目的 探究高压球囊扩张治疗前臂动静脉内瘘血栓的安全性及有效性.方法 选取我院收治的前臂动静脉内瘘血栓患者168例,根据治疗方法将其分为一般球囊组和高压球囊组,每组84例.一般球囊组使用普通球囊进行手术,高压球囊组使用高压球囊进行手术.比较2组患者血红蛋白(Hb)、红细胞分布宽度变异系数(RDW-CV)、红细胞分布宽度(RDW)、血清肌酐(Scr)、血尿素氮(BUN)、血清血小板计数(PLT)、总胆固醇(TC)、三酯甘油(TG)水平.采用生活质量评分量表对患者生活质量进行评价,统计术后3个月开通率及并发症发生情况.结果 治疗后高压球囊组患者Hb、RDW-CV、RDW水平低于一般球囊组(P<0.05);治疗后高压球囊组患者PLT水平高于一般球囊组,TC、TG水平低于一般球囊组(P<0.05);治疗后高压球囊组患者Scr、BUN水平低于一般球囊组(P<0.05);治疗后高压球囊组患者社会生活、焦虑、抑郁、日常生活评分高于一般球囊组(P<0.05);高压球囊组患者术后3个月开通率高于一般球囊组(P<0.05);一般球囊组患者并发症发生率高于高压球囊组(P<0.05).结论 使用高压球囊对前臂动静脉内瘘血栓患者进行治疗,能够改善患者红细胞及PLT水平,增强止血功能,减少肾功能损伤,治疗效果较好,安全性较高.

目的:探讨儿童自体颅骨瓣回植修补颅骨缺损的疗效。方法:回顾性分析2010年1月至2017年12月中国人民解放军陆军第八十一集团军医院收治的儿童自体颅骨回植治疗颅骨缺损19例，Ⅰ期减压术后自体颅骨埋于腹部皮下，4周内Ⅱ期颅骨成形术。近期观察切口并发症，远期(>2年)观察颅骨成形外观及骨瓣稳定性。结果:所有患者骨瓣解剖复位，切口均1期甲级愈合。1例皮下血肿和3例皮下积液均于2周后自然吸收。远期(>2年)颅骨成形外观满意，骨瓣无松动。结论:自体颅骨大骨瓣修补手术难度降低，术后并发症少，具有良好的临床应用价值。

目的 探讨小骨瓣开颅内镜辅助下手术治疗老年急性硬膜下血肿(ASDH)的安全性及有效性.方法 回顾性分析19例老年创伤性急性硬膜下血肿应用小骨瓣开颅内镜辅助下手术清除血肿患者的临床资料;对患者的影像学特点、手术方式及预后进行分析.结果 根据格拉斯哥预后量表(GOS)评分评定预后,本组患者中恢复良好15例、轻度残疾3例、死亡1例(因心肺并发症致死).结论 应用小骨瓣开颅内镜辅助下清除老年急性硬膜下血肿手术方式安全、有效,手术并发症少,值得临床推广使用.

Thromboelastography (TEG) is an internationally recognized method to monitor and evaluate the function of coagulation factors, platelets, fibrinogen and fibrinolytic process, which can reflect the state of coagulation and fibrinolytic function timely and correctly. There are many serious neurosurgery patients with many complications, including acute brain trauma, cerebral hemorrhage and intracranial tumor, such as hematoma progression expansion, postoperative rebleeding, deep vein thrombosis of lower extremity, etc., all need to be monitored by TEG to prevent rebleeding and deep vein thrombosis of lower extremity, and adjust corresponding treatment measures in time, so as to reduce mortality and disability rate. This article reviews the clinical application of TEG in neurosurgery.

脑囊虫病为常见影响中枢神经系统有手术指征的寄生虫病[1],脑内囊虫根据寄生部位可分为 4型:脑实质型囊虫、脑室型囊虫、脑池型囊虫及混合型囊虫[2].脑池型囊虫由于包囊内多无头节,药物治疗效果不如脑实质内囊虫,且囊虫囊泡有逐渐增大的可能,一般采取手术摘除.解放军陆军第八十一集团军医院神经外科收治双侧外侧裂池、视交叉池、颈动脉池、纵裂池、脚间窝池、桥前池内多发性脑池型囊虫病患者 1 例,经一次单骨瓣开颅成功摘除 7 个脑池内 15 颗囊虫,术后恢复顺利,现报告分析如下.

