严重急性呼吸综合征无创通气胸部CT影像变化的研究

目的探讨严重急性呼吸综合征（SARS）患者使用无创通气后对胸部CT影像变化的影响及临床意义。方法回顾性分析18例SARS患者使用无创通气前及使用后（4～12d）胸部CT影像变化，并做远期（3～36个月）胸部CT随访。设未使用无创通气SARS患者27例为对照组。结果（1）使用无创通气18例患者中15例出现特殊CT表现：7例肺内实性病灶密度减低呈磨玻璃密度灶；5例肺下叶支气管血管束周围环形肺气肿；8例出现胸膜下肺气肿；2例出现纵隔气肿及气胸。远期随访（36个月）观察，2例患者残留胸膜下弧形线状影但有吸收。（2）对照组27例治疗过程中未出现上述CT表现。结论使用无创通气对SARS患者胸部CT影像表现产生影响，全面认识SARS影像动态变化有利于合理使用无创通气治疗相关性肺炎。     

CT引导下骶髂关节注药治疗强直性脊柱炎

目的:探讨CT引导下骶髂关节腔内注药治疗强直性脊柱炎骶髂关节痛疗效。材料和方法:对16例强直性脊柱炎患者行CT引导下双侧骶髂关节腔内注入曲安奈德(1ml) 甲氨蝶呤(5mg) 1%利多卡因(3ml),随访2~10个月,观察患者临床症状的变化情况。结果:16例均成功完成CT引导下的双侧骶髂关节腔内注药的治疗。其中,14例有效,2例无效。结论:CT引导下骶髂关节腔内注药治疗强直性脊柱炎骶髂关节痛的近期疗效好,远期疗效有待观察。     

SARS胸部并发症的临床及影像学分析

目的:分析SARS胸部并发症的临床和影像学特点.材料和方法:回顾分析SARS 患者住院期110例及随访期(2个月)61例胸部并发症的临床及胸部影像学资料.结果:住院期发现并发症4例(3.64%),分别是纵隔气肿及皮下气肿、肺部继发肺结核、真菌感染和局部胸膜增厚粘连各1例.随访期胸部HRCT扫描,发现肺纤维化10例(16.39%).结论:SARS胸部并发症主要与医源性因素、SARS及患者的基础疾病本身有关.住院期并发症少,但严重影响预后.随访期胸部并发症较多,主要是肺纤维化.影像学检查对发现SARS并发症有重要意义.     

夏季我院发热门诊323例临床分析

目的　分析 2 0 0 3年 7月我院发热门诊患者特点以及有无 SARS复发或新发病例。　方法　对每位患者询问 SARS流行病学史 ,常规查体、测量体温、化验血、尿、便常规及胸部 Х 线片检查。　结果　未发现 SARS患者 ,也未出现其它传染病暴发。本市患者人数最多 ,I类患者人数最少。 2 0～ 2 8岁为高发年龄段。急性上呼吸道感染和急性胃肠炎为最常见病因 ;在部队上呼吸道感染患者中 ,男性显著多于女性 (P<0 .0 5 )。　结论　 2 0 0 3年 7月我院发热门诊无 SARS发现。发热患者以本市年轻人多见 ,最常见病因为急性上呼吸道感染和急性胃肠炎。     

改良髋关节磁共振成像扫描方法在发现骶髂关节病变中的应用价值

目的：通过对髋关节磁共振成像（MRI）冠状位扫描的改良,从而发现骶髂关节病变,弥补临床医生判断失误,提高疾病的检出率。方法对265例申请髋关节MRI检查的患者增加冠状位扫描层数,使每例患者双侧骶髂关节均能大部分显示。结果发现骶髂关节病变的共计20例,发现率为7．5％,年龄11-65岁,其中强直性脊柱炎16例,退行性骨关节炎2例,骶髂关节结核1例,外伤导致骨挫伤1例。结论骶髂关节病变,尤其是强直性脊柱炎是一种以危害年轻人为主的慢性炎性疾病,起病隐匿,临床部分患者以髋关节为主述症状,引起误诊,MRI在检查髋关节时适当在冠状位上增加扫描层数,能发现7．5％的遗漏病变,方法简便易行,值得推广。     

