多节段脊柱骨折的临床特点

目的 通过与单节段骨折进行比较,研究多节段脊柱骨折(MSF)的临床特点.方法 回顾性分析2004年3月至2009年3月收治的143例脊柱损伤患者,根据损伤节段数分为多节段组(53例)和单节段组(90例),统计和比较两组的致伤原因、脊柱损伤节段、合并伤、并发症、治疗和转归.结果 两组的主要致伤原因均为高处坠落伤、交通事故伤和重物压砸伤,其中腰椎最易受累,保守治疗率和死亡率相近,且治疗后随访的ASIA评级均较治疗前好转.但是多节段组的人均损伤部位和脊柱节段、ISS总分、重伤和极重伤(ISS≥16)率、电解质紊乱和呼吸系统感染发生率、延期手术率、手术距入院平均时间、住院时间均显著高于单节段组,差异有统计学意义(P＜0.05);多节段组治疗后A-SIA分级E级率显著低于单节段组,差异有统计学意义(P＜0.05).结论 MSF发生率高,多为高能量原因致伤,腰椎最易受累,伤情重且危急,伤后并发症多,早期难以开展有效治疗,致残率高.     

多节段脊柱骨折的临床特点

目的 通过与单节段骨折进行比较,研究多节段脊柱骨折(MSF)的临床特点.方法 回顾性分析2004年3月至2009年3月收治的143例脊柱损伤患者,根据损伤节段数分为多节段组(53例)和单节段组(90例),统计和比较两组的致伤原因、脊柱损伤节段、合并伤、并发症、治疗和转归.结果 两组的主要致伤原因均为高处坠落伤、交通事故伤和重物压砸伤,其中腰椎最易受累,保守治疗率和死亡率相近,且治疗后随访的ASIA评级均较治疗前好转.但是多节段组的人均损伤部位和脊柱节段、ISS总分、重伤和极重伤(ISS≥16)率、电解质紊乱和呼吸系统感染发生率、延期手术率、手术距入院平均时间、住院时间均显著高于单节段组,差异有统计学意义(P＜0.05);多节段组治疗后A-SIA分级E级率显著低于单节段组,差异有统计学意义(P＜0.05).结论 MSF发生率高,多为高能量原因致伤,腰椎最易受累,伤情重且危急,伤后并发症多,早期难以开展有效治疗,致残率高.     

多节段脊柱骨折的治疗

目的探讨多节段脊柱骨折的损伤机制，伤情特点及诊治方法。方法对于1998年10月至2003年12月期间脊柱多阶段骨折进行回顾性分析。52例多节段骨折，相邻型33例（63．5％），非相邻型19例（36．5％），其中胸腰段损伤30例（57．5％），50例（96％）伴有神经损伤，脊髓功能按Frankel分级，A级11例，B级17例，C级15例。D级7例。E级2例，平均年龄38岁，延迟诊断19例。损伤原因以高处坠落（55．8％），交通事故（25％）为主。保守治疗28例，手术治疗24例，除7例行胸椎单纯减压以外，颈椎、胸腰段、胸椎均行切开减压并不同内固定器械固定。计有Orion1例。TSRH1例，Dick4例，SF2例，RF3例，AF2例，CD4例。固定椎体跨2节到4节不等。结果经过平均16．5个月随访。52例多节段骨折均获骨性愈合，脊髓功能改善1级者21例，改善2级者11例，无改善者20例。其中FrankelA级11例，仅有2例有改善。结论多发性脊柱骨折发生率较低，易漏诊。伤情重，合并伤多，多伴有脊髓损伤，以青壮年男性多发。高空坠落，交通事故是常见原因。损伤的康复取决于脊髓受伤程度，手术积极干预，对患者康复有帮助。     

多节段脊柱损伤128例分析

目的 提出一种多节段脊柱损伤的分类方法,以提高诊断意识与治疗水平。方法 对128例多节段脊柱损伤进行回顾性分析,平均随访8．2年。按自行设计的分类方法进行分类。结果 相邻型82例(占64．1％),非相邻型46例(占35．9％);损伤部位以胸腰段为主;脊髓功能：Frankel A级60例,B级12例,C、D级27例,E级29例。手术治疗69例(其中减压内固定42例),保守治疗59例。随访94例,改善1级者30例,改善2级者29例,无改善者35例。结论 类型不同其患病率、致伤因素、脊髓损伤严重度及诊断失误率均不同,诊断必须正确,必要时摄脊柱全长X线片。     

脊柱多节段脊柱骨折的特点及治疗

脊柱多节段脊柱骨折可以是连续的,也可以是跳跃的。文献报道发病率占脊柱损伤的3%～5%。随着现代诊断技术的提高,其发病率有增加趋势,多节段脊柱骨折往往为高能量损伤,常合并其他部位损伤,易于漏诊、误诊,影响康复。自1995年1月～2002年12月共收治脊柱骨折764例,其中多节段脊柱骨折132例,现报告如下。     