目的 总结改良T形切口大骨瓣减压术后颅骨成形术的经验.方法 回顾性分析2014年6月至2017年1月应用改良T形切口大骨瓣减压术治疗的31例颅脑损伤的临床资料,去骨瓣减压术后8～20周行颅骨成形术,术后随访38～66个月,平均50.2个月.结果 末次随访GOS评分5分22例,4分9例.3例颞肌轻度萎缩,但不影响功能.所有病人额纹对称,切口、皮瓣、头发等生长良好,钛网稳定性良好.结论 改良T形切口大骨瓣减压术可为颅骨成形术创造良好条件.

目的 探讨改良T形切口大骨瓣减压术后颅骨缺损修补的安全性.方法 回顾性分析51例改良T形切口大骨瓣减压术后颅骨缺损病人的临床资料,均行原改良T形切口颞肌下颅骨缺损修补术.术后近期(2周内)观察颞肌肿胀或血肿、切口愈合情况;远期(术后6个月)观察颞肌萎缩、面神经颞支功能、术区皮肤感觉.头颅CTA观察颞浅动脉、颞中横静脉的保存率.结果 术后2周内均未出现颞肌血肿或极度肿胀,切口均一期甲级愈合.术后6个月无颞肌萎缩43例,出现轻度萎缩8例,无明显美容及功能障碍.51例均无面神经颞支功能障碍.术区皮肤感觉正常46例,不同程度麻木5例.头颅CTA示:颞浅动脉双支保留36例(70.6％),额支保留13例(25.5％),顶支保留2例(3.9％).颞中横静脉保留率100％.结论 改良T形切口大骨瓣减压术后颅骨缺损按原切口颞肌下颅骨修补有效避免颞肌及切口并发症,术区神经、血管保存率高,手术并发症少,值得临床应用推广.

目的 探讨前路减压复位融合内固定术及益肾补骨汤对下颈椎骨折脱位合并脊髓损伤的影响研究.方法 选取从2019年1月至2019年12月期间患有下颈椎骨折脱位合并脊髓损伤患者60例作为本次调查对象,随机分为常规组与研究组,30例/组.常规组患者采用前路减压复位融合内固定术治疗,研究组患者则在常规组基础上联合益肾补骨汤共同治疗,比较两组患者临床治疗效果.结果 患者在给予两种治疗方案后,分析和统计两组患者治疗总有效率,常规组为73.3% ,研究组为90% ,差异明显具有统计学意义(P<0.05).结论 针对下颈椎骨折脱位合并脊髓损伤患者的治 疗,采取前路减压复位融合内固定术及益肾补骨汤不仅提供治疗效果,也有利于患者其他并发症发生,对患者康复和生活质量提升具有重要意义.

目的 研究益肾补骨汤结合前路减压复位融合内固定术治疗下颈椎骨折脱位合并脊髓损伤的临床效果.方法 对照组患者采用前路减压复位融合内固定术治疗,观察组在对照组治疗方法的基础上采用益肾补骨汤结合治疗.观察两组患者治疗后的临床效果和并发症的发生情况.结果 两组患者术后的Cobb角距离椎体的水平位移大小较对照组更小(P<0.05).观察组和对照组相比脊髓神经功能改善的效果更好(P<0.05).观察组患者手术后并发症的发生情况较对照组更低(P<0.05).结论 将益肾补骨汤结合前路减压复位融合内固定术治疗下颈椎骨折脱位合并脊髓损伤能促进患者颈椎解剖结构的恢复,改善患者的生活水平,有利于患者预后.

目的:对下颈椎骨折脱位合并脊髓损伤病人应用益肾补骨汤联合前路减压复位融合内固定术的效果进行研讨.方法:将在我院骨科进行住院治疗的50名下颈椎骨折脱位合并脊髓损伤病人按照随机分组的方法,分成两个组别,对照组:病人给予前路减压复位融合内固定术治疗,观察组:病人在前路减压复位融合内固定术的基础上再给益肾补骨汤,治疗结束后将两组治疗结果进行对比分析.结果:观察组病人治疗有效率高于对照组的病人,观察组病人肿痛消失时间腹胀消失时间、骨折愈合时间短于对照组病人,两组病人对比差异显著,有统计学意义(P<0.05).结论:对下颈椎骨折脱位合并脊髓损伤病人除前路减压复位融合内固定术治疗外,益肾补骨汤联合前路减压复位融合内固定术治疗效果更好,可以提高患者生活质量,在临床中起显著作用.

脑干出血具有起病急、病情重、病情进展迅速的特点,多在1～2 d内死亡,预后不良,死亡率高[1-3].因为脑干是生命的中枢所在,包涵大量神经核团和纤维结构,几乎参与中枢神经系统的所有重要功能[4].过去认为桥脑出血手术风险高,救治成功率低,随着显微外科技术的发展,有文献报道采用微创手术治疗脑干出血取得了满意的效果[5-7].

