第八章 生殖系统与乳腺
本章为自学内容。
第九章 骨、关节与软组织
一、目的与要求
1．了解骨、关节与软组织的影像检查方法；
2．熟悉骨、关节与软组织的正常X线解剖，掌握小儿与成人骨关节的影像特点及其区别；
3．掌握骨骼、关节基本病变的X线表现，熟悉软组织基本病变的影像学表现；
4．熟悉骨、关节创伤、椎间盘突出的影像学表现。
5．掌握化脓性骨髓炎、化脓性关节炎、脊椎结核、关节结核、股骨头缺血性坏死以及良、恶性骨肿瘤的典型X线表现；熟悉慢性关节病、代谢性骨疾病的X线表现。
二、教学内容
第一节 检查方法
1．X线检查：摄片的基本要求及注意事项；
2．CT检查：适应范围及检查方法；
3．MRI检查：适应范围及检查方法。
第二节 正常影像学表现
1．骨的解剖结构与发育；重点讲授小儿长骨的特点、构造及骨龄的定义与意义；
2．熟悉成人长骨、脊柱、关节的正常X线、CT、MRI表现。
第三节 基本病变的影像学表现
1．骨骼基本病变：着重讲授骨质疏松、骨质软化、骨质破坏、骨质增生硬化、骨质坏死与骨膜增生的定义、病理基础及其X线表现。
2．关节基本病变：着重讲授关节肿胀、关节破坏、关节退行性变、关节强直和脱位的定义、病理基础及X线表现。
3．软组织基本病变：讲授软组织肿胀、软组织肿块、软组织钙化与骨化、软组织气体的影像学表现。
第四节 骨、关节与软组织损伤
1．创伤性骨折：讲授骨折的定义、分类及长骨骨折、脊柱骨折、儿童骨折（青枝骨折、骺离骨折）、疲劳骨折与病理性骨折的X线表现；
2．关节创伤：讲授关节脱位的X线表现；
3．椎间盘突出的CT和MRI表现。
第五节 骨、关节与软组织感染
1．急、慢性化脓性骨髓炎：结合病理基础与临床表现，重点讲授其X线平片表现；
2．化脓性关节炎：结合病理基础与临床表现，重点讲授其X线平片表现；
3．骨关节结核： 讲授骨骺与干骺端结核、脊柱结核与关节结核的病理、临床及其X线表现。
第六节 慢性关节病
类风湿关节炎、强直性脊柱炎、退行性骨关节病的影像学表现（可自学）。
第七节 代谢性骨疾病
维生素D缺乏症、肾性骨病的影像学表现（可自学）。
第八节 骨缺血性坏死
着重讲解股骨头缺血性坏死的影像学表现。
第九节 骨肿瘤与肿瘤样病变
1．概述骨肿瘤的分类、临床及其影像学检查的作用与要求，重点概述讲解良恶性骨肿瘤的影像鉴别诊断。
2．良性肿瘤：结合临床、病理，重点讲授骨软骨瘤、骨巨细胞瘤的影像学表现；
3．恶性骨肿瘤：结合临床、病理，重点讲授骨肉瘤、骨转移瘤的影像学表现；
4．肿瘤样病变：一般介绍，可自学；
5．软组织肿瘤：一般介绍，可自学。
三、实验内容与要求
1．通过示教片，了解骨、关节与软组织的影像检查技术；
2．通过教学片熟悉了解骨的结构与发育；小儿长骨的特点；熟悉成人长骨、脊柱、关节的正常X线、CT、MRI表现。
3．通过示教片掌握骨质疏松、骨质软化、骨质破坏、骨质增生硬化、骨质坏死、骨膜增生、关节肿胀、关节破坏、关节退行性变、关节强直和关节脱位的X线表现以及软组织肿胀、软组织肿块、软组织钙化骨化与软组织气体的X线、CT、MRI表现。
4．通过示教病例，掌握长骨骨折、脊柱骨折、儿童骨折（青枝骨折、骺离骨折）、疲劳骨折、病理性骨折的X线表现；椎间盘突出的CT、MRI表现；急、慢性化脓性骨髓炎及化脓性关节炎的X线表现；骨骺与干骺端结核、脊柱结核及关节结核的X线表现；股骨头缺血性坏死的X线表现；骨软骨瘤、骨巨细胞瘤、骨肉瘤、骨转移瘤的影像学表现和诊断、鉴别诊断。
四、教学时数分配
（一）理论课学时分配
（一）理论课学时分配
|
章 节 |
理 论 课 内 容 |
学 时 |
|
第九章第一、二节 |
X线检查技术与正常X线影像 |
1 |
|
第九章第三节 |
基本病变的影像表现
|
2 |
|
第九章第四节 |
骨、关节与软组织损伤 |
2 |
|
第九章第五六七八节 |
骨关节与软组织感染、慢性关节病、代谢骨病、骨缺血坏死 |
2 |
|
第九章第九节 |
骨肿瘤与肿瘤样病变 |
2 |
|
总 学 时 |
9 |
（二）实验课学时分配
|
序 号 |
实 习 课 内 容 |
实 验 类 型 |
学 时 |
|
1 |
检查方法；正常骨关节X线影像、基本病变的X线表现 |
演示性实验 |
2 |
|
2 |
骨折，化脓性骨髓炎，骨结核，骨肿瘤 |
演示性实验 |
2 |
|
总 学 时 |
4 |
思考题
1．正常成人骨骼与儿童骨骼的X线表现有什么区别？
2．骨质疏松、骨质软化、骨质破坏、骨质增生硬化、骨质坏死、骨膜增生的定义与X线表现是什么？
3．关节肿胀、关节破坏、关节退行性变、关节强直和脱位的X线表现是什么？
4．儿童骨折（青枝骨折、骺离骨折）、疲劳骨折、病理性骨折的X线表现是什么？
5．椎间盘突出的CT和MRI表现；
6．急、慢性化脓性骨髓炎的X线平片表现及化脓性关节炎的X线表现是什么？
7．骨骺与干骺端结核、脊柱结核、关节结核的X线表现是什么？
8．影像学上化脓性关节炎与关节结核如何鉴别？
9．股骨头缺血性坏死的X线平片表现是什么？
10．骨软骨瘤、骨巨细胞瘤、骨肉瘤与骨转移瘤的影像表现是什么？
11．影像学上如何对良、恶性骨肿瘤进行鉴别诊断？
Chapter 9 Musculoskeletal system
一、Objective and requirement
Comprehend imaging techniques of bones, joints and soft tissues；
Conversant with normal radiological anatomy of bones, joints and soft tissues, master image characteristics and difference of bones and joints in children and adults;
