[目的]比较前路颈椎体切除融合术(anterior cervical corpectomy and fusion,ACCF)联合前路颈椎间盘切除融合(anterior cervical discectomy and fusion,ACDF)与多节段单纯ACDF治疗多节段脊髓型颈病(cervical spondylotic myelopathy,CSM)的临床效果.[方法]回顾性分析2015年8月—2019年8月前路减压融合治疗CSM 86例患者的临床资料.依据术前影像病变程度,21例采用联合术式(单节段ACCF＋单节段ACDF),65例采用多节段单纯ACDF术.比较两组围手术期、随访结果与影像资料.[结果]联合组术中显著失血量多于ACDF组(P＜0.05),但两组手术时间、早期并发症发生率、住院时间的差异均无统计学意义(P＞0.05).术前联合组深反射评级、病理反射评级均显著重于ACDF组(P＜0.05),与术前相比,术后两组患者深反射评级、病理反射评级、VAS评分和NDI评分均显著改善(P＜0.05).术后联合组患者的深反射评级、病理反射评级均显著优于ACDF组(P＜0.05).相应时间点,两组间VAS、ODI评分的差异均无统计学意义(P＞0.05).影像方面,与术前相比,末次随访时两组患者CL、SCA、C2-7 SVA均显著改善(P＜0.05).术前两组CL、SVA的差异均无统计学意义(P＞0.05),联合组SCA显著小于ACDF组(P＜0.05),末次随访时,两组间CL、SCA、SVA的差异均无统计学意义(P＞0.05).[结论]对于部分长节段ACDF手术无法获得充分减压的多节段CSM患者,联合减压植骨融合术是一个安全而又有效的替代方法,可避免长节段ACCF的潜在并发症.

目的:对比使用显微镜和不使用显微镜对颈前路椎间盘切除植骨融合术(ACDF)治疗脊髓型颈椎病临床效果的影响.方法:回顾性分析2015年12月-2017年12月笔者所在医院诊断为单节段脊髓型颈椎病的63例患者,根据患者是否在显微镜辅助下实施ACDF分为显微镜组(32例)及普通组(31例).比较两组术中失血量、术后引流量、手术时间、术后疼痛视觉模拟评分(VAS)和颈椎功能障碍指数(NDI)及术后并发症等指标.结果:显微镜组手术时间短于普通组,术中出血量和术后引流量均低于普通组,差异均有统计学意义(P<0.05).两组并发症发生率比较差异无统计学意义(P>0.05).两组患者术后3个月VAS和NDI评分比较差异无统计学意义(P>0.05).结论:显微镜辅助下行ACDF可明显缩短手术时间,减少出血,值得临床推广.

目的:探讨微创经椎间孔腰椎椎体间融合术(MIS-TLIF)与单切口双侧Wiltse入路的经椎间孔腰椎椎体间融合术(W-TLIF)治疗单节段腰椎椎管狭窄症的临床效果.方法:选取2015年7月1日-2017年7月1日笔者所在医院收治的100例单节段腰椎椎管狭窄患者,根据治疗方式不同将其分为MIS-TLIF和W-TLIF组,每组50例.比较两组术中失血量、手术时间、住院时间、术后ODI、VAS评分及并发症发生情况.结果:MIS-TLIF组手术时间长于W-TLIF组,术中出血量显著少于W-TLIF组,差异均有统计学意义(P<0.05).两组住院时间比较差异无统计学意义(P>0.05).术后6周两组ODI及VAS评分比较差异均无统计学意义(P>0.05).两组并发症发生率比较差异无统计学意义(P>0.05).结论:与MIS-TLIF相比,W-TLIF手术时间较短,但失血量更多,但是两种方法治疗单节段的腰椎管狭窄症的效果相近,术者可根据自己的经验选择手术方式.

