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1.
目的:了解脊髓型颈椎病的发病规律,评价自然史在早期诊断和治疗中的意义。方法:综合分析1263例脊髓型颈椎病(CSM)患者的自然史,将其演变方式归纳为5型,I—IV型为起病轻者,其中Ⅱ—Ⅳ型无论是否经过稳定期,最后均出现恶化,I型长期保持稳定,随访期内无恶化倾向或结果,V型为突然严重起病,无法缓解者。结果:I型137例(10.88%),Ⅱ型534例(42.31%),Ⅲ型96例(7.57%),IV型407例(32.24%),V型89例(7.05%)。结论:脊髓型颈椎病仅少数长期处于良性稳定状态,该病多数呈相对恶性的发展趋势,其发展结果将造成更加严重的脊髓损害。下胶麻木、行走缓慢、步态异常、手臂麻木、精细动作障碍等可作为早期诊断的参考要点。  相似文献   

2.
脊髓型颈椎病自然史及其早期诊断研究   总被引:35,自引:2,他引:33  
目的:了解脊髓型颈椎病的发病规律,评价自然史在早期诊断中的意义。方法:综合分析188例脊髓型颈椎病(CSM)患者的自然史,根据其起病状态、患者自我感受和临床的特征性表现,将其演变方式归纳为5种。第1~4种为起病轻者,其中第2~4种无论是否经过稳定期,最后均出现恶化,第1种长期保持稳定,随访期内无恶化倾向的结果,第5种为突然严重起病,无法缓解者。结果:第1种演变方式20例(10.64%),第2种演变方式80例(42.55%),第3种演变方式15例(7.98%),第4种演变方式60例(31.96%),第5种演变方式13例(6.91%)。起病状态表现为下肢麻木者107例次,手麻、精细动作障碍者112例次,双下肢轻度乏力,行走时常感觉发软无力者136例次,步态不自然者126例次,颈肩部酸痛不适者54例次。结论:脊髓型颈椎病仅少数长期处于良性稳定状态,该病多数呈相对恶性的发展趋势,其发展结果将造成更加严重的脊髓损害。下肢麻木、行走缓慢、步态异常、手臂麻木、精细动作障碍等可作为早期诊断的参考要点  相似文献   

3.
目的:建立腰椎间盘突出症的评分分型方法并将其应用于临床.方法:1993年1月~2003年1月,10年间共收治腰间盘突出症1 127例,从疼痛、直腿抬高试验、CT表现、MRI表现、椎管造影5个方面进行总结,对这5个项目进行评分,根据严重程度每项评为1~3分,诊断时只需将得分最高的一项临床分和一项影像分相加,根据所得分(2~6分)将腰椎间盘突出症分为Ⅰ~Ⅴ型;此方法简称为“6分Ⅴ型法“.2004年1月~3月在门诊应用该分型对159例门诊病人进行分型,并跟踪随访.结果:对159例病人进行分型,其中Ⅰ型15例(9%),Ⅱ型36例(23%),Ⅲ型54例(34%),Ⅳ型33例(21%),Ⅴ型21例(13%).结论:腰椎间盘突出症的评分分型方法(简称为“6分Ⅴ型法“)将病人的症状体征和影像表现相结合进行了分型,综合反映病人病情的严重程度,具有简单实用且便于患者理解的特点.根据作者的初步应用经验,Ⅰ型、Ⅱ型病人采取保守治疗;Ⅳ型、Ⅴ型需手术治疗;Ⅲ型先行保守治疗,无效转手术治疗.  相似文献   

4.
脊髓型颈椎病是颈椎病中最严重的一型,常见于40岁以上的中年人,轻则手足麻木,影响劳动,重者四肢瘫痪。我院骨科1983.5~1989.6.对21例脊髓型颈椎病行前路减压植骨融合术,经长期随访疗效满意,现报导如下:  相似文献   

