骶正中动、静脉解剖变异对脊柱腰骶椎前路手术的临床意义

目的对骶正中动静脉的位置分布及变异进行解剖观察及实际测量其与周围重要结构的位置关系,为临床医师提高腰骶椎前路手术安全性提供必要的参考信息。方法收集2008年5月-2011年1月期间l因疾病及意外死亡者新鲜人体尸体标本30例,对其进行解剖学研究,观察并测量骶正中动、静脉的发出点与走行,骶正中动、静脉的数量与缺失情况,以及骶正中动、静脉间的相互走行关系。结果①骶正中动脉在主动脉发出以及走行的位置相对固定,无明显多支与缺失情况;骶正中动脉均为腹主动脉根部背侧发出,未见发出点位于左右髂总动脉。发出后行于左侧髂总静脉后方,跨过腰5／骶1椎间盘下行。骶正中静脉与骶正中动脉伴行的情况占总数的60．0％;②骶正中静脉多支常见,没有发现有骶正中静脉的缺失。1支的占总标本数的66．7％,2支的占30．O％,3支的占3．3％。结论当选择分叉下入路,应该特别注意骶正中动静脉的解剖位置。动脉的变异相对较小,而静脉的变异程度非常大,发出点变异,多支的情况多见,这些原因都造成了静脉容易损伤的原因,在手术中应该特别注意。     

先天性骶椎裂伴纤维脂肪瘤的护理1例

椎管内肿瘤是指生长于脊髓本身及椎管内与脊髓相邻近的组织结构的原发性肿瘤及转移性肿瘤的统称[1].骶段椎管内肿瘤是其中一种,临床上并不多见,伴先天性骶椎裂的成年患者更是少见.2003年6月9日我院收治1例,现将护理体会报告如下.     

后路椎弓根系统内固定并髂骨植骨修复多节段腰骶椎结核:重建稳定的腰骶段

背景:多节椎体破坏的腰骶椎结核在治疗上比较复杂,除了考虑病灶清除,解除脊髓压迫外,恢复脊柱椎体的高度及脊柱的稳定性也是必要的。目的:探讨后路椎弓根系统内固定前路一期病灶清除自体髂骨植骨修复多节段腰骶部结核的效果。方法:选择2005年3月至2012年12月收治的多节段腰骶椎脊柱结核患者25例,病变节段位于L2-S2,经正规抗结核治疗2-4周后,行一期后路椎弓根系统内固定、前路病灶清除自体髂骨植骨治疗。修复后定期复查X射线片与CT扫描,评估骨块融合和畸形矫正情况,并记录不良事件及材料宿主反应。结果与结论:修复后进行了平均16个月的随访,23例切口全部愈合,2例切口二期愈合,无窦道形成,术后所有患者腰腿痛均消失;随访期间植骨块无滑脱移位,无断钉断棒,6个月内均出现骨性融合,术后1年结核病灶无复发,血沉正常,X射线片显示病变椎体已骨性愈合。术后腰骶角为16°-36°,平均26°;末次随访时为15°-30°,平均20°。提示:一期病灶清除多节段腰骶骨结核,并同期行后路椎弓根系统内固定完成后凸畸形矫正,可重建稳定的腰骶段,恢复躯体矢面平衡,取自体髂骨植骨能提高融合率,效果满意。     

1例严重腰骶段后凸畸形患者围手术期的护理

腰骶段后凸畸形在临床上并不常见,因为结核病导致的腰骶段后凸严重畸形更是罕见.因结核造成腰骶段骨质破坏,解剖结构改变,给手术带来很大风险,治疗有一定难度,使护理极具挑战性,到目前为止,文献少有报道.2006年9月,我科收治1例因结核病导致的严重腰骶段后凸畸形病例,行手术治疗,经康复护理,2周痊愈出院.现将其护理方面的经验报道如下.……     

1例严重腰骶段后凸畸形患者围手术期的护理

腰骶段后凸畸形在临床上并不常见,因为结核病导致的腰骶段后凸严重畸形更是罕见。因结核造成腰骶段骨质破坏,解剖结构改变,给手术带来很大风险,治疗有一定难度,使护理极具挑战性,到目前为止,文献少有报道。2006年9月,我科收治1例因结核病导致的严重腰骶段后凸畸形病例,行手术治     

脊柱前裂合并椎管内囊肿及融合肾新生儿尸检1例

死婴男性,新生儿.因脐带脱垂,急诊行剖宫术.新生儿重度窒息,全身水肿,胸腹片提示先天性脊柱裂(颈胸段),内脏畸形;家属放弃抢救而死亡.其母孕期中未进行过任何遗传学方面的检查.     

