核磁共振在隐匿的脊柱及相关部位疼痛的诊断价值

目的 探讨隐匿的脊柱及相关部位疼痛患者进行相应节段脊柱核磁共振成像(MRI)检查的必要性.方法 分析27例脊柱相关部位隐匿疼痛的患者临床表现及相应节段脊髓MRI、X线和CT检查结果.结果 27例针对脊髓进行的MRI平扫发现:脊柱肿瘤15例,脊柱附近病变5例,椎管内累及神经根病变3例,累及脊髓病变3例,脊柱结核1例.临床证实上述异常是导致患者颈胸背腰腿痛的原因.在MRI检查前,其中17例患者进行过脊柱X线检查,未能发现上述病变；8例行脊柱CT检查,6例未能发现上述病变.结论 进行相应节段脊柱MRI平扫,是明确隐匿的颈肩臂、胸、背、腰腿痛诊断的必要检查手段.     

腰骶段脊髓室管膜瘤的MRI诊断及其鉴别诊断

目的:分析腰骶段脊髓圆锥及终丝室管膜瘤的MRI影像特点,提高该病的诊断准确性和对鉴别诊断的认识。方法:回顾性分析经手术病理证实的14例腰骶段脊髓内室管膜瘤,所有病例均行MRI平扫和增强扫描,分析肿瘤的部位、病理类型、生长方式和信号特点、强化方式、有无囊变,观察有无含铁血黄素沉积。结果:肿瘤发生在脊髓圆锥2例,终丝12例,10例可见囊变,11例T₂W1见低信号,13倒不均一明显强化。结论:MRI可以反映脊髓内室管膜瘤MRI特征,是诊断和鉴别诊断的重要手段,有助于提高诊断正确率,有含铁血黄素沉积时倾向于诊断室管膜瘤。     

三种手术术式治疗51例胸腰段脊柱骨折伴脊髓损伤的临床观察

目的 探讨手术治疗胸腰段脊柱骨折伴脊髓损伤的临床疗效.方法 回顾性分析笔者所在医院收治的51例胸腰段脊柱骨折伴脊髓损伤患者的病历资料,所有51例患者根据具体病情分别采用前路手术、后路手术、前后联合入路手术三种手术术式进行治疗.结果 51例患者胸腰段脊柱骨折都进行了有效的内固定,前路手术组术后各项指标均高于后路手术组,差异有统计学意义（P＜0.05）.结论 前后路手术均可有效治疗胸腰段脊柱骨折伴脊髓损伤,应根据具体病情选择术式.     

手术切除20例脊髓髓内肿瘤临床报告

目的:报告20例脊髓髓内肿瘤的手术切除治疗情况.方法:20例脊髓髓内肿瘤患者均行显微外科手术切除肿瘤,其中10例室管膜瘤患者,瘤体全切8例,次全切除2例.8例星形细胞瘤及间变性星形细胞瘤患者,大部切除4例,部分切除4例.2例血管母细胞瘤患者全部手术全切,疗效评估参照病人出院时临床症状和体征进行神经功能综合评价.结果:临床疗效好转12例(60.0%),无变化6例(30.0%),加重2例(10.0%).结论:显微外科手术治疗脊髓髓内肿瘤有较好疗效.     

终丝表皮样囊肿的临床特点与外科治疗

目的 总结终丝表皮样囊肿的临床特点、手术治疗及治疗结果.方法 回顾性分析10例经手术和病理证实的终丝表皮样囊肿患者的病历资料.10例患者中男2例,女8例,年龄( 34.5±18.3)岁,病程(67.3±84.5)个月.下肢或鞍区感觉异常及二便功能障碍为常见症状,阳性体征较少.MRI表现与其他部位表皮样囊肿类似,但影像学检查常可发现脊髓低位、脊髓分裂、脊柱侧凸等病理改变.10例患者均行手术治疗,其中仅1例全切.结果 10例患者中8例出院时术前症状均有不同程度改善.8例患者获随访10～62(30.4±17.4)个月.3例患者术前症状、体征完全消失,4例明显改善,1例无变化,随访期内MRI复查均未见囊肿复发.结论 终丝表皮样囊肿病程较长、临床症状不典型,易延误诊断.MRI是本病的首选检查方法,有助于早期诊断.终丝表皮样囊肿常合并脊柱侧凸、脊髓分裂等病理改变.手术全切困难,但预后较好.     

