腰椎间盘摘除及侧隐窝神经根管或椎间孔扩大术

报告腰椎间盘摘除及侧隐窝、神经根管、椎间孔扩大术23例,介绍了手术方法,并对其解剖、老年人腰骶神经根致压特点进行了讨论。     

MRN联合MIP在LDH老年患者腰骶脊神经根的应用价值研究

目的分析MR成像术(MRN)联合最大信号强度投影(MIP)于腰骶脊神经根对老年腰椎间盘突出患者诊断的应用价值。方法 86例老年患者均采用常规MRN扫描序列成像并诊断为LDH,分析其腰骶脊神经根MR成像术的图像结果,通过对腰骶脊神经根成像的信号进行分析,同时对神经根受压与LDH的图像进行分析。结果仅有1根神经根受累的椎间盘突出106个(64.6%),与椎体相同的序数受到累及,而下一个椎体的神经根也会受到累及;同时有两根神经根受累的椎间盘突出则有28个(17.1%),且同时累及两侧的神经根,或累及同侧的上下两根;同时累及上下椎体的多根神经根的椎间盘突出有12个(7.3%);神经根没有受累而硬膜囊受压的椎间盘突出有18个(11.0%)。对照组受试者的图像则均清晰显示出脊膜套袖、硬膜囊、硬脊膜鞘外形、神经节、神经根节内段及部分节后段的走行,双侧对称,边缘光整而走行自然。结论腰骶脊神经根MR成像术可清楚直观显示出腰骶部脊神经根的走行和受压情况,对老年患者治疗方案的有效制定更有帮助。     

多层螺旋CT对脊髓、神经根、椎间孔相互关系的研究

采用多层螺旋CT(MSCT)三维重建和MRI评估脊髓、神经根与相应椎间孔的关系.对50例健康查体者(正常组)及20例脊椎病变患者(病例组)行MSCT及MRI检查,分别测量脊髓、神经根、椎间孔诸径线.结果 正常组颈段、胸段、腰段神经根鞘与椎间孔的截面积之比分别约为0.38、0.39、0.39;正常脊髓与椎管截面积比值介于0.27～0.35,按比值≥0.36有临床意义时对病例组椎管狭窄诊断符合率达93.7%;正常神经根与椎间孔截面积比值介于0.25～0.43,按比值≥0.45有临床意义时对椎间孔狭窄诊断准确率达97.1%.提示MSCT三维重建和MRI可明确显示脊髓、神经根与椎间孔的比例关系,在脊髓神经根性病变诊断中具有重要价值.     

Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄的短期临床效果

目的 探讨后路椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期临床效果。方法回顾性分析2008年1月至2010年12月在解放军空军总医院行后路椎管减压、Wallis棘突间动态内固定治疗的25例腰4．5节段椎管狭窄症的老年患者。男11例,女14例;平均年龄65岁。所有患者随访期均≥6个月。记录所有患者术前、术后3天、术后1个月、术后6个月Oswestry功能障碍指数（ODI）评分及视觉模拟评分（VAS）评分,测量手术节段（腰4-5）和邻近节段（腰3-4、腰 5-骶1）椎间隙与椎间孔高度。记录所有患者术中、术后并发症。结果25例患者均在椎管减压后顺利置人Wallis系统。术中、术后未发生手术相关并发症。所有患者术后临床症状均有缓解,术后3天、1个月、6个月时ODI评分和VAS评分与术前比较,差异均有统计学意义（P〈0．01）。术后1个月、6个月邻近节段（腰3-4、腰 5-骶1）椎间隙与椎间孔高度与术后3天比较,差异均无统计学意义（P〉0．05）。结论椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期随访临床效果满意,Wallis系统可有效维持手术节段椎间隙及椎间孔高度,短期随访未发现引起邻近节段明显退变。     

