30例小脑出血临床分析

一、资料与方法 1．一般资料：我院2005年8月-2006年5月经CT证实小脑出血病例30例，男16例，女14例；发病年龄40-75岁，平均年龄57．5岁，其中50岁以下8例，51-60岁12例，71-80岁6例．81-90岁4例。就诊时血压大于140／90mm Hg者28例。其中误诊为眩晕综合征8例，误诊至更正诊断间隔时间12h-2d．因误诊延误治疗导致病情恶化死亡3例。[第一段]     

Selective dorsal rhizotomy: long-term experience from Cape Town

Introduction Given the large number of cerebral palsy patients who have undergone selective dorsal rhizotomy in the past two decades, it is clearly imperative that the clinical community be provided with objective and compelling evidence of the long-term sequelae of the procedure. Materials and methods In the early 1980s, Peacock in Cape Town shifted the site of the rhizotomy from the conus medullaris to the cauda equina, and in the past 25 years, more than 200 children have been operated on. We have studied the incidence of spinal deformities after multiple-level laminectomy and recorded a 20% incidence of isthmic spondylolysis or grade-I spondylolisthesis. We have also conducted a long-term prospective gait analysis study on a cohort of 14 ambulatory patients who were operated on in 1985. Results Ten years after surgery, our patients had increased ranges of motion that were within normal limits. Step length was significantly improved, although cadence was unchanged postoperatively and was significantly less than normal age-matched control subjects. Discussion We have recently tracked down all 14 patients from the original cohort and are currently completing a 20-year prospective follow-up analysis of their neuromuscular function and gait. Our preliminary data suggest that selective dorsal rhizotomy is not only an effective method for alleviating spasticity but it also leads to long-term functional benefits.     

中药敷脐治疗胸腰椎术后腹胀便秘的效果观察

目的探讨使用大黄厚朴煎剂热敷脐部治疗胸腰椎术后患者腹胀、便秘的疗效。方法选择2005年1月至2006年12月中山大学第二医院骨外科胸腰椎术后出现腹胀便秘的患者80例。分成两组,治疗组用大黄厚朴煎剂热敷脐部;对照组使用开塞露塞肛。观察两组患者肛门排气,排便,腹胀消除及停药复结情况。结果治疗组的总有效率95%,对照组总有效率70%;停药复结情况:治疗组5%,对照组42.5%;腹胀减轻情况:治疗组95%,对照组52.5%。结论大黄厚朴煎剂热敷脐能有效减轻肠胀气,软化大便,对于消除胸腰椎术后患者腹胀便秘明显优于使用开塞露塞肛效果。     

Integrating Nursing Care into Systems of Care for Children with Emotional and Behavioral Disorders

PROBLEM: Recent developments in providing care to children with emotional and behavioral disorders, especially those with serious emotional disturbance, have included the establishment of systems of care. Guided by a set of principles and values, these systems of care have organized and delivered services to children and families with complex needs. To date, nurses have not had a salient role in systems of care. RESULTS: It is estimated that 20% of American children and adolescents have an emotional or mental disorder. As many as two thirds of these children are not receiving services. Systems of care have been funded to provide services for these children, particularly for the most severely affected. To date, nursing has not had a prominent role in these systems of care. CONCLUSIONS: Based on their knowledge, skills, and holistic approach to care, nurses could better integrate nursing care into systems of care. Possible roles as case managers, primary therapists, in-home interventionists, and in educational programs are suggested.     

胸腰椎病变CT监视下穿刺活检路径分析

目的探讨胸腰椎病变CT监视下穿刺活检中穿刺路径的选择方法。方法141例胸腰椎病变临床诊断不清患者，其中胸椎70例，腰椎71例。根据病变位于脊椎的不同部位选择合适的穿刺路径，于CT监视下穿刺取材。穿刺路径：经椎旁路径63例，经椎弓根路径45例，经肋椎关节路径11例，其他路径22例。结果141例中共有128例诊断正确，穿刺结果诊断正确率为90．8％。无并发症发生。结论胸腰椎病变穿刺路径的选择要根据病变的位置不同具体分析。总的原则是安全、取材量多、对患者损伤小。     

