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101.
椎板后移回植的椎管扩大术治疗椎管狭窄症 总被引:43,自引:0,他引:43
作者报告棘突劈开、椎板后移回植的椎管扩大术治疗椎管狭窄症182例,使椎管容积扩大34.8%,横径扩大3.8mm,矢径扩大6.1mm。随访2年9个月,优良率86.6%,椎板愈合率96.9%。本文探讨少数椎板迟延愈合的原因和预防措施,如斜切椎板、缝合固定和腰背筋膜与棘上韧带悬吊缝合等。术后卧床10~12周,用石膏型保护。作者认为本法能有效的预防术后脊柱不稳,顽固性腰痛等并发症。 相似文献
102.
103.
报告手术治疗腰椎间盘突出症合并退行性腰椎管狭窄症104例。术后随访90例,随诊时6个月~6年。优良率86.5%,无腰椎不稳和腰椎滑脱等并发症。为获得优良效果,作者强调在处理椎间盘突出的同时必须彻底解除侧隐窝及神经根管,黄韧带肥厚对神经根的压迫,才能彻底根除症状 相似文献
104.
Raj P. Kapur Ian Neilson Robert M.W. Hofstra Lynda W. Holloway Ron C. Michaelis Kathleen A. Leppig 《American journal of medical genetics. Part A》2002,108(1):51-56
Congenital hydrocephalus associated with aqueductal stenosis and/or agenesis of the corpus callosum has been described in newborn males with mutations in L1CAM, a gene that encodes a neural cell adhesion molecule. These males usually have severe mental retardation and may have spastic paraplegia and adducted thumbs. In contrast, Hirschsprung disease, or absence of ganglion cells in the distal gut, has rarely been described in such individuals. We report a male infant who had severe hydrocephalus identified in the prenatal period with evidence of aqueductal stenosis and adducted thumbs at birth. He developed chronic constipation, and rectal biopsy confirmed the diagnosis of Hirschsprung disease. Molecular testing of the L1CAM gene revealed a G2254A mutation, resulting in a V752M amino acid substitution. A common polymorphism in RET, but no mutation, was identified. Our patient represents the third example of coincident hydrocephalus and Hirschsprung disease in an individual with an identified L1CAM mutation. We hypothesize that L1CAM‐mediated cell adhesion may be important for the ability of ganglion cell precursors to populate the gut, and that L1CAM may modify the effects of a Hirschsprung disease–associated gene to cause intestinal aganglionosis. © 2002 Wiley‐Liss, Inc. 相似文献
105.
Preoperative metoprolol improves cardiovascular stability and reduces oxygen consumption after thoracotomy 总被引:1,自引:0,他引:1
C.–J. JAKOBSEN S. BILLE P. AHLBURG L. RYBRO K. D. PEDERSEN B. RASMUSSEN 《Acta anaesthesiologica Scandinavica》1997,41(10):1324-1330
Background : Increased sympathetic activity perioperatively and associated cardiovascular effects play a central role in cardiovascular complications. High thoracic epidural blockade attenuates the sympathetic response, but even with complete pain relief, haemodynamic and endocrine responses are still present. Beta–adrenoceptor blockade is effective in situations with increased sympathetic activity. This study was designed to evaluate the perioperative haemodynamic effect of preoperative βblockade and its influence on the haemodynamic aspects of the surgical stress response.
Methods : Thirty–six otherwise healthy patients undergoing elective thoracotomy for lung resection were randomised doubleblinded to receive either 100 mg metoprolol or placebo preoperatively. Anaesthesia was combined high thoracic epidural block and general anaesthesia. The epidural analgesia was continued during recovery. Patients were monitored with ECG, pulse oximetry, invasive haemodynamic monitoring, arterial blood gases and electrolytes.
Results : After induction of anaesthesia the mean arterial pressure (MAP) decreased in both groups, and decreased further in the placebo group after initiation of the epidural block. The heart rate (HR) was slightly less throughout the observation period after metoprolol. Peroperatively, the only difference in measured haemodynamics was a marginally higher MAP after metoprolol. Postoperative cardiac index (CI) was lower with a lower variability and cardiac filling pressures were slightly higher in the metoprolol group. The oxygen consumption index was higher after placebo throughout the observation period, with no difference in the oxygen delivery.
Conclusion. We found that preoperative β–blockade during combined general anaesthesia and high thoracic epidural blockade stabilised perioperative HR and CI and decreased total oxygen consumption. 相似文献
Methods : Thirty–six otherwise healthy patients undergoing elective thoracotomy for lung resection were randomised doubleblinded to receive either 100 mg metoprolol or placebo preoperatively. Anaesthesia was combined high thoracic epidural block and general anaesthesia. The epidural analgesia was continued during recovery. Patients were monitored with ECG, pulse oximetry, invasive haemodynamic monitoring, arterial blood gases and electrolytes.
