双梅花针治疗股骨干中下段骨折

目的：提供一种既符合生物力学的要求、又简单实用的治疗股骨干中、远端骨折的手术方法。方法：选择两根适当型号的普通梅花针，在远端适当预弯后制成弧形并相扣在一起，使其在击入股骨髓腔后在冠状面形成“X”形，远端插入股骨的两髁中，此方法应用于50例股骨干中下段骨折病例。结果：随访48例，骨折全部愈合，无膝关节僵硬等并发症发生。结论：髓腔内“X”形分布的双梅花针能有效地抵抗扭转、剪切的作用，配合钢丝防止短缩，是一种经济实惠的内固定方法。     

Femoral instrumentation using the anterosuperior iliac spine as a landmark in total knee arthroplasty: An anatomic study

Twenty-six adult cadavers were utilized in an anatomic study designed to measure intramedullary femoral alignment in relation to the anterosuperior iliac spine. Fifty femurs were measured to determine the reliability of the anterosuperior iliac spine as an accurate landmark for distal femoral resection in total knee arthroplasty (TKA). A precision machined stainless steel U-shaped parallel alignment guide was fabricated and inserted into the femoral canals of intact adult cadavers. The guide's relationship to the anterosuperior iliac spine was measured and recorded. All hips were maintained in neutral alignment. Independent variables recorded included gender, knee alignment, and side of lower extremity. The range for medial deviation was 1-28 mm for the right femur and 2-25 mm for the left femur (average, 8.5 mm). The range for lateral deviation was 3-14 mm for the right femur and 2-17 mm for the left femur (average, 10.3 mm). There was no statistical correlation between the independent variables of side measured, gender, and measured offset at the anterosuperior iliac spine. Based on this highly variable pattern of alignment, utilizing simulated intraoperative technique, use of the anterosuperior iliac spine does not provide a landmark accurate enough to repeatedly produce a distal femoral resection within 2 degrees-3 degrees of ideal. Use of the anterosuperior iliac spine may lead to less than ideal femoral resection and malpositioning of total knee components.     

Suprasellar germinomas; Relationship between tumour size and diabetes insipidus

Summary The clinical and neuro-endocrinological aspects of 17 suprasellar germinoma patients treated between 1972–1991 are reported. Surgical extirpation was not initially attempted, but all patients received irradiation with or without a biopsy. Sixteen of those have led useful lives with appropriate hormonal replacement therapy during a mean follow up of 8 years.Seven tumours at diagnosis were less than 2 cm in diameter (type 1), nine tumours more than 2 cm (type 2), and one double midline tumour was of unknown size. All 7 type 1 patients required 1-deamino-8-D-arginine-vasopressin (DDAVP) to control diabetes insipidus (DI), but only 2 of the 9 type 2 patients have needed DDAVP since completion of the treatment. Patients with smaller tumours required more DDAVP following tumour disappearance, than those with larger tumours. The prognostic indicators for the post-treatment course of DI and retarded growth appeared to be the tumour size and the age at diagnosis.We also emphasize the absence of metastasis in unoperated cases and the use of tumour markers as a diagnostic criterion which obviates surgical acquisition of tissue to make the diagnosis. Possible reasons are discussed and the literature reviewed.     

Morphology of augmenting inspiratory neurons of the ventral respiratory group in the cat