脑干出血具有起病急、病情重、病情进展迅速的特点,多在1～2d内死亡,预后不良,死亡率高[1-3],因为脑干是生命的中枢所在,且包涵大量神经核团和纤维结构,几乎参与中枢神经系统的所有重要功能[4].过去认为桥脑出血手术风险高,救治成功率低[5-7],随着显微外科技术的发展,有文献报道采用微创手术治疗脑干出血取得了满意的效果[8-11].我科近期收治1例脑干出血患者,在神经电生理监测(neurophysiological monitoring,NPM)下行微创血肿清除术,治疗效果良好,现报告如下.

目的 探讨超早期经中央沟下点入路治疗伴意识障碍快速进展的外侧裂后部脑内血肿的手术经验.方法 回顾性分析17例伴意识障碍快速进展的外侧裂后部血肿病例资料,均超早期经中央沟下点手术清除血肿并行外侧裂探查.分析血肿清除率,侧裂探查情况,术后意识转归与随访情况.结果 血肿清除率(97.4±0.7)％.14例脑疝病人术后瞳孔全部恢复正常.平均手术时间(2.8±0.7)h.术后第1日GCS(7.5±2.1)分,术后3个月GCS(11.4±1.7)分.截止最后随访日期,根据格拉斯哥预后量表(GOS):重度残疾1例,中度残疾6例,恢复良好10例.结论 经中央沟下点入路治疗外侧裂后部血肿安全可靠,不仅能够彻底清除血肿,而且能很好地处理破裂的大脑中动脉分叉部动脉瘤.

Objective To investigate the therapeutic effect of CT-guided stereotactic minimal invasive and drainage for hypertensive cerebellar hemorrhage.Methods 46 patients with hypertensive cerebellar hemorrhage which hospitalized in 251 hospital of PLA from January 2013 to J un 2016 were selected,the amount of bleeding was 10～20 ml,they divided into the stereotatic group and craniotomy group according to the random number table method,23 patients in each group.The stereotatic group was given CT-guided stereotactic minimal invasive and drainage treatment,after operation,poured urokinase into the hematoma to dissolved it.The craniotomy group was performed posterior cranial fossa craniotomy after general anesthesia and the hemotoma was removaled by the microsurgery,after operation,the hemostasis,dehydyation etc were given to the patients.Results The average hospitalization days of the stereotatic group was significantly shorter than the craniotomy group (P =0.01).The postoperative complication of the stereotatic group less than the craniotomy group(P=0.03).The emptying time of hematoma of the stereotatic group langer than the craniotomy group (P =0.04).The ADL classification after six months treatment of the stereotatic group no statistical difference with the craniotomy group (P=0.33).Conclusion The stereotactic minimal invasive and drainage for cerebellar hemorrhage could achieve considerabl reset effect compare with the posterior cranial fossa craniotomy,and it was accurate positioning,little injury,less complication,shorter hospitalization and so on.The stereotactic minimal invasive and drainage for hypertensive cerebellar hemorrhage is worthy for the clinical popularization and application.

Objective To investigate the therapeutic effect of CT-guided stereotactic minimal invasive drainage for little hypertensive cerebral hemorrhage of basal ganglia region. Methods One hundred and ten patients with little hypertensive cerebral hemorrhage of basal ganglia region which hospitalized in 251 hospital of PLA from January 2013 to December 2015 were selected, the amount of bleeding was 20-30 ml, divided into the operation treatment group and conservative treatment group according to the random number table method, 55 patients in each group. The operation treatment group was given CT-guided stereotactic minimal invasive and drainage treatment, after operation, poured urokinase into the hematoma to dissolved it. The conservative treatment group was given internal medicine treatment alone. Results The emptying time of hematoma of the operation treatment group [(5.40±0.87) d] was significantly shorter than the conservative treatment group[(22.07 ±2.79) d] (P=0.001). The average hospitalization days of the operation treatment group [(19.35 ±3.67) d] was significantly shorter than the conservative treatment group [(23.26 ±2.80) d] (P<0.05). The ADL classification of the operation treatment group (81.82%) which six months after treatment was excelled than the conservative treatment group (58.18%) (P<0.05). Conclusion Thestereotactic minimal invasive and drainage for little hypertensive cerebral hemorrhage of basal ganglia region were effective, with little injury, shorter hospitalization, supernal security, which can relieved the stress to important nerval tissue and ease the progressive injury and promote rehabilitation of function in the early. Thestereotactic minimal invasive and drainage for little hypertensive cerebral hemorrhage of basal ganglia region is worthy for the clinical popularization and application.

