235棋牌

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                        • 靠谱的棋牌---首页_Welcome 蓝洞棋牌官网送3金币---首页_Welcome 聚友棋牌官网下载安装-首页 叮叮棋牌抓红三---首页_欢迎您 有什么好玩棋牌游戏-Welcome 磁共振检查病例报告-犬外伤性瘫痪

                          235棋牌

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                                              • 磁共振检查病例报告-犬外伤性瘫痪
                                              • 贝斯达MRI科普服务专栏
                                              • 2015-01-07 09:53:59
                                              • 来源: 饶宇腾
                                              • 临床工作中,神经学检查主要由精神状态、姿势、步态、体位反应、肌肉紧张度、脊反射、感觉和疼痛、尿道功能、颅神经检查组成。

                                                1.病例概况

                                                1.1 泰迪犬,雄,7岁, 5KG

                                                1.2 主诉:235棋牌半月前被大狗咬伤颈部,四肢瘫痪。经抢救住院后仍瘫痪,现饮食正常。大小便能控制。

                                                1.3 临床检查

                                                1.3.1SHIZHEN:JINGSHENCHENYU,SHENZHANCETANG。

                                                235棋牌1.3.2 CHUZHEN:WAIZHOUSHENJINGXUEJIANCHA-HOUZHIJIQIANZHIYOUSHENBUTONGJUE,YOUXITIAOFANSHE,YOUGANGZHOUFANSHE,YOUPIJIFANSHE。NAOSHENJINGJIANCHA—WEIXIEFANSHE,TONGKONGFANSHE,YANJIANFANSHE,BICHUJUEFANSHE,JIAOMOFANSHEDENGJUNMINGXIAN。CHUZHENWEISIJITANHUAN(WUFAXINGZOU,DANYOUSHENBUTONGJUE,TU1)。


                                                TU1.JIANCHAQIANZHUANGTAI

                                                235棋牌1.3.3 XXIANJIANCHA


                                                图3.DR颈部侧位


                                                图4.DR颈部腹背位


                                                235棋牌 TU5.DRJINGBUJINGZHUIHENGTUGUZHE

                                                235棋牌ZHU:TU5WEIJINGBUDRFUBEIWEI,HONGSEJIANTOUSUOZHIQUYUWEIDIWUJINGZHUIHENGTUGUZHE。

                                                235棋牌YINSHANGQINGJIAOZHONG,YUZHURENGOUTONGJINXINGBINGBIANBUWEIDECIGONGZHEN(MRI)JIANCHA。

                                                1.3.4CIGONGZHEN(MRI)JIANCHA


                                                图6.MRI检查矢状面定位 


                                                TU7. T1XIANGSHIZHUANGMIAN4


                                                图8.T2项矢状面4


                                                TU9.T2XIANGSHIZHUANGMIAN(4)

                                                ZHU:TU8WEIJINGBUT2XIANGSHIZHUANGMIANJIAQUANXIANG,TU9WEIJINGBUT2XIANGSHIZHUANGMIANJIAQUANXIANGBIAOJITU,HUANGSEJIANTOUQUYUNEIWEIJINGBUYAOSHANGYINQIDEZUZHIYANXINGSHUIZHONG,ZAIT2XIANGZHONGCHENGXIANDAOSANJIAOXINGGAOLIANGXINHAO。HONGSEJIANTOUWEIC5DUANJISUISHOUYINGXIANGBUWEI,ZAIT2JIAQUANXIANGZHONGCHENGZHONGGAOXINHAO。

                                                图10.横断面定位

                                                图11.T2项横断面6


                                                图12. T2项横断面7


                                                TU13. T2XIANGHENGDUANMIAN8

                                                ZHU:TU12-14WEIYAOSHANGBUWEIHENGDUANMIANT2JIAQUANXIANG,XIANSHIJINGBUJIZHUSHANGFANGJIROUCENGYOUGAOLIANGXINHAO,YOUCEJISUIBIAOMIANJIEGOUBUWANZHENG,T2JIAQUANXIANGCHENGZHONGDENGXINHAO。