Results : After induction of anaesthesia the mean arterial pressure (MAP) decreased in both groups, and decreased further in the placebo group after initiation of the epidural block. The heart rate (HR) was slightly less throughout the observation period after metoprolol. Peroperatively, the only difference in measured haemodynamics was a marginally higher MAP after metoprolol. Postoperative cardiac index (CI) was lower with a lower variability and cardiac filling pressures were slightly higher in the metoprolol group. The oxygen consumption index was higher after placebo throughout the observation period, with no difference in the oxygen delivery.
Conclusion. We found that preoperative β–blockade during combined general anaesthesia and high thoracic epidural blockade stabilised perioperative HR and CI and decreased total oxygen consumption. 相似文献
106.
对AF系统整复压缩爆裂骨折椎体高度及椎管横截面的观测 总被引:4,自引:3,他引:1
目的 :量化评价AF系统恢复胸腰段压缩爆裂椎体高度椎管截面积的效果。方法 :测量AF系统治疗的 72例胸腰段压缩爆裂骨折术前后影像。统计椎体前后缘高度、Cobb角、椎管截面积资料。结果 :术后伤椎前缘高度恢复至 ( 96.5± 2 .3 ) %后缘高度恢复至 ( 98.2± 0 .9) % ,Cobb角恢复至 ( 5 .4± 1.5 )° ,椎管截面积恢复至 ( 97.2± 2 .1% ) ,各项指标与术前比较有非常显著性差异 (P <0 .0 0 1)。术后随访 0 .5~ 3 .5年 ,神经功能按Frankel评定 :60例提高 1~ 3级。结论 :AF系统能恢复或基本恢复胸腰段压缩爆裂骨折椎体的前后缘高度、Cobb角、椎管容积 ,为脊髓神经功能的恢复提供一个良好的环境。是治疗脊柱胸腰段压缩爆裂骨折较好的内固定器。 相似文献
107.
赵诚 《中国介入影像与治疗学》2006,3(4):288-290
目的探讨代谢综合征(MS)患者中肾动脉狭窄的发生率及无创性筛检的必要性与可靠性。方法45例MS患者预行肾动脉螺旋CT血管造影(SCTA),对所检出的14例肾动脉狭窄者行肾动脉数字减影血管造影(DSA)对照,并对SCTA及DSA结果进行对比分析。结果45例MS患者中SCTA显示肾动脉正常31例,其余14例患者存在单侧或双侧肾动脉狭窄,DSA对照显示肾动脉正常6条,肾动脉狭窄22条,与SCTA显示的情况基本符合。结论MS患者中肾动脉狭窄的发生率约31.1%,对可疑患者应常规予以肾动脉SCTA检查。 相似文献
108.
腰椎管狭窄症的手术减压与内固定选择(259例临床分析) 总被引:20,自引:2,他引:18
目的:探讨腰椎管狭窄症的手术减压指征、减压范围及内固定选择。方法:回顾性分析腰椎管狭窄症患者259例,平均年龄52.2岁,平均病程4年1个月。根据病情分别采用椎板间节段开窗潜行减压术139例,腰椎管内径扩大成形术63例,全椎板切除减压、椎间植骨融合内固定术57例。结果:221例获得平均4年2个月随访。三种手术方法优良率分别为91.53%、87.50%和85.45%;手术并发症发生率为13.69%、15.87%和20.11%。结论:对严重的腰椎管狭窄症若手术适应证和减压范围掌握恰当,不论采取何种手术方式的神经减压术,均可取得满意疗效。正确选择病例和熟练的外科技术是应用内固定器械的重要条件。 相似文献
109.
肝移植术后门静脉并发症的诊断和治疗(附6例分析) 总被引:4,自引:0,他引:4
目的 探讨肝移植术后门静脉并发症的诊断和治疗。方法 回顾性分析160例原位肝移植临床资料。结果 肝移植术后门静脉并发症发生率为3.75%,与门静脉并发症相关死亡率为0。门静脉狭窄发生率为1.25%,门静脉栓塞发生率为2.5%,需治疗的门静脉并发症占33.3%。结论 术前有门脉高压症手术治疗史、移植术前门静脉血栓、门静脉手术史以及严重感染病史等是门静脉并发症的高危因素;彩色多普勒超声检查是监测门静脉并发症的有效方法,确诊门静脉并发症依赖门静脉造影;有症状的门静脉并发症需及时行再血管化手术。 相似文献
110.