骨水泥在脊柱外科中的应用

骨水泥在脊柱外科中的应用钟继平综述梅芳瑞审校１骨水泥在脊柱外科中的应用情况目前，稳定脊柱优先考虑的材料主要有自体骨、同种异体骨、异体骨和骨水泥。骨块植骨早期不能有效地固定脊柱，常需辅以外固定或内固定，以保证植骨块愈合。骨水泥具有快速固定的特点，能早期...     

胸腔镜在脊柱外科中的应用进展

内镜微创脊柱外科新技术是目前脊柱外科领域中一项新型实用技术，由于该技术(尤其是胸腔镜在脊柱前路手术中的应用)具有前路脊柱开放手术无法比拟的微小创伤优势，因而在国外已得到广泛开展，国内也正逐渐开展此方面的研究和临床应用。本文就胸腔镜在脊柱前路手术中应用的有关历史、优缺点、适应证和禁忌证、手术技术、初步的临床应用结果和前景做一综述。     

记忆合金在脊柱外科中的应用进展

记忆合金自从1963年问世以来，应用于航天、航空、机械很多方面。近年来，国内外医学生物材料工作者对记忆合金的机械性能、记忆效应及生物性能进行了大量的基础研究，发现镍钛合金具有稳定的形态记忆效应、良好的超弹性、低磁性、耐疲劳、耐磨损、耐腐蚀及良好的生物相容性等特点，是一种难     

甲基强的松龙在脊柱脊髓外科中的应用

脊髓损伤（spinal cord injury，SCI）的治疗一直是医学界的一大难题。直到20世纪80年代末和90年代初，世界上一系列的基础和临床研究才给SCI患者带来了康复的希望。1990年，N Engl J Med发表了全美急性脊髓损伤研究（National Acute Spinal Cord Injury Study，NASCIS Ⅱ）有关大剂量甲基强的松龙（MP）治疗急性脊髓损伤的随机和双盲的对照研究，即大剂量MP 24h的治疗方案，改变了严重脊髓损伤被认为是不可逆改变的观念。MP的作用机制是：通过糖皮质激素受体介导达到抗炎：通过免疫抑制作用抑制细胞素和抗体物质的产生；抗氧化和抑制脂质过氧化的作用（仅在大剂量时存在）。其细胞的效应是：减轻脊髓的坏死和水肿，抑制炎症前体基因的表达，抑制白质发生凋亡。可以说，MP是针对脊髓损伤后继发性改变的二级干预研究的重要里程碑。然而，过去的不幸在于激素的初始剂量、间隔时间和治疗时间差异甚大，以及往往强调运用保守的小剂量，因而在脊髓损伤的保护性治疗方面始终无大的突破。     

PET/CT在脊柱肿瘤外科的应用

PET/CT作为一门新兴影像诊断技术在肿瘤学应用中取得了成功,近年逐渐引入脊柱外科,主要应用于脊柱转移癌的诊断。PET/CT对脊柱病灶筛查有较高的敏感性和特异性,对脊柱疑难病灶的鉴别诊断也是一个很好的补充手段,而对转移瘤原发灶的查找除了有很高的发现率外,还具有一次扫描获得全身信息、避免其他转移灶漏诊的优点。PET/CT对局部病灶诊断和病人全身状况评估均有较高应用价值,为脊柱肿瘤外科医生治疗决策提供了非常重要的参考信息。     

脊柱外科动态

实时影像导航下放射治疗脊柱肿瘤：据《Medscape》网站报道，一种实时影像导航下放射治疗系统近期已经在美国开始用于治疗脊柱肿瘤。该系统由一个计算机控制的机器手和安装在其上的小型直线加速器组成。手术时在术前肿瘤检查的基础上，通过实时CT影像导航由机器手将射线刀头置入距肿瘤约1mm之内，然后进行射线治疗。     

微创技术在脊柱外科的应用进展

微创外科(Minimally Invasive Surgery MIS)通常是指在影像系统帮助下通过管道化技术进行的外科手术。近年来得到了较快的发展，其中的胸腔镜、腹腔镜、椎间盘镜和椎体成形术等一些微创技术已先后被引进到国内的脊柱外科进行应用，本文对部分微创技术在脊柱外科的应用进展进行综述。     

Evolving role of positron emission tomography (PET) in urological malignancy

We present a review on the increasing indications for the use of positron emission tomography (PET) in uro‐oncology. In this review we describe the details of the different types of PET scans, indications for requesting PET scans in specific urological malignancy and the interpretation of the results.     