                                                235棋牌MRIJIANCHAJIEGUO:JINGBUDIWUJIZHUSHANGFANGJIROUJIRUANZUZHICENGT2JIAQUANXIANGCHENGGAOXINHAO,BINGZAOWEIDAOSANJIAOXING,BIANJIEBUQING。DIWUJINGZHUIJISUIC5-C6DUANRUANHUA,T2JIAQUANXIANGCHENGZHONGGAOXINHAO,BINGZAOXINGTAIWEIDAOSANJIAOXING(JIANTU9HONGSEJIANTOU)。YOUCEJISUIBIAOMIANJIEGOUBUWANZHENG,JISUINEISHUIZHONG,C5YOUCEHENGTUGUZHE,TONGSHIJINXINGXUECHANGGUI、SHENGHUAJICFANYINGDANBAIJIANCHA。

                                                1.3.5 XUEYESHENGHUAJIANCHAJIEGUO:

                                                BIAO1  XUECHANGGUIJIANCHA

                                                235棋牌XUECHANGGUIJIANCHAJIANBAIXIBAOYOUSUOSHANGSHENG, XUEXIAOBANYOUSUOXIAJIANG。TISHIYOUGANRANJININGXUEBULIANGZHENGZHUANG。

                                                BIAO2 SHENGHUAJIANCHA


                                                SHENGHUAJIANCHAJIANALTYOUQINGWEISHANGSHENG,GENJUBINGQINGYUYAOSHANGYOUGUAN。

                                                BIAO3 CFANYINGDANBAI(CRP)


                                                CFANYINGDANBAIJIANCHAWEIZHENGCHANGFANWEI

                                                1.3.6  YISHENGJIANYI:ZHENJIUBAOSHOUZHILIAO

                                                2、病情分析

                                                TANHUANZAISHOUYILINCHUANGGONGZUOZHONGHUIBUDINGSHIYUDAO,XIANGXINHENDUOSHOUYIZAIGONGZUODUIYUTANHUANDEZHENDUANGUOCHENGHUODUOHUOSHAOGANJUEYOUDIANJINGYANBUZU。

                                                235棋牌LINCHUANGGONGZUOZHONG,SHENJINGXUEJIANCHAZHUYAOYOUJINGSHENZHUANGTAI、ZISHI、BUTAI、TIWEIFANYING、JIROUJINZHANGDU、JIFANSHE、GANJUEHETENGTONG、NIAODAOGONGNENG、LUSHENJINGJIANCHAZUCHENG。TONGGUOSHANGSHUJIANCHAKEJIANGXIAODONGWUTANHUANKEFENWEIWUJI。YIJI:ZOULUZHENGCHANG,BEIBUYOUYATONG;ERJI:ZOULUYAOHUANG,BEIBUYOUYATONG;SANJI:WUFAZOULU,SIZHIKEDONG;SIJI:WUFAXINGDONG,DANYOUSHENBUTONGJUE;WUJI:WUFAXINGDONG,SHENBUTONGJUESANGSHI。

                                                235棋牌ZAICHUZHENGUOCHENGZHONGXIANJIANCHAWAIZHOUSHENJINGXITONG,RUGUOWAIZHOUSHENJINGXITONGMEIYOUYICHANG,ZAIQUEDINGZHONGSHUSHENJINGXITONG。BENBINGLIZHONG,TONGGUOSHIZHENHEWAIZHOUSHENJINGXITONGJIANCHAKEQUEDINGJINGBUJISUISHOUSUN,ZHONGSHUSHENJINGXITONGZHENGCHANG。PANDINGWEISIJITANHUAN。DUIHUANBINGDONGWUSHOUSUNBUWEIDINGWEIHOU,JINYIBUTONGGUOMRIJIANCHA,ZHENSHIFANYINGHUANBINGBUWEIDESHENGLIJIEGOU、SHOUSUNQINGKUANG、BINGQINGFAZHANQINGKUANGDENG。

