防止椎板切除术后硬脊膜外瘢痕粘连的实验研究

作者在４个平面间隔切除１１只山羊的椎板，分别用硅胶膜、自体游离脂肪片、带蒂肌肉瓣覆盖硬脊膜，一处平面作空白对照。术后４个月组织学检查，结果显示，硅胶膜后方有少许瘢痕组织增生，间质中有炎细胞灶状浸润，硅胶膜与硬膜囊无瘢痕形成，新形成的椎管后壁光滑，硬膜囊无受压；脂肪片被纤维组织取代，周围纤维组织增生轻微，形成菲薄之纤维膜，与硬脊膜容易分离；带蒂肌肉瓣周围形成较多瘢痕与硬脊膜粘连重，肌肉瓣已完全纤维化，空白组形成瘢痕最多，与硬脊膜粘连最重。术后硬膜囊矢状径以硅胶膜组最大，脂肪片组次之，带蒂肌肉瓣组再次之，空白组最小。作者认为，硅胶膜与脂肪片能明显防止椎板切除术后纤维瘢痕粘连对硬膜囊的压迫，在支架诱导作用方面，硅胶膜优于脂肪片，在生物相容性方面脂肪片优于硅胶膜。带蒂肌肉瓣优于对照组，但不及前两者。     

鞍旁硬膜间腔岩尖入路治疗三叉神经鞘瘤

目的探讨鞍旁硬膜间腔岩尖入路显微手术治疗三叉神经鞘瘤的疗效。方法利用鞍旁硬膜间腔岩尖入路对中颅窝型、中后颅窝哑铃型三叉神经鞘瘤12例进行了显微手术治疗,对术中解剖、手术技巧及疗效进行分析。结果鞍旁硬膜间腔岩尖入路能充分暴露肿瘤,肿瘤全切除9例,次全切除3例;经病理学检查均为神经鞘瘤。术后颅神经功能障碍较术前改善。结论鞍旁硬膜间腔岩尖入路能安全切除肿瘤,提高手术切除率,减少术后并发症。     

Iatrogenic Creutzfeldt–Jakob disease subsequent to dural graft: persisting risk after 1987

The first case of Creutzfeldt-Jakob disease (CJD) related to the use of a dura mater graft of cadaveric origin was identified in 1987 and this procedure is now considered as one of the main causes of iatrogenic CJD. Although the decontamination procedure for the preparation of graft material was modified, the product was withdrawn from the market in many countries a few years later and replaced by synthetic material. In this context, two patients treated in our institution developed CJD following a cadaveric dural graft performed after cerebral and lumbar trauma. Their clinical presentation, showing predominant cerebellar symptoms, late deterioration and myoclonic jerks, and a rapid disease course until death, was similar to that of previously reported cases involving the iatrogenic form. As the graft for one of the patients was performed in 1991 (several years after modification of the decontamination procedure), this fourth reported case suggests that the risk of iatrogenic CJD may have persisted in some patients treated after 1987, when grafts of cadaveric origin were totally abandoned.     

异体硬脊膜桥接周围神经缺损的实验研究

探讨异体硬脊膜修复周围神经缺损的可行性。方法：采用狗的异体硬脊膜桥接缺损２ｃｍ的狗腓总神经，对照组仅切取２ｃｍ神经而不作处理。在术后不同时间段作大体观察、神经电生理检测、光镜利电镜检查。结果：再生神经纤维在管腔内呈纵行整齐排列Ｔ偕窬宋峤岣弧＝崧郏菏5验结果证实异体硬脊膜能成功地引导周围神经再生。     

MR imaging of dural arteriovenous malformations with ocular signs

Summary Four patients with dural arteriovenous malformation (AVMs) draining into the cavernous sinus, who presented ophthalmic manifestations, were studied by magnetic resonance (MR) imaging. In all patients signal decrease in the involved cavernous sinus was demonstrated in coronal spinecho (SE) imaging. It is attributable to rapid venous flow in the sinus, and this high velocity signal loss is a fairly pathognomonic finding in this condition. We stress the validity of MR imaging in the primary diagnosis of dural AVMs with ophthalmic symptoms.     

