详细的二维及彩色多普勒检查,并与MRI检查结果进行比较。结果RA/OA组髌上囊或关节腔积液及髌上囊内滑膜增生的诊断结果经对比,超声与MRI无明显的差异(P >0 .0 5 ) ;对髌上囊两侧隐窝内的滑膜增生,MRI优于超声,超声为MRI的76 % ;对RA/OA组软骨Ⅰ级退变的显示,MRI明显高于超声;对软骨Ⅱ～Ⅳ级的退变,超声与MRI结果基本一致。RA组与OA组对比,RA患者以滑膜增生为主;OA患者以软骨及骨质破坏为主。结论超声激励脉冲编码技术是一项有价值的诊断技术,对RA和OA的诊断具有高度的特异性和敏感性。     

膝关节树枝状脂肪瘤的MRI诊断

目的 探讨MRI对膝关节树枝状脂肪瘤(LA)的诊断价值.方法 回顾性分析5例经手术及病理证实为LA的MRI表现.所有患者均行MR平扫,其中1例同时行增强扫描.结果 5例均位于髌上囊.MR显示4例髌上囊滑膜明显增厚,呈"棕榈叶状"改变,1例髌上囊滑膜 "绒毛状"轻度增厚,明显强化;增厚的滑膜T1WI上表现为高信号、T2WI上表现为稍高信号,脂肪抑制序列上表现为低信号,梯度回波序列上表现为高、低混杂信号;5例髌上囊大量积液,2例滑膜囊内多发游离体;5例髌软骨均轻度损伤;1例胫骨平台外侧部滑膜囊肿.结论 膝关节LA具有特征性MR表现,术前MRI能对其定性诊断.     

外伤性膝关节腔积液的超声诊断

本文对300例因外伤引起的关节腔积液进行了超声诊断。其中232例髌股间隙暗区>1mm≤2mm,浮髌试验及超声暗区变化均为阴性为正常组。8例髌股间隙暗区>2mm≤5mm,浮髌试验阴性,超声暗区变化为阳性及60忻髌股间隙暗区>5mm,两项检查为阳性,共68例均为积液组(P<0.01)。总结了(一)膝关节腔积液的超声特点,尤其在少量积液时超声诊断比单纯浮髌试验敏感,检出率高。(二)超声检查的最佳位置为膝关节伸直位。(三)超声诊断膝关节积液有利于临床定位穿刺。(四)超声对膝关节腔积液的诊断存在假阳性,但易于鉴别。总之超声诊断外伤性膝关节腔积液是一种理想的首选方法。     

膝关节损伤的MRI诊断价值

目的：探讨MRI在膝关节损伤中的诊断价值。方法对20例经X线平片检查诊断为阴性而行MRI检查的病例进行了回顾性分析。结果：半月板损伤者12例。其中内侧半月板损伤者7例，外侧半月板损伤者5例；交叉韧带损伤者8例，其中前交叉韧带损伤者6例。后交叉韧带损伤者2例；侧副韧带损伤者6例，其中胫侧副韧带损伤者4例。腓侧副韧带损伤者2例。骨挫伤及软骨损伤者5例。合并滑膜水肿、出血、增厚、关节囊积液及周围肌肉软组织肿胀、出血者8例。结论MRI是诊断膝关节损伤最理想的检查方法。     

膀胱尖的高频彩色多普勒超声表现

目的:探讨膀胱尖的高频超声声像图特征。方法:对128例膀胱镜检阴性患者行超声检查,观察其膀胱尖的位置、形状、大小、回声及内部血流情况,并测量膀胱尖的厚度。结果:高频彩色多普勒超声示膀胱尖为膀胱前壁正中肌层局部增厚处,厚度平均(3.99±0.70)mm,膀胱两侧壁厚度平均(1.45±0.14)mm,两者差异有统计学意义(P0.01)。膀胱尖呈椭圆形、梭形或线样,内部回声为低或高回声。CDFI示部分膀胱尖内可见血流信号,脉冲多普勒(PW)测得动脉频谱。结论:高频彩色多普勒超声能清晰显示膀胱尖的位置、形状、大小、回声及内部血流情况。掌握膀胱尖的声像图特征,可提高对其正确认识,降低误诊率。     

