硬脑膜动静脉瘘介入诊治新进展

硬脑膜动静脉瘘是较常见的颅内动静脉畸形,脑血管造影可以及时准确的诊断,并显示其供血动脉,引流静脉,瘘口的位置,血流情况。为进一步选择治疗方案奠定基础。本文主要探讨硬脑膜动静脉瘘介入治疗的研究进展。介绍Onyx在治疗硬脑膜动静脉瘘中的应用,疗效,注意事项。Onyx是目前较理想治疗脑动静脉畸形的栓塞材料。     

肺动静脉瘘两例报告

<正> 肺动静脉瘘是一种较少见的肺血管疾病,是肺动静脉直接交通,引起右至左分流的一种血管畸形。肺动静脉瘘较大者,可呈呼吸困难,紫绀、杵状指及红血球增多等。现将我院经X线诊断为肺动静脉瘘四例中经手术证实的两例介绍如下: 临床资料病例1:男,27岁,自十余年前起周身无力,活动后气短,有时伴头痛、头晕。     

脑动静脉畸形的手术治疗

本文报告脑动静脉畸形10例,其中位于额顶叶中央区的6例,颞叶1例,外侧裂1例,侧裂深部1例,顶后部大脑内侧面1例。10例脑动静脉畸形出血并发脑内血肿者6例。8例作了脑动静脉畸形切除术,1例术中人工栓塞后切除动静脉畸形,1例作单纯血肿消除术,手术后无死亡。着重对脑动静脉畸形切除术的手术适应症和手术方法作了讨论。     

右侧颌面部巨大动静脉畸形1例

动静脉畸形即蔓状血管瘤或动静脉瘘,是一种高流速血管畸形.颌面部巨大动静脉畸形不多见.我科于2006年5月收治1例右侧颌面部巨大动静脉畸形患者.     

动静脉瘘和动静脉畸形的实验模型及其应用

动静脉瘘(AVF)和动静脉畸形(AVM)是较常见的颅内血管畸形。AVF和AVM的实验模型包括动物模型、体外模型以及生物数学模型，可用于研究病理生理学特征、模拟临床治疗以及检测栓塞材料等。本文综述上述实验模型的形成方法，分析其优缺点，并简要介绍这些模型的应用。     

下肢动静脉瘘介入治疗一例报告

目的：探讨下肢动静脉瘘的治疗方法。方法：通过介入超选至动静脉瘘处畸形血管予以栓塞。结果：下肢动静脉瘘消失，随访无复发。结论：介入栓塞治疗为微创手术，对于下肢动静脉瘘有较好的治疗效果。     

肾动静脉瘘的诊治体会（附5例报告）

目的探讨肾动静脉瘘的诊治方法。方法回顾性分析2004～2010年我院收治5例肾动静脉瘘患者的临床资料,结合文献对其诊治方法进行复习讨论。结果 3例患者行经介入治疗,2例行肾动静脉内漏阻断及肾全切术,术后5例患者均恢复良好。结论影像学检查是诊断肾动静脉瘘的主要手段,介入治疗及外科手术是目前治疗肾动静脉瘘的主要方法,治疗时应根据肾动静脉瘘的类型及合并症选择合适的治疗方法。     

腹部动静脉瘘的超声诊断

目的讨论腹部动静脉瘘的超声诊断.方法根据患者超声检查的表现进行诊断.结论结合灰阶和多普勒彩色超声检查,动静脉瘘的诊断一般比较容易,但发生在腹膜后间隙的动静脉瘘,因其位置深在,走行纡曲,变异较大,常受胃肠道气体的遮盖,超声表现相对不典型,需注意与动静脉瘤和腹膜后囊性或囊实性肿瘤等其他疾病相鉴别,肾动静脉瘘也还要注意与肾内肾盂肾盏扩张进行鉴别.此外,还应进一步追踪动静脉瘘的来源动脉及远端静脉,以明确瘘口位置和发生动静脉瘘的血管及有无侧支循环形成.     

