腰椎间盘突出症患者的下肢压痛点及其临床意义

目的：研究腰椎间盘突出症患者的下肢压痛点并探讨其临床意义。方法：检查１７４名腰椎间盘突出症患者下肢臀中肌,臀大肌,股四头肌,股二头肌。半腱半膜肌,胫骨前肌,腓肠肌内侧头和腓肠肌外侧头以及坐骨神经,胫神经共计１０个压痛点。结果：１２７名患者（７３％）存在下肢压痛点,但Ｌ４－５椎间盘突出与Ｌ５－Ｓ１突出患者的阳性率无显著差别（Ｐ〉０．０５）,压痛点总数与年龄成正相关（Ｐ〈０．０５）,与直腿胎高试验阳性     

Effects of light exposure and sleep displacement on dim light melatonin onset

The purpose of the study was to induce in two different ways, a phase-angle difference between the circadian pacemaker and the imposed sleep-wake cycle in humans, we intended to: (i) shift the circadian pacemaker by exposure to bright light and keep the timing of the sleep-wake cycle fixed; and (ii) keep the timing of the circadian pacemaker fixed by a constant light-dark cycle and displace sleep. We monitored dim light melatonin onset (DLMO), core body temperature and sleep. DLMO was delayed significantly after 3 days of a 3-h delayed sleep-phase when compared with 3 days of sleep at a normal or 3-h advanced sleep-phase. The shifts in DLMO were not accompanied by shifts in body temperature, changes in waking-up time or by a change in the duration of the first rapid eye movement (REM) sleep episode. Three days of light exposure in the morning or evening resulted in shifts in DLMO of similar magnitude, but this was accompanied by shifts in the rhythm of body temperature, changes in waking-up time and in the duration of the first REM sleep episode. We conclude that the changes observed after light exposure reflect shifts in the circadian pacemaker. In contrast, we propose that the changes observed in DLMO after sleep displacement are not mediated by the circadian pacemaker. These results raise some doubts about the reliability of DLMO as a marker of circadian phase in cases of sleep disturbances. Finally, we initiate a search for changes in sleep that might be responsible for the unexpected effects on DLMO.     

颈椎椎间盘与相应椎管及内容物关系的影像解剖学研究

目的 :建立正常椎间盘与相应椎管及内容物相互关系的解剖数据。方法 :选用 43例尸体颈椎进行CT、MRI扫描 ,自蛛网膜下腔注入铸型造影剂后制作横断层标本并行X线轴位摄影。结果 :第 4至 7颈椎的椎管矢径与椎间盘矢径之比分别为 82 .42± 10 .10、80 .44± 9.0 7、81.83± 7.0 4% ,硬膜囊矢径与椎间盘矢径之比分别为 6 2 .6 6± 8.12、5 3 .46± 2 4.3 4、70 .5 8± 11.3 1% ,硬膜囊矢径与椎管矢径之比分别为76 .47± 11.5 6、79.10± 9.3 9、77.85± 6 .84% ,椎管面积与椎间盘面积之比分别为 96 .12± 10 .3 0、80 .87±10 .96、72 .73± 10 .40 % ,标本的解剖学与影像学各测量结果经统计学处理无显著性差异 (P >0 .0 5 )。结论 :本文从实验材料到方法接近于临床对活体的测量结果 ,所测数据可作为青年人颈椎正常解剖数据标准     

RF与圆柱状自体骨块椎间融合治疗脊椎滑脱

目的：探讨ＲＦ椎弓根螺钉系统与圆柱状自体骨块椎间植骨融合治疗脊椎滑脱的方法。方法：对２３例脊椎滑脱症患者的神经受压部位针对性地彻底减压,并用ＲＦ椎弓根螺钉系统对滑脱的脊椎进行复位固定,恢复脊椎的正常解剖结构,自髂嵴后部取圆柱状骨块嵌入椎间植骨。结果：术后随访６个月～５年８个月,平均３年６个月;滑脱复位８０％～１００％;４个月后均达骨性愈合,无固定螺钉松动、断裂及再滑脱现象。结论：ＲＦ椎弓根螺钉系统固定与圆柱状自体骨块椎间植骨融合治疗脊椎滑脱可有效减少固定螺钉松动、折断及再滑脱等并发症。     