5.
目的:探讨骨质疏松性椎体骨折影像类型与椎体成形术疗效的关系.方法:采用椎体成形术治疗骨质疏松性胸腰椎骨折348例.术前全部进行伤椎影像学检查(包括X光片、MRI及CT),按椎体骨折影像学形态改变将骨折病例分为5种类型(Ⅰ型:无变形型32例;Ⅱ型:单纯压缩型75例;Ⅲ型:伴非后缘崩裂型139例;Ⅳ型:伴后缘崩裂形65例;Ⅴ型 伴椎管轻度占位型37例).将五种型椎体骨折病例椎体成形术疗效进行比较分析.结果 随访6个月~12个月,5种类型中术后疗效以Ⅰ型疗效最佳,完全缓解(CR)率100%.Ⅱ型CR率94.67%,Ⅲ型CR率88.49%,Ⅳ型CR率86.15%,Ⅴ型CR率86.49%.疗效对比结果:除Ⅱ型与Ⅰ型之间对比结果差异无显著性外,其他类型与Ⅰ型对比结果差异均有显著性.骨水泥椎体外渗漏病例数除Ⅱ型与Ⅰ型之间对比结果差异无显著性外,其他类型与Ⅰ型对比结果差异均有显著性.结论:胸腰椎骨折影像诊断类型与椎体成形术疗效、风险直接相关,有重要临床意义.  相似文献   

6.
脊髓型颈椎病的早期诊断和手术时机   总被引:47,自引:0,他引:47  
Jia L  Yuan W  Ni B  Zhu H  Chen X  Shi Z 《中华外科杂志》1998,36(4):224-226
目的探讨脊髓型颈椎病早期诊断和外科手术时机。方法报告并讨论74例脊髓型颈椎病患者早期诊断,并经颈前路减压、自体髂骨融合术的临床表现、治疗方法及结果等。结果脊髓型颈椎病早期起病隐匿,颈部痛觉轻微,以肢体运动和感觉异常及手臂症状最为常见,检查时可发现神经功能的改变;影像学检查的特征性变化有助于本病的早期诊断。本组74例患者中,68例获随访,平均随访时间16个月,按我国40分评定法,30分以上者58例(85.3%)。结论脊髓型颈椎病早期诊断,早期施行手术治疗是提高脊髓型颈椎病疗效的重要因素。  相似文献   

7.
脊髓型颈椎病的自然史和外科治疗   总被引:2,自引:0,他引:2  
脊髓型颈椎病在各类型颈椎病中危害最为严重,脊髓型颈椎病的自然史总体呈相对恶性的发展趋势。本文主要论述了脊髓型颈椎病的自然史、自然史与脊髓影象学变化的相互联系、外科手术时机及手术入路的选择问题。  相似文献   

8.
肾病综合征表现的儿童IgA肾病临床和病理分析   总被引:2,自引:1,他引:1  
目的:分析儿童IgA肾病(IgA nephropathy,IgAN)中表现为肾病综合征的患儿临床和病理的特点.方法:总结1995年12月~2004年6月我科98例肾活检病理诊断为原发IgAN中,表现为肾病综合征(NS)的临床、组织病理特点.结果:98例中表现为肾病综合征22例,占IgAN的(22.4%).按1982年WHO病理组织分类,肾小球病理改变为Ⅰ级2例(9.1%),1例单纯性肾病,1例肾炎性肾病;Ⅱ级5例(22.7%),1例单纯性肾病,4例肾炎性肾病;Ⅲ级9例(40.9%),Ⅳ级6例(27.3%),均有肾炎性肾病.免疫荧光分型:IgA型5例(22.7%),IgA IgG型4例(18.2%),IgA IgM型9例(40.9%),IgA IgG IgM型4例(18.2%),以IgA IgM型多见.小管间质损害(TIL)分型:Ⅰ级11例(50.0%),Ⅱ级7例(31.8%),Ⅲ级4例(18.2%),Ⅳ级未见.结论:IgA肾病表现为肾病综合征者临床及病理改变均较重,肾小球变化以Ⅲ~Ⅳ级改变为主,免疫荧光中以IgA IgM型多见,小管间质损害以Ⅰ级和Ⅱ级多见.  相似文献   

