Hyperacute spinal subdural haematoma as a complication of lumbar spinal anaesthesia: MRI

We report two cases of hyperacute spinal subdural haematoma secondary to lumbar spinal anaesthesia, identified with MRI. Prompt diagnosis of this infrequent, potentially serious complication of spinal anaesthesia is essential, as early surgical evacuation may be needed. Suggestive MRI findings in this early phase include diffuse occupation filling of the spinal canal with poor delineation of the spinal cord on T1-weighted images, and a poorly-defined high-signal lesion with a low-signal rim on T2-weighted images. Received: 10 November 1998 Accepted: 6 April 1999     

Vascular complications in lumbar disk surgery: report of four cases

Vascular injuries in lumbar disk surgery, although rare, are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important that surgeons and radiologists be aware of these potentially fatal complications and develop an appropriate symptom-based diagnostic paradigm. We reviewed 8099 consecutive cases of lumbar disk surgery, performed over a 14-year period at a single institution, for postoperative vascular complications. We identified four patients (0.05%) with lumbar disk surgery-related vascular complications: intraoperative lacerations of the abdominal aorta and median sacral artery, an arteriovenous fistula between the left common iliac artery and vein detected 19 days postdiskectomy, and a partially thrombosed aortic aneurysm with an arteriovenous fistula between the aneurysm and the inferior vena cava, diagnosed 11 months after surgery. The majority of cases in the literature of vascular injury in lumbar disk surgery were reported prior to 1965. Diagnostic approaches described in that period do not reflect the great range of diagnostic techniques available today. Angiography remains the gold standard for diagnosis and guidance as to surgical repair. However, a high index of suspicion based on clinical signs and/or the use of sonography or CT is important in the detection of these complications.     

Collateral pathways in lumbar epidural venography

Summary Opacification of collateral pathways other than the central channels is very rare in lumbar epidural venography. Two cases of opacification of the inferior mesenteric vein following extravasation of contrast medium at the tip of the lateral sacral vein catheter are reported. One case is presented in which filling of normal parametrial venous plexuses and the left ovarian vein occurred as a consequence of incompetent or absent valves in the internal iliac vein. The literature containing comparable collateral flow patterns in disease is reviewed. The significance of the phlebographic features in our cases is discussed.     

人工髋关节置换术早期并发症26例

目的探讨应用组配柄对骨缺损情况下全髋股骨翻修的疗效。方法回顾性分析625例人工髋关节置换术患者，其中股骨头置换312例，全髋关节置换313例。总结并发症的临床特点及防治措施。结果26例（4．2％）患者出现并发症，其中伤151浅层感染1例（0．2％），脱位3例（0．5％），股骨假体周围骨折5例（0．8％），下肢深静脉栓塞11例（1．8％），应激性溃疡出血3例（0．48％），坐骨神经损伤1例（0．2％），假体松动2例（0．3％）。2例死亡。结论严格手术适应证、正确手术操作、强调术前准备和术后处理是减少术后并发症发生的关键。     

两点法腰硬联合麻醉在子宫全切除术中的应用

目的观察两点法腰硬联合麻醉用于子宫全切术的临床效果。方法选择ASAⅠ～Ⅱ级行子宫全切术患者120例,随机分成两组,每组60例,Ⅰ组为一点法,即L2～3腰椎单次腰麻后置入硬膜外导管;Ⅱ组为两点法,即T12～L1行硬膜外置管,再行L2～3单次腰麻。比较两组患者血流动力学变化、麻醉效果,记录腰麻平面不对称例数、硬膜外腔用药量、需要辅助用药的例数及术后头痛、腰背痛情况。结果在进腹探查和牵拉宫颈时,Ⅰ组患者心率下降幅度大于Ⅱ组患者的心率下降幅度(P<0.05);Ⅱ组肌松满意度和防止牵拉反应明显优于Ⅰ组(P<0.05);腰麻平面不对称例数、硬膜外腔用药量和需要辅助用药的例数Ⅰ组多于Ⅱ组。结论两点法腰硬联合麻醉用于子宫全切术麻醉效果确切,更合理安全。     

