后路一期椎体全切除治疗胸椎椎体肿瘤

目的探讨后路一期手术治疗胸椎肿瘤的疗效及方法。按脊柱肿瘤来源可分为原发肿瘤,转移肿瘤。方法 8例胸椎骨肿瘤患者实施后路全脊椎切除重建术。经胸椎后入路行单椎节切除6例,双椎节切除2例,均采用Harm钛网植骨/钛网骨水泥联合TSRH/MOSS/CDH M12椎弓根钉内固定系统重建。结果随访3个月3.5年,平均23个月。7例术后近期疗效较满意,局部疼痛和神经症状均有不同程度改善或缓解;4例脊髓神经功能完全恢复;1例术后1.5年局部复发;术后18个月死亡1例。结论胸椎后路全脊椎切除能显著降低胸椎骨肿瘤局部复发率,改善脊髓神经功能,提高手术疗效。钛网植骨/钛网骨水泥联合椎弓根螺钉系统能有效重建脊柱的前后柱稳定,同时可减少创伤、缩短手术时间、减少并发症的发生。     

脊髓血管畸形的早期诊断与治疗

脊髓血管畸形是一种先天性疾患或脊髓血管发育异常。由于本病无特殊临床表现,故早期诊断较困难,国内大宗报道亦较少。现将本院1989年11月～1991年7月收治的3例脊髓血管畸形报道如下。1临床资料 病例1:柯××,男, 46岁。疑为胸椎管狭窄症于1989年11月27日入院。患者于入院前4个月不明原因腰痛,渐加重伴双下肢麻木,入院前3周始有双下肢运动障碍。查体:下胸椎及上腰椎棘突压痛,T10平面以下针痛觉减退,双下肢不完全软瘫,跟、膝腱反射消失,病理反射阴性,肛门括约肌松弛,留置导尿。胸腰椎平片未见异常。胸椎2次CT扫描示局限性椎体后缘骨质增生,…     

胸椎黄韧带骨化症合并硬膜骨化3例报告

胸椎黄韧带骨化症临床报告较多 ,而胸椎黄韧带骨化同时累及硬膜骨化者少见 ,这类患者手术治疗难度较大。自 1992～ 1998年手术治疗 3例 ,报告如下。1　临床资料　 3例中男 2例 ,女 1例。年龄 46～ 6 2岁 ,病程 2个月～ 3年 ,均无明显外伤史。患者主要症状是进行性的双下肢麻木、无力、不灵活、行走不稳、足底踩棉感等。 2例有腹部束带感 ,1例大小便障碍 ,1例下肢灼样痛。体征主要有 :下肢肌力减退 3例 ,出现明显感觉平面 3例 ,锥体束征阳性 3例 ,相应节段胸背叩痛 1例 ,下肢放射痛 1例等。X线片均见相应节段棘突间隙从椎管后壁起自椎板和关…     

胸椎小关节紊乱引起右胁部疼痛的临床观察

右胁部疼痛常见于肝胆疾病 ,但我们在临床治疗中常发现一部分右胁部疼痛不适的患者是因下胸段胸椎关节紊乱所引起的神经刺激症状 ,经采用推拿手法治疗 ,取得了满意的疗效。1　临床资料1.1　一般资料　本组 18例 ,男 5例 ,女 13例 ;年龄 2 8～ 5 1岁 ,平均年龄 37 2岁 ;病程 3天～半年。1.2　临床表现与诊断　 (1)患者感到右胁部疼痛不适 ,有时疼痛延向腰背部 ,深呼吸或活动腰背部有时感到疼痛加重 ;(2 )肝胆无明显的相应体征 ,肝功能、Ｂ超检查肝胆无异常 ;(3)查Ｔ7～Ｔ12 棘突间、棘突旁、横突、肋间隙可有明显压痛 ,有时有沿肋间隙放射痛 …     