仿真椎管镜诊断腰椎间盘突出症的初步探讨

目的：寻找一种能在椎管内直视观察椎间盘突出变化的有效方法,进而指导治疗。方法：在椎管内注射造影剂后使用ＣＴ扫描,应用Ｎａｖｉｇａｔｏｒ等软件处理,形成椎管内的动态三维图象。通过仿真镜头的移动来观察椎管、椎间盘、马尾神经及神经根孔的变化,分析仿真椎管镜下椎间盘突出的特点。结果：临床观察２４例患者全部经过手术证实,仿真椎管镜可从椎管内清楚地观察到椎管内的形态,椎间盘突出的状态,尤其是神经根管及硬膜外压迫的立体形态。结论：仿真椎管镜能有效地诊断椎间盘突出,特别对马尾神经压迫和根管压迫的观察明显优于脊髓造影和ＣＴＭ检查,是诊断椎间盘突出症并能推测预后的一种有效方法。     

腰间盘突出物上摘除切式的改进及其意义

目的：搪塞腰间盘突出症术后腰膜囊、神经根前方粘连受突出物上切口的影响。方法：对１１７例患者采用改良和传统两种切式,并经肉眼观察、比较。结果：切口改进后,局部光滑,无宽大腔隙与会传统切式不同。结论：改进切口对预防或减轻硬膜囊前方粘连可能有一定价值。     

Intervertebral disc degeneration - an autopsy study

This is an autopsy analysis of 126 thoracolumbar spines. Extensive histomorphological examination identified microscopic changes in the nucleus and annulus fibrosus before any gross or radiological changes were evident. Histomorphological evidence of microavulsion of the attachment of the annulus fibrosus from its mooring at the margin of the cartilaginous endplate of the vertebral body suggests that forces (compression, distraction, rotation) applied during movement are contributing factors to the pathogenesis of degenerative disc disease.     

Microendoscopy lumbar discectomy (MED System)

Summary The lumbar discectomy using an endoscopic view and a posterior approach (system MED) is an interesting surgical technique which beneficiates from the principles of the classic approach and the endoscopic gestures. It beneficiates of an instrumentation perfectly adapted to the gestures that have to be done and requires a training period. It deserves to be evaluated because the global results from the first series are promising and it suits to compare it with other therapeutic possibilities in the wide range already existing to take care of a sciatica by a herniated disk.      

经显微内窥镜治疗腰椎间盘突出症的临床应用

目的 介绍一种新型的显微内窥镜椎间盘切除系统(MED)治疗腰椎间盘突出症的临床应用及手术适应征。方法 对20例腰椎间盘突出症患者23个间隙用MED治疗,对该组资料进行回顾性总结。结果 20例术后功能评定按改良Macnab分级:优17例,良2例,可1例。结论 MED系统是一种新型的腰椎间盘摘除手术系统,该技术在髓核摘除基础上又保证神经根充分减压,并具有手术切口小、创伤少、恢复快等特点,近期效果十分满意。     

测量左房室平面位移评价左室收缩功能与CK技术的比较

目的：探讨左房室平面位移（ＬＡＶＰＤ）在评价左室收缩功能中的价值。方法：研究对象为冠心病组３０例,正常对照组２０例。采用Ｍ超测量对应间壁、侧壁、下壁及前壁四个位点的ＬＡＶＰＤ,然后在２ＤＥ上测量左室ＥＦ值,并采用彩色室壁运动分析（ＣＫ）技术分析对应室壁的局部运动状况,加以记分。结果：１．冠心病组四个位点的ＬＡＶＰＤ均值与左一显著正相关,相关系数０．８７（Ｐ〈０．００１）。各个位点的ＬＡＶＰＤ测值均