胸椎椎间盘突出症11例报告

作者报告了１１例胸椎间突出病例。１１例均行Ｘ线平片，脊髓造影，脊髓造影如ＣＴ扫描（ＣＴＭ）检查，其中３例进行了ＭＲＩ检查。１１例均经手术证实。１１例有１３处间盘突出，其中Ｔ１０，１１４处，Ｔ１１，１２５处，Ｔ１２，Ｌ１，４处。中央型９例，旁中央型１例，外侧型１例。１１例术前均有明确的临床表现，本组病例初诊多诊断为腰椎间盘突出，甚至心，肺，消化道及泌尿系疾患。作者认为误诊的主要原因是：（１）本病发病     

膀胱癌组织中p53基因突变的研究

作者应用聚合酶链反应－单链构象多态性分析（ＰＣＲ－ＳＳＣＰ）和直接测序等分子生物学技术，分析检测了２１例膀胱移行上皮癌ｐ５３基因５～８外显子。结果，在１４例浅表性膀胱癌中，发现１例（Ｔ＿１期）ｐ５３基因突变；７例浸润性膀胱癌中，４例发现ｐ５３基因突变，其中Ｔ＿２期１例，Ｔ＿３期２例，Ｔ＿４期１例。４例Ｇ＿１级膀胱癌无一例检出ｐ５３突变，５例Ｇ＿２级膀胱癌１例检出ｐ５３突变，１２例Ｇ＿３级肿瘤４例发现ｐ５３基因突变。结果表明：ｐ５３基因突变在膀胱癌的发生发展中起着重要作用。     

小儿颈椎椎间盘钙化症

我院收治小儿颈间盘钙化症患者７例，男４例，女１３例，平均８．９岁。临床表现为颈部疼痛，活动受限、头颈歪斜和脊髓神经受压症状和体征；颈椎间盘钙化均为单发，颈３－４１例，颈４－５３例，颈５－６２例，颈７－胸１１例。钙化灶呈球形、椭圆形、蝌蚪状、或烛泪样向后突出压迫脊髓。３例曾被误诊。１例因外院手术失误而遗留中形，其余６例以颈托固定等保守疗法痊愈。随访６－１８月无复发。讨论：小儿椎间盘钙化症发病率低、病     

腹腔镜胆囊切除术并发皮下气肿对P_（ET）CO_2的影响

腹腔镜胆囊切除术并发皮下气肿对Ｐ＿（ＥＴ）ＣＯ＿２的影响许太武，丁玉兴，董发团１９９１年９月～１９９３年１２月，我院施行腹腔镜胆囊切除术（ＬＣ１６５０例，其中发生皮下气肿１１例。气腹后发生皮下气肿时呼气终末ＣＯ＿２分压（Ｐ＿（ＥＴ）ＣＯ＿２）、血压（...     

下胸椎及胸腰段椎后缘骨内软骨结节

通过临床病例报道以及对相关文献的复习,探讨胸椎后骨内软骨结节的临床特征及病因,病理机制,方法６例下胸椎及胸腰段脊髓压迫症患者经Ｘ线片及ＣＴ扫描证实,共发生椎体后缘内软骨结节９个,其中４例各发生１个,另２例分别为２个,３个,Ｔ１１下缘１个,Ｔ１２下缘５个,Ｔ１２上缘１个、Ｌ１及Ｌ２下缘各１个。Ｘ线侧位片示：５个椎体后下角或后上角表现为缺损以及相对应的游离骨块,且二者间有线状裂隙,相对应处骨硬化,２个     

儿童颈椎椎间盘钙化10例报告

作者对１０例颈椎间盘钙化病例的临床表现，治疗及长期随诊结果进行了分析，男５例，女５例。年龄６～１４岁，平均９．４岁，１０例Ｘ线片发现１１个颈椎间盘钙化，９例单发，１例为２个节段合并环枢椎半脱位，有２例间盘钙化突入椎管，侵占椎管面积大于５０％，其均有神经根刺激症状，但无脊髓受体征，８例在治疗后２周内症状消失，另２例在治疗后２个月缓解，８例随１访１年以上，钙化影在２～８个月内消失，本病的特点为：（１）     

