腰椎椎体后缘离断合并椎间盘突出症

目的 分析腰椎椎体后缘离断合并椎间盘突出症的发病机理，探讨手术治疗方法。方法 回顾总结10例腰椎后缘离断合并椎间盘突出症患的临床表现、影像学资料及手术方法选择。结果 10例患中，6例表现为单侧腰腿痛，4例为双侧；4例合并间歇性跛行，其中2例伴有马尾神经受压。CT检查显示全部病例腰椎椎体后缘形成突向椎管内的骨块，其相应的椎体后角骨缺损区为椎间盘髓核组织，其中7例椎间盘突出物超过椎体后缘骨。10例均行手术切除突出的椎间盘组织，其中6例同时行离断骨块切除。全部病例经3～36个月随访取得满意效果。结论 本病发病机理主要还是由于青少年时期椎体后缘环状骨骺变异或损伤逐步引起椎间盘突出的继发改变，最终造成神经根和硬膜囊的压迫。椎体后缘骨块仅部分参与神经根压迫。椎管内神经根及硬膜囊的彻底减压才能达到满意效果。     

腰椎椎体后缘离断症

目的：对9例腰椎椎体后缘离断症进行回顾性分析。方法：所有病例均行X线片、CT扫描检查，其中2例行MRI检查，并对照症状体征进行诊断，手术加以证实。结果：病变主要见于L4、5椎体后上缘或下缘，典型的X线表现为病椎后角有一骨质缺损，其后有一骨块突入椎管；CT扫描均可见椎体后缘类园形或囊状骨质缺损，呈典型的许莫氏结节，椎体后缘突向椎管内的骨块与椎间盘髓核组织一起构成中央管或神经根管的狭窄，压迫马尾或神经根。结论：椎体后缘离断的征象可能是青少年时期椎体后缘环状骨骺陈旧性损伤及其继发改变的结果，X线片、CT、MRI检查具有诊断价值。     

腰椎椎体后缘离断并间盘突出症（附9例报告）

对腰椎椎体后缘离断并间盘突出症的发病机理和临床进行研究。方法：对９例患者的临床表现、影像学、手术所见及治疗方法进行研究。结果：９例患者均有典型的腰腿疼痛或（和）下肢间歇性跛行,共有１０个腰椎椎体后缘离断骨块和椎间盘共同突向椎管,１例患者有Ｌ５下缘和Ｓ１上缘两个骨块,其相对应的椎体后缘骨缺损被髓核组织所充填,７例进行了手术治疗,减压后症状消失。结论：其发病的主要机理是青少年时期椎体后缘的离断以及在此基础上与椎间盘的突出相互作用,离断骨块和椎间盘共同构成了对硬膜囊或（和）神经根的压迫,产生间歇性跛行或（和）下肢疼痛,减压后症状消失。     

腰椎椎体后缘离断症的诊断与治疗8例报告

腰椎椎体后缘离断症的诊断与治疗８例报告毛家明朱维亮胡庆华洪志友赵磊作者单位：２４２３００宁国市人民医院骨科（毛家明，朱维亮，胡庆华）；ＣＴ室（洪志友，赵磊）随着ＣＴ机的普及，另一种引起腰腿痛的疾病一腰椎椎体后缘离断症，已越来越多地被认识，我院自１９９...     

读者来信

《读者来信》一阅读贵刊2012年第7期上刊登的《儿童颈椎椎体后缘离断症1例报道》一文后有若干疑问,与作者讨论。(1)将此病例诊断为"儿童颈椎椎体后缘离断症"是否合理?多数学者认为椎体后缘离断症是Schmorl结节形成并长期挤压使后缘骨片和椎体分离所致,椎体后缘离断症大多发生在腰椎,好发于成年人,影像学上表现为椎体后缘     

青壮年腰椎软骨板破裂症的临床特征与治疗

发生于青壮年的腰椎软骨板破裂症，目前发病机制尚未完全明了。近5年来，国内文献开始陆续出现报道，但命名不一，如：腰椎间盘突出症并椎体后缘离断症、腰椎椎体后缘骨内软骨结节、腰椎椎后缘离断症等等。但其特殊的CT影象学表现及由于突出物压迫硬膜囊和神经根引起椎管狭窄及类似腰椎间盘突出症的临床表现，已逐渐为临床学者所认识。本文总结近5年来经手术治疗的青壮年腰椎软骨板破裂症患者共56例，对其临床表现、影像学特点、治疗方法进行讨论。     