颈椎转移性骨肿瘤的手术治疗

目的：探讨颈椎转移性骨肿瘤的临床表现和治疗等。方法：对29例患者（枢椎3例，下颈椎26例）的临床表现，手术适应证，外科治疗进行分析，结果：术后随访6个月－5年，1例枢椎肿瘤术后症状无改善，呼吸衰竭死亡；25例术后局部疼痛，神经根痛缓解甚至消失，神经压迫症状改善或缓解；3例患者分别于13、19、25个月后因全身多处转移、衰竭死亡，结论：颈椎转移必骨肿瘤多数患者表现为疼痛，部分患者有神经损害的表现，手术必须考虑全身情况，限于颈椎不稳，神经功能进行性损害，疼痛剧烈，或原发灶不明，手术作为明确病理诊断以指导进一步治疗的患者，根据肿瘤侵犯悦位，患者耐受手术情况，预期寿命等选择前路，后路或前后路的一期或二期手术，手术能够稳定和重建颈椎减轻或消除患者的疼痛，维持或改善神经功能，从而改善患者的生活质量。     

异位促肾上腺皮质激素综合征的临床分析

目的 提高异位促肾上腺皮质激素综合征（异位ACTH综合征）诊断和治疗效果。方法 回顾分析1985年7月－1999年7月收治的12例异位ACTH综合征患者的临床表现、诊断和治疗的临床资料。结果 12例患者经内分泌检查诊断为异位ACTH综合症，10例经影像学检查发现原发肿瘤。随访7个月－8年，5例手术切除肿瘤者，3例死亡；3例肾上腺切除者，1例存活至今；4例化疗者均死亡。结论 对有库欣综合征症状的患者，先经内分泌检查确诊为异位ACTH综合征，结合原发肿瘤的症状和体征，对好发肿瘤的部位进行影像学筛查，有助于发现原发肿瘤。对原发肿瘤进行根治性切除，预后较好。     

后外侧入路全脊椎切除重建术治疗胸椎骨肿瘤

目的探讨胸椎骨肿瘤后外侧入路全脊椎切除方式、重建技术及其疗效。方法25例胸椎骨肿瘤患者实施后外侧入路全脊椎切除重建术。经胸椎后外侧入路行单椎节切除22例、双椎节切除3例,均采用Harms钛网植骨/钛网骨水泥联合TSRH/MOSS/CDHM8椎弓根钉内固定系统重建。结果随访3个月~6年,23例术后近期疗效较满意,局部疼痛和神经症状均有不同程度改善或缓解;21例脊髓神经功能完全恢复;1例术后出现一过性瘫痪加重;3例分别于术后1~3年局部复发;术后12和18个月各死亡1例。结论胸椎后外侧入路全脊椎切除能显著降低胸椎骨肿瘤局部复发率,改善脊髓神经功能,提高手术疗效。钛网植骨/钛网骨水泥联合椎弓根螺钉系统能有效重建脊柱的前后柱稳定,同时具有减少创伤、缩短手术时间、降低并发症的优势。     

胸椎管狭窄症致急性单下肢瘫2例报告

正胸椎管狭窄症是胸椎及其软组织的退行性改变致胸椎管有效容积减少,产生的脊髓或神经根压迫症状的一系列症候群,本病发病率较低,保守治疗效果差,常需手术治疗[1]。该疾病病史较长,呈缓慢发展,常累及双下肢致感觉运动障碍,较少发生在单侧。我科经手术治疗证实2例胸椎管狭窄致急性单下肢瘫患者,术后患者恢复效果良好,将其诊断、临床表现及治疗效果报告如下。典型病例一为61岁女性患者,超市理货员,于入院前7     