9.
脊髓型颈椎病是一种常见病 ,且症状较严重 ,一旦延误诊治 ,常发展成不可逆性损害。因此早期诊断意义重大 ,现将各种诊断方法综述如下。1 临床症状体征脊髓型颈椎病的发病年龄平均为 48~ 61岁 ,男多于女 ,以颈脊髓损害为主。其临床症状多种多样 ,一般起病缓慢 ,2 0 %可有外伤史 ,创伤可引起急剧发病 ,常见的临床症状和体征如下 :1 1 感觉障碍 早期多有手足麻木 ,由于病变的椎间盘突出物由髓外压迫脊髓 ,首先损害传递肢体远端感觉的脊髓丘脑束的外侧神经纤维 ,故感觉障碍先出现于肢体远端。随着病变发展 ,脊丘束由外向内受损 ,感觉障碍逐…  相似文献   

10.
前后路Ⅰ期减压术治疗脊髓型颈椎病   总被引:7,自引:0,他引:7       下载免费PDF全文
目的:探讨脊髓前后受压所导致脊髓型颈椎病的手术治疗方法.方法:采用前路减压植骨自 锁钢板内固定和后路单开门椎管扩大成形术一次性完成的手术方法对26例脊髓型颈椎病(为脊髓前后均受压的脊髓型颈椎病患者)进行治疗观察,其中男9例,女17例;年龄63~81岁,平均69岁.并对其治疗结果进行分析总结.结果:26例获得1.5~6年的随访,22例症状完全消失,4例尚留有轻度手臂麻木.按JOA评分标准:优16例,良6例,可4例,差0例.结论:采用前后路Ⅰ期手术治疗脊髓前后同时受压的脊髓型颈椎病减压彻底、固定可靠、疗效满意,不但使治疗周期大大缩短、复发率明显减少,而且可使脊髓和神经根受压症状得到彻底缓解.  相似文献   

11.
手术治疗脊髓型颈椎病的长期疗效评价   总被引:49,自引:3,他引:46  
目的:研究脊髓型颈椎病经手术治疗远期疗效及影响疗效因素。材料与方法:报告115例脊髓型颈椎病,对发病因素、病程及影像学表现特征作了分析。全部实施颈前路减压及自体髂骨移植融合,其中16例于术后6个月-2年再次手术。术后随访8年6个月-18年,平均10年4个月。结果:功能评价:优47例(40.87%),良33例(28.69%),可12例(10.43%)及差23例(20%)。根据40分评分法,平均提高7.5分,其中36-40分41例,31-36分37例。病程在6个月内,优于1年以上(P<0.01)。结论:脊髓型颈椎病手术治疗远期效果是肯定的;手术减压时机、病理变化程度及手术技术等对治疗效果有明显影响。  相似文献   

12.
颈椎病外科治疗选择及远期疗效评价   总被引:31,自引:6,他引:25  
目的研究脊髓型颈椎病经手术治疗的远期疗效及影响疗效的因素.方法报告4 585例脊髓型颈椎病,对发病因素、病程及影像学表现进行分析.全部实施颈前路减压及自体髂骨移植融合术,其中335例于术后6个月~2年再次手术.术后985例随访5年7个月~17年,平均7年7个月.结果功能评价,优476例(48.32%)、良335例(34.01%)、可94例(9.54%)及差80例(8.13%).手术疗效与病变严重程度、病程长短、减压程度和颈椎稳定性相关,病程在6个月内的患者疗效优于1年以上者(P<0.01).结论脊髓型颈椎病前路手术减压远期效果是肯定的;手术时机、病理变化程度及手术技术等对治疗效果有明显影响.  相似文献   