高频彩色多普勒超声对早期、活动期类风湿性关节炎患者指、腕关节病变诊断价值

目的探讨高频彩色多普勒超声对早期、活动期类风湿性关节炎(RA)患者指、腕关节病变的诊断价值。方法选取自2016年9月至2017年1月于沈阳军区总医院就诊的50例RA早期患者作为RA组;同时,选择43例健康体检者,作为常规组。超声检测两组滑膜厚度、关节腔积液及骨侵蚀程度;X线影像检查RA组患者的关节骨侵蚀程度;超声检测RA组活动期患者治疗前后增生滑膜内血流信号。结果常规组860个关节中,滑膜均未见明显增厚,关节腔内均未见明显积液;RA组1 000个关节中,75.4%(754/1 000)出现滑膜增厚,58.6%(586/1 000)有关节腔积液,5.6%(56/1 000)出现骨侵蚀。两组滑膜厚度及关节腔积液比较,差异有统计学意义(P<0.05)。治疗前,RA组35例活动期患者中,28.3%(283/1 000)的关节出现血管增生。经1~2个月治疗后,283个血管增生关节中,0级血流由0增加到56.5%(160/283),Ⅰ级血流由59.7%(169/283)减少至24.0%(68/283),Ⅱ级血流由24.0%(68/283)减少至15.2%(43/283),Ⅲ级血流由16.3%(46/283)减少至4.3%(12/283),差异均有统计学意义(P<0.05)。X线检出RA组患者骨侵蚀关节个数占9.0%(9/100),而超声检出骨侵蚀个数占25.0%(25/100),差异有统计学意义(P<0.05)。结论采用高频彩色多普勒超声诊断早期、活动期RA患者指、腕关节病变,可动态观察疾病的发展变化,可作为RA早期诊断及随访的常规辅助检查。     

膝关节半月板及其损伤的MRI研究

目的　研究正常和损伤的膝关节半月板的MRI表现。方法　对经手术、关节镜或临床证实的 2 6例共 3 2个损伤的半月板与 15例正常的膝关节半月板进行回顾性MRI对比观察。结果　显示正常膝关节半月板在T1WI和T2 WI上均呈三角形低信号。 3 2个损伤的半月板 ,其中内侧损伤 15个 ,外侧损伤 11个 ,两侧半月板同时损伤 3例 6个 ,将 3 2个损伤的半月板按Stoller的 4级分法分类 ,其中 0级 0个 ,I级 6个 ,Ⅱ级 12个 ,Ⅲ级 14个。 18例出现并发症 ,其中合并半月板囊肿 6例 ,内侧副韧带损伤 10例 ,外侧副韧带损伤 9例 ,前交叉韧带损伤 7例 ,后交叉韧带损伤 6例 ,骨挫伤 8例 ,骨折 5例 ,关节囊积液 11例 ,膝关节周围软组织内瘀血 6例。结论　MRI能够清晰显示膝关节半月板的解剖结构 ,能准确诊断半月板的损伤并进行分级 ,还能发现多种并发症。     

男性职业足球运动员膝关节损伤的MRI分析

目的 探讨男性职业足球运动员膝关节损伤的MRI表现及损伤特征.方法 将2011年12月至2013年4月到本院就诊的29名男性职业足球运动员共31个膝关节损伤作为实验组,运动员年龄(23.6±3.5)岁,接受专业足球训练时间(15.3±3.6)年;随机选取普通膝关节急性损伤的相同年龄段门诊患者31例作为对照组;两组均采用1.5 TMR扫描仪、膝关节标准阵列线圈成像,由2名高年资放射科医师评估膝关节软骨、半月板、韧带、肌腱、骨髓、髌下脂肪垫及关节积液等病变.采用Pearson卡方检验法及两独立样本的非参数检验法对评估结果进行统计学检验.结果 实验组关节软骨、半月板、前交叉韧带、内侧副韧带、外侧副韧带、腘绳肌、肌腱或韧带损伤、多韧带或肌腱损伤,骨髓水肿,髌下脂肪垫水肿和关节腔积液受累的膝关节分别为11、16、12、17、14、6、29、19、23、25、10个,对照组分别为4、11、14、13、5、1、19、8、14、19、10个.其中两组间关节软骨、外侧副韧带、肌腱或韧带损伤、多韧带或肌腱损伤、骨髓水肿发病率差异有统计学意义(P＜0.05),而半月板损伤、前交叉韧带损伤、内侧副韧带损伤、髌下脂肪垫水肿、关节积液的发病率差异无统计学意义.实验组关节软骨、半月板、韧带、肌腱损伤及骨髓水肿病灶数分别为28、34、50、15及57.对照组分别为7、15、41、3、32.其中,关节软骨、半月板及骨髓水肿病灶数量两组间差异有统计学意义(P＜0.05).实验组关节软骨1级、2级、3级、4级病灶分别为12、9、3、4处;半月板1级、2级、3级病变分别为11、12、11处;韧带或肌腱1级、2级病变分别为52、13处.对照组分别为2、3、2、0;3、3、9;35、9.其关节软骨与半月板的病灶两组间的差异有统计学意义(P均=0.000).结论 MRI显示男性职业足球运动员膝关节损伤常累及韧带或肌腱,多为多韧带或肌腱损伤,关节软骨、半月板病灶较常见且较严重,骨髓水肿亦较常见于足球运动损伤中.     

