气囊压迫控制骶前静脉丛术中破裂出血6例

骶前静脉丛破裂出血凶猛、量大 ,如不及时或处理不适当均可危及生命。以往的处理方法均存在不足 ,如缝压及肌瓣介导电烙等方法操作难度大 ,明胶海绵及图钉钉压和ＴＨ胶不牢靠 ,凡士林纱布填压止血后会阴切口需行二期缝合。 1990～ 2 0 0 1年 ,我们在直肠癌术中采用气囊压迫控制骶前静脉丛破裂出血 ,效果满意。1　临床资料1 1　一般情况　男 5例 ,女 1例 ;年龄 4 6～ 72岁 ,平均 5 6岁。均为直肠癌 ,行Ｍｉｌｅｓ术 ,其中因癌肿外侵骶前筋膜 4例 ,游离时损伤静脉丛 ,在将切除直肠拉出会阴切口时损伤静脉丛 1例 ,因采用去头吸引器抽吸盆底积血…     

正常人骶前间隙测量(附500例分析)

目的：建立正常成人骶前间隙量化标准。方法：收集500例正常成人气钡灌肠标准侧位片，测量出骶前间隙宽度并进行统计学处理，按其年龄段和性别。结果：统计各组95％正常值范围，分别简要归纳，列出正常值范围。结论：本组结果可用于判断骶前间隙正常与否的重要依据。     

骶前静脉丛大出血的处理体会

盆腔的手术引起的骶前静脉丛破裂大出血,出血凶险,如果处理不当后果严重.我们处理过三例,现将我们的初步体会报告如下:病例介绍例1:男,因直肠中段癌行经腹会阴直肠癌切除术,癌组织与骶前筋膜粘连较紧,手指盲目钝性分离,将骶前静脉撕破大出血,血压降至90/60mmHg,经快速输血1000ml,局部纱布垫压迫止血,结扎二侧骼内动脉后,局部出血减少,吸尽局部积血,可见骶骨前中部不断渗血,缝扎后出血停止.术后恢复良好.     

骶髂螺钉不同进针点置钉对骨盆外旋不稳定的生物力学影响

目的 测量骶髂螺钉不同进针点置钉对骨盆外旋不稳定的生物力学影响,为临床应用提供试验依据.方法 10具新鲜冰冻成人骨盆标本,骶髂关节拉力螺钉经进针点B(髂后下棘前2.5 cm与坐骨大切迹上4.0 cm的交点)、A(B点同一水平面前方1.0 cm)、C(B点同一水平面后方1.0 cm)固定骶髂关节.测量骶髂关节前韧带完整组、A进针点组、B进针点组、C进针点组在相同外旋应力下骶髂关节、耻骨联合的分离距离,从而比较不同进针点的固定强度.结果 在对抗外旋力上,韧带完整组、C进针点组与A/B组差异均具有统计学意义(P<0.05);A、B进针点组之间差异无统计学意义(P>0.05).在骶髂关节稳定性上,除韧带完整组、B进针点组之间差异无统计学意义(P>0.05)外,余各组间差异均具有统计学意义(P<0.05).结论 对骶髂关节稳定性B进针点更为优越,更为安全、有效.     

成人骶前乏脂肪型成熟型畸胎瘤的CT、MRI表现及鉴别诊断

目的 :分析成人骶前乏脂肪型成熟型畸胎瘤的CT、MRI表现及其与常见原发骶前占位性病变(神经鞘瘤、脊索瘤)的鉴别诊断。方法:回顾性分析经手术、病理证实的8例成人骶前乏脂肪型成熟型畸胎瘤及7例神经鞘瘤、10例脊索瘤的术前CT或MRI资料,分析肿瘤钙化、大小、成分、骨质破坏、形态、与骶尾骨的关系、骶孔扩大、强化等影像学特征,采用方差分析及Fisher’s确切概率法进行统计学分析。结果:成人骶前乏脂肪型成熟型畸胎瘤多为囊性病变,囊壁常钙化,常多个囊腔独立存在且呈"囊挤囊样"改变,与骶前神经鞘瘤及脊索瘤相比,表现为完全囊性或以囊性为主病灶,与尾骨相连,无骨质破坏,无骶孔扩大,增强扫描无强化,且差异有统计学意义(P0.05)。结论:术前CT、MRI对成人骶前乏脂肪型成熟型畸胎瘤的诊断及鉴别诊断具有很高价值。     

