脊椎动脉瘤性骨囊肿3例报告

脊椎动脉瘤性骨囊肿比较少见,我科自1956年以来仅收治3例,报告如下。临床资料男1例,女2例,年龄分别为16、20、22岁。病程1～3个月。病变主要在C_5、T_7、L_5椎体各1例。检查:病变部位有明显压痛,脊柱有畸形和活动受限。2例为不全性截瘫,1例为完全性截瘫。X 线是椎体呈囊性溶骨改变。T_7椎体扁平,椎旁有球形阴影,L_5病变同时侵及椎弓根。但椎间隙均正常。2例行单纯搔刮,其中1例同时行植骨融合。1例行肿瘤切除“人工椎体”骨水泥填塞。T_7病变者术后用钴^(60)照射17天(23次),剂量为33GY。术后随访5年8个月～25年,平均13年,未见复发。

脊髓血管畸形的快速增强MRA与DSA诊断的比较研究

目的评价椭圆形中心顺序(elliptic centric ordered)的快速增强磁共振血管成像(fastcontrast-enhanced MR angiography,CE-MRA)在脊髓血管畸形中的诊断和临床应用价值。方法25例临床怀疑脊髓血管畸形的患者在1.5TMR机上接受了椭圆形中心顺序的快速CE-MRA检查,所有病例行选择性全脊椎动脉造影,18例施行了外科手术,其中2例术前行血管内栓塞,术后MRA随访了10例;以选择性全脊椎动脉造影为金标准,就病变诊断、供养动脉起源、供养动脉、瘘口或瘤巢、引流静脉和血管的图像质量(包括血管的连续性、强化程度和清晰度)进行MRA和DSA的比较。结果经外科手术证实18例,包括脊髓动静脉畸形3例、髓周动静脉瘘5例、硬膜动静脉瘘7例、椎旁动静脉瘘1例、自发性椎管内硬膜外血肿2例;MRA显示脊髓血管畸形的诊断、供养动脉起源、供养动脉、瘤巢或瘘口、引流静脉与DSA的符合率分别为93.8%、92%、96.2%、100%和100%,MRA显示血管强化和清晰度类似于DSA(P>0.05),DSA显示血管的连续性优于MRA(P<0.05);9例MRA未见椎管内异常血管,与DSA完全符合。术后MRA随访的10例原异常血管未再显示。结论椭圆形中心顺序的快速CE-MRA能够初步诊断脊髓血管畸形的亚型,能够显示脊髓血管畸形的供养动脉起源、供养动脉、瘤巢或瘘口、引流静脉,能够指导选择性脊椎动脉造影和手术治疗,是脊髓血管畸形术前诊断和术后随访的重要手段。

自动触发椭圆形中心编码对比增强磁共振血管成像技术在脊髓硬膜动静脉瘘中的初步应用

目的初步探讨自动触发椭圆形中心编码对比增强磁共振血管成像(MRA)技术在脊髓硬膜动静脉瘘(SDAVF)中的应用价值。方法对5例疑为胸腰段的SDAVF患者行椭圆形中心编码的增强MRA检查,均经选择性脊椎动脉造影和手术证实。结果自动触发椭圆形中心编码的增强MRA显示,5例SDAVF患者的瘘口水平和引流静脉的方向均与数字减影血管造影检查和手术结果相符。MRA检查对于瘘口的定位和引流静脉引流方向的诊断准确率达100%。结论在脊髓血管造影前,椭圆形中心编码的增强MRA检查可以帮助诊断SDAVF,并能初步明确其瘘口水平。

《脊柱脊髓影像学》——一部完整的脊柱脊髓影像学教材

近一个世纪以来，脊柱的X线成像局限于骨性结构。虽然椎管造影、髓核造影、脊椎动脉造影等相继为椎管内病变、椎间盘病变、脊髓血管性病变的直接或间接诊断提供了可能性，然而由于都是损伤性检查，成像质量也不满意，临床应用受到一定的限制。直到CT、MRI的问世，使脊柱骨性结构的精确解剖定位和椎管内脊髓的直接成像成为现实，尤其是MRI，可任意平面成像以及对病变组织的高度敏感度，

