腰椎椎体后缘离断合并椎间盘突出症

目的 分析腰椎椎体后缘离断合并椎间盘突出症的发病机理，探讨手术治疗方法。方法 回顾总结10例腰椎后缘离断合并椎间盘突出症患的临床表现、影像学资料及手术方法选择。结果 10例患中，6例表现为单侧腰腿痛，4例为双侧；4例合并间歇性跛行，其中2例伴有马尾神经受压。CT检查显示全部病例腰椎椎体后缘形成突向椎管内的骨块，其相应的椎体后角骨缺损区为椎间盘髓核组织，其中7例椎间盘突出物超过椎体后缘骨。10例均行手术切除突出的椎间盘组织，其中6例同时行离断骨块切除。全部病例经3～36个月随访取得满意效果。结论 本病发病机理主要还是由于青少年时期椎体后缘环状骨骺变异或损伤逐步引起椎间盘突出的继发改变，最终造成神经根和硬膜囊的压迫。椎体后缘骨块仅部分参与神经根压迫。椎管内神经根及硬膜囊的彻底减压才能达到满意效果。     

腰椎椎体后缘离断症

目的：对9例腰椎椎体后缘离断症进行回顾性分析。方法：所有病例均行X线片、CT扫描检查，其中2例行MRI检查，并对照症状体征进行诊断，手术加以证实。结果：病变主要见于L4、5椎体后上缘或下缘，典型的X线表现为病椎后角有一骨质缺损，其后有一骨块突入椎管；CT扫描均可见椎体后缘类园形或囊状骨质缺损，呈典型的许莫氏结节，椎体后缘突向椎管内的骨块与椎间盘髓核组织一起构成中央管或神经根管的狭窄，压迫马尾或神经根。结论：椎体后缘离断的征象可能是青少年时期椎体后缘环状骨骺陈旧性损伤及其继发改变的结果，X线片、CT、MRI检查具有诊断价值。     

腰椎椎体后缘离断并间盘突出症（附9例报告）

对腰椎椎体后缘离断并间盘突出症的发病机理和临床进行研究。方法：对９例患者的临床表现、影像学、手术所见及治疗方法进行研究。结果：９例患者均有典型的腰腿疼痛或（和）下肢间歇性跛行,共有１０个腰椎椎体后缘离断骨块和椎间盘共同突向椎管,１例患者有Ｌ５下缘和Ｓ１上缘两个骨块,其相对应的椎体后缘骨缺损被髓核组织所充填,７例进行了手术治疗,减压后症状消失。结论：其发病的主要机理是青少年时期椎体后缘的离断以及在此基础上与椎间盘的突出相互作用,离断骨块和椎间盘共同构成了对硬膜囊或（和）神经根的压迫,产生间歇性跛行或（和）下肢疼痛,减压后症状消失。     

腰椎椎体后缘离断症的诊断与治疗8例报告

腰椎椎体后缘离断症的诊断与治疗８例报告毛家明朱维亮胡庆华洪志友赵磊作者单位：２４２３００宁国市人民医院骨科（毛家明，朱维亮，胡庆华）；ＣＴ室（洪志友，赵磊）随着ＣＴ机的普及，另一种引起腰腿痛的疾病一腰椎椎体后缘离断症，已越来越多地被认识，我院自１９９...     

读者来信

《读者来信》一阅读贵刊2012年第7期上刊登的《儿童颈椎椎体后缘离断症1例报道》一文后有若干疑问,与作者讨论。(1)将此病例诊断为"儿童颈椎椎体后缘离断症"是否合理?多数学者认为椎体后缘离断症是Schmorl结节形成并长期挤压使后缘骨片和椎体分离所致,椎体后缘离断症大多发生在腰椎,好发于成年人,影像学上表现为椎体后缘     

青壮年腰椎软骨板破裂症的临床特征与治疗

发生于青壮年的腰椎软骨板破裂症，目前发病机制尚未完全明了。近5年来，国内文献开始陆续出现报道，但命名不一，如：腰椎间盘突出症并椎体后缘离断症、腰椎椎体后缘骨内软骨结节、腰椎椎后缘离断症等等。但其特殊的CT影象学表现及由于突出物压迫硬膜囊和神经根引起椎管狭窄及类似腰椎间盘突出症的临床表现，已逐渐为临床学者所认识。本文总结近5年来经手术治疗的青壮年腰椎软骨板破裂症患者共56例，对其临床表现、影像学特点、治疗方法进行讨论。     