The present study examined, in Nembutal-anesthetized and artificially ventilated cats, the morphologic properties of the inspiratory neurons of the ventral respiratory group (VRG). Horseradish peroxidase (HRP) was injected into 21 augmenting inspiratory or late inspiratory neurons with peak firing rates in the late inspiratory phase. The majority of the stained neurons were antidromically activated by stimulation of the cervical cord. Thirteen somata, located within or around the nucleus ambiguus (AMB), between 100 microns caudally and 2,000 microns rostrally to the obex, were stained. In ten cases, the stem axons issuing from the cells of origin coursed medially to cross the midline without giving off any axonal collaterals. Three neurons gave rise to axonal collaterals on the ipsilateral side, distributing boutons in the medullary reticular formation, in the vicinity of the AMB, hypoglossal nucleus, solitary tract, and dorsal motor nucleus of the vagus. In eight neurons, only the axons were labeled; in four of these, which were antidromically activated from the spinal cord, the stem axons crossed the midline 2,000-3,000 microns rostral to the obex and descended in the reticular formation around the AMB down to the cervical cord. They issued several axonal collaterals, distributing terminal boutons at the level of the caudal end of the retrofacial nucleus and about 1,000 microns rostral and caudal from the obex. Terminals were found mainly in and around the AMB, and a few were found in the vicinity of the dorsal motor nucleus of the vagus. The remaining four nonactivated axons distributed their terminal boutons widely in the reticular formation around the AMB. Thus, the augmenting inspiratory neurons of the VRG were shown to project not only to the spinal cord, but also to the VRG, hypoglossal nucleus, and dorsal motor nucleus of the vagus.     

Spontaneous Regression of a Residual Pineal Tumor after Resection of a Cerebellar Vermian Germinoma

A case of multiple intracranial germ cell tumor in which a pineal tumor regressed spontaneously after resection of the cerebellar mass is reported. Immunohistochemical staining of the cerebellar mass showed that most of the infiltrating lymphocytes were positive for CD3 and CD8. The anti-Ki-67 monoclonal antibody MIB-1 staining of the resected tumor revealed a high MIB-1 positivity ratio (36.1%) among the large tumor cells, and TUNEL staining demonstrated that positivity in up to 6% of the tumor cells. Possible mechanisms responsible for this spontaneous regression including immunological responses and apoptosis induced by T lymphocytes are discussed.     

Intramedullary “holocord” oligodendroglioma: Case report

Summary Primary spinal cord oligodendrogliomas are rare tumours. Only 3 holocord cases have been reported in the literature. We present a primary intramedullary holocord Oligodendroglioma in a 13 year-old male. Scoliosis was the initial symptom. Neurological deterioration prompted MRI, which demonstrated the lesion. Total removal was achieved. This case shows that meticulous surgery may obtain an optimal result in holocord oligodendrogliomas. 2 years after surgery, the young patient has made an excellent recovery.     

“Epi-” and intramedullary neurilemmoma of the spinal cord with denervation atrophy in the related skeletal muscles

Summary The autopsy of a 68-year-old male who died of cardiac infarction revealed an ep - and intramedullary neurilemmoma of the spinal cord as an associated finding half a year prior to death. The patient had suffered from progressive weakness and sensory disturbances of the lower limbs together with muscular wasting for 6 months. Repeated neurological examinations had led to the diagnosis of an intraspinal space occupation which, however, could not be substantiated by myelography because of its surprisingly small size. The Schwann cell proliferation originated from the adventitia of the epi- and intramedullary vessels of the conus medullaris. The main tumor mass was epi-medullary and extended into the medullary parenchyma via the penetrating vessels forming intramedullary nodules. The special findings in the present case seem to support the hypothesis that intramedullary neurilemmomas originate from the perivascular nerve endings.

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Zusammenfassung Bei einem 68jährigen, an einem Herzinfarkt verstorbenen Manne fand sich bei der Sektion ein epi- und intramedullär entwickeltes Neurilemmom im Bereiche des Conus medullaris des Rückenmarkes. Seit 1/2 Jahr vor dem Tode hatten sich gravierende motorische und sensible Störungen in den Beinen eingestellt, die nach mehrfachen neurologischen Untersuchungen klinisch auf einen intraspinalen raumfordernden Prozeß wegen der typischen Verteilung der sensiblen Störungen zurückgeführt worden waren. Myelographisch war ein solcher Prozeß allerdings nicht zu sichern. Die Schwannzellproliferation ging von den Adventitiae der pialen Rückenmarksgefäße aus und schob sich über die radiär ins Rückenmark eindringenden Gefäße in die zentralen Medullaabschnitte vor, wo sich ebenfalls kleine Tumoren entwickelten. Die eindeutige Ableitung von den Gefäßwänden scheint die Vermutung früherer Autoren zu bestätigen, daß intramedulläre Neurilemmome sich von den perivasculären Nervengeflechten aus entwickeln.