骶前间隙肿瘤的MRI诊断

目的：了解骶前间隙肿瘤的MRI表现特征。方法：分析73例骶前间隙肿瘤的MRI表现，包括纤维脂肪血管瘤、未分化癌和淋巴瘤各1例，畸胎瘤和骨巨细胞瘤各3例，神经源性肿瘤18例，骶尾部脊索瘤22例，转移瘤24例。结果：畸胎瘤含脂肪、纤维和液体等成分；纤维脂肪血管瘤含有粗大血管；骨巨细胞瘤呈溶骨性破坏，1例在T2WI有液－液平面；神经源性肿瘤通过骶孔与骶管内病变相连，神经节母细胞瘤和神经外胚层瘤破坏孔；9例脊索瘤在T2WI有条状低信号纤维结构和高信号粘液基质；未分化癌和淋巴瘤T1WI呈略低信号，T2WI呈略高和较高信号；19例转移瘤有多处骨骼破坏，5例只有骶椎侵犯。结论：MRI可清楚地显示骶前间 隙肿瘤的部位和范围，其中多数肿瘤可以定性。     

经皮骶髂关节螺钉治疗骶骨纵形骨折

目的应用经皮骶髂关节螺钉固定术治疗骶骨纵形骨折及疗效评价。方法牵引复位后，C形臂X线机透视下经皮骶髂关节螺钉固定骶骨纵形骨折19例，男11例，女8例；年龄18～57岁，平均30．2岁。其中17例行骨盆前环固定，闭合复位耻骨支经皮空心拉力螺钉固定9例，耻骨联合分离经皮拉力螺钉固定2例，耻骨支骨折合并耻骨联合分离经皮拉力螺钉固定1例，耻骨支切开复位钢板螺钉固定5例。结果手术时间30～65min，平均42．5min。术后住院时问3～12d，平均6．5d。19例均获得随访，时间6～34个月，平均18．5个月。无骶髂部疼痛16例，轻度疼痛3例；18例均恢复原工作，1例术后再移位行切开复位内固定术而发生医源性S1神经损伤。结论经皮骶髂关节螺钉固定骶骨纵形骨折是一种安全、有效的治疗方法，手术创伤小，并发症少，手术时问短，康复快。     

骶前畸胎瘤2例

骶尾部畸胎瘤是一种先天良性肿瘤,位于脊柱下端,在直肠和骶尾骨之间,属于先天发育异常的错构瘤,女性占绝大多数,骶尾部畸胎瘤在成人很少见,发生率约为1／87000,男女比率约为1：10,多为囊性及良性。部分病例有家族史或家族成员中有双胎史。此病是由于外胚层包埋于中胚层或内胚层中,在青春期性激素分泌旺盛,上皮组织（包括汗腺、皮脂腺）分泌功能增强,故常在青春期后发病。本病临床比较少见,易于误诊,患者多以肛瘘、肛周脓肿求治。     

骶髂关节解剖学与影像学对比研究

本文通过对新鲜尸体骶髂关节的解剖学、组织学研究 ,详细剖析骶髂关节影像学 (含X线、CT、MRI)的意义。材料与方法在第一军医大学解剖学教研组的协助下 ,取得存放时间为一天的正常成年人新鲜尸体 (经甲醛液注射并浸泡 )带皮肉骨盆一具 ,先拍摄X线片、CT片、MR片后 ,再行骶髂关节的解剖。肉眼观察该尸体的骶髂关节及其邻接部分 ,分段写出观察所得。然后分段切取标本行镜下组织学观察。骶髂关节由骶骨耳状面和髂骨耳状面构成 ,骶骨耳状面约位于骶骨上面 3节的外侧 ,关节面前宽后窄 ,表面有很多点状凸起和与之相对应的凹陷 ,两骨互相嵌合 …     