[目的]探讨Zero-P系统在单节段前路颈椎减压融合术(ACDF)的临床与影像学结果.[方法]回顾分析35例采用Zero-P系统的行ACDF术的患者.记录围手术期和随访资料,影像测量颈椎前凸角(CL),手术节段前凸角(0L);融合节段前缘高度(AIH)和融合节段后缘高度(PIH).[结果]35例患者均顺利手术,术中末发生重要血管、神经、器官损伤,无硬膜撕裂.35例患者随访9～42个月,平均(23.29±13.42)个月.末次随访35例患者病理发射较术前显著减轻,差异有统计学意义(P＜0.05).末次随访时VAS和NDI评分较术前显著减小,差异均有统计学意义(P＜0.05).影像评价方面,CL由术前的(18.29±8.43)°增加到术后6个月的(19.18±10.72)°,末次复查的(23.06±7.13)°(P＜0.05).OL由术前(8.23±4.54)°,增加至术后(14.23±5.11)°(P＜0.01),而末次随访时又减少至(11.24±5.16)°,不同时间点间差异有统计学意义(P＜0.05).AIH由术前(33.24±4.61) mm,显著增加至术后6个月的(36.57± 4.78) mm (P＜0.05),末次随访时又减少至(35.16±4.81) mm,差异无统计学意义(P＞0.05).而PIH术前、术后初次复查和末次随访时无显著改变(P＞0.05).至末次随访时,融合率为91.43％.[结论]Zero-P系统ACDF可以保证良好的融合率,能明显改善C2-7的颈椎生理前凸,但在改善融合节段生理曲度和椎间高度方面并不理想.

OBJECTIVE: S2 alar screw would be an alternative choice without breaking the sacroiliac joint. The aim of this study was to measure radiographic parameters for optimal placement of posterior S2 alar screw for instrumentation and fusion. METHODS: Three-dimensional computed tomography scans of the pelvis of 60 normal adults were used to map the S2 alar screw. Entry point was typically chosen lateral and superior to the S2 dorsal foramen. Ideal S2 alar screw trajectories were explored by rotating the three-dimensional pelvis, while ensuring trajectories were of maximum length and width. After identification of an optimal trajectory, related linear anatomic parameters and sagittal and transverse angles were determined. RESULTS: Ideal S2 alar screw trajectories were identified in each computed tomography scan. According to this morphometric study, trajectories for female patients were more lateral in the transverse plane (female 33.73 +/- 5.99 degrees vs. male 29.82 +/- 4.11 degrees, P < 0.001). Maximal length of trajectory in male patients was significantly longer than in female patients (female 40.82 +/- 4.29 mm vs. male 43.42 +/- 4.02 mm, P = 0.001). Fourteen S2 alar screws were used in 7 patients with high-grade spondylolisthesis, scoliosis, or nonunion at lumbosacral site. No complications occurred during S2 alar screw placement. One S2 screw failed owing to severe local osteoporosis. No patient developed local pain or wound-related problems. CONCLUSIONS: S2 alar screw is an alternative sacral fixation point to provide additional biomechanical stability of lumbosacral constructs. A trajectory with maximum length through the S2 ala can be determined using three-dimensional computed tomography.

