直接数字化X线摄影（DR）在工业性氟骨症影像诊断中的应用研究

发布时间：2018-02-27 12:32

本文关键词： 工业性氟骨症直接数字化X线摄影影像诊断　出处：《内蒙古大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：利用直接数字化X线摄影(direct digital radiography, DR)的影像优势对工业性氟骨症进行筛查,总结出工业性氟骨症,尤其是早期病例在DR中的影像特征,为规范工业性氟骨症在DR下的检查方法及诊断标准提供依据。资料与方法：选择从事触氟工作5年以上,尿氟检查高于包头市正常尿氟水平的观察对象一共314人。根据触氟时间长短分为A、B、C三组,将工龄5-10年的观察对象设为A组,共107人；将工龄10—15年的观察对象设为B组,共125人；将工龄15年以上的观察对象设为C组,共82人。对每一个人行骨盆正位、右尺桡骨及胫腓骨正侧位、腰椎正侧位DR摄影。所有图像均由3人以上具有相关专业知识的高年资诊断医生进行集体确诊,参照国家氟骨症X线诊断标准(WS192-1999)及工业性氟病诊断标准(GBZ5-2002)对所得影像资料进行归纳及分期,并与国家工业性氟病影像诊断标准(GBZ5-2002)进行对比。结果：全部314位观察对象,确诊为工业性氟骨症的为249人,占全部观察对象的79.30%。其中A组107人,符合氟骨症Ⅰ期(早期)影像改变者34人,符合Ⅱ期影像改变者8人,其余65人为阴性,阳性率39.25%；B组125人,符合氟骨症Ⅰ期(早期)影像改变者71人,其余54人均符合Ⅱ期影像改变,阳性率100%；C组82人,符合氟骨症Ⅱ期影像改变者61人,其余21人均符合工Ⅱ期影像改变,阳性率100%。氟骨症Ⅰ期在DR影像中主要表现为：骨小梁增粗增浓,呈“沙粒样”或骨斑或“纱布样”改变；尺桡/胫腓骨有局限的骨间膜骨化,部分肌腱韧带钙化,关节轻度退行性改变；Ⅱ期氟骨症主要表现：骨质密度明显增高,骨小梁明显增粗稀疏,呈粗布纹状或破毯状改变,尺桡骨或胫腓骨可见小丘状/波浪状骨间膜骨化；肘伸屈肌腱骨化突出,有关节退行性变。或其他部位的肌腱或韧带出现明显骨化；Ⅲ期氟骨症主要表现为骨小梁广泛粗大或细密,严重者呈“大理石纹样”改变或象牙样硬化；骨间膜骨化广泛而显著,肘伸屈肌腱骨化突出,髓腔变窄关节退变明显,其他部位肌腱或韧带骨化突出。结论： 1.工业性氟骨症工期在DR影像中的改变,除GBZ5-2002标准中所提出的骨质密度增高,骨小梁增粗、增浓,交叉呈“纱布样”表现；尺、桡骨或胫、腓骨骨间膜有明确的钙化或骨化表现外还可以观察到：(1)沙粒样骨小梁和/或骨斑形成。(2)不典型骨间膜增厚,典型的骨间膜骨化可表现为幼芽破土样。(3)肘部、骨盆、腰椎等处肌腱、韧带轻度骨化。 2.工业性氟骨症Ⅱ期在DR影像中的改变,除GBZ5-2002标准中所提出的骨质密度明显增高,骨小梁明显增粗,呈“麻袋纹样”表现；骨周改变较为明显和广泛外还可以观察到：(1)骨小梁呈“破毯样”表现。(2)骨间膜骨化更加明显,呈“小丘样”或“波浪样”表现。(3)肌腱、韧带明显骨化,可伴有轻度关节退变,以肘关节尤为典型。 3.工业性氟骨症Ⅲ期在DR影像中的改变,除GBZ5-2002标准中所提出的骨质密度显著增高,骨小梁模糊不清如“大理石样”；长骨皮质增厚,髓腔变窄。骨周改变更为明显和广泛,椎体间可有骨桥形成外还可以观察到骨小梁呈“磨玻璃样”表现。(2)骨间膜骨化广泛出现,典型者呈“融蜡样”或“冰凌样”表现。(3)肘伸屈肌腱或其他部位肌腱或韧带骨化突出,关节明显退变。 4.GBZ5-2002标准中氟骨症的X线检查部位中包括腰椎正侧位,本课题认为应用DR诊断工业性氟骨症,腰椎正侧位观察骨小梁结构效果欠佳。 GBZ5-2002标准制定的时候是以普通X线平片的影像表现作为基础进行归纳总结,各期氟骨症的影像征象描述比较少,概念不够明确,影像征象不够全面,可操作性不强。现在DR设备已经广泛应用于各级医疗及体检机构,建议重新制订工业性氟骨症的DR影像表现及诊断标准。
[Abstract]:Objective: the use of direct digital radiography (direct digital radiography, DR) imaging advantage screening of industrial fluorosis, summed up the industrial fluorosis, especially the imaging features of early cases in DR, provide the basis for the standard under the DR examination method and diagnostic standard of industrial fluorosis.
Materials and methods: choose to engage in contact fluoride work for more than 5 years, higher than normal levels of urine fluoride fluoride urine examination in Baotou City observed a total of 314 people. According to the length of time of contact fluoride is divided into A, B, C three groups, will be working for 5-10 years were divided into group A, a total of 107 people; the length of service 10 - 15 years of observation group B, a total of 125 people; the service for more than 15 years were divided into group C, a total of 82 people. For each individual line anteroposterior, right forearm and tibial lateral, lateral lumbar spine DR photography. All the images were composed of 3 people the above has high seniority diagnosis related professional knowledge off the doctor diagnosed according to the national collective, skeletal fluorosis X-ray diagnostic criteria (WS192-1999) and industrial fluorosis diagnostic criteria (GBZ5-2002) of the image data were summarized and staging and disease diagnosis standard of national industrial fluoride (GBZ5-2002) were compared.
Results: all 314 subjects, diagnosed as industrial fluorosis was 249, accounting for all subjects 79.30%. A group and 107 with fluorosis stage (early) image changes in 34, with phase II image changes in 8, the remaining 65 were negative, the positive rate was 39.25% B; group of 125 people, with fluorosis stage (early) image changes in 71, the remaining 54 per capita with changes of phase II image, the positive rate was 100%; C group of 82 people, with flurosis II image changes in 61, the remaining 21 per capita consistent with phase II findings, the positive rate of 100%.
