本文關(guān)鍵詞： 工業(yè)性氟骨癥 直接數(shù)字化X線攝影 影像診斷　出處：《內(nèi)蒙古大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：利用直接數(shù)字化X線攝影(direct digital radiography, DR)的影像優(yōu)勢(shì)對(duì)工業(yè)性氟骨癥進(jìn)行篩查,總結(jié)出工業(yè)性氟骨癥,尤其是早期病例在DR中的影像特征,為規(guī)范工業(yè)性氟骨癥在DR下的檢查方法及診斷標(biāo)準(zhǔn)提供依據(jù)。 資料與方法：選擇從事觸氟工作5年以上,尿氟檢查高于包頭市正常尿氟水平的觀察對(duì)象一共314人。根據(jù)觸氟時(shí)間長(zhǎng)短分為A、B、C三組,將工齡5-10年的觀察對(duì)象設(shè)為A組,共107人；將工齡10—15年的觀察對(duì)象設(shè)為B組,共125人；將工齡15年以上的觀察對(duì)象設(shè)為C組,共82人。對(duì)每一個(gè)人行骨盆正位、右尺橈骨及脛腓骨正側(cè)位、腰椎正側(cè)位DR攝影。所有圖像均由3人以上具有相關(guān)專業(yè)知識(shí)的高年資診斷醫(yī)生進(jìn)行集體確診,參照國(guó)家氟骨癥X線診斷標(biāo)準(zhǔn)(WS192-1999)及工業(yè)性氟病診斷標(biāo)準(zhǔn)(GBZ5-2002)對(duì)所得影像資料進(jìn)行歸納及分期,并與國(guó)家工業(yè)性氟病影像診斷標(biāo)準(zhǔn)(GBZ5-2002)進(jìn)行對(duì)比。 結(jié)果：全部314位觀察對(duì)象,確診為工業(yè)性氟骨癥的為249人,占全部觀察對(duì)象的79.30%。其中A組107人,符合氟骨癥Ⅰ期(早期)影像改變者34人,符合Ⅱ期影像改變者8人,其余65人為陰性,陽(yáng)性率39.25%；B組125人,符合氟骨癥Ⅰ期(早期)影像改變者71人,其余54人均符合Ⅱ期影像改變,陽(yáng)性率100%；C組82人,符合氟骨癥Ⅱ期影像改變者61人,其余21人均符合工Ⅱ期影像改變,陽(yáng)性率100%。 氟骨癥Ⅰ期在DR影像中主要表現(xiàn)為：骨小梁增粗增濃,呈“沙粒樣”或骨斑或“紗布樣”改變；尺橈/脛腓骨有局限的骨間膜骨化,部分肌腱韌帶鈣化,關(guān)節(jié)輕度退行性改變；Ⅱ期氟骨癥主要表現(xiàn)：骨質(zhì)密度明顯增高,骨小梁明顯增粗稀疏,呈粗布紋狀或破毯狀改變,尺橈骨或脛腓骨可見小丘狀/波浪狀骨間膜骨化；肘伸屈肌腱骨化突出,有關(guān)節(jié)退行性變�；蚱渌课坏募‰旎蝽g帶出現(xiàn)明顯骨化；Ⅲ期氟骨癥主要表現(xiàn)為骨小梁廣泛粗大或細(xì)密,嚴(yán)重者呈“大理石紋樣”改變或象牙樣硬化；骨間膜骨化廣泛而顯著,肘伸屈肌腱骨化突出,髓腔變窄關(guān)節(jié)退變明顯,其他部位肌腱或韌帶骨化突出。 結(jié)論： 1.工業(yè)性氟骨癥工期在DR影像中的改變,除GBZ5-2002標(biāo)準(zhǔn)中所提出的骨質(zhì)密度增高,骨小梁增粗、增濃,交叉呈“紗布樣”表現(xiàn)；尺、橈骨或脛、腓骨骨間膜有明確的鈣化或骨化表現(xiàn)外還可以觀察到：(1)沙粒樣骨小梁和/或骨斑形成。(2)不典型骨間膜增厚,典型的骨間膜骨化可表現(xiàn)為幼芽破土樣。(3)肘部、骨盆、腰椎等處肌腱、韌帶輕度骨化。 2.工業(yè)性氟骨癥Ⅱ期在DR影像中的改變,除GBZ5-2002標(biāo)準(zhǔn)中所提出的骨質(zhì)密度明顯增高,骨小梁明顯增粗,呈“麻袋紋樣”表現(xiàn)；骨周改變較為明顯和廣泛外還可以觀察到：(1)骨小梁呈“破毯樣”表現(xiàn)。(2)骨間膜骨化更加明顯,呈“小丘樣”或“波浪樣”表現(xiàn)。(3)肌腱、韌帶明顯骨化,可伴有輕度關(guān)節(jié)退變,以肘關(guān)節(jié)尤為典型。 3.工業(yè)性氟骨癥Ⅲ期在DR影像中的改變,除GBZ5-2002標(biāo)準(zhǔn)中所提出的骨質(zhì)密度顯著增高,骨小梁模糊不清如“大理石樣”；長(zhǎng)骨皮質(zhì)增厚,髓腔變窄。骨周改變更為明顯和廣泛,椎體間可有骨橋形成外還可以觀察到骨小梁呈“磨玻璃樣”表現(xiàn)。(2)骨間膜骨化廣泛出現(xiàn),典型者呈“融蠟樣”或“冰凌樣”表現(xiàn)。(3)肘伸屈肌腱或其他部位肌腱或韌帶骨化突出,關(guān)節(jié)明顯退變。 4.GBZ5-2002標(biāo)準(zhǔn)中氟骨癥的X線檢查部位中包括腰椎正側(cè)位,本課題認(rèn)為應(yīng)用DR診斷工業(yè)性氟骨癥,腰椎正側(cè)位觀察骨小梁結(jié)構(gòu)效果欠佳。 GBZ5-2002標(biāo)準(zhǔn)制定的時(shí)候是以普通X線平片的影像表現(xiàn)作為基礎(chǔ)進(jìn)行歸納總結(jié),各期氟骨癥的影像征象描述比較少,概念不夠明確,影像征象不夠全面,可操作性不強(qiáng)�，F(xiàn)在DR設(shè)備已經(jīng)廣泛應(yīng)用于各級(jí)醫(yī)療及體檢機(jī)構(gòu),建議重新制訂工業(yè)性氟骨癥的DR影像表現(xiàn)及診斷標(biāo)準(zhǔn)。
[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.

【學(xué)位授予單位】：內(nèi)蒙古大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R135.1;R816.8

【共引文獻(xiàn)】

相關(guān)博士學(xué)位論文 前1條

1 白生賓;氟對(duì)破骨細(xì)胞增殖的影響及可能的分子機(jī)制[D];中南大學(xué);2012年

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本文編號(hào)：1542682