颈椎终板弧形高度与椎间隙后缘骨赘的相关性研究

目的：通过对颈椎病患者上下终板弧形高度、椎间隙高度与椎间隙后骨赘的影像学测量，研究其相关性及其临床应用价值。方法：收集2017年9月至2018年9月颈椎病手术108例患者的临床资料，男48例，年龄30~72岁，平均52岁，女60例，年龄37~79岁，平均54岁。其中C_2，3 6例，C_3，4 15例，C_4，5 32例，C_5，6 42例，C_6，7 13例。术前及术后摄颈椎X线片，利用PACS（Picture Archiving and Communication Systems）调阅影像，测量椎间隙的下上终板弧形高度（L₁，L₂），椎间隙高度（L₃）及后方骨赘的宽度（L₄）。利用Spearman分析它们之间的相关性。结果：L₁与L₄对比（r=-0.34，P<0.05），L₃与L₄对比（r=-0.36，P<0.05），存在负相关。L₁与L₃对比（r=0.38，P<0.05），L₂与L₃对比（r=0.48，P<0.05），存在正相关。L₁与L₂对比（P>0.05），L₂与L₄对比（P>0.05），差异无统计学意义。结论：下终板弧形高度与椎间隙后缘骨赘宽度呈负相关，通过其测量可明确颈椎退变程度，对颈椎病的早期防治有指导意义。     

Herpes zoster ophthalmicus and the orbital apex syndrome

Herpes zoster ophthalmicus (HZO) commonly causes isolated ophthalmoplegic syndromes. Visual loss caused by optic neuritis secondary to HZO can be reversible or irreversible. HZO rarely presents as an orbital apex syndrome, when an association with meningo-encephalitis has been reported. We report a case of orbital apex syndrome secondary to HZO treated with systemic steroids and acyclovir. Our patient suffered no systemic complications and displayed a rapid resolution of optic neuropathy. We discuss this case in the light of previous reports and explore the possible pathogenic mechanisms involved.     

定量组织速度成像对右室起搏患者左室收缩运动的研究

目的　应用定量组织速度成像 (QTVI)评价右室心尖起搏 (RVAP)VVI型对左心收缩功能的影响。方法　应用GEVivid 7彩色多普勒超声显像仪对 2 0例RVAP患者和 2 0例正常人的心尖四腔切面的室间隔和左室外侧壁速度和位移曲线进行观察 ,测量心电图Q波分别至室间隔和左室外侧壁收缩期峰速度的时间 ,并除以R R间期进行校正。结果　QTVI显示右室起搏器置入者的室间隔与左室外侧壁速度曲线的收缩期S波非同步出现。Q波至室间隔收缩期峰速度的时间短于Q波至左室外侧壁收缩期峰速度的时间 ,两者分别为 ( 0 .12± 0 .0 2 )s和 ( 0 .14± 0 .0 2 )s,P <0 .0 5。结论　右室起搏后早期的左室整体收缩功能虽未见明显下降 ,但QTVI可以发现室间隔与左室壁收缩明显的不协调 ,可作为早期分析左室收缩运动的定量方法。     

右室心内膜流入道永久性起搏电极植入的体会

目的 :探讨右室心内膜永久性起搏电极植入术中 ,心尖部起搏与流入道起搏二者在术中起搏参数比较 ,以及流入道起搏电极植入方法。方法 :选择本院行永久性心脏起搏器安置术的 67例患者为研究对象 ,在右室心尖部起搏电极不易固定或测试起搏参数不理想时 ,改为右室流入道起搏 (12例 )。结果 :①右室心尖部及流入道两种位置起搏阈值、R波振幅、心肌阻抗比较无显著性差异 ;②术后随访 2～ 14个月两组病例均未发生电极脱位、感知异常、膈肌收缩。结论 :①右室流入道起搏与心尖部起搏一样是电极植入的有效部位 ;②右室流入道起搏与心尖部起搏一样心室电极植入技术简单易行     

Infracture Technique for the zygomatic body and arch reduction

In the Orient, prominent malar regions are considered unaesthetic and the majority of women with a prominent malar want to reduce the zygoma. Various operative procedures such as shaving or chiseling the zygomatic body or the zygomatic arch have been used for reducing malar eminence, but the zygomatic arch cannot be reduced sufficiently by these methods. By combining intraoral shaving of the zygomatic body and a new effect arch infracture technique through a temporopreauricular incision, we have obtained very satisfactory results in 19 cases and notable minimal complications over the last three years.     