创伤性上升性脊髓缺血损伤

脊椎损伤后,脊髓损伤平面上升较为少见。作者报告了５例,其中Ｔ１０－１１骨折脱位２例：１例于伤后２周内,截竣平面上升至Ｃ２,呼吸麻痹死亡,１例上升至颈部脊髓,双上肢无力;另３例为Ｔ１２骨折２例,Ｌ３骨折１例：其中截竣平面上升至Ｔ９至１例,Ｔ８者２例。５例患者双下肢皆呈软竣,１例死亡患者尸检见脊髓完整,Ｔ９－１０段脊髓前后动静脉血栓,其向上至Ｃ３,向下至Ｓ１,脊髓前血管、中央血管、髓内小血管多处 栓,     

BCG膀胱灌注对局部免疫细胞功能的影响

对２７例表浅膀胱癌术后ＢＣＧ膀胱灌注前后膀胱壁Ｔ＿３、Ｔ＿４、Ｔ＿８、ＩＬ－２Ｒ表达及尿液中肿瘤坏死因子（ＴＮＦ）含量进行了研究。结果表明，ＢＣＧ膀胱灌注后膀胱壁大量淋巴细胞浸润，Ｔ＿４／Ｔ＿８比值由灌注前０．６上升至１．９，２０例患者膀胱壁形成淋巴肉芽肿，粘膜下散在淋巴细胞表面广泛表达ＩＬ－２Ｒ，但肉芽肿淋巴细胞表面几乎不表达ＩＬ－２Ｒ。灌注后２４小时尿液中ＴＮＦ含量显著升高（Ｐ＜０．０１），实验结果提示：Ｔ＿４、巨噬细胞在ＢＣＧ抗肿瘤效应中起着非常重要的作用。     

注射胶原酶治疗腰椎间盘突出症失败的原因

我院１９９４年以来采用注射胶原酶治疗腰椎间盘突出症共８６例,其中１２例改行外科手术治疗,现结合注射胶原酶术后腰椎ＣＴ扫描复查及术中所见分析失败原因。１　临床资料本组男７例,女５例。年龄２５～６０岁。发病时间为３个月～５年,平均为２－４年。病变部位：Ｌ４～５椎间１９９９０１１９收稿,１９９９０４０９修回作者单位：绍兴市人民医院骨科,浙江　绍兴　３１２０００作者简介：金以军,男,３７岁,主治医师。研究方向：脊柱外科,创伤骨科盘６例,Ｌ５～Ｓ１椎间盘８例（其中２例为２个间隙病变）。ＣＴ扫描：椎…     

加用垂体后叶素治疗小儿烧伤应激性消化道溃疡出血

我科自１９９５年９月至１９９８年１１月应用垂体后叶素（南京生物化学制药厂生产）治疗小儿烧伤应激性消化道溃疡出血１２例，效果满意。１临床资料 本组１２例，男１０例，女２例，年龄２－８岁，平均４岁，烧伤面积 １２％－ ３０％ＴＢＳＡ，平均 １８％，创面以深Ⅱ度为主。入院时间：伤后４－９ｄ，平均８ｄ。出血时间：伤后４－６ｄ者３例，７－９ｄ者９例。本组症状主要为解暗红色血便或柏油样便，２例伴呕少量暗红色血性液体。均出现明显休克症状。２治疗方法 入院后常规予补液输血抗休克、广谱抗生素抗感染、对症处理。静注法莫…     

扩大后外侧入路处理中央型胸腰段椎间盘突出症

目的胸腰段中央型椎间盘突出采取扩大后外侧入路去除突出及钙化的椎间盘。方法本组病例男16例,女5例,年龄21～65岁,平均43.9岁,L1-2突出为11例次,T11-12为8例次,T12-L1为5例次。均为中央型突出为主,均行扩大后外侧入路处理。结果所有病例均获得改善,随访1～3.5年,平均2年。结论扩大后外侧入路行胸腰段中央型椎间盘突出,出血少,创伤小,对脊髓影响小,能达到完全减压的目的。     

