[目的]探讨胸椎结核伴截瘫患者手术后神经恢复的影响因素.[方法]回顾性分析2014年4月～2019年4月本中心收治的45例胸椎结核伴截瘫患者的临床资料.其中男23例,女22例,年龄17～80岁,平均(57.33±15.12)岁.术前脊髓损伤美国脊髓损伤协会分级(American Spinal Injuy Association,ASIA)A级1例,B级30例,C级4例,D级10.所有患者均行胸椎后路手术治疗.[结果]术后随访18～48个月,平均(31.80±8.12)个月.至末次随访时,23例神经功能完全恢复(complete recov-ery,CR),22例神经功能未完全恢复(incomplete recovery,IR).单项因素比较表明:CR组年龄显著小于IR组(P＜0.05),CR组术前瘫痪时间显著短于IR组(P＜0.05),CR组术前ASIA分级轻于IR组(P＜0.05),CR组影像学脊髓压迫程度显著轻于IR组(P＜0.05).二元多因素逻辑回归分析结果表明,神经功能不完全恢复的独立危险因素是高龄(OR=1.262,P=0.009)、术前瘫痪时间长(OR=1.122,P=0.014)、ASIA分级重(OR=11.494,P=0.010)、术前脊髓压迫程度重(OR=14.087,P=0.038).[结论]影响胸椎结核伴截瘫患者术后截瘫恢复的危险因素包括术前瘫痪时间长、术前ASIA分级低、影像学脊髓压迫程度重、耐药结核.尽早手术、充分减压、矫正后凸畸形、基于药敏试验的个体化化疗对截瘫恢复具有重要意义.

目的 观察不同因素对经口内镜下肌切开术(peroral endoscopic myotomy,POEM)治疗效果的影响.方法 回顾性分析2014年11月至2015年5月解放军总医院消化科诊断为贲门失弛缓症(achalasia,AC)并接受POEM治疗的42例患者的临床资料,总结并分析影响POEM效果的因素.结果 术前Eckardt评分、年龄均与症状缓解呈负相关;芝加哥分型Ⅱ型及Ling Ⅰ型患者疗效最佳;初治较经治患者疗效好;短隧道及标准隧道、渐进式全层切开、肌切开长度等因素对POEM疗效无显著影响.结论 术前Eckardt评分(＜6分)、年龄(＜60岁)、芝加哥分型Ⅱ型、Ling分型Ⅰ型及初治的患者为预后良好的预测指标,手术方式的选择需个体化,不作为预测指标.

Objective To analyze the MR manifestations and differential diagnosis of nontraumatic spinal epidural hematoma. Methods 10 patients with nontraumatic spinal epidural hematoma were performed MR plan scan, 7 of which enhanced. 9 cases were proved by surgery and pathology and 1 case were proved by follow up. Results Hematoma occurred in cervical level in 4 cases, cervical-thoracic level in 3 cases and thoracic level in 3 cases. Hematoma were located in the dorsal of spinal cord in 7cases, located in the ventral of the spinal cord in 1 case and both in 1 case. The hematomas in 7 cases were spindle-shaped, 2 were strip-shaped and 1 was oval. Vessel bleeding were found in 2 case, angioma in 2 case and AVM in 1 case by surgery. Hematoma were demonstrated slight hyper intensity on T1WI and slight hypo intensity on T2WI in acute phase. In subacute phase, hematoma showed iso- or hyper signal intensity on T1WI, hypo-or hyper intensity on T2WI, and isointensity on both sequences in chronic phase. The enhanced pattern was different towards period and different reason. Conclusions MR is valuable in diagnosing the nontraumatic spinal epidural hematoma with presenting the extend of lesions precisely, judging the phase of hematoma correctly and help in analyzing the reason some degree.

