腰椎间盘组织中磷脂酶A2活性水平与神经根性疼痛的关系

作者既往临床研究的结果表明，腰椎间盘突出症病人的神经根受压程度与临床症状和腰腿疼痛的程度并无直接关系。手术中病理观察发现，神经根有炎症表现者，在临床上表现出剧烈的根性疼痛，这似乎提示神经根性疼痛与局部的炎症有密切关系。磷脂酶（ＰＬ）Ａ２是人体内重要的炎症介质和致痛物质，也是组织炎症的标志物。作者采用生化方法测定了２０例腰椎间盘突出症病人手术中获取的髓核组织中的ＰＬＡ２活性水平，并将其结果与病人的神经根性疼痛程度和术中病理所见进行对照研究。研究结果表明：（１）腰椎间盘突出症病人椎间盘髓核中ＰＬＡ２活性显著高于自身血液中和健康人椎间盘髓核中ＰＬＡ２活性水平；（２）腰椎间盘突出症病人的腰腿痛程度与其髓核中ＰＬＡ２活性明显相关；（３）直腿抬高试验强阳性者的髓核中ＰＬＡ２活性水平显著增高；（４）腰椎间盘突出的类型与其髓核中ＰＬＡ２活性无显著关系。作者还就ＰＬＡ２在腰椎间盘突出症所引起的放射性疼痛中的作用进行了讨论。     

腰椎间盘源性疼痛机理的临床研究

目的 :分析腰椎间盘突出症病人的临床症状、体征与椎间盘和神经根大体病理形态改变的关系 ,临床症状、体征和椎间盘突出类型与髓核中炎症介质 (磷脂酶A2 )水平的关系以及临床症状、体征和椎间盘突出类型与脑脊液 (以下简称CSF)中神经肽类递质变化的关系。从临床角度探讨腰椎间盘突出症疼痛机理。材料与方法 :分析161例腰椎间盘突出病人的髓核突出类型及神经根病理形态改变与腰腿痛程度的关系 ;分析 2 0例腰椎间盘髓核组织中磷脂酶A2 活性水平与神经根性疼痛程度的关系 ;3 1例腰椎间盘突出症病人脑脊液中P物质和降钙素基因相关肽含量与神经根性疼痛程度进行比较。结果 :①腰椎间盘的膨出、突出、脱出和脱出游离各组之间无疼痛程度的统计学显著差异。而神经根呈急性炎症反应的病人中重度疼痛高达 80 % (P <0 .0 1)。②腰椎间盘突出症病人椎间盘髓核中磷脂酶A2 活性显著高于自身血液中和健康人椎间盘髓核中磷脂酶A2 活性水平 ,腰椎间盘突出症病人的腰腿痛程度与其髓核中磷脂酶A2 活性明显相关。③腰痛病人脑脊液中P物质和降钙素基因相关肽水平高于正常对照组 ,并与疼痛等级有关。结论 :①腰椎间盘突出物的病理形态和对神经根的机械压迫与其引起的临床疼痛症状和神经根体征无明确关系 ,而神经根性疼痛与局部     

腰椎间盘突出症脑脊液和血清免疫球蛋白升高机理的初步探讨

本研究有助于进一步了解腰椎间盘突出症所致坐骨神经痛的免疫发病机理。方法：采取３６例腰椎间盘突出症和２０例对照组病人的脑脊液和血清，用放射免疫分析法测定样本的ＩｇＡ、ＩｇＧ、ＩｇＭ、ＡＬｂ含量。结果和结论：我们的研究结果显示ＩｇＧｃｓｆ／ＩｇＧｓ×１０￣３、ＩｇＭｃｓｆ／ＩｇＭｓ×１０￣３较对照组增高，尤其是破裂型和游离型腰椎间盘突出症患者增高更显著。表明神经根与突出的髓核接触可引起炎症反应，腰椎间盘突出症坐骨神经痛可能与这种神经根炎症反应有关，本实验还证实了腰椎间盘突出症体液免疫异常。     