中老年股骨颈骨折全髋关节置换术和骨折内固定术临床观察

目的：探讨中老年股骨颈骨折全髋关节置换术和骨折内固定术临床疗效情况。方法分析本院收治的中老年股骨颈骨折患者89例临床资料,中老年股骨颈骨折患者根据治疗方式的不同进行分组,骨折内固定术组39例和全髋关节置换术组50例。结果全髋关节置换术组中老年股骨颈骨折患者手术时间、术中出血量均高于骨折内固定术组,全髋关节置换术组术后功能恢复时间明显低于骨折内固定术组,全髋关节置换术组中老年股骨颈骨折患者的术后功能优良率明显高于骨折内固定术组,P＜0．05,差异有统计学意义。结论全髋关节置换术治疗中老年股骨颈骨折患者临床效果明显,预后功能恢复良好。     

胰十二指肠切除术13例报告

目的：评价改良的胰十二指肠切除术效果，减少并发症，降低死亡率。方法：回顾性分析1995－05－2000－05，作者采用改良的胰十二指肠切除术治疗胰腺癌等恶性肿瘤共13例，观察手术效果。结果：无胰瘘、胆瘘及胃肠吻合口瘘发生，无手术死亡，随访生存11－56个月，效果较好，结论：手术方法正确，吻合技术操作可靠，是减少并发症，降低死亡率的关键。     

Accuracy in certification of cause of death in a tertiary care hospital – A retrospective analysis

Every physician is duty bound to issue a “Cause of Death” certificate in the unfortunate event death of his/her patient. Incomplete and inaccurate entry in these certificates poses difficulty in obtaining reliable information pertaining to causes of mortality, leads to faulty public health surveillance, and causes hindrance in research. This study intends to evaluate the completeness and accuracy of Medical Certification of Cause of Death in our Institute and to formulate strategy to improve the quality of reporting of cause of death. During the period from January 2012 to December 2012, a total of 151 certificates of cause of death were issued by the faculty members of various departments. Maximum number of death certificates were issued for patients in the extremes of the age <10 years (n = 42, 27.82%) and in >60 years (n = 46, 30.46%). The various inadequacies observed by us are as follows: 40 (26.49%) cases had inaccurate cause of death, interval between onset and terminal event was missing in 94 (62.25%) cases, in 68 (45.03%)cases the seal with registration number of the physician was not available on the certificate, incomplete antecedent & underlying cause of death was found in 35 (23.18%) & 84 (55.63%) cases, in 66 (43.71%) cases there was use of abbreviations and the handwriting was illegible in 79(52.32%) cases.     

Fibromyxoma of bone

We report two cases of fibromyxoma, one affecting the iliac crest and the second involving the proximal shaft of the tibia. Fibromyxoma is a rare neoplasm related to benign fibrous tumors and is characterized by exuberant, extracellular, ground substance production. Its histologic appearance is benign and distinctive and can be readily distinguished from that of myxoid chondrosarcoma or chondromyxoid fibroma. The radiographic picture is, however, difficult to interpret, and the entity can be easily mistaken for other tumors.     

