蛛网膜下隙穿刺术后去枕平卧的疑义与探讨

为了防止蛛网膜下隙穿刺脑脊液渗漏造成低颅压性头痛 ,以往术后常规去枕平卧 6小时[1 ] 。但现在采用细腰穿针 ,头痛发生率极低 ,是否应延用这一常规 ,尚有疑问。资料与方法随机选择分为脊麻组和椎管造影组 ,分别作去枕和垫枕平卧比较和组间比较。两组ＡＳＡ分级皆为Ⅰ～Ⅱ级。年龄范围、性别比例无明显差异。脊麻组 2 2 4 0例 ,随机又分为去枕 640例 ,垫枕 1 60 0例。应用美国Ｂ Ｄ公司 2 5Ｇ腰穿针 ,经硬膜外针刺入蛛网膜下隙后注入 0 5 %布比卡因 2～ 3ｍｌ;椎管造影组 1 68例 ,随机又分为去枕 1 0 1例 ,垫枕 67例 ,应用国产 2 0Ｇ传统…     

退行性腰椎滑脱与不稳关系的探讨

退行性腰椎滑脱与退行性腰椎不稳均是造成中老年腰背痛和或神经功能障碍的常见原因。目前,对于两者的病因学、病理学及发病机制均有较深入的了解,但临床当中对于两者的关系仍存在许多混淆点,如不稳是否包含着滑脱,滑脱是否就说明不稳等。且未见对两者之间的关系进行报道的文献,导致临床诊断错误及治疗方面是否融合存在偏差。     

成年人下腰痛与腰椎前凸和骶骨倾斜角的关系

目的 探讨下腰痛患者的发病与腰椎前凸和骶骨倾斜角变化的关系.方法 对86 例患有下腰痛病人和90 例无症状者摄腰椎立位X线侧位片,测量腰椎总前凸角、节段前凸角和骶骨倾斜角.结果 患病组的总前凸角和骶骨倾斜角明显低于对照组(P＜0.05).总前凸角的丢失主要来自于L4～5和L5S1节段前凸角的减少.两组的腰椎总前凸角与骶骨倾斜角呈明显的正相关.结论 腰椎前凸和骶骨倾斜角的丢失可能是下腰痛的解剖基础之一.     

腰椎椎体后缘离断症的影像学诊断与探讨

目的 :总结腰椎椎体后缘离断症的影像学诊断特点并探讨其价值。方法 :对 3 2例经手术证实的腰椎椎体后缘离断症患者的影像学表现进行回顾性分析。结果 :3 2例中X线平片显示腰椎椎体后缘离断症 2 1例 (65 6% )、CT平扫显示 3 2例 (10 0 % ) ,行MRI检查 2 1例 ,显示 2 0例 (95 2 % )。结论 :CT平扫是腰椎椎体后缘离断症最可靠的诊断方法 ,MRI可显示髓核退变后突和硬膜囊受压的程度 ,X线平片则是检查的基本方法     

小儿十二指肠损伤的诊断与治疗（附8例报告）

目的 探讨小儿十二指肠不同程度外伤性破裂的临床表现及治疗方法。方法 对我院1994－1998年收治的8例十二指肠损伤患儿的临床资料进行回顾性分析。结果 ①全部患儿均有上腹部外伤史；②大多数破裂处位于十二指肠第三段；③单纯缝合修补加近端十二指肠隧道式造瘘术是有效的治疗方法。结论 小儿十二指肠外伤性破裂以十二指肠第三段为主，单纯缝合修补加近端十二指肠隧道式造瘘术是简单易行的手术方法。     

小儿原发性膀胱输尿管返流的诊断与手术治疗(附39例报告)

目的：总结小儿原发性膀胱输尿管返流（PVUR）诊治经验。方法：回顾分析PVUR39例的诊治资料，1例4月龄婴儿做膀胱造口，2例患侧及1例对侧并发肾发育异常者共做3例肾切除，1例上尿路正常者用药物治疗，余35例均行膀胱内、外的横向推进抗返流输尿管膀胱再植术。结果：35例（92％）术后效果满意，2例双侧病变者第一次手术仅做严重的一侧，术后尿内持续有脓细胞，复查时原对侧Ⅰ、Ⅱ度返流增重，经再次手术治愈。1例手术后仍不能挖掘尿路感染，经患肾穿刺造瘘后好转。结论：外科矫治PVUR（Ⅳ-Ⅴ）的手术成功率，双 侧病变一期完成双侧手术。6月龄以内的PVUR（Ⅳ-Ⅴ）应做膀胱造口，周岁后应考虑抗返流的输 尿管膀胱再植术。     

腰肌指数、腰椎椎体骨髓脂肪分数与骨密度关系及对骨质疏松的诊断效能

目的 探讨腰肌指数(psoas muscle index, PMI)、腰椎椎体骨髓脂肪分数(fat fraction, FF)与骨密度(bone mineral density, BMD)间的关系及对骨质疏松(osteoporosis, OP)的诊断效能。方法 选取四川省骨科医院2018年3月至2021年5月BMD筛查的200例检查者作为研究对象,根据BMD分为骨量正常组(T值≥-1.0,n=105)、骨量减少组(-2.5相似文献   

