飞行员颈性眩晕与椎动脉先天发育异常的关系

目的探讨飞行员颈性眩晕与椎动脉先天发育异常之间的关系。方法利用二维超声及彩色多普勒超声回顾性分析71例颈性眩晕飞行员患者的椎动脉走行、内径及血流动力学变化等,总结颈性眩晕飞行员患者中椎动脉先天发育异常的比例。结果根据椎动脉异常的超声诊断标准,本组71例患者142条椎动脉中,85条椎动脉起始段清晰显示,显示率为59.9%(85/142),椎间段均清楚显示,显示率为100%;椎动脉纤细者20例,占28.2%(20/71),共包括21条椎动脉(左侧8条,右侧13条),其中1例为双侧椎动脉纤细,均为均匀性纤细;椎动脉走形变异22例,占31.0%(22/71),共包括椎动脉37条;同时存在椎动脉纤细和椎动脉走行异常者12例,占16.9%(12/71)。血流动力学参数异常者13例,28例患者合并颈椎X线片改变;椎动脉纤细者左右侧椎动脉内径、收缩期峰值流速(Vmax)及血流量之间差异无统计学意义。结论椎动脉发育异常是飞行员颈性眩晕的主要原因之一,椎动脉超声检查可作为招飞检查项目。     

彩色多普勒超声对椎动脉型颈椎病人椎动脉系的检测研究

椎动脉型颈椎病，是椎动脉血液供应异常引起的一种颈椎病，其病因可以是椎动脉本身病变引起。也可以是因周围组织结构的改变导致其受压、变形而使血液供应异常。应用彩色多普勒超声检测技术能清晰显示椎动脉的走行、管腔的宽窄、内膜变化、有无斑块形成及管腔内血流亮度和色彩的改变，并可利用多普勒技术测量其血流速度。观察其频谱形态，从而推断其病因，做出诊断。     

飞行学员椎动脉二维及彩色多普勒超声检测分析

目的 了解2010年度招收的飞行学员椎动脉发育情况,为椎动脉超声检查列入招飞体检提供依据.方法 利用二维及彩色多普勒超声回顾性分析722名飞行学员的椎动脉起始位置、内径、走行及血流动力学变化等,总结飞行学员中椎动脉先天发育异常的比例.结果 722名飞行学员左侧椎动脉起始段(Dl)与椎动脉椎间段(D2)内径(分别为3.624±0.017、3.623±0.018mm)宽于右侧(分别为3.489±0.018、3.438±0.019mm,P＜0.05),左侧椎动脉椎间段收缩期峰值流速(53.547±0.412cm/s)高于右侧(48.463±0.405cm/s,P＜0.05).椎动脉直径在2.5 ～3.0mm的比例较大,为17.5％,而小于2.5mm比例稍低,为6.9％;右侧椎动脉窄细者(16.0％,116/722)多于左侧(8.3％,60/722),差异有统计学意义(P＜0.05).双侧椎动脉走行异常者24例(占3.3％),其中双侧椎动脉起始位置正常,仅走行异常者19例,起始部伴走行异常者5例.19例仅走行异常者左右侧之间无明显差异(P＞0.05),5例起始部伴走行异常者中2例伴有同侧椎动脉窄细.结论 飞行学员中存在多种椎动脉先天发育异常,应早日将椎动脉的超声检查列入招飞体检项目中.     

症状性永存三叉动脉1例

正患者男,39岁。因头晕1个月来我院就诊。颈、颅血管频谱多普勒超声提示右侧颈内动脉虹吸段血流速度增快,VS=137cm/s,频窗充填,声音粗糙(图1),余颅内动脉血流速度及频谱形态大致正常。头颅MRI及MRA检查,可见右侧颈内动脉海绵窦段后外侧壁发出一较粗大血管,沿鞍背右侧缘向后走行与基底动脉汇合,汇合部以下基底动脉及双侧椎动脉较细(图2)。颅脑MRI显示脑实质形态、信号未见明显异常。MRI诊断:永存三叉动脉。     

