腰椎间盘突出症419例3种非手术疗法疗效分析

为比较下腰痛非手术疗效,４１９例腰椎间盘突出症患者采用腰椎牵引（甲组１９５例）、激素硬膜外注射（乙组１９２例）及经皮穿刺椎间盘切吸术或胶原酶溶解术（丙组３２例）进行治疗和随访,采用改良Ｍａｃｎａｂ标准评定。结果：优良率甲组４９％,乙组６６％,丙组８４％,Ｐ＜０．０１;甲组疗效与病程相关,病程＜６个月疗效较好（Ｐ＜０．０５）;平均治疗次数有甲组＞乙组＞丙组的倾向。结论：单纯腰椎牵引对病程较短者疗效较好;病程较长,神经根刺激症状明显者加用激素硬膜外注射可提高疗效;经腰牵、激素硬膜外注射等非手术治疗无效者,如严格掌握适应证和操作技术,采用经皮穿刺椎间盘切吸术或胶原酶溶解术可取得很好疗效     

Vitrectomy for macular pucker and vitreomacular traction syndrome

During the course of a so-called posterior vitreous detachment, a thin layer of the posterior vitreous cortex often remains adherent to the underlying retina. Tangential stretch of this vitreous pseudomembrane may cause vitreomacular traction syndrome, edema, and macular hole formation. The same process appears to underlie the development of true epimacular membranes (idiopathic macular pucker). Vitrectomy is generally agreed to be the most appropriate treatment for these clinical situations. We evaluated the incidence of vitreomacular adhesion and of visual improvement after vitrectomy of eyes with macular pucker (group 1; n=60) and vitreomacular traction syndrome (group 2; n=50). Vitreomacular attachment was assessed during vitrectomy under the condition of continuous air infusion. In the two groups, complete or partial vitreous attachment to the macula was observed in 57.4% and 74%, respectively. We conclude that vitreomacular adhesion is a common feature of the two clinical situations. Visual improvement was achieved in 73% of both groups. High rates of postoperative visual acuities of 20/50 or better (60.6% in group-1; 65.7% in group-2 cases) occurred only in eyes with preoperative values of 20/100 or better. It is reported that the visual outcome of vitreoretinal surgery for the two clinical conditions deteriorates with increasing duration after initial manifestation. Vitrectomy should not be postponed in patients who complain of disturbing visual symptoms such as reduced visual acuity, metamorphopsia and disturbance of binocular reading. This revised version was published online in July 2006 with corrections to the Cover Date.     

Diabetic maculopathy induced by vitreo-macular traction: evaluation by optical coherence tomography (OCT)

Aim: To evaluate the role and efficacy of optical coherence tomography (OCT) in the evaluation of diabetic maculopathy induced by vitreo-retinal traction. Methods: 12 patients affected by diabetic maculopathy induced by vitreo-retinal traction were examined using biomicroscopy with a three-mirror contact lens, fluorescein angiography (FA) and OCT scanning in order to identify the presence of a vitreomacular traction. Results: OCT revealed two patterns of maculopathy which were characterised by a thickening of the superior profile of the OCT tomogram or by the disappearance and inversion of the physiologic foveal depression respectively. Conclusions: OCT may be useful in the characterisation and monitoring of diabetic maculopathy induced by vitreo-retinal traction. This revised version was published online in July 2006 with corrections to the Cover Date.     

Dixyrazine,a phenothiazine derivate,can prevent brain oedema induced by intracarotid injection of protamine sulphate

Summary The present study was performed to determine whether an opening of the blood-brain barrier (BBB) induced by intracarotid infusion of protamine sulphate necessarily leads to brain oedema and, if so, whether dixyrazine, a phenothiazine, can prevent the oedema. Evans blue albumin was used to detect BBB opening. Endogenous serum albumin was determined in CSF sampled before and after protamine infusion.The brain specific gravity, a sensitive indicator of brain oedema, was determined one hour after intracarotid infusion of 5 or 10 mg protamine sulphate in 100 or 200 l solvent in rats. Both doses opened the BBB and the CSF albumin was significantly increased (p<0.05 for 5 mg and p<0.01 for 10 mg protamine sulphate). However, only 10 mg protamine significantly reduced the specific gravity in the cerebral cortex and basal ganglia in the right (injected) hemisphere. Pretreatment with dixyrazine 10 mg/kg completely prevented the brain oedema and significantly reduced the albumin increase in CSF. We conclude that a) a moderate opening of BBB induced by 5 mg protamine sulphate does not lead to brain oedema and b) dixyrazine can prevent the brain oedema induced by 10 mg protamine sulphate.     