Spinal needle design and size affect the incidence of postdural puncture headache in children

Background: In adults, pencil point spinal needles are known to be less traumatic and hence to be superior compared with cutting point needles in respect of postpuncture complications. In children, only a few trials have evaluated the difference in the incidence of postdural puncture headache (PDPH) using spinal needles with different tip designs. The aim of this study was to evaluate the success rate and the incidence of PDPH and backache following spinal anesthesia (SA) with the two types of needles currently in use for children. Methods: This is a retrospective study of prospectively collected data. The success rate and postpuncture complications of 26G cutting point (Atraucan^®) spinal needle were compared with 27G pencil point (Pencan^®) spinal needle in 414 children aged 2–17 years undergoing surgery with SA. Results: Both needles had similar first‐attempt success rates: 87% in the cutting point group and 91% in the pencil point group (P = 0.16). Pencil point needles caused less PDPH compared to cutting point needles; 0.4% vs 4.5%, respectively (P = 0.005). Both needles caused similar backache (P = 0.08). No severe neurologic symptom was reported for both needles. Conclusion: The data suggest that 27G pencil point spinal needles lead to less PDPH compared to 26G cutting point spinal needles in children.     

下腰椎脊神经根发出部位与盘黄间隙解剖关系的临床研究

目的 探讨下腰椎脊神经根分出部位与盘黄间隙的解剖关系在腰椎退行性疾病的应用.方法 回顾性分析167 例经后路手术治疗存在盘黄间隙狭窄的下腰椎退行性疾病患者的临床资料.根据术前MRI显视和术中所见,将下腰椎脊神经根分出部位与盘黄间隙的解剖关系分为三种类型,Ⅰ型：分出部位在盘黄间隙上缘或以上;Ⅱ型：分出部位在盘黄间隙中部区域;Ⅲ型：分出部位在盘黄间隙下缘或以下;盘黄间隙狭窄分为轻度（2～5 mm）和重度（小于2 mm）.对不同类型及分度进行统计学分析.结果 Ⅰ型（88节段）：L3～40节段、L4～521节段、L5S167节段;Ⅱ型（69节段）：L3～44节段、L4～554节段、L5S111节段;Ⅲ型（33节段）：L3～416节段、L4～517节段、L5S10节段;各型节段间隙差异均有统计学意义（P＜0.05）.各型所占轻、重度盘黄间隙狭窄数差异有统计学意义（P＜0.05）.结论 下腰椎脊神经根发出部位在盘黄间隙从L3～4到L5S1有上移的趋势;Ⅰ型和Ⅱ型患者轻度下腰椎盘黄间隙狭窄易出现神经根性症状,Ⅲ型患者常表现为重度盘黄间隙狭窄.明确脊神经根发出的部位与盘黄间隙之间的关系,有利于明确相关腰椎退行性疾病的部位诊断和减压范围.     

Spinal anaesthesia in infants and children

Every anaesthetist who deals with paediatric patients should have the expertise to perform spinal anaesthesia. Often, children undergoing surgery in the lower part of the body have contraindications for general anaesthesia; in these children spinal anaesthesia is a convenient option.The aim of anaesthesia is to provide good operating conditions for the surgeon while avoiding any harmful psychological sequelae for the child. In addition, the anaesthetist's goal is to lessen the physiological stress response to surgery and to prevent post-operative morbidity. In children, spinal anaesthesia produces a dense intra-operative analgesia and, when combined with general anaesthesia, it reduces the requirements for anaesthetic agents and opioids intra-operatively. Spinal anaesthesia allows a fast return to a bright and alert status, and a rapid return of normal appetite. Following spinal anaesthesia, analgesia continues into the early post-operative period, and nausea and vomiting are uncommon. Consequently, ambulation and discharge are not delayed.Some children develop complications following spinal anaesthesia—for example, a post-lumbar puncture headache and transient neurological symptoms. In young children these symptoms may be difficult to perceive if parents are not informed. When long-lasting, these symptoms may surpass the benefits of spinal anaesthesia and should therefore be identified and treated appropriately.     

Spinal anaesthesia with 29 gauge Quincke point needles and post dural puncture headache in 2,378 patients

Two thousand three hundred and seventy–eight spinal anaesthetics using a 29 G Quincke point needle were administered in a District Hospital between May 1983 and December 1991. The overall post dural puncture headache rate (PDPH) was 1.2% with a maximum of 2.5% in patients between age 30 and 39. PDPH was related to the experience of using 29 G needles (0.5% in consultants versus 2.0% in trainees, P<0.05).     

Depression Following Spinal Cord Injury: Its Relationship to Demographic and Socioeconomic Indicators

Background:

Depression is a common psychological problem that decreases life satisfaction and quality of life in people with spinal cord injury (SCI).

Objective:

The aim of this study was to investigate the prevalence of depression after SCI and its association with pathophysiological, demographic, and socioeconomic factors, including sex, age, level of injury, financial status, and suicidal thoughts.

