寰枢椎椎弓根钉固定治疗伸直型齿状突骨折合并寰枢关节半脱位

Objective To explore the clinical outcome of atlantoaxial pedicle screw instrument in treatment of extension-type odontoid fracture combined with aflantoaxial subluxation. Methods From December 2002 to December 2006, seven patients with extension-type odontoid fracture combined with at-lantoaxial subluxation were reduced and fixed with atlantoaxial pedicle screw instrument of Vertex system under general anesthesia. There were five males and two females, at mean age of 39.2 years (range 21-59 years). All odontoid fractures were fresh type Aderson Ⅱ. JOA scores of spinal core function was 8.6-14.9 (average 10.7) preoperatively. The X-ray examination, CT scanning and skull traction were performed in all patients preoperatively. Results There found no severe complications such as injuries of vertebral artery, nerve root and spinal cord postoperatively. All patients obtained complete reduction and healing of the fracture and dislocation. The mean off-bed time was four days (3-6 days) after opera-tion. A follow-up for 12-36 months (average 22 months) in all patients showed that the clinical symptom was improved significantly six months postoperatively and that all screws were in proper position verified by X-ray and CT scanning. All patients obtained solid bony union on radiographs, with no loosing or breakage of instrument. The postoperative JOA scores was 13.5-16.9 (average 15.8). Conclusions Allantoaxial pedicle screw fixation has advantages of intraoperative reduction, reliable fixation and high fusion rate and can be used as an effective method for extension-type odontoid fracture combined with at-lantoaxial subluxation.     

Pathological laughter and crying in patients with multiple system atrophy-cerebellar type.

In the cerebellar type of multiple system atrophy (MSA-C), the burden of pathological changes involves the cerebellum and its associated brainstem structures in the basis pontis and the inferior olivary nucleus, and as a result, the clinical phenotype is dominated early on by the cerebellar dysfunction. We report our clinical and post mortem findings in a patient with MSA-C who exhibited pathological laughter in the absence of any congruent changes of mood. A review of the clinical notes of 27 other patients with MSA-C revealed a problem with pathological laughter, or crying, or both in 9 more patients. Our finding of about 36% occurrence suggests that the problem of dysregulation of emotional expression is more prevalent in MSA-C than the paucity of reports in the literature suggests. Our findings are consistent with the view that the cerebellum and its interconnected structures may be involved in the regulation of emotional expression.     

腰椎管狭窄症的手术减压与内固定选择(259例临床分析)

目的：探讨腰椎管狭窄症的手术减压指征、减压范围及内固定选择。方法：回顾性分析腰椎管狭窄症患者259例，平均年龄52．2岁，平均病程4年1个月。根据病情分别采用椎板间节段开窗潜行减压术139例，腰椎管内径扩大成形术63例，全椎板切除减压、椎间植骨融合内固定术57例。结果：221例获得平均4年2个月随访。三种手术方法优良率分别为91．53％、87．50％和85．45％；手术并发症发生率为13．69％、15．87％和20．11％。结论：对严重的腰椎管狭窄症若手术适应证和减压范围掌握恰当，不论采取何种手术方式的神经减压术，均可取得满意疗效。正确选择病例和熟练的外科技术是应用内固定器械的重要条件。     

大鼠急性脊髓损伤时IκBα的表达及其意义

目的 研究大鼠急性脊髓损伤时抑制蛋白α(IkBa)表达变化规律。方法 将60只SD大鼠随机分为两组：损伤组48只大鼠，行脊柱椎板切除及脊髓打击术。对照组12只大鼠，仅行椎板切除术。应用免疫组织化学及Western blot分别测定脊髓细胞浆内IkBα的表达变化情况。免疫组织化学以细胞浆出现棕黄色颗粒为阳性结果，Western blot以醋酸纤维素膜上出现棕色条带为阳性结果。结果 在损伤后1h，IkBα表达开始下降，12h降到最低点，损伤后24h表达开始回升，5d逐步恢复正常。结论 IkBα活性变化可作为急性创伤性脊髓损伤时炎症反应程度的一项观测指标，通过抑制IkBα磷酸化降解环节，成为抑制炎症反应的新途径。     

