急性脊柱创伤诊断及治疗的临床研究

目的研究急性脊柱创伤诊断及急性脊柱创伤手术治疗方法。方法回顾34例脊柱创伤的患者的临床及影像学资料,均采用短节段椎弓根钉固定治疗。术后1月复诊,观察骨折的恢复情况,神经功能恢复按Frankel评分。结果患者术后恢复情况良好,Frankel评分有显著改变。结论手术方法的选择应参考患者骨折类型,内固定器的特点,适合的手术方法,对患者的恢复及术后并发症的减少是很有意义的。     

A less invasive surgical concept for the resection of spinal meningiomas

Summary   Background. The surgical strategy for spinal meningiomas usually consists of laminectomy, initial tumour debulking, identification of the interface between tumour and spinal cord, resection of the dura including the matrix of the tumour, and duroplasty. The objective of this study was to investigate whether a less invasive surgical strategy consisting of hemilaminectomy or laminectomy, tumour removal and coagulation of the tumour matrix allows comparable surgical and cinical results to be obtained, especially without an increase of the recurrence rate as reported in the literature. Patients and methods. Between 1990 and 2005, 61 patients (11 men, 50 women) underwent surgery for spinal meningioma. All patients were treated microsurgically by a posterior approach. In 56 of the 61 patients, the above outlined – less invasive – surgical technique with tumour removal and coagulation of the tumour matrix was performed. In 5 patients, dura resection and duroplasty was additionally performed. Electrophysiological monitoring was routinely used since 1996. Recurrence was defined as new onset or worsening of symptoms and radiological confirmation of tumour growth. The pre-and post-operative clinical status was measured by the Frankel grading system. Results. Pre-operatively, 40 patients were in Frankel grade D, 13 patients in grade C, 6 patients in grade E and 1 patient each in grade A and B. Following surgery no patient presented a permanent worsening of clinical symptoms. All patients who initially presented with a Frankel grades A–C (n = 15) recovered to a better grade at the time of follow-up. Patients who presented with Frankel grade D remained in stable condition (n = 27) or recovered to a better neurological status (n = 13). Two patients experienced a temporary worsening of their symptoms, but subsequently improved to a better state than pre-operatively. Two (3.3%) complications (pseudomeningocele, wound infection) requiring surgery, were encountered. The pseudomeningocele developed in a patient who underwent durotomy. During the follow-up period of 2 months to 10 years (mean 31.3 months), 3 patients (5%) required surgery for symptomatic recurrence: 1 patient had 2 recurrences that occured 4 and 7 years after first tumour removal and matrix coagulation, 1 recurrence occurred 1 year after tumour removal that was accompanied by matrix coagulation in a patient with a diffuse anterocranial tumour extension and 1 occured 3 years after tumour removal and durotomy. Two patients showed a small recurrence on MRI during follow-up after 2 and 5 years, respectively, without any symptoms requiring surgery. Conclusions. The high rate of favourable clinical results combined with the low rate of recurrences supports our less invasive surgical concept, which does not aim for resection of the dural matrix of the spinal meningioma. Correspondence: Azize Bostr?m, M.D., Department of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.     

前路内固定术治疗下颈椎骨折脱位的临床疗效分析

目的：探讨前路内固定术治疗下颈椎骨折脱位的临床疗效。方法：将本院2009年7月-2012年1月确诊为下颈椎骨折脱位的39例患者作为研究对象,术前皆行颈椎CT扫描,充分评估下颈椎骨折脱位及脊髓压迫程度。术中采用后路减压复位术联合前路内固定术治疗,术后辅以康复治疗效。结果：术后随访7～21个月,39例患者脱位完全复位,损伤节段稳定,均未出现内固定断裂、松动、脱出及神经、血管、食管损伤等并发症。所有手术均顺利完成,患者均未发生围手术期并发症。JOA评分治疗评分改善率为43．17％,神经损伤均有恢复,脊髓Frankel分级平均提高1级。结论：对于下颈椎骨折脱位的患者,前路内固定术联合后路减压复位术具有有效、安全的特点,值得临床推广应用。     

内固定联合椎体成形术对脊柱骨折患者Frankel分级与Cobb角影响探讨

目的 探讨内固定联合椎体成形术对脊柱骨折患者Frankel分级与Cobb角的影响. 方法 整群选取并回顾性分析2013年12月—2015年6月该院诊治的80例脊柱骨折患者临床资料,结合患者予以或病情需要,按照治疗时不同治疗方案分为两组,将采用内固定治疗的34例患者设为对照组,其余46例采用内固定+椎体成形术治疗患者设为研究组,对比两组具体治疗情况.结果 治疗后,研究组Frankel分级E级患者71.74%比对照组55.88%高;且临床疗效指标均优于对照,比较差异均具有统计学意义(P<0.05). 结论 内固定联合椎体成形术治疗脊柱骨折患者疗效确切,可改善Frankel分级,缩小Cobb角.     

献血者丙氨酸氨基转移酶活性筛检标准的探讨

目的通过对血站系统无偿献血者丙氨酸氨基转移酶测定评价,以及分析探讨生理、病理因素对丙氦酸氨基转移酶活性的影响。制定出既要减少因输血传播疾病的危险,又要避免宝贵血源浪费的方案。方法 于2003年及2004年向全省各级血站发放三批质控样品,每批为5份不同浓度单位的丙氨酸氨基转移酶。在规定时间各血站与常规标本一起采用速率法或赖氏法进行检测。收集2003年到2004年本中心各项血样化验检测数据。结果分析三批全省血站系统室间质控结果发现丙氨酸氨基转移酶两种检测方法有显著差异,特别是临界值附近的样品。结论 丙氨酸氨基转移酶活性特异性较差,现行《血站管理办法》制定的检测方法和标准界定值值得探讨,应制定出更为合理,并适合国情的筛选标准。     

利用肝癌小鼠动物模型改进临床生物化学与检验实验的研究

目的增加学生对《赖氏法测定血清丙氨酸氨基转移酶（ALT）》实验的学习兴趣。方法利用赖氏法测定Ras转基因肝癌小鼠与对照组小鼠的血清丙氨酸氨基转移酶（ALT）的活性,以提高学生的认识和教学效果。结果 Ras转基因肝癌小鼠的血清ALT活性显著高于对照组小鼠。结论利用肝癌小鼠动物模型改进临床生物化学与检验实验,实验结果较为理想,增加了学生学习的主动性,提高了教学效果,可予推广应用。