成人单纯Arnold-Chiari畸形颅颈交界区CT参数测量

目的探讨不合并颅底凹陷的单纯Arnold-Chiari畸形(Arnold-Chiari malformation,ACM)颅颈交界区CT参数的变化。方法对40例成人单纯ACM和20例正常成人对照组头颈CT原始数据行正中矢状位重建,研究颅颈交界区CT线性及角度参数的变化。结果单纯ACM患者的斜坡长[(40.66±3.11)mm vs(43.44±3.34)mm,P<0.01]、齿突Chamberlain线间距[(1.23±2.41)mm vs.(1.25±2.29)mm,P<(0.001)]、齿突McRae线间距[(4.04±1.39)mm vs.(4.95±1.29)mm,P(<0.05)]、斜坡椎管角(147.93°±7.84°vs.157.33°±8.51°,P<0.001)、减压枕骨角(139.11°±10.14°vs.144.49°±8.03°,P<0.05)明显小于对照组,而斜坡McRae线角(130.82°±7.85°vs.124.60°±7.35°,P<0.01)、减压枕骨椎管角(127.71°±11.75°vs.118.86°±11.33±,P<0.01)明显大于对照组,差异具有统计学意义。结论成人单纯ACM斜坡长度较正常人明显缩短,枕骨大孔区附近枕骨倾斜角度明显增加。     

微创经肌间隙入路椎间孔椎体间融合术治疗下腰椎退变性疾病的评价

目的　报道经多裂肌间隙入路椎间孔椎间融合术治疗下腰椎退变性疾患的临床效果。 方法　2010年4月至2012年4月对27例患者经多裂肌间隙入路椎间孔椎间融合术治疗下腰椎退变性疾病。其中男性12例,女性15例,年龄58.2岁（46~74岁）。极外侧型椎间盘突出7例,椎间盘开窗摘除术后复发3例,退变性腰椎不稳17例。 结果　切口长度4.2 cm（4.0~4.5 cm）,手术时间90 min（70~160 min）,术中出血量130 ml（90~2500 ml）。随访8～20个月,无严重并发症,27例均获骨性融合。末次随访时患者VAS腿痛评分从术前平均(7.4±1.1)分降至(2.4±1.3)分,VAS腰痛评分从术前平均(6.7±1.3)分降至(1.8±1.5)分。临床疗效评定：优22例,良3例,可2例,优良率92.6%。 结论　经多裂肌间隙入路椎间孔椎间融合术具有创伤小、时间短、出血少、并发症少、疗效确切等优点,在合理选择适应证的情况下是一种理想的下腰椎融合方法。     

枕骨大孔区病变与运动诱发电位的研究

目的：了解枕骨大孔区病变运动诱发电位表现，方法；对经核磁共振（ＭＲＩ）证实的５１例枕骨大孔区病变患者，进行了电刺激运动诱发电位（ＭＥＰ）测试。结果：枕骨大孔区病变患者ＭＥＰ异常率为９４．１％，表现为潜伏期延长，中枢运动的传导时间（ＣＭＣＴ）延长，波幅降低，枕骨大孔区肿瘤中，颈延型肿瘤的ＭＥＰ异常较延颈型肿瘤的ＭＥＰ异常更显著，腹侧肿瘤的ＭＥＰ异常较侧后方的ＭＥＰ异常更显著。结论：ＭＥＰ改变较临床评     

Radiographic studies of the ventricles in syringomyelia

Summary Radiographic investigations of 171 patients with communicating syringomyelia have been reviewed. Hydrocephalus was found in onethird of the cases and has occasionally progressed after operation on the posterior fossa, sometimes with accompanying clinical deterioration. The outlets of the fourth ventricle were usually abnormal; tonsillar descent, arachnoiditis and both together were seen. Arachnoiditis correlated strongly with a history of difficult birth. The foramen of Magendie was sometimes patent and sometimes blocked. There was no consistent level of occlusion corresponding to a persistent roof of the fourth ventricle. The cisterna magna was usually small or obliterated but some examples of large cisterns or subarachnoid pouches were found. Radiological demonstration of a communication from the fourth ventricle to the syrinx occurred in only seven patients by positive contrast material and not by air. It is suggested that a sizable communication is rare at the time when patients seek treatment.     