非相邻多节段脊柱骨折与脊髓损伤的临床诊疗策略

目的分析非相邻多节段脊柱骨折(MNSF)的受伤机制、诊断要点、治疗原则。方法 2001年1月～2008年12月,共收治48例MNSF。有41例进行了规范的康复训练,依据Frankel分级和AISA评分进行术前、术后的比较。结果 40例得到了随访,均无感染,内固定松动失败1例,植骨不融合1例,神经症状改善明显,有效率100%。结论非相邻多节段脊柱脊髓损伤,应避免漏诊。治疗应尽早实施手术,重建脊柱的稳定性,松解压迫的脊髓或神经根,另一方面强调脊髓损伤的急性期需在常规治疗的同时需早期康复。     

多节段脊柱骨折诊疗方法的分析

目的 分析多节段脊柱骨折的诊疗方法、伤情特点。方法回顾性分析1996年4月-2005年1月54例脊柱多节段骨折患者,探讨致伤原因、损伤节段分布及治疗效果。结果患者平均年龄43．2岁,50岁以下占59．3％。Ⅰ型骨折33例．Ⅱ型骨折21例,其中胸、腰段及腰椎多节段骨折33例,占61．1％,合并神经损伤37例,占68．5％。致伤原因为高处坠落伤、交通事故伤和重物砸伤占83．3％。手术治疗27例,非手术治疗27例。30例患者获得随访,平均随访14．6个月,随访病例中22例伤时有神经损伤,其中90．9％的病例治疗后神经功能恢复1-2级。结论多节段脊柱骨折患者以男性中青年多见,多数伴有神经损伤。最常见的致伤原因是高处坠落伤、交通事故伤和重物压砸伤。全面、仔细地检查伤情,早期正确诊断与治疗,可获得良好效果。     

多节段脊柱骨折的分类及相关问题研究

本文通过２８７例脊柱骨折的回顾性分析，发现多节段脊柱骨折８１例，并提出一种分类方法。结果表明；分类不同其发病率，、诊断失误率、脊髓损伤严重度，致伤因素均不相同，对该病的早期正确诊断至关重要必要时全脊柱摄片亦不为过。     

Clinical features of multiple spinal schwannomas without vestibular schwannomas

BackgroundMultiple spinal cord tumors in a single patient are very rare and most often seen in cases of neurofibromatosis and associated disorders. Schwannomatosis, which is characterized by the development of multiple schwannomas without vestibular schwannomas, has been newly defined as a distinct form of neurofibromatosis. The purpose of the present study was to describe and review the clinical and radiological features and the management of patients with multiple spinal schwannomas without vestibular schwannomas.MethodsBetween 1986 and 2016, 19 patients with multiple spinal schwannomas without vestibular schwannoma were diagnosed and treated. Of the 19 patients, 13 were males, and 6 were females. The mean age at the first surgery for spinal schwannoma was 45.2 years old. The mean follow-up period was 123.4 months. The clinical features and radiological findings of the patients with multiple spinal schwannomas were retrospectively reviewed.ResultsAmong the 19 patients, there were more than 140 spinal schwannomas. The most common area of spinal schwannoma was the thoracolumbar-lumbar region. Initial symptoms and chief complaints caused by spinal schwannomas were primarily pain in the trunk or extremities in 17 (89.5%) of 19 patients. More than 60 spinal schwannomas were surgically resected. Multiple spinal surgeries were required in six patients. In all 19 patients, surgical treatment has provided successful relief of symptoms and neurological recovery.ConclusionsSurgical treatment was safe and effective in patients with multiple spinal schwannomas without vestibular schwannomas. After surgery, we recommend that all patients be followed with magnetic resonance imaging to monitor for asymptomatic tumors or detect new tumors early.     

胸椎骨折39例治疗分析

目的探讨胸椎骨折的损伤特点及治疗。方法对39例胸椎骨折患者的临床资料作回顾性分析。稳定压缩骨折10例单纯保守治疗,不稳定压缩骨折15例行后路减压植骨融合加椎弓根螺钉内固定,爆裂骨折10例行前路减压植骨融合Z-plate前路钢板内固定;骨折脱位3例及爆裂脱位1例采用前后联合入路。结果全部病例均获随访,时间6~24个月,平均12个月。神经功能明显改善,术后6个月植骨融合率达100%,未见内植物松动及断裂现象。结论胸椎骨折的治疗应根据骨折的类型及稳定性,对于不稳定骨折应行融合及内固定手术,合并有不完全性脊髓损伤者还应同时行减压手术。     