Master image appearance of bones and joints’ basic diseases in x-ray film, conversant with image appearance of soft tissues’ basic diseases in x-ray film;
Conversant with image appearance of trauma of bones, joints and protrusion of intervertebral disc;
Master typical x-ray image appearance of purulent osteomyelitis, pyogenicarthritis, tuberculosis of spine and joint, avascular necrosis of femoral head, benign and malignant bone tumors; conversant with x-ray image appearance of chronic arthropathy, metabolic bone disease.
二、Content of teaching
Section 1 Examination method
1. X-ray examination: Basic requirement and what should pay attention to in radiography.
2. CT examination: Application scope and examination method;
3. MRI CT examination: Application scope and examination method;
Section 2 Normal image anatomy
1. The anatomical structure and development of bones, especially the characteristics and structure of child’s long bones, conception and significance of bone age.
2. Conversant with normal appearance of bones, spinal column and joints in adult in x-ray film, CT scan and MRI.
Section 3 Image appearance of basic disease
1. Basic diseases of bones: Emphasis on the definition, pathology and x-ray appearance of osteoporosis, osteomalacia, destruction of bone, hyperostosis and osteosclerosis, necrosis of bone and periosteal reaction (periostosis).
2. Basic diseases of joints: Emphasis on the definition, pathology and x-ray appearance of swelling, destrution, degeneration, ankylosis and dislocation of joints.
3. Basic diseases of soft tissues: Showing image appearance of swelling, tumor, calcification, ossification of soft tissue and gas in soft tissue.
Section 4 Trauma of bones, joints and soft tissues
1. Traumatic fracture: Definition, classification of fracture; the x-ray image appearance of fracture of long bone, vertebrae, fracture in children which indicating greenstick fracture and epiphyseal separations, fatigue and pathological fracture.
2. Trauma of joints: To narrate x-ray appearance of dislocation of joints.
3. The imaging appearance of protrusion of intervertebral disc in CT and MRI.
Section 5 Infection of bones, joints and soft tissues
1. Acute and chronic pyogenic osteomyelitis
Master their x-ray image appearances combining pathological principles with clinical appearances;
2. Pyogenicarthritis
Master its x-ray image appearances combining pathological principles with clinical appearances;
3. Tuberculosis of bones and joints
Master pathology, clinical and x-ray image appearance of tuberculosis of epiphysis, metaphysis, spinal column and joint.