骶管与骶管套管注药治疗腰椎间盘突出症疗效对比

目的　分析两种治疗方法对腰椎间盘突出症的临床疗效。方法　骶管与骶管套管 (进入 10～ 15cm)两种注射方法均注入曲安奈德 2 0mg、5 %碳酸氢钠 10ml、透明质酸酶 3 0 0 0U、地塞米松 5mg、维生素B12 1mg、维生素B110 0mg、复方丹参 8ml、盐酸山莨菪碱 10mg、2 %利多卡因 5ml,加生理盐水至 5 0ml,每周 1次 ,5次为 1疗程 ,疗程结束后即进行疗效评定 ,随访至少 1年再进行疗效评定。结果　骶管治疗组 45例 ,治愈率 75 6 % ,治疗后 1年治愈率 71 1% ;骶管套管组 45例 ,治愈率 84 4% ,治疗后 1年治愈率 88 9%。结论　骶管与骶管套管药物注射对腰椎间盘突出症均有较理想的近、远期疗效 ,但是骶管套管方法略优于骶管方法 ,尤其是远期疗效 ,主要是使局部药物浓度增加所致     

CT引导下经皮穿刺医用生物蛋白胶治疗神经根囊肿

目的探讨CT引导下经皮穿刺纤维蛋白粘合剂治疗神经根囊肿的疗效。材料与方法对9例骶神经根囊肿患者,在高分辨力CT引导下定位,行腰穿针经骶孔刺入神经根囊肿内,抽尽囊肿内液体。将医用生物蛋白胶(FG)的主体和催化剂溶解液,同时等量注入囊腔内。结果9例骶神经根囊肿患者经治疗后,神经压迫症状解除,术后随诊1～19个月无神经损伤、无感染、无复发。术后CT复查显示囊肿内CT值增高,无脑脊液存留。MRI示囊肿消失。结论CT引导下经皮穿刺引流囊肿内注射FG粘合剂治疗骶神经根囊肿是一种安全、可靠、经济、有效的新疗法。其远期疗效有待于进一步观察。     

全面认识SARS的影像学表现

严重急性呼吸综合征(SARS)的影像学内容包括SARS影像的基本形态、常见的影像表现、影像的病理基础、影像与临床的联系、影像表现的动态变化和鉴别诊断等。从SARS初次发现至今1年多的时间，放射学医师自始至终密切关注着患者影像表现的发展变化，总结了大量的临床病例，对SARS的影像进行了充分的研究，逐渐获得较为全面的认识。     

硬膜内型骶神经前根电刺激器治疗脊髓损伤后排尿功能障碍一例

脊髓损伤后的排尿功能障碍容易导致反复的下尿路感染、尿路结石和肾盂肾炎等,进而引起膀胱壁的纤维化和膀胱功能的彻底丧失;而肾盂肾炎导致的肾脏损害和尿毒症已经成为我国长期生存的脊髓损伤患者最为常见的死亡原因之一[1-3].骶神经前根电刺激器(sacral anterior roots stimulator,SARS,英国Finetech公司)置入术是目前治疗脊髓损伤后排尿功能障碍的有效方法 ,国内已有使用硬膜外型骶神经前根电刺激器获得成功的病例报道[4,5].我科引进硬膜内型骶神经前根电刺激器治疗1例T10-12骨折脱位、完全性圆锥上脊髓损伤合并排尿功能障碍患者.现报告如下.     

儿童SARS患者传染性很小

北京儿童医院副院长杨永弘教授在北京医学会举办的防治SARS学术论坛上指出 ,SARS患儿与成人患者相比 ,不仅发病率低 ,临床症状轻 ,而且传染性也很小。根据他们诊治儿童SARS的经验 ,目前尚没有发现SARS患儿传染给其他家庭成员和密切接触者的证据 ,也没有儿科的医护人员因为接触SARS患儿而感染。据不完全统计 ,广东 14岁以下儿童确诊病例占总确诊发病数的 5 %左右 ,而北京只占不到 3 %。儿童SARS患者的症状与成人患者类似 ,以高热、咳嗽、干咳为主 ,X线片异常多表现为单侧肺实质浸润性病变 ;但不同的是 ,儿童SARS患者无一人病情加…     