     

Subependymal gliomas

Summary Three cases of subependymoma are described. In two of them, the tumour had produced clinical symptoms, in one it was found incidentally at autopsy. The tumours were located in the right lateral ventricle, in the fourth ventricle and in the cervical spinal cord. Operation was performed in the latter case, this being the first case of successfully operated subependymoma of spinal cord localization described in the literature. The lateral ventricular and the spinal tumours were subjected to electron microscopic study. Light and electron microscopic investigations showed that the tumour cells were of fibrillar astrocytic character, yet owing to other morphological features the tumours could not be absolutely identified with fibrillary astrocytomas.P.S. while in press: Subependymoma will be an entity of the forthcoming Histological Classification of Tumours of the Central Nervous System of the World Health Organization as subependymal glomerate astrocytoma.

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Zusammenfassung Es werden 3 Fälle von Subependymom beschrieben, in 2 von diesen hat der Tumor eine klinische Symptomatologie hervorgerufen, der 3. war ein Zufallsbefund bei der Autopsie. Die Tumoren lagen im rechten Seitenventrikel, im 4. Ventrikel und im Halsmark. Im letzterwähnten Falle wurde eine Operation durchgeführt und dies ist der erste erfolgreich operierte Fall eines Subependymoms des Rückenmarks, der in der Literatur beschrieben wird. Bei dem Tumor im Ventrikel und bei dem spinalen Tumor konnten elektronenmikroskopische Untersuchungen durchgeführt werden. Licht- und elek-tronenoptische Untersuchungen zeigten, daß die Tumorzellen einen fibrillären Charakter wie bei Astrozyten hatten, doch konnte aufgrund andersartiger morphologischer Strukturen der Tumor nicht absolut mit dem fibrillären Astrocytom gleichgesetzt werden.P. S. während der Drucklegung: Das Subependymom ist in der neuen Nomenklatur der Weltgesundheitsorganisation vorgesehen als subependymäres glomeruläres Astrozytom.

     

髌上入路髓内钉技术治疗胫骨干骨折的研究

目的 比较髌上入路与传统髌下入路髓内钉技术治疗胫骨干骨折的临床疗效。方法 回顾性分析2013年3月至2015年3月本院收治采用髓内钉技术治疗的79例胫骨干骨折患者的病例资料。髌上入路41例(A组),男26例,女15例,年龄(41.54±10.52)岁。传统髌下入路38例(B组),男22例,女16例,年龄(39.47±8.20)岁。全部患者为单侧下肢骨折,行闭合复位内固定治疗。比较两组的手术时间、术中出血量、住院时间、骨折愈合时间、术后膝关节功能评分、临床优良率、术后膝前疼痛发生率等情况。结果 所有手术顺利完成,术后随访6～24个月,平均14.7个月。参照Johner-Wruh评分标准,A、B两组术后第24周临床优良率分别为95.1％和79.0％,Lysholm平均评分分别为92.2分和87.7分,功能评分及膝前疼痛发生率方面差异有显著性意义(P<0.05)。结论 髌上入路可以避免切开髌腱等组织,减少膝前疼痛率,利于患者早期进行功能锻炼,提高临床效果,值得在临床上推荐。     

闭合复位伽玛型髓内钉治疗老年股骨转子间骨折

正2012月5月~2014年9月,我科采用闭合复位伽玛型髓内钉内固定治疗28例老年股骨转子间骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组28例,男12例,女16例,年龄60~87岁。骨折根据Evans分型:Ⅰ型4例,Ⅱ型9例,Ⅲ12例,Ⅳ型3例。受伤至手术时间3~8d。1.2治疗方法硬膜外麻醉或全身麻醉。C臂机正、侧位透视确定骨折复位满意后,于股骨大转子上方取4~5 cm