骨髓同部位活检技术在疑难血液病诊断中的价值

目的：探讨骨髓同部位活检技术在凝血病诊断中的价值，方法：对１９８６年～１９９６年１０年间收治的疑难血液病１４例在骨髓穿刺的同时进行了同部位的骨髓活检，通过骨髓穿刺的阳性率与骨髓活检阳性率对比的实验研究，结果：骨髓活检阳性率（１１／１４）明显高于骨髓穿刺的阳性率（１３／１４）结论：骨髓组织病理结果说明骨髓同部位活检技术是诊断疑难血液病一种方便必不可少的方法。     

继发性骨淋巴瘤的18F-FDG PET/CT影像学表现

目的 探讨继发性骨淋巴瘤在18F-FDG PET/CT显像中的影像学特点。 方法 对2012年4月至2015年6月行全身18F-FDG PET/CT显像的46例继发性骨淋巴瘤患者的PET/CT影像学表现进行回顾性分析。并将骨髓穿刺结果分为阳性和阴性两组,对两组显像相应穿刺部位（髂棘）SUV进行独立样本t检验,同时绘制穿刺部位SUV诊断继发性骨淋巴瘤的受试者工作特征曲线（ROC）。 结果 46例继发性骨淋巴瘤患者中,霍奇金淋巴瘤6例、非霍奇金淋巴瘤40例;单发10例,多发18例,全身弥漫分布18例。46例患者骨质异常表现多样,其中,骨髓浸润型31例（67.40%）、混合型10例（21.74%）、硬化型3例（6.52%）、溶骨型2例（4.34%）。46例患者中肱骨或股骨受累32例（69.57%）,均为骨髓浸润型表现。骨髓穿刺阳性组及阴性组SUV独立样本t检验结果显示t=4.036,P < 0.001,提示两组差异有统计学意义。穿刺部位SUV诊断继发性骨淋巴瘤的ROC曲线结果显示SUV诊断界值为2.35,其诊断继发性骨淋巴瘤的特异度和灵敏度分别为83.3%和80.0%。 结论 继发性骨淋巴瘤的18F-FDG PET/CT影像学表现存在一定的特征性,在该病的诊断与鉴别诊断中具有重要的临床价值,且对骨髓穿刺部位的选择具有指导意义。     

IV度烧伤骨外露创面的修复

目的：总结修复Ⅳ度烧伤骨外露创面的经验.方法：1994-04～2004-12,采用5种不同的修复方法治疗61例102处Ⅳ度烧伤骨外露创面,对其临床治疗与随访资料进行分析总结.结果：除修复3例3处长管状骨外露创面的皮片完全坏死,板障层移植皮片成活率约为90%外,其余皮片、皮瓣和扩张皮瓣均100%成活,伤口一期愈合.15个扩张囊经超量注水,扩张容量达到390～820 ml,注水过程中无1例发生并发症.术后随访1～15个月,创面愈合良好,毛发生长满意.结论：骨髓面或板障层皮片移植术可用于修复短管状骨或板状骨外露,但不能用于长管状骨外露创面的修复;在条件允许的情况下皮瓣或筋膜瓣可用于修复各种骨外露创面;头皮扩张术是修复颅骨外露创面的良好方法.     

骨髓涂片联合骨髓活检对诊断骨髓增生异常综合征的意义

目的探讨骨髓穿刺涂片与骨髓活检切片同步观察对诊断骨髓增生异常综合症（MDS）的临床意义。方法针对86例MDS患者采用骨髓抽吸一活检双标本一步法取材,同步观察其涂片和切片。结果86例MDS患者骨髓穿刺涂片增生程度极度减低-减低30例（34．88％）,活跃、明显活跃、极度活跃56例（65．12％）,红系病态造血43例（50．00％）,粒系病态造血32例（37．21％）,巨核系病态造血22例（25．58％）。骨髓活检切片的增生程度极度减低-减低15例（17．44％）,活跃、明显活跃、极度活跃71例（82．56％）,红系病态造血16例（18．61％）,粒系病态造血52例（60．47％）,巨核系病态造血56例（65．12％）。结论骨髓涂片和活检在MDS的诊断和分型中各有优点,两者相互补充,二者同步观察比常规穿刺涂片形态学观察更有利于提高MDS诊断的准确性。     

Sudden death due to aortic rupture complicating undiagnosed coarctation of the aorta in a teenager - a case report and review of the literature

