家兔缺血再灌流损伤脊髓的病理学研究

目的 探讨缺血再灌流损伤脊髓的病理变化特征及其意义。方法 用３０只成年家兔，随机均分为正常组、对照组、缺血３０分钟组、缺血６０分钟组和缺血９０分钟组，以选择性腰动脉阻断法制备腰髓缺血再灌流损伤模型，术后１、３、７、１４天时，取腰髓进行ＨＥ和Ｈｏｌｍｅｓ还原银染色以观察其病理学改变。结果 （１）受损脊髓组织早期即发生出血、水肿、变性坏死，伤后７天时可见明显的炎性细胞浸润，伤后１４天炎性反应减轻；（２     

伤椎置钉单节段固定与短节段固定治疗胸腰段脊柱骨折分析

对32例胸腰段脊柱骨折分别采用经伤椎椎弓根置钉单节段固定（16例）和短节段固定（16例）治疗;两组在治疗后1周及末次随访时,伤椎后凸角、视觉模拟评分（VAS）无显著差异（P＞0．05）。单节段固定植骨融合治疗胸腰段骨折安全、有效、创伤相对更小,但局限适用于单侧终板损伤且椎弓根无骨折的胸腰椎骨折。     

术前MRI检查确定椎体压缩性骨折节段及数量价值分析

目的：探讨术前MRI检查确定急性骨质疏松性椎体压缩性骨折（OVCFs）节段及数量的价值。方法：选择临床拟诊的OVCFs121例,脊柱标准位平片和CT扫描检查均在入院时完成,脊柱薄层短翻转恢复（STIR）序列的MRI扫描在术前1周内完成;分为单节段骨折组（89例）和多节段骨折组（32例）,将每组患者最初通过标准位平片和CT检查确定的骨折节段和数量与MRI结果进行比对。结果：单节段组MRI与标准位平片和CT扫描检查诊断不一致率为25．8％（23／89）,多节段组诊断不一致率为62．5％（20／32）;多节段组标准位平片和CT扫描检查误诊率非常显著高于单节段组（P〈0．01）。结论：OVCFs（特别是多节段）,术前加行MRI检查能够显著降低误诊率。     

肝动脉栓塞与经肝静脉逆行栓塞联合应用的实验研究

目的：为了使肿瘤及载瘤肝段完全坏死，获得介入性肝段（叶）切除的效果，作者进行了肝动脉栓塞与经肝静脉逆行栓塞（ＴＨＡＥ－ＲＨＶＥ）联合应用的动物实验。材料和方法：８只健康犬进行了ＴＨＡＥ－ＲＨＶＥ，肝动脉栓塞时用带囊导管阻断区域肝静脉后，向相应区域肝动脉注入碘化油，再注入明胶海绵碎片；逆行栓塞肝静脉时，在球囊阻断肝静脉下注入无水酒精－泛影葡胺（１１）混合剂。对照组（单纯肝静脉逆行注入酒精）４只。术后复查肝功能、ＣＴ，定期处死实验动物，行肝脏及肺病理学检查。结果：ＴＨＡＥ－ＲＨＶＥ及对照组技术均成功，实验组与对照组肝功能指标均呈一过性增高。ＣＴ复查显示实验组碘油充填栓塞区肝段及所属门脉分支。实验组术后１周病理检查，栓塞区肝段呈完全性、凝固性坏死，肝静脉、门静脉分支壁厚，其内充满机化血栓，２周时坏死周围有肉芽组织及炎症细胞浸润，４～８周栓塞肝叶明显萎缩，坏死区逐步为纤维组织取代。对照组肝段呈不完全性凝固性坏死，范围较小。结论：ＴＨＡＥ－ＲＨＶＥ方法安全，能获得选择性肝叶（段）切除的效果，可用于单发性巨块型肝癌的治疗。     

DSA引导下肋间动脉栓塞法分度建立犬脊髓缺血模型及扩散加权成像初步研究

目的 采用DSA引导下肋间动脉栓塞法分度建立犬脊髓缺血模型并进行磁共振扩散成像（DWI）的初步应用。方法 9只犬采用完全随机分组法分为3组，按照不同配比的碘油栓塞剂栓塞犬9-11肋间动脉，观察其神经功能、病理变化，并在1.5T磁共振仪进行常规MRI和DWI。结果 除1例栓塞失败外，余均成功建模。轻度组（3例）损伤较轻，肌力3-5级之间，有一定恢复性，病灶范围2个椎体左右，中度组（3例）均表现截瘫，肌力0-1级，伴大小便失禁，病灶范围在3-4个椎体间；重度组（2例）均截瘫，肌力0级，大小便失禁，病灶范围〉4个椎体。常规MRI和DWI均表现为病灶高信号。结论 采用不同配比的碘油栓塞剂可以分度建立犬脊髓缺血模型，并可以在1．5T磁共振仪进行DWI，为进一步脊髓缺血研究奠定了基础。     

