尿酸盐结晶在手足部位的沉积规律

目的：了解尿酸盐结晶在人体手足的沉积部位,探索其分布规律。方法：128例痛风患者均在双源CT（DECT）上行手足部位的尿酸盐结晶扫描,利用痛风识别软件处理,记录绿色尿酸盐结晶沉积部位并统计分析。结果：尿酸盐结晶在手足沉积部位依次为跖趾关节、腕骨韧带、跖趾骨肌腱、掌指关节、胫腓骨肌腱、指浅屈肌腱、踝关节、跗关节、腕关节。结论：尿酸盐结晶在痛风患者手足多部位均有沉积,除关节外,周围组织也存在大量尿酸盐结晶沉积现象。     

黄韧带退行性改变的组织学观察及其与腰椎椎管狭窄症的关系

黄韧带的退行性改变是腰椎椎管狭窄症的主要病理改变之一。作者报告了对腰椎椎管狭窄症患者黄韧带的组织学观察结果，发现弹力纤维明显减少和胶原纤维的增生是黄韧带退行性变的主要组织病理学特征。作者认为这一病理变化将使黄韧带的弹性受到破坏，而黄韧带的肥厚又将造成神经根管狭窄，使神经根受到卡压。     

椎管内痛风的研究现状

痛风是指单钠尿酸盐（monosodium urate, MSU）结晶超过了其在血液或者组织液的饱和度，从而沉积在全身关节，能够诱发局部炎症反应和组织结构破坏的代谢性疾病。当MSU沉积在关节突关节、黄韧带、硬膜外间隙等部位时，便可能导致脊柱椎管内痛风的形成。该病可发生于颈椎、胸椎、腰椎各个节段，早期无特异性临床症状，常规的影像学检查手段不易诊断该病，因此容易发生误诊误治。自1950年首次报道该病以来，已经有多篇文献分别从该病的病因、临床表现、诊断和治疗等方面进行了讨论。本文将在此基础上，对上述文献进行综述，以便加深对该病的认识。     

经皮内窥镜技术治疗老年单节段退行性腰椎椎管狭窄症

腰椎椎管狭窄症（LSS）是骨科常见病之一。随着我国老龄化的加速,老年退行性腰椎椎管狭窄症（DLSS）的发生率逐年增加,腰腿痛和间歇性跛行严重影响患者的生活质量^[1]。DLSS往往由椎间盘突出或合并钙化、小关节骨赘增生及黄韧带肥厚等原因引起,部分患者合并发育性椎管狭窄^[2-3]。临床上根据解剖部位将LSS分为中央管狭窄（椎管中央型狭窄）、关节下管狭窄（神经根管的关节下段,包括侧隐窝）和椎间管狭窄（椎弓根及椎间孔段）^[4-5]。老年DLSS患者一般病史较长,影像学资料提示多节段的椎间盘膨出或突出、黄韧带肥厚、小关节增生、侧隐窝狭窄,有时神经根病变的定位诊断也不明确,是否需要将所有狭窄的间隙部位减压,是否需要广泛的融合固定一直是临床争论的问题^[6]。传统腰椎减压融合术治疗DLSS效果明显,但手术创伤较大,术后感染、切口愈合不良、植骨区不融合、内固定松动断裂、邻椎病等手术并发症使得此类技术的应用受到限制^[7]。近年来,经皮内窥镜技术在治疗DLSS方面优势明显,通过术前病史询问、体格检查及相关影像学资料的反复研究,并根据病情需要可结合椎间盘造影,最终精准定位责任椎间隙及椎管狭窄部位行靶向穿刺,达到定点精准减压。2014年5月-2017年8月,本院采用经皮内窥镜下减压术并射频消融术治疗老年单节段DLSS患者40例,现将诊疗过程报告如下。     

腰椎管狭窄症病理形态学基础及椎管造影表现

腰椎管狭窄症是由先天或后天原因造成的中央椎管、神经根管及椎间管容量减少，导致马尾及神经根受压而产生临床症状的一组综合征。椎间盘突出及其它软组织占位性病变通常不视为椎管狭窄症’‘’。近年来，随着研究的不断进展，人们对该症的病理形态学基础及椎管造影表现有了更全面、深入的认识。l黄韧带肥厚黄韧带是中央椎管后外侧壁和神经根管后壁的重要组成部分，主要由弹性纤维构成，连接相邻椎骨的推板和椎间小关节，大致可分为两部分：内侧部位于椎板之间，参与构成中央椎管的后壁和后外侧壁，该处韧带自上一椎骨椎板的前下线连接到下…     

胸椎黄韧带内痛风石致截瘫1例并文献复习

正痛风是一种因体内嘌呤代谢紊乱而导致的疾病,男性患者居多,其病理特点为高尿酸血症和尿酸盐结晶沉积,常发部位以关节为主,尤其是膝、踝、跖趾关节的滑囊、周围肌腱和韧带。临床上以急性痛风性关节炎表现、慢性痛风石形成或肾脏组织受损多见,波及范围广,浅层累及皮下,深层可至肾脏。痛风石脊柱沉积亦有报道~([1]),以腰椎居多,颈椎、胸椎次之,而且位置也多集中在脊柱关节上。痛风石在胸椎黄韧带内沉积较为少见。笔者于2015-07-02诊治1例全身多     