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。     

Endplate channel actions of a hemicholinium-3 analog,DMAE

Summary The effect of the hemicholium-3 analog, DMAE, on endplate currents (EPC) was investigated in the transected cutaneous pectoris muscle of the frog using a conventional two-microelectrode voltage clamp. At a low concentration (5 M), DMAE produced a long-lasting decrease in the rate constant of decay () and an increase in the peak current amplitude (Ip). At higher concentrations (10–100 M), DMAE produced biphasic changes characterized by a transient, marked decrease of and increase of Ip followed by a long-lasting marked increase of and decrease of Ip. When DMAE was removed from the bath recovery from block was asymmetrical in that recovered more quickly than did Ip. Pretreatment with neostigmine or collagenase partially antagonized the initial effects without affecting the steady state effects of DMAE, indicating that the initial effects of DMAE may be, at least in part, due to inhibition of the enzyme acetylcholinesterase. The drug reverses the normal voltage dependence of without altering the single exponential nature of decay of the EPC. The inward EPC was more markedly blocked than outward EPC, resulting in a highly non-linear current-voltage relation with Ip decreasing with increasing hyperpolarization. This effect may indicate that DMAE causes a voltage-dependent block of closed acetylcholine-activated ion channels.     

尖头梅花髓内针与带锁髓内针治疗胫腓骨骨折比较

目的　比较改良的尖头梅花针与带锁髓内针治疗胫腓骨干骨折的临床综合疗效 ,正确选取内固定物。方法　分别用改良的尖头梅花针与带锁髓内钉内固定治疗胫腓骨干骨折 74例 ,比较两组的综合疗效。结果　改良梅花针组 48例 ,轻度外旋畸形 2例 ,无骨不愈合 ,平均骨折愈合时间 3.5个月 ,平均手术时间 40 mim ,住院费用 30 0 0元 (人民币 ) ,优良率93.75 % ;带锁髓内钉组 2 1例 ,发生骨延期愈合 2例 ,平均骨折愈合时间 5个月 ,平均手术时间 6 0 mim ,住院费用 5 5 0 0元(人民币 ) ,优良率 95 .2 4%。除胫骨远端下 1/ 3或严重的粉碎性骨折外 ,两组疗效无明显差异 (P >0 .0 5 )。结论　改良尖梅花针内固定操作简单、价格低廉、疗效确切 ,仍有较高的临床使用价值 ;带锁髓内钉能满足胫骨各种类型的骨折 ,扩大了髓内固定的适应症 ,随着成本的降低 ,已逐渐成为治疗胫腓骨骨折髓内固定的方向。     

Intracranial Extension of Acquired Aural Cholesteatoma

Objective Cholesteatoma of the petrous bone extending into the intracranial region is an unusual occurrence. Most cases have been attributed to secondary extension of a primary epidermal blastomatous malformation of the temporal bone into the middle or posterior fossae. Within the past two and a half decades, intracranial extension of acquired aural cholesteatoma has been recognized as a likely alternative to this mechanism. Recent literature has rejoined this observation by considering both primary and secondary cholesteatoma of the petrous bone as a single group, petrosal cholesteatoma. The present study is presented to analyze the clinical presentation, imaging findings, and surgical treatment of six patients with acquired aural cholesteatoma extending into the intracranial region. Findings in this study are compared with the extant literature on congenital and acquired cholesteatoma of the petrous bone. This study proposes that petrosal cholesteatoma is a valid anatomical construct; however, the pathogenesis of petrosal cholesteatoma is still important in understanding the clinical presentation and management of cholesteatoma that extends beyond the usual confines of the middle ear and mastoid. Study Design Retrospective case review conducted at a tertiary referral center. Methods From 1985 to 1999, 477 patients were surgically treated for acquired aural cholesteatoma. Patients with intracranial extension of cholesteatoma were studied. Clinical presentation, imaging studies, operative findings, surgical treatment, and postoperative results were evaluated. Results Six cases in a series of 477 patients with acquired aural cholesteatoma had intracranial extension of disease. In this series, the most frequent pathway for intracranial extension was supralabyrinthine through the supratubal recess into the middle cranial fossa. A less frequent pathway was via the retrofacial air cells into the posterior cranial fossa. Surgical access for removal of intracranial cholesteatoma was accomplished through several approaches including translabyrinthine, transcochlear, retrolabyrinthine, and middle cranial fossa. In two patients who had reoperation for possible residual disease, one was free of residual disease and one was found to have residual cholesteatoma in the region of the horizontal facial nerve. Conclusion Acquired aural cholesteatoma can extend into either the middle or posterior cranial fossae. In this study, cholesteatoma extended into the middle fossa through the supratubal recess along the labyrinthine facial nerve and into or above the internal auditory canal. A less frequent path is through the retrofacial air cells into the posterior fossa. Intracranial acquired cholesteatoma is generally small and presents with complaints related to underlying otitis media rather than the neurological deficits that are often associated with primary petrous bone cholesteatoma. While computed tomography and magnetic resonance imaging are both required to differentiate congenital petrous cholesteatoma from other lesions of the petrous bone, computed tomography of the temporal bone is usually sufficient to diagnosis and define intracranial extension of acquired aural cholesteatoma. These lesions can be completely excised rather than exteriorized.     

