CT导引下腰椎间盘造影的技术应用

目的：探讨CT导引下对腰椎间盘造影的作用和CT操作技术。材料与方法：用300mg/ml欧乃派克对27例患者49例椎间盘经CT检查证实为腰椎间盘突出的进行穿刺造影，包括L45椎间盘22例，L5-S1椎间盘27例，穿刺时病人俯卧位。结果：穿刺成功率100％，22例患者39例椎闻盘注射造影荆引起疼痛，6例患者10例椎间盘注射造影剂时引起道疼痛，77.8％的病人确诊疼痛来源。本组无并发症。结论：CT导引下对腰椎间盘造影术是诊断腰腿痛痛源的好方法。     

不同体位行经皮穿刺椎体成形术的比较研究

目的 评估侧卧位行经皮椎体成形术的可行性和安全性。方法 采用随机前瞻性分组方法。全组55例胸腰椎骨质疏松性单、多椎体压缩性骨折,分为俯卧位组29例（A组14例,Am组15例）和侧卧位组26例（B组14例,Bm组12例）。术前将俯卧位组不能耐爱俯卧位时间测试的患者转入侧卧位组。各组均在局部麻醉下,经单“C”型臂引导行经皮椎体成形术。观察手术时间、骨水泥注射量、术后并发症并进行组间比较。结果 A组2例,Am组3例合并严重慢性阻塞性肺病或肥胖患者分别转入B组和Bm组。各组手术时间、骨水泥注射量及术后并发症发生率之间没有显著差异。结论 侧卧位或俯卧位行经皮穿刺椎体成形术的可行性和安全性无显著差异;侧卧位有得对俯卧耐爱能力差的患者。     

经皮穿刺激光腰椎间盘减压术的临床应用

评价半导体二极管激光仪治疗腰椎间突出的作用及效果。方法搜集临床拟诊为腰椎间盘,经近期ＣＴ或ＭＲＩ检查证实的患者１００例,其中１４－５椎间盘突出６５例,１５－Ｓ１椎间盘突出３５例,在ＤＳＡ透视下,取侧卧位或俯卧位进针。经穿刺定位针导入粗０．４ｍｍ的光导纤维至椎间盘内,以每次１５Ｊ、总量为１２００－１３００Ｊ（Ｌ３－４、Ｌ５－Ｓ１）或１３００－１５００Ｊ（Ｌ４－５）的能量对髓核进行汽化切割,凝固,从而     

俯卧位硬膜外麻醉的实验研究

我院自1986年3月在作硬膜麻醉时,选择性地应用俯卧位穿刺术,对20例病人进行临床观察,术后5例行硬膜外造影,摄腰正侧位片,另选侧卧位穿刺5例作为对照组。结果:硬膜外穿刺体位不同,导管在硬膜外腔的方向,位置等均一致。此法适用于侧卧位硬膜外穿刺困难的患者。现报告如     

超声引导穿刺治疗腹部脓肿的体会

自1988年以来，我们应用超声引导穿刺治疗了41例腹部脓肿患者，临床效果满意，其方法与结果报告如下：资料与方法本组41例，男23例，女18例，年龄18～74岁，平均462岁。其中隔下脓肿2例，肝脓肿17例，腹膜后脓肿1例，肾脓肿2例，阑尾脓肿13例，盆腔脓肿6例。采用日本Alok。ssd—280LS型超声仪，穿刺探头频率3．SMHZ。穿刺抽脓冲洗注药使用18G带针芯粗针，穿刺置管引流选用多侧孔导管针。术前常规检查血小板、出凝血时间，视病灶所在部位不同选用仰卧位，侧卧位或俯卧位，使病变清楚显示后再选择最佳的穿刺途径。常规消毒铺巾，局麻后在…     

