腰椎伸展运动对椎管,硬膜囊矢径值的影响—动态CTM扫描研究

腰椎伸展运动对椎管、硬膜囊矢径值的影响──动态ＣＴＭ扫描研究２０００５２上海解放军第８５医院孙荣华，连平，杨维权中国图书资料分类号Ｒ６８．５应用Ｘ线平片、脊髓造影和ＣＴ扫描技术测量腰椎椎管、硬膜囊矢径值以作为评估腰椎管狭窄症重要参考依据的临床报告越来...     

L4、5,S1上关节突间距及其与硬膜囊横径的关系

腰椎管狭窄症较常见,文献对其矢状径分析报道较多,但对其横径,尤其是对上关节突间距的研究较少,且测量点不够明确[胡有谷,陈伯华,周秉文,等.退行性腰椎管狭窄症的ＣＴ测量及意义.中华骨科杂志,1993,13(3):193],也未见上关节突间距与硬膜囊横径相关性研究的报道。本研究在200例正常成人腰椎ＣＴ片上分别测量Ｌ4、5,Ｓ1上关节突间距及同一冠状面硬膜囊横径。1　资料和方法本组ＣＴ受检者男女各100例,年龄21～36岁,平均28.9岁。均无腰椎管狭窄的症状和体征。用ＭＡＸ—Ⅱ型ＣＴ机。扫描条件120ｋＶ,45ｍＡ,5.8ｓ。矩阵320×320,小视野靶重建(25…     

156例成人脊髓圆锥和硬膜囊下端位置的MRI研究

目的评价成人脊髓圆锥和硬膜囊下端位置正常范围的临床应用价值。资料与方法对156例正常成人进行下腰段脊柱MRSE序列矢状位扫描，测定脊髓圆锥和硬膜囊相应的脊椎位置。所得结果进行统计学处理。结果156例成人脊髓圆锥下端位置多在L1中、下份(73例，46．8％)，硬膜囊下端位置多在Sl-S2、S2上份(60例，38．4％)，各性别、年龄、身高组差异无显著性，脊髓圆锥和硬膜囊二者间位置不相关。结论熟悉脊髓圆锥和硬膜囊下端位置的正常范围，能帮助临床诊断脊髓栓系综合征等疾病及腰椎穿刺定位。     

动态增强MRI诊断髓外硬膜下肿瘤的研究

探讨髓外硬膜下各类肿瘤的动态增强ＭＲＩ表现及其临床意义,方法用动态增强ＭＲＩ方法对经手术和病理证实的３１例髓外硬膜下肿瘤进行前瞻性研究。结果在对比增强率时间曲线上,血管母细胞瘤表现为迅速增强,４５秒即达到高峰,然后逐渐下降。     

L4～4、L4～5、L5～S1椎间盘与硬膜囊和脊神经的距离及临床意义

目的:明确L3～4、L4～5、L5～S1椎间盘与硬膜囊、神经根和脊神经前支的距离.方法:在200例腰椎正常CT片和21具成人腰椎标本上分别观测了L4、L5、S1神经根出硬膜囊的水平及L3～4、L4～5、L5～S1椎间盘与硬膜囊、神经根和脊神经前支的距离.结果:L3～4椎间盘与硬膜囊及L4～5椎间盘与硬膜囊和L5神经根关系密切,L5～S1椎间盘与硬膜囊和S1神经根相隔一定距离,L3～4、L4～5、L5～S1椎间盘与其外后方脊神经前支的距离递减.结论:L3～4椎间盘突出易压迫硬膜囊,L4～5椎间盘突出易压迫硬膜囊和L5神经根,L3～4、L4～5、L5～S1椎间盘的椎间孔外侧型突出,压迫脊神经前支的机会递增.     

L_(3～4)、L_(4～5)、L_5～S_1椎间盘与硬膜囊和脊神经的距离及临床意义

目的 :明确L3～ 4 、L4～ 5、L5～S1椎间盘与硬膜囊、神经根和脊神经前支的距离。方法 :在 2 0 0例腰椎正常CT片和 2 1具成人腰椎标本上分别观测了L4 、L5、S1神经根出硬膜囊的水平及L3～ 4 、L4～ 5、L5～S1椎间盘与硬膜囊、神经根和脊神经前支的距离。结果 :L3～ 4 椎间盘与硬膜囊及L4～ 5椎间盘与硬膜囊和L5神经根关系密切 ,L5～S1椎间盘与硬膜囊和S1神经根相隔一定距离 ,L3～ 4 、L4～ 5、L5～S1椎间盘与其外后方脊神经前支的距离递减。结论 :L3～ 4 椎间盘突出易压迫硬膜囊 ,L4～ 5椎间盘突出易压迫硬膜囊和L5神经根 ,L3～ 4 、L4～ 5、L5～S1椎间盘的椎间孔外侧型突出 ,压迫脊神经前支的机会递增。     