Coarctation of the aorta is one of the more common congenital cardiac defects accounting for between 5 and 10% of cases of congenital heart disease. It has traditionally been divided into infantile (pre-ductal) and adult (ductal) types. Prior to the development of surgical treatment for coarctation, the condition was associated with significant morbidity and mortality with the most common causes of death being aortic rupture, congestive cardiac failure, endocarditis and intracerebral haemorrhage. Presentation of undiagnosed aortic coarctation as sudden and unexpected death is today a distinctly uncommon phenomenon. We report one such case, that of an adolescent male who at autopsy was noted to have coarctation of ductal type with aortic dissection and haemopericardium. The presence of this condition should be considered by the forensic pathologist confronted with aortic dissection, particularly in a young person.     

汗腺的种植(附2例报告)

目的大面积深度烧伤治疗的半数致死面积(LA50)已达98%,但由于伤面切除植皮后无汗液分泌,使患者的生活质量显著下降。目前,由于烧伤治疗技术已趋成熟,存活者日益增多,因而汗腺再生的问题必须解决,而通过干细胞移植诱导再生汗腺是其中的重要方法之一。方法分离培养人骨髓间充质干细胞(MSCs)和人汗腺细胞(SGCs)并进行鉴定。通过共培养方式促进骨髓间充质干细胞向汗腺细胞分化。将具有汗腺表型的干细胞局部移植于裸鼠烫伤脚掌,观察汗腺组织再生修复情况,结合碘-淀粉发汗试验检测汗腺功能以判定治疗效果。在动物实验初步证明转化的汗腺细胞能发挥修复汗腺功能后,选择2例烧伤自愿患者。1例患者双上臂背侧均有相似的烧伤后遗留的瘢痕,经发汗腺试验证明无汗液分泌。抽取其骨髓并切取小块正常皮肤分离培养骨髓间充质干细胞和汗腺细胞进行共培养,诱导骨髓间充质干细胞获得汗腺细胞表型,通过自行设计的方案将该细胞种植于右侧切除瘢痕处。创面愈合后治疗侧行发汗试验、汗液成分分析以及组织学检查。另1例为颏颈挛缩、瘢痕切除解除挛缩的患者,在其1/3的创面上种植诱导的汗腺细胞,2个月后进行发汗试验。结果通过共培养方式培养的骨髓间充质干细胞表达汗腺细胞特异性标志,可获得汗腺细胞表型。发汗试验和形态学观察证实将具有汗腺细胞表型的干细胞移植于裸鼠脚掌的创面后,能显著促进受损汗腺的修复与再生。人体移植试验表明,种植诱导的汗腺细胞后患者创面愈合部位呈现出汗功能,对照部位发汗试验阴性,形态学检测显示移植汗腺的真皮浅层有大量癌胚抗原(CEA)阳性细胞,结构类似正常汗腺组织。汗液成分分析结果显示移植处收集的汗液与正常皮肤处收集的汗液具有类似的pH值、渗透压和化学组分。第2例创面移植汗腺细胞后发汗试验也呈阳性。结论干细胞能够在体外成功诱导为汗腺细胞,移植后在创面能形成具有功能的汗腺。但在大面积烧伤患者早期切除焦痂后进行汗腺修复能否获此功效,尚待进一步研究。     

Forensic relevance of post-mortem CT imaging of the haemopericardium in determining the cause of death

The post-mortem diagnosis of pericardial tamponade is associated with several medical legal problems. Thus, we explored whether post-mortem computed tomography might provide useful and reliable information for the diagnosis of this relevant disease in combination with autopsy data.We retrospectively reviewed the post-mortem computed tomography and autopsy reports of 15 autopsy cases with haemopericardium detected at the Institute of Forensic Medicine in Berne from July 2005 to February 2010.Two computer tomography findings were examined in combination with autopsy results. The first was the “hyperdense armoured heart,” which has been previously described as post-mortem evidence of heart beating for a time after the initiation of intrapericardial bleeding. The second was the “flattening of the anterior surface” of the heart which has been previously observed in vivo as a sign of the compression effect of the haemopericardium on the heart.Our retrospective analysis showed the combined presence of both of these findings in all cases of autopsy evidence of pericardial tamponade with the exception of one case. In contrast, the concomitance of both of them was never observed in cases of autopsy death due to haemorrhage in which neither the flattening of the anterior surface of the heart was detected except for one case.In conclusion, these results should be considered a first step toward the potentially using post-mortem computed tomography in combination with autopsy data in the diagnosis of pericardial tamponade especially considering the possibility to detect sign as the flattened heart signal which cannot be assessed after opening the pericardium at autopsy.     