CT导引下椎体穿刺活检

目的：评价ＣＴ导引下椎体穿刺活检对诊断的意义和价值。材料与方法：３６例椎体活检，包括颈椎２例、胸椎１１例、腰椎２１例和骶椎２例。活检时病人体位为俯卧位，穿刺针为Ａｃｋｅｒｍａｎｎ针，有时辅以抽吸针。结果：刺中率为１００％，正确率为８８．６％，假阴性为１１．４％。本组未出现并发症。结论：ＣＴ导引下椎体穿刺活检是一种简便、正确率高的诊断和鉴别诊断的有效方法。     

恶性肿瘤腹腔种植转移CT分析

本文回顾性收集经手术和病理证实的腹腔种植转移31例，所有病例术前均行版或盆腔增强前后CT扫描，其中11例另加侧卧位或俯卧位扫描。通过对照手术所见，CT扫描直接检出18例（58.1％）43个区域（42．6％）的种植灶，6例CT仅见一些间接征象。种植灶的各种CT表现与其大小、密集程度和部位相关。     

经皮穿刺O2-O3混合气体盘内注射术治疗颈椎间盘突出症

目的 探讨经皮穿刺O2-O3混合气体注射术治疗颈椎间盘突出症的疗效及安全性。方法 32例患者经MRI证实为颈椎间盘突出症，表现为上肢麻痛、颈肩痛及头晕等。在透视下经右颈总动脉与气管间隙穿刺至颈椎间盘中央，每个椎间盘内注射O2-O3混合气体1．5～3．0ml，椎旁间隙注射3～5ml，其O3浓度为（30～50）μg／ml。结果 32例随访时间3至32个月，总有效率为78．1％。其中显效17例（53．1％），有效8例（25．0％），无效7例（21．9％）。无严重并发症发生。结论经皮穿刺O2-O3混合气体注射术是治疗颈椎间盘突出症的1种安全和有效的方法。     

CT导向经皮穿剌活检及引流

CT导向经皮穿刺活检及引流主要应用于经X线及US导向穿刺有困难的病例。多应用于腹部及腹膜后骨盆部。作者对CT导向经皮活检29例,引流14例作了分析。穿刺体位经CT扫描决定采用俯卧位、仰卧位及侧卧位,依CT图象决定穿刺点及方向,而穿刺部位、病变距离及刺入角度由CT计算程序决定。作细胞学诊断的采用21G PTC针,用于组织诊断采用16G Tru-Cut针。引流时用21G PTC针穿刺,依Seldinger法,用8～16 F各种引流管引流。作为细胞学诊断钳取2～4处标本,组织学诊断钳取1～3处标本。活检29例,肿瘤最     

创伤后急性呼吸窘迫综合征俯卧位与侧卧位机械通气效果比较

 目的 探讨俯卧位和侧卧位机械通气在多发伤患者急性呼吸窘迫综合征中的应用效果.方法 对50例多发伤引起的急性呼吸窘迫综合征患者分别进行俯卧位和侧卧位机械通气,比较两组动脉血气、呼吸循环指标变化.结果 两组患者改变体位后动脉血PaCO2 无明显变化,PaO2、PaO2 /FiO2明显升高(P<0.01),以PaO2升高大于10 mmHg作为有效标准,侧卧位组18例(72%)有效,俯卧位组17例(68%)有效;两组有效率比较差异无统计学意义(P>0.05).体位变动对气道峰压、心率和平均动脉压无明显影响.结论 俯卧位和侧卧位机械通气均能改善急性呼吸窘迫综合征患者的氧合状况,侧卧位通气更方便实施.     