椎间孔镜治疗腰椎间盘突出症临床疗效观察

目的探讨椎间孔镜治疗腰椎间盘突出症临床疗效。方法将68例腰椎间盘突出症患者随机分为研究组和对照组,每组各34例,研究组采用椎间孔镜进行手术治疗,对照组采用传统外科手术治疗。比较两组患者治疗前后疼痛程度变化情况、手术时间、术后住院时间及术中出血量等指标。结果研究组术中出血量、手术时间、术后住院时间均显著少于对照组,两组疼痛程度均较术前有所改善,研究组改善程度更明显,两组比较差异均有统计学意义(P0.05)。结论应用椎间孔镜治疗腰椎间盘突出症可获得满意疗效,保障患者预后及生活质量。     

腰椎间盘突出症病人血浆、脑脊液中β-内啡肽含量的比较

本研究旨在观察腰椎间盘突出症病人不同程度的疼痛时，血浆、脑脊液中β-内啡肽含量的差异，并了解其与血浆皮质醇含量变化的关系，为临床提供参考。临床资料3５例经ＣＴ扫描确诊为椎间盘突出的病人，年龄２５～４８岁，其中男１９例，女１６例，采用视觉模拟评分及伴下肢疼痛的程度不同进行分组。轻度疼痛：腰痛并向一侧下肢放射痛，ＶＡＳ＜３；中度疼痛：腰痛并向一侧下肢放射痛，ＶＡＳ ３～６；重度疼痛：腰痛伴一侧下肢疼痛难忍，ＶＡＳ＞６。所有病人收入院，１周内禁用皮质类固醇、儿茶酚胺及镇静镇痛类药物，利用椎管造影机会采集…     

37例腰椎间盘突出症脑脊液蛋白质含量观察及临床有关问题探讨

脑脊液蛋白质含量的病理性改变,对多种疾病的诊断,鉴别诊断,以及根据蛋白质含量的动态变化情况,分析治疗效果和病情预后都有一定的参考价值。在腰椎间盘突出症中,很少见到有关脑脊液蛋白质含量病理性改变的报告,我们本着对这方面知识的了解,于1985年5月至1986年5月,对腰椎间盘突出症脑脊液蛋白质含量(下称蛋白量)进行重点观察,现将我们仅有的37例(占同期腰椎间盘突出症治疗病例的75.51％)经造影并手术证实的腰椎间盘突出症,根据蛋白量测定结果和有关知识的复习,结合临床对蛋白量病理性改变的机理、蛋白量改变与腰椎间盘突出形态的关系进行了探讨。提出     

腰椎间盘突出症手术的护理体会

目的总结腰椎间盘突出症手术的护理体会。方法对75例腰椎间盘突出症手术的患者,进行心理、饮食、体位、康复指导等综合护理干预,回顾性分析患者的临床资料。结果本组患者均顺利完成手术,术后VAS评分、SAS评分及SDS评分明显低于术前,差异均有统计学意义(P0.05)。患者均未发生切口感染、脑脊液漏等并发症。结论对腰椎间盘盘突出症行手术治疗的患者,做好综合护理干预,可促进患者康复,减轻腰腿疼痛。     

腰椎间盘突出症分型治疗的疗效分析

[目的]探讨腰椎间盘突出症分型治疗规律.[方法]分析2000～2005年住院的536例凸起型及破裂型腰椎间盘突出症手术及非手术治疗的病例.[结果]凸起型腰椎间盘突出症手术与非手术治疗疗效比较差异不显著(P＞0.05),但与破裂型手术治疗疗效比较呈显著性差异(P＜0.05);破裂型腰腿痛多呈突然加剧(P＜0.01),疼痛分级多为重度疼痛(P＜0.01);破裂型手术与非手术治疗疗效比较差异显著(P＜0.01),破裂型与凸起型非手术治疗疗效比较也呈显著性差异(P＜0.01).[结论]凸起型腰椎间盘突出症大多疼痛程度较轻、根性损害较少,非手术治疗疗效好;破裂型腰椎间盘突出症多种疼痛因素并存,腰腿痛症状较重,首选手术疗法.     