超声检查对动脉瘤与动静脉瘘的临床研究

为探讨动脉瘤与动静脉瘘的超声表现与超声检查的诊断价值。笔者对经X线血管造影、CT及/或手术证实的21例动脉瘤与7例动静脉瘘患者施行了超声观察。结果发现动脉瘤与动静脉瘘病损血管均显示有形态结构的异常和血流动力学的改变。认为:动脉瘤与动静脉瘘的超声表现具有显著的特征性,超声检查可作为动脉瘤与动静脉瘘一种新的、简便有效的辅助检查方法。     

经动脉途径以低浓度氰基丙烯酸正丁酯栓塞硬脑膜动静脉瘘的疗效分析

目的 探讨经动脉途径以低浓度氰基丙烯酸正丁酯栓塞治疗硬脑膜动静脉瘘的技术方法和疗效。方法 采用低浓度（10％～20％）氰基丙烯正丁酯（NBCA）经供血动脉对18例不同部位硬膜动静脉瘘患者进行栓塞治疗。18例患者中海绵窦区硬膜动静脉瘘12例，顶部硬膜动静脉瘘6例。该技术的关键操作方法是将低浓度NBCA注入静脉端使之闭塞并反流入其他供血动脉。结果 18例患者中17例在栓塞后达到解剖治愈，术后临床症状消失。另1例通过海绵窦区硬膜动静脉瘘栓塞后一度症状好转，2d后症状加重，复查造影发现静脉未完全闭塞，回流静脉发生改变，经压颈10d后症状明显好转。结论 经动脉途径以低浓度NBCA栓塞治疗硬脑膜动静脉瘘对于有些病例是较好的选择，其特点是低廉、快捷，疗效满意。     

脚趾截除后大鼠前扣带回锥体神经元突触传递持续性增强

截肢患者中50%-80%经历过幻肢疼痛.前扣带回(anterior cingulate cortex,ACC)是参与疼痛情绪反应形成的一个重要部位.为揭示前扣带回在幻肢疼痛中的作用,我们采用成年大鼠右后中趾截除慢性疼痛模型,麻醉固定后在体纪录大脑前扣带回锥体神经元之间突触传递特性的变化.所记录神经元经形态学确认为前扣带回锥体神经元.结果显示,在右后中趾截除后3-7 d,大鼠前扣带回锥体神经元兴奋性突触后电位持续性增强,同时,反映突触前机制参与突触可塑性的配对脉冲易化(paired-pulse facilitation,PPF)值增大.结果 表明,大鼠在体脚趾截除引起前扣带回锥体神经元兴奋性突触后电位持续性增强,这个增强的突触传递可能参与了幻肢疼痛的形成过程.     

A clinical report of entangled neonates' umbilical cord with queen's fur in Persian cat

A 3-year-old Persian queen was referred to Teaching Veterinary Hospital while 3 neonates'' umbilical cords were entangled with the queen''s tail hair. Close inspection of the cat showed that the umbilical cords of 3 kittens had twisted around together and entangled with the moms'' hairs in the base of tail region. Also this complex has been warped around the left tarsus of one of the involved kittens and caused swelling and skin darkness in the involved limb. Operation was carried out urgently. After cutting the queen''s involved hairs the kittens were released. Then the twisted umbilical cords and the hairs were isolated from the umbilical cord and the involved leg was released from the umbilical cords and the twisted umbilical cords were separated from each other. During one week follow up, dry gangrene occurred in the distal extremity of the injured limb and consequently, amputation was performed on the distal part of tibia. Our clinical findings suggest that long hair coats of queens could be a maternal life threatening factor for neonates'' life.     