外伤性急性颈椎间盘突出症(附19例报告)

本文旨在阐明MRI对急性颈椎间盘突出的诊断价值。19例均有明显的外伤史,X线片无骨折脱位者12例。其中C_(5～6),髓核突出7例,C_(5～6)、C_(1～5),突出5例。有小关节绞锁半脱位者7例,MRI均示损伤间隙有髓核突出。19例均为不全瘫。全部病例经前路椎间盘切除、植骨融合。平均随访15个月,植骨块平均于12周愈合。除1例骨块退出4～5mm外,余位置良好。脊髓功能均有明显恢复。结论:外伤是急性颈椎间盘突出的主要原因,而颈椎间盘突出又是SCIWORA综合征的主要原因。对小关节绞锁半脱位者应考虑同时有椎间盘突出的可能。手术治疗一般效果良好。     

Circumspinal decompression and fusion through a posterior midline incision to treat central calcified thoracolumbar disc herniation: a minimal 2-year follow-up study with reconstruction CT

Purpose

There have been several surgical approaches used in the treatment of thoracolumbar disc herniation (TLDH) from T10/11 to L1/2. However, central calcified TLDH cases are still challenging to spine surgeons. The anterior transthoracic approaches and lateral/posterolateral approaches are all essentially performed from one side; thus, the compressive lesion and the dura matter on the other side of the spinal canal are not clearly visualized, predisposing the procedure to incomplete decompression or inadvertent cord manipulation. Moreover, a number of these approaches are technically demanding and require entry into the chest. The purpose of this study was to introduce a new surgical procedure—circumspinal decompression and fusion through a posterior midline incision—for the treatment of central calcified TLDH and to evaluate its surgical outcome.

Methods

In this study, 22 patients (15 males and 7 females; mean age 49 years) with central calcified TLDH underwent this procedure between April 2008 and April 2011. Altogether, 26 discs were excised, with two discs at T10/11, eight discs at T11/12, nine discs at T12/L1 and seven discs at L1/2. Of these patients, 16 returned for final follow-up, with a mean follow-up period of 41 months (range 24–57 months). Clinical outcomes, including operative time, blood loss, perioperative complications, post-operative time of hospitalization, neurological status improvement, extent of decompression, back pain, local spinal curvature and fusion, were investigated. The patients’ neurological status was evaluated by a modified Japanese Orthopedic Association scoring system of 11 points. Fusion and the extent of decompression were evaluated by reconstruction CT at final follow-up.

Results

The mean operative time was 185 min, the mean blood loss was 896 ml and the mean post-operative hospitalization time was 8 days. Four patients suffered perioperative complications, but only two were related to dura violation and none involved the respiratory system. All of the 16 patients who returned for the final follow-up showed improvement, and evidence of improvement was found in five of the other six patients who did not return for final follow-up through telephone interview or earlier follow-up evaluations. Complete decompression was achieved in 12 of the 16 patients who returned for final follow-up. In the 16 patients who returned for final follow-up, back pain was significantly reduced and local spinal curvature remained unaltered. In addition, based on reconstruction CT images, solid fusion was observed in 15 of the 16 patients who returned for final follow-up.

Conclusions

The circumspinal decompression and fusion through a posterior midline incision procedure can be used to treat central calcified TLDH patients with neurological deficits. This method’s greatest advantage is that it is a highly effective and safe procedure for decompression. Although it is a major and destructive procedure, spinal stability was well maintained in most of the cases. In this era when minimally invasive spine surgeries like thoracoscopy have been in an upward trajectory, spine surgeons still should be made aware of this procedure.     

