反序运动联合药物治疗腰椎间盘突出症

目的:观察反序运动联合药物治疗腰椎间盘突出症的疗效.方法:将113例腰椎间盘突出症患者随机分为2组,治疗组58例,对照组55例；治疗组采用反序运动联合药物治疗,对照组采用单纯药物治疗.治疗1个疗程后,参照《中医病证诊断疗效标准》腰椎间盘突出症疗效评定标准对2组疗效进行评定,并比较2组疗效.结果:治疗组疗效优于对照组,差异有统计学意义(Z=2.381,P=0.017)；2组患者均获随访,随访时间1～4年,中位数2年；治疗组复发4例,对照组复发12例.结论:反序运动联合药物治疗腰椎间盘突出症,疗效优于单纯的药物治疗,且反序运动不受时间和场地的限制,练习方便,值得在临床推广应用.     

Rapid Progression of Solitary Plasmacytoma to Multiple Myeloma in Lumbar Vertebra

The prognosis of solitary plasmacytoma varies greatly, with some patients recovering after surgical removal or local fractional radiation therapy, and others progressing to multiple myeloma years later. Primary detection of progression to multiple myeloma is important in the treatment of solitary plasmacytoma. There have been several analyses of the risk factors involved in the early progression to multiple myeloma. We describe one case of solitary plasmacytoma of the lumbar vertebra that was treated with surgical decompression with stabilization and additional radiotherapy. The patient had no factors associated with rapid progression to multiple myeloma such as age, size, immunologic results, pathological findings, and serum free light chain ratio at the time of diagnosis. However, his condition progressed to multiple myeloma less than two months after the initial diagnosis of solitary plasmacytoma. We suggest that surgeons should be vigilant in watching for rapid progression to multiple myeloma even in case that the patient with solitary plasmacytoma has no risk factors for rapid progression to multiple myeloma.     

CT定位像扫描量化定位法的再探讨

目的：探寻一种CTCR像量化定位方法及其公式，材料与方法：使用多种类型的CT机和多种扫描野，应用量化位法及其公式，对胸部，腰椎，髋关节等部位进行量化定位扫描CR像，共计291例。结果：依据各部为CR像质量等级评定标准，对291幅不同部位的CR像进行质量评定和统计，结果显示，胸部，腰椎，髋关节甲级CR像率分别为95％，99％，98％，其CR像扫描成功率均达到100％，结论：CTCR像量化定法及其公式，它适用于国内外多种CT机型，多种扫描野和多项检查部位，能显著提高CTCR像的扫描质量，使CTCR像扫描有了一种科学的质量控制方法。     

Evaluation by quantitative magnetic resonance imaging of trabecular bone quality in mandible and cervical vertebrae

Objective: The purpose of this study was to make a comparison between mandibular and cervical vertebral bone quality (BQ) using quantitative magnetic resonance imaging (MRI). Methods: The cervical MRI images included in this study belonged to 36 patients (23 women, 13 men; mean age 54 years) who had various clinical symptoms (e.g., headache, vertigo, imbalance). The mandible and cervical vertebrae BQ measurements were performed by the same investigator on these sections. Mandibular and cervical vertebral T2^* axial cross sections were performed following receipt of consent from each patient. T2^* relaxation time values were determined in the trabecular area. Results: The relationship between cervical vertebral and mandibular BQ was revealed by regression and correlation analysis. The correlation coefficient was r=0.04, r²=0.002, and P=0.818, which is not statistically significant. The relation between age and mandible BQ was very weak (r=0.001, r²=0.000001, and P=0.995), and the relation between age and cervical vertebrae BQ was correlated (r=?0.585, r²=0.342, and P<0.001). Conclusions: There is a low correlation between the BQ measurements of cervical vertebrae and the mandible. Precise mandibular BQ measurement does not provide information that correlates with BQ in the other sites of the skeleton. Although an age‐dependent decrease occurs in vertebral BQ, no significant alteration occurs in mandibular BQ. To cite this article:
Celenk P, Celenk C. Evaluation by quantitative magnetic resonance imaging of trabecular bone quality in mandible and cervical vertebrae.
Clin. Oral Impl. Res. 21 , 2010; 409–413.
doi: 10.1111/j.1600‐0501.2009.01869.x     

Cross-sectional Area of Lumbar Vertebrae in Peri- and Postmenopausal Patients With and Without Osteoporosis