232例脑瘫患者腰骶神经根的观察测量结果分析

以往对神经根的研究多侧重于脊髓圆锥以上的神经节段，而对腰骶神经根的研究则较少，尤其该处神经根的解剖资料目前鲜有报道。我们在对部分脑瘫患者实施腰骶神经后根切断术的过程中，观察了其神经根的外观，伴随血管、神经根的变异情况及后根的分束，并测量了神经前后根的外径。现报告如下。１　资料与方法本组男１６０例，女７２例；年龄３～３２岁，平均１０．２岁。均因脑瘫而接受腰骶神经后根切断术。手术采用腰骶后正中切口，显露并切除腰２～骶１棘突及椎板，显露并切开硬脊膜；观察腰２～骶１神经根的外观，并测量神经前后根的外径，…     

部分椎弓根椎体内截骨矫形术对胸腰段陈旧性骨折患者椎间孔内径的影响

目的观察部分椎弓根椎体内截骨矫形术对胸腰段陈旧性骨折患者椎间孔内径的影响。方法采用部分椎弓根椎体内截骨矫形术治疗胸腰段陈旧性骨折20例,术前及术后7d均行CT检查,测量脊柱旁矢状位重建后椎间孔上下径、上前后径、下前后径及椎间孔面积。结果术前椎间孔上下径为（23．80±2．27）mm,上前后径为（11．63±1．61）mm,下前后径为（11．67±1．35）mm,横截面积为（63．15±4．34）mm^2;术后分别为（22．50±1．76）、（12．95±1．34）、（11．84±1．12）mm及（57．43±3．54）mm^2。手术前后上下径、上前后径比较,P均〈0．05。结论部分椎弓根椎体内截骨矫形术治疗胸腰段陈旧性骨折,可使患者椎间孔上下径缩小、上前后径扩大。     

MED椎间盘镜手术治疗腰椎间盘突出症神经根解剖变异

目的 探讨MED椎间盘镜手术治疗腰椎间盘突出症术中神经根解剖变异的价值.方法 采用第二代经后路腰椎间盘镜系统(MED)手术治疗腰椎间盘突出症560例,术中发现16例神经根解剖变异,发生率为2.8%.按Kadish分型:Ⅱ型10例,Ⅲ型1例,Ⅳ型5例.其中腰4、5间隙突出6例,腰5骶1间隙突出9例,腰4、5及腰5骶1间隙均突出1例.16例手术均在镜下顺利完成.结果 16例术后症状和体征完全消失,没有神经根损伤表现.近远期随访均未见复发.结论 腰骶神经根解剖变异发生率低.MED椎间盘镜手术系统视野清晰,镜下容易分辨出突出椎间盘与神经根,对神经根解剖变异显露清楚,可以有效防止神经根损伤,避免并发症的发生.     

骶神经根切断吻合治疗脊髓损伤后痉挛性膀胱

对40例脊髓损伤(SCI)后痉挛性膀胱患者行选择性骶神经根切断、吻合术,重建跟腱-膀胱反射弧.术后随访22个月,患者膀胱充盈后可引起自控性排尿,尿流动力学显示排尿完全由膀胱逼尿肌的收缩引发,优良率达85%.认为骶神经根切断后重新吻合建立新的跟腱-膀胱反射弧能恢复SCI后痉挛性膀胱患者的排尿功能.     

髓核摘除加侧隐窝扩大术治疗腰椎间盘突出伴侧隐窝狭窄症(附18例报告)

我院1986～1990年采用髓核摘除、侧隐窝扩大术治疗腰椎间盘突出伴侧隐窝狭窄及单纯侧隐窝狭窄患者18例,收到良好效果。 1.资料及方法:男10例,女8例;年龄35～55岁,平均48岁。均表现为单侧腰、腿根性痛。病变位于腰_(4、5)12例,腰_5骶_1 6例。其中15例合并侧隐窝狭窄,单纯侧隐窝狭窄者3例。病程8个月至16年。均采用半椎板切除法:患者俯卧位,局麻下作腰_3至骶_1棘突正中切口。剥离患侧骶棘肌,用椎板拉勾率开。根据术前定位标记,作相应的椎板间隙按压,有局部痛及放射性痛的位置即是病变位置。在病变处椎板下用蛾眉凿凿开一小窗,大小以神经根与突出之椎间盘显露清楚为度。在神经根上方注射1％普鲁卡因0.5ml,探查神经根肩、腋、     

