下腰椎失稳合并椎管狭窄症的手术治疗

目的：观察下腰椎失稳合并椎管狭窄症患者经椎弓根螺钉系统及椎体融合器治疗的效果。方法：采用后路减压，椎弓根螺钉系统内固定，椎体间融合器BAK融合。结果：术后随访1年一4年3个月(平均2年4个月)，椎体间骨性融合率1年89．6％，2年2个月100％，临床症状消失满意率92％。结论：采用椎管减压、椎弓根螺钉系统加椎间融合器固定，可使滑脱失稳的椎体部分或全部复位，保证脊柱骨性融合，达到脊柱稳定、解除症状的目的。     

Platelet aggregation,disc haemorrhage and progressive loss of visual fields in glaucoma

Platelet aggregationin vitro, deterioration of visual field defects (VFD) and the prevalence of disc haemorrhages (DH) were assessed in 49 patients with primary open angle glaucoma (POAG) and compared with the findings for 67 individuals with suspected glaucoma (GS) in a seven-year follow-up study (range 5.8 to 8.2 years). The percentage patients with spontaneous platelet aggregation (SPA) was higher for POAG patients with visual field deterioration (60%) than both POAG patients without progressive loss of visual fields (12.5%; P<0.005) and those with suspected glaucoma (22.4%; P<0.005). The occurrence of DH was higher among POAG patients with progressive loss of visual field (28%) compared to the GS group (8.4%; P<0.025) and the group of patients consisting of POAG patients without deterioration of VFD and GS (9.9%; P<0.05). DH also occurred more often in patients with low tension glaucoma (41.6%) than in the remaining POAG patients (13.5%; P<0.05). No relation between the patients with SPA and the patients with DH was observed.Abbreviations NPB normal platelet behavior - SPA spontaneous platelet aggregation - DH disc haemorrhage     

HBV_2患者血清HBsAg的氨基酸组成分析

将２例ＨＢＶ＿２患者血清ＨＢｓＡｇ纯化，分析了ＨＢＶ＿２的ＨＢｓＡｇ氨基酸组成，并与分子量为６３０１９８道尔顿ＨＢＶ＿１的ＨＢｓＡｇ三种多肽氨基醚组成比较。实验发现，ＨＢＶ＿２与ＨＢＶ＿１的ＨＢｓＡｇ的氨基醚组成有较大区别，且区别指数均在１３以上。提示ＨＢＶ＿１和ＨＢＶ＿２的ＨＢｓＡｇ在一级结构上存在较大差异；ＨＢＶ＿２可能系一新的乙型肝炎病毒，也可能系由于ＨＢＶ＿１Ｓ区核苷酸突变所致的变异株。     

Role of technetium-99m planar bone scanning in the evaluation of low back pain

The records of 1018 patients with low back pain in a tertiary spine referral practice were reviewed. One hundred thirty-nine out of 1018 (13.6%) underwent technetium-99m planar bone scanning as part of their investigation. Seventy-three out of 139 scans (52%) showed increased uptake in some area, but only 27 out of 139 (19.4%) showed increased uptake specifically in the low back. Scans consistently yielded no findings with reference to the back when the prescan diagnosis was spinal stenosis, lumbar pain syndrome, herniated nucleus pulposus, or postlaminectomy syndrome. Some scans gave positive findings in patients with a diagnosis of degenerative disc disease, pseudarthrosis, spondylolisthesis, fracture, infection, metabolic disorder, or tumor. Positive scans were generally obtained early after presentation (within 3 months) and negative scans obtained later (after 6 months), suggesting that clinical suspicion is still the main indication for early scanning. Planar bone scanning was helpful in both diagnosis and therapeutic decisionmaking in many conditions.     