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACPUNCTURE COMBINED WITH MASSAGE FOR CERVICAL SPONDYLOSIS OF VERTEBRAL ARTERIAL TYPE BY USING TRANCRANIAL DOPPLYER ULTRASONOGRAPHY

To observe the effect of acupuncture combined with massage on blood flow velocity of the vertebro-basilar artery in cervical spondylosis of vertebral arterial type （CSVAT） patients. Methods： In the present study, methods of evidence-based medicine, triple-centers, single-blindness, randomization and control were used. A total of 100 cases of CSVAT patients were randomized into acupuncture plus massage （acu-massage） group （n = 38）, acupuncture group （n = 32） and massage group （n = 30）. Acupoints used were Fengchi （风池, GB 20）, cervical Jiaji （颈夹脊 EX-B 2）, Baihui （百会 GV 20）, and the methods of massage used were kneading-rolling, adhesion-separating and acupoint-digital pressing, topical digital pressing and rubbing, traction-extending and mild palm-rubbing. The treatment was conducted once daily, with 7 sessions being a therapeutic course and continuously for 2 courses. Changes of peak velocity （Vp）, end-diastolic velocity （Vd）, mean velocity （Vm） of blood flow of the vertebral artery （VA） and basilar artery （BA）, etc were detected before and after the treatment by using transcranial Doppler （TCD） ultrasonography. Resuits： After the treatment, the abnormally low Vp of both VA and BA in acu-massage, acupuncture and massage groups, Vm of VA in acu-massage and acupuncture groups, Vm of BA in acu-massage and massage groups, and Vd of VA and BA in the 3 groups all increased significantly in comparison with their own pretreatment（ P 〈 0.05, 0.01）, and the therapeutic effects of acu-massage group in the 3 indexes were significantly superior to those of acupuncture group and/or massage group （P 〈0.05, 0.01 ）. The abnormally increased Vp of VA in acu-massage and acupuncture groups, Vm of VA in the 3 groups, and Vd of VA in acu-massage and massage groups decreased obviously after the treatment in comparison with their own pretreatment （P 〈 0.05, 0.01）, and the therapeutic effects of acu-massage group were significantly superior to those of acupuncture and/or massage group in the 3 indexes of VA （P〈0.05, 0.01）. In addition, the abnormally increased Vp, Vm and Vd of BA in the 3 groups showed a similar tendency. No significant differences between acupuncture and massage groups in 3 indexes （ P 〉0.05）. Conclusion： The therapeutic effects of acupuncture plus massage is significantly superior to those of simple acupuncture and simple massage therapies in improving abnormal blood dynamics of vertebral and basilar arteries in CSVAT patients.

MULTI-CENTER RANDOMIZED CONTROLLED TRIALS OF COMBINED TREATMENT OF VERTEBRAL ARTERY TYPE CERVICAL SPONDYLOSIS WITH ACUPUNCTURE AND MASSAGE