腰椎椎体后缘骨骺离断症合并腰椎椎间盘突出症椎板开窗减压术后致对侧神经根症状1例报告

椎体后缘骨骺离断症（PRAS）合并腰椎椎间盘突出症（LDH）好发于青少年,如伴有神经根、马尾压迫症状,手术治疗是最主要且最有效的手段。针对术中是否需要完全切除离断的椎体后缘骨块,目前尚存争议。本研究通过1例PRAS合并LDH患者的诊疗经过进行文献回顾,探讨该病的诊疗措施,旨在为临床医师提供参考,现报告如下。     

小切口手术治疗腰椎椎体后缘离断症

目的：探讨腰椎椎体后缘离断症的有效手术方法。方法：将腰椎椎体后缘离断症分为侧方型及中央型,采用椎板拉钩法的小切口手术治疗腰椎椎体后缘离断症12例,均为男性;年龄23～40岁,平均30岁;病程17.9个月。侧方型10例,其中离断骨块位于L4椎体后下缘1例,L5椎体后上缘3例,S1椎体后上缘6例,均合并同侧椎间盘突出;中央型2例,离断骨块均位于S1椎体后上缘。侧方型采用单侧椎板间开窗,摘除突出的椎间盘髓核,摘除椎体后缘骨块;中央型采用双侧椎板间开窗,摘除突出的椎间盘髓核,摘除椎体后缘骨块。结果：所有患者获得随访12～36个月,平均22.5个月,按照Macnab术后评定标准：优10例,良2例。结论：小切口手术治疗腰椎椎体后缘离断症具有手术创伤小、操作方便的优点,可完整摘除椎体后缘骨块,是一有效的手术方法。     

腰椎椎体后缘离断症

目的：认识腰椎椎体后缘离断症的临床及影像学诊断依据，提出治疗及手术要点。方法：8例腰椎椎体后缘离断症的患者，术前被冠以腰椎间盘突出症合并软骨结节突出4例，后纵韧带骨化2例，2例临床诊断有腰椎椎体后缘离断症的存在，术中均见大小不等的与突出的椎间盘组织并不相连的浮动骨块。结果：8例病人全部手术治疗，术后疼痛症状消失。随访4～18个月，只有2例患者诉残留阴雨天腰部酸痛症状。结论：腰椎间盘突出症的患者在CT扫描见突出物合并有骨化块时，要仔细分析有无腰椎椎体后缘离断的现象。清晰的腰椎正侧位X线片，病椎间隙CT轴位扫描有助于术前诊断。卧床休息，一般不做牵引及推拿，手术宜采取椎板双侧开窗以求完整切除骨块。     

多排螺旋CT在腰椎椎体后缘离断症诊断中的应用

<正>腰椎椎体后缘离断症,又称为腰椎后缘软骨结节、腰椎软骨板破裂症等[1-4],是指多种原因引起椎体后缘骨突与椎体分离,向椎管内突出,进而造成椎管狭窄、神经根受压等改变[5]。以往对该病的认识不足,相关的研究报道较少。近年来随着多排螺旋CT的飞速发展以及多平面重组等后处理技术的广泛应用,越来越多的学者开始关注本病,对其研究愈发深入[1-2]。本文对我院收治的35例腰椎椎体后缘离断症患者     

Abgeschlossene und derzeit laufende adjuvante Therapieprotokolle bei Patientinnen mit operablem Mammakarzinom (II)