Methods:

This was a cross-sectional study of 134 adults (≥18 years old) with SCI who were referred to the Brain and Spinal Cord Injury Research Center (BASIR) clinic, Tehran University of Medical Sciences, for outpatient rehabilitation. The Beck Depression Inventory (BDI-II Persian), a 21-question multiple-choice inventory, was used to measure the presence and severity of depression. Data were collected by interview.

Results:

Sixty-six (49.3%) participants had mild to severe depression. There was a higher probability of depression in individuals with SCI who were female, had tetraplegia, had suicidal thoughts, had a history of suicide attempt, had a low education level, or were taken cared for by a family member other than a spouse or parents.

Conclusion:

Depression was highly prevalent in individuals with SCI and was related to some demographic, pathophysiological, and socioeconomic indicators. The primary predictive indicators and the factors influencing depression should be determined to provide early detection and timely treatment to prevent more complications and improve quality of life for individuals with SCI.     

Decrease in the incidence of post-dural puncture headache: maintaining CSF volume

The incidence of epidural needle-induced post-dural puncture headache (PDPH) in parturients following dural puncture with a large bore (18-gauge) needle has been reported to range 76-85%. We describe seven cases in which the performance of epidural anesthesia in parturients was complicated by an unintentional dural puncture with an 18-gauge epidural needle. In all seven cases, the unintentional dural puncture was followed by (i) injection of the CSF in the glass syringe back into the subarachnoid space through the epidural needle, (ii) insertion of a epidural catheter into the subarachnoid space (now referred to as an intrathecal catheter), (iii) injection of a small amount of preservative free saline (3-5 ml) into the subarachnoid space through the intrathecal catheter, (iv) administration of bolus and then continuous intrathecal labor analgesia through the intrathecal catheter and then (v) leaving the intrathecal catheter in-situ for a total of 12-20 h. PDPH occurred in only one of these cases (14%).     

High success rate and low incidence of headache and neurological symptoms with two spinal needle designs in children

BACKGROUND: In children, only a few trials have evaluated the use of spinal needles with special tip designs. In this study, we compared the success rate and incidence of post-dural puncture complaints of two small-gauge spinal needle designs used in children undergoing spinal anaesthesia (SA). METHODS: Three hundred and three children aged 9 months to 17 years presenting for subumbilical surgery were randomly assigned to have a 26G Atraucan (n = 156) or 27G Whitacre (n = 147) spinal needle for SA. The number of attempts to obtain successful cerebrospinal fluid (CSF) return and the success rate of SA were recorded. The first week of recovery was recorded by a diary. RESULTS: Both groups had a similar one-attempt success rate: 80% in the Atraucan group and 81% in the Whitacre group. Failure to obtain CSF occurred in one patient in the Atraucan group and in two patients in the Whitacre group. Paraesthesia was observed more commonly in the Whitacre group (10%) than in the Atraucan group (2%) (P = 0.004). The success rate of SA was 96%, with no differences between the two needles; one child was given general anaesthesia and 11 children (3%) a single dose of supplemental analgesia for the skin incision. Forty-one children (15%) developed a headache, 13 of which were classified as post-dural puncture headache (PDPH), seven cases (5%) in the Atraucan group and six (4%) in the Whitacre group; none of the children required a blood patch. Fifteen children (10%) in the Atraucan group and nine (7%) in the Whitacre group developed low back pain. Two children (1%) in the Atraucan group and four (3%) in the Whitacre group developed transient neurological symptoms (TNSs). CONCLUSION: Both needles were associated with a high success rate and a low incidence of complaints.     

脑胶质瘤病人化疗行颈总动脉穿刺方法的探讨

为探讨方便,可靠的化疗穿刺法,提高化疗的安全性,分别用普通动脉穿刺法和留置针穿刺法对１０例脑胶质瘤病人行经颈总动脉化疗４０次。结果表明：两种方法 策 经统计学处理,Ｘ＾２＝０．５１３,Ｐ〉０．０５,无显著性差异。     

Prognostic Significance of the Delayed Plantar Reflex Following Spinal Cord Injury

Abstract

The delayed plantar reflex (DPR) is a pathologic flexor variant which requires unusually strong stimulation of the sole of the foot and is characterized by a prolonged interval between the stimulus and the response, slow and protracted plantarflexion of the great toe and/or other toes and slow return to the neutral position. The purpose of this study was to evaluate prospectively the functional outcome of spinal cord injury (SCI) patients based on the presence or absence of a DPR immediately following injury. Thirty-six subjects were evaluated within one week of injury. A complete neurological evaluation following American Spinal Injury Association (ASIA) standards was performed and the presence or absence of a DPR was noted on admission. Ambulation status and ASIA Impairment Scales were recorded at discharge from the rehabilitation unit and the data were analyzed by the Chi-square method with Yates’ correction for continuity. The data demonstrated a high correlation of the DPR with motor complete injuries (p <0.01) and a poor prognosis for recovery of ambulation (p <0.01). Clinicians should recognize this abnormal reflex, which may be used in conjunction with a complete neurological examination, to help prognosticate future function in the acute SCI patient. (J Spinal Cord Med 1997; 20:207-211)