MRI在急性颈椎骨折并发椎间盘突出中的应用

应用磁共振成像（ＭＲＩ）检查５０例急性颈椎骨折，其中伴有椎间盘突出３２例（６４％）。在过伸性 损伤１２例中，椎间盘突出７例（５８．３％）；屈伸性损伤３８例中，椎间盘突出２５例（６８．４％）。在ＭＲＩ上显 示３种情况：（１）单纯性椎间盘突出，硬膜囊与脊髓是高信号，表示脊髓水肿；（２）椎间盘与骨块一起 压迫脊髓，脊髓内有暗淡假信号，表示脊髓内出血或实质性损害；（３）椎间盘突出与脊髓信号变化不在 同一椎节平面，脊髓信号增高处可能是损伤的椎节。在治疗上，单纯性椎间盘突出患者的效果比较满 意。椎间盘与骨块同时压迫硬脊膜者，效果比较差；第三种患者可给予保守治疗，必要时手术，能获 得满意效果。     

侧前方减压治疗腰椎间盘突出症

目的 讨论腰椎间盘突出症的治疗方法。方法 用侧前方减压术对11例胸椎间盘突出进行手术治疗。结果 该手术方法直接、充分显露硬膜囊和神经结构,切除突出的椎间盘和刮除骨赘,减压安全有效,同时对脊柱的稳定性和脊髓的血供影响较小,通过对11例患者观察结构为优7例,良4例。结论 侧前减压术进行胸椎间盘切除减压是治疗胸椎间盘突出症的一种安全有效的方法。     

腹腔镜辅助腰椎前路椎间融合术治疗腰椎退变性疾病

 目的 探讨腹腔镜辅助腰椎前路椎间融合术治疗腰椎退变性疾病的疗效。方法 2006年 1月至 2009年 6月腰椎退变性疾病患者 37例行腹腔镜辅助腰椎前路椎间融合, 男 22例, 女 15例;年龄 16~55岁, 平均 43.7岁。全部病例行血管造影三维 CT检查、17例行椎间盘造影检查, 确定责任椎间盘为 L5S1 21例, L4-5 11例, L3-4 2例, L2-3 2例, L1-2 1例。 29例经腹腔入路、8例经腹膜后入路行椎间盘切除及椎间融合器融合, 3例以骨盆重建钛板固定。术后 3、6、12个月通过 X线或 CT观察植骨融合情况, 3个月时采用中华医学会骨科学分会脊柱学组腰背痛手术评分评价疗效。结果手术时间 60~140 min, 平均 100 min;术中出血 50~300 ml, 平均 120 ml;住: 时间 7~12d, 平均 8d。 2例经腹腔入路患者出现麻痹性肠梗阻。全部病例随访 6~35个月, 平均 18.7个月。疗效为优 23例、良 11例、差 3例, 优良率 91.9%(34/37)。 23例于术后 3个月、12例于术后 6个月植骨融合;2例术后 6个月时椎间前缘高度丢失 1.3 mm和 1.9 mm, 无明显不适症状, 术后 12个月植骨融合。无内植物松动、脱落等并发症。结论腹腔镜辅助腰椎前路椎间融合术创伤小、卧床时间短、并发症少。经腹腔入路术后肠梗阻相对多见。在选择手术入路时应考虑术者经验和下腰椎前方大血管的解剖位置。     

Results of hemivertebrectomy and fusion for symptomatic thoracic disc herniation

We retrospectively analysed ten consecutive patients (age range 32-77 years) treated surgically from 1994 to 1999 for symptomatic thoracic disc herniation between the 6th and 12th thoracic discs. Clinically, eight patients had varying grades of back pain and eight patients had paraparesis. Radiography showed calcification in 50% of the herniated discs. Two patients had two-level thoracic disc herniation. Hemivertebrectomy followed by discectomy and fusion was carried out in all patients. Instrumentation with cages was performed in eight patients and bone grafting alone in two patients. The average follow-up was 24 months (range 13-36 months). Six patients had an excellent or good outcome, three had a fair outcome and one had a poor outcome. One patient had atelectasis, which recovered within 2 days of surgery. Another patient had developed complete paraplegia, detected at surgery by SSEPs, and underwent resurgery following magnetic resonance (MR) scan with complete corpectomy and instrumented fusion. At 2 years, she had a functional recovery. The patient with poor outcome had undergone a previous discectomy at T9/10. He developed severe back pain and generalised hyper-reflexia following corpectomy and fusion for disc herniation at T10/11. We advocate anterior transthoracic discectomy following partial corpectomy for symptomatic thoracic disc herniation between the 6th and 12th thoracic discs. This procedure offers improved access to the thoracic disc for an instrumented fusion, which is likely to decrease the risk of iatrogenic injury to the spinal cord.     