胸椎黄韧带骨化症13例

胸椎黄韧带骨化常致胸椎管狭窄 ,压迫脊髓。今将我院自 1992年～ 1998年手术治疗的 13例胸椎黄韧带骨化症总结如下。1　临床资料13例中男 9例 ,女 4例 ;年龄 41～ 6 9岁。病程 2月～ 4年 ,均无明显外伤史。病人主要症状是进行性的双下肢麻木、无力 ,不灵活及行走不稳、足底踩棉感等。胸腹部束带感 (8例 ) ,足底踩棉感 (10例 ) ,腰腿疼 (4例 ) ,大小便障碍 (7例 )。体征主要有 :下肢肌力减退 (13例 ) ,出现明显感觉平面 (10例 ) ,锥体束征阳性 (13例 ) ,相应节段胸背叩疼 (7例 ) ,下肢放射疼 (4例 )。Ｘ线片均见相应节段棘突间隙从椎管后壁起…     

骨肿瘤患者的护理

骨肿瘤是骨及其附属组织发生的肿瘤，是骨内细胞异常增生的疾病。临床表现主要是疼痛、肿块形成和功能障碍。骨肿瘤有良恶性之分，其间没有截然的界限，根据临床表现、影像学检查及组织学报告最终明确诊断。治疗一般是手术切除加联合化疗。骨肿瘤患者的护理目标主要是减轻患者疼痛，改善生存质量，延长患者生命。护理问题主要是恐惧、焦虑、疼痛、营养紊乱、药物性静脉炎、化疗并发症等。     

脊柱骨巨细胞瘤的CT与MRI诊断

目的探讨脊柱骨巨细胞瘤的CT、MRI表现及其诊断价值。方法本组17例为经手术病理证实的脊柱巨细胞瘤患者,男13例,女4例,平均年龄49岁;临床与影像学资料齐全。分析病灶的影像学特征及其对诊断与鉴别诊断意义。结果17例脊柱巨细胞肿瘤患者中颈椎5例,胸椎7例,腰椎2例,骶椎3例;14例仅累及1个椎体,3,例累及2个椎体。本组患者X线片示：11例表现为椎体溶骨性破坏并具一定的膨胀性,6例表现为椎体不同程度的压缩。CT示：椎体破坏区无骨性成分存留。MRI示：T1 WI为较均匀中至低信号,T2 WI为较均匀高信号,病灶部分呈良性的硬化骨边缘,部分终板破坏形成软组织肿块。结论脊柱巨细胞瘤影像学表现不同于四肢巨细胞瘤,瘤内无孵确骨性成分存留;可分为膨胀型和压缩型,兼有良、恶性肿瘤的影像学特征,主要应与脊柱动脉瘤样骨囊肿及转移瘤相鉴别。     

Percutaneous computed-tomography-guided biopsy of the thoracic and lumbar spine

Axial computed tomographic scans were used to guide percutaneous needle biopsies in 76 patients with thoracic and lumbar spinal lesions. Prebiopsy evaluation included spine radiographs, radionuclide bone scans, computed tomographic scans, magnetic resonance imaging scans in some cases, and coagulation studies. Forty-five patients were diagnosed as having metastatic lesions, 11 infection, and 12 primary bone tumors. Of all patients, 34 had lytic vertebral lesions with significant collapse and questionable spinal stability. Six of those had a concomitant paravertebral mass. A clinical and pathologic correlation was completed for each of the cases studied. Histologic diagnosis confirming the clinical suspicion was obtained on the first biopsy attempt in 65 (86%) of the 76 cases.     

Solitary plasmacytoma in the thoracic spine. Two case reports

Plasmacytoma of the spine is rather common, but solitary occurence is not. We report two cases of solitary plasmacytomas in the thoracic spine. A 72 year old male and a 77 year old male presented with progressive paraparesis. In both cases, magnetic resonance images revealed tumors in the thoracic spine which predominantly occupied the posterior elements of the spine with compression of the spinal cord. Abnormal proteinuria and proteinemia were not detected. The tumors were removed and patients' symptoms improved, the tumors were diagnosed by histopathology to be plasmacytomas. Further neuroradiological studies suggested them to be single lesions, so that the final diagnosis was solitary plasmacytomas. Solitary plasmacytoma should be considered for diagnosis of single spinal lesion even without abnormal proteinemia or proteinuria.     