体位护理对ARDS患者通气效果的影响

目的研究不同体位条件下ARDS患者的通气效果,为采取最佳体位通气方法提供参考。方法将120例ARDS患者分为A、B、C三组,分别接受侧卧位、侧俯卧位和完全俯卧位通气。监测三组患者呼吸、心率、血压等参数变化并进行对比分析。结果本研究死亡17例,103例患者经改变体位后氧合情况改善,住ICU病房5~23天后转至普通病房。结论 ARDS患者采取间歇侧俯卧位后能明显改善通气效果,从而尽早脱离呼吸机,减少监护病房住院时间,提高救治成功率。     

The prone position for CT of the lumbar spine

In scanning the L5-S1 disk space, the known technical difficulty is limitation of the gantry angle. A prone scanning technique used to examine the lumbar spine may help to overcome or lessen this problem. A prospective CT scanning of the L5-S1 level was performed in both the prone and supine positions on 25 patients who had low back pain and who had not undergone previous laminectomy or fusion. The angle between the S1 vertebral end plate and maximum tilted gantry line (15 degrees on the G.E. 8800) was measured in the supine position and compared with the same angle in the prone position. In 20 of 25 cases (80%), significant improvement in alignment was noted in the prone position. The prone scanning technique is also more desirable if CT is performed with metrizamide. Finally, printed images from the prone technique allow easier image-patient orientation for viewing in the operating room.     

局麻下侧卧位后路脊柱镜下腰椎间盘切除266例

目的总结局麻下侧卧位MED手术治疗腰椎间盘突出症的效果。方法2002年4月—2005年11月采用局麻下侧卧位显微椎间盘镜髓核摘除术266例,全为单间隙突出者合并侧陷窝狭窄者72例。突出间隙L3~411例,L4~598例,L5~S1157例。突出位置:后外侧型183例,中央型78例,极外侧型5例。结果所有病例均获得3~18个月的随访,平均7.5个月。优228例,良34例,可4例,差0例,无术后椎间盘炎、复发、神经根损伤者。结论局麻下侧卧位MED手术是具有手术损伤小,出血少,恢复快的有效方法之一。     

Total Body Irradiation before Bone Marrow Transplantation Technique and Acute Toxicity

PURPOSE: To evaluate the total body irradiation methods in the National Institute of Oncology between January 1984 and February 1998. PATIENTS AND METHODS: One hundred and twenty-four patients underwent total body irradiation prior to bone marrow transplantation in the last 15 years. A special cobalt unit has been used, the dose rate was 6 to 8 cGy/min in the midline of the abdomen. The source-midline distance (SMD) was 340 cm and the field size was 80 x 200 cm. The dose calculation was done on the basis of a tissue-phantom ratio curve measured in total body irradiation conditions and effective tissue thickness (ETT). Between 1984 and 1992 the beam direction was horizontal, the patients laid in lateral position. In 11 cases the total dose to the abdominal midline was 10 Gy in 1 fraction. From 1986 the fractionation changed to 4 x 3 Gy in 4 days. Within individual lung shielding the average lung dose was 8.5 Gy. In 44/124 cases the order of conditioning treatment was chemo-radiotherapy. Since 1992 vertical beams were used, and the patients (80/124) laid in prone/supine position. The fractionation remained the same but radio-chemotherapy regime has been used. RESULTS: The irradiation in prone position proved to be safer than lateral because of smaller patient motion and it resulted in a more accurate positioning of lung shielding too. In all cases, the acute side effects (headache, nausea, vomiting) were moderate. Using radio-chemotherapy the acute side effects during the total body irradiation were uncommon and well tolerable. CONCLUSION: Our technique with the large source-midline distance, vertical beam direction and the supine/prone position is stable, convenient and safe to produce homogeneous dose distribution and ensures accurate and reproducible lung shielding.     

