胶原酶注射治疗腰椎间盘突出症32例随访报告

为了解胶原酶治疗腰椎间盘突出症的远期疗效,对３２例病人进行了随访。其中１５例将胶原酶４００～６００Ｕ注入病变椎间盘内（盘内注射法）;１７例将胶原酶６００～１２００Ｕ注入病变椎间盘的椎间孔附近的硬膜外间隙（盘外注射法）。３年随访结果为：优１７例、良２例、可６例、劣７例（其中４例又做开放椎间盘髓核摘除术）。优良率５９．４％,有效率７８．１％,再手术率为１２．５％,未发现明显并发症。     

右前外侧切口不阻断主动脉体外循环心脏直视手术57例

本研究采用右前外侧切口不阻断主动脉体外循环的方法对５７例心脏病人施行了心内直视手术。结果表明,一例房缺病人因引流多而再次开胸止血,另一例法乐氏四联症术后残余分流者术中修补不满意,其余效果良好,无手术死亡及术后住院死亡,无伤口感染发生;也解决了长期以来许多女性病人因正中切口显眼的瘢痕所造成的心理压力,取得良好的手术美容效果。     

颈椎椎间盘与后部结构断层解剖及影像学研究

选用43具青年尸体,蛛网膜下腔注入铸型造影剂,低温冷冻,以椎间盘为中心制作断层标本,同时选取40例正常健康人进行超声、CT及MR扫描图像分析.发现同组中不同椎间盘水平测量数据的大小不同;解剖学与影像学各测量结果进行比较无显著性差异.     

High Cervical Disc Lesions in Elderly Patients – Presentation and Surgical Approach

Summary  The incidence of high cervical disc lesions is extremely rare, and the mechanism of their development is unclear. We report these three cases, and discuss the possible mechanisms. We also describe surgical strategies for these lesions.  The first and second cases were an 82-year-old male and an 84-year-old male with retro-odontoid disc hernia. The third was an 83-year-old female with a herniated disc at C2/C3. To investigate Aetiological mechanisms of these lesions, we examined the findings on cervical images in extension and flexion, and compared the results in a younger than 80-year-old group and an older than 80-year-old group.  The patients underwent surgery via a posterolateral intradural approach. Wide laminectomy and incision of the dentate ligaments enabled access to the ventral space of the upper cervical spinal canal and sufficient decompression. All patients became ambulatory postoperatively without special fixation of the cervical spine. In the younger group, the level mostly loaded during cervical movement was C5/6, however, the levels in the older group were C2/3 and C3/4.  In elderly patients, less mobilization of the middle and/or lower cervical spine due to spondylotic change causes overloading at higher levels resulting in high cervical disc lesions. Retro-odontoid disc lesions can be caused by a herniated disc at C2/C3, which migrates upward. Regarding surgical strategy, the posterolateral intradural approach is less invasive and more advantageous for these lesions.     

腰椎间盘突出症419例3种非手术疗法疗效分析

为比较下腰痛非手术疗效,４１９例腰椎间盘突出症患者采用腰椎牵引（甲组１９５例）、激素硬膜外注射（乙组１９２例）及经皮穿刺椎间盘切吸术或胶原酶溶解术（丙组３２例）进行治疗和随访,采用改良Ｍａｃｎａｂ标准评定。结果：优良率甲组４９％,乙组６６％,丙组８４％,Ｐ＜０．０１;甲组疗效与病程相关,病程＜６个月疗效较好（Ｐ＜０．０５）;平均治疗次数有甲组＞乙组＞丙组的倾向。结论：单纯腰椎牵引对病程较短者疗效较好;病程较长,神经根刺激症状明显者加用激素硬膜外注射可提高疗效;经腰牵、激素硬膜外注射等非手术治疗无效者,如严格掌握适应证和操作技术,采用经皮穿刺椎间盘切吸术或胶原酶溶解术可取得很好疗效     