高频彩色多普勒超声诊断与鉴别诊断阴囊肿块的价值

目的:探讨彩色多普勒超声对阴囊肿块的诊断与鉴别诊断价值.材料和方法:对34例阴囊肿块行彩色多普勒超声检查,恶性病变23 例,良性病变11例,分析恶性病变及良性病变的超声声像图特征.结果:恶性病变声像图特征是睾丸形态失常,体积增大,肿瘤呈低回声(15/23)或不均匀混合回声(8/23),边界不清楚,CDFI显示肿块周边和内部血流丰富,呈条状或树枝状血流.良性病变声像图特征是睾丸大小形态常正常,病变多呈低回声,边界清楚,形态规整,CDFI显示病变内血流信号较少(8/11)或无血流信号(3/11).超声对阴囊肿块性质的诊断准确率88.2%(30/34),与手术和穿刺病理结果无显著性差异(P＞0.05).结论:彩色多普勒超声对阴囊肿块诊断与鉴别诊断有较高的临床应用价值.     

招飞体检椎动脉超声检查标准的初步研究

目的 探讨并初步制定招飞体检推动脉的超声检查标准. 方法 回顾性分析招飞体检合格的722名飞行学员的椎动脉超声检查结果,了解飞行学员的椎动脉先天发育异常情况. 结果 722名飞行学员椎动脉存在多种先天发育异常,包括内径、起始位置及走行异常,其中椎动脉直径小于3.0 mm的比例较大,占17.5％(126/722),而小于2.5 mm比例稍低,占6.9％(50/722)；仅走行异常的占2.6％(19/722)；起始部位置异常及走行异常占3.3％(24/722).椎动脉内径异常及其起始位置异常均为右侧多发；椎动脉起始段内径、椎间段内径及收缩期峰值流速左侧大于右侧(t=4.669、6.424、10.490,P＜o.01),阻力指数两侧无明显差别. 结论 招飞体检椎动脉的超声检查标准应引起重视.依据本研究的结果及发现的问题,初步制定了招飞体检椎动脉超声检查标准.     

血管球瘤的临床表现及高频超声诊断价值

目的 分析血管球瘤的临床症状及声像图表现，探讨高频超声检查对血管球瘤的诊断价值。方法 选取在我院行超声检查并经病理证实为血管球瘤患者42例，记录患者的临床资料及瘤体的大小、回声、边界、形态、钙化、甲下骨侵蚀、后方回声增强或衰减、血流信号及“血管柄征”等声像图表现。结果 二维超声检查显示42例瘤体中低回声95.2%(40/42),边界清95.2%(40/42),圆形38.1%(16/42),椭圆形52.4%(22/42),无钙化100%(42/42),后方回声增强57.1%(24/42),指(趾)下血管球瘤26例，指(趾)甲下骨侵蚀46.2%(12/26),彩色多普勒超声显示瘤体内血流信号丰富71.4%(30/42),40个有血流的瘤体中，血流混合型75.0%(30/40),血管柄征55.0%(22/40)。42例患者中术前超声检查显示血管球瘤者38例，准确率90.5%。结论 典型血管球瘤超声声像图表现为孤立的低回声瘤体，边界清，形态规则，内见丰富血流信号，后方回声增强，无钙化，部分可见“血管柄征”及骨侵蚀。高频超声检查诊断准确率高，可作为血管球瘤的首选检查方法。     

彩色多普勒超声和二维超声诊断肾血管平滑肌脂肪瘤

目的:评价彩色多普勒超声和二维超声在诊断肾血管平滑肌脂肪瘤(RAL)中的应用价值。方法:应用二维超声、彩色多普勒血流图(CDFI),检测26例肾血管平滑肌脂肪瘤。结果:二维超声显示26例肾血管平滑肌脂肪瘤,分四型,高回声型,低回声型,无回声型,混合回声型,20个肿瘤彩色多普勒血流图其内可显示血流信号,6个肿瘤其内未显示血流信号。结论:彩色多普勒超声有助于对RAL的诊断。     

2例卵巢肿瘤定位诊断错误分析

<正>1资料卵巢肿瘤是常见的女性盆腔肿瘤,可通过超声等影像学检查作出诊断。超声对女性盆腔肿块的定位、定性诊断往往基于肿块的位置及其与周围组织、器官的关系,肿块的形态、边界、回声以及彩色多普勒血流成像(color Doppler flowimaging,CDFI)显示的血流信号等,但部分盆腔肿块的来源不易确定,尤其是大于5 cm的肿块会引起脏器组织形态和位置的变化,     