Section 6 Chronic arthropathy
Narrate image appearance of rheumatoid arthritis, ankylosing spondylitis and degenerative osteoarthropathy. (students can teach themselves).
Section 7 Metabolic bone disease
Narrate image appearance of metabolic diseases induced by vitamin D shortage and renal diseases.
Section 8 Avascular necrosis of bone
Narrate especially the image appearance of avascular necrosis of femoral head.
Section 9 Bone tumor and tumor-like disease
1. Summarize the classification, clinical appearance of bone tumors, with effect and requirement of imaging examination, and emphasis on how to differentiate benign from malignant bone tumors in image appearance.
2. Benign bone tumors: Combining clinical with pathological appearance, emphasis on image appearance of osteochondroma and giant cell tumor.
3. Malignant bone tumors: Combining clinical with pathological appearance, emphasis on image appearance of osteosarcoma and metastatic tumor of bone.
4. Tumor-like disease: General introduction. (Students can teach themselves)
5. Tumor of soft tissues: General introduction. (Students can teach themselves)
三、Experiment content and requirement
1. Comprehend examination methods of bones, joints and soft tissues by demonstrating with teaching films.
2. Demonstrated with typical films, conversant with bone structure and development, characteristics of child’s long bone, and conversant with imaging appearance of long bones, spinal column and joints of adult in x-ray, CT scan and MRI.
3. By demonstrating, master image appearance of osteoporosis, osteomalacia, destruction of bone, hyperostosis and osteosclerosis, necrosis of bone, periosteal reaction (periostosis), swelling, destrution, degeneration, ankylosis and dislocation of joints, swelling, tumor, calcification, ossification of soft tissue and gas in soft tissue
4. With showing typical films, master x-ray appearance of fracture of long bone, vertebrae, fracture in children which including greenstick fracture and epiphyseal separations, fatigue and pathological fracture; master imaging appearance of protrusion of intervertebral disc in CT and MRI; master x-ray appearance of acute and chronic pyogenic osteomyelitis, pyogenicarthritis , tuberculosis of epiphysis, metaphysis, spinal column and joints; master x-ray appearance of avascular necrosis of femoral head; master image appearance, diagnosis and differentiation diagnosis of osteochondroma, osteochondroma, giant cell tumor, osteosarcoma and bone metastasis.
四、Lessons arrangement
1. Theory lessons arrangement
Chaper and sectionContent of theory lessonsSchool hour
Section 1 and 2 of chaper 9Examination techniques and normal image appearance of x-ray 1
Section 3 of chaper 9Image appearance of basic diseases
2
Section 4 of chaper 9 Trauma of bones, joints and soft tissues2
Section 3,4,5,6,7,8 of chaper 9Infection of bones and soft tissues, chronic arthropathy, metabolic bone disease and avascular bone necrosis2
Section 9 of chaper 9Bone tumors and tumor-like disease2
Total school hours 9
2. Experiment lessons arrangement
Code Content of experiment lessonsMethodsSchool hour
1Examination method, x-ray appearance of normal bones, joints and basic disease.demonstration 2
2Fracture, pyogenic osteomyelitis, bone tuberculosis and bone tumorsdemonstration 2
Total hours 4
Questions
1. What is the difference between x-ray appearance of bones in adult and child?
2. What is the definition and x-ray appearance of osteoporosis, osteomalacia, destruction of bone, hyperostosis and osteosclerosis, necrosis of bone and periosteal reaction (periostosis)?
3. What is the x-ray appearance of swelling, destrution, degeneration, ankylosis and joints dislocation.
4．What is the x-ray appearance of fracture in children including greenstick fracture and epiphyseal separations, fatigue and pathological fracture?
5. What is imaging appearance of protrusion of intervertebral disc in CT and MRI?
6. What is the x-ray appearance of acute and chronic pyogenic osteomyelitis, and pyogenicarthritis?
7. What is the x-ray appearance of tuberculosis of epiphysis, metaphysis, spinal column and joints.
8. How to differentiate pyogenicarthritis from tuberculosis of joint?
9. What is the x-ray appearance of avascular necrosis of femoral head?
10. What is the image appearance of osteochondroma, giant cell tumor, osteosarcoma and bone metastasis?
11. How to differentiate benign from malignant bone tumors in image