手法治疗急性足下垂型腰椎间盘突出症

目的探讨脊柱定点旋转复位法为主的非手术综合疗法治疗腰椎间盘突出症合并足下垂的疗效及临床特点。方法回顾分析我院1996—2006年诊治的35例腰椎间盘突出症并发急性足下垂患者的临床资料。全部采用脊柱定点旋转复位法为主的非手术综合疗法治疗。结果手法治疗后有12例足背伸肌力恢复到正常肌力Ⅴ级,2年后,34例获得随访,足背伸肌力恢复至正常Ⅴ级肌力者22例。结论腰椎间盘突出症合并足下垂患者,运用脊柱定点旋转复位法为主的非手术综合疗法的疗效是确切的,在患者不愿手术的前提下,可选择该疗法。     

Acute myoedema: an unusual presenting manifestation of hypothyroid myopathy

We describe a patient with primary hypothyroidism due to autoimmune thyroiditis, presenting with acute myoedema and spontaneous rhabdomyolysis. During his hospital stay, he developed altered sensorium due to hypo-osmolal hyponatraemia and later developed bilateral foot drop that responded to appropriate treatment.     

神经生长因子治疗腰椎间盘突出症并足下垂20例疗效分析

目的评价神经生长因子（NGF）应用对腰椎间盘突出症并足下垂的疗效。方法40例腰椎间盘突出症并足下垂患者随机分为观察组和对照组各20例，在常规腰椎间盘髓核摘除术后分别使用NGF及未用NGF的传统治疗，观察两组疗效。结果肌力恢复：观察组总有效率90．0％，对照组55．0％，两组比较差异有显著意义（P〈0．05）。感觉恢复：观察组总有效率95．0％，对照组65．0％，两组比较差异有显著意义（P〈0．05）。结论NGF对腰椎间盘突出症并足下垂疗效肯定。进一步证实外源性NGF可提高神经损伤处内源性NGF含量及活性。     

Bilateral foot drop, weight loss and rectal bleeding as an acute presentation of Crohn's disease.

We report a 71 year old lady who presented with weight loss, rectal bleeding and bilateral foot drop having been previously fit and well. Clinical examination, laboratory investigation and postmortem examination confirmed the diagnosis of active Crohn''s disease and acute peripheral neuropathy. The clinical course of this patient suggests that the peripheral neuropathy might have resulted from the common pathogenesis for Crohn''s disease.     

Optic neuropathy in patient with Wegener's granulomatosis

A 32-year-old white male presented to the Jones Eye Institute at the University of Arkansas for Medical Sciences with blurred vision of the right eye (OD) and severe bilateral retrobulbar pain. He had an eight-year history of Wegener's granulomatosis. On examination there was optic disc edema OD and extensive bilateral orbital involvement with compression of the right optic nerve by neuroimaging studies. Optic nerve compression is rare in Wegener's granulomatosis. The ophthalmic manifestations are reviewed.     

Two cases of exudative retina detachment and uveitis following H1N1 influenza vaccination

Uveitis was a rare adverse event of vaccination. We met two cases of acute uveitis with exudative retinal detachment following vaccination of H1N1 influenza. Case 1 was a 10-year-old boy who was admitted for bilateral blurred vision at 10 days after vaccination of H1N1 influenza. Vitreous opacity was obvious in both eyes. Broad exudative retinal detachment was observed in the right eye. Case 2 was a 47-year-old female who suffered from an acute high fever at 2 days after the vaccination of H1N1 influenza. Later, she encountered bilateral headache and decreasing vision. In both eyes, mutton fat keratic precipitates, positive Tyndall phenomenon, congestion of optic disc and exudative retinal detachment were observed.

