一针三点脊神经根阻滞法治疗带状疱疹

目的 以一针三点脊神经根阻滞法同时治疗脊柱损伤和疼痛难忍的带状疱疹（Hz），与其他疗法比较优劣。方法选与Hz相对应的有压痛的脊椎间关节处进针，深达骨膜注入阻滞合剂3ml，然后退针至皮下，针尖刺向有伤痛的同一椎间隙并注药2ml，然后再退针皮下针尖刺向同一节段的椎间孔部位并注药5ml。结果经治42例，与其他疗法的16例对比显示，疗效显著。结论本法止痛迅速，疗效确切，有治疗脊柱损伤和Hz及其后遗神经痛的多重功效和诸多优点。     

骨科患者发生压疮的原因分析与护理对策

目的探讨骨科患者压疮发生的原因，提高护理质量。方法对2005年2月～2009年9月笔者所在医院的2126例骨科患者进行调查分析。结果2126例骨折患者中发生压疮21例，其中骶尾部压疮17例，足跟部压疮4例。结论老年及脊柱骨折合并脊髓损伤患者为压疮高危人群，高温与潮湿是压疮发生的环境因素。加强病房管理，严格执行交接班制度，对高危人群和好发部位重点观察，积极做好基础护理和健康教育，给予患者良好的营养支持，可降低压疮的发生率。     

脊柱外科手术切口细菌感染与无菌性炎症的危险因素分析及防治

目的 探讨脊柱外科手术切口细菌感染与无菌性炎症发生相关的高危因素及治疗,为预防切口感染提供理论依据.方法 回顾性分析2006-2011年845例脊桂外科手术患者的临床资料,探讨发生无菌性炎症及细菌感染的危险因素,并总结两者的治疗与预防对策.结果 845例手术患者中切口细菌感染23例,占2.7％,无菌性炎症86例,占10.2％;手术操作不当致组织过度损伤、残腔、内固定物、止血材料等人工材料为脊柱外科手术患者发生切口无菌性炎症的危险因素;老年体弱、糖尿病、术前皮肤准备不当为脊柱外科手术患者发生切口细菌感染的高危因素.结论 脊柱外科手术切口细菌感染与无菌性炎症的发病原因不同,了解与两者发生相关的高危因素,采取合适的治疗与预防措施,有助于提高脊柱外科手术的手术效果.     

急诊护理中的创伤性脊柱损伤的护理分析

脊柱损伤约占全身骨折的4.2%,多发生在青、壮年,绝大多数都是间接外力所致,直接暴力相对少见.脊柱损伤常见于T12～L1,其次为C1～2、C5～7,但约有20%脊柱损伤是多椎体骨折.脊柱损伤除椎体骨折外,常伴有附件骨折、韧带断裂等联合损伤,若伴脊髓损伤可产生截瘫.本文的目的是探讨创伤性脊柱损伤的护理措施.本文通过对134例脊柱损伤患者的护理措施得出总结.结果33例Ⅰ型患者没有1例在急诊科死亡或发生神经损伤加重.31例Ⅱ型患者也无一例加重神经损伤,最后都顺利入院.21例Ⅲ型患者中,7例脊柱的稳定性较差,有一定的神经损伤倾向,进而转入骨科治疗;5例出现迟发性神经症状转入骨科治疗;另5例经3天的观察无异常变化,回家进行保守治疗,效果良好.     

脊椎骨折的现场救助

在工伤、交通事故和自然灾害中，脊柱常可受到暴力作用，发生骨折和脱位。脊柱骨折、脱位与一般骨折、脱位不同，它是人体的“大梁”，椎管内有功能重要却又十分娇嫩的脊髓和神经。一旦受伤，脊髓和神经失去保护或受到威胁，可能受到错位椎骨或碎骨片压迫，引起功能障碍，发生不同程度的瘫痪。据调查统计，有不少脊柱骨折、脱位伤员，受伤当时手脚都能动，但救出后在送往医院的途中，双下肢才发生瘫痪，原因不是别的，乃是抢救、搬运过程中脊髓和神经受到二次损伤。脊髓神经细胞受到损伤发生坏死后，根据目前医学水平，尚无弥补的办法。胸腰…     

24例脊柱脊髓损伤病例随诊报告并文献回顾

目的回顾与分析脊柱脊髓损伤的治疗效果与预后.方法总结2002年7月～2004年8月在我院就诊的24例脊柱脊髓损伤患者的资料并随诊,统计分析致伤原因、损伤部位、院内死亡率及出院后恢复情况.结果损伤原因主要为交通事故,损伤为下颈椎及胸腰椎为主,院内死亡率为29.2%,出院后大部分病人仍处于生活不能自理的状况.结论脊柱脊髓损伤的治疗效果还应通过交通环境改造,恢复训练等手段进一步提高.     

