寰枢椎后路椎板钉内固定术1例手术配合

寰枢椎部位深在,周围有诸多重要神经和血管,解剖结构及毗邻关系复杂。这一区域的手术难度高、风险大。椎动脉损伤是最严重的并发症,处理无效可致死。关于寰枢椎椎板钉治疗寰枢椎不稳定的临床报道还不多,Wright首先报道了枢椎椎板置钉以完成寰枢关节固定的临床病例。在国内也只有北京大学第三医院骨科的王超主任的文献报道。现将1例寰枢椎后路椎板钉内固定术治疗寰枢椎不稳定的手术配合及护理体会报告如下。     

创伤性寰枢椎不稳的影像学诊断及Apofix手术治疗

目的：探讨创伤性寰枢椎不稳的影像学诊断特点，并评价APOFIX椎板钩内崮定手术治疗的效果。方法：对三例创伤性寰枢椎不稳进行X线、螺旋CT、MRI等影像学检查，并对其中两例实施寰枢椎后路融合、植骨、APOFIX椎板钩内固定手术。结果：X线、螺旋CT、MRI显示两例齿状突骨折伴寰枢椎不稳，另一例显示寰椎爆裂骨折。术后随访3—6个月，X线复查示均获骨性愈合。结论：X线、螺旋CT、MRI均是检查创伤性寰枢椎不稳的重要方法，需结合使用；寰枢椎后路融合、植骨、APOFIX椎板钩内固定手术是治疗枢椎齿状突骨折伴寰枢椎不稳的简单、安全、有效的方法。     

寰枢椎肿瘤的根治性切除

目的:探讨寰枢椎肿瘤手术显露与根治性切除的可能性和方法, 以及枕颈内固定技术.方法:对19例经手术治疗的寰枢椎肿瘤病例进行回顾性分析.结果:19例中16例获平均32个月完整随访,其中12例未见肿瘤复发,1例术后死于呼吸道痰液梗阻,1例肿瘤复发放弃治疗,2例肿瘤复发后再次手术.17例伴有神经功能障碍者,Frankel分级平均提高1.6级.结论:寰枢椎肿瘤尽管治疗困难,但经合理的手术显露与根治性切除,仍可能获得良好疗效.     

经口咽前路减压术治疗寰枢椎脱位

目的：总结寰枢椎脱位经口咽入路减压的显微外科治疗体会。方法：分析11例寰枢椎脱位经口咽前路减压术的术前准备、手术适应证、手术方法、术后并发症的处理及手术结果。结果：本组11例寰枢椎脱位病人中,先天性寰枢椎脱位6例,齿状突骨折伴脱位3例,齿状突发育不全合并局部结缔组织增生2例。随访0．5～9．0年,临床症状有明显改善者10例,其中恢复轻体力劳动者7例,生活自理3例;1例临床症状无变化,无死亡。结论：寰枢椎脱位经口咽入路行显微外科减压可有效的改善临床症状,降低术后并发症和死亡率。严格掌握手术适应证和时机、重视围手术期的处理、预防脑脊液漏和感染是手术成功的关键。     

经后路寰枢椎侧块螺钉固定治疗寰枢椎脱位

目的：探讨经一路寰枢椎侧块螺钉固定治疗寰枢椎脱位的手术方法。方法：采用和枢椎介块螺钉治疗６例寰枢椎前脱位,结果：随访６￣２４月,４例肌力完全恢复正常,２侧肌力基本恢复正常,无断钉脱打现象。结论：经后路寰枢椎侧块螺钉固定治疗寰枢椎脱位,可使寰枢椎达到稳定的状态,该方法有效且可靠。     

ApoFix椎板钩在齿状突骨折治疗中的应用

目的：探讨ApoFix椎板钩在齿状突骨折治疗中的应用。方法：采用ApoFix椎板钩治疗新鲜齿状突骨折（AdersonⅡ型）16例，陈旧性骨折3例，均伴有寰枢椎不稳，并有不同程度的枕颈部疼痛，活动受限。术前行颅骨牵引，使用ApoFix椎板钩作寰枢椎内固定并植骨。结果：术后随访3～24个月，齿状突骨性愈合，寰枢椎复位并融合，无内固定断裂或其他并发症。结论：ApoFix椎板钩手术操作简单，寰枢椎复位佳，固定可靠。是一种较理想的治疗齿状突骨折的手术方法。     

寰枢椎不稳37例手术治疗

目的 对寰枢椎不稳的手术治疗进行探讨. 方法 37例寰枢椎不稳患者中,齿突骨折21例,寰椎横韧带断裂4例;寰枢原发椎肿瘤4例,寰椎椎弓骨折2例;类风湿性枕颈部发育畸形6例.行颈后路手术32例,前路手术4例,前后路联合手术1例. 结果 全部骨性愈合.术前合并神经系统症状28例中,症状明显改善的22例,3例加重. 结论 对于各种原因引起的寰枢椎不稳,应早期进行前后路融合术;充分控制寰枢椎活动,精心准备植骨床却是保证手术成功的关键.     

齿突游离小骨的诊断及其外科治疗

目的：探讨齿突游离小骨的诊断和治疗方式。方法：对２５例齿突游离小骨患者的诊断及治疗进行回顾总结，术前诊断依据齿突基底部缺知的影像学表现。所有患者均行后路融合术，寰枢椎融合８例，枕颈融合术１７例，结果：所有患者经６个月至１８年随访，均获骨性融合，取得满意效果。结论：当齿突游离小骨伴有寰枢椎不稳时，应行手术治疗，对寰枢椎能复位者选择寰椎融合，脱位不能复位者应行枕颈融合术。     

APOFIX内固定治疗创伤性寰椎横韧带断裂

目的：通过对6例创伤性寰椎横韧带断裂合并寰枢椎半脱位应用APOFIX内固定治疗的疗效分析、评价APOFIX在C1-2半脱位的内固定稳定性。方法：6例C1-2半脱位均在后路应用APOFIX行C1-2内固定，自体髂骨植入进行寰枢椎融合。结果：6例手术均未出现并发症，术前症状获得较大改善，均获得寰枢椎骨性融合。结论：APOFIX在寰枢椎半脱位的固定手术中安全、坚强，是高位颈椎较理想的固定材料。     

应用APOFIX椎板钩治疗创伤性寰枢椎不稳

目的：评价Apofix椎板钩治疗创伤性寰枢椎不稳的效果。方法：对创伤性寰枢椎不稳患者进行颈1-2后路融合、Apofix椎板钩内固定术。包括齿状突发育不全1例，颈1-2旋转性半脱位1例。结果：术后随访3个月，颈椎侧位X线片检查，2例均获骨性愈合。结论：寰枢椎后路融合、Apofix椎板钩内固定术适合于创伤性寰枢椎不稳。解剖复位是手术成功的主要措施。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.