Fluorosis stage mainly in DR image: Liang Zengcu bone thickening, a "sand" or "bone spots or gauze like" change; Ulnar / tibiofibular narrow interosseous membrane ossification, part of tendon and ligament calcification, but mild degenerative changes of skeletal fluorosis mainly; performance: the bone density increased, trabecular bone became thicker is sparse, coarse wrinkles or broken blanket like change, ulna and radius and tibia and visible hummock / wavy interosseous membrane ossification; elbow flexion tendon ossification have prominent joint degeneration. Or in other parts of the tendon or ligament appear significantly phase III ossification; skeletal fluorosis is mainly trabecular bone wide coarse or fine, serious show "marbled" change or Ivory like hardening; ossification of interosseous membrane widely and significantly, elbow flexion tendon ossification is prominent, medullary cavity narrowing of joint degeneration is obvious, other parts of tendon or ligament bone Protruding.
Conclusion:
Change the 1. industrial fluorosis period in the DR images, in addition to the proposed GBZ5-2002 standard in trabecular bone density increased, Liang Zengcu, thickening, cross a gauze like "performance; foot radius or tibia, fibula interosseous membrane calcification or ossification showed clear but also can be observed: (1) the formation of sand like trabecular bone and / or spot. (2) atypical interosseous membrane thickening, typical ossification of interosseous membrane can be expressed as scion. (3) broken elbow, pelvis, lumbar, tendon, ligament ossification of mild.
Change the 2. industrial flurosis II in DR images, in addition to the proposed GBZ5-2002 standard bone density increased, trabecular bone became thicker, a "sack pattern"; the bone is obviously changed and widely but also can be observed: (1) the trabecular bone was broken blanket "performance. (2) the interosseous membrane ossification was more obvious," hill "or" wave ". (3) tendon, ligament ossification significantly, accompanied by mild joint degeneration, the elbow is particularly typical.
Change the 3. industrial fluorosis in phase III of DR image, in addition to the proposed GBZ5-2002 standard bone density increased, bone trabecula blurred as "marble"; long bone cortical thickening, medullary cavity narrowed. Bone change is more obvious and wide, with interbody bone bridge formation can also be little Liang Cheng observed bone ground glass. (2) the interosseous membrane ossification occurs widely, typical "melt like wax" or "ice". (3) elbow extensor flexor tendon or other parts of tendon or ligament ossification prominent joint degeneration.
The X-ray location of skeletal fluorosis is included in the 4.GBZ5-2002 standard, including the lateral aspect of the lumbar spine. This topic considers that DR is a good method for the diagnosis of industrial skeletal fluorosis.
When the GBZ5-2002 standard is based on the X-ray imaging findings as the basis of summing up, the imaging features of each period of fluorosis description is relatively small, the concept is not clear enough, imaging is not comprehensive enough, operability is not strong. Now DR has been widely used in various medical and medical institutions, recommends a re formulation DR features and diagnostic criteria of industrial fluorosis.

【学位授予单位】：内蒙古大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R135.1;R816.8

【共引文献】