下颈椎经关节螺钉钉棒系统固定的生物力学研究

目的：比较下颈椎三柱损伤后单独经关节螺钉固定（TAS）、经关节钉棒系统同定（TRS）和侧块螺钉钉棒系统固定（LRS）的三维稳定性。方法：12具新鲜颈椎标本．制成C4／5、C5／6节段三柱损伤模型，分别进行单独经关节螺钉（TAS组）、经关节螺钉钉棒系统（TRS组）和侧块螺钉钉棒系统（LRS组）三种方法固定，在非限制性和非破坏性的实验条件下测试其前屈、后伸、左右侧弯和轴向旋转运动状态的稳定性。结果：TAS组和TRS组在各方向的运动范同（ROM）和中性区（NZ）的均数均显著小于完整标本组，差异有统计学意义（P〈0．05）；LRS组在前屈、后伸、侧弯运动中的ROM和NZ与完整标本组比较有显著降低，差异有统计学意义（P〈0．05）；LRS组在旋转运动中的ROM和NZ与完整标本组比较有不同程度的降低，但差异无统计学意义（P〉0．05）。TAS、TRS在各个方向稳定性明显优于LRS组（P〈0．05）。TRS在前屈运动中的ROM和NZ与TAS组比较有所减小，但无统计学意义（P〉0．05）；在后伸、侧弯和旋转运动中，TRS组稳定性明显优于TAS组，有统计学意义（P〉0．05）。结论：在下颈椎三柱损伤选择经关节固定技术时以钉棒形式同定稳定性更好。     

Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up

BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type B, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p<.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs.     

学习成绩、家庭环境对学龄儿童自我意识的影响

目的探讨学习成绩、家庭环境对儿童自我意识的影响。方法采用经验评估法、家庭环境量表和Piers Harris儿童自我意识量表对 9.5～ 12岁 2 87名儿童的学习成绩、家庭环境和自我意识进行评定。结果自我意识总分学习困难组 ( 5 8.76± 11.0 1) <学习中等组 ( 64 .5 9± 7.87) <学习优秀组 ( 69.80± 7.5 1) ,家庭环境量表中的亲密度、情感表达、矛盾性、知识性、娱乐性和控制性 6个因素与自我意识相关。结论学习成绩、家庭环境对学龄儿童自我意识的形成和发展起重要的作用 ,改善家庭环境、提高学习成绩 ,可有利于儿童自我意识的发展。     

急性重症胆管炎的介入治疗

目的讨论经皮经肝穿刺放置引流管(简称PTCD)减压引流治疗急性重症胆管炎(简称AOSC)的可行性及疗效.方法 1996年3月～2001年4月行PTCD治疗AOSC病人15例,男10例,女5例,胆石症术后8例,胆管癌2例,胰腺癌3例,胆道畸形2例,其中4例放置了胆道内支架.结果 15例病人技术成功率100%,无1例出现穿刺置管所致的严重并发症.病情缓解后针对病因有8例行手术治疗痊愈,4例不能手术的肿瘤患者植入了胆道内支架,1例于置管后3d死于多脏器功能衰竭,2例置管引流病情稳定后因各种原因放弃继续治疗,保留引流管自动出院.结论 PTCD可有效降低胆管压力,缓解病情,降低AOSC的死亡率,为进一步的病因治疗创造条件.     

小儿注射性坐骨神经损伤的脊髓运动诱发电位诊断

目的利用肌电图常规电刺激器测定脊髓运动诱发电位（MEP）技术，建立小儿注射性坐骨神经损伤诊断的新方法。方法采用英国Medelec公司生产的MS6型肌电图机，刺激器采用本机所配刺激器，刺激电压250～300mv，脉宽0．5～1ms。刺激电极为表面鞍型电极。刺激部位：负极处于L1棘突间，正极处于其上方。刺激方式为单次手动触发。记录部位为健、患侧胫前肌群及腓肠肌群。记录电极采用2支单极针电极。结果7例患儿主要异常形式表现为：诱发波的振幅降低，潜伏时延迟。结论测定表明该方法具有直接测定损伤段神经，异常表现出现早等优点。