目的 研究后路短节段经皮置钉结合伤椎螺钉非融合技术治疗胸腰椎爆裂性骨折的疗效.方法 选取2016年7月至2018年6月应用此技术治疗胸腰椎爆裂性骨折患者26例(AO分型A3/A4型),记录手术时间、出血量、C臂透视次数.测量患者术前、术后即刻、末次随访时的X线平片上的局部后凸角度(Regional kyphotic angle,RKA)和伤椎前缘高度比值,术前、术后7 d、末次随访时进行疼痛VAS视觉模拟评分和Oswestry功能障碍指数(ODI),并对术前、术后7 d、末次随访的影像学测量结果和VAS评分及ODI指数进行统计学分析.结果 26例患者共置入160枚经皮椎弓根螺钉,均获得成功.手术时间(93±15.2)min,术中出血量(85±18.6)ml,术中C臂透视次数(25±6.2)次.无严重围手术期并发症,术前RKA(27.3±3.9)°,术后即刻(3.3±2.6)°,末次随访(4.0±2.8)°;术前伤椎前缘高度比值(52.3±11.2)％,术后即刻(91.2±5.6)％,末次随访(89.5±6.7)％;术前VAS评分(8.27±1.45)分,术后7 d(4.12±1.22)分,末次随访(1.86±1.66)分;术前ODI指数(91.5±2.35)％,术后7 d(35.6±3.8)％,末次随访(10.3±1.4)％.术前RKA、伤椎前缘比值与术后即刻、末次随访相比差异具有统计学意义(P<0.01),但术后即刻与末次随访相比差异无统计学意义.术前、术后7 d、末次随访的VAS评分和ODI指数相比差异具有统计学意义(P<0.05).结论 后路短节段经皮置钉结合伤椎螺钉非融合技术治疗胸腰椎爆裂性骨折符合微创理念,具有很好的临床效果.

目的 探讨氨甲环酸(TXA)在成人退变性侧弯(ASD)后路矫形术患者围术期的应用效果.方法 选取2014年3月～2018年3月在我院诊断为ASD患者60例,随机分为实验组和对照组,每组各30例.实验组切皮前15 min静脉滴注TXA 20 mg/kg,手术开始后以10 mg/(kg·h)持续滴注至手术结束;对照组静脉滴注等量的生理盐水.记录两组术中、术后24 h出血量,术中、术后自体输血量和异体输血量,同时予以双下肢静脉彩超检查两组术后深静脉血栓的发生情况.结果 实验组术中出血量和术后24 h引流量明显少于对照组,(1224±245)mlvs.(1653-±315)ml和(410±122)ml vs.(624±187)ml(P＜0.01);围术期自体血输血量和异体输血量少于对照组,(320±75) ml vs.(578±172)ml和(389±85)ml vs.(465±97)ml(P＜0.05).两组术后无深静脉血栓发生.结论 静脉应用TXA可减少ASD后路矫形术患者围术期出血量和输血量,且安全有效.

目的 评价第2骶骨翼螺钉(S2-alar screw) 在复杂下腰椎手术中应用的安全性和疗效.方法 收集应用S2-alar螺钉固定的23例患者的临床资料, 分析其手术方法、技术要点、并发症和软组织覆盖情况.结果 所有23例患者术中置入S2-alar螺钉均获得成功, 置入螺钉直径6.5 mm, 长度4.0～5.0 cm, 螺钉末端软组织覆盖厚度为(3.24±1.06) cm.随访时间均超过2年, 平均随访时间(42.0±8.3) 个月, 随访期间未出现内固定失败, 所有病例达到骨性融合, 患者无诉腰骶段不适感.结论 S2-alar螺钉置入安全, 切迹低, 目前可以作为增强内固定系统远端固定强度的理想选择.

目的:探讨氨甲环酸(TXA)在减少颈椎后路单开门椎管成形术围手术期失血量的有效性及安全性.方法:将50例颈椎后路单开门椎管成形术的患者随机分为TXA组与对照组,每组25例.TXA组患者于麻醉生效后、切皮前10 min静脉输注氨甲环酸氯化钠注射液,10 mg/kg;对照组输注0.9％氯化钠注射液,10 mg/kg.对比术中出血量及术后24h引流量,比较两组患者深静脉血栓的发生率.结果:两组患者术中失血量比较,差异无统计学意义(P＞0.05).TXA组术后引流量及血红蛋白量明显优于对照组,差异有统计学意义(P＜0.05),两组术后均无深静脉血栓发生.结论:TXA可减少后入路颈椎单开门成形术围手术期出血量,且不增加血栓事件,使用安全、有效.

