重复癌(multiple primary carcinoma,MPC)临床较少见,本文报道1例合并肺癌、喉癌的老年便血患者诊治经过.

目的 探讨Cronkhite Canada综合征(Cronkhite Canada syndrome,CCS)患者的临床特点、治疗方法.方法 回顾性分析2010年8月至2018年5月在中国人民解放军总医院第七医学中心消化内科诊断为CCS的4例患者的病例特征.结果 CCS患者常存在典型的消化道症状(腹泻、腹痛、味觉减退等)和外胚层病变[脱发、色素沉着、指(趾)甲营养不良],易合并便潜血阳性,低蛋白、低钾、低钙血症等;消化道息肉以胃、结肠最常见,病理多表现为管状腺瘤、炎性息肉.3例患者予塞来昔布治疗有效,1例患者予糖皮质激素治疗有效.结论 CCS血清IgG4阴性患者可考虑塞来昔布治疗,推荐剂量400 mg/d.

Objective To investigate the postoperative clinical results of calcified intervertebral disc herniation treated by percutaneous endoscopic transforaminal discectomy(PETD). Methods From September 2013 to September 2014, the clinical data of 20 patients(L5/S14 and L4/L516) with calcified lumbar intervertebral disc herniation underwent PETD and calcified tissue removal were retrospectively analyzed. Lumbar CT and MRI were performed before and after the surgery. The surgical approach was determined based on the different shape,position of the herniation and the relationship between herniation and traversing nerve root. Preoperative and postoperative clinical status were analyzed by visual analogue scale(VAS) score and MacNab criteria. Results All the operations were performed successfully. The patients were followed up for more than 3 months. The postoperative lumbar CT showed calcification at the paracentral position and nerve root was fully resected on the symptomatic side. The calcification at the center or the asymptomatic position remained partially. The spinal nerve root canal was decompressed. The postoperative VAS score for leg and back pain was 0-1,and the evaluation was excellent based on MacNab criteria. Conclusion PETD avoids excessive traction of nerve roots,reduces the probability of intraoperative nerve injury,and can remove the calcification at the nerve root canal. It can also effectively relieve the symptoms of patients,and is safe and effective for the treatment of calcified lumbar disc herniation.

寰椎位于人类脊柱的最上段,因其结构特点而具有特殊的功能.寰椎骨折最早由Cooper报道于1822年,在其进行尸体解剖时发现.虽然寰椎骨折发现较早,但对其较深入的研究只有100年左右的时间.长期以来,对于寰椎骨折的诊断及治疗方法选择,一直存在争议.准确的分型与对骨折机制的把握有助于寰椎骨折的诊断,故笔者首先对寰椎骨折的分型以及致伤机制进行了复习归纳,着重对目前临床常用的治疗方法及其进展进行综述,并总结了临床使用时的选择原则.

Objective To analyzed the digestive system management clinical application in pa-tients with cervical spine injury with paraplegia in perioperative period,retrospectively. Methods Analysis of Shanghai changzheng hospital spinal surgery in 2011-2013,84 patients with digestive system management mode of treatment of cervical vertebra trauma patients with paraplegia with clini-cal data,including age, gender,injury factors,cervical vertebra injured segments,operation situation, abdominal management methods and prognosis,statistical via abdomen symptom relief after processing. Digestive management of patients with paraplegia with cervical vertebra trauma,our methods are the nutrition support, fluid management,physical stimuli,effective purge and so on. Results Through perioperative effective digestive system managemen,67 patients’s abdominal symptoms eased in the varying degree,no one had colostomy. That method proved to improve the quality of life. Conclusion Reasonable and timely digestive system management can effectively reduce the cervical vertebra trauma patients with paraplegia with abdominal symptoms, improving quality of life of postoperative patients.