经椎间孔神经根周围硬膜外封闭治疗坐骨神经痛

1993～ 2 0 0 0年 3月 ,我们应用腰椎间孔神经根周围硬膜外封闭治疗坐骨神经痛 (下称腰椎间孔封闭 )患者 46例 ,收到良好效果 ,现报告如下。临床资料 :本组男 32例 ,女 14例 ;年龄 15～ 70岁 ,病程 1个月至 15年。患者均有腿痛伴麻木、行走困难。主要体征为腰椎前屈变浅 ,有的出现侧凹 ,压痛、放射痛、直腿抬高试验阳性 ,部分腱反射减弱和足背外侧皮肤感觉减退。腰椎 X线片显示腰变直 ,侧凹畸形 ,椎间隙有的前窄后宽或变窄。坐骨神经痛病因为腰椎间盘突出 15例 ,神经根周围炎 2 3例 ,椎管狭窄 8例。行腰4～ 5 椎间孔封闭 2 7例 ,腰 5 骶1 …     

ALPHA-FETOPROTEIN IN THE ANTENATAL DIAGNOSIS OF ANENCEPHALY AND SPINA BIFIDA

α-fetoprotein (A.F.P.) has been measured in the amniotic fluids of thirty-one pregnancies leading to anencephaly (or anencephaly and spina bifida), three leading to spina bifida, and three leading to hydrocephaly (or hydrocephaly and spina bifida). In the anencephalic cases all A.F.P. concentrations were well above the normal range between 25 and 35 weeks of gestation; after 35 weeks five out of nine cases were clearly above normal. In a single case of spina bifida, where amniotic fluid was obtained at 13 weeks, A.F.P. concentration was four times greater than the highest normal level. After 30 weeks' gestation amniotic fluids from pregnancies leading to spina bifida and hydrocephaly could not be distinguished from normal pregnancies. These results suggest that amniotic-fluid-A.F.P. measurements will be valuable in the early antenatal diagnosis of anencephaly and spina bifida and will enable termination of these pregnancies.     

Quality of life of children with spina bifida in Kenya is not related to the degree of the spinal defects

Objectives To assess the relationship between the degree of symptoms and defects caused by spina bifida and the quality of life (QoL) of children with spina bifida in Kenya. Methods Children with spina bifida at BethanyKids at Kijabe Hospital, at mobile clinics throughout Kenya and a control group of healthy children were interviewed regarding their QoL. The SEIQoL‐DW was used as an instrument to measure the QoL. This instrument can transfer well across cultures by using open questions clustered in six domains chosen based on the study group responses. Symptoms and impairment caused by spina bifida were obtained from the medical files. Results Sixty‐nine per cent of 102 patients with spina bifida had a myelomeningocele, 59% had hydrocephalus, and of 49 incontinent children older than 2.5 years, 67% used clean intermittent catheterization. Quality of life of children was 65.1 on a scale from 0 to 100, compared to 78.0 in the healthy control group. Not one single determinant made a significant difference in the overall QoL. The most important domains were ‘development’ and ‘self‐actualization’. The lowest scores were found in the domain ‘health and disease’. Conclusion This study showed no significant influence of the degree of defects of spina bifida on the QoL, but identified domains that can be targeted for improvement in children with spina bifida.     