     

A case of polyarteritis nodosa limited to lower legs with a high titer of MPO-ANCA under precedence of idiopathic pulmonary fibrosis

A 58-year-old man with a 15-year history of idiopathic pulmonary fibrosis was hospitalized for rapid progression of muscle weakness to bilateral foot drop. Although laboratory data revealed high titers of myeloperoxidase anti-neutrophil cytoplasmic antibody (489 EU), the patient was diagnosed as polyarteritis nodosa limited to the lower portions of the legs. Despite of the treatment with large doses of corticosteroids and cyclosporin A, his symptoms barely improved during the following two months.     

Bilateral multicystic renal dysplasia with potter sequence. A case with penile agenesis

Hereditary renal adysplasia (HRA) is a rare autosomal dominant condition. Patients have several other anomalies including Potter facies, thoracic, cardiac, and extremity deformities. The case present dysmorphic facial features such as hypertelorism, prominent epicanthic folds, a flat and broad nose, choanal stenosis, low-set ears, and a receding chin. He had femoral bowing, hypoplastic right tibia and agenesis of the right foot. He had rich and thick skin. He had also a dysplastic empty scrotum, penile agenesis, and anal atresia. The autopsy revealed pulmonary hypoplasia, ventricular septal defect, bilateral multicystic renal dysplasia, agenesis of both ureter and bladder, intraabdominal testicles, and a single umbilical artery. The penile agenesis was first reported, and including the consanguinity in the parents might further delineate the bilateral multicystic HRA. Vater/caudal regression anomalies, Mullerian duct/aplasia, unilateral renal agenesis, and cervicothoracic somite anomalies association, and Coloboma, heart anomaly, choanal atresia, retardation, genital and ear anomalies syndrome has been considered in differential diagnosis.     

Pneumomediastinum as a complication of fast bowling in cricket

The case is described of a 15-year-old patient who developed acute pneumomediastinum and bilateral pneumothoraces whilst playing cricket. He made a rapid and uncomplicated recovery.     

Necrotizing fasciitis complicated by multiple pneumoceles

This paper reports a 14-year-old male patient who developed necrotizing fasciitis of the leg after a minor trauma. He was admitted to our intensive care unit with septic shock and acute lung injury. The clinical course was complicated by bilateral multiple pneumoceles resulting in bilateral pneumothoraces. The causative organism was found to be Staphylococcus aureus. This young patient survived and was discharged home in fair general condition.     

Acute respiratory distress syndrome with miliary tuberculosis

A 71-year-old man was admitted to the hospital complaining of productive cough and weight loss. Physical examination showed fine bilateral basal crackles. Laboratory findings showed elevated liver enzymes. Tuberculin skin test and sputum smear for acid-fast bacilli were negative. On the fifth day of admission, he deteriorated and developed severe respiratory distress. A chest radiograph demonstrated worsening pulmonary infiltrates. He was electively intubated and was put on a mechanical ventilator. The chest CT scan revealed diffuse bilateral pulmonary nodules and airspace disease. Based upon the clinical suspicion of acute respiratory distress syndrome associated with miliary tuberculosis (TB), empiric treatment with antituberculosis and systemic steroids was started. He was extubated after 6 days. The diagnosis of miliary TB was confirmed by a thoracoscopic lung biopsy. He was discharged with a near normal chest radiograph and was followed up as an outpatient.     

动踝防旋防足下垂支具预防脑卒中偏瘫患者足下垂的效果观察

目的探讨分析脑卒中偏瘫患者穿动踝防旋防足下垂短腿支具对预防足下垂的临床效果。方法选择临床40例脑卒中偏瘫患者,年龄35~65岁,患肢肌力≤2级,随机分成实验组和常规组,实验组从入院的第1天开始穿动踝防旋防足下垂短腿支具,常规组使用足底放置方枕的方法,比较两组患者在住院2周后足下垂的发生率及下肢功能的康复情况。结果足下垂的典型症状下肢伸肌痉挛发生率实验组为15%,常规组为60%;踝关节足跖屈的发生率实验组为15%,常规组为50%;踝关节不能背屈的发生率实验组为10%,常规组为40%;踝关节背屈功能减弱的发生率实验组为20%,常规组为75%;足内翻的发生率实验组为40%,常规组为65%;两组进行统计学分析,差异有统计学意义(P<0.01)。结论对脑卒中偏瘫患者早期使用动踝防旋防足下垂短腿支具可有效预防足下垂,保护患肢功能,促进患肢康复。     

