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1.
目的探讨腰椎关节突关节滑膜囊肿的诊断及治疗方法。方法对2001-2005年收治的4例腰椎关节突关节滑膜囊肿患者的诊断及治疗进行回顾性分析。术前均行CT检查,其中2例行MRI检查。治疗均采用椎板减压囊肿切除术,术后随访时间为3-6个月。结果CT及MRI检查可明确诊断腰椎关节突关节滑膜囊肿。4例病人中,3例疼痛症状消失,1例缓解。结论CT及MRI检查对腰椎关节突关节滑膜囊肿有定性及定位诊断价值,手术治疗效果良好。  相似文献   

2.
腰椎椎管内小关节突旁囊肿手术治疗体会   总被引:1,自引:0,他引:1  
[目的]探讨腰椎椎管内小关节突旁囊肿的诊断及治疗方法。[方法]对2004年6月~2007年6月收治的7例腰椎椎管内小关节突旁囊肿患者的临床资料进行回顾性分析。其中黄韧带囊肿1例,小关节突关节滑膜囊肿6例;病变位于L4、5节段5例,L5S1节段2例。术前常规行腰椎正、侧位、动力位X线片,CT与MRI检查,其中2例患者术前影像学检查提示存在椎间不稳。治疗方法采用椎板开窗减压囊肿切除、关节突内侧1/3切除术,伴椎间不稳患者加行短节段椎弓根系统内固定及后外侧植骨融合。术后随访时间9~24个月,平均14个月,通过VAS及ODI量表评估治疗结果。[结果]7例病人术后均得到不同程度改善,5例疼痛症状完全消失,2例明显缓解。3例术前存在下肢感觉障碍的患者术后均有不同程度恢复。术前CT及MRI影像学诊断与术中所见及术后病理诊断相符。[结论]腰椎椎管内小关节突旁囊肿是下腰痛的病因之一,CT及MRI检查对其有定性及定位诊断价值,手术治疗效果确切。  相似文献   

3.
腰椎关节突关节滑膜囊肿(1umbarfacetjointsynovialcysts,LFJSCs)起自关节突关节内侧关节囊,囊肿突出椎管及侧隐窝压迫硬膜囊与神经根,引起临床上常见的腰痛和下肢放射性疼痛,不易与腰椎椎间盘突出证相鉴别,易被误诊。随着人口老龄化的增加,CT及MRI的应用,LFJSCS的检测率不断提高。LFJSCs多见于老年人,  相似文献   

4.
<正>腰椎关节突关节滑膜囊肿(lumbar intraspinal synovial cysts,LISC)起自关节突关节内侧关节囊,囊肿突出椎管压迫硬膜囊与神经根,引起腰痛和下肢放射性疼痛等临床症状,不易与腰椎间盘突出症相鉴别,临床上少见,易被误诊。文献报道LISC多发于脊柱活动量最大的L4、5(61%90%)节段,其次是L3、4和L5S1节段(5%90%)节段,其次是L3、4和L5S1节段(5%17%)[1]。本院于2012年11月6日收治1例腰椎关节突关节囊肿患者,报告如下。  相似文献   

5.
为评价X线平片和CT检查对腰椎关节突关节的诊断价值,通过对80例腰椎CT片中L_3、L_4、L_5关节突关节角及其形态进行了测量与观察,所获504个数据,经统计学处理。结果:不同性别同一椎体、同一性别不同椎体关节角均有显著差异,L_3、L_4关节突关节形态多为浅弧形,L_5则多为直线形。同时关节角的大小和形态个体变异较大。表明X线对关节突关节病变的诊断价值有限,而CT扫描能较全面客观地反映关节突关节,为临床提供较可靠诊断依据。  相似文献   

6.
目的:探讨儿童多关节滑膜结核的发病机制、临床特点和治疗原则。方法:回顾7例儿童多关节滑膜结核,其原发及继发病变均发生在下肢大关节。关节液结核PCR检查5例,病理检查2例,关节液PCR及病理检查2例。药物保守治疗5例,滑膜切除手术治疗2例,常规抗痨等对症治疗12~18个月。结果:随访2年以上其中关节功能优3例,良3例,中1例。结论:多关节滑膜结核临床较少见,其临床表现及X线检查无典型特征,误诊、漏诊率高,可疑病例早期行关节液结核PCR检查或病理学检查。治疗上主张保守抗痨治疗为主,对合并有骨质破坏或混合性关节感染应尽早实施手术治疗。  相似文献   