浅谈乳腺叶状囊肉瘤与乳腺纤维腺瘤超声影像的相关性及临床意义

乳腺纤维腺瘤发病率在乳腺良性肿瘤中居首位,而乳腺叶状囊肉瘤在临床恶性病变中也并不罕见,有的学者报道与乳腺癌之比可达1∶20.国内有些学者认为,叶状囊肉瘤虽然可以由纤维腺瘤经肉瘤变而成,但是也可能开始时就是肉瘤.本文通过对32例经手术病理证实的病例进行回顾分析,以探讨二者超声影像的相关性及临床意义.     

L3～4、L4～5、L5～S1椎间盘与硬膜囊和脊神经的距离及临床意义

目的明确L     

Myelographic findings in cervical spines without degenerative changes

Summary One hundred cervical myelographies in patients without degenerative changes on plain radiographs were evaluated. Pathologic changes were seen in 75 patients, most of them with congenital spinal canal stenosis and dural sac stenosis. Normal values for sagittal diameter of the dural sac from C2 to C6 were established. It was found that a quotient <0.9 between the sagittal diameter of the spinal canal and the midsagittal diameter of the vertebral body indicated congenital stenosis. It is concluded that plain radiographs of the cervical spine are unreliable in predicting the diagnostic value of cervical myelography.     

骨间前神经转移修复鱼际肌支伤恢复手内肌功能的实验研究及临床应用

为满意地恢复去神经手内肌功能，作者设计了骨间前神经转移修复鱼际肌支或尺神经深支伤，进行了有关神经显微解剖和动物实验研究。结果表明，本手术方法符合解剖生理及中枢神经系统代偿调节协同肌功能，由于各神经束解剖结构相接近，转位修复后，其远端再生神经纤维数量及成熟度接近正常。有髓纤维通过率达１５６．１６％。临床经治２０例病人，其中１５例随诊１～６年（平均３年），肌力均有不同程度恢复，１０例肌电图为正常肌电位，计Ｍ＿２２例，Ｍ＿３４例，Ｍ＿４６例，Ｍ＿５３例。讨论了手术适应证。关键词     

碳酸利多卡因硬膜外持续输注给药麻醉方案的临床研究

通过临床手术麻醉 ,评价碳酸利多卡因在硬膜外麻醉中持续输注给药方案的安全性和有效性。采用利多卡因硬膜外麻醉常规剂量加持续输注给药方案 ,对 5 1例下腹部或下肢手术病人 ,观察其临床麻醉效果、血压、心律、心率及连续监测利多卡因血药浓度。结果 5 1例病人麻醉效果基本满意 ,除 1例出现心律失常外 ,余病人的血压、心律、心率均正常 ,无明显不良反应发生。 5 1例病人手术过程中共取标本 146份 ,平均 (2 9± 0 5 )份。利多卡因血药浓度为 (3 2 2± 1 48) μg /ml,范围 0 92～ 9 90 μg/ml。其中 5 0 7%标本血药浓度在理论计算值范围内 ,81 5 %在安全有效浓度内。结果表明 ,用此方法给药 ,可获得临床满意的麻醉效果 ,且无明显不良反应发生 ,大部分标本的血药浓度是在安全有效浓度范围内。证明该方案适于临床应用     

