脊椎转移瘤的MRI探讨

目的 观察ＭＲＩ各序列对脊椎转移瘤的诊断价值并分析其ＭＲＩ征象。方法 对２２例脊椎转移瘤病人行Ｔ１ＷＩ，Ｔ２ＷＩ，Ｐ（Ｎ）Ｉ，小翻转角准Ｔ２Ｗ等序列检查并对病变信号的清晰度分级。     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

硬膜外腔注射生理盐水对剖宫产术患者腰麻效果的影响

目的探讨硬膜外腔注射生理盐水对剖宫产术患者腰麻效果的影响。方法择期行子宫下段剖宫产术患者60例,年龄24～30岁,体重59～73 kg,随机分为2组,每组30例,A组蛛网膜下腔注射规定剂量的0.75%布比卡因后硬膜外腔注射生理盐水5 ml;B组蛛网膜下腔注射0.75%布比卡因。按序贯法进行试验,设定布比卡因的起始剂量为9 mg,剂量梯度为1.5 mg,若上一例有效,则下一例递减一个剂量梯度,若无效则下一例递增一个剂量梯度,蛛网膜下腔阻滞有效的标准为注射布比卡因后20 min内阻滞上平面达T5。采用概率单位法计算ED50。结果A组布比卡因的ED50（5.8 mg）低于B组（8.1 mg）,两组比值为0.72,95%置信区间为0.27～0.98,区间范围不包括1,差异有统计学意义（P〈0.05）。结论硬膜外腔注射生理盐水可增强剖宫产术患者腰麻的效果。     

老年性脊椎骨质疏松症（附10例报告）

老年性脊椎骨质疏松症是原发性骨质疏松在脊椎骨的表现，是老年人腰背痛的一个重要病因，尤其是绝经后妇女更为常见。随着人口不断老龄化，骨质疏松症的诊治已成为当前一个值得重视的问题。我院近年来收治１０例老年性脊椎骨质疏松症，现报告如下，并对其病因、诊断及治疗...     

革兰氏阴性细菌,HLA—B27与脊椎关节炎

强直性脊椎炎，反应性关节炎和Ｒｅｉｔｅｒ＇ｓ综合征等是一类血清阴性的脊椎关节炎，与主要组织相容性抗原同度相关。关于这类疾病的发病机制至今仍不清楚。其中“分子模拟”是解释这类疾病发病机制的一种说。此学说认为，ＨＬＡ－Ｂ２７和某些革兰氏阴性细菌的某些成分具有结构的相似性，在受感染的机体内，细菌和机体组织的ＨＬＡ－Ｂ２７抗原发生了分子模拟反应，从而造成了疾病的发生。本文拟就有关内容作一综述，但尚未获得分     

人体腰椎活动节段应力分布的实验研究

本文采用三维光弹性实验方法观察了正常腰椎活动节段的应力分布。用精密浇铸,严格几何相似的光弹性环氧树脂腰椎和硅橡胶椎间盘模型进行三维光弹性实验,并观察腰椎的等应力差图和有效应力值分布。本实验观察到,腰椎椎体上下缘应力分布较均匀对称,其后缘应力大于前缘,后部结构应力较小。作者认为,三维光弹性实验方法具有直观性强,能有效和准确地确定腰椎的应力分布,对腰椎生物力学研究具有重要的实用价值。腰椎后缘应力大于前缘,使椎体后缘承载较大,将会增加腰椎间盘退变和损伤的机会,这可能是引起腰腿痛的重要因素。     

凭腰椎平片误判腰椎序列2例

随着影像诊断技术的发展,一次对脊柱全长行平片检查已成为可能.但出于传统检查习惯、经济或认识局限性等原因,许多医院对腰椎疾患行影像检查时,仅摄腰椎平片,很少行脊柱全长片定位.一旦脊椎出现解剖变异,多参照Tuffier线(即髂嵴最高点连线)判定腰椎序列.由于男女骨盆结构不同,传统认为,在腰椎正位X线像,男性L5一般位于Tuffier线以下,而女性整个L5或其上半位于Tuffier线以上[1].但我们发现上述判定法亦有可能错误.本文报道2例.     

骶髂关节真空征36例CT扫描报告

目的：报告骶髂关节真空征,探讨其临床意义。方法：计量资料用X^2检验,等级资料用秩和UC检验。结果：受检人群中该征象的出现率为11．18％（36／322）。男性5．61％（11／196）;女性19．84％（25／126）,X^2=15.637;秩和检验UC＝1．027。结论：该征象在受检人群中并不少见。女性明显多于男性,范围无性别差异。成因与骶髂关节软骨变性、崩解有关。间接地反映了关节软骨变性、崩解的范围。该征象是一种非特异性征象,与血清阴性脊柱关节病有关。