颈部旋转在超声诊断椎动脉型颈椎病中的价值

目的 :探讨颈部旋转对在超声常规体位检查中血流动力学无异常改变的椎动脉型颈椎病的诊断价值。材料和方法 :对 90例临床症状典型 ,CT、X线诊断为椎动脉型颈椎病而超声检查血流动力学无明显改变的患者 ,进行了颈部向检查对侧旋转约 70°后的超声检查 ,并对其结果进行了统计学检验。结果 :( 1)二维图像 :椎动脉均匀狭窄并可伴有内膜毛糙及斑块形成 ,内径 <3mm ;椎动脉骨段走形扭曲 ;( 2 )频谱多谱勒 :椎动脉供血不足时PI、RI增高 ,血流速度明显降低 ,椎动脉频谱形态异常 ;( 3)彩色多谱勒 :供血不足时椎动脉血流速变细、扭曲、中断。结论 :颈部旋转在超声诊断椎动脉型颈椎病鉴别诊断中具有实用价值。     

Follow-up of extracranial vertebral artery stents with Doppler sonography

OBJECTIVE: The objective of our study was to determine the Doppler sonography findings suggestive of restenosis in the follow-up of patients treated by stent placement in the extracranial vertebral artery. CONCLUSION: Follow-up of vertebral artery stents with Doppler sonography may be performed by direct insonation of the stent or by indirect measurements from the V2 segment (the part of the vertebral artery that courses within the intervertebral foramina). The V2 segment Doppler sonography measurements may guide future examinations and provide essential information regarding the proximally deployed stent.     

跨伤椎与经伤椎短节段内固定术在治疗胸腰椎椎体骨折的临床观察

目的探讨跨伤椎与经伤椎短节段内固定在胸腰椎椎体骨折的临床疗效。方法收集亳州市人民医院骨科2015年1月～2016年7月收治的50例经短节段内固定治疗的胸腰椎椎体骨折患者进行回顾性分析,采用跨伤椎短节段内固定手术的22例(对照组)和采用经伤椎短节段内固定手术的28例(实验组),比较两组患者术前、术后、术后6个月的椎体前缘高度比、矢状面Cobb角的变化及手术时间、术中出血量。结果 (1)在椎体前缘高度比、矢状面Cobb角的对照中,术前两组间比较差别无统计学意义(P0.05),术后与术前比较差异有统计学意义(P0.05);术后两组间对照中,实验组的椎体前缘高度比(88.8±10.5)%大于对照组(85.1±10.1)%、矢状面Cobb角(5.7±3.2)°小于对照组(6.3±4.7)°,差异有统计学意义(P0.05);术后6个月两组间对照中,实验组的椎体前缘高度比(86.0±10.4)%大于对照组(80.6±10.4)%、矢状面Cobb角(6.8±3.6)°小于对照组(12.1±5.6)°,差异均有统计学意义(P0.05)。(2)手术时间、出血量实验组分别为(125±20.5)min和(252.6±48.4)m L,均大于对照组(100±26.4)min和(146.4±50.2)m L,差异有统计学意义(P0.05)。结论经伤椎短节段内固定在胸腰椎椎体骨折的后凸畸形矫正、骨折椎体高度重建、术后恢复上优于跨伤椎短节段内固定,手术时间长,出血多。     