Summary Background: Between 1984 and 1996 4336 patients with operated breast cancer were included in trials of the Austrian breast cancer study group. Methods: Based on prognostic factors patients were randomised with 2 different treatment groups. Results: The largest ever performed oncological trial (study VI) in postmenopausal breast cancer patients is already finished. 5 other trials are open for randomisation. Conclusions: It is the intention of the Austrian breast cancer study group to accrue patients for ongoing trials in whole Austria and to increase the number of randomised patients. K. Abbrederis, Ch. Armbruster, Gabriele Barbieri, Doris Bauer, Th. Bauernhofer, S. Beller, J. Berger, O. B?ckl, A. Brunhofer, F. Burger, Ursula Denison, Elke Derstvenscheg, Ch. Dittrich, Manuela Djavanmard, W. D?ller, Daniela Eckhoff, H. Eidtmann, R. Fegerl, J. Fellinger, F. Friedrich, Sabine Fuchs, Barbara Gebhart, Friederike Gieseking, Ch. Gr?ger, Karin Haider, D. Haidinger, E. Hanzal, E. Hell, C. Hinterbuchinger, W. Horvath, W. Jonat, Daniela Kandioler, Anna-Katrin Kasparek, M. Kern, R. Kocher, Veronika Kohlmayer, R. Kolb, Ch. Kopf, S. Kriwanek, Irene Kührer, Christine Kurz, Iris Kuss, W. Kwasny, Caroline Lackner, M. Lang, O. Langer, J. Lenz, S. Leodolter, A. Lepsinger, P. Lisborg, G. Lokker, H. Ludwig, G. Luschin-Ebengreuth, H. Maass, M. Markovic, P. Mayer, M. Medl, Elisabeth Melbinger, R. Menzel, Brigitte Mlineritsch, Elke Moosbrugger, E. Moritz, Renate Moser, W. Neunteufel, A. Obermair, J. Omann, P. Oppitz, M. Pecherstorfer, A. Pertl, Catharina Pietrzak, F. Ploner, M. Pober, R. P?hnl, R. Punzengruber, Friederike Püribauer, Ch. Rass, J. Ritschl, H. Rosen, Christine Sam, L. Schiller, W. Schippinger, J. Schüller, M. Seifert, M. Smola, P. Speiser, H. Spoula, G. Steger, Birgit Steiner, H. St?ger, G. Tatzer, Susanne Taucher, J. Tschmelitsch, P. Uher, A. Unger, M. Van Trotsenburg, N. Vavra, Sonja Vogl, B. Wenky, V. Wette, A. Wiegele, G. Winter, Monika Wirth, B. Zeh, G. Zimmermann.     

202. Y-Nagelung und Y-Verriegelungsnagelung bei subtrochanteren Frakturen

Zusammenfassung 1881 tierexperimentelle Lungenresektion, Gluck, Berlin. 1882 Lungenresektion, Block, Berlin. Intraoperativer Tod der Patienten. Intrapleuraler Pneumothorax, Forlanini, Milano. 1983 erste erfolgreiche Lungenresektion, Krbnlein, Zürich. 1886 Thoracoplastik, Cerenville, Lausanne. 1887 Pneumotomie, Quincke, Kiel. 1891 geplante und erfolgreiche Lungenspitzenresektion Tuffier, Paris. 1900 Lobektomie, Heidenhain, Berlin. 1902 Intubationsnarkose, Kuhn, Kassel. 1904 Druckdifferenzverfahren, Sauerbruch, Breslau. 1911 Pfeilerthoracoplastik, Wilms, Heidelberg; Thoracoskopie, Jacobaeus, Stockholm. 1912 individuelle Unterbindung der Hilusgefäße, Davies, London. 1929 geschlossene Pleuraraum-Drainage, Brunn, San Francisco. 1931 Pneumonektomie, Nissen, Berlin. 1932 Hilustourniquet, Shenstone, Toronto. 1933 einzeitige Pneumonektomie wegen Ca., Graham, St. Louis. 1939 Segmentresektion, Churchill, Boston. 1947 anatomisch gerechte Segmentresektion, Overholt, Boston.     

BOOK REVIEWS AND BOOKS RECEIVED

Stanley Hoppenfeld MD & Piet De Boer MA, FRCS R. N. Allan , MD, PhD, FRCP, M. R. B. Keighley , MS, FRCS, J. Alexander -Williams , MD, ChM, FRCS, FACS and Clifford Hawkins , MD, FRCP. John L. Cameron . Baltimore Maryland: B. C. Decker/C. V. Mosby William F. Enneking . H. A. F. Dudley , ChM, FRCS (Eng), FRCS (Edin), FRACS, (Associate editor, B. P. Waxman, BMedSc, MB, FRCS, FRACS). John J. Bergan , MD.     

