A new approach to the intercosto-brachial anastomosis in the treatment of brachial plexus paralysis due to root avulsion. Late results

Summary The author introduces a new personal technical approach for the treatment of brachial plexus paralysis-direct intercosto-brachial anastomosis-and presents his own experiences and results. The main factors which may influence the results of this technique are explained. He stressed that the discouraging results reported recently should not lead one to abandon intercosto-brachial anastomoses because this would mean abandoning young patients to their deficits.     

Treatment outcome and complications in patients treated for malignant epidural spinal cord compression (SCC)

Sixty-seven episodes of spinal cord compression (SCC) were retrospectively evaluated regarding presenting features and treatment outcome. They were divided into three motor function groups. Group 1 consisted of 35 ambulatory patients, group 2 of 29 non-ambulatory patients and group 3 of three paraplegic patients. Lower extremity weakness was usually a late presenting feature and was frequently rapidly progressive. We suggest that SCC is an emergency, as successful treatment is unlikely if motor function is poor. All of the group 1 patients completing treatment remained ambulatory, in contrast to group 2 patients, in which only 25% regained the ability to walk, and group 3 patients, none of whom regained the ability to walk. Initial surgery or initial radiotherapy appeared to be equally effective in restoring or maintaining the ability to walk. Survival of patients ambulatory at completion of treatment was superior to that of non-ambulatory patients (p < 0.03). Analysis of steroid-related complications suggested that frequent, severe and sometimes fatal complications can result from prolonged use with these drugs.     

Fenestration of the middle cerebral artery

Summary Three cases of angiographically demonstrated fenestration of the middle cerebral artery are reported. The incidence of demonstration of fenestration of the middle cerebral artery by angiography is 0.26%. Its clinical significance is discussed briefly.     

Intramedullary spinal cord sarcoidosis

A case of histologically proven intramedullary spinal cord sarcoidosis diagnosed antemortem is presented. The patient manifested symptoms referable only to the spinal cord simulating a tumor—progressive tetraparesis. The histologic diagnosis of sarcoidosis was established through exploratory laminectomy. Surgical intervention is the only way to rule out a malignant process in case of sarcoidosis limited to the spinal cord.     

全椎板切除脊柱内固定用于老年退行性腰椎管狭窄症治疗的临床观察

目的观察全椎板切除脊柱内固定术治疗老年退行性腰椎管狭窄症的临床疗效。方法选取2007年5月～2011年12月我院收治54例老年退行性腰椎管狭窄症患者为研究对象,所有患者均行全椎板切除加脊柱内固定手术治疗,观察患者手术后疗效以及X线表现的改变。结果①本组术后1个月时椎体间相对距离为0.812±0.048,与术前比较有所增加,差异有统计学意义(P<0.05);椎体间矢状面活动角度、椎体间冠状面活动角度和椎体间水平面活动角度手术前后变化不明显,差异无统计学意义(P>0.05)。②术后疗效,优29例,良18例,中7例,优良率为87.04%。术后随访1～3个月,X线检查显示植骨均融合,内固定未见松动或断裂。结论全椎板切除减压脊柱内固定术治疗老年退行性腰椎管狭窄症,在正确掌握适应症的情况下,可获得满意的效果,既可实现彻底减压的目的,又能维持术后脊柱稳定性。     

经半椎板锁孔显微手术治疗椎管内髓外良性肿瘤（附32例报告）

目的探讨经半椎板锁孔显微手术治疗椎管内髓外良性肿瘤的手术技巧和适应证。方法对32例椎管内髓外良性肿瘤行经半椎板锁孔显微切除术,其中部分哑铃状肿瘤使用神经内镜辅助技术。结果 32例肿瘤中全切除30例,大部分切除1例,近全切除1例,无手术死亡、致残及相关并发症。结论经半椎锁孔显微手术是治疗椎管内髓外良性肿瘤的微创治疗技术,恰当选择适应证、合理利用显微神经外科技术和神经内镜技术可帮助提高疗效。     

