婴幼儿脊髓栓系松解术的手术配合

婴幼儿脊髓和脊柱末端的各种先天性发育异常均可导致脊髓栓系,如隐性脊柱裂、脊膜膨出、脊髓脊膜膨出、腰骶椎管内脂肪瘤等,脊髓栓系使脊髓末端发生血液循环障碍,出现相应的神经症状,脊膜膨出或脊髓脊膜膨出患儿往往早期即出现尿失禁症状,且随患儿年龄增长而逐渐加重,松解栓系修补脊膜膨出,可防止畸形进展.所以提倡早期手术[1]我院在2000年1月至2007年12月为48例腰骶部脊膜、脊髓脊膜膨出患儿行脊髓栓系松解及脊膜修补术,效果良好,现将手术配合体会介绍如下.     

儿童脊髓栓系综合征的MRI诊断

目的探讨儿童脊髓栓系综合征（TCS）的MRI影像学特点，提高对谊痛的诊断水平。方法回顾性分析15例经手术病理证实的儿童脊髓栓系综合征患者的MRI资料。结果本组TCS中单纯型脊髓栓系者2例。复杂型脊髓栓系13例，其中合并脊柱裂脊膜膨出、脊髓脊膜膨出及脂肪脊髓脊膜膨出9例，合并脊髓纵裂1例，合并椎管内脂肪瘤4例，合并骶管囊肿2例。结论MRI可以作为TCS诊断的首选影像方法，为儿童脊髓栓系综合征患者的手术治疗提供可靠依据。     

先天性脊膜脊髓膨出50例治疗体会

我院1970～1983年收治脊膜脊髓膨出50例,现将治疗体会介绍如下。临床资料男22例,女29例。年龄4周至5岁,大多数<6个月。病变部位:颈部6例,腰部9例,腰骶部35例。病变类型:单纯脊膜膨出24例,脊膜脊髓膨出20例,脊膜膨出合并脂肪瘤6例。神经症状:因不易     

脊髓栓系综合征的手术治疗方法探讨

根据脊髓栓系综合征的病理基础探讨其手术方法。方法；基于本症的病理基础和神经功能恢复的潜力，用显微神经外科技术，扩大椎板切除减压，分离松解园锥，马尾束，切断终丝和脊膜膨出修补等。结果；对脊柱裂伴黄韧带增厚，牵拉终丝，泌尿系症状较轻者其手术效果良好。     

脊髓栓系综合征35例手术疗效与预后分析

目的探讨脊髓栓系综合征(TCS)的病因、病理、手术疗效及处理要点。方法分析35例TCS患者的临床资料和治疗效果,本组均行MRI检查确诊,手术切除脂肪瘤或切除瘢痕、松解粘连、切断终丝,使TCS得到松解。结果32例得到随访,单纯双下肢软瘫的3例患者中1例治愈,2例好转;29例尿失禁患者中5例治愈,13例明显好转,11例无变化。结论TCS患者应尽早行松解术,显微镜下操作能够提高疗效。对脊髓脊膜膨出患儿均应行MRI检查,在脊膜修补的同时行TCS松解术。     

成人原发性脊髓拴系综合征的分型及显微外科手术治疗

目的：总结成人原发性脊髓拴系综合征(tethered cord syndrome, TCS)的临床特点、分型及手术治疗经验。方法：回顾性分析2007年3月至2019年10月北京大学第三医院手术治疗的171例成人原发性TCS患者的临床资料，男性61例，女性110例，年龄18～65岁，平均年龄(39.02±11.81)岁，主要症状为腰腿痛、双下肢麻木无力和大小便功能障碍。按照临床特点及医学影像学分为5型：终丝牵张型(69例)、脊髓纵裂型(21例)、脊髓脊膜膨出型(20例)、脂肪脊髓脊膜膨出型(36例)、皮窦道型(25例)。对不同类型的TCS采取相应的显微手术治疗，以Kirollos分级评定手术拴系松解程度，以视觉模拟疼痛评分(visual analogue scale, VAS)评估疼痛情况，采用关键肌肉力量0～5级评分评价下肢运动功能，用日本骨科协会(Japanese Orthopaedic Association, JOA)括约肌功能评分评价膀胱功能。结果：171例患者均经显微手术松解粘连，切断终丝，其中61例将伴随病灶也分离切除。脊髓拴系均达到KirollosⅠ级松解，均重建硬膜囊。...     

显微镜下脊膜囊减压马尾神经剥离术治疗腰骶部脊膜膨出并二便失禁

先天性腰骶部脊膜膨出症以往采用单纯脊股膨出切除，修补的治疗方法。对于合并有二便失禁等脊髓控系综合征的病人来说，还远不能达到满意疗效。由于二便失禁，下肢运动受限及由于神经营养不良所致感觉障碍，皮肤粗糙，褥疮等症状，给病人带来了很大痛苦、我们采用了显微镜下脊膜囊减压，马尾神经剥离术，疗效满意，现报道如下：临床资料本组病人23例，男10例，女13例，年龄：5月－33岁，平均年龄10．6岁。其中13例病人系二次手术。全部病人均有不同程度二便失禁，5例合并有下肢功能障碍，畸形4例合并有经久不愈的褥疮。术后病人二便失禁均有…     

脊膜膨出的显微外科治疗

作者对1980～1991年9月收治的14例已有逐渐加重的大,小便障碍和肢体瘫痪的脑脊膜膨出(MC)和脊髓脊膜膨出(MMC),在常规修补术的同时,应用手术显微镜作椎管内减压,脊髓神经松解和终丝切断。结果:1例脊柱侧弯,术中证实并发栓系综合征和脊髓脂肪瘤,术后脊柱屈曲,大、小便失控,下肢轻瘴均明显好转,1例出院后失访外,13例术     

显微手术治疗脊髓脊膜膨出的疗效及影响因素分析(附532例报告)

目的探讨脊髓脊膜膨出的显微外科疗效。方法选择532例脊髓脊膜膨出患者,均行神经系统检查及MRI检查。采用显微外科手术治疗,比较手术前后尿动力学、神经电生理及膀胱B超等检查结果。术后疗效按显效、有效、无效和加重进行评定。结果按Kirollos术中松解分级评定方法519例（97.6%）达到Ⅰ级,11例（2.0%）达到Ⅱ级,2例（0.4%）为Ⅲ级。手术近期疗效,显效81例（15.2%）,有效321例（60.3%）,无效125例（23.5%）,加重5例（0.93%）。结论早期手术可避免患者严重残疾,MRI检查、尿动力学以及神经电生理、术中使用显微镜可提高脊髓拴系综合征的疗效。     

小儿腰骶脊膜膨出治疗方法探讨

小儿腰骶部脊膜膨出是临床常见的小儿神经管发育畸形.其病因尚不明了,可能与放射线,缺氧有关.脊柱裂通常表现为棘突及椎板缺损.有隐性和显性两大类:隐性脊柱裂,其发病率占人口1%～1.5%.北方高于南方,农村高于城市.临床上包括无明显神经症状的单纯性脊膜膨出和具有神经障碍的脊髓脊膜膨出,有的还合并先天性椎管内肿瘤.我科采用脊膜膨出切除+椎管扩大神经松解+脊膜修补[1],治疗小儿腰骶部脊膜膨出取得满意疗效,现报道如下.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.