13.
Natural history of petroclival meningiomas   总被引:5,自引:0,他引:5  
Van Havenbergh T  Carvalho G  Tatagiba M  Plets C  Samii M 《Neurosurgery》2003,52(1):55-62; discussion 62-4
OBJECTIVE: For evaluation of the natural history of petroclival meningiomas, a cooperative retrospective study of 21 conservatively treated patients is reported. METHODS: All patients had petroclival meningiomas that were observed for at least 4 years, with regular clinical and radiological control examinations. The follow-up periods ranged from 48 to 120 months (mean, 82 mo; median, 85 mo). Functional evaluations were performed by using the Karnofsky index. Individual growth curves and rates were defined. RESULTS: Age and sex distributions and presenting symptoms were comparable to those of other studies. During follow-up monitoring, radiological tumor growth was observed in 76% of the cases. With 63% of the growing tumors, there was functional deterioration. We performed statistical analyses of demographic features, radiological findings, and functional deterioration. Severe functional deterioration was observed to be statistically significantly associated with infratentorial growth and increased growth rates. A change in the growth pattern often preceded functional deterioration. CONCLUSION: This study provides a better understanding of the natural course of petroclival meningiomas. The growth patterns of these tumors are unpredictable and variable. The exact factors influencing growth remain unclear. This study can contribute to the optimization of individual management of these tumors.  相似文献   

14.
脊髓型颈椎病手术治疗的远期疗效   总被引:68,自引:0,他引:68  
目的 研究脊髓型颈椎病经手术治疗的远期疗效及影响疗效的因素。方法 报告185例脊髓型颈椎病,对发病因素,病程及影像学表现特征进行分析,全部实施颈前路减压及自体髂骨移植融合术,其中25例于术后6个月-2年再次手术,术后随访5年6个月-15年,平均6年7个月,结果功能评价,优89例(48.1%),良57例(30.8%),可28例(15.1%)及差11例(6.0%),根据40分评分法,平均提高8.5分,  相似文献   

15.
Summary A retrospective study of operative results after a minimum follow-up period of five years was carried out in a series of 34 patients operated upon for cervical spondylotic myelopathy (CSM).In all the cases, myelography showed involvement of two or more intervertebral spaces. Constitutional spinal canal narrowing was not present, and only one operation was performed in each patient. Of the 34 patients, 16 also had symptoms of cervical spondylotic radiculopathy (CSR).Seventy-four percent of the patients thought that operation resulted in overall improvement of the preoperative clinical picture. This subjective improvement was similar whether the operative procedure consisted of anterior intersomatic fusion or of laminectomy.Amelioration of CSM symptoms occurred in only 8 of the 20 patients subjected to anterior fusion (40%), in contrast to 10 of the 14 patients subjected to laminectomy (71%). In the 16 patients with CSR symptoms associated with CSM, amelioration of CSR symptoms occurred in 6 of the 11 patients subjected to anterior fusion (55%), and in 4 of the 5 patients subjected to laminectomy (80%).It is suggested that laminectomy offers the best results for CSM, associated or not with CSR, when two or more intervertebral spaces are affected.  相似文献   

16.
Summary The results of surgery for treatment of cervical spondylotic myelopathy (CSM) were assessed 3 months (early results) and 2–8 years (late results) postoperatively in 99 patients.Extensive laminectomy as well as anterior decompression and fusion, or the two procedures at staged intervals, were used.Immediate postoperative deterioration was never seen after laminectomy performed under local anaesthesis (84 patients), while transient deterioration occurred after anterior surgery in 2 of 28 patients.Cervical spondylotic radiculopathy (CSR) was found in 73% of the patients. Operative treatment for CSM also improved root symptoms, anterior surgery to a larger extent than posterior decompression. Only 10% of the patients treated with extensive laminectomy needed a second anterior operation for radiculopathy.The progression of myelopathy was arrested in 95% of the patients after surgery. Improvement was obtained in 80% both in the early and late follow-up review when compared to the preoperative functional status. The evaluation disclosed a tendency of rapid improvement during the first 3 months, subsequently followed by slow improvement in 50% and slight deterioration in 15% of the patients.The degree of improvement was in many patients not sufficient to raise the functional capability to a higher level in the employed grading system. In our opinion it is therefore important to operate patients with CSM as early as possible before neurological deficits are too pronounced.  相似文献   

