Lipoma of the spermatic cord, fatty herniation, liposarcoma

Summary Speed [1914] reported the incidence of cord lipoma, encountered equally with both indirect and direct herniae, to be 47.4%. All appeared to arise, with their blood supply, from the preperitoneal fat pad. High excision was recommended to prevent hernial recurrence. Fawcett [1997] confirmed these observations, finding 1% arising from the cord itself, which is now known to form in the preperitoneal space of Bogros. Watson [1948] insisted that inguinal Hpomas should be called hernias only when accompanied by a peritoneal sac. However, 7% of cord lipomas are reported to be sac-less, associated occasionally with ureteral prolapse. To avoid medicolegal consequences, they now should also be considered hernias. Inguinal hernia classifications need to reflect this reality.A case of an elderly, obese male with a giant cord lipoma who underwent excision of a large, irreducible, complete, sliding, sac-less, indirect fatty inguinal hernia is detailed. Three veterans, presenting with purported inguinoscrotal herniation, had large cord lipomas, which after funiculo-orchiectomy, were shown to be liposarcoma. One developed large retroperitoneal and local recurrences and received radiation and chemotherapy. Another underwent lymphadectomy and irradiation, while the third did well without adjuvant treatment.In conclusion, ubiquitous cord lipomas are not tumors but essentially all are herniations of extraperitoneal fat. Proper inguinal hernia repair mandates their complete excision. Occasionally, they may be the only herniation. Inguinal hernia classifications need to include not only fatty hernias, but sac-less, fatty protrusions. Malignancy is a rarehazard, sometimes associated with the more commonly encountered sarcoma of non-herniated retroperitoneal fat. The risk does not warrant pathological examination of small cord lipomata.     

Intervertebral Disc Calcification in Childhood – A Case Report and Review of the Literature

Summary  The authors report the case of a 10-year-old girl with intervertebral disc calcifications from the levels C6/C7 to Th1/Th2, presenting with a herniated calcified intervertebral disc at the C7/Th1 level, causing spinal cord compression with subsequent progressive paresis and sensory loss of her left leg. After anterior cervical discectomy and fusion the neurological deficits completely resolved within 2 weeks. It can be concluded that calcification of an intervertebral disc is a rare syndrome in childhood, causing progressive neurological deficit only in a few reported cases. Although the treatment of choice is conservative, surgery is required in patients who develop progressive neurological deficit.     

小切口椎板开窗加生物蛋白胶治疗腰椎间盘突出症

目的探讨小切口椎板间开窗髓核摘除术加生物蛋白胶治疗腰椎间盘突出症的临床疗效。方法从2002年10月至2006年10月采用小切口椎板间开窗髓核摘除术加生物蛋白胶预防粘连治疗腰椎间盘突出症36例。全部患者为单节段单纯腰椎间盘突出症,都有腰痛和单侧下肢疼痛及浅感觉障碍。结果获得随访32例,随访最长30个月,最短5个月,平均14个月,按Nakai标准评定治疗优良率为87.5%。结论小切口椎板间开窗髓核摘除术加生物蛋白胶治疗单纯的腰椎间盘突出症具有创伤小、术后恢复快,效果肯定,后期并发症少、对脊柱稳定性影响小等优点,因此是治疗腰椎间盘突出症较为有效和可靠的方法之一。     

ADAMTS-4在退变腰椎间盘髓核组织中的表达及其意义

目的 探讨ADAMTS-4在退变的腰椎间盘髓核组织中的表达及其意义. 方法 应用免疫组织化学方法检测40例(男27例,女13例)退变的腰椎间盘和8例(男3例,女5例)特发性脊柱侧凸腰椎间盘髓核组织中ADAMTS-4蛋白的表达.将获得的数据进行统计学分析. 结果 40例实验组髓核组织中32例表达阳性,8例对照组中均无阳性表达.ADAMTS-4在退变腰椎间盘髓核中的表达明显增加(χ2=10.53,P<0.005). 结论 髓核中ADAMTS-4的表达增强可能是腰椎间盘退变的重要因素之一.     

