自发性椎管内硬脊膜外血肿1例报告

患者 ,女 ,2 6岁 ,持续性腰痛向双下肢放射伴有双下肢麻木感、乏力进行性加重 10天 ,排尿困难 1天 .起病前无发热、咽痛、皮肤感染或用抗凝药史 .体查 :双侧肋缘下皮肤痛、温、触觉减弱 ,大小便失禁 ,双下肢肌力Ⅱ度 ,肌张力减弱 ,双侧腱反射减弱 ,双侧巴彬斯基征阳性 .MRI :平扫 :胸腰椎骨质未见异常 ,T8椎体下缘至T12 椎体中部脊髓背侧见长条状异常信号影 ,T1WI为低信号 ,T2 WI为高信号 ;强化扫描 :横断面T2 WI扫描未见强化 (见图 1～ 2 ) ,考虑硬脊膜外血肿或脓肿 .实验室检查 :RBC 4 .12× 10 9/L ,Hb :110g/L ,WBC :7.0× 10…     

自发性椎管内硬脊膜外血肿1例报告

患者,女,26岁,持续性腰痛向双下肢放射伴有双下肢麻木感、乏力进行性加重10天, 排尿困难1天.起病前无发热、咽痛、皮肤感染或用抗凝药史.体查:双侧肋缘下皮肤痛、温、触觉减弱,大小便失禁,双下肢肌力Ⅱ度,肌张力减弱, 双侧腱反射减弱,双侧巴彬斯基征阳性.     

自发性椎管内硬脊膜外血肿的诊治体会

自发性椎管内硬脊膜外血肿（SSEH）在临床上并不多见,它是指无明显诱因的椎管内硬脊膜外血肿。其起病急,发展迅速,如不及时确诊行手术减压,常可导致脊髓功能不可逆损伤,     

自发性椎管内硬脊膜外血肿的诊治体会

自发性椎管内硬脊膜外血肿(SSEH)在临床上并不多见,它是指无明显诱因的椎管内硬脊膜外血肿.其起病急,发展迅速,如不及时确诊行手术减压,常可导致脊髓功能不可逆损伤,最终致终生残疾甚至危及生命.我科于2005年1月-2010年1月共收治自发性椎管内硬脊膜外血肿患者11例,现报告如下.     

硬脊膜外原发性淋巴瘤

硬脊膜外原发性淋巴瘤胡学信杨珍凤段尚林刘晓军一、材料与方法硬脊膜外原发性恶性淋巴瘤较为罕见，本院从１９８７年１月至１９９５年５月收治３例，收集５例（会诊４例，矿务局医院１例），共８例。标本经１０％福马林固定，常规石蜡包埋制片，ＨＥ及Ｇｏｍｏｒｉ网状纤...     

硬膜外麻醉穿刺穿破硬脊膜后处理的讨论

硬膜外穿刺是一种盲探性操作，对针尖到达位置的判断主要是依据操作者的经验和感觉以及硬膜外腔的负压。由于操作因素和患者身体的不同，所有的检查装置和方法都没有100％的可靠性，实际操作中难免会有穿破硬脊膜的情况发生（特别是初学者）。对于穿破后的处理，基本的意见是更换其他的麻醉方法。下腹部，下肢，或肛门会阴区的手术，若穿刺点在L2以下，可谨慎地施行脊麻，     

脊柱硬脊膜外腔“膜椎韧带”的研究进展

第40版格式解剖学中记载,meningovertebral韧带,将硬脊膜连接到衬在椎管内表面的组织上,在前方和侧方发育的较好,相似的条带把神经根鞘固定在它的通道里,本文暂将其译为"膜椎韧带"。据Newell报道,硬脊膜与椎管壁间的纤维束最先由Meckel(1817)和Humphry(1858)报道,Trolard(1888)和Hofmann(1889)详细描述了这些纤维条带,随后此韧带冠名     

外伤性后颅窝硬膜外血肿的诊治探讨

目的探讨外伤性后颅窝硬膜外血肿的诊断与治疗。方法回顾性分析34例外伤性后颅窝硬膜外山肿的临床资料。结果手术治疗30例,保守治疗4例。根据GOS评分结果:良好25例,中残4例.重残2例,死亡3例。结论CT扫描是诊断外伤性后颅窝硬膜外向肿的首选检查方法。外伤性后颅窝硬膜血肿及早确诊后,尽早手术,预后良好。     