静脉注射不同剂量异丙酚对血流动力学及通气功能的影响

应用阻抗法和分气流监测法观察静脉注射不同剂量异丙酚（Ｐｒｏｐｏｆｏｌ，ＰＲＯ）后患者血流动力学（ＭＡＰ、ＮＲ、ＳＬＣＩ、ＩＦＩ、ＶＥＴ、ＥＶＩ、ＳＶＲＩ、ＩＣ、ＰＦＩ、ＬＳＷＩ）与通气功能（ＶＴ、ＲＲ、ＶＥ、ＦＥＶ１％、ＥＴＣＯ２、ＳＰＯ２、 Ｉ－ＥｔＯ２）的变化。 ４０例（ＡＳＡⅠ～ Ⅱ）随机分成四组，ＰＲＯ剂量分别为 １．０ｍｇ／ｋｇ、１．５ｍｇ／ｋｇ、２．０ｍｇ／ｋｇ、２．５ｍｇ／ｋｇ。结果：（１）１～４组呼吸暂停发生率为０％、２０％、３０％、８０％，苏醒时间分别为３ ０±１．５、７．４±２．３、９．１±３．６、９．６±４．２分钟：（２）静脉注射不同剂量ＰＲＯ启ＳＡＰ、ＤＡＰ、ＭＡＰ、ＳＩ下降，ＨＲ、ＣＩ、ＳＶＲＩ无明显变化，心肌收缩性（ＩＣ、ＰＦＩ、ＥＶＩ）明显减弱，ＳＶＲＩ减少；（３）ＰＲＯ对呼吸有抑制作用，以ＶＴ和ＶＥ影响最大，与剂量呈正相关；对面罩吸氧患者ＳｐＯ２、ＲＲ、ＥＴＣＯ２无明显改变，Ｉ－ＥｔＯ２减少；舌后坠者托起下颌对ＶＴ、ＶＥ的恢复颇为有效。     

切脾对晚期血吸虫病病人的远期影响

目的 观察切脾后对病人的远期影响.方法 239例晚期血吸虫病人抽取周围静脉血检测WBC、RBC、PLT、EOS、ALT、ALP、A、TB、HA、LN、Ⅳ-C、PCⅢ、IGG、IGA、C3、C4、CD3、CD4、CD8、CD19.结果 切脾组WBC、PLT、EOS明显高于巨脾组,接近正常水平;切脾组ALT、ALP高于巨脾组,A、TB低于巨脾组;切脾组CD3、CD4较低,CD19较高;IGG、IGA较高,C3、C4较低;切脾组LN、Ⅳ-C高于巨脾组,HA、PCⅢ无明显差异.结论 切脾后不利于肝功能恢复;细胞免疫受损,体液免疫增强;有加速肝纤维化进程的可能.笔者认为对于晚期血吸虫病人选择切脾时,应更加慎重.     

Axillobifemoral bypass and aortic exclusion for vascular septic lesions: A multicenter retrospective study of 98 cases

Ninety-eight patients with aortic infection or aortoenteric fistula were treated by axillobifemoral bypasses and aortic exclusion by 22 surgical teams. Early mortality was 24%. Primary patency at two and five years was 62% and 55%, respectively. Actuarial primary patency at two and five years was 82% and 65%, respectively. The actuarial rate of limb salvage at two and five years was 90% and 82%, respectively. Eight aortic stumps ruptured in less than eight months, postoperatively. Two of these ruptures were treated with success. Infection of the axillobifemoral bypasses was observed in seven cases, six of which were treated successfully. Eight patients had axillary complications, all treated successfully without upper limb sequelae. In eight cases, the axillobifemoral bypass was replaced by a thoracic aortic bypass. Early mortality was higher after emergency operation (30%) than after elective operation (14%). Mortality after cure of primary infection (7%) was lower than after secondary infection (27%). The rate of infection in polytetrafluoroethylene axillobifemoral bypass (3%) was lower than in Dacron axillobifemoral bypass (13%). The rate of occlusion of polytetrafluoroethylene axillobifemoral bypass and Dacron axillobifemoral bypass was identical. The rate of occlusion in ringed reinforced grafts was lower (9%) than in the nonreinforced grafts (22%). The rate of occlusion was significantly higher after ablation of graft for occlusive lesions (38%) than after graft for aneurysms (7.9%) (p<0.01).the French University Association for Research in Surgery, Paris, France: Bernard Andréassian, MD, François Bacourt, MD, Xavier Barral, MD, A. Barret, MD, Jean-Pierre Becquemin, MD, Alain Branchereau, MD, R. Brenot, MD, Jean-Michel Chevalier, MD, M. David, MD, J.P. Dereume, MD, Jean-Michel Fichelle, MD, G. Fievé, MD, C. Gautier, MD, H. Giudicelli, MD, Bernard Habozit, MD, Edouard Kieffer, MD, P. Lagneau, MD, J.L. Magne, MD, Dominique Maiza, MD, H. Mary, MD, Philippe Piquet, MD, J.P. Ribal, MD, J.M. Serisé, MD, C. Stankowiak, MD, J. Testard, MD, J. Watelet, MD.     

