经皮激光椎间盘减压术治疗腰椎管狭窄症长期疗效观察

正目的:观察经皮激光椎间盘减压术(percutaneous laser disc decomperssion,PLDD)治疗腰椎管狭窄症的长期临床疗效。方法:2003年2月至2010年8月,应用Nd:YAG激光治疗腰椎管狭窄症患者142例,31例获得长期随访,其中男性16例,女性15例;平均年龄62.1岁。31例均有间歇性跛行,直腿抬高试验均为阴性。影像学检查:以前方中央型间盘突出压迫马尾神经为主而后方受压较轻者25例,以后方     

经皮激光椎间盘减压术治疗腰椎管狭窄症长期疗效观察

目的:观察经皮激光椎间盘减压术(percutaneous laser disc decomperssion,PLDD)治疗腰椎管狭窄症的长期临床疗效。方法:2003年2月至2010年8月应用Nd∶YAG激光治疗腰椎管狭窄症患者142例,31例获得长期随访,其中男性16例,女性15例,平均年龄62.1岁。31例均有间歇性跛行,直腿抬高试验均为阴性。影像学检查:以前方中央型间盘突出压迫马尾神经为主而后方受压较轻者25例,以后方黄韧带肥厚压迫马尾神经为主而前方受压较轻者6例。应用数字评分法(NRS)和日本整形外科学会腰痛治疗成绩判定标准(JOA29分)对31例患者术前及末次随访进行评价。结果:平均随访(95.6±30.1)个月,共50个手术间隙,其中L4/5间隙23个(46%),L3/4间隙14个(28%),L5/S1间隙11个(22%),L2/3间隙2个(4%);其中下肢麻木28例,间歇性跛行27例,至末次随访时下肢麻木、间歇性跛行VAS评分均较术前降低(P0.01)。术前和末次随访时疗效的JOA评分为别为16.71±4.90、23.77±5.92,改善率为57.7%。结论:PLDD治疗前方受压为主的腰椎管狭窄症长期疗效满意,该治疗方法损伤小,风险低。     

次全椎板切除加潜行减压治疗腰椎管狭窄症196例

腰椎管狭窄症是骨科常见病之一。当椎管及神经根管狭窄时，管内的马尾神经和神经根受到压迫，即可引起腰腿疼痛、麻木，伴间歇性跛行及括约肌功能障碍等。1997年12月～2003年2月，我们采用次全椎板切除加潜行减压治疗腰椎管狭窄症196例，疗效较好。     

腰椎管狭窄症的x线检查诊断(附50例造影分析)

腰椎管狭窄症是因原发骨性狭窄,或继发原因如劳损、退行病变、骨质增生、韧带肥厚、急性外伤等,使腰椎管径变小,引起对马尾神经压迫的症侯群。本病已成为大家重视探讨的新课题。近年来在诊断和治疗方面有较大进展,但还存在一些部题有待解决。我院自1978年以来收治腰椎管狭窄症患者50例,均进行过碘苯脂(Myodil)造影检查,大部分实行了手术治疗,效果较好。现就50例腰椎狭窄症的造影检查诊断问题作一粗浅的总结分析。     

经口咽前路枢椎椎体次全切在陈旧性寰枢椎脱位中的应用

目的 探讨经口咽前路枢椎椎体次全切除椎管扩大范围减压术治疗陈旧性寰枢椎脱位伴以C2后方受压为主的脊髓压迫症的疗效。方法 对15例先天畸形或外伤(12例先天畸形,3例外伤)引起的陈旧性寰枢椎脱位伴高位脊髓压迫症患者,采用经口咽前路C2椎体次全切除术(11例仅行C2椎体次全切除,4例行C2椎体次全切除同时切除C1前结节和齿突)。结果 术后平均随访20个月,按Symon和Lavender临床评定标准和影像学评定标准评定疗效。临床总有效率15／15,显效率9／15,术后影像学显示椎管减压改善率平均为79．8％。本组无术中脊髓损伤、血管损伤及术后感染等并发症。结论 该术式减压充分,是治疗以C2后方受压为主的脊髓压迫症较好的术式。     

PLDD治疗腰椎间盘突出症中光热效应机理的研究进展

腰椎间盘突出症(lambar disc herniation,LDH)是临床多发病、常见病。严重者可引起神经根或马尾神经功能障碍,非手术治疗很难治愈,复发率较高,而各种开放性手术对脊柱正常结构都会造成破坏,影响远期疗效。基于LDH导致临床症状出现的病因,利用经皮激光汽化减压术(percutaneous laser disc decompression,PLDD)的光热效应进行治疗取得良好的临床疗效,现将PLDD光热效应与LDH机械压迫与炎性细胞因子相互作用机理研究进行综述,以期更深入地了解PLDD的作用机制。     

扩大开窗术治疗腰椎管狭窄症的近期临床疗效观察

目的探讨应用扩大开窗术治疗腰椎管狭窄症的临床疗效。方法选取诊断明确的腰椎管狭窄症患者30例,按统一的扩大开窗术式实施手术治疗并进行临床观察。结果本组所有患者完成预期的减压,30例随访6月-1年,平均7.5月。JOA评分改善率78.20％±16.43％;Macnab分级评价疗效优良率86.7％。发生腰椎不稳1例,硬膜囊破裂1例。结论扩大开窗术治疗腰椎管狭窄症的近期疗效满意;关节突的斜行切除方式可以使减压操作简便安全,对椎体的稳定性影响较小。     

经皮激光椎间盘减压术治疗青少年腰椎间盘突出症

目的观察经皮激光椎间盘减压术（PLDD）治疗青少年腰椎间盘突出症的疗效。方法青少年腰椎间盘突出症患者29例,男性23例,女性6例;年龄15～21岁。半导体激光波长980 nm,功率10 W,脉冲时间1 s,脉冲间隔1 s,照射时间25～70 min。总能量800～1 000 J,治疗29个椎间隙。随访12～21个月,按Macnab标准评定疗效。结果优：23例,良：3例,可：3例,优良率为89.7%。结论 PLDD治疗青少年椎间盘突出症,创伤小、安全性高、疗效满意。     

后路椎间盘镜治疗腰椎管狭窄症手术体会

目的 :探讨后路椎间盘镜微创手术治疗腰椎管狭窄症。方法 :对后路椎间盘镜治疗 36例腰椎管狭窄症病例进行回顾性分析。结果 :疗效良 31例 ,可 5例。结论 :后路椎间盘镜可以用于治疗腰椎管狭窄症 ,具有疗效好、微创、对脊柱稳定性干扰小、术后恢复快等特点。     

腰椎间盘突出症的疼痛机制与非手术治疗

腰椎间盘突出症是因椎间盘发生退行性变 ,纤维环破裂、髓核突出、刺激和压迫神经根及马尾神经所表现出的一种临床综合征。其疼痛机制与椎间盘的解剖生理特点、压应力对神经产生的机械效应以及生物化学物质和神经肽在疼痛感受中所起的作用有着密切的关系 ;另外也与神经根受压水肿产生的炎性反应、粘连和纤维化刺激神经引起疼痛有关。其治疗对策主要以局部物理康复治疗为主 ,辅以对症处理及药物、针灸治疗。85 % 90 %的腰椎间盘突出症患者经过积极的非手术治疗均可获得较满意疗效     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.