如何选择单节段椎弓根内固定治疗胸腰椎骨折的手术适应证

对胸腰椎骨折的手术治疗方法一直存在争议，就后路手术而言，按固定节段可分为短节段固定、长节段固定及长一短节段结合固定方式。由于短节段固定（伤椎的上下椎置人椎弓根螺钉）能较好地保留脊柱的运动功能，故成为后路手术的主要方法。20世纪80年代，苏州大学附属第一医院骨科采用的单节段椎弓根内固定理念，是在骨折椎与相邻正常椎体内置人椎弓根螺钉。其优点是只需固定1个节段，较短节段固定而言，     

相邻椎体单节段椎弓根内固定椎间植骨融合治疗胸腰椎骨折

目的研究相邻椎体单节段椎弓根内固定椎间植骨融合治疗轻、中度胸腰椎骨折的可行性和临床疗效。方法回顾性研究32例应用相邻椎体单节段椎弓根内固定技术治疗的胸腰椎骨折的患者，观察复位及植骨融合情况，矫正丢失、腰痛、腰椎活动情况及融合椎体相邻椎间盘退变等并发症发生情况。结果平均随访4．6个月时达到骨性融合，所有患者均得到满意复位，复位率达96％，术后腰痛症状明显缓解，未出现顽固性腰痛、腰椎活动受限等并发症，融合节段相邻椎间盘退变率仅为6％，临床效果明显优于多节段内固定。结论只要适应证选择合适，相邻椎体单节段内固定不但可以达到骨性融合、满意复位、坚强骨性融合，而且较三椎体二节段固定可明显降低顽固性腰痛、腰椎活动受限、相邻椎间盘退变等并发症的发生。     

胸腰结合段侧面血管的影像解剖学研究

目的:为脊柱胸腰结合段侧面的节段血管走行、’变异及毗邻关系提供影像学解剖基础。资料和方法:对32例正常成人经肘静脉造影后行脊柱胸腰段CT扫描,在图像上观察节段动脉的走行特点并在脊柱侧面正中线上对上、下位节段动脉之间的距离进行测量。结果:在影像三维图像上可观察脊柱胸腰段侧面,节段动脉较为恒定地存在并走行于相应椎体侧面中央浅沟内。上、下位节段动脉间构成了一个相对无血管、神经的安全区,椎间隙恰好位于该安全区中部。并且测量了相关数据,左右两侧比较无显著性差异(P>0.05)。结论:CT三维重建图像能有效观察脊柱胸腰结合段侧面节段动脉的走行及毗邻关系,并能准确测量出安全区。     

犬急性大块肺动脉栓塞动物模型的建立

目的制作一种适合器械祛栓试验使用的犬急性大块肺栓塞动物模型。方法7只杂种犬,体外制作动物自体血栓,采用经皮股静脉穿刺置入导管,选择性插入一侧肺动脉中央分支动脉后注入制作好的自体血凝块,栓塞一侧肺动脉中央分支动脉,栓塞前后检测血气、肺动脉压及肺动脉造影。实验存活动物于12h后处死,取两侧肺组织进行病理检查。结果1只注射血栓时造成两侧肺栓塞死亡,1只在栓塞12h后肺动脉有部分再通;其余各只均成功栓塞至靶肺动脉的中央分支动脉。结论该方法制作急性大块肺栓塞的动物模型是可行和可重复的,可以为相关试验提供急性大块肺动脉栓塞动物模型。     

地震伤多节段相邻型脊柱骨折的MSCT和MRI表现

目的明确多节段相邻型脊柱骨折的多层螺旋CT（MSCT）、MRI表现。方法对地震伤致相邻多节段脊柱骨折的5例患者的影像资料进行回顾性分析。5例均行MSCT检查,4例行MRI检查。结果 1例发生在胸椎,3例发生在胸腰段脊柱,1例发生于骶椎。CT表现：4例表现为相邻多个椎体压缩性骨折;1例相邻多个椎体爆裂性骨折。MRI主要表现为椎体内T1WI呈稍低或等信号改变,T2WI为高信号,STIR更高信号。结论结合患者高能量外伤病史,MSCT和MRI能准确、快速地对相邻多节段脊柱损伤患者进行诊断,为临床治疗起到指导作用。     

