脊柱复合性损伤的救治风险与早期治疗

目的评估脊柱复合性损伤的特点和救治风险,探讨风险控制与最佳治疗的方法。方法采用AIS、ISS、TRISS及APACHEⅡ等评分方法对273例脊柱复合性损伤患者进行定量评价与救治分类,并依据伤后的损伤分级、参数评定及计量评分等指标进行量化分析和统计处理。结果颈椎合并伤115例,胸椎合并伤141例,胸腰椎合并伤294例,腰骶椎合并伤181例;患者的救治风险和脊椎伤的治疗选择或手术时机与其合并伤的解剖伤势及由此所构成的整体伤情密切相关(P<0.01或<0.05);高风险性伤员往往综合伤势严重,生存概率(Ps)趋低,并发症和死亡率高(P<0.01或<0.05)。结论脊柱脊髓损伤常合并有严重的多发伤,高危伤情不仅可增加其救治风险和脊柱伤的处理难度,且还易于丧失手术最佳时机。分类救治对伤员的风险控制和脊柱伤的专科治疗是有益的。     

Recovery profile of single motoneurons after electrical stimuli in man

The H-reflex of 120 soleus motoneurons was recorded using fibre EMG. The recovery profile of these motoneurons was studied during monitoring surface H-reflex records in 28 adult subjects. The spectrum of motoneurons tested was homogeneous with two extremes of neurons having different characteristics. A motoneuron population (forming about 69% of our sample) had a high threshold level for electrical stimuli, short recovery time, and short recovery fringe time (called type A). A second population of motoneurons (forming about 20-30% of our sample) had a low threshold level for electrical stimuli, long recovery fringe time (called type B). During an isometric muscle contraction every motoneuron showed an early shift in recovery time (i.e. each had a shorter recovery time) with shortened recovery fringe time. These changes were larger for motoneurons type B than motoneurons type A. With paired identical electrical stimuli of varying interstimulus intervals a motoneuron may fire in response to the conditioning and test stimuli giving an H2, but not in response to both stimuli. This occurred for interstimulus intervals of 4-11 ms. A strong inhibition period was recorded with interstimulus intervals of 12-80 ms in which all motoneurons did not show any recovery. Most motoneurons recovered in orderly fashion between 80 and 300 ms of interstimulus interval, and this recovery coincided with the fast recovery recorded in surface H-reflex. All motoneurons were recovered by 3000 ms of interstimulus intervals. These findings emphasize the importance of eliciting the H-reflex every 3-5 s in H-reflex methodology in order to be assured that all excited motoneurons have been recovered.     

Mechanisms mediating the brain stem control of somatosensory transmission in the dorsal horn of the cat's spinal cord: an intracellular analysis

Summary The effect of brainstem stimulation was studied on neurones recorded intracellularly in the superficial and deeper laminae of the lumbosacral dorsal horn of the spinal cord in anaesthetised cats. Stimulation in the nucleus locus coeruleus (LC) produced a hyperpolarisation in 4/13 multireceptive neurones and produced a biphasic action consisting of a hyperpolarisation which was followed by a depolarisation in 3/13 neurones. These actions were produced irrespective of whether the multireceptive neurone was located in the superficial or deeper laminae of the dorsal horn. Stimulation failed to produce postsynaptic potentials in the remaining 6/13 multireceptive neurones. The amplitude of hyperpolarisation was increased by the passage of depolarising pulses through the recording microelectrode and decreased by hyperpolarising pulses. Stimulation in other brainstem areas such as, the lateral (FTL), paralemniscal (FTP) and central (FTC) divisions of the tegmental field and the nuclei raphe magnus (NRM) and reticularis magnocellularis (RMc) also hyperpolarised neurones in the dorsal horn. The polarity of hyperpolarisation evoked from some brainstem areas (FTP, FTC, RMc) could be reversed to depolarisation by the passive diffusion of ions from the recording microelectrode containing 3M-KCl. Brainstem (LC, NRM, FTP, FTL) stimulation generated long lasting (700 ms) hyperpolarisation on 4/4 selectively nocireceptive neurones of lamina I. There was, however, no effect on the activity of 5/5 neurones recorded in laminae I/II which in addition to receiving excitatory cutaneous inputs were inhibited by heat stimuli. Stimulation in LC also produced dorsal root potentials (DRPs) and reduced the amplitude of simultaneously recorded excitatory postsynaptic potentials (EPSPs) generated by the activation of primary afferent fibres in 3 multireceptive neurones. It is concluded that inhibition of nociceptive transmission in the spinal cord from LC and other brainstem areas may involve both pre- and postsynaptic mechanisms.     

