肛管直肠损伤

本文给出一种全自动沙盘电控系统的设计方案，该控制系统主要由ＭＣＳ－５１单片微机、脉冲发生器、延时电路等组成，已证明该方案具有功能齐全、运行可靠、操作简便、成本低廉等特点。     

直肠肛管损伤的处理

直肠肛管外伤后局部污染严重,如处理不当,易导致直肠周围间隙或盆腔感染,后期还可能引起肛门狭窄、失禁及肛肠瘘等严重后果。我院1985～1997年共收治直肠肛管损伤20例,其中严重损伤14例,现报告如下。临床资料1　一般资料本组男16例,女4例;年龄2～66岁,14岁以下8例。损伤原因:跌倒或坠落被利物戳伤10例、刀刺伤4例、车祸伤2例、乙状结肠镜检查致直肠医源性损伤3例、直肠异物1例。损伤至入院时间1/2小时～72小时。损伤部位:腹膜返折以上直肠损伤10例,伴有腹膜炎7例;腹膜返折以下直肠肛管损伤10例,其中伴肛门括约肌断裂2例,肛管、会阴部裂伤及…     

肠易激综合征患者直肠肛管侧压的研究

研究肠易激综合征 (IBS)患者直肠肛管压力的变化。应用美国Sandhill公司提供的BIOLAB消化道压力检测仪及固态压力传感器导管 ,对 43例明确诊断为IBS患者及 2 0名正常人进行直肠肛管压力检测 ,观察各参数的改变。结果IBS患者腹泻组的FSV、DSV、DUSV、MTV均较正常对照组低 ,其中DSV、DUSV和MTV与对照组比较有显著性差异 (P <0 0 1) ,便秘组的FSV、DSV、DUSV及MTV均较对照组高 ,其中FSV、DSV和DUSV和对照组比较有显著性差异 (P <0 0 1) ;IBS患者腹泻组的RRP、ARP及MSQP较对照组高 ,ARPD较对照组低 ;便秘组的RRP、ARP及ARPD均较对照组高 ,MSQP较对照组低 ;ISB患者腹泻组、便秘组的ARIR量均高于对照组且有显著性差异 (P <0 0 1) ;IBS患者腹泻组的顺应性降低而便秘组的顺应性增高 (P <0 0 1)。提示IBS患者的排便功能有不同程度的异常     

肛管直肠损伤的诊治现状

近年来，肛管直肠损伤的诊断和治疗有许多新的进展，利用其可提高肛管直肠损伤的救治水平。     

肛管、直肠损伤的诊治

肛管直肠损伤多为钝性损伤 ,且合并全身多发伤 ,病情复杂 ,易被漏诊 ,应提高对本病的认识。     

直肠损伤致肛管闭锁的教训

报道 1例外伤性骨盆骨折、后尿道断裂、直肠破裂 ,先后 2次手术 ,术后 3个月发现直肠完全闭锁。笔者总结 :(1)骨盆骨折的病人应考虑有直肠刺伤的可能 ;(2 )患者住院及出院均应协助、指导定期行扩肛并定期检查     

外伤性直肠肛管损伤的诊治体会

总结 76例外伤性直肠肛管损伤的临床资料 ,认为及时正确地早期诊断和早期清创、修补破损、粪便转流和充分引流是提高直肠肛管损伤疗效的关键     

直肠肛管损伤的特点及诊治

由于直肠肛管解剖及生理上的特点，一旦损伤，往往污染严重，感染易扩散到直肠肛管周围间隙，如诊治不当，可能发生严重的并发症。现结合我院10年来收治的37例直肠肛管外伤，就其伤情特点和诊断治疗中的一些问题讨论如下。     

直肠肛管损伤21例诊治分析

直肠肛管损伤复杂多样,如诊断不及时或处理不当,可导致直肠周围间隙及盆腔脓肿、肠瘘、肛门失禁或狭窄等并发症。1998年1月～2005年11月,我们收治直肠肛管损伤21例,疗效满意。现报告如下。     

脊髓损伤患者的骨质疏松

外伤性脊髓损伤后骨质疏松的发生机理尚不十分明确［１］，这方面的研究报道迄今尚不多见。我们对脊髓损伤患者的腰椎及髋部骨量丢失情况作了研究，现报告如下。材料和方法１．临床资料：外伤性脊髓损伤所致截瘫患者８３例，其中男６６例，女１７例。年龄１８～６７岁，平...     