Transcatheter embolization of the kidney with butyl-2-cyanoacrylate: Experimental and clinical results

The technique and efficacy of therapeutic catheter embolization of the kidney with butyl-2-cyanoacrylate (Histoacryl) were studied in 80 rabbits (including control groups) and in 10 dogs. A mixture of butyl-2-cyanoacrylate, 50% glucose, and tantalum powder was used for the embolization. Complete and permanent vascular occlusion was found in nearly all cases. The main complication observed was a reflux of embolizing material into the lumbar arteries, which occurred in seven rabbits. Clinically, therapeutic embolization was performed in six patients with hypernephroma. The indication for embolization in these patients, as well as in two others with iatrogenic lesions, was pronounced hematuria. Cessation of bleeding was achieved in all cases. For embolization the coaxial catheter technique is recommended; in special cases with extensive arteriovenous shunts, adjunctive balloon occlusion would be advisable.     

动脉造影阴性的消化道大出血的试验性栓塞治疗指征和疗效

目的 探讨试验性栓塞对造影阴性的动脉性消化道大出血的指征和疗效。资料与方法 对150例消化道大出血患者根据临床表现和内镜检查结果提示行相应动脉造影，阴性者64例作试验性栓塞治疗，其中胃十二指肠动脉52例，胃左动脉6例，直肠上动脉2例，直肠下动脉4例，栓塞剂采用明胶海绵颗粒及钢圈。结果 栓塞技术成功率为100%，出血控制率为56%（36/64），未见胃肠道缺血坏死等严重并发症发生。结论 动脉造影阴性的消化道大出血根据临床表现和内镜检查结果提示的部位行试验性栓塞可控制部分出血，且技术上较安全可行。     

PLIG技术在治疗中老年多节段腰椎不稳中的临床应用

目的:评价应用PLIG技术治疗中老年腰椎多节段退行性变并腰椎不稳的疗效。方法:对248例中老年患者采用后路椎体间植骨技术(PLIG),即一期彻底切除椎间盘,选择性椎管减压、后路单侧斜入式椎间植骨及椎弓根钉棒系统固定,恢复节段间的正常序列,使腰椎即刻稳定。结果:随访6个月~5年,优158例,良81例,可7例,差2例,优良率96.37%。术后3、6、8、12个月摄X线片显示复位稳定,椎间植骨良好,8个月后均获得骨性融合,6例由于骨质疏松出现椎间隙高度部分丢失,5例出现骨吸收现象,10例异体骨融合期延长,2例出现相邻间隙退行性变。结论:该技术治疗中老年多节段腰椎不稳,可彻底清除椎间盘组织,解除神经卡压,矫正畸形,提供稳定的生物力学环境,促进椎体间植骨融合,保存正常的功能。     

Embolization of superior mesenteric artery branches in dogs. Ischemic bowel changes depend on location of vessel occlusion and embolic materials.

OBJECTIVE: To evaluate the degree of ischemic changes of the small intestine after arterial embolization of proximal or distal arteries with Gelfoam particles and coils in dogs. METHODS: Superselective arterial embolization in 18 dogs was performed using a coaxial catheter system. Gelfoam occlusion of the proximal level of ileal or jejunal arteries was performed in four dogs (group A). Gelfoam occlusion of the distal level was performed in four dogs (group B). Coil occlusion of the proximal level was performed in five dogs (group C). Coil occlusion of the distal level was performed in five dogs (group D). All 18 dogs were killed 1 day after the procedure. Gross and microscopic findings were evaluated. RESULTS: The embolizations were successful in all dogs. In group B, significant mucosal destruction, lymphocyte proliferation of the submucosa and mucosa, and diffuse swelling in all layers of the intestine were found in all four dogs. Three revealed diffuse ischemic changes and one showed focal ischemic changes. In groups A and C, all the layers of the intestine were intact and did not show any ischemic changes. In group D, one dog showed erosion of a small portion of mucosa and lymphocytic infiltration. The other dogs showed nonspecific findings in all layers of the intestine. CONCLUSIONS: Proximal embolization with Gelfoam and coils as well as distal embolization with coils did not cause ischemia. However, ischemic changes in the intestinal wall could be observed after distal embolization with Gelfoam.     