The purpose of this study was to analyze the midvertebral area of lumbar vertebrae in osteoporotic and nonosteoporotic female patients and to find out whether the midvertebral area may be used as an additional parameter in the diagnosis of osteoporosis. In 195 peri- and postmenopausal patients (average age 51.7 ± 5.2 years) trabecular and cortical bone mineral density (BMD) were determined using quantitative CT (QCT) in L2–4. In addition, midvertebral cross-sectional area was measured in a standardized fashion on the CT sections and the height of the second lumbar vertebra was determined on the lateral digital radiographs. Body height and weight were obtained and vertebral fracture status was determined. According to WHO criteria 29 patients (average age 57.2 years) were considered osteoporotic, 93 osteopenic (average age 52.2 years) and 73 normal (average age 48.6 years). Body weight and size did not show significant differences between the individual groups. Average midvertebral area was 1278 ± 173 mm² in the osteoporotic patients, 1186 ± 125 mm² in the osteopenic patients and 1126 ± 127 mm² in the normals. A correlation of r=−0.39 (p<0.05) was obtained between BMD and area. Thirty-six of 195 patients showed osteoporotic vertebral fractures. Midvertebral area in these patients was 1266 ± 171 mm² versus 1159 ± 133 mm² in the nonfractured females (p<0.05). We therefore conclude that the lumbar midvertebral area is larger in osteoporotic and osteopenic patients compared with women with normal BMD. In contrast to biomechanical considerations midvertebral area seems not to be suited as an additional measure of bone strength in vivo. Received: 8 March 1999 / Accepted: 15 September 1999     

Stanford B型主动脉夹层术中主动脉内膜脱套的腔内处理策略

术中主动脉内膜脱套（AII）是胸主动脉腔内修复术（TEVAR）术中一种罕见但致命的并发症，补救处理难度大且易漏诊、误诊、误判，正确识别术中AII并快速有效地给予治疗是一大挑战。术中AII属于继发性AII，具体病因仍不明确，可能与手术操作原因和潜在的主动脉病变等原因相关。本文结合相关文献及临床诊疗经验，对主动脉夹层患者TEVAR术中AII的发生原因、分型、诊断评估要点及紧急腔内处置方法等进行介绍和探讨。首先，笔者提出基于脏器血流灌注的细化分型方案：即在原分型的基础上增加脏器分支缺血严重程度的评价，依据术中数字减影血管造影显示的脏器分支灌注情况细分为a、b两个亚型。新分型法的优势在于除了可以区分脏器缺血严重程度，还可用于指导腔内紧急处置策略。第二，对于疑诊术中AII的患者，需要进行术中详细造影确定分型。笔者建议分三步完成主动脉支架近端、支架远端造影及腹主动脉真腔内造影，这有助于明确近端锚定区的稳定性以及术中AII类型，确定灌注不良的脏器分支、严重程度及缺血阻塞类型，对下一步采取的补救措施至关重要。最后，腔内补救支架治疗效果良好且具备创伤小、术后恢复快等优势，已成为术中AII治疗的首选；腔内补救支架治疗应按照先近端再远端、先主干再分支的顺序进行。针对重建支架远端胸腹主动脉真腔血供，现有主流方案存在一定局限性，笔者推荐采用“两步法”方案重建主动脉真腔血供，该方案可以避免脱套内膜进一步向远端撕脱。     

Acute pancreatitis complicating anterior lumbar interbody fusion

Postoperative pancreatitis may occur following surgery in regions remote from the pancreas and the biliary tree. Though uncommon, it carries a high mortality rate. Pancreatitis complicating spinal surgery is extremely rare. This report describes a case of acute pancreatitis following an anterior lumbar interbody fusion and discusses the possible mechanisms of pancreatic cellular injury. Received: 17 May 1999/Revised: 6 December 1999/Accepted: 16 December 1999     

Internal comparative audit in a thoracic surgery unit using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM)

Objective: The aim of the study was to use the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) to assess the performance of our thoracic surgery unit during two successive periods of activity. Methods: From 1992 through 1997, 801 candidates for thoracic procedures at our institution were considered for the study. After validation of the logistic regression model, including the POSSUM score, observed and POSSUM-predicted morbidities were compared within two groups of patients divided by year of operation (group 1: 1992–1994, n=362; group 2: 1995–1997, n=439) by means of the z-test for the comparison of a proportion with an expected value. Results: The POSSUM-predicted morbidity was significantly lower than the observed one in the first period of activity of our unit (19.6 vs. 24.3%, respectively; z-test for the comparison of a proportion with an expected value, 2.25; P=0.01), whereas no difference was found in the second period (20.5 vs. 19.1%, respectively; z-test for the comparison of a proportion with an expected value, −0.71; P=0.76). Conclusions: The result suggests a worse-than-expected performance of our unit in the first period of activity, showing that POSSUM can be reliably applied as an instrument of internal comparative audit in a thoracic surgery unit.     

70岁以上老年人开胸手术的围手术期处理

目的探讨老年人开胸手术期的处理。方法总结46例70～84岁老年人围手术期的临床经验。结果术后并发心律失常31例，心功能不全7例，腔隙脑梗塞1例，肾功能不全1例，肝功能不全1例，均有不同程度的ALI，其中9例符合ARDS，应用容许性高碳酸血症机械通气治疗而愈。结论老年人开胸手术并存症、并发症高，术前必须最大限度的改善患者的全身情况，对麻醉、手术及术后处理均提出较高要求，尤以心肺并发症为术后防治重点，容许性高碳酸血症机械通气治疗在一定程度上改善了ARDS患者的预后。