经椎间孔入路经皮内窥镜下减压术治疗单节段腰椎椎管狭窄症的疗效及其影响因素

正腰椎椎管狭窄症发生机制复杂,主要与骨质或纤维组织增生、肥厚导致椎管或神经根管的矢状径缩短,刺激或压迫神经根或马尾神经有关[1]。通过手术对责任节段进行减压是治疗腰椎椎管狭窄症的有效手段,随着脊柱微创技术的进步,经椎间孔入路经皮内窥镜下减压术成为治疗该病的主要微创术式[2]。如何规范手术适应证,保障手术预后是目前临床研究的热点[3]。回顾性分析在本院接受经椎间     

脊柱痛风石压迫脊髓致瘫痪1例报告

<正>痛风是一种嘌呤代谢紊乱所致的疾病,多见于男性及绝经期后女性,临床特点为高尿酸血症和尿酸盐结晶沉积在关节、滑囊、肌腱、韧带、肾脏、皮下和其他组织,所导致的特征性关节炎、痛风石形成、肾脏等组织器官受损[1]。痛风石形成的典型部位位于耳轮,也常见于第一跖趾、指(趾)间、踝、腕、膝、肘关节等处,发生在脊柱部位的痛风石较为罕见。目前原因仍不明确,考虑与负重损伤及温度有关,因腰椎负重大,易损伤,故脊柱痛风多发生于腰椎,颈     

腰椎黄韧带骨化并椎管狭窄

黄韧带骨化可见于脊柱各节段，临床相关报道均集中于颈椎及胸椎，腰椎黄韧带骨化较少提及。与胸椎黄韧带骨化的起因不同，腰椎黄韧带骨化多为腰椎管狭窄症中黄韧带增生、肥厚及钙盐沉着为特征的一种退行性变，严重者易导致不可逆性重度椎管狭窄。自2000年7月至2006年10月共收治该类患者5例，本文就其临床表现、影像学特征、治疗方法等问题进行探讨。     

尿酸盐结晶沉积与手足着力部位的关系

尿酸盐结晶是痛风发作的根本原因,而尿酸盐沉积部位规律目前尚无定论.通过对痛风患者进行手足双源CT扫描尿酸盐结晶沉积分析,结合查阅的国内外相关文献,认为手足部尿酸盐结晶沉积部位与手足部着力有关.     

Segmental spinal instrumentation for neuromuscular spinal deformity

Seventy-six consecutive surgical cases of paralytic neuromuscular spinal deformity were retrospectively analyzed. Posterior arthrodesis with segmental spinal stabilization with Luque L-rods, sometimes preceded by anterior release, was done in all cases. The infection rate of 14.5% was observed to be markedly higher in patients with myelodysplasia. Deep placement of the rods lateral to the spine and well beneath full-thickness skin is recommended to reduce the incidence of this complication.     

Intra-operative spinal sonography in spinal intramedullary tumor

Recently, operative results of intramedullary spinal cord tumors have been greatly improved since the introduction of microsurgery. It is very important to know the precise size and location of the tumor prior to the operation so that we can approach the tumor with a minimum of damage to the spinal cord. However, it is not always possible to demonstrate the precise localization of the tumor preoperatively. In this report, we emphasize that intraoperative spinal sonography is very useful in determining the extent of the tumor and differentiating solid component from cystic component of the tumor. Methods and Materials We performed intraoperative spinal sonography on ten patients with intramedullary spinal cord tumor. This series included three cases of hemangioblastoma, three cases of astrocytoma, two cases of ependymoma, one case of subependymoma, and one case of mixed glioma. Eight out of ten cases were associated with cysts. The intraoperative spinal sonographic examinations were performed after laminectomy. The linear scanning probe of 5 or 7.5 MHz transducer was used. Results 1) Solid components The acoustic pattern of the solid tumor was either hyperechoic or iso-echoic. Six cases (three hemangioblastomas, two ependymomas, and one astrocytoma) were hyperechoic. Other four cases (two astrocytomas, one subependymoma, and one mixed glioma) were iso-echoic. 2) Cystic components The cysts associated with the tumor were anechoic in six out of eight cases, which were confirmed at surgery, and multiple cysts were identified.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rationale for spinal fusion in lumbar spinal stenosis

In order to define the indications for spinal fusion in patients undergoing decompression for lumbar spinal stenosis, 114 patients surgically treated were reviewed. Follow-up was 24 to 108 months. Patients were grouped into four categories: 15 with lateral recess stenosis, 45 with central-mixed stenosis, 43 with stenosis following prior lumbar surgery(s), and 11 with scoliosis and spinal stenosis. Only two patients with lateral recess stenosis underwent fusion with fair results. Approximately one-third of those with central-mixed stenosis required a fusion. Results were good in 70%. In those with stenosis following prior lumbar surgeries, although not statistically significant, those who had concomitant decompression and arthrodesis had a better outcome than those in whom decompression only was done. Patients with scoliosis and stenosis had decompression for significant motor and reflex deficits and fusion over the length of their major curves. Patients having decompression for lumbar stenosis with degenerative spondylolisthesis, isolated disc resorption with degenerative facet joints, intervertebral disc disease with instability, and those with scoliosis with multidirectional instabilities benefit from concomitant spinal fusion.