                                                MRISHIMUQIANJIANCHAJIZHU、JISUIBINGBIANZUIJIADEWUCHUANGXINGFANGFA,TEBIESHIDUIYIWEIZHUIGUANNEIBINGBIANHUOZHUITIBINGBIANDEHUANBINGDONGWU,MRIYINGZUOWEISHOUXUANDEYINGXIANGXUEJIANCHAFANGFA。MRIJIANCHASHIYONGYUJIZHUHEJISUIDECHUANGSHANG、ZHONGLIU、GANRAN、XUEGUANJIXING、JISUIKONGDONG、JISUIBIANXINGXINGWEISUO、ZHUIJIANPANTUCHUDENGJIBING。BENBINGLITONGGUOMRIJIANCHA,KEJINGQUEDINGWEIDIWUJINGZHUIJISUISHOUSUN,TONGSHINENGGOUQINGCHUXIANSHIJISUIYUZHOUWEIZUZHIDEGUANXI,TONGGUOMRIJIANCHAYISHICAIQUBAOSHOUZHENJIUZHILIAO,SHIDEHUANBINGDONGWUTANHUANZHENGZHUANGYOUSUOGAISHAN。

                                                CHANGGUIMRISAOMIAOFANGXIANGBAOKUOSHIZHUANGMIAN、HENGDUANMIAN。DANGBINGBIANWEIYUZHUIGUANYICEHUOZHEXUYAOGUANCHALIANGCEDUICHENGXINGSHI,YINGZENGJIAGUANZHUANGWEISAOMIAO。HUAIYIYOUZHUITIHUOZHUIPANGRUANZUZHIBINGBIANSHI,YUANZESHANGYINGJINXINGT2JIAQUANXIANGZHIFANGYIZHIXULIESAOMIAO。MRIJIANCHAYINGXIANGTONGSHIYEFENWEIT1JIAQUANXIANGHET2JIAQUANXIANG。TONGGUODUIBIT1JIAQUANXIANGHET2JIAQUANXIANGLAIFENXIBINGBIANBUWEIZUZHIJIEGOUHESHENGLIZHUANGTAI[1]。

                                                3.讨论

                                                3.1 磁共振系统

                                                MRISHI“Magnetic ResonanceImaging”DEYINGWENSUOXIE,QIHANYIWEICIGONGZHENCHENGXIANG。DAOLE20SHIJI80NIANDAICHU,ZUOWEIYIXUEXINJISHUDENMRCHENGXIANG(NMR Imaging)YICIYUELAIYUEWEIGONGZHONGSUOSHUXI。WEILETUCHUZHEIYIJIANCHAJISHUBUCHANSHENGDIANLIFUSHEDEYOUDIAN,TONGSHIYUSHIYONGFANGSHEXINGYUANSUDEHEYIXUEXIANGQUBIE,FANGSHEXUEJIAHESHEBEIZHIZAOSHANGJUNTONGYIBA“HECIGONGZHENCHENGXIANGSHU”JIANCHENGWEI“CIGONGZHENCHENGXIANG(MRI)”。

                                                235棋牌CIGONGZHENSHIYIZHONGWULIXIANXIANG,DAO1973NIANCAIJIANGTAYONGYUYIXUELINCHUANGJIANCE。MRITONGGUODUIJINGCICHANGZHONGDERENTISHIJIAMOUZHONGTEDINGPINLVDESHEPINMAICHONG,SHIRENTIZHONGDEQINGZHIZISHOUDAOJILIERFASHENGCIGONGZHENXIANXIANG。TINGZHIMAICHONGHOU,ZHIZIZAICHIYUGUOCHENGZHONGCHANSHENGMRXINHAO。TONGGUODUIMRXINHAODEJIESHOU、KONGJIANBIANMAHETUXIANGZHONGJIANDENGCHULIGUOCHENG,JICHANSHENGMRXINHAO。CIGONGZHENJIJIANCEQINGZHIZIDEYUNDONG。

