中美飞行人员医学鉴定对照实证研究--腰椎峡部裂

目的：通过分析我军飞行人员腰椎峡部裂的医学鉴定情况,与美军标准比较异同以促进我军选拔工作。方法对2013～2015年在空军总医院空勤科进行医学鉴定的结果进行统计,将腰椎峡部裂的具体情况按中美标准进行对比,分析其异同及可能的原因。结果我军飞行人员医学鉴定合格率约为85％,实际鉴定情况与美军标准相似,两军飞行合格率差异无统计学意义（P＞0．05）。结论我军在腰椎峡部裂这一病种的飞行人员医学鉴定标准方面与美军相似,说明在招飞选拔相关标准中可进行适当改进。     

飞行员腰椎椎弓根峡部裂的医学鉴定

目的总结飞行员腰椎椎弓根峡部裂的医学鉴定经验。方法对62名腰椎椎弓根峡部裂飞行员的资料进行分析，对其中14名高性能歼击机飞行员进行了1～4年的随访。结果62例中：27例改装合格，21例原机种合格，10例暂不合格，4例停飞。其中10例暂不合格中，有6例因腰椎峡部裂或伴滑脱，并有长期腰腿痛症状暂不合格，4例因其他疾病而暂不合格。停飞4例中：有2例因腰椎峡部滑脱合并长期腰腿痛症状或伴有腰椎间盘突出停飞，2例因其他疾病而停飞。结论在飞行员腰椎椎弓根峡部裂的医学鉴定时应考虑身体状况、飞行任务等各种因素的影响。     

腰椎峡部裂的CT诊断

腰椎峡部裂是腰椎一侧或两侧椎弓上下关节突之间的峡部有骨质缺失,失去连续性。是引起腰腿疼痛的常见原因之一。过去主要依靠X线平片诊断,CT扫描可以显示腰椎平片所不及的征象。笔者就38例腰椎峡部裂CT资料作回顾性分析。     

腰椎椎弓峡部裂的CT诊断

目的:分析腰椎椎弓峡部裂的CT表现,提高诊断、鉴别诊断水平.材料和方法:回顾性分析21例腰椎椎弓峡部裂的CT表现.结果:21例中,双侧19例单侧单侧2例,腰515例,腰46例.21例均表现为椎弓峡部层面关节突间的低密度裂隙,断面呈锯齿状,即"裂隙征",裂隙边缘骨质硬化,周围可见碎骨片,呈现"假肥大小关节",16例伴椎体滑脱,呈现"假性间盘突出征"及"双边征".结论:CT对腰椎椎弓峡部裂的诊断优于X线平片,并可同时显示其相关并发症.     

腰椎峡部裂的CT诊断

目的：回顾性分析腰椎峡部裂的ＣＴ表现并讨论其诊断与鉴别诊断，材料与方法，２３例患先行腰椎侧位扫描定位图像，采用与椎间盘平行的角度，自病变脊椎的上一椎体下缘边续发描至于下椎体上缘，层厚４或５ｍｍ必要时在峡部行２ｍｍ，层厚扫描，结果；２３例中，累及双侧２１例，单侧２例，发生在Ｌ５１６例，Ｌ４７例，ＣＴ表现为同一脊椎关节突间的低密度裂隙，出瑞椎弓根下缘平面，走行不规则，裂隙可宽可窄，表面不光滑。     

腰椎峡部裂的MRI评价

目的 :描述腰椎峡部裂的MRI表现 ,探讨MRI在本病中的诊断价值。方法 :回顾性分析经X线平片或CT证实的 2 9例腰椎峡部裂患者 (单纯崩裂 5例、崩裂滑脱 2 4例 )及 2 5例退行性腰椎滑脱患者的MRI检查资料 ,并对崩裂滑脱与退行性滑脱的MRI表现进行对比分析。结果 :2 9例峡部裂患者双侧椎弓峡部均出现不规则状T1WI低信号、T2 WI低或高信号骨性缺损。单纯崩裂组椎管前后径 19.0mm± 2 .7mm ,不伴有脊柱滑脱、椎间盘假性膨出及椎间孔变形 ;3例患椎棘突基底部与硬膜囊之间存在脂肪间隙 ;所有患椎棘突基底部均位于上下棘突基底部连线前方。崩裂滑脱组椎管前后径2 5 4mm± 4 .4mm ,均伴有脊柱滑脱、椎间盘假性膨出、椎间孔变形 ;患椎棘突基底部与硬膜囊之间均存在脂肪间隙 ;患椎棘突基底部位于上下棘突基底部连线后方 2 3例 ,稍前方 1例。退行性滑脱组椎弓峡部完整 ,无骨性缺损 ;椎管前后径15 2mm± 1.6mm ,明显小于崩裂滑脱组 (t =10 .87,P <0 .0 1) ,2 5例均伴有椎间盘假性膨出及椎间孔变形 ;患椎棘突基底部与硬膜囊之间无脂肪间隙 2 4例 ,存在线状脂肪间隙 1例 ;患椎棘突基底部均位于上下棘突基底部连线前方。结论 :腰椎峡部裂有特征性MRI表现 ,MRI可为临床评价该病提供正确、全面的影像学证据     