椎板减压椎间植骨融合器椎弓根钉棒系统固定融合术治疗老年人退行性腰椎滑脱的疗效分析

目的探讨椎板减压椎间植骨融合器椎弓根钉棒系统固定融合术治疗老年人退行性腰椎滑脱的疗效。方法对本院2010年3月—2012年5月收治的78例退行性腰椎滑脱老年患者的临床资料进行回顾性分析。综合考虑患者身体状况和经济水平等因素后,对36例患者实施椎板减压联合椎间植骨融合术,设为2联组;其余42例患者实施椎板减压椎间植骨融合器联合椎弓根钉棒系统固定融合术,设为3联组。术后对患者进行长期随访,观察并比较2组患者手术前后及随访JOA评分、椎间隙高度、融合率、手术时间、术中出血量和并发症发生率的情况。结果 2联组和3联组患者术后JOA评分相比于治疗前均明显升高(P<0.05),末次随访2联组JOA评分相比于术后差异无统计学意义(P>0.05),而末次随访3联组JOA评分相比于术后明显升高(P<0.05);2联组和3联组患者术后椎间隙高度较治疗前明显提高(P<0.05),末次随访2联组椎间隙高度与术后相比明显下降(P<0.05),而3联组椎间隙高度相比于术后差异无统计学意义(P>0.05);3联组植骨融合率明显高于2联组(P<0.05);3联组手术时间、出血量、并发症均显著高于2联组(P<0.05)。结论椎板减压椎间植骨融合器椎弓根钉棒系统固定融合术用于治疗老年人退行性腰椎滑脱时,可以长期缓解患者的下腰痛症状,提高椎间隙高度。但是,该手术时间长,术中出血量多,导致并发症发生率增加,故在治疗时,应根据患者的身体状况选择合适的手术方式。     

Comparison of Three Methods of Drug Delivery in the Rat Lumbar Spinal Subarachnoid Space

This study aimed to compare three most widely used surgeries for experimental lumbar spinal drug delivery in rats. The comparison consisted of assessing the effects of the surgeries and evaluating the deficits produced by these three methods. Sprague Dawley rats underwent acute needle puncture, chronic catheterization via laminectomy or nonlaminectomized catheterization. Body weight changes were measured, animals' general and neurological conditions were observed after surgeries, and motor function was examined by Rota Rod test both prior to and post surgery. Furthermore, nociceptive tests were performed to assess the animals' nociception; hematoxylin, and eosin staining of lumbar spinal cord tissue was performed to evaluate local inflammation caused by surgeries; and both lidocaine paralysis detection; and toluidine blue dye assay were used to confirm the exact location of the catheter. Both needle puncture and catheterization via laminectomy had relatively low success rate of surgery and induced various neurological signs; more severe motor dysfunction, hyperalgesia, allodynia, and local inflammation. Nonlaminectomized catheterization had a higher success rate of surgery, and induced only mild agitation, slight cerebral spinal fluid leakage, mild sensory and motor abnormalities, and minimum pathology in the lumbar spinal cord. The nonlaminectomized catheterization used in this study induces a phenotype of less detectable effects on the animal's behavior and is well‐tolerated compared to the acute needle puncture and laminectomized catheterization that are widely used in the literature. Nonlaminectomized catheterization is a safe, accurate and effective way for lumbar drug delivery in rats. Anat Rec, 2012. © 2012 Wiley Periodicals, Inc.     

单侧完全性唇腭裂患者前牙区牙槽骨开窗、骨开裂的锥形束CT研究

目的 利用锥形束CT（cone-beam CT,CBCT）研究单侧完全性唇腭裂（unilateral cleft lip and palate,UCLP）患者前牙区牙槽骨开窗、骨开裂的发生率。方法 选取2014年6月—2017年9月就诊于中南大学湘雅二医院的UCLP患者42例（男25例,女17例）。匹配性别和年龄,纳入42例骨性Ⅲ类非唇腭裂患者为对照组。利用CBCT评估UCLP组与对照组前牙区骨开窗和骨开裂的发生率,采用SPSS 22.0软件包对数据进行统计学分析。结果 裂隙侧、非裂隙侧及对照组前牙骨开裂发生率分别为50.88%、42.39%和28.77%。UCLP组裂隙侧上颌前牙同名牙骨开裂的发生率均显著高于对照组（P<0.05）,非裂隙侧上颌侧切牙骨开裂的发生率显著高于对照组（P<0.05）,裂隙侧上颌中切牙骨开裂发生率显著高于非裂隙侧（P<0.05）。裂隙侧、非裂隙侧与对照组前牙区骨开裂均好发于唇侧。骨开窗的发生率在裂隙侧、非裂隙侧及对照组间无显著差异（P>0.05）。结论 在UCLP患者中,牙槽骨开窗和骨开裂较常见,临床治疗中应引起重视。