后路减压及内固定手术治疗合并脊髓损伤的多节段脊柱不稳的疗效观察

目的探讨和学习脊柱各节段后路手术的内固定装置技术治疗因多种原因所致的伴不同部位脊髓损伤的多节段脊柱不稳，并观察其疗效。方法特性化各个不同节段脊柱后路的开窗减压、内固定和融合技术治疗69例此类病例，包括暴力性急性多节段脊柱骨折、慢性多节段椎管狭窄和外伤后的先天性颈椎和颅底凹陷畸形等三种情况。术后随访1-3年，术前和术后随访的脊髓损伤情况按ASIA的标准作分级和疗效分析。结果52例病人完全恢复。9例绝大部分恢复。4例需扶杖行走。2例全瘫病人恢复不理想。1例仍全瘫。1例半年死亡。其治愈率和基本治愈率分别是75％和13％，总有效率88％。结论该技术对多节段脊柱不稳治疗有效，特别对伴有不完全性脊髓损伤病例。     

胸腰段脊柱前路手术并发症的临床预防

目的探讨胸腰段脊柱前路手术并发症的发生情况及原因,以期找出最佳的预防手术并发症的手段。方法选取2008年1月—2011年1月在该院进行胸腰段脊柱前路手术的48例胸腰段骨折患者,其中8例患者术后出现并发症,通过术前和术后的CT检查、X线片以及术后的跟踪随访情况,分析探讨出胸腰段脊柱前路手术并发症的类型、原因以及治疗方法。结果 8例并发症患者中1例为腹膜后乳糜液漏,切口疝并发症1例,气胸1例,2例为深静脉血栓栓塞,肺炎合并胸腔积液1例。6例并发症经过积极治疗后,全部治愈。结论明确探寻出胸腰段脊柱前路手术并发症的发病原因,可以有效预防并发症的发生,或及时找出最佳的治疗手段,将损伤降低到最小。     

四肢脊柱骨折合并脏器损伤临床探析

目的：探讨四肢脊柱骨折合并脏器损伤后的临床诊治措施及临床意义。方法：选取笔者所在医院2008年1月-2010年12月四肢脊柱骨折合并脏器损伤患者64例，观察临床诊治方案和临床效果，在入院4周后对症状改善、术后病情进行统计。指导临床对脏器损伤重症的临床实践。结果：64例四肢脊柱骨折合并脏器损伤患者经综合及时治疗方案，60例经相关手术脱险，抢救成功率为93．75％。致残3例，1例死亡。结论：早期快速诊断，积极有效的急救是抢救四肢脊柱骨折合并脏器损伤的关键，能为使患者快速脱离危险，为后期手术赢得时间。     

X线平片与CT在脊柱损伤诊断中的临床意义

目的探讨CT扫描和X线平片在在脊柱损伤中的临床意义。方法对80例脊柱损伤患者的X线与CT资料进行回顾性分析。结果80例中X线平片发现椎体骨折60例,CT扫描发现椎体骨折70例,多椎体骨折16例,椎管狭窄12例。结论X线是脊柱损伤的基本诊断方法,CT扫描是全面观察脊柱损伤的重要手段之一。     

Herpes zoster: an early manifestation of HIV infection

Herpes zoster, also known as shingles, is a reactivation of a previous infection with the herpes varicella-zoster virus. A person's first encounter with the virus causes chicken pox, usually in children. Once the chicken pox has healed, the virus remains in the posterior root ganglion of the spinal cord for the rest of the person's life. If a person's immunity is reduced for any reason, the virus can be reactivated, travel down one of the sensory nerves to the skin and cause herpes zoster. Herpes zoster cannot be contracted from someone who has it, for the infection always comes from one's own spinal cord. However, chicken pox can be caught from someone with herpes zoster. Before signs of herpes zoster become apparent on the skin, there is pain along the course of one of the sensory nerves of the skin. A rash then appears 2-3 days later, beginning with grouped vesicles either confined to 1 dermatome or spread over 2 adjacent dermatomes. The vesicles will later crust over before healing in 3-4 weeks. The rash remains painful until it has healed. Herpes zoster-related problems at the eye, tongue, chest and abdomen, and bladder and bowel are noted. In Africa, the presentation of a patient with herpes zoster should always lead the clinician to suspect HIV infection, for since the beginning of the AIDS pandemic, herpes zoster has often been the first manifestation of HIV infection. Various treatments with analgesics and topical and antiretroviral agents are described.     