腰大肌纤维肉瘤误诊为腰椎结核1例分析

对腰大肌纤维肉瘤误诊为腰椎结核1例分析如下。 1 病历摘要 男，44岁。2005-01因右下肢麻木0．5a余，发现右腹股沟肿块1个月收治入院。查体：腰部无明显压痛，双下肢直腿抬高试验阴性，右腹股沟可触及一鸡蛋大小肿块，质软，无活动度，右髋关节活动无明显受限，右下肢皮肤浅感减弱，右膝反射减弱。拟诊为右腹股沟肿块，行右腹股沟肿块切除术，术中见一囊性包块位于髂腰肌前方，切开囊壁，见似干酪样组织和脓液，取作病理学检查，术中诊断腰椎结核，术后病理报告示：无结构的坏死物、渗出物及软骨样组织，不排除腰椎结核可能。     

2例隐球菌性脑膜炎合并颅内高压患者持续腰大池引流的护理

总结2例隐球菌性脑膜炎持续颅内高压患者行持续腰大池引流术的护理。隐球菌性脑膜炎患者病程长,腰大池引流管留置时间长,且引流管管路长,增加了临床护理工作的难度。密切观察患者脑脊液引流情况,做好持续腰大池引流管护理,妥善固定,保持通畅,预防穿刺点感染,严防并发症,做好鞘内注射护理,以及做好患者的心理护理和出院指导,提高患者治愈率。     

Neurogenic bladder and spina bifida occulta: a case report

A case report is presented in which a neurogenic bladder, presumably due to spina bifida occulta, is successfully managed by manipulation.     

超声诊断胎儿隐性脊柱裂(皮毛窦)1例

孕妇29岁,孕24周,孕1产0,于我院行常规产前超声检查。超声检查：胎儿各生长指标测值正常,颅内结构正常,小脑横径29 mm,后颅窝池5 mm,胎儿脊柱骨排列整齐,连续性良好,弯曲度正常,脊髓圆锥低位,位于骶1~2平面,局部骶尾部皮下回声异常（图1）,三维超声表面成像可清晰显示骶尾部背部皮肤稍凹陷（图2）。     

Tethered cord syndrome complicating spina bifida occulta. A case report

The insidious onset of back and/or leg pain, weakness and spasticity of the lower limb, sensory deficits and neurogenic bladder and bowel in a child with spina bifida might represent a tethered cord syndrome. A case report of a child with sudden neurologic deterioration describes this condition. The successful management in children and adults with tethered cord syndrome is improved with early recognition and careful monitoring.     

The problem with prevention: the case of spina bifida.

In this paper, I present a viewpoint about prevention and spina bifida that is not usually expressed within the occupational therapy literature. Using an autoethnographic account, I convey my experiences as a person with impairments from spina bifida in order to problematize current preventive efforts undertaken to eradicate this birth defect. This self-reflexive account connects my personal experiences to historical and medical views about spina bifida. The messages inherent in preventive efforts are discussed from a disability rights perspective. Occupational therapists are challenged to examine their attitudes toward disability, act as advocates in their practice, and, in a more informed manner, support or contest policy initiatives.     

超声诊断胎儿脊柱裂1例

患者女,34岁,妊娠38周,孕2产1,在我院接受常规产前检查.彩色超声检查示:胎儿头位,双顶径89 mm,股骨长67 mm,羊水指数及胎盘正常.胎儿骶椎间距稍增宽,略呈"八"字形,骶尾部可见一长条状无回声区,稍隆起,形态规则,边界清晰,皮肤连续性完整(图1).超声诊断:①宫内单胎头位存活;②胎儿脊柱裂.胎儿足月分娩后证实超声所见.对出生3个月后的婴儿行CT检查,发现右侧部分骶椎椎板发育不完全(图2A、B),左侧部分椎板畸形、肥大、后突,相应部位硬膜囊及脂肪呈囊袋状向后方突出(图2C),局部皮下脂肪层明显增厚;CT诊断:先天性骶椎发育不全伴脂肪脊髓脊膜膨出、局部皮下脂肪沉积.     

Needs assessment in a spina bifida program: a comparison of the perceptions by adolescents with spina bifida and their parents

The primary purpose of this study was to describe and compare medical, psychosocial, and economic needs of adolescents and young adults with a neural tube defect and their parents. A secondary aim of the study was to establish the psychometric properties of a previously published needs assessment tool. Forty-nine adolescent and 59 parents receiving services from a comprehensive spina bifida program at a large children's hospital completed a needs assessment survey designed to measure perceived needs for health and social services. The Needs Assessment Questionnaire includes 8 subscales (Accessibility/Transportation/Independence, Financial Concerns, Medical Resources, Communication/Acceptance of individuals with spina bifida, Family/Socialization, Education of others regarding spina bifida, School Services, and Vocational Training). Factors related to perceived needs and differences between adolescents and parents were explored. There was a significant difference ( <.05) between parents and adolescents in 6 of the 8 subscales. On the remaining 2 subscales, differences between parents and adolescents approached significance. In all areas of needs for services, parents were less satisfied with the delivery of services and reported that needs were not being met. A significant negative correlation between age of the adolescent and perceived needs related to Transportation/Independence ( = -0.35) and School Services ( = -0.31) was found. Parents with more than a high school education perceived significantly greater needs for Vocational Training than those with less education ( = -2.1, =.04). Identification of medical, psychosocial, and economic needs of adolescents with a neural tube defect and their families has implications for quality improvement and program development.     

三维彩超诊断胎儿露脑合并颈、胸、腰段开放性脊柱裂1例

患者女,35岁,孕3产1,孕32+3,不规则产检,患者腹围103 cm,宫高34 cm,相当于孕36周.超声检查:颅骨光环及脑中线不显示,双顶径、头围无法测量,胎儿颅顶部后方可见一大小约4.92 cm×4.39 cm的混和性包块,边界清,与颅相连,内部结构紊乱,呈网格状;