针刺、自主牵引、药物外敷治疗腰椎间盘突出症疗效观察

目的 :观察针刺、自主牵引、药物外敷治疗腰椎间盘突出症 (简称治疗组 )的疗效。方法 :随机分为针刺、自主牵引、药物外敷组和单纯针刺组进行对比观察。结果 :治疗组总有效率 94 .1% ,明显高于对照组 75 .8% ,经统计学处理 ,P <0 .0 5 ,具有显著性差异。结论 :治疗组疗效优于对照组     

防滑钢针及Y形酒精滴管在下肢骨牵引病人中的应用

为探讨自制防滑钢针及Y形酒精滴管在下肢骨牵引病人中的应用效果.选择需行下肢骨牵引的病人100例,随机分成实验组和对照组各50例.实验组采用自制防滑钢针及Y形酒精滴管;对照组采用传统钢针及酒精点滴.观察2组病人钢针滑动、压疮、针道感染情况.结果实验组钢针牵引滑动率显著低于对照组(P＜0.01).针道感染率明显低于对照组(P＜0.01).表明应用自制防滑钢针及Y形酒精滴管效果确切,经济实用,使用方便,可有效避免并发症的发生.     

针刺加斜扳法治疗脊神经后支源性下腰痛的临床观察

目的:比较邵氏点针刺加斜扳法、华佗夹脊针刺加斜扳法治疗脊神经后支源性下腰痛的疗效.方法:将70例脊神经后支源性下腰痛患者随机分为2组,分别使用邵氏点针刺加斜扳法、华佗夹脊针刺加斜扳法治疗,每组35例.结果:治疗后邵氏点针刺加斜扳法组疗效较优,且短病程较长病程疗效优.结论:运用神经定位取穴的邵氏点针刺加斜扳法治疗病程较短的脊神经后支源性下腰痛有较好的疗效.     

Adaptative effects of loss of vision on upright undisturbed stance

In order to evaluate the long term effect of blindness on an undisturbed postural task, seven blind individuals (BLI) were compared to twelve healthy individuals (REF) who were required to close their eyes. To this aim, centre of pressure (CP) trajectories were recorded through a force platform on which the subjects remained upright. Through a low-pass filter, the vertical projection of the centre of gravity (CG(v)) and consequently the difference CP-CG(v) were estimated. The former represents the controlled variable whilst the latter is assumed to express the resultant joint stiffness. A first analysis consisted in studying the frequency distribution of these motions. Increased mean amplitudes in both elementary motions and no difference between frequency distributions were observed for the BLI when compared to the REF group. These trajectories were then modelled as a fractional Brownian motion process in order to gain insight about the nature of the control mechanisms called into play and their spatio-temporal organisation. Moreover, the main characteristic observed in the BLI group is a decreased in CP-CG(v) motions, which, according to Winter's model, may be related to joint stiffness. In addition, reduced spatial transition point co-ordinates and more deterministic control mechanisms aimed at returning the estimated CG to an equilibrium point during the longest Deltat were observed. This phenomenon is more pronounced in the antero-posterior direction and also allows the blind subject to significantly diminish their CG sways. Finally, these features are discussed in relation to other similarly analysed investigations.     

手法整复杉树皮外固定结合皮牵引治疗小儿股骨干骨折疗效观察

为对名中医张绍富的手法整复杉树皮外固定结合皮牵引治疗小儿股骨干骨折的经验进行临床观察与疗效评价,以规范操作,便于推广.将153例小儿股骨干骨折采用多中心(4家医院)双盲随机(DME)[1]法,分为两组,治疗组102例采用手法整复杉树皮外固定结合皮牵引治疗,对照组51例,采用手法整复石膏外固定治疗,分别进行临床疗效与卫生经济学评定.经1～3.5年(平均1.8年)的随访.结果显示,治疗组较对照组肿胀消退快,并发症减少,疼痛积分减少2.69分,临床愈合时间缩短5.7天,骨性愈合时间提前7.4天,肢体功能恢复至正常时间提前7.3天,远期疗效无差异,治疗费用明显减少.表明手法整复杉树皮外固定结合皮牵引治疗小儿股骨干骨折,能减轻患儿痛苦,缩短病程,疗效优良.     

Non-lymphoid lesions that may mimic cutaneous hematopoietic neoplasms histologically

This review considers neoplastic lesions that originate in the skin, and which have the potential to imitate hematopoietic proliferations at a histological level. They include lymphoepithelioma-like carcinoma, Merkel cell carcinoma, benign lymphadenoma, pseudolymphomatous angiosarcoma, lymphadenoid dermatofibroma, lymphomatoid atypical fibroxanthoma, histiocytoid (epithelioid) hemangioma, and inflamed melanocytic lesions. The clinical and pathological features of those tumors are considered.