高位颈段椎管内肿瘤的手术治疗

目的：探讨对于高位颈段椎管内肿瘤的手术治疗方法,并观察其临床治疗效果。方法随机选取15例以显微外科技术作为辅助手段、通过手术治疗高位颈段椎管内肿瘤的患者,对临床症状、基本体征、病理的类型以及手术的疗效等方面进行讨论及分析。结果本次研究的所有患者当中,75%属于髓外硬膜下肿瘤,其他25%属于髓内肿瘤,对100%的髓外肿瘤进行了全切除术,对半数的髓内肿瘤进行了全切除术,肿瘤全切除率达到了87.5%。经肿瘤切除及手术治疗后,本次研究当中的12例患者症状明显改善,2例患者症状无任何变化,1例患者症状恶化,本次研究中无发生死亡的患者。结论以显微外科技术作为辅助手段,进行高位颈段椎管内肿瘤切除手术能够有效改善椎管内肿瘤的临床症状,预后效果良好,而且能够对脊柱稳定性进行重生性建立,具有极高的临床应用与推广价值。     

胸腰段骨折的手术治疗

目的 探讨GSS-Ⅱ通用脊柱内固定系统治疗胸腰段脊柱骨折的疗效.方法 对53例胸腰段脊柱骨折患者采用GSS-Ⅱ通用脊柱内固定系统行复位固定术,观察神经功能恢复情况和并发症发生情况.结果 1例患者出现固定失败,T12左侧螺钉断裂,未出现其他并发症手术前后椎体前后缘高度及Cobb角对比差异有统计学意义(P﹤0.05).神经功能Frankel分级均明显降低.结论 GSS-Ⅱ通用脊柱内固定系统治疗胸腰段脊柱骨折效果确切,操作简单,椎体复位效果好,固定牢固.     

2种手术方法治疗胸腰段脊柱骨折的效果比较

目的探讨不同手术方法治疗胸腰段脊柱骨折的临床效果,以期为胸腰段脊柱骨折的临床诊治提供依据。方法选取2013年12月-2014年12月商丘市某医院收治的68例胸腰段脊柱骨折患者作为研究对象,随机分为研究组和对照组,每组34例。研究组患者采用椎弓根螺钉内固定联合椎板间植骨术治疗,对照组患者采用椎弓根螺钉内固定治疗,比较2组患者的Cobb角大小、椎体前缘和后缘高度及脊髓神经功能恢复情况。结果治疗后,研究组患者的Cobb角小于对照组,且椎体前缘和后缘高度高于对照组,差异均有统计学意义(P0.05);研究组患者的神经功能恢复总有效率为64.71%,高于对照组(29.41%),差异具有统计学意义(P0.05)。结论采用椎弓根螺钉内固定联合椎板间植骨术治疗胸腰段脊柱骨折,临床效果显著,是临床治疗的理想方案之一。     

原发性脊髓胶质瘤的综合治疗现状

原发性脊髓胶质瘤是起源于脊柱神经外胚层的肿瘤,包括室管膜瘤、星形细胞瘤、多形性胶质母细胞瘤、少枝神经胶质瘤和混合性胶质瘤;是最常见的脊髓髓内肿瘤,约占脊髓髓内肿瘤的80％;在椎管内肿瘤中并不少见[1-13].临床上本病远较脑胶质瘤少见,但由于其发生部位的特殊性,致残率高,对患者危害大,因此,值得深入研究.原发性脊髓胶质瘤主要以室管膜瘤和星形细胞瘤最为常见.现复习新近国内外相关文献并结合个人体会,就脊髓胶质瘤治疗进展综述如下. 一、显微手术治疗 近年随着影像学、神经电生理监测手段的不断进步,使得显微神经外科手术切除脊髓胶质瘤更加安全,也使得在保留神经功能完善的前提下能更完整地切除肿瘤.     