Diagnostics and therapy of spinal metastases

Out of all skeletal metastases 30% are located in the spine as are 10% of primary bone tumors, whereby 52% of metastases occur in the lumbar region, 36% in the thoracic spine and 12% in the cervical spine. Patients suffer from local pain caused by irritation of the periosteum due to rapid growth of the tumor or subsequent pathologic fractures which may lead to compression and neurological impairment with paresthesia, paresis and paraplegia. If the diagnosis cannot be confirmed exactly by radiological imaging and laboratory tests, a biopsy should be performed. A precise diagnosis of the tumor entity as well as an estimation of the prognosis provides an important basis for further decision-making. The aim of therapy is pain relief and stabilization by operative and non-operative measures. Therapy is palliative with the aim of pain relief and preservation of mobility. In cases of solitary metastasis a curative operative treatment should be performed.     

Diagnostik und Therapie von Wirbels?ulenmetastasen

Out of all skeletal metastases 30% are located in the spine as are 10% of primary bone tumors, whereby 52% of metastases occur in the lumbar region, 36% in the thoracic spine and 12% in the cervical spine. Patients suffer from local pain caused by irritation of the periosteum due to rapid growth of the tumor or subsequent pathologic fractures which may lead to compression and neurological impairment with paresthesia, paresis and paraplegia. If the diagnosis cannot be confirmed exactly by radiological imaging and laboratory tests, a biopsy should be performed. A precise diagnosis of the tumor entity as well as an estimation of the prognosis provides an important basis for further decision-making. The aim of therapy is pain relief and stabilization by operative and non-operative measures. Therapy is palliative with the aim of pain relief and preservation of mobility. In cases of solitary metastasis a curative operative treatment should be performed.     

原发性甲状旁腺功能亢进手术治疗对骨代谢影响的研究

目的观察原发性甲状旁腺功能亢进（PHPT）患者手术治疗后症状、体征改善情况、骨代谢指标及骨量变化.方法将31例PHPT患者分为3组：绝经后妇女组、绝经前妇女组和男性组.手术前后分别检测血及尿骨代谢生化指标和骨密度测量.结果①术后3个月开始骨痛明显减轻直至消失,骨骼畸形和行走困难均有不同程度缓解;②3组患者术后半年骨量都明显增加,1年时达到最高,2年时男性组及绝经前妇女组骨量基本维持不变,绝经后妇女组骨量开始减少.骨量增加的部位以腰椎最为明显,股骨次之,前臂骨量变化较缓慢;③术后绝大部分患者骨代谢指标均达正常范围.结论PHTP如不及时治疗对骨骼的危害极大,尽早手术可减轻原发性甲状旁腺功能亢进对骨骼的影响,提高患者的生活质量.     

脊柱浆细胞瘤的CT表现特征及鉴别诊断

目的探讨脊柱浆细胞瘤的CT特征及鉴别诊断。方法回顾性分析12例经手术病理证实的脊柱浆细胞瘤患者。均摄X线脊柱平片和CT扫描。影像学重点分析肿瘤形态学、病灶密度、发生部位、椎管和软组织的变化。结果12例中有5例发生于颈椎,4例发生于胸椎,1例发生于腰椎,2例发生于骶椎。5例病变位于椎体,3例位于脊柱附件,4例同时累及椎体和附件。CT表现为椎体内线状骨小梁残留和终板皱褶样的骨破坏,肿瘤均匀强化。椎体不完全破坏5例,椎体完全破坏4例,椎体塌陷3例。结论脊柱浆细胞瘤单发多见,位于颈、胸椎为主,CT表现为瘤体内线状骨小梁残存和终板呈皱褶样改变。鉴别诊断包括单发血管瘤,转移瘤和巨细胞瘤。     