原发性骶前肿瘤19例

骶前肿瘤多为良性 ,以直肠指诊确诊率高。若早期诊断、及时治疗能提高治愈率。 1990年 11月～ 2 0 0 0年 7月 ,我院共收治原发性骶前肿瘤 19例。1　临床资料1 1　一般情况　 19例中 ,男 3例 ,女 16例 ;年龄 32～ 71岁 ,平均 4 2 6岁。出现症状至就诊时间 1个月～ 2年 ,平均 6 5个月。肿瘤最小 2ｃｍ× 1 5ｃｍ× 2ｃｍ ,最大 18ｃｍ× 15ｃｍ× 14ｃｍ ;囊性 11例 ,囊实性 3例 ,实性 5例。主要症状为肛门下坠感 13例(68 4 % ) ,大便困难 9例 (4 7 3% ) ,骶尾部胀痛 4例(2 1 1% ) ,严重者肛门剧烈疼痛 ,部分有下腹胀痛、每天大便 3～ 6次 ,…     

Peritoneal reflections of left perihepatic region: radiologic-anatomic study.

To clarify the anatomy of the peritoneal reflections of the left perihepatic region, the authors examined 95 cadavers. Thirty-eight were studied radiographically, 37 with sagittal dissection, and 20 with transverse dissection. In over 80% of the cadavers, the left triangular ligament of the liver separated the left suprahepatic space into anterior and posterior sections. The lesser omentum extended to the diaphragm, where its anterior layer reflected and continued as the posterior layer of the left triangular ligament. Thus, the posterior left suprahepatic space and the lesser sac were clearly separated by the lesser omentum and the stomach and over-lapped each other in three dimensions. The posterior left suprahepatic space was located anterosuperior to the lesser sac and in turn was continuous with the gastrohepatic space inferiorly. Carefully researched diagrams of both the midline sagittal and left parasagittal perihepatic spaces were developed. This information has clinical value when the radiologist is called on to drain a left perihepatic abscess.     

Sectional anatomy of the peritoneal reflections of the upper abdomen in the coronal plane

PURPOSE: The purpose of this study was to provide practical anatomic data for the imaging diagnosis and surgical treatment of the diseases of the subphrenic spaces. METHODS: The sectional anatomy of the subphrenic spaces on the coronal plane was investigated on serial coronal sections of the upper abdomen of 30 Chinese adult cadavers. RESULTS: The space between the anterior margin of gastropancreatic fold and the posterior layer of hepatogastric ligament is the only direct pathway between the superior and inferior recesses of the lesser sac. That pathway can be divided into 3 types on the coronal plane. The right layer of the gastrophrenic ligament is continuous with the posterior layer of the lesser omentum, and its left layer is continuous with the right layer of the phrenosplenic ligament and the posterior layer of the gastrosplenic ligament. The gastropancreatic fold is continued to the left and right layers of the gastrophrenic ligament upwards. The bare area of the stomach is located between the left and right layers of the gastrophrenic ligament; its existing rate is 100%. The bare area of the spleen is located among the phrenosplenic ligament, gastrosplenic ligament, splenorenal ligament, and splenocolic ligament. Its greatest width exists between the two layers of the splenorenal ligament. It can be divided into the splenic hilus and splenorenal parts. CONCLUSION: The coronal section is dominant to show the anatomic relationships of the gastrophrenic ligaments and the gastropancreatic folds, and the bare area of the stomach.     