严格手术指征提高手术质量——就有关腰椎间盘突出症的手术谈些意见

严格手术指征提高手术质量——就有关腰椎间盘突出症的手术谈些意见胡有谷腰椎间盘突出症发病率日趋增高．国内已成立研究腰椎间盘突出症的学术团体，部分城市有治疗此症的专科诊所，１９９４年和１９９６年已和将召开全国性腰椎间盘突出症的学术研讨会，每次骨科学术会议...     

腰间盘突出症患者术前疼痛及心理状态的相关性研究

目的：探讨腰椎间盘突出症患者术前疼痛及心理状态的相互关系。方法：对64例腰椎间盘突出症患者，应用长海痛尺、症状自评量表（SCI-90），进行术前疼痛及心理状态调查，并对两者之间进行相关分析。结果：腰椎间盘突出症患者术前疼痛与“躯体化”、“人际”、“总分”、“偏执”呈相关关系。结论：腰椎间盘突出症患者术前存在不同程度疼痛伴随一定的心理问题；其疼痛程度与“躯体化”、“人际”、“总分”呈正相关，与“偏执”呈负相关。     

Buchbesprechungen/Book Reviews

Book reviewed in this article: Scheunert, A., und A. Trautmann: Lehrbuch der Veterinär-Physiologie . Bearbeitet von K. Bronsch, J. Brüggemann, H. Eder, H. Erbersdobler, K. Gärtner, D. Giesecke, H. Hill, G. Hofecker, V. Horn, H. HÖrnicke, A. Kment, H. Petry, H.-P. Sallmann, J. Schole, H. Spörri, J. Tiews, G. Vogel, A. Wels, G. Wittke, K. Zerobin, H. Zucker. Ueberreiter, O.: Klinische Krebsforschung bei Tieren. Meske, Christoph, Ahrensburg, und Ernst Pfeffer, GÖttingen, unter Mitwirkung von J. Matthiesen, GÖttingen; K. H. Ney, Hamburg; A. Pieper, GÖttingen; V. Potthast, GÖttingen; H. D. Pruss, Hamburg; und J. Reimers, Kiel: Ernährungsphysiologische Untersuchungen an Karpfen und Forellen. Fiedler, W.: Tiergarten Schönbrunn — Geschichte und Aufgabe. 197 Hennig, Arno, und Siegfried Poppe: Abprodukte tierischer Herkunft als Futtermittel. 232 Muller, G. H., und R. W. Kirk: Small Animal Dermatology. 809 Seiten, 2^rd edition. Verlag W. B. Saunders Company     

BOOK REVIEWS

Book Reviews in this article. GASTROINTESTINAL HAEMORRHAGE Edited by Peter W. Dykes , MD, FRCP FRACP and Michael R. B. Keighley , MS FRCS. CLINICAL AND RADIOGRAPHIC INTERPRETATION OF FACIAL FRACTURES By Amil J. Gerlock , Jr ., MD, Douglas P. Sinn , DDS, and Kevin L. Mc Bride , DDS COLOUR ATLAS OF GYNAECOLOGY By Norman A. Beischer , MD, BS, MGO, FRCS, (Ed.), FRACS, FRCOG, FRACOG and Eric V. Mac Kay , MB, BS, MGO, FRCS, (Ed.), FRACS, FRCOG, FRACOG, FACOG (Hon) ADVANCES AND TECHNICAL STANDARDS IN NEUROSURGERY Volume 8 Edited by H. Krayenbuhl DISPLACEMENT OFTHEHIP IN CHILDHOOD: AETIOLOGY, MANAGEMENT ANDSEQUELAE By Edgar W. Somerville , MA, FRCS, FRCS (Ed.) INTESTINAL FISTULAS By John Alexander -Williams , MD, ChM, FRCS, FACS and Miles Irving , MD, ChM, FRCS CLINICAL SURGERY INTERNATIONAL VOLUME 3 TISSUE TRANSPLANTATION Edited by Peter J. Morris , PhD, FRCS, FRACS DISEASES OF THE GASTROINTESTINAL TRACT AND LIVER By David J. C. Shearman , PhD, MBChB, FRCP, (Ed.), FRACP, and Niall D. C. Finlayson , PhD, MBChB, MRCP (Lond.), FRCP (Ed.)     

