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胸椎骨巨细胞瘤并动脉瘤样骨囊肿1例报道
骨巨细胞瘤多发于四肢长骨骨端,发生于脊柱者少见.我院于2011年2月收治1例胸椎骨巨细胞瘤并动脉瘤样骨囊肿患者,报道如下.患者男性,24岁,因"右胸背疼痛2个月,加重伴行走不稳6d"于2011年2月21日来我院就诊.患者人院前2个月无明显诱因出现有胸背部隐痛,于我院门诊就诊口服中药等治疗后,自觉症状改善不明显.入院前6d因胸背痛在当地医院行推拿治疗后逐渐出现双下肢麻木、乏力,行走不稳,胸部有束带感,症状持续不能缓解并逐渐加重,小便有便意但排尿迟缓,便秘.近期体重无明显减轻.查体:T4、T5棘突叩击痛(+),双侧乳头以下皮肤感觉减退,腹壁反射消失,提睾反射消失,双下肢髂腰肌、股四头肌肌力3级,左(足母)背伸肌肌力3级,右弹背伸肌肌力2级,双膝腱及跟腱反射亢进,双侧巴氏征(+).
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胸椎椎体上皮样血管内皮瘤一例
患者女,22岁.反复腰背部酸痛2年,病初疼痛呈间歇性,后呈持续性.体检:腰椎前屈、后伸、侧弯均受限.T12、L1棘突压痛、叩击痛,右侧腰背肌压痛.
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胸椎结核合并截瘫病人的护理
截瘫是胸椎结核严重的合并症,这与胸椎管较狭窄、脊髓体积较大、缓冲余地较小有关[1].若病人不能得到及时有效的治疗,可导致终生残废.传统的治疗方法是单纯的病灶清除术,复发率高,并发症多.我院2005年1月-2008年7月治疗胸椎结核合并截瘫45例,现将护理总结如下.
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脊髓型颈椎病合并胸椎管狭窄症的康复干预
Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took respective analysis on diagnosis, treatment and recovery results of 12 cases, whose symptoms, signs and MR were explicit. Results Follow ups times were from 9 months to 5 years and 8 months. Nerve function of 8 cases recovered completely or nearly completely; that of 2 cases improved apparently and that of 2 cases improved slightly. Conclusion Detailed disease history collection, particular body examination and MR reading are very important to early diagnosis of cervical spondylotic myelopathy combined with thoracic spinal stenosis. Early operation combined with cervical and thoracic spinal canal decompression at same time or at different stages is the single effective method to patients' function recovery.
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1例儿童胸椎骨巨细胞瘤并动脉瘤样骨囊肿
患者 男,3岁,因走路不稳、腰背部间断疼痛1个月来本院就诊。查体:胸腰段脊柱棘突压痛、叩痛(+),无放射痛,左下肢自膝关节以下感觉减退,左侧肛周感觉减退,双下肢各肌群肌力Ⅲ级,肌张力正常,双侧 Babinski 征阴性。胸椎 X 线片侧位像显示 T1~T3椎体附件溶骨性骨质破坏(图1)。MRI 示T2~T4椎体相应水平椎板、棘突及其椎管内见团片状异常信号,边界欠清,病灶呈等及稍长 T1、等及长 T2信号(图2),压脂像呈混杂信号(图3),横轴位示病灶呈膨胀性改变,邻近硬膜囊及脊髓受压(图4)。
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Objective: To study the mechanism and treatment principle of spinal fractures combined with paraplegia and diaphragm injury. Methods: A total of 16 patients (14 males and 2 females, aged from 18 to 50 years) with spinal fractures combined with paraplegia and diaphragm injury, receiving emergency treatment and admitted to our hospital in the past 20 years, were retrospectively analyzed in this study. Results: The injuries were caused by direct or indirect violence. Six cases were of fractures of cervical spine combined with paraplegia and diaphragm injury, 2 of fractures of thoracic vertebra combined with paraplegia and diaphragm injury, and 8 of thoracolumbar fractures combined with paraplegia and diaphragm injury. Six cases received non-operative treatment, but died finally. Ten cases received spine surgical treatment, of which 4 died and 6 were improved. The total mortality rate was 62.5%. Conclusions: Spinal fractures combined with paraplegia and diaphragm injury are one of the most severe traumas in departments of orthopaedics. Paraplegia can be found easily, but diaphragm injury is often neglected and missed. When a patient suffers from both of them, he is in danger of death. What measures should be taken to rescue the patients life depends on the severity of the wounds.