急性中央型颈髓损伤综合征的临床治疗

目的探讨急性中央型颈髓损伤综合征的临床治疗.方法对30例急性中央型颈髓损伤综合征患者,根据病情分别采取保守治疗、颈椎前路、后路脊髓减压手术.结果平均随访4年8个月,根据ASIA分级标准,在21例非手术治疗组中,治疗前B级1例,C级5例,D级15例,治疗后恢复至D级者4例,恢复至E级者15例,无明显恢复者2例;在9例手术治疗组中,治疗前B级2例,C级4例,D级3例,治疗后恢复至C级者1例,恢复至D级者3例,恢复至E级者4例,无明显恢复者1例.结论对于MRI显示脊髓无明显受压的患者,经保守治疗多可取得满意疗效.对于MRI显示脊髓明显受压的患者,行颈椎前、后路脊髓减压手术,有利于脊髓功能的恢复.     

重复注射胶原酶治疗腰椎间盘突出症

目的:探讨重复注射胶原酶治疗腰椎间盘突出症的疗效及安全性。方法:经过注射胶原酶治疗效果不理想的腰椎间盘突出症患者58例,重复注射胶原酶,观察疗效及影像学变化。L4,527例L5S131例;年龄20~61岁,平均42岁;男25例,女33例;病程2个月~5年,平均3·7个月。第1次注射到本次注射的时间平均为3·8个月。结果:根据疗效评价标准优46例,良5例,可2例,差5例。46例症状体征消失,患者术后1个月复查CT,原突出的椎间盘缩小2~6mm,平均3·4mm;余12例效果不理想的患者,术后1周复查CT,7例突出的椎间盘较术前大,5例椎间盘形态、体积无改变。此12例第3次溶盘术后其中10例症状体征消失,2例症状体征有所改善,其中1例行第4次溶盘术后症状进一步改善。27例CT显示有椎间盘出现真空征。复查CT突出的椎间盘溶解率73%,未发生过敏、感染、破坏、椎体滑脱等情况。结论:注射胶原酶治疗腰椎间盘突出症可以重复进行,适应证选择恰当可以彻底治愈此病,并且有较高的安全性。     

Magnetic resonance imaging of diseased cervical and lumbar intervertebral discs

Magnetic resonance images (MRI) of diseased cervical and lumbar intervertebral discs involving both intrinsic and extrinsic cord lesions were examined using either a 0.15 T resistive or a 0.5 T superconductive magnetic imaging system. High resolution images were obtained by means of a surface coil in most cases. The vertebrae, intervertebral discs, and spinal cord were delineated in greatest detail on spin-echo (SE) images with a long repetition time (TR) and a short echo time (proton density-weighted image), on which the spinal cord was appreciated without overshadowing by the cerebrospinal fluid-filled subarachnoid space. Protrusion of degenerated intervertebral discs into the spinal canal was clearly demonstrated not only on sagittal but also on parasagittal and transverse views. The location of protruded discs and compression of the spinal cord, caudal sac, and nerve roots were well visualized three-dimensionally. Pathological features of intervertebral discs were better appreciated on T2-weighted images with long TR and SE pulse sequences. Degeneration of intervertebral discs resulted in decreased signal intensity in cases involving lumbar disc lesions but not those involving cervical disc lesions. In a case of suspected myelomalacia, the intrinsic cord lesion resulting from traumatic disc protrusion appeared as focal low signal intensity on T1-weighted images and as somewhat high intensity on T2-weighted images. The inversion recovery sequence with median inversion time displayed an inferior image of low contrast and was judged uninformative in comparison to SE images. The authors' observations demonstrate that MRI is an essential diagnostic technique for spinal cord disorders.(ABSTRACT TRUNCATED AT 250 WORDS)