Analysis of orthograde fast axonal transport and nonaxonal transport along the optic pathway of albino rabbits during increased and decreased intraocular pressure

Orthograde fast axonal and nonaxonal transport through the optic disc was studied quantitatively and autoradiographically in albino rabbits during elevated (30 or 50 mmHg), normal (13–15 mmHg) and decreased (0–4 mmHg) intraocular pressure (IOP). In cases of intraocular hypertension up to 50 mmHg, autoradiographic findings of a disturbed orthograde fast axonal transport were seen in the optic disc within 3 hr. The blockage was relatively mild and uniform, and was distributed adjacent to the extension line of sclera. Despite this histological evidence of blockage, a quantitative analysis showed no statistically significant decrease in axonally transferred radioactivity within 3 hr. Decrease in the transferred material was evident at 6 hr, and the extent of decrease was mild (ca. 20% at the most prominent portion). In cases of moderate intraocular hypertension (30 mmHg) for 6 hr, a quantitative analysis showed no decrease in axonal transport. After 3–6 hr of intraocular hypotension (0–4 mmHg), papilledema did not develop and autoradiographically there was no accumulatjon of axonal components. Axonally transferred material remained quantitatively at the same level as in the control animals. Nonaxonal transport along the optic nerve was doubly enhanced in cases of intraocular hypertension up to 50 mmHg, and was reduced to one thrid at level of 0–4 mmHg. Filtration of intraocular fluid through the optic disc appears to be the largest component of the nonoxonal transport.     

Lumbar disc herniation in teenagers

Summary We report 48 patients operated on for lumbar disc herniation in the second decade of life (aged 13–20 years) in our Neurosurgical Division. To analyze the clinical and diagnostic features and surgical outcome of the disease in teenagers and to point out any differences from adults, we made a detailed study of over 900 juvenile cases and compared them with 11000 adult cases reported in the literature. Low-back pain proved to be less frequent among youngsters both as a first symptom and at diagnosis, while sensorimotor deficits have the same frequency in the two age groups. Herniation occurs more often at L4–L5 and is more frequently median among teenagers. The long-term surgical results in children and adolescents are better than in adults.     

Histochemical and ultrastructural observations on brown degeneration of human intervertebral disc

Thirty-eight fresh human intervertebral discs collected during anterior interbody fusion surgery were histochemically and ultrastructurally analyzed for pigments. Macroscopically, five stages of degeneration were classified according to the color, fibrosis, and fragility of the nucleus pulposus of the discs. In order to demonstrate lipofuscin granules, specimens were subjected to special staining procedures, including carbol fuchsin lipofuscin stain, the Schmorl's reaction, and autofluorescence. Lipofuscin granules were distributed from the inner layer of the annulus fibrosus to the nucleus pulposus. Such granules were numerous in cases of slight or severe degeneration, whereas fewer granules were found in cases of moderate degeneration. However, the stage of macroscopic degeneration of the intervertebral disc did not necessarily correlate with the incidence of lipofuscin granules. By ultrastructural observation, the morphological features of the components of the intervertebral disc and the ultrastructure of the lipofuscin granule were clarified. The ultrastructure of the "brown degeneration" disc exhibited markedly increased amorphous electron-dense bodies located among collagen fibrils in the matrix.     

腰痹舒治疗腰椎间盘突出症临床疗效分析

用中药腰痹舒治疗腰椎间盘突出症 3 1例 ,治愈 2 8例 ,有效 3例。治疗后随访 6～ 1 8个月 ,无 1例复发。与牵引、按摩、秋水仙碱内服对照组比较 ,中药疗效显著优于对照组 (P<0 .0 5 )。经 CT检查 ,腰痹舒治愈后椎间盘的后突压迫、粘连均有不同程度的解除。提出可根据症状、体征将腰椎间盘出症的腰腿痛分为 1 0级。作为判断病情和疗程的主要指标。其治疗宜通经、化瘀散寒为主。