Objective.To evaluate the clinical value of synthetical therapy of acupuncture and massage for treating vertebral artery type cervical spondylosis （VACS）. Methods： In the present study, triple-center, single-blind, randomized and control methods were adopted. Qualified subjects were randomly assigned to three groups： acupuncture-massage （acu-mas） group, acupuncture group, and massage group （60 subjects in each group）. Bilateral Fengchi （风池 GB 20）, Jiaji （夹脊 EX-B 2, C4-7） and Baihui （百会 GV 20） ware punctured in combination with massage at the neck-shoulder and back region. The treatment was conducted once daily, 14 times altogether. Results. After treatment, of the 60 cases in each of acu-mas, acupuncture and massage groups, 28, 11 and 13 were cured, 13, 20 and 17 markedly effective, 12, 14 and 16 effective, and 7, 15 and 14 ineffective, with the total effective rates being 88.3%, 75.0% and 76.7% respectively. The therapeutic effect of acu-mas group was significantly superior to that of simple acupuncture and massage groups （P〈 0.05）. The scores of clinical symptoms and signs in 3 groups all declined significantly after treatment （ P〈 0.01 ）, and the score of symptoms of acu-mas was markedly lower than those of acupuncture and massage groups （P〈 0.05）. No significant differences were found among 3 groups in the score of clinical signs and between acupuncture and massage groups in the score of clinical symptoms （P〉0.05）. The time for producing therapeutic effects in acu-mas group was significantly shorter than those of acupuncture and massage groups （P〈0.01, 0.05）, meanng a faster of aou-mas group in producing clinical effect. No adverse events ware found in all the 3 groups. Conclusion： Acupuncture and massage are effective and safe in the treatment of VACS, and the therapeutic effect of acupuncture combined with massage is superior to that of simple acupuncture and simple massage therapy.

Clinical observation on cervical chiropractic for cervical spondylosis of vertebral artery type

Objective：To observe the curative effect of cervical chiropractic for cervical spondylosis of vertebral artery type （CSA） and to explore its possible mechanism.Methods：Sixty CSA patients were randomly divided into two groups.Thirty patients in the treatment group were treated with chiropractic manipulation for cervical vertebrae,once every other day,7 treatments in total.The other 30 patients in the control group received oral administration of flunarizine hydrochloride,10 mg per night,for 14 d.Cervical vertigo and functional assessment scale and transcranial cerebral Doppler （TCD） were measured before treatment and 7 days after treatment.Results：The total effective rate was 96.7% in the treatment group and 83.3% in the control group.The curative rate was 66.7% in the treatment group and 20% in the control group.The differences between the two groups in the total effective rate and the curative rate were statistically significant （both P〈0.05）.The scores of cervical vertigo symptom and functional assessment after treatment in both groups were significantly higher than those before treatment （both P〈0.01）;the difference between the two groups was statistically significant （P〈0.05）.After treatment,the maximum systolic velocity （Vs）,the maximum diastolic velocity （Vd）,the mean velocity （Vm）,the pulsatility index （PI） and the vascular resistance index （RI） in both groups were significantly improved compared with those before the treatment （all P〈0.01）;there were significant differences between the two groups （all P〈0.05）.Conclusion：Cervical chiropractic is an effective method for CSA,and its curative effect is better than that of flunarizine hydrochloride alone.Its mechanism may relate to correcting cervical instability.

Observation on Clinical Efficacy of Acupuncture Therapy for Posterior Circulation Ischemia Vertigo

Objective： To observe the clinical efficacy of acupuncture for posterior circulation ischemia vertigo （PCIV）. Methods： A total of 71 PCIV cases were randomly allocated into an acupuncture group （37 cases） and a medication （oral Flunarizine Hydrochloride） group （34 cases）. After 6 weeks of treatment, the therapeutic efficacies in the two groups were analyzed. Results： After treatment, the mean blood flow velocities （VM） of both the vertebral artery （VA） and the basilar artery （BA） in acupuncture group were significantly increased, showing statistical differences when compared with the pre-treatment result of the same group （P〈0.05）; despite some decrease in pulsatility index （PI） after treatment, there was no statistical difference when compared with the pre-treatment result. After treatment, the mean blood flow velocities of both VA and BA in the medication group were increased, showing statistical differences when compared with the pre-treatment result of the same group （P〈0.05）; there was no statistical difference in PI before and after the treatment （P〉0.05）. Regarding the improvement of VM, the acupuncture group was superior to the medication group, showing a statistical difference （P〈0.05）; there was no statistical difference in PI improvement between the two groups. Considering from the clinical efficacy, both acupuncture and medication are effective. However, acupuncture obtained a significantly better effect than medication （P〈0.05）. Conclusion： Acupuncture therapy can posterior circulation ischemia vertigo. obtain a better effect than oral Flunarizine Hydrochloride for