陈旧性Denis Ⅱ型骶骨骨折合并骶神经损伤的诊断与治疗

目的：探讨陈旧性Denis Ⅱ型骶骨骨折合并骶神经损伤的诊断及手术方法。方法：取60具骶骨干标本及26具完整骨盆标本，测量S1棘突与S1后孔同位置关系、骶前区血管、骶神经及梨状肌之间关系；对14例陈旧性DenisⅡ型骶骨骨折合并骶神经损伤患者，在常规骨盆X线片，CT，螺旋CT三维重建的同时，又采用显示骶神经全长的骶骨斜冠状位MR扫描，观察神经走向及眦领关系。11例行自行设计的后略骶神经管扩大减压术，3例行非手术治疗。结果：S1棘突于S1后孔中上1/3者占90%，骶前区主要血管有骶外侧动静脉和骶外侧血管、骶正中血管及臀上血管进入骶前孔的分支。血管位于骶丛神经腹侧，骶外侧斑管距离S1前孔大于10mm，S2前孔大于5mm。骶骨斜冠状位MR扫描可以显示骶神经全长及周围眦领关系。骶神经损伤时，发现有神经根走行改变(13例），损伤处神经很周围脂肪消失（11例），神经根管狭窄(10例)。14例均获得随访。随访时间6--12个月。平均7.1个月，术后改善情况，优9例，无变化1例。结论螺旋CT三维重建及骶骨斜冠状位MR扫描对于骶神经损伤的定位及定性诊断有重要价值。后路骶神经管扩大减压术是针对骶神经管、骶前孔处神经损伤的较理想手术方法。     

Limited proteolysis of single-chain tetanus toxin by tissue enzymes,in cultured brain tissue and during retrograde axonal to the spinal cord

Summary Single-chain toxin was investigated in vitro and in vivo for limited proteolysis into the fully active two-chain toxin. Plasmin from serum, elastase and gelatinase from leucocytes, as well as clostripain from C. histolyticum cleaved single-chain toxin and increased by that way its ability to inhibit [³H]noradrenaline release in vitro. Cultured mouse brain generated fragments from ¹²⁵I-single-chain toxin which were cell-associated. Some of them comigrated in electrophoresis with light and heavy chain after mercaptolysis. When injected i. v. into rats, ¹²⁵I-single-chain-toxin disappeared from the blood with a half-life of about 11 h without signs of nicking. However, after its injection into the triceps surae muscle both single- and two-chain toxin were found in the ipsilateral ventral horn of the spinal cord. Thus single-chain toxin is subjected to limited proteolysis by enzymes involved in tissue damage, by cultured brain tissue, and during or after its retrograde axonal transport to the spinal cord. Limited proteolysis is necessary for the release of the light chain known to mediate the action of toxin on several systems.     

Gd-DTPA-enhanced MR in thoracic disc herniations

Summary The Gd-DTPA-enhanced magnetic resonance findings in two patients with herniated thoracic intervertebral discs are reported. The first patient was a 56-year-old woman with a small subligamentous T6-7 disc herniation, slightly lateralized to the right. The second patient was a 51-year-old man with a central and right posterolateral disc herniation, including a large calcified fragment, at the T8-9 level. The nonenhanced MR examination revealed the presence of an extradural mass lesion in both patients, impinging upon the dural sac and compressing and displacing the spinal cord posteriorly. The lesion was slightly hypointense on both T1- and T2-weighted spin echo sequences. Following intravenous injection of Gd-DTPA in a dosage of 0.1 mmol/kg body weight, enhancement of the posterior longitudinal ligament was noted and triangular areas of contrast uptake were seen to occur in the epidural space above and below the herniated disc. At surgery, they were found to correspond to dilated and congested epidural veins.     

Quantitative autoradiographic study of L-glutamate binding sites in normal and atrophic human cerebellum.

In the present work the distribution of L-glutamate binding sites in the different layers of human cerebellum of normal individuals and of seven patients who died with olivopontocerebellar atrophy (OPCA) was examined with the technique of quantitative autoradiography. Specific L-[3H]glutamate binding was higher in the molecular than in the granule cell layer of normal cerebellar tissue. A significant decrease of L-[3H]glutamate specific binding was observed in the molecular layer of all OPCA tissues. In the granule cell layer L-[3H]glutamate binding was decreased only in two patients who suffered from late-onset sporadic OPCA and in one patient who suffered from a form of OPCA inherited in a dominant manner. Quisqualate-sensitive binding sites were the most abundant binding sites in the molecular layer of normal cerebella, whereas N-methyl-D-aspartic acid (NMDA)-sensitive binding sites were the most abundant type in the granule cell layer. A significant decrease of quisqualate-sensitive and an increase in NMDA-sensitive binding sites were observed in the molecular layer of OPCA cerebellar tissues. No significant changes were observed in the granule cell layer of these tissues.     

Delineating the sites and progression of in vivo atrophy in multiple system atrophy using fluid-registered MRI.

We describe the pattern and progression of atrophy delineated using fluid registration of serial magnetic resonance imaging scans in a case of multiple system atrophy (MSA). The in vivo findings were consistent with those found at postmortem, including significant supratentorial atrophy concurrent with an unusual degree of cognitive impairment for MSA.     

多发性肌炎与皮肌炎(附25例报告)

多发性肌炎与皮肌炎25例,其中多发性肌炎21例,皮肌炎2例,多发性肌炎或皮肌炎伴发恶性肿瘤2例。从临床表现、生化检查、肌电图及肌肉活检等方面进行分析,提出多发性肌炎与皮肌炎的诊断条件。本组均采用皮质类固醇治疗,5例合并免疫抑制剂治疗,其中临床治愈4例,显著好转10例,好转5例,无效2例,死亡4例。