腰椎间盘突出合并马尾神经损伤

腰椎间盘突出症是骨科常见病。但腰椎椎间盘突出并合马尾损伤在临床上较少见 ,却因出现鞍区感觉障碍而影响病人的生活。故应提高临床诊断和治疗 ,减少病残率。至今 ,作者收治经手术症实的腰椎间盘突出合并马尾损伤 35例 ,现报告如下 :1　临床资料1 1　一般资料　本组男 2 8例 ,女 7例。年龄 2 1～ 5 4岁 ;平均 37岁。发病诱因 :急性腰损伤 7例 ,慢性发病 5例 ,不合理治疗 (推拿、按摩 )后发病 2 3例。腰腿痛病史 8月～ 5年。1 2　临床表现　腰痛、腿痛 35例。双腿痛 30例 ,单腿痛 5例。下肢及会阴部感觉丧失 2 7例 ,下肢或鞍区感觉减退 8例…     

腰椎术后硬膜外瘢痕的形成机制及其防治研究

腰椎间盘突出症、腰椎管狭窄症、腰椎管内肿瘤等疾病是骨科临床上常见的脊柱疾病,椎板切除术是治疗此类疾病常规的手术步骤和常用的减压方式,能够明显缓解腰部和下肢疼痛症状,促进患者肢体功能的恢复。然而,约有10%～15%的患者会出现腰椎手术失败综合征     

腰椎间盘突出症合并马尾神经损伤11例

腰椎间盘突出症合并马尾神经损伤,导致括约肌功能障碍,大小便失禁或尿潴留,鞍区麻木,下肢部分肌肉瘫痪,甚至截瘫在临床上少见。我科从1990年～1996行134例腰椎间盘手术,其中合并马尾神经损伤的有11例,报告如下。1　临床资料11　一般资料　11例中男7例,女4例。年龄25～58岁,平均37岁。病史及诱因:患者有腰痛及坐骨神经痛病史,最短20ｄ,最长28年。出现马尾神经症状至手术时间最短3ｄ,最长的4个月,平均25ｄ。临床均有腰痛及坐骨神经痛表现。马尾神经受压,大小便失禁,鞍区麻木,感觉丧失,下肢部分肌肉瘫痪5例;鞍区麻木,感觉减退,小腿肌肉瘫痪4例;…     

腰椎间盘突出合并马尾神经损伤的治疗

腰椎间盘突出合并马尾神经损伤是腰椎间盘突出症的严重并发症。会造成病人大小便失禁,马鞍区麻木,下肢肌肉不同程度的瘫痪,临床上并不多见〔１〕。我科从１９８５年以来,手术治疗腰椎间盘突出合并马尾神经损伤２６例,取得满意疗效,现报告如下：１临床资料１１一般...     

腰椎间盘突出致马尾综合征的机制与对策

马尾综合征(cauda equina syndrom,CES),是马尾神经(L2～5,S1-5,Col)部分或全部受压力或牵张力损伤而引起的以直肠、膀胱功能障碍、鞍区麻木,下肢感觉、运动功能减退或丧失的一组征侯.由Vebiest (1949)首次报道并命名.因腰椎间盘突出引起的马尾综合征,主要累及马尾神经上部(L2～S2).其发生率文献报道不一,从0.4％ ～ 10.6％,多数认为是1％～2％[1-2].为引起高度重视,故临床上又称为"腰椎间盘突出症危象".除腰椎间盘突出症外,其他各种先天或后天性因素,造成的椎管相对或绝对狭窄,若压迫马尾神经时,均可引起本征[3].     

腰椎间盘突出合并马尾神经损伤的外科治疗

目的探讨腰椎间盘突出症伴马尾神经综合征的发病机制、治疗及预后。方法回顾性分析18例腰椎间盘突出症伴马尾神经综合征病例,均在出现症状7 d后行手术减压治疗。结果术后平均随访3.1年,所有患者腰痛全部恢复,下肢肌力部分恢复16例,未恢复2例,但括约肌功能障碍无明显改善。按Masato标准评价疗效：好转8例,差10例。结论腰椎间盘突出症伴马尾神经综合征是手术的绝对适应证,一经明确诊断必须尽早手术,以抢救神经功能。     

显微内镜下治疗腰椎间盘突出症伴马尾神经损伤一例

<正>腰腿痛是腰椎间盘突出症最主要的症状,马尾神经损伤既是LDH症状也是并发症之一,是手术的绝对适应证。马尾神经损伤的典型特征是出现鞍区感觉、括约肌功能、性功能三大障碍~([1-6])。腰椎间盘突出症并发马尾神经综合征(CES)患者,应该尽可能的早期手术,有利于马尾神经的功能恢复和避免损     

快速牵引治疗腰椎间盘突出症致马尾神经损伤一例

牵引疗法是腰椎间盘突出症非手术治疗方法之一，临床应用广泛。快速牵引治疗腰椎间盘突出症而致马尾神经损伤在临床十分少见，若未及时治疗，将导致严重的神经功能障碍。笔者于2002年5月收治1例此类患者，经积极手术治疗，取得良好效果。     

