Objective To observe the clinical efficacy of radiofrequency ablation for treatment of discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope operation. Methods Thirty-six patients with discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope surgery admitted to the Affiliated Hospital of Logistics University of People's Armed Police from December 2011 to December 2017 were enrolled. According to difference in therapeutic methods, they were randomly divided into two groups, 18 cases in each group. The radiofrequency ablation group was treated with X-ray imaging guided lumbar spinal nerve posterior branch radiofrequency thermo-coagulation; the drug group received oral diclofenac sodium conservative treatment, 75 mg twice daily for 3 weeks. Both groups were followed up for 6 months, visual analogue scores (VAS) were used to evaluate the pain before and after treatment, the Oswestry dysfunction index was used to assess the degree of lumbar function recovery, and the surgical complications and adverse drug reactions were observed. Results The VAS scores in the two groups were similar before treatment; after treatment for 1 month, the VAS scores in both groups were significantly lower than those before treatment (radiofrequency ablation group: 1.83±0.71 vs. 5.67±0.77; drug group: 2.22±0.43 vs. 5.28±0.67, both P < 0.05); after treatment for 3 months and 6 months, the VAS scores were increased gradually, however, the scores of radiofrequency ablation group were significantly lower than those in the drug group (3 months was 2.00±0.59 vs. 3.39±0.70, 6 months was 2.17±0.51 vs. 3.61±0.50, both P < 0.05), moreover, the excellent and good rates of postoperative pain efficacy and of Oswestry dysfunction index improvement in the radiofrequency ablation group were significantly higher than those in the drug group [excellent and good rates of postoperative pain efficacy: 94.44% (17/18) vs. 22.22% (4/18), excellent and good rates of Oswestry dysfunction index improvement: 77.78% (14/18) vs. 44.44% (8/18), both P < 0.05]. There were no complications of infection and spinal nerve anterior branch injury in the radiofrequency ablation group, and 6 patients in the drug group presented mild gastric discomfort, which was relieved after symptomatic treatment. Conclusion The radiofrequency ablation is an effective method for treatment of discogenic lumbar neuralgia after vertebral column operation, compared with the conservative therapy, the ablation is more effective to relieve pain for a long time, promote the recovery of neural function, and the operation is safe with very few adverse reactions.

原发性醛固酮增多症亦简称为原醛症,由于肾上腺腺瘤自主性分泌过多的醛固酮,临床上常以高血压、低血钾为主要临床表现,是继发性高血压的常见原因。近年来,由于对本病检查手段的提升及认识的加深,确诊率有增高趋势,在高血压人群中约占10% [1] 。目前腹腔镜手术是治疗肾上腺肿瘤的主要手段,由于具有损伤小、出血少、恢复快、住院时间短等优点,已逐渐取代传统开放手术,成为治疗肾上腺肿瘤的金标准 [2] 。我科自2012年12月至

Objective To evaluate the clinical results of percutaneous transforaminal endoscopic bilateral decompression (PTED)via unilateral approach for lumbar spinal stenosis (LSSS) caused by lumbar disc herniation (LDH).Methods From January 2014 to January 2016,35 cases of LSS caused by LDH were treated with PTED via unilateral approach at Affiliated Hospital of Logistics University of Chinese Armed Police Force,and their data were used for a retrospective analysis.The surgical effect was evaluated using the Macnab score at 3 months post-operation.Visual analogue scale (VAS) and Oswestry disability index (ODI)were used to assess the outcomes at 6 month post-operation.MxLiteView DICOM Viewer software was used to measure the change of spinal canal area before and after operation based on the parameters of axial MRI images.Results The mean operation time was (89.1 ± 8.7) min in 35 patients.The preoperative and 6-month postoperative VAS values were (7.9 ± 0.8) and (2.1 ± 0.5) points,respectively,and the ODI were(61.5 ±3.7) and(21.3 ± 2.1)points,respectively.Both differences were statistically significant (P ＜0.05).As per the Macnab criteria,19 patients (54.4％) reported excellent effect,13 (37.1％) demonstrated good outcome,2 (5.7％) reported faireffect,and 1 (2.9％) demonstrated poor result.The excellent/good rate reached 91.4％.Compared with the preoperative conditions,the cross sectional areas of spinal canal at the levels of L3-4,L4-5 and L5-S1 were increasedby (35.7 ± 8.5) mm2,(40.9 ± 4.1) mm2 and (42.5 ± 9.1) mm2,respectively.No postoperative rupture of spinal dura,or injury of nerves,blood vesselsas well as intestines,or infection occurred in this series.The most frequently observed complication was transient paresthesia due to irritation of nerve root.Conclusions The procesure of PTED via unilateral approach demonstrate satisfactory short-term effect in the treatment of LSS caused by LDH.Further long-term observations are needed to investigate postoperative stability of lumbar spinal canal,the risk of restenosis,and possibility of re-operation in case of restenosis.