前、后路减压治疗胸腰段脊柱骨折合并脊髓损伤的临床效果

目的探讨前、后路减压治疗胸腰段脊柱骨折合并脊髓损伤的临床效果。方法将68例胸腰段脊柱骨折合并脊髓神经损伤患者随机分为观察组与对照组,每组各34例,对照组采用后路减压手术,观察组采用前路减压手术,比较两组患者的手术时间、术中出血量、术后效果等。结果观察组患者的手术时间及术中失血量均显著高于对照组(P<0.01);观察组术后的运动评分、触觉评分、椎体高度及Cobb's角均显著高于对照组术后水平(P<0.01)。结论后路减压手术治疗胸腰段脊柱骨折合并脊髓损伤具有更少的术中失血量及手术时间,但在椎体高度恢复、解除脊髓受压方面效果不如前路减压手术。     

Syringomyelia and Chiari's malformation in a child with scoliosis

A 9-year-old boy who since 3 years had been treated with a brace for presumed idiopathic thoracic scoliosis was referred because of severe syringomyelia on MRI of the spinal cord. Neuroimaging of the spinal cord had been performed because of back pain, although the patient had no neurological signs or symptoms. Besides extensive syringomyelia, the MRI revealed a type I Chiari's malformation which we assumed to be the primary cause of the syringomyelia and the subsequent scoliosis. Surgical decompression of the Chiari's malformation led to a remarkable reduction of the syringomyelia and to stabilisation of the scoliosis. In children with structural scoliosis, ancillary investigation in the way of neuroimaging of the spinal cord should be considered to exclude underlying spinal cord pathology, even in the absence of neurological abnormalities.     

Scoliosis

The most common form of scoliosis (lateral curvature of the spine) is adolescent idiopathic scoliosis (AIS). The prevalence of AIS is 10-20 individuals per 1,000 population screened. Progressive AIS affects females more frequently than males. Only 1-2 per 1 ,000 individuals have progressive AIS and need brace or surgical treatment. Early screening programs for scoliosis and other spinal deformities are instituted in schools in the fifth to ninth grades to achieve early detection of progressive AIS. If detected early, progressive AIS can in most cases be successfully treated by use of an external spinal brace. More severe scoliosis is successfully treated with surgical instrumentation and spinal fusion. Although much progress has been made in understanding the natural history of AIS, its cause remains unknown.     

椎管内肿瘤的诊断与治疗

目的总结椎管内肿瘤的诊断与治疗经验。方法回顾性分析1992~2003年收治的123例椎管内肿瘤的治疗结果。结果脊膜瘤24例(19.5%),神经鞘瘤/神经纤维瘤32例(26.0%),室管膜瘤8例(6.5%),星形细胞瘤13例(10.6%),脂肪瘤10例(8.1%),转移瘤5例(4.1%),血管瘤5例(4.1%),蛛网膜囊肿9例(7.3%),其他17例(13.8%)。其中髓外硬膜内占56.1%,硬膜外占21.1%,髓内占22.8%。颈段30.1%,胸段37.4%,腰段19.5%,骶段13.0%。髓外肿瘤70.1%,髓内肿瘤60.7%。全切除率69.1%。运动改善率75.2%,感觉障碍改善73.8%,括约肌功能改善77.8%。结论椎管内肿瘤以良性居多,手术效果好,MRI检查和显微外科技术的应用是提高治疗效果的关键。如果术中破坏了脊柱的稳定性,重建稳定性非常必要。     

腹侧椎管内硬膜下髓外肿瘤的显微外科治疗

目的 探讨腹侧椎管内硬膜下髓外肿瘤的显微外科治疗方法.方法 回顾性分析2000年1月至2013年12月应用显微外科技术切除的16例腹侧椎管内硬膜下髓外肿瘤病例,对肿瘤的性质、部位、切除程度、症状缓解情况进行总结.结果 16例肿瘤均成功手术切除,14例完全切除,2例大部切除,术后局部症状和神经症状获得较高的缓解率,仅2例出现感觉障碍、运动障碍较术前加重,1例出现切口脑脊液漏.结论 应用显微外科技术切除腹侧椎管内硬膜下髓外肿瘤,具有解剖层次清楚,对正常脊髓及周围组织损伤小,肿瘤完全切除率高等优点.     

Surgical resection as treatment of spinal intramedullary tumors

The authors retrospectively report the results of surgical treatment of spinal cord tumours in the Department of Neurosurgery, University Hospital Utrecht, Holland and review the recent literature. Twenty-eight patients were operated on for an intramedullary spinal cord tumour between 1981 and 1990. The mean follow-up period was 31 months. Neurological evaluation was done using the grading system described by Cooper and Epstein, immediately postoperatively and after 6 months. A total or subtotal resection could be performed in 22 (79%) of the 28 patients. Postoperatively, the neurological function of the legs improved or remained stable in 21 of the 28 patients, and the function of the arms in 26 of the 28 patients. After six months the neurological function in arms and legs had improved or remained stable in 19 of 21 patients. The most frequently occurring tumour, ependymoma, could be radically resected more often (82%) than astrocytoma (33%). Postoperative morbidity is closely related to the level of involvement. Microsurgical exploration at the cervical level is far less dangerous than has always been believed. Surgical mortality was 0%. Radical resection of intramedullary tumours should be attempted and can be achieved with stabilisation or improvement of neurological deficit in the majority of patients.     