7.
退变性腰椎滑脱与关节突关节的方向性   总被引:9,自引:4,他引:5  
目的:探讨腰椎关节突关节的方向性在退性变腰椎滑脱发生中的病因学意义。方法:34例L4/5退变性腰椎滑脱患者及30名正常对照者的CT扫描片,侧位X线片上关节突关节的方向性及腰椎滑脱程度进行分析。结果:退变性腰椎滑脱患者的关节突关节方向与对照组比较更偏向吴矢状位(P<0.01),关节突关节不对称程度也更为明显(P<0.05),小关节椎弓根角更倾向于水平位(P<0.01),关节突关节角,不对称程度及小关节椎弓根角与腰椎滑脱程度无显著相关性(P>0.05)。结论:腰椎关节突关节的方向性在退变性腰椎滑脱的发生中可能有一定的病因学意义。  相似文献   

8.
木荣华 《中国骨伤》1997,10(5):30-30
采用腰椎关节突关节封闭配合手法治疗病程长久,纠缠难愈的腰椎间盘突出症60例,效果满意,现介绍如下。16$资料本组60例中男32例,女28例;年龄20~65岁;全部病例病史均在1年以上,最长为12年;全部病例均经CT明确诊断,L。-。突出25例,L。~S;突出35例。治疗方法1.腰椎关节突关节封闭:(l)药物组成:l%普鲁卡因3ml,注射用水3ml,确炎舒松A10mg。(2)操作方法:病人俯卧,腰部垫枕,术侧垫高30’,常规备皮。在病所棘突连线外4cm处作皮肤浸润,然后用9号穿刺针(13cm)调整针尖与皮肤倾斜45‘缓慢进针,在透视下将针尖刺入上…  相似文献   

9.
目的:对邻关节骨囊肿(骨内腱鞘囊肿)进行回顾分析,方法:采用回顾性研究方法对手术治疗的1例股骨上段巨大,多发性邻关节骨囊肿(骨内腱鞘囊肿)进行分析,手术方法采用病灶刮切术加自体骨充填植骨术,结果:随访4年无复发,结论:邻关节骨囊肿是一种罕见的良性骨肿瘤,难于早期正确诊断,建议行MRI检查,并尽早结合手术探查及病理检查完成诊治。  相似文献   

10.
目的:探讨腰椎关节突关节骨性关节炎的CT分级及其临床意义。方法:回顾性分析2008年1月~2010年12月在我院就诊的100例腰痛或腰痛伴下肢麻木疼痛患者的腰椎CT。男43例,女57例;年龄23~81岁,平均52.5岁。采用CT骨窗轴位像关节突关节的关节间隙宽度、骨赘形成及骨质变化情况作为分级依据征象,将每个征象按照其严重程度分为4个等级,相应赋予0~3分,按3个征象总分分为4级:0级,0分;Ⅰ级,1~3分;Ⅱ级,4~6分;Ⅲ级,7~9分。由初、中、高级职称3位医师在PACS系统对100例患者从L1/2至L5/S1节段的双侧关节突关节分别进行2次独立分级,Kappa分析评价3位医师分级结果的一致性。同时对患者腰痛VAS评分、Oswestry功能障碍指数(ODI)和年龄与分级结果进行Spearman相关分析。结果:3位医师分别2次对100例患者的1000个腰椎关节突关节进行分级,0级200~211个(20.0%~21.1%),Ⅰ级384~403个(38.4%~40.3%),Ⅱ级301~310个(30.1%~31.0%),Ⅲ级85~106个(8.5%~10.6%)。同一医师前后分级一致的关节突关节数为84.1%~88.4%,Kappa值为0.773~0.833;不同级别医师分级一致的关节突关节数为82.9%~87.9%,Kappa值为0.756~0.827。患者VAS评分和ODI与分级结果的相关系数分别为0.186、0.192,无显著相关性(P>0.05);年龄与分级结果的相关系数为0.558,呈显著性正相关(P<0.05)。结论:腰椎关节突关节骨性关节炎CT分级具有良好的一致性,对关节突关节退变程度的评估和研究有指导意义;腰椎关节突关节骨性关节炎CT分级与年龄呈正性相关,而与腰痛程度及腰椎ODI无显著相关性。  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

13.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

14.
Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.  相似文献   

15.
Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.  相似文献   

16.
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

17.
Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg?1 i. v. and 32 μg · kg?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg?1. The mean ED50s, calculated from dose-response curves, were 5.4 mg · kg?1, 3.9 μg · kg?1 and 0.4 mg · kg?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg?1 and 8 μg · kg?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.  相似文献   

18.
Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.  相似文献   

19.
A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.  相似文献   

20.
Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.  相似文献   

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