Stereotaktische Vakuumbiopsie in liegender und sitzender Position

Purpose. The purpose of our study was to determine the accuracy of vacuum-assisted biopsy (VB) and to evaluate the side effects of this method depending on the positioning of the patient during the intervention. Methods. Interventions were performed with the 11-G biopsy needle either in prone position (Mammotest S, Fischer Imaging, USA) on a dedicated table for breast intervention (n = 308) or in upright position with a dedicated digital stereotactic mammography system (Mammomat 3000, Optima, Siemens, Germany). VB was indicated because of indeterminate or suspicious microcalcifications (84.1%) or because of dense lesions (15.9%). All benign results found with VB have been followed up after 6 and 12 months by mammography. All malignant or histological findings discordant to imaging features have been verified by open surgery. Results. Histology after VB offered 215 (64.4%) benign lesions. In neither case a carcinoma developed during follow-up. In 90 (27%) cases malignancy was found with VB. After reexcision the diagnosis of VB was confirmed in 85.6%. In 8.9% of the cases in which VB showed DCIS, histology after open surgery revealed also invasive tumor components. Technical problems occurred in 4 cases. Major side effects developed neither in prone position nor in upright, sitting position of the patient. Conclusion. VB is a reliable method with less side effects for the histiological evaluation of breast lesions. The accuracy and complications are not depending on the type of stereotactic device or on the patients position. The accuracy of the histological diagnosis achieved with VB can be compared to that of open surgery. The relative high costs of this method may cause a problem. But compared to the costs resulting by open diagnostic surgery this disadvantage is only a relative one.     

MEBT/MEBO/救治重度与特重度烧伤392例体会

目的：总结重度与特重度烧伤的治疗经验，提高救治水平。方法：以1991年5月至2002年8月间收治的重度与特重度烧伤病人为回顾总结对象，他们均采用规范的(MEBT/MEB0)技术和全身治疗措施，在保障疗效的同时，对不同部位烧伤采用仰、俯、侧卧与自由体位和功能锻炼。结果：392例病人非植皮治愈，所有病例经复查无增生性瘢痕及残疾。结论：规范再生医学治疗措施可提高重度与特重度烧伤病人救治成功率。     

The prone chest film.

Frontal chest radiographs in the prone position enhanced visualization of the posterior lung base in the presence of pleural effusions. Though the lateral decubitus view often displaced fluid adequately, in several cases only the prone film revealed basilar lung pathology; this was due to gravitational shift of the fluid away from this region as well as improved aeration of the lower lobe in the prone position, as shown by horizontal-beam lateral views. The prone chest film is recommended for evaluation of the lung base when obscured by fluid.     

Occult lumbar lateral spinal stenosis in neural foramina subjected to physiologic loading.

PURPOSETo measure the effect of extension, flexion, lateral bending, and axial rotation loads applied to the spine on the anatomic relationship of the spinal nerves in the neural foramen to the ligamentum flavum and the intervertebral disk, anc to determine the effect of disk degeneration on the response to loading.METHODSCadaveric lumbar motion segments were examined with CT and MR imaging, loaded with pure moment forces, frozen in situ, reexamined with CT, and sectioned with a cryomicrotome. The morphology of the intervertebral disks was classified on the basis of the appearance of the cryomicrotome sections. The neural foramina were classified as having no evident stenosis, as being stenotic, as having occult stenosis, or as showing resolved stenosis on the basis of the images and sections before and after loading. The stenotic and nonstenotic foramina were stratified by disk level, intervertebral disk classification, and type of loading applied. The effect of spinal level, disk type, and load type on the prevalence of stenosis was studied.RESULTSOn average, extension, flexion, lateral bending, and axial rotation resulted in the ligamentum flavum or intervertebral disk contacting or compressing the spinal nerve in 18% of the neural foramina. Extension loading produced the most cases of nerve root contact, and lateral bending produced the fewest cases. Each of the loading types resulted also in diminished contact between the spinal nerve and the intervertebral disk or ligamentum flavum in some cases. Disk degeneration significantly increased the prevalence of spinal stenosis. All foramina associated with advanced disk degeneration and half of the foramina associated with disks having radial tears of the annulus fibrosus either developed occult stenosis or were stenotic before loading.CONCLUSIONSThe study supports the concept of dynamic spinal stenosis; that is, intermittent stenosis of the neural foramina. Flexion, extension, lateral bending, and axial rotation significantly changed the anatomic relationships of the ligamentum flavum and intervertebral disk to the spinal nerve roots.