Laminoplasty for the treatment of extramedullary intradural tumors in the thoracic and lumbar spine: greater than two‐year follow‐up

Objective: To investigate the outcome of a laminoplasty technique without additional instrumentation for fixation of laminae in the treatment of extramedullary intradural tumors in the thoracic and lumbar spine. Methods: Twenty‐four patients (15 men and 9 women) with extramedullary intradural tumors in the thoracic and lumbar spine were included in our study. The average age was 36.2 years (range 18 to 61 years). The pathological diagnosis was neurofibroma in 13, ependymoma in 6, lipoma in 2 and teratoma in 3 cases. All patients underwent the same laminoplasty surgery as follows: the laminae were reattached to their original sites, the ligaments (including the supraspinal, interspinal and yellow ligaments) were conserved, and primary stability of the re‐attached laminae was achieved with silk or nylon sutures. Results: Sixty‐six laminae were re‐implanted in 24 patients. The average length of follow‐up was 34.2 months (26.5 to 41 months). Fusion of the laminae was achieved in a mean of 4.5 months (3 to 6 months). Unilateral healing of the incision lines was observed in seven cases, including one with two‐level laminotomy, three with three‐level laminotomy and three with four‐level laminotomy. The other 17 cases underwent bilateral fusion. Conclusion: Fixing the laminae, spinous processes and ligaments with sutures can achieve satisfactory primary stability and high fusion rates for resected laminae. Additional instrumentation may be necessary in greater than three‐level laminoplasty.     

医学影像检查方法的选择在诊断椎管内肿瘤中的意义

目的：医学影像检查方法的选择及其结果的评价对早期诊断椎管内肿瘤十分重要。本文就医学影像检查在诊断椎管内肿瘤中的作用提出讨论,试图寻找一个较为合理的选择方案。方法：将７３例经手术治疗,病理证实的原发性椎管内肿瘤的临床资料、医学影像检查结果进行分析。结果：椎管造影,ＣＴＭ,ＭＲＩ确诊率高,Ｘ线平片和ＣＴ则较低。结论：Ｘ线平片作为一般性鉴别诊断是必要的,在神经系统定位体征不明显时首选椎管造影,否则选用ＭＲＩ,ＣＴ作为首选方法应慎重。结果的评价应结合临床,不应唯影像学为是。     

Surgical treatment of infectious spondylitis in patients undergoing hemodialysis therapy

Treatment of infectious spondylitis in hemodialysis patients remains a challenge because of comorbidities. This study aimed to evaluate the impact of end-stage renal disease (ESRD) on the clinical manifestations and surgical outcomes of patients with spinal infection. Sixteen patients who underwent surgical intervention were included. There were 3 thoracic and 13 lumbar lesions. All patients presented with intractable back pain at the start of treatment. Six patients had a fever, nine had inflammation at the hemodialysis access site, and six of them had concomitant bacteremia. Ten patients had an elevated leukocyte count. Serological tests indicated an elevation of the C-reactive protein and erythrocyte sedimentation rate level in all patients. Five patients had a neurological compromise. Postoperative complications included two mortalities, two iliac bone graft and implant dislodgement, and one retroperitoneal wound dehiscence. The preoperative mean visual analog scale score was 7.7 (range, 6–9), which improved to 3.4 (range, 2–5) at the final follow-up for 14 surviving patients. Neurological improvement was obtained by at least one grade in four Frankel C category patients. The radiographs revealed a good bony fusion in 12 cases although with a variable bone graft subsidence. In conclusion, early diagnosis of infectious spondylitis is difficult due to latent symptoms. A spine infection should be suspected in hemodialysis patients with severe back pain, even when they are afebrile. Surgical intervention for infectious spondylitis in ESRD patients undergoing hemodialysis can be performed with acceptable outcomes; however, the complication and mortality rates are relative high.