Magnetic resonance imaging findings of redundant nerve roots of the cauda equina

BACKGROUNDRedundant nerve roots (RNRs) of the cauda equina are often a natural evolutionary part of lumbar spinal canal stenosis secondary to degenerative processes characterized by elongated, enlarged, and tortuous nerve roots in the superior and/or inferior of the stenotic segment. Although magnetic resonance imaging (MRI) findings have been defined more frequently in recent years, this condition has been relatively under-recognized in radiological practice. In this study, lumbar MRI findings of RNRs of the cauda equina were evaluated in spinal stenosis patients.AIMTo evaluate RNRs of the cauda equina in spinal stenosis patients.METHODSOne-hundred and thirty-one patients who underwent lumbar MRI and were found to have spinal stenosis between March 2010 and February 2019 were included in the study. On axial T2-weighted images (T2WI), the cross-sectional area (CSA) of the dural sac was measured at L2-3, L3-4, L4-5, and L5-S1 levels in the axial plane. CSA levels below 100 mm² were considered stenosis. Elongation, expansion, and tortuosity in cauda equina fibers in the superior and/or inferior of the stenotic segment were evaluated as RNRs. The patients were divided into two groups: Those with RNRs and those without RNRs. The CSA cut-off value resulting in RNRs of cauda equina was calculated. Relative length (RL) of RNRs was calculated by dividing the length of RNRs at mid-sagittal T2WI by the height of the vertebral body superior to the stenosis level. The associations of CSA leading to RNRs with RL, disc herniation type, and spondylolisthesis were evaluated.RESULTSFifty-five patients (42%) with spinal stenosis had RNRs of the cauda equina. The average CSA was 40.99 ± 12.76 mm² in patients with RNRs of the cauda equina and 66.83 ± 19.32 mm² in patients without RNRs. A significant difference was found between the two groups for CSA values (P < 0.001). Using a cut-off value of 55.22 mm² for RNRs of the cauda equina, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) values of 96.4%, 96.1%, 89.4%, and 98.7% were obtained, respectively. RL was 3.39 ± 1.31 (range: 0.93-6.01). When the extension of RNRs into the superior and/or inferior of the spinal canal stenosis level was evaluated, it was superior in 54.5%, both superior and inferior in 32.8%, and inferior in 12.7%. At stenosis levels leading to RNRs of the cauda equina, 29 disc herniations with soft margins and 26 with sharp margins were detected. Disc herniation type and spondylolisthesis had no significant relationship with RL or CSA of the dural sac with stenotic levels (P > 0.05). As the CSA of the dural sac decreased, the incidence of RNRs observed at the superior of the stenosis level increased (P < 0.001).CONCLUSIONRNRs of the cauda equina are frequently observed in patients with spinal stenosis. When the CSA of the dural sac is < 55 mm², lumbar MRIs should be carefully examined for this condition.     

含血运的神经外膜管桥接神经缺损的实验研究与临床应用

用含有血运的神经外膜管桥接兔坐骨神经缺损4cm,术后6个月神经纤维沿着外膜管生长良好,神经纤维排列规则,其复合运动电位、传导速度、波伏、横径平均值与自体神经移植者无差异。临床应用48例获得较好效果。     

外周神经瘤样增生的临床病理学研究

对外周神经瘤样增生22例进行了临床病理学研究,该病实质由分化成熟的神经轴索、雪旺细胞、纤维细胞、胶原纤维和毛细血管构成。其继发病变有含铁血黄素沉着、玻璃样变、粘液性变、炎症细胞和(或)异物巨细胞反应,该病变形成时限>6个月,伤部感染是重要病因之一,本文提出了临床病理诊断的5项指标。外周神经瘤样增生一词比创伤性神经瘤更确切地反映了该病本质。     

颞骨骨折及其并发症的临床研究

为探讨颞骨骨折及其并发症的特点及救治方法，作者对1989年1月－1999年11月收治的48例颞骨骨折临床资料进行了回顾性分析。结果显示，48例颞骨骨折患者中交通事故所致的占66．7％，存活43例（89．6％），死亡5例（10．4％）；中、内耳或颅脑损伤占77．1％，听力下降或耳鸣占48％；纵行骨折的脑脊液耳漏占36．7％，面瘫占3％；横行骨折的面瘫占37．5％，脑脊液耳漏则占25％。研究结果表明，交通事故伤是造成颞骨骨折的首要高危因素，其严重并发症为颅脑损伤，合并多脏器伤常是致死性并发症；其常用并发症为听力下降或耳鸣等中、内耳损伤；纵行骨折以脑脊液耳漏多见，横行骨折易造成面瘫。     

大型上颌骨缺损自制弹簧鼻突式腭托支架临床应用

为解决在临床修复手术中治疗大型上颌骨缺损面部畸形导致的张口受限、发育困难、咀嚼功能障碍。采用自制弹簧鼻突式腭托支架修复技术,对４例大型上颌骨缺损面部畸形患者进行修复,了面部形态,咀嚼功能,发育清晰,达到了赝复体义齿修复的目的要求,临床效果满意。本方法临床效果好,制作简单,容易掌握,值得临床推广应用。     

肝内胆管囊腺癌的临床与病理

目的　分析肝内胆管囊腺癌的临床及病理特点。方法　通过B超、CT检查及光镜观察分析 14例肝内胆管囊腺癌的主要临床表现。结果　突出的症状为右上腹疼痛及腹胀 ,主要体征是肝大 ,多呈囊性感。B超及CT检查均提示肝囊性占位性病变。根据肝内胆管囊腺癌囊壁癌组织有无浸润至肝实质或肝内扩散 ,可分为两种类型 ,即浸润型 (本组有 8例均于确诊或术后 9～ 3 7个月死亡 )和非浸润性型 (本组有 6例 ,术后均健在)。结论　提出肝内胆管囊腺癌的临床及病理诊断要点。提出浸润型及非浸润型对指导临床治疗方案的制定及判断预后均具有重要意义