康脑液对脑缺血再灌注损伤大鼠软脑膜微循环的影响

目的 探讨康脑液对脑缺血再灌注损伤大鼠软脑膜微循环的干预作用.方法 大鼠分为2组,干预组每日以康脑液灌胃,对照组以生理盐水代替,连续18 d后,采用颈动脉引流法复制脑缺血再灌注损伤模型,用活体显微电视录像技术,观察软脑膜微循环变化,并以田牛氏加权积分法对流态进行分析.结果 ①康脑液可改善脑缺血再灌注时软脑膜微血流的流态：造模前微血流速度快,细动脉为线流,细静脉为线粒流,无红细胞聚集,两组间未见统计学差异（P〉0.05）.造模后模型组微血流速度显著变慢（P〈0.01）,多为粒流及粒缓流,重度红细胞聚集;微动脉血流明显减少,再灌注后渗出明显.康脑液组微血流速度也变慢,但流态变化较轻（P〈0.05）,多为线粒流及粒线流,红细胞聚集及渗出也较轻,其流态积分值显著低于模型组（P〈0.05～0.01）.②康脑液可拮抗脑缺血再灌注时微血管口径的收缩：造模后模型组微血管立即收缩,细动脉以脑缺血15～30 min及再灌注后15～120 min、细静脉以脑缺血15 min收缩显著（P〈0.05～0.01）,而康脑液组微血管口径变化不明显（P〉0.05）.两组比较,康脑液组软脑膜微血管口径缩窄明显较轻（P〈0.05～0.01）.③康脑液可改善脑缺血再灌注时毛细血管的关闭：造模后虽两组毛细血管交点计数均减少（P〈0.01）,但模型组可见毛细血管大量关闭,而康脑液组毛细血管交点数显著多于模型组（P〈0.05～0.01）.结论 康脑液能减轻大鼠脑缺血再灌注时软脑膜微循环障碍,表现为对脑缺血再灌注时的微血流变慢、红细胞聚集、微血管口径缩窄及毛细血管关闭具有很好的干预作用.     

内皮素对失血性休克鼠脑微循环的影响及尼莫地平、川芎嗪的治疗作用

利用大鼠颅骨开窗观察脑软膜微循环的方法研究了内皮素（ＥＴ－１）从１０－７～１０－１０Ｍ对脑软膜微循环的影响以及失血性休克时脑软膜对ＥＴ－１的反应性。并用１０－７Ｍ造成失血性休克后脑血管痉挛的模型，观察尼莫地平、川芎嗪、６５４－２内对皮素引起血管痉挛的治疗作用。结果显示：１０－９、１０－８、１０－７Ｍ三种浓度ＥＴ－１可使脑软膜小动脉、细动脉强烈收缩，收缩率分别为２７．７％、１６．８％、７８．５％，其收缩强度与ＥＴ－１的浓度有关。对静脉的作用不明显。１０－１０ＭＥＴ－１可使细动脉轻度扩张。出血性休克时，脑软膜血流明显减慢，小动脉、细动脉管径对ＥＴ－１的收缩作用更敏感，脑组织血流明显减少。尼莫地平具有较好的拮抗ＥＬ－１引起脑软膜动脉的收缩和改善局部微循环的作用。川芎嗪也能拮抗ＥＴ－１引起脑软膜动脉的收缩，但作用较尼莫地平弱。６５４－２不能缓解ＥＴ－１对脑软膜动脉的收缩作用。     

椎板切除；脊柱；硬膜；粘连；预防

目的观察应用可吸收医用膜预防椎板切除术后硬膜外粘连的效果.方法在14例患者行椎板切除减压后,于硬膜外放置可吸收医用膜,并定期随访观察.结果全部患者的切口均一期愈合,无不良反应,防粘连效果优良.结论可吸收医用膜是一种良好的预防硬膜外粘连的材料.     

冻干人硬脑膜用于修补硬脑膜缺损和血管内栓塞治疗的临床观察

目的：探讨用冻干人硬脑膜行硬脑膜成硬脊膜缺损修补和血管内栓塞治疗的效果。方法：用冻干人硬脑膜修补因脑肿瘤、脑外伤、脊髓内肿瘤手术引起的硬脑膜或硬脊膜缺损,并不同规格的的冻干人硬脑膜微粒或微丝行靶血管栓塞。结果：（１）冻干人硬脑膜用于硬脑或硬脊膜缺损修补患者２２９例,无颅仙感染等并发症,用于血管内栓塞靶血管２８例,可明显减少或闭塞颅内肿瘤的血供。结论：冻干人厝脑膜是一种较为理想的硬脑膜缺损修补和血管