Objective To explore the effect of S2-alar screw(S2-AS) in lumbosacral spinal revision surgery. Methods From June 2011 to May 2014,due to failed previous lumboarcal spinal surgery,7 patients accepted revision with S2-AS to enhance the anchoring strength at sacral side. The operation time,blood loss and the complications relative to S2-AS were recorded in the study retrospectively. The outcome of fusion at the level of L5/S1 was also evaluated. The visual analogue scale(VAS) score and Oswestry disability index(ODI) at pre-operation,post-operation and the final follow-up were recorded respectively. Results All cases were operated successfully. All cases were followed-up for 12-36 months,mean 18 months. The operation time was 180-300 min,mean 240 min. The blood loss was 450-800 mL,mean 614 mL. No complications relative to S2-AS were found. The VAS scores at pre-operation,post-operation and the final follow-up were 6.86±1.07,1.85±1.10 and 1.57±0.87, respectively. The difference of the VAS scores between pre-revision and post-revision was statistically significant(P<0.01). The ODI at pre-operation,post-operation and the final follow-up were (28.29±7.61)%,(8.57±2.64)%and (7.29±2.43)%, respectively. The difference of the ODI between pre-revision and post-revision was statistically significant(P<0.01). Further improvement of ODI could be found during the follow-up. The difference of the ODI between post-revision and the final follow-up was statistically significant(P<0.05). Conclusions The technique of S2-AS is safe and effective in enhancing the anchoring strength at sacral side during lumbosacral fusion surgery. The anchoring force of S2-AS can prevent the weak S1 pedicle screws from failure in the situation of lumbosacral spine revision,and it is helpful for improving the fusion of L5/S1 level.

Objective To evaluate the clinical results of Wiltse approach combined with fixation at fractured vertebra in the treatment of thoracolumbar fracture. Methods From May 2009 to May 2014,Forty-six patients with fractures of thoracolumbar in department of orthopeolic Fujian Provincical Hospital received surgical treatment of Wiltse approach. As control group,another 31 similar patients received classical posterior approach surgical treatment.The surgical time and surgical blood loss of two groups were recorded and contrastively analyzed.The VAS,ODI and sagittal Cobb angle at the time point of pre-operation,post-operation and the last follow-up were analyzed in intra-group and inter-group. Results Wiltse group:The surgical time and surgical blood loss was (54.5±15.3)min and (260.8±53.7) ml respectively. The VAS at the point of pre-operation,post-operation and the last follow-up was(5.3±1.9),(2.8±0.9),(1.5±0.6) points re-spectively.The ODI at the point of pre-operation,post-operation and the last follow-up was (24.5±4.9),(17.3±7.5),(7.4± 3.3) points respectively.The sagittal Cobb angle at the point of pre-operation,post-operation and the last follow-up was (22.3±4.5)°,(7.4±3.7)°,(8.6±4.7)° respectively.Control group:The surgical time and surgical blood loss was (85.4±36.9)min and (554.3±106.5)ml respectively.The VAS at the point of pre-operation,post-operation and the last follow-up was(5.8± 2.1),(3.4±1.5),(2.5±0.8) points respectively.The ODI at the point of pre-operation,post-operation and the last follow-up was (26.3±5.7),(18.9±4.2),(13.5±6.8) points respectively.The sagittal Cobb angle at the point of pre-operation,post-op-eration and the last follow-up was (25.4±6.9)°,(6.8±5.2)°,(7.0±4.9)° respectively.ODI,VAS of two groups in each time point was compared,with statistical difference(P<0.05).Before and after the surgery,the posterior sagittal Cobb angle was significantly different (P<0.05),but no difference between the point of last follow-up and post-operation (P>0.05).There&nbsp;was no statistic difference in operative time between two groups (P>0.05).The amount of bleeding in Wiltsegroup was less (P<0.05).No difference of VAS and ODI were found between two groups at the time point of pre-opera-tion and post-operation(P>0.05).But compared to control group,better results of VAS and ODI in Wiltse group(P<0.05). There was no statistic difference of Cobb angle between two groups at each time point (P>0.05). Conclusion Wiltse ap-proach in line with the concept of minimally invasive surgery,can better reduction and decompression of thoracolumbar fractures,combined with vertebral pedicle screw can reduce the stress concentration,so as to effectively maintain the sagittal Cobb angle.