Varicella and herpes zoster incidence prior to the introduction of systematic child vaccination in Navarre, 2005-2006

Varicella is an acute and highly contagious disease produced by the varicella-zoster virus, which leaves lasting immunity. Herpes zoster is produced by reactivation of a latent infection of the same virus. The introduction of systematic and free vaccination against varicella in children of 15 months in Navarre from 2007 onwards can be expected to produce important epidemiological changes. For this reason we describe the previous epidemiological situation in the period from 2005 to 2006. We analysed all cases of varicella and herpes zoster registered in the electronic clinical files of primary care, in the database of hospital discharges and in the mortality register. Between 2005 and 2006, 9,908 cases of varicella were diagnosed (8.29 annually per 1,000 inhabitants), with 90% in children under 15 years old. There were 80 hospital admissions (8 for every 1,000 cases), complications in 2.5 out of every 1,000 cases, and there was one death due to this cause (0.1 per 1,000 cases). In the same period, 4,959 cases of herpes zoster were diagnosed (4.15 cases per 1,000 inhabitants), half in people over 55 years old. There were 179 hospital admissions (36 per 1,000 cases), whose average age was 77, and 83 presented complications (16.7 per 1,000 cases). This epidemiological pattern is similar to that found in other places before the introduction of the vaccine.     

Prevalence of antibodies to four herpesviruses among adults with glioma and controls.

The authors previously reported statistically significant inverse associations between adult onset glioma and histories of chickenpox and shingles among 462 cases and 443 controls in the San Francisco Bay Area Adult Glioma Study (1991--1995) and a suggestive but nonsignificant inverse association with immunoglobulin G antibodies to varicella-zoster virus in a small subset of these cases. This report considers antibodies to four common herpesviruses (varicella zoster, herpes simplex, cytomegalovirus, and Epstein Barr) among 134 cases and 165 controls that represent all subjects for whom usable blood specimens were available. The prevalences of immunoglobulin G antibodies to varicella-zoster virus, herpes simplex virus, cytomegalovirus, and Epstein-Barr virus were 90%, 71%, 57%, and 90%, respectively. After adjustment for age, White versus non-White ethnicity, and gender, glioblastoma cases were less likely than controls to have immunoglobulin G antibodies to varicella-zoster virus (odds ratio = 0.4; 95% confidence interval: 0.1, 0.9). They were also somewhat less likely to have antibodies to Epstein-Barr virus but somewhat more likely to have antibodies to herpes simplex virus and cytomegalovirus. Antibody prevalences to all four herpesviruses were similar between cases with other glioma histologies and controls. These results corroborate our previously suggestive findings of an inverse association of varicella-zoster virus antibodies with adult onset glioma.     

某高校一起带状疱疹病例引起水痘疫情的调查报告

目的 了解苏州某高校一起带状疱疹病例引起水痘疫情的调查处置情况,分析疫情发生原因及控制效果,为高校传染病疫情防控提供参考经验。方法 建立带状疱疹及水痘病例定义,查看学校缺课记录、医院就诊记录、传染病疫情报告网络系统等进行病例搜索,并逐一进行个案调查。采用描述性流行病学方法分析疫情流行病学特征及传播过程。结果 本次疫情共发生1名带状疱疹病例和4名水痘病例,班级罹患率分别为1.33 %（1/75）和5.33 %（4/75）,该班级的水痘-带状疱症病毒感染罹患率为6.67%(5/75)。疫情持续33 d,控制在一个班级内。病例均为男性,病例年龄在18～20岁之间,居住在同一个宿舍楼的两个房间。1名患者有明确水痘疫苗免疫史,水痘突破发病时间与免疫接种间隔18年。结论 该高校水痘疫情为由1名带状疱疹病例传播水痘-带状疱疹病毒引起。建议高校今后加强带状疱疹和水痘疾病监测和管理,提前采取干预措施,避免疫情扩散。     

A population study of herpesvirus infections and HLA antigens

In a population-based study of herpesvirus infection and human leukocyte antigen (HLA) phenotype, conducted during the period 1977-1979 in the Framingham Study cohort, HLA-Bw16 was found less often and HLA-Cw2 more often in individuals with histories of herpes labialis than in other individuals. Similarly, both geometric mean antibody titer to herpes simplex type 1 and proportion of individuals with detectable antibody were higher in those without Bw16 and in those with Cw2. No strong association was found between HLA and history of herpes zoster or titer to herpes simplex type 2, varicella-zoster virus or cytomegalovirus.     