应力性骨折的诊断试验评价

作者以核素骨扫描为金标准，用随机抽样、盲法检测、四格表法评价了Ｘ线摄影、红外线热成像、超声波诱痛试验和临床诊断检出应力性骨折的结果。Ｘ线检查了１３４个应力性骨折部位和１７９个对照部位，红外线热成像分别检查了１４６个和１６１个部位，超声波诱痛试验分别检查了７８个和６９个部位，临床诊断分别检查了２１７个和２４８３个部位。Ｘ线的灵敏度、特异度和符合率分别为１０％、１００％和６１％，红外线热成像分别为５６％、６７％和６２％，超声波诱痛试验分别７３％、４１％和６０％，临床诊断分别为７４％、９８％和９６％。作者认为针对新兵这一特殊的应力性骨折高发人群，临床医生只要对该损伤有足够的重视和认识，熟练掌握临床诊断标准，则可大大地提高对临床型应力性骨折诊断的正确性。所评价的３种非核素骨扫描诊断方法均不能替代核素骨扫描，为了寻找有效且简单易行的替代方法，尚需做进一步的研究。     

BOOK REVIEWS

Book reviewed in this article: By James M. Hunter , MD, Lawrence H. Schneider , MD, and Evelyn J. Mackin K. F. Russell . By Peter Fielding , MB, FRCS, FACS., and John Welch . MD. FACS. Hans Troidl . Walter O., Spitzer , Bucknam Mc Peek , David S. Mulder and Martin F. Mc -Kneally . Edited By James C. Thompson , George H. Greeley Jr , Phillip L. Rayford and Courtney M. Townsend Jr . By Arthur S. M. Lim , MB BS, AM, FRACS, FRACO, FRCS, DO.     

Book Reviews

Book reviewed in this article:
Enke, 1993. 3. bearb. Aufl., VIII, 206 Seiten, 5 Abbildungen, 2 Tabellen, kartoniert DM 68,-. ISBN 3–432–25443–1.
J. Baltzer, H. Mickan: Gynäkologie —ein kurzgefaßtes Lehrbuch. Thieme, 1993. 736 Seiten, 274 Abbildungen, 35 Tabellen, flex. TB DM 54,-. ISBN 3–13–460605–4.
M. Grillo: Experimentelle Untersuchungen zum Einfluß von Escherichia coli und Ureaplasma urealyticum auf die Fertilität. Thieme, 1994. 156 Seiten, 24 Abbildungen, DM 54,-. ISBN 3–13–132901–7
L. S. Neinstein: Issues in Reproductive Management. Thieme, 1994. X, 246 pages, 16 tables, cloth DM 70,-. ISBN 3–13–119001–9.
W. H. Weiske: Infertilität beim Mann. Thieme, 1994. VIII, 74 Seiten, 42 Abbildungen, 13 Tabellen, gebunden, DM 128,-. ISBN 3–13–133 101–1
C. Wernz: Sexualität als Krankheit. Ein medizinischer Diskurs zur Sexualität um 1800 (Beiträge zur Sexualforschung, Bd. 67). Enke, 1993, 328 Seiten, 4 Abbildungen, kartoniert DM 48,-. ISBN 3–432–25421–0.     

A history of hand surgery in New York City

The origins of Hand Surgery in New York City are temporally centered around World War II. Arthur J. Barsky, MD, Condict W. Cutler, Jr, MD and Emanuel B. Kaplan, MD laid the groundwork for our regional specialty prior to the War. J. William Littler, MD, Robert E. Carroll, MD, served in the Armed Forces and were instrumental in the development of the specialty in the second half of the 20th century. Hand services evolved in each of the major academic centers in New York including those led by Lee Ramsey Straub, MD, at the Hospital for Special Surgery, Richard J. Smith, MD at the Hospital for Joint Disease, Robert W. Beasley, MD at New York University and Berish Strauch, MD, and Morton Spinner, MD, at Albert Einstein and Montefiore. Several surgeons who worked with or were trained by these masters formed the nucleus of the next generation of leaders including Richard G. Eaton, MD, Martin A. Posner, MD, Harold M. Dick, MD, and Charles Melone, MD. Their proteges and a relatively small number of surgeons trained elsewhere, like Andrew J. Weiland, MD, and Robert Hotchkiss, MD, make up the current leadership of Hand Surgery in New York City.