目的比较两种磁共振胰胆管成像技术屏气采集法与呼吸导航采集法的优劣。方法分析117例同时用屏气与呼吸导航两种方法进行MRCP检查的患者图像,对两种MRCP采集方法的图像质量、显示胰胆管的解剖结构及病变的清晰度进行比较。结果117例中91例确诊为胰胆管病变,26例为正常,两种方法获得的图像质量及对胰胆管系统各解剖结构显示差异均无统计学意义(P>0.05)。屏气采集多用于患者配合较好时,其原始图像对病变显示优于呼吸导航,呼吸导航采集多用于患者配合不佳甚至无意识时,其3D重建图像优于屏气。结论这两种方法用于胰胆管病变检查各有优势,在工作中可将这两种方法针对不同情况的患者结合使用,以达到最佳的检查效果。

目的探讨数字化X线摄影(Digital radiography,DR)系统的双能量减影(Dual-energy sub-traction,DES)在泌尿系成像中对泌尿系结石诊断和治疗的临床价值。方法使用美国GE公司-Definium6000数字摄影系统,对168例泌尿系阳性结石患者行腹部DR双能量减影检查,每例患者分别获得其腹部平片的DR标准图像、双能量减影软组织像和双能量减影骨组织像,比较腹部平片DR标准图像和DR双能量减影骨组织图像对泌尿系结石的显示率。结果159例患者的双能量减影骨组织像可清晰直观地显示结石的部位、大小、形态。结论DR双能量减影对泌尿系结石的定性和定位诊断更为明确,对体外碎石和手术方式有指导性作用,可明显减少结石残留率。

目的探讨脑囊虫病的磁共振表现及误诊原因,提高对脑囊虫病的认识。方法经病理活检或临床确诊的曾经误诊的脑囊虫病6例,回顾分析其MR影像学表现。结果多发病灶4例、12个,单发病灶2例,均位于额顶叶皮髓质交界区,5个病灶T1WI囊液信号高于脑脊液,T2WI呈高信号,9个病灶T2WI显示囊内容物呈低信号,或高低混杂信号。病灶周围均可见水肿带,并呈环形强化。4例误诊为转移瘤,2例误诊为脑脓肿。结论MR是诊断脑囊虫病的重要检查方法,重视流行病学,提高对MR征象的认识,可以避免误诊。

Objective:To study the effects of intradiscal injected collagenase on a novel sheep model of intervertebral disk herniation and degeneration and reevaluate the mechanism of chemonucleolisis.Methods:Sheep lumbar intervertebral disks were surgically injured 10 weeks before intradiscal injection of collagenase,inducing disk displacement and degeneration.Disk height index on radiography and histological changes were studied 1 day,1 week,2 weeks,4 weeks,12 weeks after intradiscal injection of collagenase.Results:Chemonucleolysis effects of collagenase on degenerative intervertebral disks tissue were similar to normal disk tissue.Collagenase can dissolve nucleus pulposus in the center of model disks and protrusion sites simultaneously while only central portion and inner annulus fibrosus was dissolved in normal disks.Endplates in normal disks were destroyed more severe than that in model disks after collagenase injection.The staining properties with Safranin-O staining of the nucleus pulposus in model disks was similar to that in normal disks before collagenase injection,but diminished after injection.Conclusions:Collagenase can dissolve nucleus pulposus in the center and protrusion sites of sheep intervetebral disc hernitiation model.Collagenase does not destroy the degenerative disk matrix ability to regenerate after 12 weeks.

Objective To study the effects of intradiscal injected collagenase on a novel sheep model of intervertebral disk displacement and degeneration and speculate the reason of pain response after chemonucleolysis. Methods Sheep lumbar intervertebral disks were surgically injured,inducing disk displacement and degeneration 10 weeks before intradiscal injection of collagenase. Disk height index on radiography and histological changes were studied 1 day,1 week,2 weeks,4 weeks,12 weeks after intradiscal injection of collagenase. Results Collagenase has chemonucleolysis effects on degenerative intervertebral disks similar to normal disk tissue. Collagenase can dissolve nucleus pulposus in the center of model disks and protrusion sites simultaneously while only central portion and inner annulus fibrosus was dissolved in normal disks. Endplates in normal disks were destroyed more severe than in model disks after collagenase injection. Conclusion Collagenase can induce chemonucleolysis in model disks and dissolve nucleus pulposus in the center and protrusion sites. Endplate injuries might be the main reason for pain response after chemonucleolysis.