                                                CIGONGZHENYINGXIANGHUIJIETEDIANSHI,CIGONGZHENXINHAOYUQIANG,ZELIANGDUYUDA,CIGONGZHENDEXINHAORUO,ZELIANGDUYEXIAO,CONGBAISE、HUISEDAOHEISE。GEZHONGZUZHICIGONGZHENYINGXIANGHUIJIETEDIANRUXIA:ZHIFANGZUZHI,SONGZHIGUCHENGBAISE;NAOJISUI、GUSUICHENGBAIHUISE;NEIZANG、JIROUCHENGHUIBAISE;YETI,ZHENGCHANGSUDULIUXUEYECHENGHEISE;GUPIZHI、QITI、HANQIFEICHENGHEISE。HECIGONGZHENDELINGYITEDIANSHILIUDONGYETIBUCHANSHENGXINHAOCHENGWEILIUDONGXIAOYINGHUOLIUDONGKONGBAIXIAOYING。YINCIXUEGUANSHIHUIBAISEGUANZHUANGJIEGOU,ERXUEYEWEIWUXINHAODEHEISE。ZHEIYANGSHIXUEGUANHENRONGYIYURUANZUZHIFENKAI。ZHENGCHANGJISUIZHOUWEIYOUNAOJIYEBAOWEI,NAOJIYEWEIHEISEDE,BINGYOUBAISEDEYINGMOWEIZHIFANGSUOCHENTUO,SHIJISUIXIANSHIWEIBAISEDEQIANGXINHAOJIEGOU。

                                                3.2 磁共振系统与CT系统

                                                磁共振成像的图像与CT图像非常相似,二者都是“数字图像”,并以不同灰度显示不同结构的解剖和病理的断面图像。与CT一样,磁共振成像也几乎适用于全身各系统的不同疾病,例如肿瘤、炎症、创伤、退行性病变,以及各种先天性疾病等的检查。

                                                CIGONGZHENCHENGXIANGWUGUXINGWEIYING,KESUIYIZUOZHIJIEDEDUOFANGXIANG(HENGDUAN、GUANZHUANG、SHIZHUANGHUORENHEJIAODU)QIECENG,DUILUNAO、JIZHUHEJISUIDENGDEJIEPOUHEBINGBIANDEXIANSHI,YOUYOUYUCT,CIGONGZHENCHENGXIANGJIEQI“LIUKONGXIAOYING”,KEBUYONGXUEGUANZAOYINGJI,XIANSHIXUEGUANJIEGOU,GUZAI“WUSUNSHANG”DIXIANSHIXUEGUAN(WEIXIAOXUEGUANCHUWAI),YIJIDUIZHONGKUAI、LINBAJIEHEXUEGUANJIEGOUZHIJIANDEXIANGHUJIANBIEFANGMIAN,YOUDUDAOZHICHU。CIGONGZHENCHENGXIANGYOUGAOYUCTSHUBEIDERUANZUZHIFENBIANNENGLI,TANENGMINGANDIJIANCHUZUZHICHENGFENZHONGSHUIHANLIANGDEBIANHUA,GUCHANGKEBICTGENGYOUXIAOHEZAOQIDIFAXIANBINGBIAN。

                                                磁共振成像术的主要不足,在于它扫描所需的时间较长,因而需要对患病动物进行麻醉检查,对运动性器官,例如胃肠道因缺乏合适的对比剂,常常显示不清楚;对于肺部,由于呼吸运动以及肺泡内氢质子密度很低等原因,成像效果也不满意。磁共振成像对钙化灶和骨骼病灶的显示,也不如CT准确和敏感。

                                                3.3 磁共振系统与X光系统

                                                X射线是由于原子中的电子在能量相差悬殊的两个能级之间的跃迁而产生的粒子流。X射线也是游离辐射等这一类对人体有危害的射线。

                                                X光系统是真实的成像系统,通过电子流,能反应动物机体的真实状态。MRI系统和CT系统是计算机进行验算的数字图像,需要设备计算软件的强大功能。

                                                3.4 MRI检查对于临床兽医工作的助力作用

                                                MRI检查在人医检查中已成为常规检查,不仅仅在神经学上MRI能够发挥积极作用,而且在软组织等也有很大的诊断意义。目前全国各地DR系统在兽医临床上的应用较为普遍,MRI系统只在北京、上海、深圳等一线城市有散在分布。这跟MRI检查设备的成本有一定关系。但通过医院间及医生间合作MRI检查设备可以很好的为动物神经学、软组织的诊断工作提供精确诊断。

