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.     

胸椎骨折合并胸外伤的外科治疗

目的　总结 17例胸椎骨折患者的特点与诊疗情况 ,为提高此类合并胸外伤患者的疗效提供有效的治疗方案。方法　分析了 17例胸椎骨折患者的临床特点、诊疗经过、近远期随访结果。结果　 14例 (82 .4 % )合并肋骨骨折 ,11例 (6 4 .7% )合并血气胸 ,10例 (5 8.8% )合并严重脊髓伤 ,3例 (30 % )远期脊髓伤为有用恢复。结论　胸椎骨折常合并肋骨骨折、血气胸、严重脊髓损伤 ,预后较差 ,为此应重视合并胸外伤的胸椎骨折的围手术期处理     

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。     

皮下环精索封闭疗法治疗急性附睾-睾丸炎疗效观察

目的评价急性附睾-睾丸炎皮下环精索封闭疗法的疗效.方法对80例急性附睾-睾丸炎病例随机分为两组,对照组给予传统治疗方法,而治疗组除了传统疗法外,加用皮下环精索封闭治疗.结果治疗组所有患者1～3d内发热、疼痛症状缓解,4～6 d内附睾睾丸肿胀明显减退,97.5%的病例2周内治愈;而对照组40%的患者1～3d内发热、疼痛症状缓解,75%的患者4～6d内附睾睾丸肿胀减退,80%患者2周内治愈,治疗组疗效优于对照组.结论皮下环精索封闭疗法可以迅速缓解临床症状,缩短病程,提高治愈率,是治疗急性附睾-睾丸炎的有效方法.     

常压及控制性降压下脊髓急性牵拉损伤比较研究

目的 评价控制性降压是否增加脊髓对牵拉损伤的易感性。材料与方法健康成年杂种犬6只，随机分为常压和控制性降压脊髓牵拉损伤组。观察常压及控制性降压水平下相同程度牵拉损伤后脊髓血流(SCBF)、体感诱发电位(SEP)、神经源性运动诱发电位(NMEP)改变的差异。结果 外周血有创动脉压(MABP)平均下降幅度为40．5％。经SSPS统计软件独立样本t检验，不同牵拉水平下，常压组及低压组的SCBF(％)、SEP波幅(Asep)(％)及NMEP波幅(％)无显著差异。结论 尼卡地平控制性降压不增加脊髓对牵拉损伤的易感性。     

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。     

鞘内注射吗啡加可乐定对切口痛大鼠脊髓背角蛋白激酶A催化亚单位表达的影响

Objective To observe the effect of intrathecal clonidine plus morphine on expression of protein kinase A (PKA) catalytic subunit in the spinal dorsal horn in a rat model of incisional pain. Methods Eighty male Sprague-Dawley rats were divided randomly into five groups: sham group, control group, pre-incisional morphine 2.5 μg group, pro-incisional clonidine 5 μg group and preincisional morphine 2.5 μg plus clonidine 5 lag group (n=16). lntrathecal catheter and the model of incisional pain were pro-duced according to Yaksh and Brennan's described method respectively. Changes of pain behavior were assessed by mechanical with-drawal threshold (MWT) and thermal withdrawal latency(TWL). The expressions of PKA catalytic subunit in the spinal dorsal horn were assessed by immunohistochemical method and western blotting analysis. Results Compared with sham group, MWT and TWL in control group were decreased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were increased significantly in control group (P<0.01). Compared with control group, MWT and TWL in pre-incision morphine 2 μg plus clonidine 5 lag group were increased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were decreased significantly in pre-incision morphine 2 μg plus clonidine 5 μg group (P<0.01). However, MWT, TWL and the number of positive cells and pro-tein expression of PKA catalytic subunit in the spinal dorsal horn changed with no statistical significance in pre-incisional morphine 2.5 μg group and pre-incisional clonidine 5 μg group compared with control group. Conclusion lntrathecal clonidine significantly enhances the antinociceptive effect of intrathecal morphine in a rat model of incisional pain, which might be associated with inhibi-tion of the increased expression of PKA catalytic subunit in spinal cord.     

脊柱后路减压治疗胸腰段骨折脱位合并脊髓损伤术式选择

目的研究两种不同脊柱后路减压方法治疗胸腰段骨折脱位合并脊髓损伤的手术治疗效果。方法回顾分析本院1996年3月～2002年6月收治的胸腰段骨折脱位并脊髓损伤患者76例，按不同减压方法将其分为两组：切除一侧或两侧椎板、椎弓根或部分关节突行侧前方环状减压AF内固定者40例，为直接减压组；体位复位结合AF器械矫正复位36例，为间接减压组。统计学分析，两组资料具有可比性。对术后神经功能恢复情况，按ASIA神经功能评定标准进行评定。中晚期并发症，根据是否有腰背痛，下肢根性痛、麻木无力，两便功能障碍进行评定。生活能力按FIM评定。结果两组病例获6个月～5年随访，结果表明，术前脊髓完全性损伤，术后均无恢复；术前脊髓不完全性损伤，术后两组间比较差异无显著性。中晚期并发症发生，直接减压组高于间接减压组；术后生活自理能力，间接减压组好于直接减压组。结论间接减压手术方法治疗胸腰段骨折脱位合并脊髓损伤不失为一种早期治疗的首选方法。     

Characterization of hindlimb motoneuron membrane properties in acute and chronic spinal cats

The purpose of this study was to determine if changes in hindlimb motoneuron membrane electrical properties occur 4–6 months after spinal transection in the adult animal. Eight acute and nine chronic animals were spinalized at T₁₂. Intracellular recordings from motoneurons innervating the triceps surae were performed. Membrane electrical properties, including resting potential, action potential peak amplitude, afterhyperpolarization duration, rheobasic current, input resistance and axonal conduction velocity were measured. There were no statistical differences found between group means or frequency distributions in the membrane properties of motoneurons assessed from acute and chronic spinal animals. Thus, alteration of motoneuron membrane properties does not appear to be a major contributing factor to the hyperexcitable hindlimb reflex activity demonstrated by chronic spinal animals.