Imaging of thoracic and lumbar spinal extradural arachnoid cysts: report of two cases

Extradural arachnoid cysts are uncommon expanding lesions in the spinal canal which may communicate with the subarachnoid space. Usually in the lower thoracic spine, they may cause symptoms by compressing the spinal cord or nerve roots. We report cases of thoracic and lumbar arachnoid cysts studied by cystography, myelography, CT and MRI. These techniques showed extradural cystic lesions containing cerebrospinal fluid, with variable communication with the subarachnoid space, causing anterior displacement and flattening of the spinal cord. Received: 3 November 1995 Accepted: 16 April 1996     

Thoracic epidural angiolipoma: A case report and review of the literature

Angiolipoma of the spine is a benign neoplasm consisting of both mature fatty tissue and abnormal vascular elements, and usually presents with a slow progressive clinical course. Our patient presented with bilateral lower extremity weakness and chest-back numbness. Physical examination revealed adipose elements superficial hypesthesia below the T5 level and analgesia below the T6 level. Magnetic resonance imaging (MRI) scan showed an avidly and heterogeneously enhancing mass which was located in the posterior epidural space. Compression of the thoracic cord by the fusiform mass was seen between T3-T4. During the operation, a flesh pink vascular mass (4.7 cm × 1.0 cm × 1.0 cm) with obscure margin and strong but pliable texture was found in the posterior epidural space extending from T3 to T4. There was no infiltration of the dura or the adjacent bony spine. Histopathological study of the surgical specimen showed a typical angiolipoma. We review the previously documented cases of spinal extradural angiolipomas performed with MRI.     

Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2–L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. Received: 23 August 1999; Revised: 13 January 2000; Accepted: 4 February 2000     

严重骨盆骨折及其并发症的救治

目的总结严重骨盆骨折及其并发症的急救处置经验。方法对近5年来我科收治的伴有一种或几种并发症的129例严重骨盆骨折患者的临床资料结合文献进行回顾性分析和讨论。结果本组129例中死亡8例,其中7例未及时行有效骨盆固定。总生存率为93.8%。结论严重骨盆骨折的诊治应严格遵循损害控制（DC）理论,密切监测生命体征、快速补充血容量,保持呼吸道通畅。及时、有效的骨盆固定措施能最大限度地挽救患者生命,合理的治疗方案有利于降低伤残率。     

Imaging the complications of osteochondromas.

Most osteochondromas are asymptomatic and incidental with typical radiographic characteristics. When symptomatic, complications due to space-occupying effects, mechanical deformity, or malignant transformation are usually the underlying causes. This article addresses the imaging strategy for their identification and evaluation.     

经阴道子宫切除术1 990例并发症临床分析

目的 分析经阴道子宫切除术并发症的发生率、发生原因及处理方法 ,探讨其防治措施.方法 对2000年1月～2006年6月1 990例行经阴道子宫切除术患者的手术并发症临床资料作回顾性分析.结果 1 990例经阴道子宫切除术患者中75例出现并发症,发生率为3.77%.其中膀胱损伤21例(1.06%),输尿管损伤5例(0.25%),直肠损伤6例(0.30%);术后发生残端感染30例(1.51%),残端血肿8例(0.40%),腹腔内大出血2例(0.10%),阴道狭窄2例(0.10%),肠梗阻1例(0.05%).所有并发症均经手术或保守治疗得到纠正,未遗留后遗症.术中脏器损伤多发生于伴有盆腔粘连或子宫大而活动欠佳的患者,如有盆腔手术史、子宫内膜异位症、子宫下段大肌瘤等.结论 经阴道子宫切除术较易损伤邻近器官从而发生相应并发症,术者需熟悉盆腔解剖结构,熟练掌握经阴道子宫切除术技巧,同时需严格把握手术适应证.     

