不同剂量异丙酚,咪唑安定和依托咪酯对上肢短潜伏其体感诱…

目的：观察３组不同剂量静脉麻醉药异丙酚、咪唑安定、依托咪酯对上肢短潜伏期体感诱发电位（ＳＬＳＥＰ）影响。方法：９０例择期手术患者，随机分成３组，每组再随机分为３个不同剂量组，分别单次静脉注射异丙酚１．５、２、３ｃｍ／ｋｇ，咪唑安定０．２、０．３、０．４ｃｍ／ｋｇ，依托咪酯０．１５、０．３、０．４ｃｍ／ｋｇ，观察用药后对ＳＬＳＥＰ的影响。结果：异丙酚组均对ＳＬＳＥＰ的Ｎ１４、Ｎ２０潜伏期在ＣＣＴ无明     

正常人前臂内侧皮神经感觉传导研究

首次研究应用逆向法测定正常人前臂内侧皮神经短潜伏期体感诱发电位（ｓｈｏｒｔ ｌａｔｅｎｃｙｓｏｍａｔｏｓｅｎｓｏｒｙ ｅｖｏｋｅｄ ｐｏｔｅｎｔｉａｌｓ），并研究其感觉动作电位（ｓｅｎｓｏｒｙ ｎｅｒｖｅ ａｃｔｉｏｎ ｐｏｔｅｎｔｉａｌ）。方法：（１）ＳＮＡＰ：肱骨内上髁前外侧平均２．６ｃｍ处表面双极刺激，前臂军面内侧平均１０．３ｃｍ，处记录ＳＮＡＰ． （２）ＳＬＳＥＰ：上述刺激位置不变，用四道程记录锁骨上、颈_７棘突、对侧顶区（Ｐ_３／Ｐ_４）相应的Ｎ_９、Ｎ_（１３）、Ｎ_（２０）诱发电位。通过分别对Ｎ_９、Ｎ_（１３）、Ｎ_（２０）的潜伏期、Ｎ９－Ｎ（１３）峰间潜伏期与臂长的相关分析，认为峰间潜伏期及自身双侧对照的潜伏期差值和波幅比值为临床可靠指标，可望对胸廓出口综合征（ＴＯＳ）早期诊断有指导意义。     

含指背感觉支全指背岛状皮瓣

我们采用合指神经背侧支的全指背离状皮瓣，转移修复邻指或隔指的全部或大部分常侧面皮肤缺损４例６指获得成功．皮瓣全部成活。此皮瓣可切取面积为２～３ｃｍ×６～７ｃｍ间，由于带感觉支．皮瓣感觉恢复时开始出现痛觉过敏，半年后痛觉恢复正常，但位置觉仍有双重感。     

胸椎硬膜外脓肿1例报告

患者,男,３８岁。胸背部疼痛１０天伴双下肢瘫,大小便困难３天,于１９９５－０１－０９入院。入院２０天前,腰骶部患疖病。体检：患者抬入病房,Ｔ９－Ｔ１２棘突叩击痛,脐以下痛觉消失,腹壁反射消失,马鞍区感觉麻木,提睾反射及肛门反射消失,双下肢肌张力增高,肌力３级,膝跟腱反射亢进,踝阵挛阳性巴彬斯基征阳性。Ｘ线平片Ｔ７－Ｌ２未见异常。ＣＴ示Ｔ９－１０椎管内０６ｃｍ×０．８ｃｍ大小的类圆形高密度影。体温３６９℃,白细胞２４３×１０９／Ｌ,分叶０９,淋巴　收稿日期：１９９９０２１５０１,血沉…     

恶性胰岛细胞瘤脾转移1例

患者女,４５岁。发现左上腹包块２个月,于１９９８年１１月２日入院。体查：左上腹可扪及一约４ｃｍ×３ｃｍ×３ｃｍ大小包块,表面光滑,边界不清,肝肋下２ｃｍ,无触痛。白细胞７４×１０９／Ｌ,中性粒细胞０８５,血小板１９９×１０７／Ｌ,血糖５３ｍｍｏ...     