腰椎椎体后缘骨骺离断症合并腰椎椎间盘突出症椎板开窗减压术后致对侧神经根症状1例报告

椎体后缘骨骺离断症（PRAS）合并腰椎椎间盘突出症（LDH）好发于青少年,如伴有神经根、马尾压迫症状,手术治疗是最主要且最有效的手段。针对术中是否需要完全切除离断的椎体后缘骨块,目前尚存争议。本研究通过1例PRAS合并LDH患者的诊疗经过进行文献回顾,探讨该病的诊疗措施,旨在为临床医师提供参考,现报告如下。     

小切口手术治疗腰椎椎体后缘离断症

目的：探讨腰椎椎体后缘离断症的有效手术方法。方法：将腰椎椎体后缘离断症分为侧方型及中央型,采用椎板拉钩法的小切口手术治疗腰椎椎体后缘离断症12例,均为男性;年龄23～40岁,平均30岁;病程17.9个月。侧方型10例,其中离断骨块位于L4椎体后下缘1例,L5椎体后上缘3例,S1椎体后上缘6例,均合并同侧椎间盘突出;中央型2例,离断骨块均位于S1椎体后上缘。侧方型采用单侧椎板间开窗,摘除突出的椎间盘髓核,摘除椎体后缘骨块;中央型采用双侧椎板间开窗,摘除突出的椎间盘髓核,摘除椎体后缘骨块。结果：所有患者获得随访12～36个月,平均22.5个月,按照Macnab术后评定标准：优10例,良2例。结论：小切口手术治疗腰椎椎体后缘离断症具有手术创伤小、操作方便的优点,可完整摘除椎体后缘骨块,是一有效的手术方法。     

腰椎椎体后缘离断症

目的：认识腰椎椎体后缘离断症的临床及影像学诊断依据，提出治疗及手术要点。方法：8例腰椎椎体后缘离断症的患者，术前被冠以腰椎间盘突出症合并软骨结节突出4例，后纵韧带骨化2例，2例临床诊断有腰椎椎体后缘离断症的存在，术中均见大小不等的与突出的椎间盘组织并不相连的浮动骨块。结果：8例病人全部手术治疗，术后疼痛症状消失。随访4～18个月，只有2例患者诉残留阴雨天腰部酸痛症状。结论：腰椎间盘突出症的患者在CT扫描见突出物合并有骨化块时，要仔细分析有无腰椎椎体后缘离断的现象。清晰的腰椎正侧位X线片，病椎间隙CT轴位扫描有助于术前诊断。卧床休息，一般不做牵引及推拿，手术宜采取椎板双侧开窗以求完整切除骨块。     

多排螺旋CT在腰椎椎体后缘离断症诊断中的应用

<正>腰椎椎体后缘离断症,又称为腰椎后缘软骨结节、腰椎软骨板破裂症等[1-4],是指多种原因引起椎体后缘骨突与椎体分离,向椎管内突出,进而造成椎管狭窄、神经根受压等改变[5]。以往对该病的认识不足,相关的研究报道较少。近年来随着多排螺旋CT的飞速发展以及多平面重组等后处理技术的广泛应用,越来越多的学者开始关注本病,对其研究愈发深入[1-2]。本文对我院收治的35例腰椎椎体后缘离断症患者     

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。     

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.     

实验性脊柱侧弯脊柱结构变化的观察

脊柱侧弯被定义为脊柱相对正常中心线明显地弯曲伴椎体异常旋转。它在冠状面上出现不对称弯曲，在横断面上有异常旋转。所以一个合格的脊柱侧弯动物模型应具有人脊柱侧弯的特征性变化，并且简单易行，有可重复性。我们是通过单纯于兔肩胛骨与同侧股骨大转子间连以钢丝，使脊柱发育成侧弯且进行性加重椎体旋转，出现三维结构变化但不直接损伤脊柱，３组幼兔固定后３、４、５个月分别用过量异戊巴比妥钠予以处死，观察脊柱结构变化：顶椎出现楔形变并旋转；骨盆倾斜；椎间盘髓核移向凸侧；凹侧椎体生长骺板变薄，柱状增殖细胞层变得紊乱；凸侧椎板变宽而短，对侧窄而长。横断面上顶椎前后径在凹侧增宽，骨小梁密集。实验结果表明凹侧椎体生长骺板受到超高的压力而凸侧骺板受力相对小。因此凹侧骺板由于逐渐增加的超高力的作用从而使纵行生长受到抑制，椎体楔形变，脊柱侧弯进行性加重。     

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.     