Computed tomography of sacral and presacral lesions

Summary Forty-two patients with various sacral and presacral lesions were examined by computed tomography (CT). CT was sensitive in detecting intraosseous neoplasms and presacral soft tissue masses and in seven cases identified lesions not visible on plain films. The total extent of each lesion was readily determined using CT. However, CT is diagnostically nonspecific and differentiation between primary and secondary tumors of the sacrum is generally not possible from the CT appearance alone. CT is also of considerable use in the evaluation of several non-neoplastic conditions of the sacrum, including spinal dysraphism, anterior and internal meningocele and trauma.     

正常踝外侧副韧带的解剖及MRI观察对比研究

目的解剖观察踝关节外侧各韧带的形态特点,并与低场MR扫描测量数据进行对比,为临床提高MR诊断踝关节韧带损伤提供依据。方法将10例正常成人尸体足踝关节标本（每例取一侧）进行解剖观察并测量踝外侧各韧带的长、宽、厚度值,与自然位（跖屈约20。）MR扫描测量结果进行统计学分析。结果自然位MR检查能较好地显示各韧带的解剖形态,MR测量距腓前韧带（ATFL）及跟腓韧带（CFL）的平均长度分别为（14．190±0．595）mm和（23．46±1．578）mm,宽度（8．76±0．883）mm和（5．700±0．442）mm,厚度（1．840±0．190）mm和（2．110±0．296）mm。解剖测量距腓前韧带及跟腓韧带的平均长度分别为（14．128±0．610）mm和（23．452±1．506）mm,宽度（8．782±0．916）mm和（5．704±0．453）mm,厚度（1．882±0．224）mm和（2．106±0．313）mm,解剖和MR各测量值间差异无统计学意义（P〉0．05）。结论自然位是MR检查踝关节韧带损伤的较理想体位,解剖与MR测量值基本一致,低场MRI能较准确显示踝外侧副韧带的形态。     

Interventional angiographic partial nephrectomy for idiopathic massive renal bleeding

In a patient with idiopatic massive renal bleeding in which dominant abnormal findings could not be identified even by various diagnostic imaging methods, we selectively infused absolute ethanol and a stainless steel coil into one of the renal arteries to stop bleeding. CT two weeks after arterial embolization revealed the infarcted area in the lower pole of kidney. There was no evidence of hypertension or renal failure secondary to artificial renal infarction.     

超选择性动脉栓塞术在急性动脉性大出血治疗中的应用

目的探讨超选择动脉栓塞术在急性动脉性大出血治疗中的应用价值。 方法回顾性分析23例急性动脉性大出血患者的临床资料,全部病例经内科保守治疗无法有效控制出血,对出血部位行选择性DSA,明确出血动脉后行超选择性插管术及栓塞治疗,栓塞材料为明胶海绵颗粒或条。 结果所有病例DSA均显示出血阳性征象,表现为对比剂外溢、血管增粗、扭曲等。栓塞术后21例出血立即停止,1例宫颈癌大出血患者10 h后再次出现大出血,遂行第二次栓塞术,效果满意。1例咯血患者不完全止血,术后配合内科积极治疗后出血停止。病例均无严重并发症。 结论DSA对诊断急性出血有较高价值,超选择性动脉栓塞术能迅速、有效止血,且并发症少,可作为急性动脉性大出血治疗的主要方法。     

Force displacement characteristics of the posterior cruciate ligament.