Unfallkrankengut Mehrfachverletzungen von 1953–1967

Ohne Zusammenfassung Unter Mitarbeit von:G. Best, E. B?ke, M. Braun, W. Brechmann, A. Encke, B. Hasper, I. Joppich, K. Junghanns, F. Kappey, H. Krebs, O. Kühn, J. Kürschner, H. Lambert, H. Leitner, P. Lichtenauer, M. L. Matthes, K. Munzinger, M. Nuri, K. Pittius, H. Rudolph, K. Schmittinger, M. Schoeyb, H. Schüler, E. v. Wedelstedt, Ch. Wehmer, St. Wysocki, D. Zeidler, H. J. Zimper Datenverarbeitung: IBM Datenverarbeitungsanlage/360 Modell 30Gerhild Braun, Claus K?hler Graphik:F. Heinrich Photo:H. Kramer, Jutta Matthes R?ntgen:W. Wenz     

同种异体椎间盘移植的实验研究

本研究是在自体椎间盘移植实验研究的基础上进一步通过Ｘ线、组织病理、生物学活性、生物化学和生物力学探索异体椎间盘移植是否可存活、功能及其归宿。１２只猴随机分为４组，移植术后３、６、９和１２个月分别处死检测。结果表明移植间盘高度术后下降，但１２个月时仍保持正常高度的６１．４％。光镜下未见明显排斥反应，终板和纤维环结构无明显改变，术后早期可见移植间盘终板软骨增生现象，髓核基质密度增大，成软骨样纤维细胞增生明显。３Ｈ－ｐｒｏｌｉｎｅ掺入较对照组明显增加。术后移植间盘的蛋白多糖和水含量降低，而胶原含量增加。生物力学动态变化表明术后早期移植间盘有失稳趋势，晚期则稳定性恢复。上述结果显示同种异体移植间盘可存活，生化代谢虽有变化但有一定的自限性，形态结构无明显改变，生物力学满足功能需要。     

The following abstracts were submitted for the 2nd Congress of the International Society for Rotary Blood Pumps, held September 23–25, 1994, Vienna, Austria, but papers were not submitted.

1 AXIAL FLOW BLOOD PUMP FOR CHRONIC IMPLANT USE. K. Butler. T. Maher, H. Borovetz,* P. Litwak,* and R. Kormos,* Nimbus, Inc., U.S.A., and *University of Pittsburgh, U.S.A. 2 A NEW APPLICATION OF A ROTARY PUMP IN A SIMULTANEOUS ADSORPTION/FILTRATION PROCESS. D. Falkenhagen, C. Weber, Ch. Rajnoch, H. Schima,* F. Loth. ?Interdisciplinary Institute of Bioengi-neering, Danube University, Krems, Austria, *Centre of Biomedical Research, University of Vienna, Austria, and ?Fraunhoferinstitute of Polymerresearch, Teltow, Germany. 3 TESTING AND MEASUREMENT OF THE PERISTALTIC PUMP FOR THE EXTRACORPOREAL CIRCULATION. Z. Kratochvil and P. Fleischner, Department of Hydraulic Machines and Equipment, Technical University of Brno, Faculty of Mechanical Engineering, Czech Republic 4 SIMULATION OF THE CARDIOVASCULAR SYSTEM AND SOME POSSIBILITIES OF THE BLOOD PUMP SYSTEM OPTIMIZATION. J. Nevrlv . Technical University of Brno, Czech Republic. 5 VIBRATORY ORBITING BLOOD PUMP. A.J. Sipin . Anatole J. Sipin Co., Inc. 6 MECHANICAL HEMOLYSIS DERIVED IN SEVERAL TYPES OF STENOTIC TUBES BY USING A CENTRIFUGAL PUMP. M. Umezu, Department of Mechanical Engineering, Waseda University, Tokyo, Japan. 7 BASIC PERFORMANCE OF A MINIATURE INTRA-VENTRICULAR AXIAL PUMP. M. Umezu . Y. Otake, K. Sakata, T. Fujimoto, K. Yamazaki,* H. Koyanagi,* H. Iiyama.? T. Mori,? K. Higuchi.? Department of Mechanical Engineering, Waseda University, Tokyo, Japan, *Heart Institute of Japan, Tokyo, Japan, and ?Sun Medical Technology Research Corp., Nagano, Japan. 8 A FLUID DYNAMIC ANALYSIS OF THE BAYLOR/ NASA AXIAL FLOW BLOOD PUMP FOR DESIGN IMPROVEMENT. J.-T. Wernicke . D. Meier, K. Mizugu-chi, G. Damm, G. Aber,* B. Benkowski, Y. Nose, G. P. Noon, and M. E. DeBakey, Department of Surgery, Baylor College of Medicine, Houston, TX, U.S.A. and *NASA/Johnson Space Center, Houston, TX, U.S.A. 9 USE OF HEPARIN-COATED DEVICES: IS HEPA-RINIZATION STILL NECESSARY?: A CASE REPORT. G. Wieselthaler . H. Schima, R. Seitelberger, D. Heilinger,* E. Donner, M. Hiesmayer,* and E. Wolner, Department of Cardiothoracic Surgery, LBI for Cardio-surgical Research, and *Department of Cardiothoracic Anesthesiology, University of Vienna. 10 PULSATILE VERSUS NONPULSATILE PERFU-SION USING A CENTRIFUGAL PUMP FOR CAR-DIOPULMONARY BYPASS DURING CABG EFFECTS ON HEMODYNAMICS, OXYGENATION, AND INFLAMMATORY RESPONSE. J. Driessen . H. Dhaese, L. Rondelez, G. Fransen, and L. Gevaert, St. Jans Hospital, Brugge, Belgium.     