脊柱肿瘤的诊断和外科治疗

目的回顾性分析脊椎肿瘤的早期诊断与各种外科治疗效果. 方法对1996～2002年34例脊柱肿瘤的部位、类型、临床表现、影像学特点和手术方法进行分析比较. 结果 34例安全度过围手术期,1例失访,余33例获平均3月～5年随访,术后近期疗效均较满意,有明显疼痛的29例中疼痛消失 16例,疼痛缓解 7例;瘫痪的16例肌力,感觉均部分恢复;11例术后7～16个月死亡. 结论早期诊断并且行外科治疗是最佳方法.根据脊柱肿瘤的节段和类型,结合生物力学和临床症状综合评估选择手术治疗方式.     

The effect of school screening on surgery for adolescent idiopathic scoliosis

The objective of the study was to examine the effect of screeningprogrammes for adolescent idiopathic scoliosis on populationrates for adolescent idiopathic scoliosis surgery. A case-controlstudy with data from The National Hospital Discharge Register,youth health care (YHC) departments in The Netherlands and arelevant census was used. The cases were 182 subjects aged 12–19years, admitted to hospital in The Netherlands for surgicaltreatment of adolescent idiopathic scoliosis between 1990 and1993. The total population of 12 or 13 year olds in the consecutiveyears of 1987–1992 in the regions of the participatingYHC departments served as controls. Of the 182 patients thathad surgery for adolescent idiopathic scoliosis in The Netherlandsin the years 1990–1993, 37.9% had at one time had a screeningfor spinal deformities at the age of 12 or 13 years as comparedto 37.9% of the control subjects. The odds ratio for cases thathad surgery was 1.00 (95% confidence interval: 0.74–1.35).This study does not support the view that screening for adolescentidiopathic scoliosis reduces the population rates for scoliosissurgery. As the primary aim of screening for adolescent idiopathicscoliosis is to prevent surgical intervention, this practiceshould be reconsidered.     

The treatment of neuromuscular scoliosis using segmental spinal instrumentation

In order to evaluate the effect of the treatment of scoliosis occurring in neuromuscular disease by the technique of segmental spinal instrumentation, the data of 25 patients were reviewed. The mean preoperative scoliosis angle amounted to 70 degrees, the follow-up time ranged from 1 to 5 years. By the use of this instrumentation a solid fusion was obtained in all cases. Further investigations concerned the occurrence of neurological and other complications, changes in preoperative complaints, changes in ambulation and the satisfaction of patients and their parents.     

脊柱侧弯畸形MRI检查出现伪影的诊断及鉴别

目的：探讨脊柱侧弯畸形患者MRI检查时横轴位T2WI相中出现的伪影与脊髓纵裂畸形的诊断及鉴别诊断。方法：回顾分析经手术证实的44例脊柱侧弯畸形患者横轴位T2WI相出现的伪影。结果：44例出现T2WI图像伪影的患者,均发生于脊柱侧弯处。其中,6例纵裂伪影均位于胸段脊髓;26例车轮状伪影中24例位于胸段脊髓,2例位于第1腰椎水平段;12例同时出现纵裂伪影及车轮状伪影。纵裂伪影T2WI部分高信号影形态欠规则。车轮状伪影T2WI相表现髓内及椎管内多个裂隙样辐射状高信号。结论：脊柱侧弯患者在MRI检查时T2WI相侧弯处易出现纵裂畸形伪影,应结合MRI多序列、多参数成像进行鉴别,减少误诊。     

探讨各类先天性脊柱畸形X线早期表现

目的：对先天性脊柱畸形病例X线表现加以综述,为今后临床诊断提供有价值的参考.方法：查阅近几年相关就诊病例记录,总结先天性脊柱畸形通过X线影像学可进行的分类及类型.结果：先天性脊柱畸形在X线影像学表现上可分为原发性脊柱侧弯、蝴蝶椎、脊柱裂、椎板峡部骨不连、椎管狭窄等类型.结论：先天性脊柱畸形的种类较多,在普通X线下可进行分类、分型.