颈椎终板弧形高度与椎间隙后缘骨赘的相关性研究

目的：通过对颈椎病患者上下终板弧形高度、椎间隙高度与椎间隙后骨赘的影像学测量，研究其相关性及其临床应用价值。方法：收集2017年9月至2018年9月颈椎病手术108例患者的临床资料，男48例，年龄30~72岁，平均52岁，女60例，年龄37~79岁，平均54岁。其中C_2，3 6例，C_3，4 15例，C_4，5 32例，C_5，6 42例，C_6，7 13例。术前及术后摄颈椎X线片，利用PACS（Picture Archiving and Communication Systems）调阅影像，测量椎间隙的下上终板弧形高度（L₁，L₂），椎间隙高度（L₃）及后方骨赘的宽度（L₄）。利用Spearman分析它们之间的相关性。结果：L₁与L₄对比（r=-0.34，P<0.05），L₃与L₄对比（r=-0.36，P<0.05），存在负相关。L₁与L₃对比（r=0.38，P<0.05），L₂与L₃对比（r=0.48，P<0.05），存在正相关。L₁与L₂对比（P>0.05），L₂与L₄对比（P>0.05），差异无统计学意义。结论：下终板弧形高度与椎间隙后缘骨赘宽度呈负相关，通过其测量可明确颈椎退变程度，对颈椎病的早期防治有指导意义。     

Intrathecal catheterisation after observed accidental dural puncture in labouring women: update of a meta-analysis and a trial-sequential analysis

BackgroundOur meta-analysis from 2013 showed that inserting a catheter intrathecally after an observed accidental dural puncture can reduce the need for epidural blood patch in labouring women requesting epidural analgesia. We updated our conventional meta-analysis and added a trial-sequential analysis (TSA).MethodsA systematic literature search was conducted to identify studies that compared inserting the catheter intrathecally with an epidural catheter re-site or with no intervention. The extracted data were pooled and the risk ratio (RR) and 95% confidence interval (95%CI) for the incidence of post-dural puncture headache (PDPH) was calculated, using the random effects model. A contour-enhanced funnel plot was constructed. A TSA was performed and the cumulative Z score, monitoring and futility boundaries were constructed.ResultsOur search identified 13 studies, reporting on 1653 patients, with a low risk of bias. The RR for the incidence of PDPH was 0.82 (95%CI 0.71 to 0.95) and the RR for the need for epidural blood patch was 0.62 (95%CI 0.49 to 0.79); heterogeneity of both analyses was high. The TSA showed that the monitoring or futility boundaries were not crossed, indicating insufficient data to exclude a type I error of statistical analysis. Contour-enhanced funnel plots were symmetric, suggesting no publication bias.ConclusionsConventional meta-analyses showed for the first time that intrathecal catheterisation can reduce the incidence of PDPH. However, TSA did not corroborate this finding. Despite increasing use in clinical practice there is no firm evidence on which to base a definite conclusion.     

Computed tomography imaging features for amyloid dacryolith in the nasolacrimal excretory system: A case report

BACKGROUNDNasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint, and it may derive from amyloidosis in rare cases. There are a few reports about localized amyloidosis, and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare. CASE SUMMARYA 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year. Physical examination touched a firm lump in the left lacrimal sac. Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus. Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct. During an endoscopic exploration and excision, a large number of dacryoliths were exposed. Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.CONCLUSIONThis case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction. In clinical practice, we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.     

白内障围手术期结膜囊菌群分布及药敏试验

目的 分析白内障围手术期结膜囊菌群的分布及药敏试验结果。方法 选取264例白内障患者,分别在患者入院后、手术消毒前、手术消毒后、手术结束后四个时间点取样,进行细菌培养及药敏试验,比较不同时期的细菌培养结果和药敏结果。结果 入院后结膜囊细菌培养阳性率明显高于手术消毒前、手术消毒后及手术结束后;入院后结膜囊细菌培养以表皮葡萄球菌为主;革兰氏阳性球菌对头孢西丁、加替沙星、左氧氟沙星等敏感性较高。结论 表皮葡萄球菌是结膜囊最常见的细菌,术前应常规应用抗生素点眼,聚维酮碘冲洗结膜囊等来预防术后感染性眼内炎。     

Dural puncture epidural versus conventional epidural block for labor analgesia: a systematic review of randomized controlled trials