腰椎硬脊膜腔内畸胎瘤一例报告

患者男,５８岁。因腰痛、两下肢麻木、无力６个月,加重２个月,于１９９９年５月２０日入院。查体：一般情况可,行走困难,步幅小。四肢、脊柱无畸形,下腰部活动中度受限,步态蹒跚,肌力４级稍弱,未引出明显的病理反射。Ｘ线检查显示,脊柱退行性改变。ＣＴ片示Ｌ４-５椎管明显扩大,硬膜囊有不规则的低密度块影,ＣＴ值９２～１０９Ｈｕ,脊髓呈不同程度受压;ＤＡＳ造影检查可见Ｌ４-５椎管内有２．３ｃｍ×５．５ｃｍ大小的充盈缺损区（图１）。ＣＴ及造影检查均未发现骨质破坏。初步诊断为：Ｌ４-５椎管内肿物,性质待查。手术切除时见肿瘤位于Ｌ…     

电烧伤致脊髓及面神经损伤一例

男,３８岁。被１万伏高压电击伤后２ｈ入院。伤后曾有短暂昏迷,醒后烦躁不安。查体：右枕部、耳后头皮Ⅲ度焦痂,有４ｃｍ×４ｃｍ颅骨外露,右背部肩胛区１０ｃｍ×１５ｃｍ焦痂,中央有３ｃｍ×３ｃｍ创口,右颈部及右背部有小片深Ⅱ度烧伤创面。入院后给予抗炎、脱水、止血、营养等治疗。次日行颅脑ＣＴ检查未见异常。伤后第２天,患者出现左侧鼻唇沟变浅,口角下垂、眼裂增大,味、听觉正常;双侧腹股沟平面以下浅感觉减退,伴麻木感,深感觉正常,双上肢感觉正常,四肢肌力均Ⅰ级,肌张力低,深反射消失,病理反射未引出;大小便失禁…     

拇指背动脉逆行岛状皮瓣的改进及应用

自１９９２年以来，采用拇指背动脉为蒂的逆行岛状皮瓣修复指端缺损６例，均获成功。皮瓣为１．５ｃｍ×２ｃｍ～４ｃｍ×３．５ｃｍ。经随访，拇指外形好，关节活动不受限，有痛觉恢复。手术的改进要点是：供区为第１、２掌骨背侧，不需切断拇短伸肌健。操作更简单，术后功能恢复快。     

外固定器加冲洗治疗伴大面积创面感染的骨折

我们从１９８３年４月～１９９３年４月治疗７４例合并大面积创面感染的开放性骨折，男４８例，女２６例，年龄４～５６岁，平均年龄３８．５岁。合并感染创面最小面积２６ｃｍ×１１ｃｍ，最大面积４９ｃｍ×１６ｃｍ，平均面积２３ｃｍ×２３．２８ｃｍ。创面合并绿脓杆菌感染２４例，气性坏疽感染１８例，金黄色葡萄球菌感染２２例，合并大肠杆菌感染１０例。其中１组２０例采用湿敷换药加石膏外固定；２组２８例采用牵引加冲洗疗法；３组２６例采用单侧沟槽式外固定器加冲洗疗法。其中第３组全部治愈，可早期活动关节及行走锻炼，住院时间短，除针眼感染外，无其他并发症，疗效优于１组和２组。     

腰椎间盘突出症合并上位椎弓根骨嵴一例

××，男，２３岁。腰腿痛１年余，左大腿肌肉萎缩，间歇性跛行８月。查体：膝上１０ｃｍ周径左侧较右侧小３．５ｃｍ，肌张力，　趾背伸肌力，膝腱反射皆左侧减弱。腰椎正侧斜位片正常。椎管造影：腰４、５处油柱明显狭窄，椎管前缘发现较深弧形压迹，双侧神经根未完全充盈，腰３、４前缘亦显小弧形改变，斜位神经根未见明显受压。手术医师阅片发现正位片上碘油柱于腰３推弓根内侧有１×０．３ｃｍ梭形透光环，同一水平有推弓根内侧有１×０．３ｃｍ弧形透光环，界限清楚，其中心密度与碘油柱相同。ＣＴ示：腰３、４及腰４、５椎间盘向后突…     

家犬马尾及其受压模型的建立

目的:观察家犬腰骶部神经结构与人类马尾的异同点,建立与人类马尾受压类似的动物模型,研究其病理变化。方法:废弃家犬4只经颈静脉加压灌注后,自后侧入路剖开腰骶椎管,测量椎管的直径及硬膜外间隙,观察马尾神经的组成及走行。2只家犬麻醉后自L6椎板潜行置入水囊,关闭注水,用诱发电位和MR检测。结果:犬的腰椎共有7节,椎管在L6水平横径为1.4~1.6 cm,前后径1.2~1.4 cm,硬膜外间隙约0.2 cm,共计5对神经根围绕在终丝斜向外下形成马尾。脊髓圆锥下端平L6水平。在L5,6椎板下,硬膜外间隙置入硅胶水囊后,在未注水加压时,犬的行为学及诱发电位均无改变;逐渐注水后随着压力的上升,行为学及诱发电位均有相应的改变。MR可以显示相对应的水囊所占椎管的容积。结论:家犬马尾与人类的相似,硅胶水囊置入和注水法,重复性好,动物生存率高,可以成功建立马尾慢性压迫模型。     