Use of positron emission tomography (PET) in stereotactic conditions for brain biopsy

Summary In order to take advantage of the metabolic information provided by positron emission tomography (PET) in cases of brain tumour, we have developed a technique to integrate PET images routinely in the planning of stereotactic brain biopsy. We used stereotactic PET with [¹⁸F]-labelled fluorodeoxyglucose (PET-FDG) in 38 patients undergoing brain biopsy. To evaluate the contribution of PET-FDG in guiding brain biopsy, we analyzed the diagnosis provided by the 78 Stereotactic trajectories obtained in these patients.We found that stereotactic PET-FDG seemed to provide more information in cases of anaplastic astrocytomas and glioblastomas than in low-grade gliomas. Our results also show that biopsy trajectories performed in areas where increased FDG uptake is found within the lesion boundaries always provide interpretable specimens; this was not the case for trajectories guided by CT only. Therefore, the routine integration PET-FDG in the planning of stereotactic brain biopsy may lead to a reduction in sampling. Recently, we also tested consecutive stereotactic PET with [¹¹C]-labelled methionine (PET-Met) and PET-FDG. This technique allowed us to compare accurately the tumoural glucose metabolism and protein synthesis.Our results suggest that stereotactic PET may increase the diagnostic yield of brain biopsy and may improve the understanding of PET in neuro-oncology.     

Lymph node staging for urinary bladder carcinoma with positron emission tomography (PET)

PET is a new method in nuclear medicine which examines the metabolism and not the morphology. Tumors show a higher rate of glycolysis than benign tissue and hence can be detected by radioactive glucose. This method has proved good for various tumors. In this study the lymph node staging of bladder cancer by PET was investigated. In 64 patients a PET of the pelvis after injection of fluorodeoxyglucose (FDG) was carried out preoperatively; the PET-results were compared with the histology of the OR specimen after classical pelvic lymphadenectomy. For lymph node staging positive nodes were found in 14 patients which was correct; a false-negative result was obtained in 7 patients. In 37 patients the PET-result was true-negative and in 6 patients false-positive resulting in a sensitivity of 67 %, a specificity of 86 % and an accuracy of 80 %. Therefore, our PET results are encouraging and seem to be better than those obtained by classical staging procedures such as CT or MRI.     

Lymph node staging for urinary bladder carcinoma with positron emission tomography (PET)

Summary PET is a new method in nuclear medicine which examines the metabolism and not the morphology. Tumors show a higher rate of glycolysis than benign tissue and hence can be detected by radioactive glucose. This method has proved good for various tumors. In this study the lymph node staging of bladder cancer by PET was investigated. In 64 patients a PET of the pelvis after injection of fluorodeoxyglucose (FDG) was carried out preoperatively; the PET-results were compared with the histology of the OR specimen after classical pelvic lymphadenectomy. For lymph node staging positive nodes were found in 14 patients which was correct; a false-negative result was obtained in 7 patients. In 37 patients the PET-result was true-negative and in 6 patients false-positive resulting in a sensitivity of 67 %, a specificity of 86 % and an accuracy of 80 %. Therefore, our PET results are encouraging and seem to be better than those obtained by classical staging procedures such as CT or MRI.      

Molecular positron emission tomography and PET/CT imaging in urological malignancies

OBJECTIVES: Positron emission tomography (PET) provides unique insights into molecular pathways of diseases. PET using [F-18]-fluorodeoxyglucose (FDG) has gained increasing acceptance for the diagnosis, staging, and treatment monitoring of various tumour types. The aim of this review is to provide an update on the current status of molecular PET and PET/CT imaging in urological malignancies. METHODS: The current literature on PET and PET/CT imaging was reviewed and summarized for prostate cancer, bladder cancer, renal cell carcinoma, and germ cell tumours. RESULTS: Depending on the radiotracer used, PET offers diagnostic information based on glucose, choline or amino acid metabolism and has also been applied to imaging tumour cell proliferation and tissue hypoxia in urological malignancies. The diagnostic performance of FDG-PET is hampered by the renal excretion of FDG and by the low metabolic activity often seen in tumours such as prostate cancer. However, new PET tracers including radiolabelled choline and acetate may offer an alternative approach. There is consistent evidence that FDG-PET provides important diagnostic information in detecting metastatic and recurrent germ cell tumours and it might offer additional information in the staging and restaging of bladder and renal cancer. CONCLUSIONS: Although PET imaging has been shown to be a clinically useful tool, its application in urological malignancies still needs to be fully determined by larger prospective trials. The introduction of novel PET radiopharmaceuticals along with the new technology of PET/CT will likely change the future role of molecular imaging in urological malignancies.     

F-18]-fluorodeoxyglucose (FDG) positron emission tomography (PET) as a diagnostic for hip endoprosthesis loosening

AIM: The purpose of this study was to examine the FDG-PET in respect of its diagnostic valency with regard to septic/aseptic loosening of lower limb prostheses. METHOD: 28 patients with 41 lower limb prostheses were examined by means of FDG-PET to evaluate septic/aseptic loosening of their hip prostheses. Therefore, a differentiated FDG-PET result interpretation subdivided into five categories was developed. The final diagnosis was based on operative findings with following culture and histological outcome. RESULTS: The worked-out categories showed a high agreement to the intraoperative macroscopic and histological results (n = 23 correctly positive, n = 1 false positive, n = 1 correctly negative and n = 3 false negative). CONCLUSION: With a subtly differentiated interpretation (categories I - V) of the qualitative glucose metabolism safe statements can be made regarding septic/aseptic endoprostheses loosening. This was impressively confirmed by the agreement of the FDG results with the histological results.