预防下肢深度烧伤足下垂的康复护理

目的:探讨康复护理对下肢深度烧伤患者足下垂的预防作用。方法:按住院时间先后将64例下肢深度烧伤患者分为对照组和观察组各32例,对照组常规护理,观察组在此基础上,采用综合性康复护理。结果:观察组踝关节活动度范围、背屈及趾屈活动度均显著优于对照组(P<0.01);观察组未发生足下垂,对照组发生16例,两组差异有统计学意义(P<0.01)。结论:康复护理可预防下肢深度烧伤后足下垂。     

长圆枕辅助沙袋在脑卒中卧床期患者中的应用效果评价

目的:观察和评价长圆枕辅助沙袋作为踝关节支具临床预防脑卒中长期卧床患者发生足下垂的效果。方法:选择GCS评分≤8分的120例脑卒中患者,分为常规康复(无支具)组、丁字鞋组、自制长圆枕辅助沙袋组进行观察,比较三种方法预防足下垂的效果、使用两种支具的不良反应、患者陪护及护士的满意度。结果:使用支具可减少足下垂的发生;两种支具对足下垂的预防效果差异无统计学意义(P>0.05);应用自制长圆枕辅助沙袋的患者压疮不良反应明显少于丁字鞋组,患者陪护接受程度及护士满意度高。结论:应用长圆枕辅助沙袋可有效减少脑卒中患者足下垂发生,使用过程中陪护和护士容易接受,是保障患者体位安全的辅助用具,且制作和使用简单,值得推广应用。     

双侧关节突关节切除联合椎弓根固定与椎间融合治疗双侧腰椎椎间孔狭窄症41例

目的 探讨经后路行双侧关节突关节切除术联合椎弓根固定与椎间融合治疗双侧腰椎椎间孔狭窄症(LFS)的临床疗效.方法 回顾性分析2010年2月至2013年8月天津市人民医院脊柱外科收治的因双侧LFS行经腰椎后路双侧关节突关节切除术联合椎弓根固定与椎间融合治疗的41例患者,手术前后采用Oswestry功能障碍指数(ODI)及疼痛视觉模拟量表(VAS)进行评分,测量手术前后椎间隙的前高、后高及腰1 (L1)～骶1(S1)角,计算末次随访时ODI及VAS评分,椎间隙前高、后高及L1～S1角的变化.结果 41例患者均获得随访,随访时间12～36个月,平均(26.2士2.4)个月.与术前比较,末次随访时腰痛VAS评分、腿痛VAS评分、ODI降低,椎间盘前、后高度增高,差异均有统计学意义(P＜0.05);术前与末次随访时L1～S1角比较,差异无统计学意义(P＞0.05).结论 经后路行双侧关节突切除术联合椎弓根固定与椎间融合治疗双侧LFS近期临床疗效满意.     

Severe acute gastric dilatation causing respiratory failure

Severe acute gastric dilatation occurring in the absence of bowel obstruction is uncommon. We report acute gastric dilatation developing postoperatively in a 79-year-old man, culminating in respiratory failure. On the third postoperative day following bilateral inguinal hernia repair, he developed abdominal distension with absent bowel sounds. Abdominal radiograph showed a grossly distended gastric shadow and small bowel dilatation. The patient's oxygen saturation then deteriorated suddenly and severely, necessitating intubation. He recovered well with conservative measures.     