骨髓间充质干细胞对大鼠皮肤损伤促愈作用的研究

目的：研究骨髓间充质干细胞（MSCs)对大鼠皮肤损伤所发挥的促愈作用。从而为临床皮肤损伤修复提供新的种子细胞来源。方法：体外培养扩增雄性Wistar大鼠的骨髓MSCs，选择雌性Wistar大鼠30只制作皮肤损伤模型，并随机分为MSCs-胶原膜组（接种细胞胶原膜组，A组），单纯胶原膜组（B组）和自然愈合组（对照组，C组），每组10只。采用创面大体观察、组织学检查和透射电镜等方法观察创面愈合情况，并结合原位杂交方法判定创面愈合过程中是否存在植入细胞。结果：伤后7，14d,3组中任何两组之间创口收缩率比较，差异均有非常显著性意义（P＜0．01），其顺序为A组＞B组＞C组；组织学检查显示，A组肉芽组织含量明显多于B、C组；电镜检查显示，A组受损皮肤接近正常；原位杂交结果表明，移植后7，21，27d,A组均可检测到雌性Wistar大鼠受损皮肤真皮层有雄性大鼠sry基因的表达。结论：MSCs可对皮肤损伤发挥明显的促愈作用。     

不同MRI影像特征的骨质疏松性椎体压缩骨折单侧与双侧穿刺椎体成形术的疗效比较

目的比较单侧与双侧穿刺椎体成形术在具有不同MRI影像特征的骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析2015年1月—2016年12月因骨质疏松性椎体压缩骨折在陆军军医大学大坪医院野战外科研究所脊柱外科行椎体成形术治疗的患者573例(共743个椎体)。根据脊柱MRI影像特点,将骨折椎体分为三组,椎体内有明显的裂隙影像或真空征象为A组(133个椎体),整个椎体均匀呈现高信号为B组(385个椎体),椎体局部呈现高信号为C组(225个椎体),分别采用单侧或双侧穿刺椎体成形术治疗。在三组内比较两种手术方式术后视觉模拟评分(VAS)、骨水泥注入量、骨水泥弥散以及骨水泥渗漏情况。结果所有患者术后疼痛缓解明显。三组患者术前VAS评分分别为6.1±1.4、6.1±1.3、6.0±1.3,术后VAS评分分别为2.3±1.1、2.2±1.1、2.3±1.2,P=0.4847,三组间差异无统计学意义,单侧穿刺与双侧穿刺患者VAS评分分别为2.2±0.8、2.2±1.0,P0.9999,差异无统计学意义。A、B组单侧与双侧穿刺骨水泥注入量[(5.1±1.4)m L、(5.2±1.3)m L vs.(5.2±1.6)m L、(5.8±1.4)m L]差异无统计学意义,C组单侧穿刺骨水泥注入量(4.6±1.2)m L低于双侧穿刺(5.4±1.4)m L。A组单侧与双侧穿刺骨水泥弥散[(58±17)%vs.(56±12)%]差异无统计学意义,B、C组单侧穿刺弥散较双侧穿刺差[(64±16)%、(49±16)%vs.(71±14)%、(56±14)%]。骨水泥渗漏情况,三组共97个椎体有骨水泥渗漏,渗漏率为13.1%。骨水泥渗漏率的比较,A组双侧穿刺28.6%高于单侧穿刺25.0%,B组单侧穿刺11.7%与双侧穿刺11.2%差异无统计学意义,C组单侧穿刺10.8%高于双侧穿刺7.0%。结论在选择单侧穿刺或双侧穿刺时,应根据患者椎体MRI检查影像特点有根据地进行选择,可以尽量缩短手术时间,降低老年患者手术风险。对于椎体内有明显的裂隙影像或真空征象的椎体,选择单侧穿刺能获得很好的弥散效果;对于椎体内局部呈高信号的椎体,选择双侧穿刺能获得更好的弥散效果以及更低的骨水泥渗漏率。     