                                                3.5 动物脊髓损伤的表现类型

                                                JISUISUNSHANGLEIXINGBAOKUOJISUIZHENDANG、JISUICUOLIESHANGHEJISUISHOUYA。JISUIZHENDANGSHIZHIJISUIDANCHUNGONGNENGXINGSUN。JISUICUOLIESHANGKECHENGJISUIBUFENHUOWANQUANDUANLIE,JISUINEIKEYOUCHUXUE、SHUIZHONG、YEHUAHUAISI,ZHUWANGMOXIAQIANGDENAOJIYEZHONGHANYOUXUEYE。JISUISHOUYAKEYOUYIWEIDEGUZHEPIAN、ZHUITI、ZHUIJIANPAN、RENDAI、YIWUHEJISUINEIWAICHUXUEHUOXUEZHONGYAPOYINQI。

                                                本病例中,泰迪犬由于颈部咬伤,经过MRI检查,可确定为脊髓挫裂伤,基本的运动功能受损。神经学检查,分为颈椎损伤(C1-C5),尾椎损伤(C6-T5),胸椎损伤(T3-L3),腰椎损伤(L4-S3),骶骨损伤(S1-S3)。其中,颈椎损伤又分为后肢上运动神经(UMN, upper motorneuron)症状和前肢上运动神经(UMN)症状(UMN症状:无力、软瘫、牵张反射和伸肌反射过强、没有肌萎缩) 。本病例就属于颈椎损伤UMN症状[2]

                                                3.6不同时间段软组织损伤在MRI检查上的不同及预后判断

                                                MRI检查主要检测H质子的运动状态,在咬伤出血的情况下,MRI信号特点呈现不同,根据时间划分为五期:超急性出学期、急性出学期、亚急性、亚急性后期、慢性期。具体信号特点见表4所示。

                                                BIAO4 MRIJIANCHABUTONGSHIJIANDUANNEICHUXUELEIXINGXINHAOTEDIAN


                                                235棋牌BENBINGLI,TAIDIBEIYAOSHANGWEIBANGEYUE,ZAIT1JIAQUANXIANGZHONGCHENGZHONGDENGXINHAO,T2JIAQUANXIANGZHONGCHENGGAOXINHAO,CONGMRIXINHAOTEDIANLAIKAN,JINGBUSUNSHANGCHUYUJIXINGCHUXUEQI,SUOYI,BUNENGJINPINGSHOUSHANGSHIJIANZHANGDUANLAIPANDINGMRIXINHAOTEDIAN。

                                                4.总结

                                                经上述检查结果及分析表明:该犬颈部C5横突骨折,MRI检查所见C5脊髓挫伤,C5-C6脊髓软化,功能受到影响。血常规及生化指标提示咬伤部位有炎症。

                                                通过MRI检查,精确反应颈部肌肉及软组织损伤情况,以及颈部脊髓受损状态,可为医师治疗方案提供参考依据及对预后情况的判断。MRI检查不仅仅在神经学诊断上为医师提供精确依据,而且在软组织及生理结构等方面也提供了参考意见。所以MRI检查可以作为日常必要的检查手段,为临床工作和动物福利发挥积极作用。

                                                【参 考 文 献】

                                                235棋牌[1]LIKUNCHENG.QUANGUOYIYONGSHEBEISHIYONGRENYUAN[B].JUNSHIYIXUEKEXUECHUBANSHE,2009.9:P175

                                                [2] MARK S.THOMPSON,CAOJIE.QUANMAOJIBINGJIANBIEZHENDUAN[B].ZHONGGUONONGYEKEXUEJISHUCHUBANSHE,2012.6:P203

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