Objective To develop a novel sheep model of intervertebral disk displacement forstudying intradiscal therapy. Methods 9 adult sheep were randomly divided into 3 groups according to thetime to be sacrificed, 6 intervertebral disks of each sheep were randomly and equally divided into controlgroup and model group. Left anterolateral annulus fibrosus of intervertebral disks in model group werepartial resected with 2.5mm-diameter-hole saw in depth of 5mm. Disk height index of intervertebral diskson X-ray films, areas and average T2 relaxation time of high intensity zone of disks on T2-weight MRI andhistological score on pathological sections (HE staining, Masson staining and safranin O-fast greenstaining) were measured at 2 months, 4 months and 6 months after operation. The morphology of interver-tebral disk displacement at the injured sites was also observed on axial T2-weight MRI and pathologicalsections. Results The structure and histology of sheep is similar to humans. Disk height index of modelintervertebral disks on X-ray films, areas and average T2 relaxation time of high intensity zone of modeldisks on T2-weight MRI decreased significantly (P<0.01, vs control); histological score of model disksincreased significantly (P<0.01, vs control) at 2 months, 4 months and 6 months after operation. Above-mentioned indices aggravated gradually during 2-6 months after operation, but had no significant differenceamong 2 months, 4 months and 6 months after operation. The outermost 1/3 annulus defect showed theability to heal, the defect induced by the hole saw led initially to deformation and bulging of the collagenbundles, eventually to inner extension of the tear and complete failure, nucleus pulposus protruded into theinner 2/3 defect. Conclusion A novel sheep model of intervertebral disk displacement can be developedby partial resection of anterolateral annulus fibrosus with 2.5mm-diameter-hole saw in depth of 5mmquantitatively, which is simple, rapid, effective and reproducible.

Objective To discuss the MRI manifestation of pial neurocysticercosis.Methods Twenty-eight patients with pial neurocysticercosis verified by clinic were retrospectively studied.All patients were performed with plain MR scan and contrast enhancement.Results There were 120 lesions found in subarachnoid space.Typical MRI manifestations like parenchymal neurocysticercosis were found in lesions located in the sulcus and longititudinal fissure cistern.They could be identified as active stage,degenerative and necrotic stage,calcific stage.The MRI manifestations of the lesions located in lateral sulcus and basal cisterns were atypical and could be divided into larger cysts and racemose.Conclusion The manifestations of pial neurocysticercosis are complicated and various.It is important to recognize its typical and atypical manif1estations corretivelyin in diagnosis and therapy.

Objective:To study the clinical value of three-dimension reconstruction technique with MR in spinal scoliosis.Methods:SE T1-weighted MRI and FSE T2-weighted MRI of 16 patients with spinal scoliosis were obtained,the whole spine deformity and spinal cord were showed on one MR image by three-dimension reconstruction technique.Results:The whole picture of deformed spine and spinal cord of each of 16 cases of spinal scoliosis could be showed on one MR image.The severity of scoliosis,the compression on spinal cord,the extent of the spinal deformity,and spinal cord lesion could be detected easily on three-dimension reconstruction MRI.Conclusion:With the use of three-dimension reconstruction technique with MR,spinal scoliosis can be easily evaluated,including the extent of spinal deformity and spinal cord lesion,the type of scoliosis,etc.This technique is important for the diagnosis and treatment of spinal scoliosis.

目的建立新型的山羊腰椎间盘退变合并突出的动物模型。方法9只6月龄山羊,随机分成3组,每组18个腰椎间盘,再将每只山羊的6个腰椎间盘随机等分成正常组和模型组。模型组椎间盘左前外侧纤维环用直径2.5mm的微型环锯限深5mm造成柱状纤维环缺损。术后2、4、6个月时对正常及模型椎间盘摄X线片和MR扫描,观察X线片上的椎间盘高度指数、MRIT2加权像上的椎间盘高信号区的面积和平均T2弛豫时间、椎间盘纤维环损伤区的形态学变化,进行组织病理学切片观察(HE染色、Masson三色胶原染色和番红O-固绿染色),对椎间盘组织形态学变化、生物化学变化和组织学评分等指标进行评估。结果正常成年山羊椎间盘组织学结构特点与人类相似;模型椎间盘在损伤后2个月即出现明显退变(P<0.01),包括椎间盘高度指数降低、椎间盘T2加权像高信号区面积和平均T2弛豫时间减低、组织学退变评分增高;MRI和组织学均发现损伤纤维环外侧1/3修复,内2/3出现髓核组织突出充填。损伤后4、6个月模型椎间盘退变加重,但与损伤后2个月的指标差异无统计学意义(P>0.05);椎间盘突出形态稳定。结论以成年山羊为对象,应用微型环锯对椎间盘前外侧纤维环定量损伤可以获得快速、有效、重复性好的腰椎间盘突出动物模型。