直接穿刺介入治疗激素性股骨头坏死的实验研究

目的　评价直接穿刺介入治疗股骨头坏死的可行性。方法　采用实验大白兔 2 4只 ,体重3.5kg ,随机分成 3组 ,A组为对照组 ;B、C两组做成激素性股骨头无菌性坏死模型 ,其中B组行直接穿刺介入治疗。直接穿刺介入治疗是将溶栓药物、改善微循环药物及骨质修复药物直接注入股骨头内 ,观察坏死股骨头的修复情况。显微镜观察包括空缺的骨陷窝数量、骨髓内脂肪细胞数量和直径、软骨下区血管数量。对 3组作统计学分析。结果　大体所见A、B、C 3组股骨头均完整 ,A组骨质坚硬 ,切开阻力大 ,但C组骨质松软 ,冠状面切开阻力很小 ,B组介于A、C两组之间。镜下显示A组空缺骨陷窝数、骨髓内脂肪细胞直径、软骨下区血管数量正常 ;B组接近A组水平 (P >0 .0 5 ) ;C组明显异常 ,与A组比较差异有显著性 (P <0 .0 5 )。结论　直接穿刺介入治疗法为临床治疗股骨头坏死打下了坚实的理论基础。     

CT引导下经皮穿刺活检术在骨骼病变诊断中的应用

目的探讨CT引导下骨骼病变穿刺活检技术的应用价值。方法2003年7月-2005年1月,48例患者接受CT引导下骨穿刺活检,其中34例有完整的临床资料,患者经扫描定位,选择最佳进针层面与路径,采用11～14 G骨穿针或18 G弹枪式活检针,局麻后将穿刺针刺入病灶,再次扫描确定穿刺针位置后,钻取标本,10%甲醛固定,送病理检查。结果整个操作过程耗时20～40 min,所有病例均取得了符合病理诊断要求的标本量,肯定病理诊断者30例,准确度91.2%,无操作相关并发症。结论CT引导骨穿刺活检是一种安全有效的骨骼病变的诊断手段,值得推广。     

Percutaneous punctures: a new radiological skill

Percutaneous aspiration or biopsy of abdominal masses is being performed with increasing frequency. Percutaneous puncture under fluoroscopic control is the simplest technique; it has the advantage that contrast media can be inserted into a cyst to outline its walls. Ultrasound can play an important role in guiding punctures if the mass or organ to be punctured cannot be seen on a radiograph or will be approached from an unusual angle. CT scanning is the preferred procedure for guiding the puncture of bone lesions and some small structures. The author concludes there may soon be a need for abdominal-puncture experts.     

CT引导下经皮穿刺骨嗜酸性肉芽肿注入甲泼尼龙琥珀酸钠疗效观察

目的：探讨CT引导下局部注入甲泼尼龙琥珀酸钠治疗经皮穿刺骨嗜酸性肉芽肿的效果。 方法：分析2009年9月—2016年7月间我院收治的病理学诊断证实为骨嗜酸性肉芽肿的患者15例,行CT引导下经皮穿刺骨嗜酸性肉芽肿局部注入甲泼尼龙琥珀酸钠治疗,参照Neer和Chigira的骨囊肿X线愈合评价标准进行治疗效果评估,并对其进行随访。 结果：治疗1个月后,骨质破坏区域较前缩小,骨皮质增厚;术后4～6个月,大部分骨质破坏区均得到修复,骨皮质显著变硬,骨质破坏区基本得到修复。有病变局部疼痛的患者,经治疗后局部疼痛均得到明显缓解,甚至消失,穿刺过程中及术后均无严重并发症出现。术后6个月,Ⅱ级6例,Ⅲ级3例,Ⅳ级6例;术后12个月,Ⅲ级5例,Ⅳ级10例。对患者随访3个月至6年,平均随访30个月,复查结果表明患者病灶均明显修复,未见病灶复发。均无严重并发症发生。 结论：CT引导下经皮穿刺并局部注入甲泼尼龙琥珀酸钠治疗骨嗜酸性肉芽肿,精确度高、操作微创、安全、并发症少、效果显著,值得临床推广应用。     