大鼠骶丛根性撕脱伤模型的建立

目的 建立大鼠骶丛撕脱伤模唰并评价其有效性.方法 选用20只成年SD大鼠,雌雄不限,不打开椎板,在神经孔外撕断右侧L<,4-6>神经根,左侧为对照侧.术后观察各组大鼠的存活情况,对受试大鼠进行受试鼠行为学运动(Basso-Beattie-Bresnahan,BBB)评分.并对其进行体感诱发电位(SEP)及双侧股二头肌、小腿三头肌及胫前肌刺激电位检测,辣根过氧化酶(HRP)逆行永踪,双侧股二头肌、小腿三头肌及胫前肌称重及肌肉横截面行双侧对比研究,以评价造模效果.结果 (1)一般情况:19只大鼠存活,1只大鼠死亡,存活率为95.0%.实验大鼠BBB评分为(10.78±3.15)分,而正常大鼠为21分;(2)SEP检测:17只大鼠患肢未在双侧大脑皮层检测到SEP,造模成功率为89.5%;(3)HRP示踪:2只大鼠脊髓L4-6节段内可见阳性反应,17例阴性,造模成功率为89.5%;(4)双侧股二头肌,小腿三头肌及胫前肌称重及肌肉横截面对比,差异有统计学意义;(5)电镜检测撕脱侧肌肉出现萎缩、细胞核中间移位及出现肌卫星细胞等失神经支配征象.结论 通过大鼠椎管外撕脱L4-6造模,是建立大鼠骶丛撕脱伤模型的一种可而理想的方法.     

Spontaneous ligamentum flavum hematoma in the lumbar spine

Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome.     

健侧骶神经根移位修复大鼠骶丛撕脱伤

目的 探讨采用健侧骶神经根移位修复骶丛撕脱伤的可行性.方法 选用体重200～300 g的成年SD大鼠30只,随机分为不吻合组、健侧L6-患侧L6吻合组和健侧L6-患侧L5吻合组,每组10只.大鼠右侧为实验侧,左侧为对照侧.术后观察各组大鼠的存活情况,对受试大鼠进行BBB评分.双侧股二头肌、小腿三头肌及胫骨前肌称重并进行肌肉横截而HE染色的埘比研究;电镜观察吻合口远端神经牛长情况;坐骨神经功能指数(SFI)、肌电图检查评价吻合的可行性.结果 术后12周吻合组BBB评分比不吻合组高(P<0.01).吻合组右侧的股二头肌、小腿三头肌、胫前肌与不吻合组相比均有不同程度恢复.其中L6-L5吻合组效果较L6-L6吻合组好.三组肌群恢复速度在L6-L6吻合组内有差异,其中近侧股二头肌恢复效果相对较好,吻合口远端神经电镜观察可见大量再生有髓神经纤维.肌电图显示于三组肌肉可记录到波幅,其中以近侧股二头肌及小腿三头肌峰值较大,远侧胫前肌峰值较小.结论 健侧骶神经根移位加自体神经移植或健侧骶神经移位与患侧神经根直接吻合均能蕈建截瘫大鼠骶丛神经的部分功能,其中健侧骶神经移位与患侧神经根直接吻合组效果优于健侧骶神经根移位加自体神经移植组.

Abstract：

Objective To evaluate the efficiency of normal sacral nerve root transposition in repair of the sacral plexus root avulsion. Methods A total of 30 adult SD rats were chosen and divided into three groups,ie,group A(the sciatic nerve received no repair),group B(the autologous sacral plexus root nerve was bridged with the right L6 nerve root by the translocation of the left L6)and group C (the right L5 nerve root nerve was bridged by the translocation of the left L6),10 rats per group.The left side of the rats was used as the control side and the right one as the experimental side.Twelve weeks after operation,the rats in each group were selected for the histomorphological observation of the nerves under the microscope and the electron microscope.The models were evaluated by observing the survival rates of the rats,BBB scores,electron microscope weight and muscle fiber CSA(cross section area)of double biceps femoris,triceps surae and tibial muscle. Results Twelve weeks after operation,the BBB scores in groups B and C was higher than that in group A,with statistical difference(P<0.01)between three groups.A remarkable improvement was found in the ratio of weight and muscle fiber CSA of double biceps femoris,triceps surse and tibial muscle.The repair efficiency in the group C was better than that in the group B.In the group B,the biceps femoris,triceps surae and tibial muscle recovered at different degrees.The biceps femoris recovered the best,when a great deal of myelinated nerve fiber regeneration was observed under the microscope and the electromicroscope.Electromyography revealed the volatility in the muscles of three groups,with larger peak value for the proximal biceps femoris and the triceps muscle but smaller peak value for the distal anterior tibial muscle. Conclusions L6 transposition combined with auto-graft of nerve root or without the auto-graft can reconstruct the partial function of the sciatic nerve in the paraplegia rats,when the latter has the better effect.     

L5 radiculopathy due to sacral stress fracture

We report the case of a 70-year-old man who presented with a history of left buttock pain with radiation into the left leg in an L5 distribution. MRI of the lumbar spine revealed a left sacral stress fracture with periosteal reaction involving the left L5 nerve root anterior to the sacral ala. With spontaneous healing of the fracture, the patient's symptoms resolved completely.     