64层螺旋CT血管成像在脊髓血管介入术前评估中的价值

目的 探讨64层螺旋CT在脊髓血管介入术前评估中的价值.方法 选择17例胸腰段脊髓损伤患者行脊柱64层螺旋CT增强扫描,重建薄层图像,层厚0.625 mm,间隔0.625 mm,以DICOM格式传输到ADW4.2工作站,采用容积显示(volume rendering,VR)、最大密度投影(maximum intensity projection,MIP)及多平面重建(multi-planar reformat,MPR)等后处理技术进行三维重建,分析脊髓供血动脉的走行特征.结果 17例患者中有16例患者(94%)胸腰段均可见根髓动脉供血脊髓,其中1支(6%)自T4/5左侧椎间孔进入椎管,2支(12%)自T10/11左侧椎间孔进入椎管,1支(6%)自T11/12左侧椎间孔进入椎管,4支(24%)根髓动脉自L1/2左侧椎间孔进入椎管,2支(12%)自L2/3左侧椎间孔进入椎管,2支(12%)自T11/12右侧椎间孔进入椎管,2支(12%)自T12/L1右侧椎间孔进入椎管,2支(12%)自L2/3右侧椎间孔进入椎管,10例(59%)患者根髓动脉自左侧椎间孔进入椎管.另有1例(6%)患者行CT和DSA检查均未发现根髓动脉.结论 64层螺旋CT能准确直观反映脊髓供血动脉的开口位置、走行方向、管径大小及其与周围血管的空间关系,为脊髓血管介入术前提供丰富的评估信息.

Abstract：

Objective To investigate the value of 64-slice spiral computed tomography(CT)angiography in preoperative evaluation of spinal vascular intervention.Methods Seventeen patients with segmental injury of the spinal cord underwent the enhanced 64-slice CT scan of the spine.Thin-slice reconstruction was done,with the slice thickness of 0.625 mm and interval of 0.625 mm.The data were transferred to the work station ADW4.2 in DICM format.Image postprocessing technologies such as volume rendering(VR),maximum intensity projection(MIP)and multi-planar reformat(MPR)were used to conduct three-dimensional reconstruction and analyze the anatomical characteristics of radiculomedullary artery.Results Radiculomedullary artery could be found in the thoracolumbar segment of 16 patients(16/17,94%).Among them,one artery(1/17,6%)went into the vertebral canal through the left intervertebral foramen of T4/5,two(2/17,12%)through the left intervertebral foramen of T10/11,one (1/17,6%)through the left intervertebral foramen of T11/12,four(4/17,24%)through the left intervertebral foramen of L1/2,two(2/17,12%)through the left intervertebral foramen of L2/3,two (2/17,12%)through the right intervertebral foramen of T11/12,two(2/17,12%)through the right intervertebral foramen of T12/L1,two(2/17,12%)through the right foramen of L2/3 andl0(10/17,59%)through the left intervertebral foramen.Either CT scan or DSA examination found no radiculomedullary artery in one patient.All the above findings were in accordance with the results of DSA examination.Conclusions Spiral 64-slice CT scan can provide significant preoperative evaluation information for spinal vascular intervention,for it can accurately and visually show the anatomical features of the radiculomedullary artery such as open position,flow tendency,caliber size and spatial relationship with the surrounding vessels.     

相邻椎体单节段椎弓根内固定椎间植骨融合治疗胸腰椎骨折

目的研究相邻椎体单节段椎弓根内固定椎间植骨融合治疗轻、中度胸腰椎骨折的可行性和临床疗效。方法回顾性研究32例应用相邻椎体单节段椎弓根内固定技术治疗的胸腰椎骨折的患者，观察复位及植骨融合情况，矫正丢失、腰痛、腰椎活动情况及融合椎体相邻椎间盘退变等并发症发生情况。结果平均随访4．6个月时达到骨性融合，所有患者均得到满意复位，复位率达96％，术后腰痛症状明显缓解，未出现顽固性腰痛、腰椎活动受限等并发症，融合节段相邻椎间盘退变率仅为6％，临床效果明显优于多节段内固定。结论只要适应证选择合适，相邻椎体单节段内固定不但可以达到骨性融合、满意复位、坚强骨性融合，而且较三椎体二节段固定可明显降低顽固性腰痛、腰椎活动受限、相邻椎间盘退变等并发症的发生。     