重症手足口病患儿心肺X线诊断分析

目的探讨重症手足口病（HFMD）急性期影像学表现,为手足口病的诊治提供依据,提醒临床及早发现重型病例,提高抢救成功率,降低死亡率。方法搜集本院收治的50例重症手足口病病例的相关资料,回顾性分析和总结其影像学征象。结果除发热、皮肤黏膜疹、呕吐、惊颤等临床症状外,其中18例胸部X线片检查示阴性,11例示胸部X线片两肺提示肺炎,20例胸部X线片支持支气管炎,1例胸部X线片两肺提示瘀血、水肿、出血。结论手足口病是一种自限性疾病,提高诊断警惕性和及时识别出重症病例的早期影像学表现是降低HFMD病死率的关键。     

单、双侧椎板开窗髓核摘除术髓核取出容积量比较的实验研究

目的:通过建立猪腰椎间盘退行性病变模型,明确经单侧椎板开窗术及双侧椎板开窗术取出髓核的容积量、质量及造影剂充盈面积的大小,评价两种术式对髓核容积量的影响。方法:对40具猪脊柱分别编号"1、2、3、4…",随机数字表法分为空白1组、空白2组、单侧组、双侧组;空白1组椎骨行MRI检查,明确正常猪T12-S1共计6个椎骨中每个椎间盘各自的体积;空白2组椎骨逐一行横断剖开,取出各椎骨间髓核组织分别称重并逐一记录;单侧组行单侧椎板开窗术,双侧组行双侧椎板开窗术,术后均对髓核行摘除量称重、残余空间造影及CT检查,以明确质量及容积。结果:各椎间盘容积量组间比较差异有统计学意义(P<0.05),各椎间盘髓核量组间比较差异有统计学意义(P<0.05),各椎间盘造影剂充盈面积组间比较差异有统计学意义(P<0.05)。结论:双侧组手术方式较单侧组可明显减少椎间盘髓核残留量并扩大椎间盘造影剂充盈面积,但单侧或双侧椎板开窗术均。未能彻底取出髓核组织。     

神经电生理检查对腰骶神经根病与腓总神经病的鉴别诊断价值

目的探讨神经电生理检查对腰骶神经根病与腓总神经病的鉴别诊断价值。方法对10例以足下垂为主要临床表现的患者进行双侧胫神经F波、双侧腓总神经和胫神经传导、双侧胫前肌、胫后肌、腰椎旁肌肌电图检查。结果4例以腓骨小头上一下段传导速度减慢〉10rrds或动作电位波幅下降超过50％及胫前肌神经源性损害为主,诊断为腓总神经病;5例以胫神经F波潜伏期延长和胫前肌、胫后肌、腰椎旁肌肌神经源性损害为主,诊断为腰骶神经根病;1例为腓总神经、胫神经动作电位波幅下降,感觉电位未引出,胫前肌、胫后肌神经源性损害,腰椎旁肌肌电图未见异常,诊断为坐骨神经病。10例均行腰骶段脊髓MRI。其中5例所见均与神经电生理检查结果相符。结论神经电生理检查在腰骶神经根病与腓总神经病的鉴别诊断中具有重要提示意义。     

Spontaneous regression of a lumbar disc herniation: case report.

BACKGROUND: The phenomenon of the spontaneous disappearance of herniated discs is well known. CASE REPORT: The case of a 74-year-old male presenting with a large disc herniation at L5-S1, experiencing moderate sciatic pain, and having the straight-leg-raising test positive at 30 degrees is presented. The disc herniation was documented by computed tomography. He was treated conservatively with medication and physical therapy. One year later the patient was clinically reevaluated. He proved to be symptom-free and the follow-up computed tomography revealed spontaneous disappearance of the herniated disc fragment. The disc regression could have been due to dehydration, resorption as a result of an inflammatory reaction, or retraction into the intervertebral space. CONCLUSIONS: This report discusses the three aforementioned possible explanations and underlines the need for limiting surgical treatment strictly to patients with neurological deficits, severe unremitting leg pain despite conservative measures, and repeated time loss from work.