影像学诊断骶神经根囊肿的价值

目的：探讨骶神经根囊肿的影像学特点，提高临床诊断水平。材料和方法：对68例骶神经根囊肿的MRI（35例）、CT（16例）、X线脊髓造影（29例）和X线平片（68例）等影像学特征进行回顾性分析。结果：X线平片一般不能检出骶神经根囊肿。脊髓造影一般能清楚显示神经根囊肿。CT扫描能显示骶管扩大、骶骨椎板变簿、椎体后缘凹陷性侵蚀性改变。MRI能清楚显示骶骶神经囊肿的位置、大小和形态，可做出定性诊断。结论：脊髓造影、MR和CT对本病诊断和鉴别诊断具有重要的临床价值；由于CT受扫描范围的限制和囊肿大小的影响，有时易发生漏诊。     

应用骶神经刺激术治疗排尿功能障碍

对4例临床确诊为急迫性尿失禁、尿频尿急症、尿潴留、骶柱裂排尿障碍的患者先进行试验性刺激,得到满意的症状改善后施行骶神经刺激InterStim装置永久性植入术,以探讨骶神经刺激术治疗排尿功能障碍的手术方法、疗效评估、并发症及其机制。结果表明,试验刺激后患者排尿次数、尿量、尿失禁次数和数量、残余尿量均获得75％以上氡, 久性植入术后上述各客观指标也获得了显著性改善（P＜0.05）,无明显手术并发症。提示骶神经刺激是一项疗效确切、临床中行的新技术,它为那些对常规治疗夫效的难治性排尿功能障碍者提供了一条新的治疗途径。     

Sacral nerve root neurolymphomatosis diagnosed on FDG-PET/CT and magnetic resonance imaging

A 67-year-old male with transformed diffuse large B cell lymphoma presented with severe neuropathic-type pain radiating down his posterior right thigh. Initial lumbar radiographs and MRI of the lumbar spine failed to identify a cause for his symptoms. A FDG-PET/CT scan demonstrated increased focal FDG uptake in the right sacral (S2) nerve root. Review of the lumbar spine MRI performed 6 days earlier demonstrated abnormal right S2 nerve root enhancement. The combined FDG-PET/CT and MRI findings allowed a presumptive diagnosis of neurolymphomatosis. However, the patient succumbed to his illness before planned local radiotherapy could be performed.     

开放式MR引导下神经根阻滞技术初探

目的 介绍开放式MR引导下进行神经根阻滞的技术操作方法，并评价其准确性。方法 13例椎间盘突出引起神经根痛的病人，均在开放式介人性MR引导下进行神经根阻滞。所用设备为Marconi公司生产的开放式0．23T常导型MR检查仪(Proview)，并配有iPath 200光学引导系统。穿刺针采用德国Daum公司的MR兼容性20G穿刺针。所有病人术后1—2个月(平均1．2个月)随访。通过临床体检将疗效分为4级：(1)明显缓解；(2)暂时缓解；(3)完全无效；(4)恶化。结果 明显缓解12例，暂时缓解1例。未发现病人出现明显并发症。结论 介入性MR引导下的神经根阻滞是一种安全、准确、疗效显著的新技术。     

Role of the constructive interference in steady-state sequence in the classification of sacral meningeal cysts

PURPOSE: To investigate the role of the CISS (constructive interference in steady state) sequence in sacral meningeal cysts. MATERIAL AND METHODS: Fourteen patients with sacral meningeal cysts were included. Conventional T1W and T2W sequences and the CISS sequence (TR/TE = 12.25/5.90) were obtained at 1.5-T. The 1-mm-thick base images and multiplanar reformatted images of the CISS sequence were studied. The sacral meningeal cysts were classified by the CISS sequence in accordance with the previously described surgical and histopathological criteria. RESULTS: A total of 25 sacral meningeal cysts were identified in the 14 patients. The cysts and their contents were visualized by the CISS sequence, and the CISS sequence was superior to the T1W and T2W images. Fifteen of the cysts were consistent with type I lesions (extradural meningeal cysts without nerve fibers inside) and 10 cysts with type II lesions (extradural meningeal cysts with nerve fibers inside). There were no type III lesions (intradural meningeal cysts) in the sacral region. CONCLUSION: Previous studies have indicated that conventional MRI as well as magnetic resonance myelography are inconsistent for a classification of sacral meningeal cysts. The CISS sequence with its capability to obtain T2W thin slice acquisitions is superior in showing the nerve root fibers contained in the cysts, which is essential in the differentiation of type I and II cysts. Application of the CISS sequence is recommended in the diagnosis of sacral meningeal cysts.