地塞米松明胶海绵预防硬脊膜外粘连

背景：临床上在腰椎间盘摘除中将地塞米松明胶海绵复合物放置在神经根和硬脊膜周围取得了良好的效果。目的：通过动物实验了解地塞米松明胶海绵复合物预防硬脊膜外粘连的效果。方法：将40只新西兰白兔随机均分为4组,均切除L₄、L₇椎板,造成1.0 cm×0.5 cm的硬脊膜裸露区后,其中3组分别在硬脊膜与神经根表面覆盖地塞米松明胶海绵、注射地塞米松及覆盖明胶海绵,以不用任何间置物覆盖的为空白组。术后2,4,6,8,12周完整取下整个手术节段椎体及其附件和椎旁肌,大体及组织学观察神经根及硬脊膜粘连程度。结果与结论：术后12周,地塞米松明胶海绵组大体见椎板缺损处有新生骨形成,硬脊膜周围有黄白色膜性组织,可分离,组织学见脂肪细胞结构完整,与硬脊膜之间分界明显,无瘢痕细胞形成,无粘连,软骨细胞及骨小梁增生;地塞米松组、明胶海绵组、空白组大体见硬脊膜外围有大量瘢痕组织,与硬脊膜粘连严重,无法钝性分离,组织学见芽组织胶原化,硬脊膜增厚,粘连严重。表明地塞米松明胶海绵复合物可预防硬脊膜外粘连。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

硬脊膜外原发性恶性淋巴瘤1例

患者，男性，73岁，因外伤后两下肢活动障碍3天入院。查体：全身浅表淋巴结未触及肿大，神经系统检查T1m水平以下深浅感觉消失，两下肢肌力0级，膝反射消失，大小便失禁。MRI检查显示T0-11脊髓后方见梭形肿块，长5.5cm，     

The poor outcome of the delayed diagnosis of acute spontaneous spinal epidural hematoma: two cases report

We present two patients who had acute paraplegia with sensory loss due to spontaneous spinal epidural hematoma (SSEH). One had myocardial infraction and the other had deep vein thrombosis, and the former was treated with anticoagulants and the latter was treated with thrombolytic agent. We analyzed the neurological status of our two cases each between its preoperative and postoperative state. Postoperatively both showed no improvement of neurologic symptom, and on follow-up of 12 months, one showed no neurologic improvement and the other showed a insignificant improvement of lower extremity muscle power (trace knee extensor/ankle dorsi-flexor). We thought that this poor outcome was due to delayed operation, which was done more than 24 hr after the symptom onset. The outcome in SSEH is essentially determined by the time taken from symptom onset to operation. Therefore, early and precise diagnosis such as careful history taking and MRI evaluation is necessary.     

Vascular anatomy of the spinal epidural space: Considerations on the etiology of the spontaneous spinal epidural hematoma

The anatomy of the blood vessels in the spinal epidural space is an important basis for the understanding of the etiology of the spontaneous spinal epidural hemorrhage (SSEH). The structure of the internal vertebral venous plexus and epidural arteries, in particular the poorly recognised “cluster-type” arteries, has been studied. The cluster arteries are easily mistaken for vascular anomalies. The literature is reviewed, and the different theories on the etiology of the SSEH are discussed.     

腰椎间盘突出症合并椎管内硬膜外血管畸形的解剖与临床特点

目的研究腰椎间盘突出症合并椎管内硬膜外血管畸形的解剖与临床特点。方法2001-2006年期间在我科手术治疗的7例腰椎间盘突出症合并椎管内硬膜外血管畸形,术前行MRI和选择性脊髓血管造影检查,均行椎间盘髓核摘除及畸形血管烧灼切除术。结果术中发现5例硬膜前方畸形血管,2例椎管内大量陈旧积血。术后症状消失或逐渐减轻,随访4年均无复发。根据Macnab疗效评定标准,优5例、良2例,无可及差。结论MRI、脊髓造影、手术探查是腰椎间盘突出症合并椎管内硬膜外血管畸形的主要诊断方法,充分认识其解剖与临床特点,有助于提高诊断准确率及手术疗效。     

Primary spinal epidural manifestation of malignant lymphoma

The clinical, histological and immunomorphological data in 19 cases of primary spinal epidural manifestation of malignant lymphomas collected between 1974 and 1994 are reported. The age of the patients varied between 11 and 87 years with a mean age of 56.3 years. There was a slight male predominance (11 : 8). In most cases, the onset of the clinical symptoms was rapid. The preferential tumour localization was the epidural space related to the thoracal vertebral bone. In each case, decompressive laminectomy was performed. The tumours were histologically and immunomorphologically classified as B-cell lymphomas (14 of 19), T-cell lymphomas (3 of 19) and anaplastic plasmacytoma (1 of 19). Except for one case, post-operative staging did not reveal anything other than epidural manifestation of the malignant lymphoma. The vertebral bone, however, was involved in seven cases. Irradiation alone, or in combination with chemotherapy, was performed as additional therapy. The post-operative survival time was variable.     