脊柱脊髓开放性损伤15例

目的 探讨脊柱脊髓开放性损伤的临床特点、诊断和治疗.方法 15例脊柱脊髓开放损伤患者,男14例,女1例;年龄15～46岁,平均23岁.损伤部位:颈脊髓2例,胸脊髓11例,腰脊髓2例.刀刺伤12例,火器伤2例,木棍刺伤1例.术前按美国脊髓损伤学会(ASIA)分级:A级1例,B级2例,C级7例,D级4例,E级1例.4例伤口内有异物存留,合并棘突骨折3例,椎板骨折8例,椎体骨折5例.15例均行急诊手术清创,根据损伤具体情况,行椎管探查、血肿清除、异物取出术.结果 术后发生脑脊液漏2例;1例术后伤口感染,无脊髓感染;5例术后神经功有不同程度的恢复.术后ASIA分级:A级1例,B级0例,C级3例,D级10例,E级1例.结论 脊柱脊髓开放性损伤需在充分地术前准备下急诊手术治疗,术前应了解是否有异物存留,手术探查减压,有利于脊髓功能的恢复,减少污染、出血等并发症的发生.     

颈脊髓损伤患者早期死亡的危险因素

目的 探讨创伤性颈脊髓损伤患者早期死亡原因和危险因素.方法回顾性分析553例创伤性颈脊髓损伤患者的临床资料,对影响因素进行单因素分析和多因素Logistic回归分析.结果早期死亡率4.0%(22/553).主要死亡原因为呼吸功能衰竭9例(40.9%)和电解质紊乱5例(22.7%).单因素分析发现年龄、颈脊髓损伤程度、呼吸、心血管和消化系统、电解质紊乱并发症、气管切开与颈脊髓损伤患者早期死亡有一定相关性(P<0.05).多因素Logistic回归分析发现危险因素有年龄、颈脊髓损伤程度、呼吸和心血管系统、电解质紊乱并发症、气管切开.结论 高年龄、颈脊髓损伤程度重、合并呼吸或心血管系统以及电解质紊乱并发症、气管切开是颈脊髓损伤患者早期死亡的高危因素.

Abstract：

Objective To explore the causes and risk factors affecting early death in patients with traumatic cervical spinal cord injury (SCI). Methods Clinical data of 553 patients with traumatic cervical SCI were analyzed retrospectively to discuss the related factors affecting early death of patients with traumatic cervical SCI by using univariate analysis and multivariate logistic regression analysis. Results The early mortality of the patients with traumatic cervical SCI was 4.0% ( 22/553 ). The main causes of the early death were respiratory failure in nine patients (40.9%) and electrolyte disorders in five (22.7%). Univariate analysis showed that age, cervical spinal cord injury severity, complications in respiratory, cardiovascular, digestive systems and electrolyte disturbance as well as tracheotomy were considered statistically significant for early death in patients with traumatic cervical SCI ( P < 0, 05 ). Multivariate logistic regression analysis showed that age, cervical SCI severity, complications in respiratory,cardiovascular system and electrolyte disturbance as well as tracheotomy. Conclusion Severe cervical SCI, combined respiratory, cardiovascular system and electrolyte disorder complications as well as tracheotomy are high risk factors for the early death in patients with traumatic cervical SCI.     

颈脊髓损伤患者早期死亡的危险因素

目的 探讨创伤性颈脊髓损伤患者早期死亡原因和危险因素.方法回顾性分析553例创伤性颈脊髓损伤患者的临床资料,对影响因素进行单因素分析和多因素Logistic回归分析.结果早期死亡率4.0%(22/553).主要死亡原因为呼吸功能衰竭9例(40.9%)和电解质紊乱5例(22.7%).单因素分析发现年龄、颈脊髓损伤程度、呼吸、心血管和消化系统、电解质紊乱并发症、气管切开与颈脊髓损伤患者早期死亡有一定相关性(P<0.05).多因素Logistic回归分析发现危险因素有年龄、颈脊髓损伤程度、呼吸和心血管系统、电解质紊乱并发症、气管切开.结论 高年龄、颈脊髓损伤程度重、合并呼吸或心血管系统以及电解质紊乱并发症、气管切开是颈脊髓损伤患者早期死亡的高危因素.     