Objective To assess the safety and efficacy that compare bipolar hemiarthroplasty with unipolar hemiarthroplasty for the treatment of femoral neck fracture in the patient aged more than 65 years. Methods We searched databases including PubMed Central, MEDLINE (from 1966), EMBASE (from 1980) and the Cochrane Central Register of Controlled Trials database. Only prospective randomized controlled trials (RCTs) that compare bipolar hemiarthroplasty with unipolar hemiarthroplasty for the treatment of femoral neck fracture in the elder patient were included. RevMan 5.2 from the Cochrane Collaboration was applied to perform the meta-analysis. Results Six relevant RCTs with a total of 982 patients were retrieved. From this meta-analysis, mortality rates showed no statistical difference between two treatments, 14.7 % for bipolar versus 13.8 % for unipolar. The acetabular erosion rates were significantly different between two groups ( P = 0.01), 1.2 % in bipolar versus 5.5 % in unipolar group. Overall complication rates, dislocation rates, infection rates and reoperation rates between two groups showed no statistical difference ( P > 0.05). Neither of two treatments appeared to be superior regarding the clinical function assessed by Harris hip scores or return to pre-injury state rates ( P > 0.05). Conclusions Both bipolar and unipolar hemiarthroplasty for the treatment of elderly patient suffering displaced femoral neck fracture achieve similar and satisfy clinical outcome in short-term follow-up. Unipolar hemiarthroplasty seems to be a more cost-effectiveness option for elderly patient.

Objective To explore the effect of non-surgical spinal decompression in the treatment of lumbar interverte-bral disc herniation. Methods 100 patients with lumbar intervertebral disc herniation in our hospital from July 2008 to October 2012 were selected as research objects and randomly divided into observation group and control group,each group of 50 cases.The common lumbar traction was provided in control group,while non-surgical spinal decompression for traction was adopted in observation group.After therapy,the curative effect in both groups was compared. Results The effective rate in observation group was 96.00%,higher than that in control group(82.00%),with statistical difference (P<0.05).Before treatment,VAS score and CODI in two groups was compared respectively,with no statistical difference (P>0.05).After therapy,VAS score and CODI was decreased respectively,the decreasing level in observation group was more remarkable than that in control group respectively,with statistical difference (P<0.05). Conclusion In comparison with common traction,non-surgical spinal decompression in the treatment of lumbar intervertebral disc herniation can better improve patients’symptoms and signs,help them to get recovery of daily life activity.

目的 探讨一期经病椎椎弓根截骨治疗创伤后胸腰椎后凸畸形的手术安全性和手术效果.方法 对22例创伤后胸腰椎后凸畸形患者行经椎弓根截骨术,回顾性分析其手术时间、手术失血量及手术相关并发症;对比其手术前后及末次随访时的VAS及ODI变化,及手术前后矢状位Cobb角变化.结果 本组患者手术时间(190.4±51.9) min;手术出血量(565.9±225.9) mL;除一例患者出现术后神经功能恶化外,无其他与手术相关的严重并发症发生;手术前后及末次随访时VAS评为(6.9±1.4,2.3±1.3和1.1±0.8)分;ODI为(72.6±13.9,29.3±11.1和11.1±7.2)％;手术前后Cobb角为(21.0±5.6和0.5±2.9)..各项指标比较的差异均有统计学意义(P＜0.001).结论 一期后路经病椎椎弓根截骨可以有效缓解创伤后后凸畸形患者的疼痛,改善其功能状况,并能有效矫正后凸畸形,且并发症少.