腰椎峡部裂的CT诊断

腰椎峡部裂是指腰椎椎弓峡部关节间部骨质缺损，是引起临床腰腿痛的常见原因之一。X线平片正侧位及双斜位是常规检查手段，CT检查更具有平片所不具备的优点。本文收集42例腰椎峡部裂资料，对其CT征象进行分析，探讨其诊断及临床指导意义。     

多层螺旋CT后处理技术对飞行员腰椎峡部裂的诊断价值

Objective To evaluate the clinical application value of multi-slice CT (MSCT)postprocessing techniques in diagnosing lumbar spondylolysis (LS) of pilots. Methods Three hundred and eighty-five transformed pilots, who were grouped by age (23-28 yr, 29-34yr, 35-40 yr and 41-46 yr) and by flying hours (≤800 h, 801-1600 h and 1601-2400 h), underwent volumetric MSCT scanning in physical examination. Then various postprocessing techniques including multiplanar reconstruction (MPR), maximum intensity projection (MIP) and volume rendering (VR) were carried out at workstation for getting the LS information of pilots. The efficacy of MIP, MPR and VR were compared in diagnosing LS. Results There were 16 cases (at 33 places) of LS in 385 pilots,including 13 bilateral and 3 unilateral LS. Nine cases were accompanied with lumbar spondylolisthesis.The diagnosis rate by MPR images was 100% (33/33), and in which "collar sign of Scottish hound","double articular process sign" and lumbar spondylolisthesis was respectively and clearly revealed on oblique sagittal plane, oblique axial plane and median sagittal plane. MIP images also screened out all LS cases but the viewing of soft tissue was not as good as MPR's. The diagnosis rate by VR imagines was 75. 76% (25/33) but it showed closely to the real anatomy structure of lumbar spine and stereoscopically displayed LS. Conclusions Postprocessing techniques, such as MPR, MIP and VR show good ability in diagnosing spondylolysis and its secondary abnormity. The oblique sagittal (along vertebral arch) and oblique axis (parallel to arch) MPR images are the first choice of reconstruction technique in diagnosing spondylolysis of pilots.     

多层螺旋CT后处理技术对飞行员腰椎峡部裂的诊断价值

目的 探讨多层螺旋CT后处理技术对飞行员腰椎峡部裂（1umbar spondylolysis,LS）的诊断价值.方法 对385例改装体检的歼击机飞行员按年龄（23～28岁;29～34岁;35～40岁;41～46岁）及飞行时间（≤800 h;801～1600 h;1601～2400 h）分组;进行腰椎CT容积扫描.利用多层螺旋CT的多平面重建（multiplanar reconstruction,MPR）、最大密度投影（maximum intensity projection,MIP）和容积再现（volume rendering,VR）技术对图像进行后处理,多方位观察飞行员腰椎峡部裂情况,并比较MPR图像、MIP图像及VR图像.结果 ①飞行员不同年龄分布LS检出率无统计学差异;不同飞行时间LS检出率有统计学差异（x2=7.57,P＜0.05）,随着飞行时间延长LS检出率增高.②385例飞行员中共检出峡部裂16例（33处）,9例伴滑脱;其中双侧峡部裂13例（30处）,7例伴滑脱;单侧峡部裂3例（3处）,2例伴滑脱.MPR图像LS检出率为100%（33/33）,斜矢状（沿椎弓峡部走向）位及斜轴（平行于椎弓）位可清楚地显示峡部断裂情况,分别表现为＂猎狗项圈征＂和＂双关节征＂,正中矢状位可清楚地显示椎体滑脱情况.MIP图像LS检出率100%（33/33）,但对周边软组织显示不清楚.VR图像LS检出率为75.76%（25/33）,可立体观察峡部情况.结论 多层螺旋CT的后处理技术MPR、MIP、VR可以全方位地评价飞行员的腰椎峡部情况,其中斜矢状位及斜轴位的MPR图像可作为首选的重建方法.     

单纯腰椎峡部裂的CT诊断

目的分析单纯腰椎峡部裂的CT表现,提高对单纯腰椎峡部裂CT征象的认识,减少漏诊。方法回顾性分析81例单纯腰椎峡部裂在侧定位像、横断位图像、椎弓反角度扫描或多平面重组（MPR）的CT表现。结果腰椎侧定位显示峡部裂隙56．8％,有可疑征象的37．8％,有异常征象的共计94．6％。横断位图像“环裂征”显示率约25．6％,椎弓反角度扫描或多平面重组图像“环裂征”显示率为100％。峡部裂的各种间接征象中,上关节突前上方小骨块影显示率约占50．0％;轻度假性椎间盘膨出约占38．0％;病变椎体下位小关节或椎间盘有较其他节段明显的退行性变,分别占13．4％和9．8％;螺旋扫描横断位图像椎管变形及椎板增厚约占17．6％。结论常规椎间盘横断位图像峡部裂隙容易被遗漏或误认为椎小关节,注意观察侧定位像和横断位的间接征象,发现可疑征象时加做椎弓反角度扫描或多平面重组图像,可有效避免漏诊。     

