目的 探討老年人腰椎間盤突出合并側隱窩狹窄癥的臨床特點及手術方式，總結和介紹小切口單側椎板開窗椎間盤摘除聯合側隱窩擴大術的優點和可行性。 方法 2006年7月－2011年1月對76例患者行后正中切口4.0～6.0 cm，在C臂X線機定位下，保留棘上、棘間韌帶和棘突，骨膜下剝離骶棘肌，顯露椎板、椎板間隙和關節突起，在椎板間隙間開骨窗，切除關節突內側小部分后，環形切除突出的纖維環取出髓核，擴大成形側隱窩，解除所有卡壓脊神經根組織，徹底松解脊神經根。 結果 術后76例隨訪15～24個月，平均18個月，均按中華脊柱外科學會脊柱學組腰腿痛手術評定標準評定：優63例，良10例，一般及差3例，優良率達96.05%。手術前后Oswestry功能障礙指數評分與腰痛及腿痛視覺模擬評分法評分比較，差異有統計學意義（P＜0.05）。 結論 小切口單側椎板開窗椎間盤摘除聯合側隱窩擴大術，是一種手術創傷小，能在直視下操作，避免手術失誤，徹底去除神經根致壓物，不僅能夠擴大神經根管，而且可行側隱窩的探查及松解，同時兼顧脊柱穩定結構基本不被破壞，療效滿意，尤其在老年人中值得推廣。
【摘要】 目的 比較鉆孔引流尿激酶溶解術和小骨窗開顱術治療高血壓腦出血的療效。 方法 2008年9月-2009年12月分別接受鉆孔引流尿激酶溶解術（A組，n=34）和小骨窗開顱術（B組，n=30）的高血壓腦出血患者共64例（出血量30~50 mL，無腦疝），兩組患者術前基線指標（如出血量、手術時機、昏迷程度等）比較無統計學意義。比較接受不同術式的兩組患者手術時間、術后1個月的近期療效、術后6個月遠期療效及死亡率。 結果 A組手術時間短于B組，兩組比較，有統計學意義（Plt;0.05）。術后1、6個月，A組療效優于B組，兩組比較，有統計學意義（Plt;0.05）。A、B組術后近期和遠期死亡率比較，無統計學意義（Pgt;0.05）。 結論 對出血部位在基底節區、出血量在30~50 mL，無腦疝的高血壓腦出血患者，鉆孔引流尿激酶溶解術的療效明顯優于小骨窗開顱術。【Abstract】 Objective To compare the therapeutic effect of drill drainage-urokinase perfusion (group A) and small bone flap craniotomy on hypertensive intracerebral hemorrhage. Methods A total of 64 patients with hypertensive intracerebral hemorrhage (about 30-50 mL) from September 2008 to December 2009 were collected. The patients underwent drill drainage-urokinase perfusion (group A,n=34) and small bone flap craniotomy (group B,n=30). The therapeutic effects, including operating time, short-term effect within one month, long-term effect six months after operation, operation time, and the rate of rehaemorrhagia and mortality were observed and the results of the two groups were compared. Results The operation time was shorter in group A than that in group B (Plt;0.05); one month and six months after the operation, the therapeutic effects were better in group A than those in group B (Plt;0.05); the difference in mortality between the two groups was not significant (Pgt;0.05). Conclusion The therapeutic effect of drill draiage-urokinase perfusion is better than that of small bone flap craniotomy on the patients with hypertensive intracerebral hemorrhage in basal unclei with bleeding amount of 30-50 mL and without cerebralhern.
【摘要】 目的 探討顱內動靜脈畸形切除術中彩色多普勒超聲檢查的應用價值與預后的關系。 方法 在顯微外科手術的基礎上，將65例動腦靜脈畸形患者隨機分為A、B兩組， A組34例動靜脈畸形患者在術中接受術中超聲檢查，確定其畸形血管團的數目、位置、深度、大小、范圍及其與周邊組織結構的關系，探查供血動脈及引流靜脈的數目及走行，以確定動、靜脈畸形的位置、手術切除范圍及切除術后是否有畸形血管殘留；B組31例行常規手術，比較兩組之間的差異。 結果 術中彩色多普勒超聲能清晰的顯示動靜脈畸形的情況，兩組經手術完整切除動靜脈畸形率、再出血率、術后7 d Glasgow昏迷評分及預后差異均有統計學意義（Plt;0.05）。 結論 術中實時彩色多普勒超聲能對腦動靜脈畸形準確定位，并可判定腦動靜脈畸形的血供模式及殘余情況，減少腦組織損傷及降低手術并發癥的發生，提高了手術安全性及治療效果。【Abstract】 Objective To explore the application of the colored Doppler ultrasonography in the excision of intracranial arteriovenous malformation (AVM) to determine the location of the lesion and the completeness of the resection, and to evaluate the clinical value of intraoperative ultrasonography in the diagnosis, treatment and the relation to the prognosis of patients. Methods A total of 65 patients with brain AVM were randomly divided into group A and B. The microsurgery was perfromed on the patients. Intraoperative ultrasound was performed on the 34 patients in group A to the numbers, location, depth,size of different malformation vascular clumps relationship of the arteriovenous malformation with surrounding tissues. While the pateints in group B underwent the routine surgery. The difference between the two groups were compared. Results The condition of the AVM were clearly revealed by intraoperative ultrasonography. All of the intracranial AVM in group A were completely removed. The difference in rehaemorrhagia and postoperative Glasgow coma scale score of seven day between the two groups were statistically significant (Plt;0.05). Conclusions Intraoperative color Doppler ultrasounography in the resection of intracranial AVM could accurate localize the lesions, identify vascular anatomy of the AVM vascular balls and the completeness of resection. The parameters including resistance index of the vessels may identify the abnormal vessels and reduce the operative complications and brain tissue damage, which improve the safety and efficacy of the therapeutic effect.