Posterior epidural migration of a lumbar disc fragment causing cauda equina syndrome: Case report and review of the relevant literature

Posterior epidural migration (PEM) of free disc fragments is rare, and reported PEM patients usually presented with radicular signs. An uncommon case involving a patient with cauda equina syndrome due to PEM of a lumbar disc fragment is reported with a review of the literature. The patient described in this report presented with an acute cauda equina syndrome resulting from disc fragment migration at the L3-L4 level that occurred after traction therapy for his lower back pain. The radiological characteristics of the disc fragment were the posterior epidural location and the ring enhancement. A fenestration was performed and histologically confirmed sequestered disc material was removed. An early postoperative examination revealed that motor, sensory, urological, and sexual functions had been recovered. At late follow-up, the patient was doing well after 18 months. Sequestered disc fragments may occasionally migrate to the posterior epidural space of the dural sac. Definite diagnosis of posteriorly located disc fragments is difficult because the radiological images of disc fragments may mimic those of other more common posterior epidural lesions.     

腰椎间盘突出症伴马尾神经综合征

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：对15例患者的临床资料及随访结果进行分析。结果：平均随访3年6个月，全部病例都有不同程度的恢复。其中Kostuik A型2例完全恢复，4例不全恢复；B型7例完全恢复，2例不全恢复。结论：该综合征是由压迫本身及压迫致马尾神经瘀血，水肿，影响脑脊液循环及血供障碍引起，一经确诊应尽早手术减压。急性完全性损伤预后较差，慢性不全损伤预后好。     

伴有马尾神经松弛影像学改变的腰椎椎管狭窄症患者手术疗效

目的探讨伴马尾神经松弛影像学改变的腰椎椎管狭窄症患者的临床特征及手术效果。方法收集2016年9月—2017年9月接受手术治疗的16例影像学上存在马尾神经松弛改变的腰椎椎管狭窄症患者的临床及影像学资料。16例患者腰椎MRI均可见狭窄节段上方马尾神经迂曲成团,均行常规腰椎后路椎板减压椎间植骨融合内固定术治疗,其中3例患者因术中硬膜撕裂行硬膜内探查。记录所有患者术前与术后3个月的日本骨科学会(JOA)评分评估手术疗效。结果所有患者术后腰痛及下肢放射痛等症状均缓解,无并发症发生。3例患者硬膜内探查可见马尾神经迂曲成团,无粘连及占位。16例患者术后3个月JOA评分为9～14(12.56±0.75)分,较术前4～9(7.44±0.73)分明显改善,差异有统计学意义(P 0.05)。其中6例患者术后3个月复查腰椎MRI,显示马尾神经迂曲成团现象消失。结论马尾神经松弛是腰椎椎管狭窄症发展进程的一部分,椎管内马尾神经迂曲成团是导致其影像学改变的原因。治疗腰椎原发病可以获得较好的治疗效果,不需要松解马尾神经,也不必担心马尾神经松弛现象。     

腰椎间盘突出症合并马尾神经损伤(附26例报告)

方法：采用椎板切除及带蒂复合体回植成形髓核摘除术治疗腰椎间盘突出症合并马尾神经损伤２６例。结果：平均随访５年８个月，腰腿痛症状完全消失１４例，部分缓解１２例；马尾神经功能完全恢复８例，未恢复５例；下肢肌肉瘫痪的１８例中，肌力完全恢复１２例，未恢复２例。结论：本病预后与马尾神经损伤程度及手术减压是否彻底有关，马尾神经损伤程度与突出物大小、突出速度及病程长短有关。腰椎管狭窄是本病的前置因素，继发性、粘连性马尾神经炎是影响马尾神经功能恢复的重要原因。本病一旦确诊应尽早手术。带蒂复合体回植成形髓核摘除术优于全椎板切除术     