引导性骨再生中内源性BMP的作用

为探讨引导性骨再生中，内源性ＢＭＰ对骨再生过程的作用而进行以下研究。手术的方法造成兔桡骨中段１０ｍｍ缺损。实验侧用硅胶膜管连结骨缺损，作为引导性骨再生模型。另一侧作为对照。１５只新西兰兔分为三组，分别于术后３，７及１４日处死，标本行组织学及ＢＭＰ免疫组化检查。切片上，距骨端１，２，５ｍｍ处设置ａ，ｂ，ｃ线。利用真彩色计算机图像分析系统在三条线上选点测量ＢＭＰ值。实验侧骨缺损区内有一个完整的血肿结构，其ＢＭＰ染色阳性，膜管外组织ＢＭＰ染色几乎完全阴性。对照侧ＢＭＰ弥散于骨缺损周围的肌肉组织中。１周时，实验侧及对照侧均可见新骨形成。２周时，对照侧已停止，实验侧仍可见持续骨再生。ＢＭＰ定量分析中，实验侧三条带的ＢＭＰ值大部分高于对照侧。实验侧和对照侧ｂ，ｃ带之间存在梯度差，但实验侧的差值小于对照侧。这不仅证明了Ｈｕｌｔｈ关于骨折间隙存在ＢＭＰ浓度梯度的假说，也显示膜在引导性骨再生中可将内源性ＢＭＰ局限于骨缺损区内，提高内源性ＢＭＰ浓度并改善其分布的作用。这有利于骨再生，可能是引导性骨再生机理之一。对照侧ＢＭＰ值１周时最高，而实验侧在２周时仍呈持续升高。这说明，内源性ＢＭＰ有两个来源：骨端吸收释放及骨形成细胞合成。     

Abgeschlossene und derzeit laufende adjuvante Therapieprotokolle bei Patientinnen mit operablem Mammakarzinom (II)

Summary Background: Between 1984 and 1996 4336 patients with operated breast cancer were included in trials of the Austrian breast cancer study group. Methods: Based on prognostic factors patients were randomised with 2 different treatment groups. Results: The largest ever performed oncological trial (study VI) in postmenopausal breast cancer patients is already finished. 5 other trials are open for randomisation. Conclusions: It is the intention of the Austrian breast cancer study group to accrue patients for ongoing trials in whole Austria and to increase the number of randomised patients. K. Abbrederis, Ch. Armbruster, Gabriele Barbieri, Doris Bauer, Th. Bauernhofer, S. Beller, J. Berger, O. B?ckl, A. Brunhofer, F. Burger, Ursula Denison, Elke Derstvenscheg, Ch. Dittrich, Manuela Djavanmard, W. D?ller, Daniela Eckhoff, H. Eidtmann, R. Fegerl, J. Fellinger, F. Friedrich, Sabine Fuchs, Barbara Gebhart, Friederike Gieseking, Ch. Gr?ger, Karin Haider, D. Haidinger, E. Hanzal, E. Hell, C. Hinterbuchinger, W. Horvath, W. Jonat, Daniela Kandioler, Anna-Katrin Kasparek, M. Kern, R. Kocher, Veronika Kohlmayer, R. Kolb, Ch. Kopf, S. Kriwanek, Irene Kührer, Christine Kurz, Iris Kuss, W. Kwasny, Caroline Lackner, M. Lang, O. Langer, J. Lenz, S. Leodolter, A. Lepsinger, P. Lisborg, G. Lokker, H. Ludwig, G. Luschin-Ebengreuth, H. Maass, M. Markovic, P. Mayer, M. Medl, Elisabeth Melbinger, R. Menzel, Brigitte Mlineritsch, Elke Moosbrugger, E. Moritz, Renate Moser, W. Neunteufel, A. Obermair, J. Omann, P. Oppitz, M. Pecherstorfer, A. Pertl, Catharina Pietrzak, F. Ploner, M. Pober, R. P?hnl, R. Punzengruber, Friederike Püribauer, Ch. Rass, J. Ritschl, H. Rosen, Christine Sam, L. Schiller, W. Schippinger, J. Schüller, M. Seifert, M. Smola, P. Speiser, H. Spoula, G. Steger, Birgit Steiner, H. St?ger, G. Tatzer, Susanne Taucher, J. Tschmelitsch, P. Uher, A. Unger, M. Van Trotsenburg, N. Vavra, Sonja Vogl, B. Wenky, V. Wette, A. Wiegele, G. Winter, Monika Wirth, B. Zeh, G. Zimmermann.