The prognosis for end-stage renal failure in spinal cord injury and spina bifida - Australia and New Zealand, 1970–1991*

Background: The outcome of patients with end-stage renal failure (ESRF) and spinal cord injury or disease has not been clearly documented. Methods: Fifty patients (two groups: 25 - spinal cord injury, 25 - SB) were identified retrospectively by questionnaire to individual renal units. Additional information was obtained from the Australia and New Zealand Dialysis and Transplant Registry. Dialysis and transplant history, degree of disability and cumulative survival with integrated treatment were compared between the two groups. Results: Haemodialysis was the most common form of treatment (75.8% of total treatment time in the spinal cord injury group and 66.1% in the SB group). Home or self-care dialysis for a period of more than six months was achieved in 68% of patients in each group. Ten year cumulative survival with integrated treatment was statistically better in the SB group (p < 0.01). In the 42% of all patients who underwent renal transplantation cumulative patient survival was 94% at one year and 82% at five years, with allograft survival being 73% and 70% respectively. In conclusion ESRF and spinal cord injury or SB has a good prognosis in the longer term with an integrated approach to treatment. Aims: The aim of this study was to define the prognosis and social consequences for patients with spinal cord injury or spina bifida (SB) treated for ESRF in Australia and New Zealand from 1970 to 1991.     

Colon transit time and anorectal manometry in children and young adults with spina bifida

Purpose

This study evaluates colon transit time (CTT) and anorectal manometry (ARM) in spina bifida (SB) patients in relation to the level of lesion, mobility, constipation, and continence status.

Methods

SB patients between 6 and 19 years, who are not using antegrade continence enemas and followed at the SB Reference Centre UZ Ghent, were asked to participate. Medical history was retrospectively retrieved from the medical file. Stool habits were prospectively collected using standardized questionnaires. CTT was measured using the 6-day pellet abdominal X-ray method. ARM was performed in non-sedated children with a water-perfused, latex-free catheter.

Results

Forty out of 52 eligible patients consented to perform CTT, of which 19 also performed the ARM. Fifteen (37 %) SB patients were constipated despite treatment. Twenty-six (65 %) were (pseudo) continent. The total CTT was significantly prolonged in SB patients (median CTT 86.4 vs. 36 h controls). The CTT was significantly prolonged in constipated SB patients compared to non-constipated SB patients (122.4 vs. 52.8 h). Spontaneously continent patients had a normal CTT (33.6 h) as well as a significantly higher resting pressure compared to the pseudo-continent and incontinent SB patients (resting pressure 56.5 vs. 32.5 mmHg). An abnormal CTT was associated with a treatment necessity to achieve pseudo-continence (p?=?0.006).

Conclusion

CTT in SB patients was significantly prolonged, indicating a neurogenic involvement of the bowel and slow transit constipation. SB patients with a normal CTT and a normal ARM spontaneously achieved fecal continence. CTT can help tailor the continence therapy in SB patients.     

Split notochord syndrome in an adult presenting with colonic duplication

A case of tubular colonic duplication, sigmoid colon diverticulum, and lumbar anterior spina bifida in a 28-year-old man was diagnosed as split notochord syndrome. After subtotal colectomy, including the duplicated colon, the patient recovered. Histologic study of the duplicated colon revealed multifocal, ectopic gastric fundic mucosa in a mosaic pattern. Since bleeding and perforation occur most frequently in conjunction with ectopic gastric mucosa within the duplication, we believe that complete resection of the duplicated bowel is the best procedure. Split notochord syndrome is a rare congenital anomaly. It is usually discovered in the first year of life, and the majority of reported cases have involved the cervical or thoracic region. Our patient is exceptional in having reached the age of 28 years without complaints and in that his case involved lumbar anterior spina bifida and tubular colonic duplication.     

Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion

AIM: To assess the diagnostic accuracy of multidetector-row computed tomography (MDCT) as compared with conventional magnetic resonance imaging (MRI), in identifying mesorectal fascia (MRF) invasion in rectal cancer patients.METHODS: Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner (ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 mAs. Imaging data were reviewed as axial and as multiplanar reconstructions (MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images (DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed.RESULTS: According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91 (41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged (45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value (PPV) 80.4%, negative predictive value (NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant (P = 0.02).CONCLUSION: New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications.     