目的 探讨改良T形切口开颅术治疗重型颅脑损伤合并上矢状窦损伤的疗效.方法 回顾性分析2014年3月至2015年12月改良T形切口开颅术治疗的9例重型颅脑损伤合并矢状缝损伤的临床资料.结果 6例术后24 h恢复意识;3例早期行气管切开术,术后1周内生命体征逐渐平稳,其中2例气管切开术病人4周内意识逐渐恢复,成功拔除气管插管,但有动眼神经损害、肌张力障碍及肢体轻瘫,另1例气管切开术后1周生命体征稳定后转回当地医院治疗,但因创伤及营养消耗等致并发症,死于多脏器功能衰竭.出院后随访3～18个月,根据GOS评分:恢复良好6例,中残2例,死亡1例.结论 采用改良T形切口开颅术治疗重型颅脑损伤合并上矢状窦损伤效果满意.

Objective To investigate the clinical feature of traumatic progressive intracranial hematomas and summarize its occurrence, mechanism, diagnosis and treatment. Methods Restrospectively analysed 97 cases of traumatic progressive intracranial hematoma hospitalizd in our hospital from Jan. 2011 to Dec. 2015. Results There are 97 cases traumatic progressive intracranial hematomas in total traumatic intracranial hematomas, the morbidity is 15.3%, 63 patients treated with operation in which 7 patients died; 34 patients treated without operation in which 1 patient died, the mortality rate is 8.2%. Conclusion It is very important to recognize the progressive intracranial hematoma and it is mistaken to draw up a invariable cure plan only according to the first CT scan of head. It is right to regulate the cure plan according to the changes of the patient’s hematomas and observe the changes of patients and to supervise the CT scan of head. Key words: Traumatic brain injury; Intracranial hematoma; Coma; Epidural hematoma

目的 探讨64排容积CT用于重型颅脑损伤合并颅面部骨折的优势.方法 收集整理112例重型颅脑损伤合并颅面部骨折进行64排容积CT检查并重建成像的临床资料.结果 所有患者均显示颅骨及颅面部骨折,MPR 图像的显示率为100%;VR图像及轴位图像逐渐减低,通过一站式检查,全面检查颅脑损伤及颅面部骨折,能够通过图像旋转、切割等功能从不同方向观察骨折的位置、范围、骨碎块的移位,了解骨折线的走行及外伤所致的畸形情况.结论 64排容积CT并重建成像对重型颅脑损伤合并颅面部骨折的诊断治疗具有很高的临床应用价值,能够提高对深部细微骨折的显示,尤其对于昏迷患者在治疗颅脑损伤的同时,可及时有效地配合五官科医师解决颅面部骨折,早期达到全面有效治疗的优势.

患者男,52岁.双下肢麻木、腰痛4年,加重伴进行性双下肢活动障碍半年入院.查体:胸腰段左侧棘突压痛明显,放射至右髂嵴,双髂前上嵴连线向下皮肤痛温觉减退,右大腿中下1/3以下皮肤痛温觉消失,左足掌痛温觉消失.左下肢肌力Ⅰ级,右下肢肌力Ⅱ+级,双下肢肌张力高,踝振挛阳性,巴氏征阳性.MRI:T8～10椎管内左侧硬膜外不规则稍长T1稍长T2占位,2.9 cm ×1.8 cm×5.3 cm,局部沿T9-10左侧椎间孔生长,椎间孔扩大,显著均匀强化,肿物上下缘脊膜增厚、强化,上下缘蛛网膜下腔呈袖口状变窄,脊髓受压右移(图1a,b)。

目的探讨在腹腔镜、脑室镜综合辅助下对脑积水进行脑室腹腔分流术在减少术后并发症方面有何优势,并与脑室镜辅助下进行、腹腔镜辅助下进行和传统手术相比。方法对2003-01~2009-05 383例脑室腹腔分流术进行回顾性分析,所有病例均用分流管,其中67例在腹腔镜、脑室镜铺助下进行,98例在腹腔镜辅助下进行,87例在脑室镜辅助下进行,131例为常规手术治疗。并对所有患者进行1~2 a的随访,观察术后分流管堵塞率,术后感染发生率。结果腹腔镜+腹腔镜组感染率4.5%,脑室镜组感染率4.6%,腹腔镜组感染率4.1%,传统手术组感染率4.6%,4组比较差异无统计学意义(P>0.05)。分流管梗阻率腹腔镜+腹腔镜组1.4%,脑室镜组5.1%,腹腔镜组3.4%,传统手术组16.0%,4组比较差异有统计学意义(P<0.05)。结论在腹腔镜、脑室镜综合辅助下对脑积水进行脑室腹腔分流术安全可靠,与常规乎术相比降低了分流管梗阻的发生率,从而改善预后且延长分流管有效作用时间。