Cerebrospinal fluid drainage through the diploic and spinal epidural veins

The aim of this study was to quantitatively evaluate the function of the cranial diploic and spinal epidural veins as cerebrospinal fluid (CSF) drainage pathways by measuring lipocalin‐type prostaglandin D synthase (PGDS) and cystatin C (CysC) dissolved in the blood of these veins. This was a prospective study involving 51 consecutive patients, 31 males and 20 females, who underwent 41 cranial and 10 spinal surgeries. Intraoperatively, peripheral venous blood and diploic venous blood, or peripheral venous blood and spinal epidural venous blood samples were simultaneously collected and immediately centrifuged. For all samples, dissolved albumin (for reference), PGDS and CysC were measured using an enzyme‐linked immunosorbent assay. The diploic vein/peripheral vein ratios in five cranial locations and epidural vein/peripheral vein ratios were calculated and statistically evaluated for the three biomarkers. For PGDS, the diploic vein/peripheral vein ratio was significantly increased in the frontal (P = 0.011), temporal (P = 0.028), parietal (P = 0.046) and skull base (P = 0.039), while it did not reach statistical significance for CysC. For patients older than 45 years, the diploic vein/peripheral vein ratio for PGDS was significantly decreased in the frontal region (P = 0.028), and the epidural vein/peripheral vein ratio for CysC was significantly decreased (P = 0.014). These results show that the diploic veins constitute CSF drainage pathways with heterogeneous functional intensity at different cranial locations. Compared with the diploic veins, spinal epidural veins seem to drain less CSF. The cranial diploic and spinal epidural veins may jointly function as an alternative, age‐related trans‐dural CSF drainage system.     

Effect of epidural infusion of isobaric 2% lidocaine on spinal cord ganglionic neurons

We analyzed morphological and histoenzymologic changes in spinal cord ganglionic neurons of mongrel dogs caused by epidural infusion of isobaric 2% lidocaine. Lidocaine produced no pathological structural and metabolic alterations in the nervous tissue. Both epidural infusion of 0.9% NaCl and lidocaine produced some morphofunctional rearrangements in spinal ganglionic neurons. These alterations were within the limits of physiological norm and probably attested to functional response of the examined nerve tissue structures to epidural infusion.     

Formation of locomotor patterns in decerebrate cats in conditions of epidural stimulation of the spinal cord

Acute experiments on decerebrate cats were performed to study the mechanism of formation of the locomotor pattern in conditions of epidural stimulation of the spinal cord. These studies showed that only segments L3–L5 contributed to generating the stepping pattern in the hindlimbs. At the optimum frequency (5–10 Hz) of stimulation of these segments, formation of electromyographic burst activity in the flexor muscles was mainly due to polysynaptic reflex responses with latencies of 80–110 msec. In the extensor muscles, this process involved the interaction of a monosynaptic reflex and polysynaptic activity. In epidural stimulation, the stepping pattern was specified by spinal structures, while peripheral feedback had modulatory influences.Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 89, No. 9, pp. 1046–1057, September, 2003.     

Variants in the structure and topography of the superior margin of the epidural space of the human spinal cord

Variants in the structure of the upper margin of theepidural space at sites of transition from the dura mater of the spinal cord to the dura mater of the brain were studied. Stereoepidurographic (88 observations) and corrosion studies (49 observations) identified four levels for the position of the upper margin of the anterior section (intracranially located, lower edge of the occipital bone, bodies of C₁ and C₂) along with five levels for the posterior section (occipital bone, occipital bone-arch of C₁, C₁, C₁–C₂, C₂) of the epidural space. Variants on the shape of the upper margin of the anterior (falciform, oval, and dentate in the frontal plane; pointed, flexed spurs, pointed slits, and olive-shaped in the sagittal plane) and posterior (collar-shaped, oval, and bidentate forks with prongs of equal length and forks with prongs of unequal lengths) sections of the epidural space arose as a result of asymmetry in the attachment of the upper sections of the sac of the dura mater of the spinal cord to the walls of the vertebral canal. Weak areas of the upper wall of the epidural space (sites of transition from the dura mater of the spinal cord to the dura mater of the brain, paravasal capsule of the vertebral artery, the area of the first intervertebral foramen) were seen. __________ Translated from Morfologiya, Vol. 132, No. 5, pp. 38–42, September–October, 2007.     

Relationship of inferior gluteal nerves and vessels: target for application of stimulation devices for the prevention of pressure ulcers in spinal cord injury

A study was carried out to determine whether the location of the inferior gluteal nerve could be reliably predicted using external anatomy or vascular imaging. This study was motivated by our group’s development of an electrical stimulation system to provide direct gluteal stimulation in paralyzed individuals, in particular those with spinal cord injury (SCI). Pressure ulcers are a common complication for many individuals with reduced mobility. Numerous approaches have been employed to treat and prevent pressure ulcers; however no procedure or nursing care regimen has been successful in eradicating them completely. Our group seeks to prevent skin breakdown in susceptible patients by direct electrical stimulation of the paralyzed gluteal muscle, leading to improved circulation and increased muscle mass (hypertrophy) in the treated area. Currently, percutaneous electrodes are placed through an extensive probing process to select the motor point of the target muscle. We examined 15 cadaver gluteal regions to identify the relationship between the internal anatomy of the inferior gluteal artery and nerve as well as the relationship to external anatomic landmarks. The cadavers displayed variability with regard to the morphology of the branches of both nerve and artery. Furthermore, there did not appear to be any relationship between the relative positions of the nerve and artery. However, the potential target area of the proximal origin of the inferior gluteal nerve could reliably be predicted from the external bony anatomy of the lower pelvis.