腰椎斜外侧椎间融合术后融合器沉降的原因分析

目的:观察斜外侧椎间融合(oblique lateral interbody fusion,OLIF)治疗腰椎病变术后融合器沉降现象,总结融合器沉降特点,并分析其原因,提出预防性措施。方法:回顾性分析2015年10月至2018年12月收治的144例腰椎病变资料,其中男43例,女101例;年龄20~81(60.90±10.06)岁;腰椎间盘退行性病变17例,巨大型腰椎间盘突出12例,椎间盘源性腰痛5例,腰椎管狭窄症33例,腰椎退行性滑脱26例,腰椎椎弓峡部裂伴椎体滑脱28例,腰椎内固定术后邻椎病11例,炎症转归期原发性椎间隙炎7例,腰椎退行性侧后凸5例。术前双能X线骨密度检查提示存在骨量减少或骨质疏松57例,骨密度正常87例。融合节段数:单节段124例,2节段11例,3节段8例,4节段1例。采用Stand-alone OLIF 40例,OLIF联合后路椎弓根螺钉固定104例。记录术后融合器沉降的发生情况,对可能风险因素进行单因素分析,观察融合器沉降对于临床结果的影响。结果:所有手术顺利完成,手术时间中位数99 min,术中出血量中位数106 ml;术中发生终板损伤30例,合并椎体骨折5例。所有患者获得随访,时间6~30(14.57±7.14)个月。随访过程中除原发性腰椎间隙炎病例、部分腰椎椎弓峡部裂伴椎体滑脱病例,其余出现不同程度的融合器沉降现象,其中正常沉降119例,异常沉降25例(Ⅰ级23例,Ⅱ级2例)。未出现椎弓根螺钉系统松动或断裂现象,椎间隙高度由术前的(9.48±1.84) mm恢复至术后3~5 d的(12.65±2.03) mm及末次随访时的 (10.51±1.81) mm,术后3~5 d与术前比较、末次随访与术后3~5 d比较差异均有统计学意义(P<0.05)。椎间融合率为94.4%(136/144)。腰痛和腿痛视觉模拟评分(visual analogue scale,VAS)分别由术前的(6.55±2.29)、(4.72±1.49)分降低至末次随访时的(1.40±0.82)、(0.60±0.03)分(P<0.000 1);ODI由术前的(38.50±6.98)%恢复至末次随访时的(11.30±3.27)%(P<0.05)。并发症发生率为31.3%(45/144),再手术率9.72%(14/144),其中因融合器沉降或移位而再次手术8例,占再手术的57.14%(8/14)。单因素分析结果显示:在骨量减少或骨质疏松组、Stand-alone OLIF组、2节段或以上融合组、终板损伤组中其异常沉降例数分别高于骨量正常组、OLIF联合椎弓根螺钉固定组、单节段融合组、终板无损伤组。结论:融合器沉降是OLIF术后较为常见的现象,术前骨量减少或骨质疏松、Stand-alone OLIF应用、2节段或以上融合和术中终板损伤可能是术后融合器沉降的重要因素。虽然融合器沉降程度与临床症状无明显相关,但存在融合器移位的风险,需要加强预防,以降低因融合器沉降而带来的严重并发症,包括再手术。