Objective To evaluate the effect of miacalcic on bone mineral density ( BMD ) and cytokines in the osteoporotic patients.Methods Sixty patients with osteoporosis were equally randomly assigned into 2 groups.Patients in control group ( 30 cases) received 600mg Caltrate per day.Patients in observation group (30 cases) received miacalcic besides Caltrate.The BMD of L2-4 lumbar spine and the femoral neck, insulin-like growth factor-1 (IGF-1), interleukin-6 (IL-6), and tumor necrosis factor-α( TNF-α) were determined before and after the treatment.Clinical symptoms were observed.Results BMD of the L2-4 lumbar spine and the femoral neck were higher in observation group than in control group (P<0.05).The serum levels of IGF-1, IL-6, and TNF-αwere lower in observation group than in control group (P<0.01).Pain was significantly relieved in the treatment group compared to control group (P<0.05).BMD change was positively correlated to IGF-1 but negatively correlated to IL-6 and TNF-αin both groups.Conclusion Miacalcic is effective to improve BMD and to relieve pain in patients with osteoporosis.It can improve the levels of IGF-1, IL-6, and TNF-α.It can effectively relieve pain.

OBJECTIVETo analyze the relationship between the pathological features and 64-multislice spiral computed tomography (64-MSCT) findings of pulmonary nodules in autopsies from patients with coal workers' pneumoconiosis (CWP), to investigate the optimal imaging method for the distribution of pulmonary nodules, and to provide data for the establishment of CT diagnostic criteria for CWP.METHODSCadaveric lung specimens were collected from 7 CWP patients. All of them were men, aged 42∼77 years (mean, 60.00±13.00 years), and their dust exposure time was 5∼30 years (mean, 15.4±8.01 years). The cadaveric lung specimens were treated by aeration, sectioning, and immobilization and were then examined by coronary 64-MSCT. The primitive images were reconstructed into the maximumintensity projection (MIP) images (slice thickness: 3 mm, 5 mm, and 8 mm). The sensitivities of imaging methods with different slice thickness were evaluated based on the pathology and anatomy of local pulmonary nodules, and the correlation between pathological results and radiological findings was analyzed.RESULTSThere were significant differences between the stages determined by pathological examination and high-kV chest radiography (before death) (χ(2) = 4.667, P < 0.05; kappa value = 0.167, P < 0.05). A total of 271 nodules were found in all pathological sections, including peribronchovascular nodules (27, 9.9%), centrilobular nodules (67, 24.6%), interlobular nodules (65, 24.3%), nodules within 5 mm from the pleura (45, 16.5%), pleural plaque-like nodules on the lateral chest wall (45, 16.5%), and nodules on the interlobar pleura (22, 8.1%). The likelihood ratio was the highest (0.981) between 5-mm MIP images and pathological results according to the chi-square test.CONCLUSIONThe stage of pulmonary nodules determined by pathological examination is significantly different from that determined by high-kV chest radiography. The 5-mm MIP images of 64-MSCT provide a good reflection of the local pathology and anatomy of pulmonary nodules in CWP patients.

Objective To compare the effect of Wiltse approach and traditional approach in lumbar fusion surgery. Methods 25 patients underwent one-level instrumented posterior lumbar interbody fusion with Wiltse approach in our hospital from December 2012 to December 2013 were selected as observation group,and another 25 patients taken with traditional approach were selected as control group.The operation time,amount of bleeding,postoperative drainage time of two groups were compared;visual analog scale (VAS) and Oswestry index score after 2 weeks,3 months and 6 months treatment were assessed;serum level of Creatinine kinase after 1,3,7 days treatment were detected. Results There was no significant difference about operation time between the two groups (P>0.05);amount of bleeding in observation group were less than that of control group,postoperative drainage time was shorter than that of control group,the differences were significant (P<0.05).VAS and Oswestry index score of observation group after 2 weeks,3 months and 6 months treatment were lower than those of control group,the differences were significant (P<0.05).Creatinine kinase of observa-tion group after 1,3 days treatment were lower than those of control group,the difference was significant (P<0.05);but there was no significant difference after 7 days treatment (P>0.05). Conclusion Compared with traditional approach, Wiltse approach has more advantages in blood lose,duration of catheter drainage,paraspinal muscle protection and post-operative recovery.