Usefulness of the lumbar support cushion for pilots of military helicopters

The aim of our study was to evaluate the possibility of prevention of local reflex hyperactivity of the paraspinal muscles as the one of causes of low back pain during long-term sitting in forced position. We examined eight pilots, with low back pain during and after flying tasks. In improvised conditions, sitting position was performed in an equal term as the real, with and without lumbar support cushion. The pause between two examinations was 24 to 48 hours. Activity of paraspinal muscles was measured by surface electromyography, just after the ended sitting position. In six out of eight our subjects was decreased EMG activity after using the lumbar cushion, in comparison to values registered after sitting without cushion in comparison to values registered after sitting without cushion. We concluded that reflex hyperactivity of the paraspinal muscle could be prevented with lumbar cushion which, on the other hand can improve working and operative capabilities of the pilots, and simultaneously is rational from economic point of view.     

军队飞行人员睡眠状况调查

目的调查军队飞行人员的睡眠习惯、常见睡眠问题、白天嗜睡程度和飞行前夜睡眠情况。方法采取整群随机抽样方法对1380名军队飞行人员进行问卷调查,对其中1328份有效问卷进行统计分析。结果飞行人员平均夜间睡眠时间6.99h,24h平均睡眠时间8.10h。4.10%的飞行人员24h睡眠时间不足6h。中重度打鼾发生率22.80%,易醒或(和)早醒和入睡困难≥3次/周的发生率为7.65%和5.81%,夜尿患病率4.03%。平均ESS评分5.59±4.40分,以≥11分评估嗜睡发生率为14.99%。飞行中困倦发生率14.20%。62.53%的飞行人员飞行前夜较平时睡眠发生变化。结论飞行人员中存在着多种睡眠问题,并且飞行前夜睡眠可发生变化,这些都可能影响飞行安全,应进行研究和干预。     

A survey of the sleep status among military pilots

目的 调查军队飞行人员的睡眠习惯、常见睡眠问题、白天嗜睡程度和飞行前夜睡眠情况.方法 采取整群随机抽样方法对1380名军队飞行人员进行问卷调查,对其中1328份有效问卷进行统计分析.结果 飞行人员平均夜间睡眠时间6.99h,24h平均睡眠时间8.10h.4.10％的飞行人员24h睡眠时间不足6h.中重度打鼾发生率22.80％,易醒或(和)早醒和入睡困难≥3次/周的发生率为7.65％和5.81％,夜尿患病率4.03％.平均ESS评分5.59±4.40分,以≥11分评估嗜睡发生率为14.99％.飞行中困倦发生率14.20％.62.53％的飞行人员飞行前夜较平时睡眠发生变化.结论 飞行人员中存在着多种睡眠问题,并且飞行前夜睡眠可发生变化,这些都可能影响飞行安全,应进行研究和干预.     

Cervical and lumbar spinal changes diagnosed in four-view radiographs of 732 military pilots

BACKGROUND: Pilots who fly jet fighters or helicopters frequently experience vertebral problems due to acceleration and vibration, wearing helmets and other headgear, and sitting in suboptimal postures. METHODS: We looked for spondylarthritic or spondylitic changes in 4-view radiographs (AP, lateral, left and right oblique) of the cervical and lumbar vertebrae of 732 pilots and 202 non-flying controls. The subjects included 91 F-16 jet pilots, 363 other jet pilots, 119 transport pilots, and 159 helicopter pilots. RESULTS: The prevalence of cervical changes in helicopter pilots was 19%, significantly higher than those for other pilots (8-13%) or controls (10%). There was no difference among groups with respect to prevalence of lumbar changes. Among all pilots, compression fractures were more common in the lumbar region than in the cervical region. Age was the most important variable related to spondylarthritic or spondylitic changes in all subjects, whereas height was an important factor only among jet pilots. CONCLUSION: We found an increased prevalence of cervical changes, especially osteoarthritis, in helicopter pilots. Increasing age and tall stature were associated with an increased prevalence of vertebral spondylarthritic or spondylitic changes in jet pilots.     

军事飞行员原发性青光眼的医学鉴定分析

目的 探讨因原发性青光眼和可疑青光眼住院的军事飞行员的疾病特点、飞行结论 及放飞观察情况. 方法 对95例因青光眼或可疑青光眼住院的飞行员资料进行回顾性临床分析.结果 95例住院患者中56例诊断为原发性开角型青光眼(POAG),其中停飞15例,飞行暂不合格3例,飞行合格38例,放飞观察中延长飞行年限1～26年,平均6.36±1.43年.36例怀疑青光眼者进行青光眼排除检查,33例排除了青光眼,飞行合格;3例临床可疑,飞行暂不合格.3例诊断为高眼压症,飞行合格. 结论 飞行员最多见的青光眼类型是开角型青光眼;患POAG的飞行员若视功能稳定,在严密观察下能够继续飞行;早期发现和及时治疗是控制疾病的关键.