血余炭栓塞狗肾动脉病理改变的初步研究

目的：观察中药血余炭栓塞狗肾动脉的病理改变，为临床提供实验依据。方法：将中药血余炭磨制成200-500μm大小的颗粒，超选栓塞部分末梢动脉血管。栓塞术后第7、14和56天分别处死1、2和3号犬，取出双肾固定，制作病理标本。结果：栓塞术后第7天，肉眼见栓塞部分肾脏缩小，切面末梢血管内有栓塞剂；镜下见血余炭栓塞剂附着于血管壁伴血栓形成。栓塞术后第14天，炎性反应明显，并有少量出血，血管壁炎性坏死，血栓逐渐机化。栓塞术后第56天见栓塞部分肾脏明显缩小，有大面积的缺血性梗死；镜下见血栓完全机化，栓塞组织呈缺血性梗死，栓塞血管有少量再通。结论：血余炭栓塞的病理过程为：血余炭附着血管壁，诱发血栓形成，血栓机化，血管壁炎性坏死，管腔闭塞，栓塞组织缺血性梗死，栓塞血管少量可再通。     

Vascular complications in lumbar spinal surgery: Percutaneous endovascular treatment

Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery. In two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula. We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.     

选择性动脉造影及栓塞术的并发症

Of 541 patients with selective arteriography or arterial embolization there were 16 cases developing clinically significant complications, 9(1.6%) were related to arteriography, 2 of which were pronounced hematomas at the puncture site and 7 subintimal injections in various selected arteries. 7(11.6%) complications occurred in a total of 60 cases of arterial embolization, among which there were 1 accidental embolization of the brain, 5 unexpected ischemic changes resulting in even dry gangrene and 1 vascular injury by the embolizing substance. The causes and hazards as well as prevention and management of the complications were briefly discussed.     

Experimental myocardial infarction in dogs with normal coronary arteries. Angiographic resolution of coronary arterial emboli

Percutaneous transcatheter embolization of the coronary arteries with autologous clot was performed in six dogs. The occlusions resolved completely within 14 days in the four surviving dogs. Postmortem examination revealed transmural myocardial infarction in two dogs and subendocardial infarcts in the other two. Histological sections showed no residual emboli in three dogs and a recanalized thrombus in an epicardial vessel in the fourth. These findings indicate that myocardial infarction can be produced by multiple occlusions of the distal coronary arterial branches, provided that common or contiguous myocardium is affected. The recanalized thrombus in one dog suggests that the thrombolytic process need not be complete for return to a normal angiographic appearance.     

国产PVA微球肝动脉栓塞的实验研究

Polyvinyl alcohol microsphere impregnated with barium sulfate was found to be a good embolizing agent in regard to shape, suspension and distribution in the arteries. Different-phase hepatic artery embolization with microspheres (50 approximately 100 microns, 100 approximately 300 microns) was performed in 20 dogs to evaluate the angiographic and histopathologic changes and hepatic function alterations. Permanent occlusion of the peripheral arterioles was observed on follow-up angiograms one week to six months after embolization. Shrinkage of the embolized segment and focal infarct of the liver were noticed in nearly half of the specimens both grossly and microscopically. The shape and structure of the microspheres were seen unchanged on different-phase specimens, and microspheres as small as 50 microns could reach the corresponding small peripheral arterioles. The liver function alterations were comparable with gelfoam embolization. This study suggested that permanent embolization of small arterioles was possible with such microspheres.     

椎体肿瘤椎体重建术前选择性动脉栓塞临床应用研究

目的 探讨选择性动脉栓塞后肿瘤椎体切除重建的疗效及价值. 资料与方法 选择有脊髓压迫症状的胸腰椎肿瘤患者24例,分成对照组(n=11)和研究组(n=13).对照组直接行肿瘤椎体切除人工椎体置换椎体重建术;研究组先行肿瘤供血动脉栓塞化疗后,再行肿瘤椎体重建术. 结果 对照组4例手术失败,7例手术成功,成功率57%,术中平均出血量为3385 ml、平均手术时间5 h;研究组13例肿瘤椎体全部手术切除成功,成功率达100%,术中平均出血量为842 ml,平均手术时间3 h.研究组与对照组比较术中平均出血量、手术时间差异有统计学意义(P＜0.01).所有患者随访6～36个月神经功能恢复满意,椎体重建稳定性良好. 结论 术前胸腰椎动脉栓塞便于肿瘤椎体切除及重建,可提高患者的生存质量.