中央型腰椎间盘突出症诊治体会

腰椎间盘突出症严重者椎间盘组织破入椎管,形成中央型腰椎间盘突出并马尾神经损伤。作者１９８６～１９９６年共收治３５例此类患者,报道如下。１　临床资料本组３５例,均经手术证实为腰椎间盘突出并马尾损伤,男２８例,女７例;年龄２１～５４岁。病程２个月～４年。诱因：腰扭伤７例;推拿按摩后发病２３例;慢性发病５例,均有腰腿痛病史。突出节段：Ｌ４～５２１例,Ｌ５～Ｓ１９例,Ｌ４～５＋Ｌ５～Ｓ１５例。临床表现：双腿痛３０例,单腿痛５例;下肢及会阴部感觉丧失２７例,下肢或鞍区感觉减退８例;单侧小腿肌力减弱４例,不…     

关于"腰椎间盘突出危象"概念的探讨

[目的]提出“腰椎间盘突出危象”的概念即中央型腰椎间盘突出症出现马尾神经功能障碍，并分析其在临床上对诊断和治疗的指导意义。[方法]收集符合腰椎间盘突出危象诊断的46例中央型腰椎间盘突出症病人进行临床总结分析。[结果]术后随访12—36个月，平均随访24个月，42例马尾神经损伤完全恢复，2例大小便功能恢复，但鞍区麻木、阴茎不能勃起，2例出现大小便部分失禁，鞍区麻木、阴茎不能勃起。[结论]中央型腰椎间盘突出一旦出现腰椎间盘突出危象，即出现马尾神经功能障碍，应早期诊断、早期手术治疗。     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7–, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20–, MUC2–). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

静脉皮瓣成活过程的实验研究

我们以兔为实验动物，通过微循环观察及血管内灌注填充剂，研究静脉皮瓣的成活过程。这一过程可分为２个阶段。第一阶段（术后７２小时内）为静脉血营养期：静脉血由静脉干通过小静脉吻合支、微静脉干间吻合支及终末微静脉吻合支回流至另一静脉。术后４８小时内毛细血管内无血液运动。第二阶段（术后７２小时～６周）为动脉血营养及血管改造期：术后７２小时新生血管开始向皮瓣内生长。术后７２无皮瓣动脉同主要来自皮瓣周围正常组织内的新生血管吻合使动脉血分布于整个皮瓣，这是静脉皮瓣成活的关键     

Management of sequelae of septic arthritis of hip

A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years followup of reconstruction of sequale of septic arthritis of hip joint.     

Catamnestic study of childless patients of the Department of Andrology of Hamburg-Eppendorf University Hosptal

By means of a questionnaire, we carried out a catamnestic study of 1419 patients with a complaint of infertility. 27 per cent of the replying patients reported about the birth of children. 343 patients (38%) reported about one or more conceptions. Compared with previous studies, this investigation shows better results of therapies. We interprete this to be caused in better possibilities of therapy, esp. the Kallikrein therapy.     

主动脉窦瘤破裂外科治疗的临床研究

目的　探讨主动脉窦瘤破裂局部病理改变及其合并主动脉瓣关闭不全的手术方法。方法　 3 6例主动脉窦瘤破裂 (RASV)合并主动脉瓣关闭不全 (AI) 15例、室间隔缺损 (VSD) 2 6例。补片修补 3 5例 ,其中合并VSD的均以一片法修补 ,合并AI的主动脉瓣置换 (AVR) 6例 ,主动脉瓣成形 4例。手术取材作病理检查 5例。结果　本组 3 6例中手术死亡 2例 ( 5 .6% )。存活的 3 4例病人均经门诊复查或通信随访 0 .3～ 18年 ,其中 2例死亡。病理检查见RASV合并VSD的瘤壁为纤维素样坏死或玻璃样变性。结论　主动脉窦壁纤维素样或玻璃样变性可能是其形成的病理基础。合并主动脉瓣关闭不全时应探查其病变程度 ,酌情一期矫正 ,瓣膜损伤明显时宜行主动脉瓣置换 ,对主动脉瓣环细小的病例 ,可借修补VSD和RASV的补片扩大主动脉瓣环。     

骨盆骨折的治疗进展

对于骨盆骨折的治疗 ,传统方法以卧硬板床 ,股骨髁上持续骨牵引 ,骨盆兜等保守治疗为主 ,常常引起下肢不等长 ,骶髋痛 ,步态失常等而严重影响生活质量 ,同时长期卧床易引发肺部感染、褥疮、应激性溃疡、泌尿系统结石等并发症而危及生命。下面就骨盆骨折的治疗进展作一综述。1     

Oddi括约肌肌电活动实验模型的建立

目的建立研究Oddi括约肌肌电活动的动物模型和实验方法。方法将双极金属钩状电极通过浆膜层置入Oddi括约肌，记录不同条件干预下家兔的Oddi括约肌肌电活动信号，调整电生理实验参数并经放大、滤波及计算机处理后，对其大小、波形、幅度进行分析。结果不同条件干预下的家兔Oddi括约肌的肌电活动在波形、频率、幅度等方面均有明显的不同，具有明显的规律性。重复实验可得到相似的结果。结论使用双极金属钩状电极配以合理的电生理实验参数调整可以稳定地采集到在体的家兔Oddi括约肌肌电活动信号。这为今后广泛、深入地研究Oddi括约肌肌电活动搭建了一个技术平台。