胸椎黄韧带骨化症的影像诊断

目的:探讨胸椎黄韧带骨化症的诊断及影像学特点。方法:分析90例胸椎黄韧带骨化症患者的CT和/或MRI资料,并根据影像学特征进行分类。按照MRIT2WI轴位脊髓及硬膜囊的受压迫程度分为轻度、中度、重度。9例获CT或/和MRI检查2年以上随访的患者,选择扫描条件、部位一致的骨化节段对比研究其变化情况。结果:MRI扫描的73例患者共发现黄韧带骨化节段421个。骨化节段呈跳跃性分布35例(46.58%)。多节段发生68例(93.15%)。T2WI轴位扫描的365个节段呈现有压迫:轻度193个节段,中度80个节段,重度92个节段。9例2年以上影像随访患者,随访前CT示均匀性骨化的9个节段,随访时骨化块大小密度无变化;随访前不均匀性骨化6个节段,随访时骨化块增大、密度改变。随访前MRI示骨化为无信号9个节段,随访时骨化块的形态、内部信号、对脊髓的压迫程度均无改变;随访前低信号18个节段,随访时15个节段有不同程度的生长,即对脊髓和硬膜囊的压迫程度加重,骨化块形态改变,3个节段只有骨化块信号的改变,脊髓的受压程度无明显变化。结论:胸椎黄韧带骨化多数病例为多节段,分布无明显规律性。骨化程度与对脊髓的压迫程度并不一致。CT和MRI检查可以作为判断胸椎黄韧带骨化是否成熟的手段。     

骨化的胸椎黄韧带中骨形态发生蛋白的表达、CT值测定与骨化成熟度的研究

目的研究胸椎骨化黄韧带的组织病理学、骨形态发生蛋白(BMP)的表达与 CT 值及其对应关系,为临床间接通过 CT 值确定黄韧带骨化的病理类型、制订治疗方案提供参考依据。方法病例组23例均为胸椎黄韧带骨化患者(排除由 DISH 病、强直性脊柱炎、氟骨症等继发的胸椎黄韧带骨化),并按黄韧带骨化病理分型分为成熟型和非成熟型,平均年龄51岁,病程2个月～9年。对照组5例均无黄韧带骨化,为胸椎外伤行手术治疗的青年患者,平均27岁。采用 CT 测定黄韧带各个部位;SP 免疫组化法测定 BMP。结果根据病理分型,病例组有49节非成熟型和21节成熟型黄韧带骨化。病例组 CT 值(547.2±131.4)显著高于对照组(137.7±10.6)(t=6.922,P=0.000),而且成熟型骨化(702.9±17.7)显著高于非成熟型骨化(480.5±180.2)(t=5.623,P=0.000)。对照组和成熟型骨化中 BMP 均呈阴性表达,而在非成熟骨化中呈现高表达,成熟型骨化与非成熟型骨化表达有显著差异(x~2=70.000,P=0.000)。结论 CT 值与病理结果及 BMP 评价黄韧带骨化成熟度基本一致,可通过 CT 值术前评估胸椎黄韧带骨化的成熟度,从而为制订治疗方案提供理论依据。     

全椎板截骨再植椎管扩大成形术治疗胸椎黄韧带骨化症

目的总结胸椎黄韧带骨化症导致胸椎椎管狭窄的影像学特点，探讨改良椎管减压术的临床疗效。方法胸椎黄韧带骨化症31例，男18例，女13例；年龄26—73岁，平均45．7岁。术前均行MR、CT检查以明确诊断。合并颈椎管狭窄3例、腰椎管狭窄5例，颈胸腰椎管狭窄同时存在者2例；合并胸椎后纵韧带骨化和椎间盘突出症9例。单节段3例，双节段12例，三节段11例，四节段以上5例。局限型6例，连续型17例，跳跃型8例。共94个病变节段，其中上胸段(T1～T4)23个节段、中胸段(T5～T8)19个节段、下胸段(T9-T12)52个节段。手术采用全椎板截骨原位再植椎管扩大成形术。对9例合并胸椎后纵韧带骨化和椎间盘突出者，在后方减压的同时，行切除椎管前方突出椎间盘的环脊髓减压及后路钉棒系统内固定。术后疗效评价参照Epstein标准。结果24例患者随访6—63个月，平均15个月。术后疗效优14例、良7例、可3例，优良率87．5％。1例因术后停用脱水药物过早引起下肢瘫痪症状加重；2例出现下肢静脉血栓；2例硬脊膜撕裂。结论MR结合CT检查是诊断胸椎黄韧带骨化症最有效的手段，全椎板截骨再植椎管扩大成形术安全可靠，疗效满意。     

胸椎黄韧带骨化症的手术治疗

目的探讨胸椎黄韧带骨化症的手术治疗效果。方法MRI及CT检查确定病变范围后,手术治疗黄韧带骨化所致胸椎管狭窄症患者12例38个节段（下胸段22个,中胸段6个,上胸段10个）,均采用磨钻加＂揭盖法＂切除椎管后壁减压。结果12例均获随访,时间6～41个月。参照Epstein et al标准评分：优6例,良4例,可2例。结论临床表现结合MRI及CT检查是诊断胸椎黄韧带骨化症的有效手段;用磨钻加＂揭盖法＂切除椎管后壁减压是安全、有效的方法。     