腰椎后路非融合固定系统的临床应用

复习腰椎后路非融合固定系统的设计原理、临床应用及治疗效果等相关文献,与传统的脊柱融合术相比,应用非融合系统可获得很好的疗效,并可以减少邻近节段退变的发生率。     

Spinal Drop Metastasis from a Posterior Fossa Choroid Plexus Papilloma

Choroid plexus papillomas (CPPs) are typically considered as benign tumors, with a favorable long-term prognosis. Drop metastasis of CPP into the spinal subarachnoid space is rare. We report a 42-year-old woman who presented with headache and back pain 6 years after removal of a posterior fossa CPP. Magnetic resonance imaging revealed mass lesions in the lumbosacral subarachnoid space and recurrent intracranial tumor. The lesions were resected and histologically diagnosed was CPP. We consider that CPP can spread via cerebrospinal fluid pathways and cause spinal drop metastasis. Therefore, it is necessary to evaluate the whole spinal axis and to perform periodic follow-up examinations in patients with CPP.     

肝移植术后并发胆道狭窄和胆泥淤积影像诊断及介入治疗

目的:评价肝移植术后胆道狭窄和胆泥淤积影像诊断及介入治疗的价值。方法:对39例肝移植术后并发胆道狭窄和胆泥淤积的影像诊断及介入治疗进行回顾性分析。结果:超声、T型管胆道造影、CT和MRI检查诊断胆道狭窄伴胆泥形成39例,38例介入治疗后胆道梗阻症状明显缓解;1例介入治疗后胆道梗阻症状未明显改善,后行外科胆管修补术。结论:T型管胆道造影或直接经皮胆道造影对肝移植术后胆道狭窄和胆泥淤积诊断特异性及敏感性最高,放射介入和内镜介入技术对其均发挥重要的治疗作用。     

350例脊髓血管畸形介入治疗的护理分析

目的探讨护理工作在脊髓血管畸形介入治疗中的价值。方法通过对我院介入中心350例脊髓血管畸形患者介入治疗,针对脊髓血管畸形患者的临床特点和介入治疗方法的适应证、操作过程和预后等特点,从护理学的角度对术前、术中、术后等阶段进行讨论分析。结果术前进行有效的心理护理和健康教育;术中与介入医生及技术操作人员进行有机的配合、熟练使用输液微量泵、准确使用相关药物及认真观察病情变化;术后对患者进行严密的护理观察,可减少并发症的发生,将有助于该手术的成功。结论介入护理工作对脊髓血管畸形介入治疗手术的成败起着至关重要的作用。     

单节段与双节段椎弓根螺钉固定胸腰椎单椎体骨折的生物力学比较

目的:比较单节段与双节段椎弓根螺钉固定术固定胸腰椎单椎体骨折的生物力学效果。方法:在16具新鲜小牛胸腰椎标本(T11-L3)的L1椎体上制作不完全爆裂骨折模型,分为两组,分别行单节段与双节段椎弓根螺钉固定,对固定后的标本施加扭矩为4Nm的疲劳载荷共2000次,加载频率为0.5Hz,经脊柱三维运动测量系统测量正常、损伤、固定和周期性加载后固定节段前屈/后伸、左/右侧弯和左/右旋转运动时固定节段的运动范围。结果:单节段固定组前屈、后伸、侧屈、旋转稳定指数(SPI)分别为0.78、0.80、0.92、0.83,双节段固定组SPI分别为0.88、0.89、0.95、0.85,在前屈方向单节段固定组明显小于双节段固定组(P<0.01);疲劳后,单节段固定组SPI在前屈、后伸、侧屈、旋转方向分别降低0.05、0.03、0.05、0.11,降低值均大于双节段固定组,且在旋转和侧屈方向有显著性差异(旋转:P<0.01;侧屈:P<0.05)。结论:两种术式均可重建脊柱骨折即刻稳定性,效果无明显差异。在旋转、侧屈方向,双节段椎弓根螺钉固定术抗疲劳载荷效果优于单节段固定术。     

神经根修复时间对脊髓前角运动神经元存活的影响

目的评价神经根修复时间对脊髓前角运动神经元存活的影响。方法采用大鼠颈。神经根性撕脱伤和椎孔外切断实验动物模型，根据动物神经根损伤类型和损伤后修复时间分为A、B、C、D四组，每组16只。A、C组分别将撕脱与切断的神经根即刻回植入脊髓和于椎孔外直接吻合，B、D组将撕脱和椎孔外切断的神经根旷置3周后再重复上述手术。分别于神经根撕脱和椎孔外切断术后3周、3个月、6个月取材。应用组织病理活检、免疫组化技术及神经示踪技术，对神经中枢及吻合口下段神经干检查，观察脊髓病理改变和轴突再生情况，进行A、B组和C、D组间对比。结果臂丛神经根性损伤即刻修复组脊髓前角运动神经元和尼氏体数目、形态、减少程度及周围再生神经纤维数目、发育程度均优于损伤后3周修复组。结论神经根早期修复对脊髓前角运动神经元有明确的保护作用，对外周神经再生有促进作用。