IntroductionDural puncture epidural (DPE) analgesia is a modification of conventional epidural analgesia that involves the intentional puncture of the dura with a spinal needle through the needle placed in the epidural space, without a medication being injected intrathecally. There have been contradictory findings regarding better analgesia and better block quality.MethodsA systematic literature search was done to identify randomized controlled trials (RCT) comparing DPE with epidural analgesia. The risk of bias was assessed with the Cochrane tool. Risk ratio and 95% confidence intervals were calculated.ResultsFive RCTs including 581 patients were identified. One RCT on caesarean section was excluded. Single studies suggested slightly better analgesia by finding a median time to achieve sufficient analgesia of two minutes less in the DPE group, a higher number of women having a pain score <10/100 at 20 min, a reduction in the number of epidural top-ups and better sacral spread. The studies did not show a difference between DPE and epidural analgesia for catheter replacement or manipulation rates, the incidence of intravascular placement or unilateral block.ConclusionThere is a lack of clear evidence on either the benefits or the risks of the DPE technique, such that a recommendation for or against its routine use is premature. Two of the three studies showing a beneficial effect of DPE came from the same institution and replication of the findings by other groups is warranted.     

CT引导下胶原酶注射颈椎间盘溶解术的临床研究

目的:研究CT引导下胶原酶注射颈椎间盘溶解术治疗颈椎间盘突出症的价值。方法:对15例颈椎间盘突出症患者在CT引导下行胶原酶注射颈椎间盘溶解术。结果:15例均成功,随访1~16个月,优良率93.3%,未见并发症发生。结论:CT引导下行胶原酶注射颈椎间盘溶解术治疗颈椎间盘突出症安全有效,值得进一步研究。     

Dural arteriovenous malformations at the base of the anterior cranial fossa: report of nine cases

Nine men with dural arteriovenous malformations (DAVM) at the base of the anterior cranial fossa are described. Four patients had intracerebral haemorrhage and four had seizures, associated with haemorrhage in two. In three cases the fistula was an incidental finding. In five cases the diagnosis could be made before angiography, on the basis of CT findings. Angiographically, venous drainage was always seen into ascending cortical veins. Five cases demonstrated drainage via the olfactory vein into the basal vein of Rosenthal; in four this way was the principal route of drainage. Five patients underwent surgery, the therapy of choice. One fistula closed spontaneously after angiography. Two patients refused treatment and one was not treated because of his poor general condition. Because arterial supply was usually bilateral, from small branches of the ophthalmic artery, embolisation seemed to be more dangerous. Compared to dural fistulae in other locations the DAVM of the anterior cranial fossa have a higher risk of complications and should be treated even if asymptomatic at the time of diagnosis.     

不同浓度臭氧注入猪椎间盘后氧化效果的实验研究

目的观察低、中、高浓度臭氧注入猪正常椎间盘后不同时间段髓核组织的变化,探索既高效又安全的臭氧浓度,为临床注射臭氧治疗腰椎间盘突出症提供实验依据。方法小型猪10只,于透视下用21G Chiba针刺入猪腰椎间盘中心部,经穿刺针注入臭氧3 ml,重复3次,在椎间孔处注入5 ml于椎旁组织内。其中L5~6,L4~5,L3~4和L2~3分别注入臭氧浓度为90μg/ml,60μg/ml,30μg/ml及无菌空气,L6~S1不进行任何干预,为空白对照。分别在注射后1天、1周、1个月、2个月和3个月后处死动物各2只,在相同时间点进行CT及MR检查。处死后取出椎间盘及椎旁肌肉标本,作大体和光镜下观察,对髓核氧化及退变程度进行量化评分。结果术后3个月内髓核氧化及退变程度评分随时间推移逐渐增高,臭氧浓度越高,增高趋势越明显。术后MRI随访1个月时高浓度组髓核信号T2加权开始减低,其他组不明显。术后2个月注射组所有椎间盘信号均减低,臭氧浓度越高,信号减低越明显。光镜下1天出现髄核细胞的肿胀变性,1周髄核细胞出现与注射浓度正相关的体积缩小和基质含量减少,此后胶原纤维增生,逐渐取代髄核组织,在3个月时,高浓度组髄核干涸的程度,继发纤维化均较中、低浓度组高,并且出现相邻椎体骨性融合。中、高浓度椎旁肌肉注射1周时出现肌纤维肿胀变性及间质黏液变性。结论臭氧浓度越高,髄核的干涸效果越明显,椎间盘退行性变也越明显。高浓度臭氧盘内注射,3个月后椎间盘退变严重,不宜进行临床应用,椎旁肌肉内不宜注射中、高浓度臭氧。