Perioperative mortality and morbidity in the year 2000 in 520 certified training hospitals of Japanese Society of Anesthesiologists: with a special reference to age--report of Japanese Society of Anesthesiologists Committee on Operating Room Safety

Perioperative mortality and morbidity in Japan for the year 2000 were studied retrospectively. Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 Certified Training Hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to the age group. The total number of anesthetics available for this analysis was 910,757. All cases were divided into 7 age groups; group A (< 1 months), group B (< 12 months), group C (< 5 years), group D (< 18 years), group E (< 65 years), group F (< 85 years), and group G (> 85 years). The incidences of all critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 70.04, 42.06, 17.79, 15.57, 21.14, 39.66, and 44.65 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The overall mortality rates (death during anesthesia and within 7th postoperative day) were 26.94, 5.91, 1.88, 2.57, 5.23, 11.98, and 17.50 per 10,000 anesthetics in patients with group A, B, C, D, E, F, and G, respectively. The incidences of cardiac arrest were 28.29, 8.54, 3.56, 2.57, 5.08, 10.27, and 11.47 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The mortality rates after cardiac arrest were 18.86, 4.60, 1.26, 1.57, 2.77, 5.50, and 6.64 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of all critical events, the incidence of cardiac arrest, and the overall mortality rate were much higher in group A than in other groups, but much lower than those in 1999. The incidences of all critical events and the mortality rate after cardiac arrest were lowest in group C. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidences of all critical events attributable to co-existing disease were the highest in these four groups, and 32.33, 13.80, 5.86, 4.43, 7.50, 15.34, and 21.72 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidences of all critical events attributable to anesthetic management were 13.47, 16.43, 6.28, 3.86, 4.08, 6.87, and 6.64 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of cardiac arrest in group A was much more attributable to co-existing disease and operation than other causes. The incidences of cardiac arrest attributable to anesthetic management were 0.00, 1.97, 0.63, 0.29, 0.38, 0.74, and 1.81 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. Its mortality rate in each group was 0.00, 0.00, 0.21, 0.14, 0.06, 0.04, or 0.00. There were eleven cases of death or vegetative state due to anesthetic management, like improper management of airway and overdose of anesthetics. Some of them were preventable with the anesthesiologists' effort in protocol development and skilled assistance.     