胸椎黄韧带骨化症的诊断及外科治疗

目的探讨胸椎黄韧带骨化症的诊断特点及改良手术方法的疗效。方法14例胸椎黄韧带骨化症患者,临床主要表现为肢体麻木、感觉异常(13例),下肢无力、行走困难(11例),锥体束征阳性(12例),括约肌功能障碍(10例)。经X线初步筛查,MRI联合CT或CTM证实手术切除黄韧带骨化灶41个节段。该病常见于中下胸椎,其中T894个节段,T91010个节段,T101111个节段,T11125个节段。经后路骨化灶头尾侧“开窗”,两侧“截桥”的整体“漂浮”技术,去除骨化的黄韧带。按JOA评分及Hirabayashi恢复率评价手术效果,术前JOA评分1～8分,平均4.1分。结果14例随访6～57个月,平均23个月。术后JOA评分5～11分,平均9.4分,恢复率为76.8%优良率85.6%。手术中平均失血370ml,手术时间175min,所有病例均恢复自主活动。结论临床表现结合MRI和CT或CTM检查,是诊断黄韧带骨化症的重要手段,改良外科手术技术较为安全可靠,术后疗效满意。     

胸椎黄韧带骨化症骨桥形成的特点及其意义

目的　探讨胸椎黄韧带骨化症患者椎体骨桥形成的特点及其意义。方法　分析手术治疗的 5 0例胸椎黄韧带骨化症中骨桥形成 2 8例 (占 5 4 % )的临床表现及影像学资料。结果　①骨桥与黄韧带骨化位置的关系 :骨桥与骨化黄韧带紧邻者 15例 ;其中 ,4例在某些节段可见黄韧带骨化与骨桥发生于同一间隙 ,间隔一个椎间隙的 10例、间隔 2个椎间隙的 1例、间隔 3个椎间隙的 2例。②骨桥形成的节段 :形成于一个椎间隙的 14例、2个椎间隙的 7例、3个椎间隙的 5例、5个和 7个椎间隙的各 1例。③骨桥形成的特点是在椎间形成高密度的连续骨化影。这种表现主要发生在与黄韧带骨化节段相邻的部位。结论　骨桥形成在胸椎黄韧带骨化症中出现是退变的一种表现形式 ;进一步说明胸椎黄韧带骨化是脊柱退变的一部分     

胸椎黄韧带骨化症合并脊髓型颈椎病的临床诊断要点

目的总结胸椎黄韧带骨化症合并脊髓型颈椎病的临床特点,探讨避免漏诊胸椎黄韧带骨化症的方法。方法对比分析胸椎黄韧带骨化症合并脊髓型颈椎病和单纯脊髓型颈椎病的临床表现、影像学表现、JOA评分的异同。结果共收集35例胸椎黄韧带骨化症合并脊髓型颈椎病病例,其中20例合并连续型颈椎后纵韧带骨化和/或弥漫性特发性骨肥厚症,14例是因颈椎MRI发现上胸椎黄韧带骨化后进一步行全胸椎MRI检查后确诊;胸椎黄韧带骨化症合并脊髓型颈椎病者的上肢功能评分构成比较单纯脊髓型颈椎病者为高(p<0.05)。结论胸椎黄韧带骨化症合并脊髓型颈椎病的诊断须综合分析病史、体征和影像学表现;JOA脊髓功能评分可以为其确诊提供帮助。     

颈椎黄韧带的骨化与钙化

与胸或腰椎节段相比，发生于颈椎的黄韧带骨化与钙化相对较少。本文报告１９例国人颈椎黄韧带骨化与钙化（６例经病理检查，１３例根据手术及影像学所见）。分析结果表明，颈椎黄韧带骨化或钙化多与后纵韧带骨化或发育性颈椎管狭窄等因素合并造成颈脊髓损害，这一特点与胸椎黄韧带骨化有所不同。文中就颈椎黄韧带骨化与钙化之诊疗特点进行了讨论，并重点对其发病机制及临床意义作了探讨     

胸椎黄韧带骨化症的手术治疗

目的：对胸椎黄韧带骨化症诊断及手术治疗方法的探讨。方法：9例胸椎黄韧带骨化症患，均进行手术切除，其中累及T3、4 4个节段，T10、11 6个节段，T11、12 8个节段，主要表现为下肢麻木无力，感觉异常，胸腹部束带感。经后路切除椎板及骨化灶。结果：9例随访1～49个月，平均19个月，术后优良率66．6％，1例无改善，2例加重。结论：手术是胸椎黄韧带骨化症治疗的重要手段。     

胸椎黄韧带骨化椎管侵占与神经损害的关系

目的探讨胸椎黄韧带骨化椎管侵占引发脊髓损害的临界值,建立脊柱多节段病变中确定责任节段的影像学诊断标准。方法采用病例对照研究,病例组取2002年1月至2007年4月因胸椎黄韧带骨化症行手术治疗者43例;对照组取2006年6月至2007年4月CT检查发现胸椎黄韧带骨化,而就诊前无明确神经损害者22例。在CT片上测量椎管矢状径、椎管发育性矢状径、椎管面积、椎管发育性面积,计算椎管矢状径残余率、椎管面积残余率。病例组患者的神经损害程度用JOA评分确定。结果影像学上椎管面积残余率与JOA评分相关性最大（r=0.449,P=0.003）。椎管面积残余率临界值取80%时诊断总符合率最高,其诊断灵敏度为93.0%,特异度为95.5%。结论（1）胸椎黄韧带骨化椎管侵占程度与神经损害程度相关,椎管面积残余率可以反映神经损害程度。（2）CT椎管面积残余率小于80%可作为胸椎黄韧带骨化引发脊髓损害的影像学标准。     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。