马尾神经功能障碍型腰椎间盘突出症的诊断与治疗

目的：介绍合并有马尾神经功能障碍的腰椎间盘突出症的诊断与治疗方法。方法：发生马尾神经功能障碍型腰椎间盘突出症的病人，大多为青壮年，强体力劳动者或体育运动员，因急性腰扭伤而发病。受伤后出现瘫痪症状和马鞍区麻痹、大小便失禁等现象，经X线拍片、CT和MRI检查，明确诊断后，应立即进行手术治疗。结果：作者报告10例，均经关节突间或半椎板切除入路，切除巨块型椎间盘，彻底减压马尾神经，术后均能得到良好的功能恢复，疼痛消失，唯大小便的功能恢复较迟，约在术后1～3周后尚能恢复。结论：马尾神经功能障碍型腰椎间盘突出症，应与马尾肿瘤相鉴别，一旦被确诊为巨块型腰椎间盘突出症，就应立即进行手术治疗，越早手术效果越好。     

Metastatic Grawitz's tumor to the cauda equina: case report

A case of Grawitz's tumor metastasizing to the cauda equina is presented. A 51-year-old male was hospitalized due to severe low back pain radiating to the left lower extremity. Neurological examination showed only hyporeflexia of the left patella reflex and positive Lasegue's sign. MRI showed intradural mass at the L4 level. Preoperatively, we diagnosed a cauda equina tumor. A laminectomy of both L3 and L4 was performed, and total removal of the cauda equina tumor was performed. Microscopically, the tumor cells were large, the appearance of the cytoplasm ranging from optically clear with sharply outlined boundaries, to deeply granular, with many transitional forms. These histological findings were typical findings of Grawitz's tumor, and were the same as those of this patient's renal tumor. Finally, we diagnosed Grawitz's tumor metastasizing to the cauda equina. Metastatic cauda equina tumor from outside the central nervous system is very rare and only 7 cases have been reported. This case is the first one of Grawitz's tumor spreading to the cauda equina.     

Posterior epidural migration of an extruded free fragment from a lumbar disc herniation

The majority of symptomatic lumbar disc herniations are located in a posterolateral position with resultant nerve root compression. Although caudal, rostral and lateral migrations of disc fragments are common, posterior epidural migration of an extruded free fragment from a lumbar disc herniation is a rare occurrence and sometimes may cause a dural sac compression with cauda equina syndrome. This retrospective case report describes a 63-year-old man with intractable lower back pain and cauda equina syndrome. Emergency magnetic resonance imaging (MRI) revealed a posterior epidural soft tissue compressing the dural sac. The lesion was hypointense on T1-weighted images, hyperintense on T2-weighted images and showed rim enhancement after intravenous injection of gadolinium. A laminectomy at L3 was performed and the extruded disc fragment was removed with dural sac decompression. Postoperatively the patient's radicular symptoms completely resolved. At the 2-year follow-up visit, the patient had recovered full motor, sensory and urinary functions. MRI is the modality of choice in the evaluation of an extruded free disc fragment and a cauda equina compression. In such cases a wide decompressive laminectomy is recommended. Received: 13 November 2000; Accepted: 4 December 2000     

Intrathecal paraganglioma of the cauda equina

A 33-year-old obese woman with chronic pain in her lower back presented with weakness of her right quadriceps and diminution of her patellar reflex. Her myelogram revealed an intradural oval mass at level of the interspace between her 3rd and 4th lumbar vertebrae. Operation disclosed an encapsulated mass attached to her filum terminale. Histopathological examination showed a paraganglioma with typical dense core granules, confirmed by electron microscopic examination. We report our patient to call attention to intrathecal paragangliomas as a rare and treatable cause of the cauda equina syndrome.     

急性重度犬马尾压迫模型诱导脑源性神经营养因子的合成

目的研究实验性犬急性重度马尾神经压迫48h的相关脊髓和背根神经节(dorsal root ganglion,DRG)内脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)蛋白表达水平。方法成年雄性杂种犬(n=8),随机分为实验组和对照组。实验组(n=4)行多重马尾压缢,其中第1根束缢线使整个马尾束缢了50%~75%,另3根束缢线使马尾束缢了25%~50%。对照组(n=4)仅行马尾暴露而未行马尾束缢。于术后48h取相应脊髓及DRG行HE染色、BDNF的免疫组织化学分析。结果多重马尾束缢后48h可在相应下腰骶髓和DRG神经元群体内诱导出显著的BDNF增量调节;而脊髓、DRG和神经纤维内相关结构亦见BDNF阳性表达。结论多重马尾束缢犬模型形成急性重度马尾综合征(cauda equine syndrome,CES)时,BDNF可能有神经保护作用和炎性痛、神经痛的作用。