血精症是指以排出血性精液为主要表现的病症,临床上分为肉眼血精和镜下血精2种类型.血精症的患者来院就诊原因多为性生活后偶然发现所射出的精液为红色,或者暗红色,或是由于其配偶偶然发现才前来就诊.

外科住院患者在住院期间常需留置多种导管,护理时常需反复牵拉导管以正确辨别.若护理不当可致导管脱落、判断错误而引起操作差错而影响患者康复.2013年1月至3月我院护理部自行设计导管彩色防水标识签,并应用于临床,现报告如下.

[目的]观察醒脑静联合奥拉西坦治疗重型颅脑创伤的疗效.[方法]108例重型颅脑创伤患者随机分为醒脑静组、奥拉西坦组和联合治疗组,均给予脱水降颅压、止血、营养神经等常规治疗,符合开颅手术指征的行开颅去骨瓣减压术,醒脑静组静脉滴注醒脑静注射液,20 ml/d,奥拉西坦组静脉滴注奥拉西坦注射液,4 g/d,联合治疗组静脉滴注醒脑静注射液,20 ml/d,联合奥拉西坦注射液,4 g/d,14 d为1疗程,治疗2个疗程后观察并对比GCS评分、患者预后及清醒情况.[结果]所有患者治疗2个疗程后,醒脑静组、奥拉西坦组和联合治疗组的GCS评分分别为(7.0±1.2)、(7.2±1.8)和(9.5±1.6)分,预后的良好率分别为22.2％、25.0％和38.9％,重残率分别为19.4％、22.2％和8.3％,植物生存率分别为16.7％、13.9％和5.6％,联合治疗组的这些指标与醒脑静组、奥拉西坦组有显著性差异(P＜0.05).联合治疗组清醒例数(20例)和清醒时间(17.2±5.3)d,醒脑静组和奥拉西坦组清醒例数和清醒时间为12例及(24.6±5.7)d、13例及(23.7±6.5)d,3组有显著性差异(P＜0.05).[结论]醒脑静与奥拉西坦联合治疗,可明显改善重型颅脑创伤患者的预后,提高清醒率并缩短清醒时间,有利于促进病情恢复,提高患者生存质量.

目的 分析比较经皮内镜下椎间孔镜入路与椎板间入路治疗腰椎间盘突出患者的近期临床疗效及优缺点.方法 2009年12月至2012年12月我院收治的89例腰椎间盘突出症患者,分别采用内镜下椎间孔入路(63例)及椎板间入路(26例)腰椎间盘切除术.分析比较其手术适应证、手术操作时间、卧床及术后平均住院时间,跟踪分析各组术前及术后6个月内疗效及并发症.结果 经皮内镜椎间孔入路及椎板间入路下平均手术操作时间分别为85 min及66 min,平均卧床时间为8.6h及8.5h,手术后平均住院时间为4.8d及3.9d.椎间孔入路组术前视觉模拟评分法(VAS)评分为(8.9±1.8)分,术后3 w为(1.4±0.3)分、术后3个月为(0.9±0.2)分、术后6个月为(0.5±0.1)分;椎板间入路组术前VAS评分为(8.7±2.4)分,术后3 w为(1.1±0.3)分、术后3个月为(0.9±0.2)分、术后6个月为(0.7±0.2)分.术后6个月,椎间孔入路组优良率89.6％,椎板间入路组92.0％.两组均无永久性神经根损伤和硬脊膜囊撕裂等并发症.结论 经皮内镜下椎间孔入路及椎板间入路均能获得满意疗效.根据腰椎间盘突出不同类型和部位,选择正确入路是手术成功的关键.