老年退行性腰椎管狭窄症的手术疗效分析

目的:探讨老年退行性腰椎管狭窄症患者减压手术的疗效。方法:1997年1月～2003年12月收治的70岁以上且获得2～6年随访的退行性腰椎管狭窄症患者106例,男49例,女57例;年龄70～82岁,平均76.3岁;病史4～10年,平均6.7年。42例并存1种内科疾病,55例并存两种或以上的内科疾病。均经过正规保守治疗无效。术前联合内科诊治并存的内科疾病。95例行单纯全椎板切除减压术;11例采用椎板减压、椎弓根固定、椎间植骨融合术,对手术疗效进行回顾性分析。结果:无围手术期死亡病例。出现并发症22例次,经对症及内科联合处理后好转。单纯减压组术后3周配戴腰围下床活动;内固定组术后3～5d下床活动。平均随访3年10个月,Oswestry评分从术前59.64±11.07分改善至16.81±7.36分。所有患者连续行走从术前不足15min改善到至少30min。95.2%患者自诉生活质量明显提高。结论:老年退行性腰椎管狭窄症患者在积极控制并存内科疾病的基础上,手术减压治疗对神经功能的恢复有重要作用,可获得较满意的临床疗效。     

压迫及非压迫因素在实验性神经根性疼痛中的作用

目的：探讨压迫及非压迫因素在实验性椎间盘源性神经根性疼痛中的作用。方法：取大鼠白体脊椎关节突修剪后放置在L5神经根下．造成对L5神经根的直接压迫（压迫组）；取大鼠白体尾椎椎间盘组织无压迫下放置在L5神经根表面（非压迫组）：同时设立对照组。术后不同时间点测定各组大鼠后足底机械刺激疼痛阈值的变化。结果：压迫组与非压迫组大鼠后足底均产生了一个长时程机械刺激疼痛阈值的降低；与压迫组相比．非压迫组大鼠术后1天就开始出现了疼痛阈值降低（P〈0．05），明显早于压迫组大鼠，并且疼痛阈值降低更加显著：而压迫组大鼠术后1周时才出现明显的疼痛阈值降低（P〈0．05）。对照组大鼠疼痛阈值没有发生明显的改变。结论：尽管压迫和非压迫因素都参与椎间盘源性神经根性疼痛的发生．但二者作用的时间不同＋在椎间盘突出的早期阶段非压迫因素可能在疼痛中起着重要的作用：随后压迫因素可能逐渐成为致痛的主因。     

腰椎间盘突出症和马尾神经综合征

本文报告３２例腰椎间盘突出症导致的马尾神经综合征。除腰痛及坐骨神经痛外，本组所有病人均存在鞍区麻木和括约肌功能障碍。根据尿便功能障碍发作程度和持续时间，本组有四种不同的临床表现类型，预后差。异较大。脊髓造影具有诊断和鉴别诊断价值，应用Ｏｍｎｉｐａａｕｅ较Ｃｏｎｒａｙ安全。早期诊断和手术治疗，对括约肌功能、肌力和鞍区浅感觉最大程度地恢复甚为重要。     

VASCULAR COMPLICATIONS OF ELECTIVE LOWER LUMBAR DISC SURGERY

Lower lumbar disc surgery is an extremely common operation from which vascular complications are reported rarely. However vascular injury can occur with perforation of the anterior longitudinal ligament. External haemorrhage is uncommon and the true cause of the patient's hypotension may be misdiagnosed. If the hypotension is severe or prolonged laparotomy is indicated, to prevent exsanguination and to effect a repair of the vascular injury. Alternatively, if the injury is missed, an arteriovenous fistula may develop; this diagnosis may be delayed for months or years. One case of severe haemorrhage following lower lumbar disc surgery is reported and a further 69 cases of similar arterial injury have been reviewed from the world literature.     

PARS INTERARTICULARIS STRESS AND DISC DEGENERATION IN CRICKET'S POTENT STRIKE FORCE: THE FAST BOWLER

Cricket fast bowlers are the potent strike force in a multidiscipline team. They subject their spines to repetitive sagittal plane and rotatory movements over many years. The effect of this repetitive stress has not previously been analysed. This study examined 20 former fast bowlers to determine the incidence of spondylolysis, spondylolisthesis and degenerative change. Fast bowlers are noted to have an increased incidence of spondylolysis. A mixed front/side bowling style involving more lumbar hyperextension or rotation has significant association with spondylolysis when compared with side-on bowling styles. There was a high incidence of radiological thoracolumbar degenerative facet joint and disc disease in former fast bowlers.     