MicroRNA-146 a在脓毒症髓源抑制细胞中的表达及其意义

目的：比较脓毒症3和7 d的髓源抑制细胞（ MDSC）表型差异,了解其与MDSC增殖活性及免疫功能变化间的关系,通过检测MDSC中微小RNA-146a（microRNA-146a,miR-146a）的表达,探讨miR-146a对脓毒症MDSC免疫抑制活性的影响。方法采用盲肠穿孔结扎技术制备C57BL／6J小鼠脓毒症模型,运用磁珠分选方法收集分离CLP后3和7 d时小鼠骨髓MDSC（CD11b＋Gr1＋细胞）,然后进行体外培养并给予脂多糖（LPS）刺激,收集细胞培养上清液,并检测3和7 d时分泌的细胞因子（ TNF-α、TGF-β、IL-6、IL-10）和精氨酸酶活性,以及检测对T细胞的抑制作用与miR-146a的表达。结果 CLP后3 d时MDSC以分泌促炎因子（TNF-α、IL-6）为主,CLP后7 d时以分泌抗炎因子（ IL-10、TGF-β）为主。 CLP后7 d比3 d时表现出更强的T细胞免疫抑制活性。 qRT-PCR检测小鼠骨髓MDSC中miR-146a表达,发现CLP 7 d时比3 d时的miR-146a表达量显著升高（ P＜0．05）。结论在脓毒症的进展过程中,MDSC表型随之发生演变,脓毒症晚期MDSC免疫抑制活性较早期显著增强。 miR-146 a表达上调可能是脓毒症后期MDSC免疫抑制活性增强的重要机制。     

盐酸肾上腺素在骨水泥型髋关节置换术中预防骨水泥植入综合征发生的作用

目的 探讨盐酸肾上腺素在骨水泥型髋关节置换术中预防骨水泥植入综合征发生的作用.方法 回顾分析2008年7月-2009年4月实施的骨水泥型髋关节置换术共计48例,其中骨水泥植入前未用盐酸肾上腺素盐水冲洗骨髓腔(未干预组)24例,骨水泥植入前用盐酸肾上腺素盐水冲洗骨髓腔(干预组)24例.比较两组患者骨水泥植入前、后1,2,3,4,5,6,7,8,9,10 min的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心律(HR)、血氧饱和度(SPO2)的数据变化,数据结果采集后用方差分析和Q检验进行统计学分析.结果 (1)未干预组:均有不同程度血压下降,骨水泥植入平均1 min时,血压开始下降,平均2～6 min时血压下降最为显著(P＜0.01),平均7 min时开始回升,DBP恢复更为明显(P＜0.05),平均10 min时基本恢复正常;SPO2下降明显(P＜0.05),HR无明显变化(P＞0.05).(2)干预组:骨水泥植入前用1∶500 000肾上腺素盐水冲洗骨髓腔后,用浸有肾上腺素盐水(1∶500 000)的纱布填塞骨髓腔,骨水泥灌注前、后各时相点SBP、DBP、MAP、HR、SPO2均无明显变化(P＞0.05).未干预组24例患者均有不同程度的血压下降,SPO2下降,骨水泥植入后平均2～6 min对血流动力学影响显著;干预组中1例血压轻度下降,1例出现偶发室性早搏,余22例血流动力学无明显改变.结果 盐酸肾上腺素盐水冲洗骨髓腔能有效预防骨水泥植入综合征的发生.     

Bone marrow fat and bone mineral density on proton MR spectroscopy and dual-energy X-ray absorptiometry: their ratio as a new indicator of bone weakening

OBJECTIVE: Bone weakening can be affected by agents other than bone mineral density (BMD). Increased bone marrow fat may have a direct link to bone loss. This pilot study analyzes the relationship between bone marrow fat and BMD in subjects with normal and structurally weakened vertebrae. SUBJECTS AND METHODS: Twenty-six subjects underwent both dual-energy X-ray absorptiometry and proton MR spectroscopy of 71 lumbar vertebrae. Fifteen subjects had normal-appearing vertebrae on MRI, and 11 had signs of bone weakening. RESULTS: We found that high bone marrow fat did not consistently equate with low BMD. Bone marrow fat can indicate bone weakening nearly as well as BMD, but neither parameter alone is suitable to be used independently as an indicator. The bone marrow fat/BMD ratio showed significant diagnostic power to detect bone weakening, even in this relatively small subject sample. CONCLUSION: An inverse relationship between bone marrow fat and BMD could not be confirmed. Bone marrow fat can be used to diagnose reduced bone strength nearly as well as BMD. The bone marrow fat/BMD ratio is a significant diagnostic indicator of bone weakening.     

