经皮髓核成形术治疗腰椎间盘源性疼痛的初步观察

目的:探讨经皮髓核成形术治疗腰椎间盘源性疼痛的临床效果。方法:通过经皮穿刺的微创方法,采用等离子消融髓核成形技术,治疗椎间盘源性腰痛病人11例。结果:11例病人手术前VAS评分平均为7.2分,术后1周下降为4.3分,最后随访时为4.0分。其中7例患者的VAS降低≥3分,2例≥2分,2例<1分。多数病人在手术后次日感疼痛明显减轻,3例腿痛病人的症状明显减轻。结论:经皮髓核成形术治疗椎间盘源性疼痛近期效果满意,进一步的结果尚需更多的病例及长期随访。     

Correction of degenerative scoliosis of the lumbar spine. A preliminary report

The use of the spinal internal skeletal fixation system (ISFS), originally developed for fracture treatment by Dick for the segmental correction of scoliosis, is demonstrated in eight adult degenerative lumbar spinal curves. The two main benefits of an intrapedicular screw fixation system, i.e., excellent skeletal stabilization and the ability to freely modify individual segmental vertebral position, are clearly demonstrated in this instrumentation, which is still at the prototype stage. The good preliminary results seen in this series encourages the further development of segmental intrapedicular spinal fixation systems for the treatment of scoliosis.     

L4椎管内骨软骨瘤致神经根受压1例报告

患者，男，62岁。2002年3月初开始，无明显外伤史，逐渐出现腰痛伴一侧腿痛4年余，时轻时重，经对症治疗有好转而没有引起重视。近半年腰腿痛症状加重，伴典型间歇性跛行，站立和行走时症状加重，而下蹲或坐下休息和卧床时减轻，疼痛从左侧臀部放射至同侧小腿外侧与足背。门诊以腰椎管狭窄收入院。检查：腰部无畸形，L4棘突与棘突左侧压痛，腰部过伸试验阳性。     

The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia.

In an effort to define the origin of low back pain and sciatica, 193 patients were carefully studied using progressive local anesthesia. These patients had surgery for herniated discs, spinal stenoses, or both. Various tissues were stimulated during the performance of these lumbar spinal operations. This article discusses our observations and the results of that study.     

Discal cysts of the lumbar spine: a case report

Discal cysts--intraspinal cysts communicating with an adjacent intervertebral disc--are an uncommon cause of lumbar radiculopathy. We report a case of discal cyst of the lumbar spine. The cyst contents were bloody and clotted rapidly; no disc materials were seen. Communication between the cyst and the intervertebral disc was detected. Histopathology of the cyst wall revealed fibrous connective tissue without synovial lining cells. We hypothesise that the discal cyst was formed by haemorrhage of the epidural venous plexus caused by separation of the peridural membrane by mechanical force transmitted by an annulus fibrosis fissure. The minute segmental motion caused by the affected disc may have stimulated continuous bleeding.     

Pseudo-colonic obstruction after lumbar spine surgery: a case report

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterised by abdominal distension and massive colonic dilatation without any mechanical cause of obstruction. The pathogenesis remains unknown but likely involves imbalance between sympathetic and parasympathetic colon innervation. This syndrome is well known in orthopaedic surgery, as trauma and orthopaedic surgery have been reported as aetiological factors. Some cases have been reported after cervical discectomy. We report a case of Ogilvie's syndrome after lumbar spine surgery. Medical treatment including parasympathetic agent was unsuccessful and the patient underwent a right colectomy. The pathophysiology and treatment are discussed based on a review of the literature.     

Esophageal saturation during antegrade cerebral perfusion: a preliminary report using visible light spectroscopy

BACKGROUND: Visible light spectroscopy (VLS) is newer technology that measures real-time tissue oxygenation. It has been validated in detecting mucosal ischemia in adults. During complex neonatal heart surgery, antegrade cerebral perfusion (ACP) maintains cerebral saturation. Whether ACP maintains peripheral tissue perfusion in humans is not known. METHODS: Five patients undergoing neonatal open heart surgery with hypothermic cardiopulmonary bypass (CPB) were studied using a VLS esophageal probe in addition to bilateral near infrared cerebral oximetry. Three of five patients required ACP for arch repair, while two patients did not. VLS and cerebral saturation data were collected and analyzed in 5 min intervals prior to CPB, during CPB, and during ACP. RESULTS: In the two patients undergoing heart surgery with routine hypothermic CPB, both cerebral and esophageal saturations were maintained. However in all three neonates requiring ACP, although cerebral saturations did not decrease, esophageal saturation fell below the ischemic threshold (35%). Following establishment of normal CPB, esophageal saturation returned to baseline. CONCLUSIONS: Antegrade cerebral perfusion maintains cerebral oxygen delivery, however, it does not adequately perfuse the esophagus in neonates. This could have clinical implications.