腰椎间盘突出症人工椎间盘置换手术及效果

目的 :观察采用SBCharit啨人工椎间盘置换手术治疗腰椎间盘突出症的临床效果?椒?:左下腹部腹直肌旁切口 ,切断腹直肌鞘及后层 ,钝性分离腹主动脉和静脉 ,并游离到右边用棉垫加以保护。然后作一“H”型切口切开纤维环 ,用刮匙和咬骨钳清除椎间盘组织特别是髓核。将SBCharit啨人工椎间盘植入?峁?:8例中有 7例 (87.5 % )的临床效果为相当好 ,1个病人 (12 .5 % )为一般 ,有背疼或腿部症状需偶尔服药。椎体活动范围平均为 9°。没有发现有假体松动、下沉入椎体。结论 :若适应证选择得当 ,将获得满意效果。     

腰椎间盘突出症CT诊断与三维瞬间牵引

目的 :探讨腰椎间盘突出症的 CT表观及三维瞬间牵引的治疗效果。材料与方法 :回顾分析经 CT及临床诊断为腰椎间盘突出症病例 16 7例的临床及 CT资料。结果 :16 7例腰椎间盘突出症表现为单个或多个椎间盘的突出 ,硬脊膜囊、硬膜外间隙及神经根受压等征象。经三维瞬间牵引后 6 5例 (38.9% )症状有不同程度缓解 ,其中 94例 (5 6 .3% )症状完全消失。结论 :CT是腰椎间盘突出症的有效诊断手段之一     

下腰椎失稳合并椎管狭窄症的手术治疗

目的：观察下腰椎失稳合并椎管狭窄症患者经椎弓根螺钉系统及椎体融合器治疗的效果。方法：采用后路减压，椎弓根螺钉系统内固定，椎体间融合器BAK融合。结果：术后随访1年一4年3个月(平均2年4个月)，椎体间骨性融合率1年89．6％，2年2个月100％，临床症状消失满意率92％。结论：采用椎管减压、椎弓根螺钉系统加椎间融合器固定，可使滑脱失稳的椎体部分或全部复位，保证脊柱骨性融合，达到脊柱稳定、解除症状的目的。     

Platelet aggregation,disc haemorrhage and progressive loss of visual fields in glaucoma

Platelet aggregationin vitro, deterioration of visual field defects (VFD) and the prevalence of disc haemorrhages (DH) were assessed in 49 patients with primary open angle glaucoma (POAG) and compared with the findings for 67 individuals with suspected glaucoma (GS) in a seven-year follow-up study (range 5.8 to 8.2 years). The percentage patients with spontaneous platelet aggregation (SPA) was higher for POAG patients with visual field deterioration (60%) than both POAG patients without progressive loss of visual fields (12.5%; P<0.005) and those with suspected glaucoma (22.4%; P<0.005). The occurrence of DH was higher among POAG patients with progressive loss of visual field (28%) compared to the GS group (8.4%; P<0.025) and the group of patients consisting of POAG patients without deterioration of VFD and GS (9.9%; P<0.05). DH also occurred more often in patients with low tension glaucoma (41.6%) than in the remaining POAG patients (13.5%; P<0.05). No relation between the patients with SPA and the patients with DH was observed.Abbreviations NPB normal platelet behavior - SPA spontaneous platelet aggregation - DH disc haemorrhage     

HBV_2患者血清HBsAg的氨基酸组成分析

将２例ＨＢＶ＿２患者血清ＨＢｓＡｇ纯化，分析了ＨＢＶ＿２的ＨＢｓＡｇ氨基酸组成，并与分子量为６３０１９８道尔顿ＨＢＶ＿１的ＨＢｓＡｇ三种多肽氨基醚组成比较。实验发现，ＨＢＶ＿２与ＨＢＶ＿１的ＨＢｓＡｇ的氨基醚组成有较大区别，且区别指数均在１３以上。提示ＨＢＶ＿１和ＨＢＶ＿２的ＨＢｓＡｇ在一级结构上存在较大差异；ＨＢＶ＿２可能系一新的乙型肝炎病毒，也可能系由于ＨＢＶ＿１Ｓ区核苷酸突变所致的变异株。