手术治疗56例腰椎间盘再突出的疗效观察

目的探讨不同手术方法治疗椎间盘再突出症的疗效。方法采用单纯手术摘除椎间盘和摘除椎间盘加AF钉内固定、植骨融合两种方法治疗椎间盘再突出患者56例,观察并比较其疗效。结果经24个月随访,单纯髓核摘除21例,优9例,良4例,中5例,差3例,优良率61.9%;髓核摘除、腰椎AF钉内固定加植骨融合35例,优25例,良6例,中4例,优良率88.6%。结论谨慎选择手术方式,严格把握手术指征,充分进行神经减压及内固定植骨融合,充分休息,必要的锻炼可有效治疗腰椎间盘再突出。     

经皮椎间盘切溶术治疗复杂性腰椎间盘突出症272例

目的 分析比较单纯两种方法及联合疗法治疗复杂性腰椎间盘突出症的疗效。方法 272例复杂性腰椎间盘突出症患者利用电动旋切器，经皮切吸后将600IU胶原酶推入切吸后椎间盘内，于术后3～36个月，对其疗效进行随访分析。结果 显效占94．1％，有效占5．1％，无效占0．8％，未出现严重并发症。结论 切溶术能提高疗效，方法简便，创伤小，痛苦少，治愈率高，值得推广使用。     

臭氧与胶原酶联合治疗腰椎间盘突出症的临床应用价值

目的观察DSA引导下臭氧与胶原酶联合治疗腰椎间盘突出症的临床应用价值。方法56例腰椎间盘突出症患者在DSA监视引导下，经患侧后方穿刺成功后，病变椎间盘注射60μg/mL O3 20～30mL，盘外及神经根周围注入浓度为30μg/mL O3 10-20mL，后经骶管裂孔穿刺置管于硬膜前间隙病变椎间盘处注射600～1200U胶原酶。结果术后随访1个月、3个月，3个月获得最佳疗效，其优、良、中、差率分别为62．3％、32．1％、3．9％、1．7％，优良率94．4％。结论DSA引导下臭氧与胶原酶联合治疗腰椎间盘突出症，在作用机制上优势互补，是一种安全、有效的方法。     

四维悬吊牵引调腰曲为主治疗颈腰椎间盘病

目的：探讨以四维悬吊牵引调腰曲为主的整脊法治疗颈腰椎间盘病的临床效果。方法：采取俯卧四维悬吊牵引调腰曲为主。配合颈胸椎整脊手法和针刺、内外用药综合疗法，观察各类型颈腰椎间盘病201例的治疗效果。结果：本综合疗法对颈腰椎间盘病的总有效率为97．01％，其中，临床治愈率为89．05％，颈曲恢复优良率为74．13％，腰曲恢复优良率为73．63％。平均16个月随访优良率为90．59％，治疗效果满意。结论：本疗法以调椎曲为主要治疗目标．椎曲恢复和稳定与功能锻练呈正相关。从随访病例中了解到，坚持功能锻练是巩固疗效的可靠措施。     

胶原酶对腰椎间盘髓核组织中蛋白多糖的影响

【目的】探讨胶原酶在作用时间内是否会引起腰椎间盘髓核组织中蛋白多糖的水解。【方法】经皮腰椎间盘切除术中获得髓核组织标本,-70℃保存。胶原酶15u作用于1mL（0.1g/mL）髓核组织匀浆,测定不同时间段的溶解效应。在胶原酶对髓核组织饱和溶解时间条件下,选择不同剂量的胶原酶作用于1mL（0.1g/mL）髓核组织匀浆,通过测定糖胺多糖的含量变化,推测蛋白多糖的含量变化情况。【结果】本实验的胶原酶对髓核组织饱和溶解时间为12h。胶原酶作用后髓核组织中糖胺多糖在9u胶原酶以内的各组呈独立散在分布,组间差异有统计学意义（P〈0.05）。9u胶原酶以后组间差异没有统计学意义（P〉0.05）。9u胶原酶时吸光度达到最大值,经与总量对照组比较,糖胺多糖最大水解程度为57.14%～64.76%。【结论】本实验初步证实胶原酶可以在短期内引起腰椎间盘髓核组织中蛋白多糖含量的降低,这可能与胶原酶溶解术后椎间盘退变的加重有关。     

椎间盘镜治疗腰椎间盘突出症37例报告

目的:探讨椎间盘镜治疗腰椎间盘突出症的体会,手术技巧和手术适应症。方法:对2006年1月～2007年12月间,我院使用德国Rudolf公司的椎间盘镜系统,治疗腰椎间盘突出症37例进行回顾性分析。结果:本组术后优良率达94%,全部病例无并发症发生。结论:显微椎间盘镜作为脊柱微创外科的新技术,具有创伤小、出血少、并发症少、术后恢复快的优点,是治疗腰椎间盘突出症有效且安全的手术方法。