西藏高原地区腰麻联合硬膜外麻醉与硬膜外麻醉的临床比较研究

目的:探讨腰麻联合硬膜外阻滞在西藏高原地区用于下腹及下肢的手术的临床效果。方法:36例在腰麻联合硬膜外阻滞下行下肢及下腹部手术病人(CSEA组),根据手术需要选择单点法或双点法,以26 G腰麻穿刺针通过硬膜外针刺入蛛网膜下腔,注入局麻药物重比重0．5％布比卡因0．2 mg体重(Kg),记录两组病人入手术室时和麻醉后10、30、60 min 的血压、心率以及氧饱和度;麻醉到手术开始的时间;麻醉效果;术后恢复情况,有无并发症等。选择既往2004年硬膜外麻醉病例36例作为对照组(EA组)。结果:EA组在麻醉时间和手术开始时间均明显大于CSEA组(P<0．05);在麻醉后 10min,EA组舒张压明显下降(P<0．05),CSEA组收缩压及舒张压均明显下降,麻醉后30及60min,两组病人血压均有升高,与麻醉前对比无明显差异(P>0．05);EA组病人在麻醉后吸氧(2～4)L／min,麻醉后10、30、60 min SpO2都明显高于麻醉前(P<0．01);CSEA组麻醉后10 min在未吸氧的情况下SpO2明显高于麻醉前(P<0．05),麻醉后30、60 min吸氧(2～ 4)L／min SpO2明显高于麻醉前(P<0．01)。结论:CSEA在高原环境下是安全可行的,在下腹和下肢手术中是一个比较理想的麻醉选择,与硬膜外阻滞相比,其麻醉药用量小,作用快、效果确切,对呼吸影响轻微,但对有明显心肌缺血的病人应慎用。     

退变性腰椎后滑脱症的影像学研究(附130例分析)

目的:探讨"退变性腰椎后滑脱影像学诊断。方法:以患者CR片及CT、MR检查,观察和测量病患椎体相对位置变化;并分析有无并发病变。结果:130例本病患者腰椎向后滑脱1.5～11mm,平均3.8mm。所有患者有程度不同的腰椎退变表现。结论:本病皆由腰椎退变而引起,故以"退变性腰椎后滑脱症"命名,它的发生有其解剖学基础,腰椎退变是关键,外力作用为诱因,三者共同作用促成了本病。     

肝移植术后早期胆道并发症65例诊治体会

目的探讨肝移植术后早期胆道并发症的诊断和治疗。方法回顾性分析了我院2006年5月～2008年3月以来成功实施的65例肝移植的临床资料。其中尸肝移植54例，亲体肝移植11例，女性占16．92％（11／65），男性占83．08％（54／65）。结果本组65例肝移植患者其中有8例3个月内出现胆道早期并发症，发生率为12．31％（8／65），分别为胆漏3例，胆汁瘤1例，肝内胆汁湖1例，胆泥形成1例，胆道狭窄2例。女性患者早期胆道并发症发生率为9．09％（1／11），男性患者早期胆道并发症发生率为12．96％（7／54）。8例患者中，留置T管引流1例，未留置T管引流7例。治愈6例，好转2例，死亡0例（0％）。其中3例术后3d内出现单纯胆漏，通过留置的腹腔引流管得到及时的诊断，同时应用留置的腹腔引流管持续引流4周～2月后得到治愈。5例经B超、MRCP、ERCP得到诊断；1例胆汁瘤和1例肝内胆汁湖通过B超引导下穿刺引流而得到治愈；1例胆泥形成通过ERCP进行胆道冲洗后好转出院；2例通过ERCP进行球囊扩张或者放置支架后好转出院。结论肝移植术后早期胆道并发症的诊断主要手段是留置的腹腔引流管、B超、MRCP、ERCP等：肝移植术中留置的腹腔引流管对于肝移植术后早期胆漏的治疗起着特殊的作用：B超引导下穿刺引流是治疗胆汁瘤、胆汁湖的重要手段；ERCP下胆道冲洗对胆泥形成非常有效．ERCP下球囊扩张或者放置胆道支架对胆道狭窄的治疗很有效。     

Spinal epidural lipomatosis. Case report and review of the literature

Spinal epidural lipomatosis (SEL) is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It is most frequently seen in patients on chronic glucocorticosteroid therapy for a variety of medical problems. This is a case report of lumbar epidural lipomatosis in a bodybuilder with radiculopathy supposedly induced by anabolic steroid intake.     