长期视远剥夺对人眼集合近点和调节近点的影响

Objective To study effects of sustained deprivation of far sight on human near point of convergence (NPC) and near point of accommodation (NPA). Methods Eight subjects were divided into two groups by age (group A ≥30 years old; group B<30 years old). All subjects had worked in the enclosed laboratory, unable to see the outside for 75 days. NPC and NPA were measured every 15 days. Results NPC values of both groups all increased when time elapsed. NPC of group A measured in the 75th day and NPC of group B in the 30th day all had statistical differences, when compared with the base NPC values measured in the 15th day (P<0.05). And NPC value of group B measured in the 45th, 60th and 75th days increased markedly, when compared with that of the 15th day (P<0.01 . However, statistical analysis showed that no significant difference could be seen in NPA values of the two groups (P>0.05). Conclusions Sustained deprivation of far sight could induce an increase in NPC values to various degreeal, but effects on NPA were not obvious, as noted in our experiment.     

长期视远剥夺对人眼集合近点和调节近点的影响

Objective To study effects of sustained deprivation of far sight on human near point of convergence (NPC) and near point of accommodation (NPA). Methods Eight subjects were divided into two groups by age (group A ≥30 years old; group B<30 years old). All subjects had worked in the enclosed laboratory, unable to see the outside for 75 days. NPC and NPA were measured every 15 days. Results NPC values of both groups all increased when time elapsed. NPC of group A measured in the 75th day and NPC of group B in the 30th day all had statistical differences, when compared with the base NPC values measured in the 15th day (P<0.05). And NPC value of group B measured in the 45th, 60th and 75th days increased markedly, when compared with that of the 15th day (P<0.01 . However, statistical analysis showed that no significant difference could be seen in NPA values of the two groups (P>0.05). Conclusions Sustained deprivation of far sight could induce an increase in NPC values to various degreeal, but effects on NPA were not obvious, as noted in our experiment.     

长期视远剥夺对人眼集合近点和调节近点的影响

Objective To study effects of sustained deprivation of far sight on human near point of convergence (NPC) and near point of accommodation (NPA). Methods Eight subjects were divided into two groups by age (group A ≥30 years old; group B<30 years old). All subjects had worked in the enclosed laboratory, unable to see the outside for 75 days. NPC and NPA were measured every 15 days. Results NPC values of both groups all increased when time elapsed. NPC of group A measured in the 75th day and NPC of group B in the 30th day all had statistical differences, when compared with the base NPC values measured in the 15th day (P<0.05). And NPC value of group B measured in the 45th, 60th and 75th days increased markedly, when compared with that of the 15th day (P<0.01 . However, statistical analysis showed that no significant difference could be seen in NPA values of the two groups (P>0.05). Conclusions Sustained deprivation of far sight could induce an increase in NPC values to various degreeal, but effects on NPA were not obvious, as noted in our experiment.     

长期视远剥夺对人眼集合近点和调节近点的影响

Objective To study effects of sustained deprivation of far sight on human near point of convergence (NPC) and near point of accommodation (NPA). Methods Eight subjects were divided into two groups by age (group A ≥30 years old; group B<30 years old). All subjects had worked in the enclosed laboratory, unable to see the outside for 75 days. NPC and NPA were measured every 15 days. Results NPC values of both groups all increased when time elapsed. NPC of group A measured in the 75th day and NPC of group B in the 30th day all had statistical differences, when compared with the base NPC values measured in the 15th day (P<0.05). And NPC value of group B measured in the 45th, 60th and 75th days increased markedly, when compared with that of the 15th day (P<0.01 . However, statistical analysis showed that no significant difference could be seen in NPA values of the two groups (P>0.05). Conclusions Sustained deprivation of far sight could induce an increase in NPC values to various degreeal, but effects on NPA were not obvious, as noted in our experiment.     

长期视远剥夺对人眼集合近点和调节近点的影响

Objective To study effects of sustained deprivation of far sight on human near point of convergence (NPC) and near point of accommodation (NPA). Methods Eight subjects were divided into two groups by age (group A ≥30 years old; group B<30 years old). All subjects had worked in the enclosed laboratory, unable to see the outside for 75 days. NPC and NPA were measured every 15 days. Results NPC values of both groups all increased when time elapsed. NPC of group A measured in the 75th day and NPC of group B in the 30th day all had statistical differences, when compared with the base NPC values measured in the 15th day (P<0.05). And NPC value of group B measured in the 45th, 60th and 75th days increased markedly, when compared with that of the 15th day (P<0.01 . However, statistical analysis showed that no significant difference could be seen in NPA values of the two groups (P>0.05). Conclusions Sustained deprivation of far sight could induce an increase in NPC values to various degreeal, but effects on NPA were not obvious, as noted in our experiment.