大面积脑梗死患者磁敏感加权成像的应用

目的应用磁敏感加权成像技术对大面积脑梗死患者脑微出血(CMB)的分析,探讨磁敏感加权成像对CMB诊断价值及CMB发生的相关因素,指导大面积脑梗死及其合并症的诊断及治疗。方法选取大面积脑梗死患者32例,其中CMB组27例,无CMB组5例。对患者行常规T_1WI、T_2WI、液体衰减反转恢复序列、磁共振弥散加权成像等序列检查。结果磁敏感加权成像对于大面积脑梗死CMB的识别明显优于常规MRI检查。CMB组既往脑梗死和高血压发病率明显高于无CMB组,差异有统计学意义(P<0.05,P<0.01)。既往脑梗死和高血压与CMB存在相关性。结论与常规MRI检查序列比较,磁敏感加权成像对大面积脑梗死后CMB的显示有明显的优越性,为临床早期评价大面积脑梗死患者有无继发CMB及严重程度提供信息。     

实时三维超声心动图与磁共振成像对比评价室壁瘤患者左心室容积和功能的可行性和准确性

目的:评价实时三维超声心动图(实时三维超声,RT-3DE)测量冠心病合并左心室室壁瘤患者左心室容积和功能的可行性和准确性.方法:根据室壁瘤大小分组,分别应用二维超声心动图(二维超声,2DE)、实时三维超声及磁共振成像(MRI)测量左心室室壁瘤患者手术前、后左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF),以MRI结果为标准,进行对比研究.结果:①术前、术后二维超声和实时三维超声所测各值与MRI所测各值之间小室壁瘤组、中室壁瘤组差异均无统计学意义(P均＞0.05).②大室壁瘤组术前二维超声所测LVEDV、LVESV与MRI所测值之间差异均有统计学意义(P均＜0.05),术前二维超声所测LVEF值与术后各值与MRI所测各值差异无统计学意义,术前、术后三维超声各值与MRI所测各值差异亦无统计学意义(P均＞0.05).③巨大室壁瘤组术前二维及三维超声所测LVEDV、LVESV较MRI所测值低,而LVEF较MRI所测值高,差异均有统计学意义(P均＜0.05).术后二维超声所测LVEDV、LVESV仍较MRI低,差异有统计学意义(P均＜0.05).术后实时三维超声所测各值与MRI所测各值之间差异无统计学意义(P均＞0.05).结论:与二维超声相比,实时三维超声测定大室壁瘤及巨大室壁瘤患者左心室容积与功能更接近MRI测量值,更准确可靠,但对于巨大室壁瘤患者所测术前左心室容积与MRI相比仍有低估.     

Transition of Care and Treatment of the Adult Spina Bifida Patient

Adult spina bifida patients are an underserved population in terms of healthcare in general and urologic care in particular. These patients have unique urologic issues arising from the underlying disease process as well as prior treatments. Multidisciplinary clinics deliver coordinated care in a limited number of locations and many patients receive care in their local community. In an effort to improve patient care, this article will empower the general adult urologist to care for the urologic needs of adult spina bifida patients and educate the reader about the fundamentals of transitional urologic care.     

MRCP诊断胰头癌的特异征象

目的 探讨磁共振胰胆管水成像（MRCP）诊断胰头癌的特异征象,提高胰头癌的确诊率。方法 对经手术和病理证实的25例胰头癌患者的术前MRI、MRCP表现进行分析,扫描序列包括SE序列T1WI、FSE序列T2WI、T1WIFS、T2WIFS及MRCP冠状位扫描成像。结果 MRCP扫描确诊胰头癌24例,确诊率为96％。25例胰头癌MRCP上均有胆总管和主胰管胰头段破坏残留段信号增高且扩张而不相交征。结论 MRCP可用于诊断胰头癌。胆总管和主胰管之胰头段破坏,残留段信号增高且扩张而不相交征是其特异征象。