The percent force changes in the posterior cruciate ligament were calculated using a previously validated computerized knee model after the femoral insertion sites were varied 2.5 and 5.0 mm in an anterior, posterior distal, anterior distal, and posterior distal direction. The tibial insertion sites were also varied 2.5 and 5.0 mm in the medial, lateral, proximal, and distal directions. Percent force changes were measured over a range of 0 degree to 90 degrees. These insertion sites simulated potential surgical placement errors. Results of this study demonstrated that the greatest percent force changes in the posterior cruciate ligament were at full extension. The greatest absolute percent force change between 0 degree and 90 degrees of flexion was with a femoral insertion of the posterior cruciate ligament placed 5 mm anterior to its normal attachment site, which resulted in a 39% change in the posterior cruciate ligament force. Distal femoral site attachment had the least effect (10% at 5.0 mm). Alterations at the tibial attachment site were less sensitive than on the femur; the greatest absolute percent force changes occurred with medial and lateral attachment sites (14% and 15%, respectively, at 5.0 mm). A minimal amount of percent force changes were seen between 45 degrees and 75 degrees of knee flexion in all positions tested for both tibial and femoral attachment sites. This model suggests that, like the anterior cruciate ligament, the force in the posterior cruciate ligament is also sensitive to attachment site position. As in anterior cruciate ligament studies, the femoral attachment site was found to be more sensitive.(ABSTRACT TRUNCATED AT 250 WORDS)     

Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption

Instrumented anterior/posterior laxity measurements were performed on 138 patients evaluated within 2 weeks of injury with their first traumatic knee hemarthrosis. All patients were tested with the MEDmetric Arthrometer model KT-1000 in a knee injury clinic. Seventy-five of the patients had knee arthroscopy. Thirty-three had arthrometer laxity tests under anesthesia. Eighty-seven percent of patients arthroscoped had anterior cruciate ligament (ACL) tears and 41% had meniscus tears. One hundred twenty normal subjects were tested to establish normal anterior laxity values. Three tests were used to evaluate anterior laxity: anterior displacement between a 15 and 20 pound force (compliance index), anterior displacement with a 20 pound force, and anterior displacement with a high manually applied force. Displacement measurements in normal subjects revealed a wide range of normal laxity with a small right knee-left knee difference. For example, the 20 pound anterior displacement range was 3 to 13.5 mm with a right knee-left knee difference (mean +/- SD, 0.8 +/- 0.7 mm). Eighty-eight percent of the normals had a right-left difference of less than 2 mm. In the 53 patients arthroscoped who had complete ACL tears, the anterior laxity measurements performed in the clinic were suggestive or diagnostic of pathologic anterior laxity in 50 patients.     

Extra-adrenal myelolipoma and extramedullary hematopoiesis: Imaging features of two similar benign fat-containing presacral masses that may mimic liposarcoma

ObjectiveTo describe the imaging characteristics of extra-adrenal myelolipoma and mass-forming extramedullary hematopoiesis (EMH) occurring in the presacral region.Materials and MethodsRetrospective review between 1980 and 2015 revealed 11 patients with biopsy-proven presacral extra-adrenal myelolipoma and 11 patients with presacral EMH and radiologic imaging studies.ResultsAll cases of both myelolipoma and EMH directly abutted the anterior sacrum and were centered on the midline.Myelolipomas were round or bilobed (8/11), or were multilobulated in appearance (3/11). On CT, margins could be smooth or ill defined. On MRI, all masses were well-marginated with evidence of a “capsule”. All myelolipomas showed evidence of macroscopic fat on both CT and MRI with scattered hazy and nodular soft tissue components. On MRI, all cases showed areas of high T1 signal intermixed with areas of intermediate T1 signal. On T2, all cases showed areas of low and high T2 signal. Enhancement was usually minimal or mild.Most EMH cases had a well-defined round, bilobed or macro-lobulated presacral mass (9/11); 2/11 cases were ill-defined. On CT, when a dominant fatty component was present, the soft tissue components had hazy and nodular features, similar to myelolipoma. On MRI, the masses demonstrated intermediate T1 signal, isointense to skeletal muscle with varying amounts of hyperintense T1 signal. On T2-weighted images, 3 of 4 cases showed areas of mildly hyperintense T2 signal with varying amounts of dark signal. All patients with clinically or biopsy-proven EMH had a hematologic or myeloid disorder.ConclusionPresacral myelolipoma and presacral EMH are two benign fat-containing masses that can present as discrete, often encapsulated, lipomatous masses with varying amounts of non-lipomatous soft tissue components and should be considered in the differential diagnosis of a well-defined fat-containing presacral mass.