颌面部多发性骨折的临床治疗分析

目的探讨颌面部多发性、复杂性骨折的治疗策略。方法应对非陈旧性的颌面部多发性骨折,联合神经外科、眼科、耳鼻喉科进行会诊,制定合理手术治疗方案。在骨折复位和固定治疗中,联合应用颌间结扎、钛板坚固内固定、皮瓣修复等多种技术,尽可能恢复患者的功能和面容外观。结果本组45例患者均在伤情稳定后进行骨折的整复治疗,对41处上颌骨骨折,33处下颌骨骨折,14处鼻骨骨折,12处髁突骨折,6处眶壁骨折,5处颧骨骨折进行复位和固定。术后随访3～12个月,骨折复位良好,效果满意。结论多临床学科的协同诊治有利于为患者提供更好的治疗,根据骨折的具体情况,合理选择适当的切口入路和结扎、固定方式,是颌面部多发性复杂骨折的有效治疗方法。     

老年颈椎骨折患者的临床特点及治疗

60岁以上老年人占中国人口的比例不断上升.2006年,我国老年人口占总人口比例为11.3%,高龄人口(80岁以上)占老年人口的比例为10.7%~([1]).     

胸腹联合伤的AIS-ISS评分及外科治疗

目的总结胸腹联合伤创伤评分与临床诊断和治疗方法的关系,旨在提高该病的诊断及治疗水平。方法回顾分析83例胸腹联合伤患者临床资料,并对其进行简明创伤分级（AIS）及损伤严重程度评分（ISS）。其中交通事故伤38例,刀刺伤24例,坠落伤8例,挤压伤8例,重物砸伤5例。患者手术治疗43例,胸腔闭式引流28例,保守治疗12例。结果治愈73例,死亡10例,死亡率12．1％。结论详细询问病史及查体,胸、腹部X平片,CT、胸腹部B超、消化道钡剂造影及钡灌肠造影检查有助胸腹联合伤的诊断。对诊断明确的胸腹合并伤,首先改善呼吸功能,恢复有效循环量,对ISS评分大于26的患者,应积极做好手术准备。     

Clinical features and pathomechanisms of syringomyelia associated with spinal arachnoiditis

BACKGROUND: Syringomyelia is a common intramedullary lesion associated with spinal arachnoiditis and obstruction of the foramen magnum such as in Chiari's malformation. Disturbance of cerebrospinal fluid flow around the spinal cord has an important role in the development of syringomyelia due to spinal arachnoiditis; however, the exact mechanisms have not been clarified. The purpose of this retrospective study is to understand the clinical features and pathomechanisms of syringomyelia secondary to spinal arachnoiditis and to provide the current choice of surgical treatment in this difficult clinical entity. METHODS: Clinical and radiological findings in 15 patients with syringomyelia associated with spinal arachnoiditis who underwent surgical treatment in our institutes between 1982 and 2000 were reviewed. All patients presented with paraparesis or tetraparesis on admission. RESULTS: Magnetic resonance imaging (MRI) or computed tomography-myelography revealed that the syrinx predominantly existed at the thoracic levels. Five patients showed complete block of the thoracic subarachnoid space by conventional myelography. T2-weighted MRI showed diffuse intramedullary hyperintensity at the level of arachnoiditis. As the first surgical treatment, 10 patients underwent syringo-peritoneal shunt placement. Three patients were treated with a syringo-subarachnoid shunt, and 2 patients were treated with a ventriculoperitoneal shunt. Eight patients required further shunting operations for syringomyelia 2 months to 12 years after the first surgery. Neurologic improvement was obtained in 9 patients (60%) with decreased size of the syrinx. One patient remained stable; 5 patients showed gradual deterioration. CONCLUSIONS: The syrinx originated from the thoracic levels where severe adhesion of the subarachnoid space was present. The mechanisms of syrinx formation may be based on the increased interstitial fluid in the spinal cord. Shunting procedures were effective in some population of the patients. Decompression procedures of the spinal subarachnoid space may be an alternative primary surgical treatment except for patients with longitudinally extensive arachnoiditis.     

Clinical features of multiple primary cancers including prostate cancer

We analyzed the clinical features of multiple primary cancers (MPCs) that included prostate cancer. MPCs were observed in 93 (15.2%) of the patients suffering from prostate cancer. In the MPC group, the organ most commonly involved was the stomach, followed by bladder, colon and lungs. The median age at diagnosis of the first, second and third cancers was 72, 74, and 75 years old, respectively, and the duration between the first and second cancers (median: 20 months) was longer than that between the second and third cancers (median: 8 months). In the 37 MPC patients whose cause of death was obvious, 29 (78.4%) died of a cancer; prostate cancer was not so common (6 patients) as the cause of death. Age at diagnosis and grade distribution of prostate cancer were not significantly different between the MPC and single primary cancer (SPC) groups. However, the proportion of earlier stage was significantly (p < 0.01) higher in the MPC group than in the SPC group, and this trend was more obvious in patients whose prostate cancer was diagnosed as the second cancer. The prostate cancer-specific survival rates were significantly higher in the patients with MPC, and this trend was more obvious in the patients with stage D or moderately differentiated cancer. It is important in the follow up of prostate cancer patients to be aware of the possibility of the occurrence of a second cancer.