[Objective]To explore the reason of the difference in diagnosis of pneumoconiosis between different areas,and provide evidence for improving accuracy and consistency in diagnosis of pneumoconiosis by X-ray chest film.[Methods]A total of 163 pneumoconiosis patients received lung lavage and diagnosed by high kV X-ray in original units(local diagnostic group) of different areas were selected in this study.Their chest x-ray films were read by 5 experienced pneumoconiosis diagnosticians(expert diagnostic group).The stage classification results identified twice by expert diagnostic group were analyzed statistically.And the difference of stage classification results between local diagnostic group and expert diagnostic group was compared.[Results] The 2 diagnostic results by expert diagnostic group were analyzed via kappa consistency,the Kappa value = 0.807 0.75 which indicated the satisfied onsistency of the 2 results(85.89%).The Kappa value of results by local diagnostic group and expert diagnostic group was 0.177 0.4 which indicated unsatisfied consistency of the 2 results(49.69%).The differences of CV %,high diagnostic rate,low diagnosis rate,coincidence ratio were 7.19%-75.22%,7.14%-83.33%,0.00-66.67%,14.29%-87.50% between local diagnostic group and expert diagnostic group.[Conclusion]The difference exists in diagnosis of pneumoconiosis by X-ray chest film between local diagnostic group and expert diagnostic group.It is necessary to improve the quality of chest X-ray film via condition control,to accurately grasp the diagnostic criteria,to perform regular training,to identify the film together based on the control,to persist in seeking truth from facts,to improve professional ethics,to carry out CT differential diagnosis to reduce the diagnostic error and improve diagnostic accuracy if necessary.

目的 对煤工尘肺大容量肺灌洗前后影像学改变进行评价.方法 2009年1 1月～2010年5月中国煤矿工人北戴河疗养院肺灌洗煤工尘肺患者102例,其中Ⅰ期57例,Ⅱ期37例,Ⅲ期8例;均为男性,平均年龄51.74岁,平均接尘工龄24.74年.仅对第1次复查结果进行比较分析.分析102例资料齐全的尘肺病患者比较大容量全肺灌洗前、后高千伏X线或DR胸片的期别、总体密度;比较57例尘肺病患者肺灌洗前后支气管管壁的64排螺旋CT支气管内径的影像表现;比较99例尘肺病患者灌洗前后64排螺旋CT双肺平均CT值肺密度值、双肺重量.结果 灌洗前后高千伏X线胸片和DR胸片所显示病变、影像表现均未见明显变化,尘肺期别、总体密集度等方面无明显变化,差异无统计学意义(P＞0.05).57例尘肺病患者尘肺灌洗前后右主支气管内径、灌洗前后右上叶支气管后段段支气管内径、灌洗前后右中叶支气管内侧段亚段支气管内径前后差值比较,差异有统计学意义(P＜0.05).99例尘肺灌洗前双肺平均CT值:(HU)为-803.996±65.955,灌洗后双肺HU为-829.052±65.201,灌洗前后双肺HU比较,差异有统计学意义(t=6.783,P＜0.01).99例尘肺灌洗后双肺平均重量、肺密度较灌洗前降低,差异有统计学意义(P＜0.01).结论 煤工尘肺灌洗后部分支气管内径较灌洗前增宽,肺CT值、肺组织密度、自身重量减小.提示灌洗后增加了肺的含气量,提高了肺的通气功能,改善了尘肺病患者的肺功能。