腰椎间盘突出症手术后复发的原因分析及防治

目的 分析总结腰椎间盘突出症手术后复发的原因及治疗方法。方法 腰椎间盘突出症手术后复发的范围限定于临床症状、体征及影像学证实为受累神经根与第一次手术的节段相同。回顾1990年～2001年收治的资料完整的病例38例。总结造成复发的原因，分析造成这些原因的因素以及防范措施，并提出治疗方案。结果 复发的原因为髓核再突出20例(占52．7％)、疤痕压迫5例(占13．1％)、硬脊膜及神经根四周粘连5例(占13．1％)、腰椎失稳4例(占l0．5％)、神经根管、侧隐窝狭窄4例(占l0．5％)，其中经保守治疗和手术治疗分别为2l例(占55．3％)和17例(占47．7％),治疗优良率92％。结论 腰椎间盘突出症术后复发的主要原因为髓核再突出。复发后经中西医结合治疗能取得满意疗效,治疗上首先应采用保守治疗。     

肌电图对腰神经后根节段定位作用的实验研究

目的:探讨应用肌电图行大鼠腰神经后根节段定位的方法。方法:通过电生理的方法,依次电刺激L3￣L5脊神经后根,分别记录大鼠双侧下肢主要肌肉的肌电图像,测量最早出现的感觉神经动作电位(SNAP)最大波幅值。结果:刺激L3脊神经后根,于股四头肌记录到的波幅峰值(480.8±255.9μV)显著高于其它各组肌肉(P<0.01)。刺激L4脊神经后根,于下肢四组肌肉记录到的CMAP最大波幅平均值均>100μV,其中在股四头肌(305.2±131.5μV)、胫骨前肌(340.2±310.4μV)记录到的波幅峰值显著高于在股二头肌(142.4±144.7μV)、腓肠肌(138.2±127.6μV)记录到的波幅峰值(P<0.01)。刺激L5脊神经后根,于股二头肌(377.5±264.4μV)、腓肠肌(168.4±126.7μV)记录到的波幅峰值显著高于其它各肌群记录到的波幅峰值(P<0.01)。结论:电刺激不同脊神经后根,在大鼠下肢不同肌肉记录到的SNAP的波幅峰值存在差异,综合分析记录到的SNAP的波幅峰值,可作为腰神经后根节段定位的参考。     

西酞普兰与氯丙咪嗪治疗颈椎间盘突出症术后抑郁焦虑症状的对照研究

目的比较西酞普兰与氯丙咪嗪治疗颈椎间盘突出症伴抑郁焦虑症状的疗效和不良反应。方法对200例颈椎间盘突出症伴抑郁焦虑症状患者分别以西酞普兰与氯丙咪嗪治疗,共治疗6周。采用汉密尔顿抑郁量表(HAMD)评定临床疗效,采用副反应量表(TESS)评定副反应。结果西酞普兰组有效率91%;氯丙咪嗪组有效率90%,2组疗效相当。但西酞普兰组起效时间平均(11.1±5.6)d,而氯丙咪嗪组平均(15.1±8.2)d,以西酞普兰组显著较快(P<0.01)。西酞普兰组不良反应发生率为13%,而氯丙咪嗪组发生率为50%,西酞普兰组不良反应发生率较低。结论西酞普兰治疗颈椎间盘突出症术后伴抑郁焦虑症状的疗效与氯丙咪嗪相当,副反应少,值得推广应用。     

Fracture separation of the articular pillar of C5 following brass knuckles trauma

We report the case of a fracture separation of the articular pillar at the lower cervical spine. The trauma, following a brass knuckles, repeats almost in an experimental way the rotation and extension mechanism given in literature for the genesis of such injuries. From the admission in the orthopaedic service to the surgery, the development went in a characteristic way towards a rotatory displacement. Received: 12 July 2002, Accepted: 18 August 2002 Correspondence to: R. Massicot     

计算机体层成像多平面重建在评价椎间融合中的作用

目的 探讨计算机体层成像多平面重建(CTMPR)在评价椎间融合中的作用,寻找定量评价椎间融合的新方法.方法 13例行腰椎间融合的患者术后1周、3个月、6个月行CTMPR,行椎间融合器(Cage)内植骨CT值定量测量.结果 术后1周Cage内植骨CT值为(619.52±26.97)Hu,术后3个月为(628.69±42.60)Hu,术后6个月为(657.77±37.43)Hu.术后1周与术后3个月相比无显著性差异,与术后6个月相比有显著性差异.结论 CT值的测量在椎间融合的判断中具有高准确性.