Bone marrow scintigraphy with 99m Tc labelled monoclonal anti-NCA 90 Fab' fragment: a feasibility study and comparison of bone marrow uptake with 99m Tc labelled monoclonal anti-NCA 95 antigranulocyte antibody

The aim of this retrospective study was to evaluate the usefulness of 99mTc labelled monoclonal anti-NCA 90 antigranulocyte antibody Fab' fragment (MN3 Fab') as a bone marrow imaging agent. One hundred and ten planar scans (88 patients) of the lumbar and sacroiliac regions as well as whole-body scans were performed after 1, 5 and 24 h. All the scans were evaluated visually and bone marrow uptake was determined semiquantitatively as count density ratio from sacroiliac-minus-background to background area. Results were compared to 50 age-matched patients with normal bone marrow scans obtained with the intact 99mTc labelled monoclonal anti-NCA 95 antigranulocyte antibody (BW 250/183) in a previous study. Seventy-three patients showed a physiological activity distribution in the central bone marrow. Ten patients showed a bone marrow extension, while in two patients central bone marrow depression was observed. Evaluation of the ribs, lower thoracic and upper lumbar spine was hampered by soft-tissue activity. Bone marrow uptake was 1.36+/-0.56 after 1 h, decreased thereafter and was significantly lower than that of BW 250/183 (P < 0.001). In conclusion, MN3 Fab' cannot be recommended for bone marrow scintigraphy, because relevant parts of the haemopoietically active bone marrow are not accessible to visual evaluation. A significant role of the semiquantitative evaluation of MN3 Fab' bone marrow uptake in patients with potential marrow depression seems unlikely.     

难治性骨外露的综合治疗

目的 :回顾性总结分析手术与美宝湿润烧伤膏 (MEBO)联合治疗难治性骨外露的临床疗效。方法 :对2 0 0 0年 7月至 2 0 0 4年 7月我科治疗的 2 8例难治性骨外露病例进行回顾性总结 ;早期钻骨引髓或凿除骨皮质及时应用MEBO反复换药促进肉芽生长与自体皮移植修复。结果 :8例骨外露创面 (直径 <2cm)经及时应用MEBO反复换药 ,2周～ 4周肉芽覆盖创面完全愈合 ;2 0例骨外露创面 (直径 >2cm)经钻骨引髓或凿除骨皮质肉芽形成后行自体皮移植得到一期修复。无骨髓炎及窦道等并发症。结论 :对临床治疗较棘手的难治性骨外露创面及时手术钻骨引髓后应用MEBO反复换药 ,可促进肉芽生长 ,后行自体皮移植 ,是一种理想的综合治疗措施。能有效的缩短疗程 ,提高治愈率。     

恶性血液肿瘤脊柱骨髓弥漫性浸润的动态对比增强MR灌注成像

目的 评价动态对比增强MR灌注成像对恶性血液肿瘤脊柱骨髓弥漫性浸润性病变的诊断价值. 资料与方法 经骨髓组织活检确诊的恶性血液肿瘤26例和20例正常对照者行腰椎动态对比增强MR灌注成像检查.计算峰值增强百分率(Emax)、增强斜率(ES)和到达峰值时间(TTP). 结果 脊柱骨髓弥漫性恶性浸润组与正常对照组间的Emax、ES和TTP均具有显著差异(P<0.01).骨髓轻度浸润和中度浸润之间的Emax、ES和TTP均具有显著差异(P<0.05).骨髓轻度浸润和重度浸润之间的Emax、ES和TTP均具有显著差异(P<0.01).骨髓中度浸润和重度浸润之间的Emax、ES和TTP无显著差异(P>0.05).Emax、ES和骨髓浸润程度之间具有正相关性(P<0.01),TTP和骨髓浸润程度之间具有负相关性(P<0.01). 结论 动态对比增强MR灌注成像可以判断恶性血液肿瘤是否出现脊柱骨髓弥漫性浸润,灌注参数可以反映骨髓肿瘤细胞浸润程度.     

Value of a new apparatus for percutaneous vertebral bone biopsy

Percutaneous vertebral trephine biopsy is a valuable investigation. A new type of trephine needle for vertebral biopsy is described in this paper. This trephine needle is introduced on the thin needle used for local anesthesia, following a procedure similar to vascular catheterism. Thus, the same puncture is used for local anesthesia and bone biopsy. Therefore, local anesthesia is more effective and the biopsy procedure is much safer, particularly at the thoracic level where vital organs are very close to the spine. A very practical handle design for advancing the trephine needle on the guide wire makes the biopsy procedure easy and precise. This trephine needle enhance indications of this potentially valuable procedure.