Anatomy and pathology of the aging spine

The vertebral column is a complicated anatomical structure which is composed of the intervertebral discs and the vertebrae. Both components develop special degenerative changes and morphologic features during life. This paper first reviews the anatomical fundamentals and then describes the morphological features of the aging intervertebral disc and the subsequent osseous changes of the vertebral bodies and the zygapophyseal joints. The aging intervertebral disc is characterised by processes which are labeled as intervertebral chondrosis and intervertebral osteochondrosis. Often these processes are combined with typical dislocations of intervertebral disc tissue in an anterior or dorsolateral direction. The well known Schmorl's nodules must also be mentioned in this context. Furthermore calcification and ossification of the intervertebral disc tissue can take place. More severe processes lead to osseous changes of the vertebral bodies. In particular, an osteophytosis of the vertebral bodies can be established. These sturdy osteophytes are able to stiffen the vertebral column. Furthermore the arthrotic changes of the zygapophyseal joints are delineated in this paper. The special appearances of these changes are discussed according to the different and specialised regions of the vertebral column. The advanced degenerative changes of the zygapophyseal and uncovertebral joints of the cervical spine are of essential clinical interest because the compression of the vertebral artery or the narrowing of the intervertebral foramina by these processes may cause severe neurological symptoms. The arthrotic changes of the medial atlantoaxial joint, which lead to the crowned odontoid, and the pseudospondylolisthesis (so called M. Junghanns) of the lumbar spine must also be mentioned. It is the aim of this paper, not only to explain and review the degenerative changes, but to illustrate the anatomy and pathology of the aging spine on the basis of macerated osseous specimens in order to make radiological investigations and pictures more understandable and clear.     

Vertebral and carotid artery aneurysms and polyarthritis in a patient with Takayasu arteritis: A case report

Takayasu arteritis (TA) is a common autoimmune disease in the clinical setting. However, vertebral artery aneurysms caused by TA are rarely reported. We herein describe a 28-year-old man with multiple vertebral artery aneurysms and carotid artery aneurysms caused by TA, which showed typical wall thickening and lumen dilation with a “string of beads” appearance by Doppler ultrasound and radiology. Previous studies have shown that most TA-associated vertebral artery lesions are stenosis, occlusion, and dissection of the intracranial part of the artery. In this case, TA mainly affected the cervical segment of the vertebral artery (the intracranial segment was not obviously involved), and the main manifestations were aneurysms and occlusion. This case provides more information for further understanding of TA-associated vertebral artery lesions.     

球囊扩张支架成形术治疗椎动脉狭窄致后循环脑缺血的效果分析

目的总结因椎动脉狭窄致后循环脑缺血的患者行支架成形手术的经验体会。 方法47例因椎动脉狭窄致缺血性脑卒中的患者,于我科行椎动脉支架成形术,共留置支架52枚,其中椎动脉V1段为46枚,V4段6枚。所有患者行全脑血管造影或CT血管造影随访,平均随访6.3月。分析动脉狭窄改善及其他并发症情况。 结果所有患者均成功行支架成形术。术后患者症状缓解率为85.1%（40/47）;术前狭窄率（75.2±6.7）%,术后狭窄率为(7.6±6.1)%。发生支架内再狭窄（IRS）9处（17%）,8处为椎动脉起始部,1处为V4段。 结论支架成形术是治疗缺血性椎动脉狭窄安全有效的方法,但应尽量避免IRS等术后并发症。     

永存三叉动脉的多层螺旋CT诊断

目的探讨多层螺旋CT血管成像(CTA)在诊断永存三叉动脉(PTA)中的价值。资料与方法回顾性分析2546例行头颅64层螺旋CTA检查者中的10例PTA患者的影像学资料,分析PTA的发生率、起源、走行、后循环供血及合并其他血管畸形的情况。结果 (1)PTA的发生率为0.39%(10/2546),其中1例位于右侧,9例位于左侧。(2)三叉动脉均起自颈内动脉海绵窦段,血管走行外侧型8例,中央型2例;按Saltzman分型显示PTA后循环供血情况:Ⅰ型7例,Ⅱ型1例,Ⅲ型2例。(3)吻合点近端的基底动脉及双侧椎动脉发育不良7例。结论 64层CTA能清晰、准确地显示PTA的走行及后循环供血情况。     

Subclavian artery angioplasty and the origin of the vertebral artery

Percutaneous transluminal angioplasty of the subclavian artery was performed in 35 patients. In 50% of all dilations, the angioplasty balloon was inflated across the origin of the vertebral artery. No complications occurred. All subclavian steals were corrected. The relationship between the subclavian artery stenosis and the vertebral artery origin should be determined; if the vertebral artery originates from a healthy segment of the subclavian artery or from a segment with poststenotic dilatation, the angioplasty balloon can safely be distended across the vertebral artery origin.