CT引导下经硬膜囊外直接穿刺腰椎间盘突出注射臭氧治疗腰椎间盘突出症

目的 探讨CT引导下经硬膜囊外直接穿刺突出的椎间盘组织注射臭氧治疗腰椎间盘突出症的疗效.方法 在CT扫描引导下,采用后入路穿刺,根据纤维环完整与否,于椎间盘内、盘外注射不同浓度臭氧.结果 术后1周,28例中疗效优21例、良3例,优良率85.7％;术后1月,28例中疗效优23例、良2例,优良率89.2％;术后3月,28例中疗效优24例、良1例,优良率89.2％.纤维环完整、破裂优良率分别为94.7％（18/19）、55.5％（5/9）.结论 经硬膜囊外CT引导下直接穿刺突出椎间盘组织注射臭氧治疗腰椎间盘突出,具有安全、有效、创伤小及定位准确、操作简单等特点,是腰椎间盘后方或侧后方突出理想的治疗手段.     

多发伤严重并发症的监护治疗

目的总结ICU中多发伤严重并发症的发生率和救治经验。方法回顾性分析第三军医大学大坪医院重症医学科2013年1月～2016年1月治疗的150例严重多发伤患者的临床资料,总结分析多发伤严重并发症,如创伤性休克、创伤致死三联征、脓毒症、腹腔间隙综合征、急性呼吸窘迫综合征、急性肾损伤、急性胃肠损伤的发生率以及监护治疗措施和结局。结果本组共150例,发生创伤性休克109例(72.7%);创伤致死三联征89例(59.3%),其中发生弥散性血管内凝血7例(4.7%),死亡3例(2%);脓毒症41例(27.3%),其中脓毒性休克14例(9.3%);腹腔间隙综合征2例(14.7%),死亡2例(1.3%);急性呼吸窘迫综合征36例(24.0%),死亡1例(0.6%);急性肾损伤37例(24.7%);急性胃肠损伤53例(35.3%)。ICU住院天数5～36d,平均8.9d。顺利转科136例(90.7%),自动出院8例(5.3%),死亡6例(4.0%)。结论进入ICU的多发伤患者并发症发生率高,以创伤性休克为主,而弥散性血管内凝血的死亡率最高,其次是腹腔间隙综合征,多发伤患者进入ICU实施严密监测,对并发症的防治十分重要。     

Hemorrhagic complications in embolization of a meningioma: Case report and review of the literature

We report a case of hemorrhage in a parasellar meningioma shortly after embolization of the dural cavernous carotid artery branches supplying the tumor. This represents the first report of hemorrhage within a meningioma resulting from embolization with small (50- to 150-μm) polyvinyl alcohol particles, as well as the first reported case of hemorrhage complicating meningioma embolization from internal rather than external carotid artery branch embolization. We also review previously reported cases of postembolization hemorrhage from meningiomas. Received: 16 August 1996 Accepted: 4 April 1997     

Arteriovenous fistula as a complication of lumbar disc surgery: case report

Arteriovenous fistula (AVF) is a rare, late complication of lumbar disc surgery. It is often not suspected and the symptoms are diagnosed as heart failure or deep venous thrombosis. We report a case in which the patient developed leg swelling and high-output congestive heart failure due to a left ilioiliac AVF after lumbar laminectomy. Received: 3 September 1997 Accepted: 27 October 1997     

自发性脊髓硬膜外血肿2例

患者1男,45岁。突发胸背部剧烈疼痛伴双下活动障碍6h于2011年3月22日入院。6h前患者出现胸背部刺疼,持续性加重,2h后双下肢无力,站立困难,随后双下肢不能活动。查体:体温及血压正常,脊柱颈6～胸3椎棘突上下压痛(+),乳突以下感觉消失,双下肢膝和跟腱反射、肛周