BOOK REVIEWS

CURRENT SURGERY OF THE HEART By Arthur J. Roberts and C. Richard Conti . Philadelphia: JB Lippincott, 1987. Illustrated, xx + 343 pages, includes index. Price: $120.00. TENDON TRANSFERS OF THE HAND AND FOREARM By Professor Richard J. Smith , md. Boston: Little, Brown and Company, 1987. Illustrated, 337 pages. Price: $165.00. PAEDIATRIC NUTRITION: THEORY AND PRACTICE By R. J. Grand , J. L. Sutphen and W. H. Dietz Boston: Butterworths, 1987. Illustrated, xii + 852 pages, includes index. Price: $215.00. PERCUTANEOUS RENAL SURGERY By S. R. Payne MS, FRCS and D. R. Webb MS, FRACS. Edinburgh: Churchill Livingstone, 2nd edn, 1988. Illustrated, xii + 153 pages, includes index. Price: $97.00. MUSCULOSKELETAL INFECTIONS By William Gillespie and Sydney Nade . Melbourne: Blackwell Scientific Publications, 1987. Illustrated, x + 398 pages, includes index, 25 cm × 17.5 cm. Price: $65.00. COLOUR ATLUS OF TRANSTHORACIC: REPAIR OF HIATUS HERNIA By Robert Pringle . London: Wolfe Medical Publications Ltd, Yearbook Medical Publications Inc. Illustrated, 62 pages, includes index. Price: $42.00.     

Buchbesprechungen

Book reviewed in this article: Handbuch der Tierernährung . In zwei Bänden. Herausgegeben von W. Lenkeit, Göttingen; K. Breirem, Vollebekk; E. Crasemann, Zürich. Unter Mitwirkung von D. G. Armstrong, Newcastle; C. C. Balch, Shinfield; W. Bianca, Zürich; A. L. Black, Davis; K. Breirem, Vollebekk; H. Brune, Gießen; R. C. Campling, Shinfield; E. Crasemann, Zürich; A. François, Jouy-en-Josas; K. Günther, Göttingen; H. Hill, Hannover; P. N. Hobson, Aberdeen; H. Hörnicke, Hannover; B. H. Howard, Aberdeen; P. E. Jacobsen, Kopenhagen; H. Karg, München; W. Kaufmann, Kiel; R. Müller, Bonn; L. Paloheimo, Malmi; G. Pulss, Kiel; P. M. Riis, Kopenhagen; K. Rohr, Kiel; H. H. Schlubach, Starnberg; A. Schüren, Zürich; J. Tiews, München; G. Vogel, Köln; H. Zucker, München. Band I: Allgemeine Grundlagen . Leonhardt, H.: Histologie und Zytologie des Menschen.     

激光直接心肌隧道术治疗缺血性心脏病实验研究

研究钬激光和高功率二氧化碳激光在急性缺血心肌上产生穿透室壁全层隧道对心肌缺血的保护作用。以２０ｋｇ体重Ｙｏｒｋｓｈｉｒｅ猪分为钬激光组（７只），ＣＯ２激光组（１０只）及对照组（８只）进行实验。结果表明：钬激光无法产生满意的激光隧道，但有诱发新生血管形成的可能；高功率二氧化碳激光能够产生理想的激光隧道，对急性缺血心肌提供血液灌注，并可避免室颤的发生。但远期通畅仍有待解决。     

General rules for recording endoscopic findings of esophagogastric varices (1991)

The general rules made in 1980 for recording endoscopic findings of esophageal varices have widely been used in Japan and in other countries. However, since the development of endoscopic sclerotherapy and other modalities of endoscopic treatment, these 1980 rules were found to be insufficient for recording mucosal changes after treatment. The general rules as revised in 1991 recognize mucosal changes such as erosion, ulcer, scar, thrombosed varices, and bleeding signs. These new 1991 rules, which seem useful for recording initial evaluation of gastroesophageal varices and for describing mucosal changes after sclerotherapy as well, are described here.Michio Kobayashi, M.D., Masahiro Arakawa, M.D., Katsutoshi Obara, M.D., Hiroyuki Kato, M.D., Seigo Kitano, M.D., Yoshiya Kumagai, M.D., Kensho Sanjo, M.D., Hiroaki Suzuki, M.D., Jun Toyonaga, M.D., Yasuhiro Takase, M.D., Masayuki Fujino, M.D., Hiroyasu Makuuchi, M.D., Shunji Futagawa, M.D., Yoshinobu Mitarai, M.D., Yasuyuki Yazaki, M.D.