腰椎间孔神经阻滞配合椎间孔外口针刀松解治疗腰椎间盘突出症的临床观察

目的观察腰椎间孔神经阻滞配合椎间孔外口针刀松解治疗腰椎间盘突出症的临床效果。方法将确诊为腰椎间盘突出症的患者200例随机分为观察组和对照组,观察组行腰椎间孔神经阻滞并椎间孔外口针刀松解,对照组行单纯腰椎间孔神经阻滞治疗,观察治疗后1个月、3个月、6个月的疗效,两组并进行比较。结果1个月后随访观察组优良率（92.2%,95/103例）明显高于对照组（81.4%,79/97例）（P〈0.05）;3个月和6个月后随访观察组优良率（92.2%,94/102例;90.2%,92/102例）也明显高于对照组（78.4%,76/97例;76.3%,74/ 97例）（P〈0.01）。结论腰椎间孔神经阻滞配合椎间孔外口松解,较单纯腰椎间孔神经阻滞治疗腰椎间盘突出症,可明显提高疗效,其远期效果尤为明显。     

枕骨大孔区肿瘤的手术入路及显微外科治疗

目的探讨枕骨大孔区肿瘤显微外科手术的方法和入路分析。方法自2005年2月至2008年3月应用显微外科技术切除枕骨大孔区肿瘤20例,其中脑膜瘤13例,皮样囊肿3例,神经鞘瘤2例,脊索瘤1例,脉络丛乳突状瘤1例。影像学检查17例肿瘤位于硬膜内,3例位于硬膜外,其中肿瘤位于枕骨大孔前方、前外侧12例,后、侧方8例,5例肿瘤骑跨于枕骨大孔。结果本组20例中,采用后正中入路7例,枕下外侧入路12例,经口咽入路1例。肿瘤全切除17例,次全切除2例,大部分切除1例,术后出现后组颅神经轻度麻痹2例,无手术死亡。结论枕骨大孔区肿瘤手术显微程度要求高,脑干、后组颅神经和血管保护尤为重要。手术入路应根据肿瘤位置及与脑干的关系来选择,枕下外侧入路对于处理前、外侧肿瘤是一项好的选择,而脑干被压于侧方的,即使肿瘤位于前腹侧也可选择后方入路。     

Morphometric evaluation of the foramen magnum for sex determination: A study from Saudi Arabia

The present study provides a database of various morphometric dimensions of the foramen magnum region in the Saudi population. The objective of this study was to evaluate various measurements of the foramen magnum region for sex determination in the Saudi population by using computed tomography (CT) images. The various radiological measurements of the foramen magnum region were measured in a total of 200 adult subjects of Saudi origin including 100 males and 100 females. Sexual dimorphism was observed in five parameters related to the foramen magnum, namely length of the right occipital condyle (LROC), length of the left occipital condyle (LLOC), width of the foramen magnum (WFM), area of the foramen magnum (AFM) and length of the foramen magnum (LFM). The accuracy to discriminate sex ranged from 65.5% to 62.5% when LROC, LLOC, WFM, AFM, and LFM were considered as individual parameters. When multiple parameters were combined to discriminate sex, the highest accuracy of 71% was achieved.     

电磁导航卵圆孔穿刺术的实验研究

目的:评价应用surgView-RFT电磁导航系统进行卵圆孔穿刺的准确性及对临床的指导意义.方法: 3 名初学者分别对3 个尸头的双侧卵圆孔进行盲穿和电磁导航辅助穿刺各5 次,以CT扫描结果作为金标准,测量穿刺针尖与卵圆孔前缘的距离,采用SAS 6.12统计软件的t检验和方差分析进行分析.结果: 3 名实验者盲穿均未进入卵圆孔,针尖与卵圆孔前缘平均间距8～10.6 mm;电磁导航辅助穿刺均进入卵圆孔,针尖与卵圆孔前缘平均间距2.68～3.54 mm,与CT比较误差0.59 mm,差异无显著性;盲穿与导航辅助穿刺差异存在显著性.结论:surgView-RFT电磁导航系统操作简便省时,可提高穿刺准确性,有助于避免重复穿刺和减少创伤.     

CT立体定向辅助射频热凝治疗三叉神经痛

目的分析CT立体定向技术在治疗三叉神经痛中的辅助作用.方法通过CT扫描确定卵圆孔位置,采用立体定向技术穿刺卵圆孔,射频热凝术治疗三叉神经痛,并与徒手穿刺组进行对比.结果立体定向组一次穿刺成功率和治疗优良率为100%,并发症出现率为3.8%,徒手穿刺组一次穿刺成功率83.3%,治疗优良率93.3%,并发症为16.7%.结论CT立体定向技术为定位穿刺靶点提供了客观依据,避免了穿刺的盲目性,提高了穿刺的准确性和治疗效果,降低了并发症的发生率.