脊柱脊髓开放性损伤15例

目的 探讨脊柱脊髓开放性损伤的临床特点、诊断和治疗.方法 15例脊柱脊髓开放损伤患者,男14例,女1例;年龄15～46岁,平均23岁.损伤部位:颈脊髓2例,胸脊髓11例,腰脊髓2例.刀刺伤12例,火器伤2例,木棍刺伤1例.术前按美国脊髓损伤学会(ASIA)分级:A级1例,B级2例,C级7例,D级4例,E级1例.4例伤口内有异物存留,合并棘突骨折3例,椎板骨折8例,椎体骨折5例.15例均行急诊手术清创,根据损伤具体情况,行椎管探查、血肿清除、异物取出术.结果 术后发生脑脊液漏2例;1例术后伤口感染,无脊髓感染;5例术后神经功有不同程度的恢复.术后ASIA分级:A级1例,B级0例,C级3例,D级10例,E级1例.结论 脊柱脊髓开放性损伤需在充分地术前准备下急诊手术治疗,术前应了解是否有异物存留,手术探查减压,有利于脊髓功能的恢复,减少污染、出血等并发症的发生.     

脊柱脊髓开放性损伤15例

目的 探讨脊柱脊髓开放性损伤的临床特点、诊断和治疗.方法 15例脊柱脊髓开放损伤患者,男14例,女1例;年龄15～46岁,平均23岁.损伤部位:颈脊髓2例,胸脊髓11例,腰脊髓2例.刀刺伤12例,火器伤2例,木棍刺伤1例.术前按美国脊髓损伤学会(ASIA)分级:A级1例,B级2例,C级7例,D级4例,E级1例.4例伤口内有异物存留,合并棘突骨折3例,椎板骨折8例,椎体骨折5例.15例均行急诊手术清创,根据损伤具体情况,行椎管探查、血肿清除、异物取出术.结果 术后发生脑脊液漏2例;1例术后伤口感染,无脊髓感染;5例术后神经功有不同程度的恢复.术后ASIA分级:A级1例,B级0例,C级3例,D级10例,E级1例.结论 脊柱脊髓开放性损伤需在充分地术前准备下急诊手术治疗,术前应了解是否有异物存留,手术探查减压,有利于脊髓功能的恢复,减少污染、出血等并发症的发生.     

胸腰段骨折并脊髓损伤再手术疗效分析

目的 探讨胸腰段骨折合并脊髓损伤患者I期前路/后路手术后Ⅱ期再手术的疗效.方法 回顾性分析2005年1月-2009年3月胸腰段骨折合并脊髓损伤单纯前/后路手术后残存后凸畸形伴神经功能恢复不全或未做Ⅱ期手术疗效患者12例.男9例,女3例;年龄19～57岁,平均34.6岁.根据Dems分型,爆裂型5例,压缩型5例,骨折脱位2例.I期前路手术5例,I期后路手术7例.I期手术后均存在不同程度的神经症状,对I期前路手术5例患者行Ⅱ期后路手术.I期后路手术7例者行Ⅱ期前路手术.I期手术至Ⅱ期手术最长18个月,最短12个月,平均时间13.4个月.通过影像学、神经功能及社会功能综合评估疗效,包括测量Cobb角、Frankel分级和日本骨科学会(JOA)评分.结果 术后切口均I期愈合.所有患者均获得随访,随访时间12～48个月,平均25个月.伤椎前、后缘高度压缩率术前平均42.6%、70.5%,术后平均恢复至92.5%、95,7%,至末次随访时为87.3%、92.2%;脊髓不完全损伤的患者神经功能均有Frankel 2级以上的改善.所有患者Ⅱ期术后胸腰椎生理弧度良好.Cobb角术前平均36.3°,术后矫正至5.8.,末次随访时为5.9°.JOA评分标准术后改善率,本组优9例,良2例,可1例,差0例.结论 对胸腰段骨折合并脊髓损伤患者I期前路/后路手术1年后残存神经或马尾临床症状患者行Ⅱ期手术减压后取得理想疗效,可获得满意的后凸畸形矫正和神经减压,神经功能均有不同程度恢复.