毁损肢体严重程度评分与保肢指数在儿童截肢应用中的回顾分析

目的：回顾分析该院76例创伤截肢与保肢的病例,为儿童临床截肢手术适应证提供参考。方法回顾总结分析该院1996年7月至2013年5月收治的38例外伤性截肢患儿（试验组）,同期38例严重创伤而未截肢的患儿38例（对照组）,采用毁损肢体严重程度（MESS）以及保肢指数（LSI）评分重新评估,统计分析两种评分系统与截肢术的吻合度。结果 MESS与 LSI两种评分系统均对儿童截肢术有很高的区分度。结论 M ESS与LSI均可作为儿童截肢参考系统,但LSI评分系统较M ESS更适用于儿童。     

烧伤截肢临床分型探讨--附67例(78肢)截肢报告

目的 :探讨毁损性烧伤截肢临床分型及意义。方法 :总结分析近 15年收治的 67例 (78肢 )毁损性烧伤截肢病例 ,从循证医学角度对烧伤截肢进行临床分型。结果 :本组发病年龄 3～ 78岁 ,16岁以上成人居多(4 6例 ,68 7% ) ,16岁以下少儿偏少 (2 1例 ,3 1 3 % ) ,男女之比 2 7∶1,致伤原因电烧伤占绝大多数 (5 5例 ,占82 1% ) ,上肢截肢率高达 79 5 % ,截肢临床分型为 :①缺血坏死型 ;②无法修复型 ;③修复后外形差无功能型 ;④“舍肢保命型” ;⑤患者和家属请求型。结论 :①以循证医学理念将毁损性烧伤截肢临床分型 ,可以为临床医生给患者和家属谈话 ,截肢指征的确立 ,截肢术中操作原则和预后判断等提供依据 ,也可为避免或减少无谓的医患纠纷起积极作用。②影响实施截肢因素不仅取决于伤情 ,还与当前医学发展、地区医学水平和假技技术水平、患者和家属对伤情认识及经济花费的承受能力等有关 ,所以同一伤情其处理方法会出现多样化。     

Decreasing amputation rates in patients with diabetes mellitus. An outcome study

The lower-extremity amputation rate in people with diabetes mellitus is high, and the wound failure rate at the time of amputation is as high as 28%. Even with successful healing of the primary amputation site, amputation of part of the contralateral limb occurs in 50% of patients within 2 to 5 years. The purpose of this study was to provide valid outcome data before (control period) and 18 months after (test period) implementation of a multidisciplinary team approach using verified methods to improve the institutional care of wounds. Retrospective medical chart review was performed for 118 control patients and 116 test patients. The amputation rate was significantly decreased during the test period, and the amputations that were required were at a significantly more distal level. No above-the-knee amputations were required in 45 patients during the test period, compared with 14 of 76 patients during the control period. These outcome data suggest that unified care is an effective approach for the patient with diabetic foot problems.     

复杂性完全离断上肢再植的临床研究

目的 探讨复杂性完全离断上肢再植的适应证、技术改进方法和功能康复措施.方法 2009年10月-2012年4月对该院21例复杂性完全离断上肢运用创伤显微外科技术,快速有效的清创、简单有效的骨折复位固定及血管神经显微修复再植.结果 21例再植上肢中,1例术后早期发生血管危象,于第8天截除再植肢体,其余20例再植肢体伤口全部愈合.经过6个月~2年随访,再植肢体感觉及运动功能有一定恢复.结论 对复杂性完全离断上肢,只要患者全身情况许可,肢体相对完整就可运用创伤显微外科技术进行再植修复,术后早期进行有效的康复锻炼,再植肢体可恢复一定的功能.     

Two faces of major lower limb amputations

OBJECTIVES: To review the indications for major lower limb amputations in adults and children in our patient population and to compare our experience in prosthetic rehabilitation with that of other published information. MATERIAL AND METHODS: We retrospectively reviewed charts of patients who underwent amputation between 1997 to 2004 at the Orthopaedic Department of B& B Hospital (BBH), Gwarko and Hospital and Rehabilitation center for Disabled Children ( HRDC), Banepa. There were 113 patients at BBH & 89 patients at HRDC. Major amputation was defined as any amputation at or proximal to wrist and ankle. RESULTS: Major lower limb amputations constituted 73.58%(39/53) of all major amputations at BBH and 97.77% (44/45) at HRDC.Road traffic accident was found to be number one cause for major lower limb amputations (74.29%) in adult population. In children postburn contracture was the leading cause for amputation (29.54%) followed by Congenital limb conditions (22.72%), Spina bifida with trophic ulcers ( 20.45%), Tumor (13.63%), Chronic Osteomyelitis (6.81%), Trauma (4.54%) and Arthrogryposis (2.27%). Prosthetic fitting and rehabilitation is as yet far from satisfactory in the adult population but all the children who had amputation at HRDC were fitted with prosthesis. CONCLUSION: Main causes of major lower limb amputation in both population is largely preventable by instituting safety measures and conducting awareness program. There is a need for an effective prosthetic fitting center for adults.     