17.
Surgical outcomes of elderly patients with cervical spondylotic myelopathy.   总被引:1,自引:0,他引:1  
BACKGROUND: Cervical spondylotic myelopathy is a potentially serious neurologic disorder that commonly presents with gait difficulty and hand dysfunction. Because the development of CSM is in large part related to advanced spondylosis and degenerative disk disease, elderly patients appear to be at an increased risk to develop this condition. The surgical outcomes of this patient population have been understudied; the authors seek to report their clinical results in a series of patients with CSM older than 75 years who underwent surgical treatment. METHODS: This report is composed of a cohort of 36 elderly patients (older than 75 years) and 34 younger patients (younger than 65 years) who underwent decompressive surgery for CSM at one institution between 2001 and 2005. The patients' functional status was evaluated preoperatively and postoperatively using the mJOA disability scale. RESULTS: The mean follow-up time in the elderly group was 24 months, with a range from 12 to 48 months. There was a statistically significant improvement between mean preoperative (11.3) and postoperative (14.4) mJOA scores (P< .0001). The younger group had a higher neurologic recovery rate (71%) than the elderly group (59%); however, this was not statistically significant (P= .29). The postoperative complication rate in the elderly population (38%) was higher than in the younger group (6%; P= .002). CONCLUSION: Elderly patients with CSM are likely to obtain neurologic improvement after decompressive surgery. Their postoperative complication rate is higher than that of younger patients, yet most complications appear to be self limiting and do not adversely affect neurologic outcome.  相似文献   

18.
BACKGROUND: Postoperative peritonitis is a pathologic condition with a sometime nuclear clinical occurrence and therefore with an uncertain timing for reoperation. Aim of this paper is to identify the type and frequency of the digestive and systemic symptoms in relation to the anatomo-pathologic peroperative picture. METHODS: Between 1980 and 1996, 119 patients were reoperated for a postoperative peritonitis (PPO) in the Surgical Department of Modena University. PPO was due to a lesion situated above the mesocolon in 33 patients, from the small bowel in 18, postappendicectomy in 25 and from the colon in 40. The first operation (for benign disease in 66.4%, for malignancy in 33.6%) was performed in emergency in 47 cases (39.5%) and as elective surgery in 72 (60.5%). RESULTS: The global mortality was of 33.6% (40 patients). An attempt is made to identify, the earlier and the most important bioclinical parameters for a correct indication to surgery. Twenty symptoms have been identified that, with different frequency, are strictly related with the onset of a PPO (in average 5 symptoms were positive). A research of these parameters, each 4-6 hours, allow to identify a subclinical PPO. CONCLUSIONS: During the decisional timing, it is important to check these general and digestive symptoms, apparently not serious, in order to avoid the onset appearance of an abdominal tenderness or a multiorgan failure that make the prognosis more severe.  相似文献   

19.
脊髓型颈椎病前路减压内固定价值   总被引:29,自引:2,他引:27  
目的:评价脊髓型颈椎病前路减压后应用内固定的价值。方法:对112例脊髓型颈椎病患者采用经前路减压、自体髂骨或钛质网笼植骨及AO颈椎带锁钢板内固定,获得随访104例,平均随访时间30个月,观察植骨融合率、融合节段间高度和颈椎生理曲度维持情况以及内植物并发症,并对神经功能恢复进行评价。 结果:94例单节段和两节段病变者术后3个月内获得牢固骨性融合,融合率为100%,10例三节段手术者融合率为80%,内植物并发症为2.9%(3/104)。全部病例术后椎间高度和生理曲度维持满意,JOA评分由术前平均10.3分提高到术后平均14.8分,平均改善率为67.2%。结论:脊髓型颈椎病前路手术后采用内固定可显著提高植骨融合率,并有效地维持椎间高度和颈椎生理曲度,有广泛的应用价值。  相似文献   

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