Abstract：

Objective To evaluate the outcome of reoperation(after I stage anterior/posterior operation)for thoracolumbar fractures combined with kyphosis and spinal cord injury. Methods A retrospective study was done on the medical records of 12 patients who underwent two-stage decompression with kyphosis and neurologic deficit due to single-stage approach(anterior or posterior) operation of thoracolumbar fractures combined with spinal cord injury between January 2005 and April 2009.There were 9 males and 3 females,at mean age of 34.6 years(range,19-57 years).According to the Denis classification,there were five patients with burst fractures,five with compression fractures and two with fracture dislocation.All the patients had couns medullaris injury.Of all the patients,five underwent one stage anterior approach surgery and the others underwent posterior approach operation.All the patients had vailous degrees of neurological symptoms.The patients treated with one stage anterior surgery were treated with two stage posterior surgery and the patients treated with one stage posterior surgery were treated with the two stage anterior operation.The mean interval from one stage operation to two stage decompression was 13.4 months(range,12-18 months).The radiologic,neurologic and functional outcomes were assessed through observation of the Cobb angle,Frankel spinal cord injury grading and Japanese Orthopaedic Association Scores(JOA). Results AIl the patients were followed up for mean 25 months (12-48months),which showed primary healing of the incisions in all the patients.The average anterior and posterior heisht of the vertebrae wers corrected from preoperative 42.6%and 70.5%to postoperative 92.5%and 95.7%and to 87.3%and 92.2%at the final follow-up respectively.Neurologic status was improved at least one Frankel grade in the patients who had preoperative incomplete paraplegia.The Cobb angle was corrected from preoperative 36.3°to postoperative 5.8°and to 5.9°at the final follow-up(P<0.05).No patient had any notable loss of correction between discharge and final follow-up.According to JOA coring,the results were excellent in nine patients,good in two and fair in one,with excellence rate of 92%. Conclusions Two stage decompression for epiconus and cauda equina syndrome resulted from one stage approach(anterior or posterior)operation of thoracolumbar fractures combined with spinal cord injury call attain satisfactory correction of the kyphosis and nerve decompression as well as various degrees of nerve function recovery.     

MRI in spinal lumbosacral dysraphism

The value of magnetic resonance imaging (MRI) in lumbosacral spinal dysraphism is reviewed. Althoigh some technical problems still remain to be overcome, it is obvious tha MRI is the examination of choice for the preoperative assessment of these congenital disesses.     

大鼠脊髓损伤后死亡原因分析

目的 探讨大鼠Allen脊髓损伤模型动物死亡的原因.方法 选用120只Wistar成年大鼠,采用Allen打击模型(25 g·cm),在T10段造成急性脊髓损伤,对损伤后死亡动物进行统计和解剖.结果 死亡25例,死亡率为21%,其中5只死于苏醒前,解剖未发现异常;12只死于损伤后3 d内,3只死于损伤后3～7 d,解剖发现肺部均有出血、水肿.部分动物有膀胱积血;3只死于8～14 d,1只死于损伤后15～21 d,解剖发现分别有肺部感染和泌尿系感染.3周后无死亡.结论大鼠Allen脊髓损伤模型动物早期死亡的主要原因是肺淤血和肺水肿,晚期死亡的主要原因是肺部和泌尿系感染.

Abstract：

Objective To investigate the causes for death in rats after spinal cord injury.Methods A total of 120 adult Wister rats were selected for the study. The animal model with acute spinal injury at T10 was established by using Allen' s combat (25 g · cm). The dissection analysis was performed in death rats. Results Of all, 25 patients died, with mortality rate of 21%. Of death rats, five rats were died before awakening, with no abnormal anatomy; 12 rats died within three days after injury and three died of injuries 3-7days injury. Anatomy found pulmonary bleeding and edema, even hematocele bladder in some rats. There were three rats died within 1-2 weeks, one died of injury only after 2-3 weeks, with lung infection and urinary tract infection. There was no death after three weeks. Conclusions The early causes for death of rats with spinal cord injury is mainly due to lung congestion and pulmonary edema, whereas the leading cause of late death of rats is pulmonary and urinary tract infection.     

放射性脊髓损伤的MRI诊断

目的：提高对放射性脊髓损伤ＭＲＩ表现的认识与诊断水平。方法：４例分别患鼻咽癌、纵隔淋巴瘤、食管癌及肺癌的患者,因放射治疗后５￣３６个月出现双下肢运动及感觉障碍而进行颈胸段脊髓ＭＲＩ检查。结果：脊髓病变在照射野内,表现为稍长或长Ｔ１、长Ｔ２信号。注射Ｇｄ－ＤＴＰＡ后,病变不同程度强化。结论：放射性脊髓损伤的ＭＲＩ表现具有一定的特征。     

Magnetic resonance imaging of acute spinal cord injury

Summary Magnetic resonance imaging of acute spinal cord injury is described. The traumatized cord segment was clearly shown as a hyperintensity in a T2-weighted image whereas it appeared as an isointensity in a moderately T1-weighted image. This different sensitivity may result from parenchymal hemorrhagic tissue and edematous changes due to direct trauma. Hyperintense tissue was also seen in the retro-pharyngeal and-tracheal spaces.