骨科亚学科的分化导致专业型增强。调查发现，脊柱外科研究生对脊柱激素损伤的基本概念、救治流程、预后判断和并发症防治掌握不足。教学组将损伤控制理念引入研究生的脊柱脊髓外伤教学中，帮助其把握该理念在临床应用中的适应证、熟知实际操作流程，对完成研究生期间的临床实践有明显的促进作用。

分析了骨科术后随访的重要性,采用摸底调查发现骨科研究生在术后随访中存在的不能持之以恒、形式单调、效率低下等问题,以案例教学、设计随访表、灵活使用随访方式、有效利用资料等方法进行针对性的教学,在教学中注意过程督导、医患沟通能力培养、医德教育等方面,取得了良好效果.

将目前流行的各类教学模式应用于脊柱外科研究生教学的情况进行了对比，评价其优缺点，得出多种教学模式灵活应用、重视论文的读写、结合医疗改革安排教学内容等综合优化，有利于培养脊柱外科研究生的主动学习能力、训练临床思维、提高临床技能，帮助其在硕士研究生在读期间，完成从初级住院医师到高级住院医师的转变。

目的:测试后路板-棒内固定系统治疗不稳定寰椎骨折的稳定性,为临床使用提供理论基础.方法:采集新鲜成年人尸体颈椎骨(C0～C3)标本6具,用聚甲基丙烯酸甲酯(PMMA)上下包埋,在生物力学实验机上,以150N为最大生理载荷,最大力矩为1.50N·m,依次测量完整模型组(A组)、骨折模型组(B组,包括寰椎后弓两处骨折与典型Jefferson骨折,分别作为B1组和B2组,骨折模型制作时保持横韧带完整)、内固定模型组(C组,包括B1组+内固定系统、B2组+内固定系统,分别作为C1组、C2组)C0-C1、C1-C2节段前屈/后伸、左/右侧屈和左/右旋转等6个方向的三维运动范围(ROM),通过比较,评价后路板-棒内固定系统治疗寰椎骨折的生物力学稳定性.根据测量所得ROM值,设A组各方向三维运动稳定性指数(Sf)为100％,计算B组、C组模型各运动方向Sf,进一步直观比较各模型的稳定性变化.结果:C0-C1节段,A组前屈/后伸、左右侧屈、左右轴向旋转方向的ROM分别为11.06°±1.00°,7.08°±0.62°,13.24°±1.24°;B1、B2组前屈/后伸、左右侧屈、左右轴向旋转方向ROM均较A组明显增大(P＜0.05);C1组前屈/后伸、左右侧屈、左右旋转方向的ROM均较B1组明显减小(P＜0.05);C2组各方向ROM均较B2组明显减小(P＜0.05);C1、C2组前屈/后伸、左右侧屈、左右轴向旋转方向ROM与A组比较均无统计学差异(P＞0.05).C1-C2节段,A组前屈/后伸、左右侧屈、左右轴向旋转方向的ROM分别为10.07°±1.12°,5.56°±0.54°,20.83°±2.12°;B1、B2组各方向ROM均较A组明显增大(P＜0.05);C1组各方向的ROM较B1组明显减小(P＜0.05);C2组各方向ROM较B2组明显减小(P＜0.05);C1、C2组各方向ROM与A组比较均无统计学差异(P＞0.05).C0-C1节段,B1组前屈/后伸、左/右侧屈、左/右轴向旋转方向Sf分别为71％、70％、64％,B2组各方向Sf分别为61％、55％、58％,C1组各方向Sf分别为102％、108％、108％,C2组各方向Sf分别为91％、91％、92％.C1-C2节段,B1组前屈/后伸、左/右侧屈、左/右轴向旋转方向Sf分别为70％、61％、35％,B2组各方向Sf分别为59％、54％、37％,C1组各方向Sf分别为105％、111％、106％,C2组各方向Sf分别为91％、90％、92％.结论:寰椎后路板-棒内固定系统既能恢复上颈椎稳定性,又可保留其生理运动功能.使用该系统治疗寰椎后弓两处骨折,在稳定性方面效果稍优于典型Jefferson骨折.