Successful revascularisation of near total amputation of the upper limb after ten hours of warm ischaemia

Near total amputation of the upper limb if unsalvageable would cause severe disability. However, delayed revascularisation can be life threatening. We report two cases of revascularisation of the upper limb following near total amputation that was successful and functional after a warm ischaemic time of ten hours. The first was a traction avulsion injury of the arm leaving major nerves contused but in continuity. The second was a sharp injury through the mid-forearm attached by only a bridge of skin. Attempting revascularisation of a proximal injury beyond 6 hours, in selected cases is worthwhile.     

脊髓电刺激术治疗不可手术的慢性严重肢体缺血1例

Peripheral arterial disease is one part of systematic atherosclerosis, becoming a heavy burden of human health. Patients in end stage of peripheral arterial disease manifest critical limb ischemia with severe rest pain and refractory ulcer. Surgical revascularization is the optimal option for patients with critical limb ischemia to avoid major amputation and improve quality of life. However, some of them contraindicate surgical revascularizations owing to coexisting morbidities. Spinal cord stimulation is reported to be effective and minimally invasive in pain relief and limb salvage for patients with limb ischemia. Here, we reported one case with chronic critical limb ischemia and gangrene of foot who underwent spinal cord stimulation, which was, as we knew, the first case in China. He was diagnosed with Burger disease and accompanied with history of stroke, chronic obstructive pulmonary disease and Castleman’s disease. It showed totally occlusive lesions of external iliac and femoropopliteal artery and no outflows below the knee in the computed tomography angiography. Given the complexity of lesions and weakness of the patient, spinal cord stimulation was indicated for control of rest pain and limb salvage. As specified, we implanted the temporary neurostimulator as the first step. After 2 weeks from temporary neurostimulator implantation, the patient achieved significant relief in intensity of pain, and acquired 20% improvement of transcutaneous oxygen pressure. The satisfactory results indicated probable effectiveness of spinal cord stimulation, thus we performed the permanent neurostimulator implantation 1 month later. During 2 months of follow-up, the patients stabilized at Fountain Ⅲ with pain relief with one kind of nonsteroidal anti-inflammatory drug. In our case, we confirmed the significant validity of spinal cord stimulation for pain control and consequent improvement of quality of life in non-reconstructable chronic critical limb ischemia. Furthermore, we reviewed that a number of published studies suggested that spinal cord stimulation be a reasonable option for patients with critical rest pain, especially who contraindicated surgical revascularization. The application of spinal cord stimulation in pain relief for non-reconstructable chronic critical limb ischemia was approved by related guidelines released by European Society of Cardiology and Trans-Atlantic Inter-Society Consensus. Further investigations are required for assessing the long-term outcome in limb salvage.     

游离股前外侧肌皮瓣治疗截肢术后残端坏死合并感染、骨外露

目的:应用游离股前外侧肌皮瓣治疗截肢术后残端坏死合并感染、骨外露的临床疗效。方法:对四肢严重创伤行截肢,术后残端坏死合并感染、骨外露,设计游离股前外侧肌皮瓣治疗,其中急诊截肢7例,保肢失败而2期行截肢5例,创面面积最大50cmx45cm,最小10cmx7cm,肌皮瓣面积最大9cmx26cm,最小8 cmx12 cm。结果:术后12例肌皮瓣全部成活。供区无功能障碍,受区外形满意,安装假肢后功能良好。结论:应用游离股前外侧肌皮瓣治疗截肢术后残端坏死合并感染、骨外露,抗感染能力强,成功率高,避免再次截肢,可以最大限度地保留自身关节,改善假肢功能。