Fatal outbreak of chickenpox (varicella-zoster virus infection) among institutionalised adults with learning difficulties

Most adults are not susceptible to chickenpox. We present a report of an outbreak of chickenpox among institutionalised adults with learning difficulties. An inventory of exposed and possible affected residents was done after three adult males were diagnosed with chickenpox following a case of zoster. Individuals with a recent history of chickenpox rash or herpes zoster were included as cases. Medical files were used to derive background information. Serum samples of the first two patients were tested for IgM varicella-zoster virus (VZV) antibodies. Eventually ten cases of chickenpox (eight residents and one group leader and her partner) and two residents with herpes zoster were registered over a period of four months in 2001. The first two patients tested positive in serum. One resident with chickenpox died. This outbreak suggests a higher risk from chickenpox for institutionalised adults with learning difficulties in comparison with the general Dutch population, probably due to limited contacts with the general population. Further research into varicella-zoster seroprevalence, preferably with low-invasive diagnostic methods, is necessary to determine if this potential risk is present elsewhere, since the risk of life-threatening chickenpox in adults could be reduced by the now available live attenuated VZV vaccine.     

New variant of varicella-zoster virus

In 1998, a varicella-zoster virus glycoprotein E (gE) mutant virus (VZV-MSP) was isolated from a child with chickenpox. VZV-MSP, representing a second VZV serotype, was considered a rarity. We isolated another VZV-MSP-like virus from an elderly man with herpes zoster. These gE mutant viruses may have arisen through independent mutation or may represent a distinct VZV subpopulation that emerged more than 50 years ago.     

The Nature of Herpes Zoster: A Long-term Study and a New Hypothesis

Dr Hope-Simpson presents a study of all cases of herpes zoster occurring in his general practice during a sixteen-year period. The rate was 3·4 per thousand per annum, rising with age, and the distribution of lesions reflected that of the varicella rash.

It was found that severity increased with age, but that the condition did not occur in epidemics, and that there was no characteristic seasonal variation. A low prevalence of varicella was usually associated with a high incidence of zoster.

Dr Hope-Simpson suggests that herpes zoster is a spontaneous manifestation of varicella infection. Following the primary infection (chickenpox), virus becomes latent in the sensory ganglia, where it can be reactivated from time to time (herpes zoster). Herpes zoster then represents an adaptation enabling varicella virus to survive for long periods, even without a continuous supply of persons susceptible to chickenpox.

     

Specific immunoglobulin responses after varicella and herpes zoster.

The indirect immunofluorescence technique has been used to titrate the specific immunoglobulins in 200 sera from 64 patients with varicella, and 195 sera from 67 patients with herpes zoster. IgG and IgM antibodies were detected in all patients with varicella, and IgA in 59 (92%). All three classes of antibody appeared 2--5 days after the onset of the rash, increased virtually simultaneously and reached maximum titres during the second and third weeks. IgG then declined slowly, but never became undetectable and was still present in five subjects who were retested after 2--4 years; it was present in 88 out of 100 healthy young adults and probably persists indefinitely after varicella. IgA and IgM antibodies declined more rapidly and were not detected in specimens taken more than a year after the illness. IgA, however, may possibly persist in some cases since low titres were found in 8 out of 88 young adults who possessed IgG antibody and had presumably had varicella in the past. IgA responses were significantly weaker in children under the age of 6 years than in older children and adults. Six out of 67 patients with zoster were tested at various times before the onset of the rash: IgG antibody was detected in all. IgG was present in all sera taken after the onset of the rash, increased rapidly after 2--5 days, reached maximum titres during the second and third weeks and then declined slowly. IgA antibody was detected in 66 patients (99%) and IgM in 52 (78%); both types of antibody followed transient courses, as in varicella. Maximum titres of IgG and complement-fixing antibodies were greater after zoster than after varicella, but the differences were not significant. IgA and IgM titres in young adults with zoster were significantly lower than in older patients, and also lower than in young adults with varicella. Increases in varicella-zoster antibody in patients with herpes simplex virus infections consisted mainly of IgG, sometimes IgA, but never IgM.     

Case report: occupationally related recurrent varicella (chickenpox) in a hospital nurse

Commonly accepted outcomes of varicella-zoster virus (VZV) infections include chickenpox (primary) and shingles (recurrence or latency), as well lifetime immunity against chickenpox. We report the case of a registered nurse who worked in a neurologic surgery ward in a general hospital in Taipei, Taiwan. While working there for approximately 1 year, she developed recurrent chickenpox after caring for a paraparesis patient, who had herpes zoster during hospitalization in August 2002. The varicella incubation period was 10 days, which matched the range (10-21 days). Recently negative specific serum IgM and positive specific serum IgG indicated a past VZV infection. The nurse did not get herpes zoster from the second episode of varicella on 9 August 2002 to 4 April 2005 and is now convalescing. We conclude that occupational VZV hazards exist in the health care environment and suggest testing for VZV antibody and a VZV vaccination program for susceptible health care workers. Key words: chickenpox, indirect fluroscent antibody, occupational exposure, polymerase chain reaction, shingles, Taiwan, varicella-zoster virus.