2015年 · 第95卷第23期

Traditional posterior cervical "single-door" spinal canal enlargement is a simple and effective method for the treatment of cervical spondylotic myelopathy (CSM), but long-term follow-up has complications such as poor cervical curvature, cervical stiffness, and "re-closing the door", which directly affects the long-term efficacy of the operation. In recent years, many improved surgical methods have appeared one after another. Now, the application of different modified surgical methods for posterior single-door spinal canal enlargement of cervical spine is discussed.

The patient, a 50-year-old female, went to the local hospital in April 2013 due to swelling and pain in her left eye for 1 month. No abnormalities were found in the visual acuity and visual field. The MRI of the head showed irregular and slightly long T1/T2 signal nodules in the sellar area of 23 mm ×22 mm ×17 mm, compressing the optic chiasm and uniformly enhancing, considering pituitary adenoma.Figure 1。 Blood human growth hormone (GH), adrenocorticotropic hormone (ACTH), cortisol, prolactin (PRL), and thyroid stimulating hormone (TSH) levels were in the normal range. On April 7, 2013, he underwent transnasal sphenoidal sellar area lesion resection under general anesthesia. The pituitary gland was gray and white, tough in texture and rich in blood supply. Partial resection was performed. Postoperative pathological diagnosis of atypical pituitary adenoma in sellar area (non-functional). Immunohistochemistry: ACTH (-), FSH (-), GH (-), luteinizing hormone (LH) (-), PRL (-), Ki-67 index 40%, P53 (+),Figure 2。 Stereotactic radiotherapy was administered to the sellar region at a dose of 54 Gy/27 F in May 2013. MRI of sellar region after radiotherapy showed that the tumor volume was smaller than before. In August 2013, he developed hoarseness, choking and cough after drinking water, and MRI of the head showed multiple abnormal enhancements in bilateral frontal, parietal and temporal lobes, corpus callosum, midbrain and cerebellum (Figure 1), considering metastatic tumor, so a stereotactic-assisted lower parietal lobe lesion biopsy was performed in Peking Union Medical College Hospital. Postoperative pathological diagnosis: (parietal lobe tumor) active growth with mild abnormal adenopituitary tissue, consistent with metastatic pituitary cancer, immunohistochemistry: ACTH (-), FSH (-), GH (+), LH (-), PRL (-), Ki-67 index 75%, P53 (+) (Figure 2)。 Temozolomide 150 mg·m was administered after operation^-2• d^-11 course and continued with radiotherapy for 30 Gy/15 F. Lower back discomfort occurred in September 2013. Multiple enhanced nodules and line-like foci in the spinal canal were seen on MRI of the whole spinal cord, and spinal cord metastasis was considered (Figure 1)。 Whole body PET-CT scan showed no other systemic metastases. Subsequently, chemoradiotherapy and radiotherapy were not tolerated due to three-line decrease in blood. The patient repeatedly complained of back pain and headache, gave up treatment and died in November 2013.

A 47-year-old male was admitted to the hospital on 3 October 2014 due to "inability to speak and right limb weakness for 2 h". Eight hours ago, the patient was working in farmland and was accidentally stung by a large swarm of wasps. He went home and scrubbed himself. Two hours ago, the patient had sudden right limb weakness while taking a bath, unstable right hand grip, with vague speech, no headache, nausea and vomiting. Previous history of hypertension for 2 years, less regular medication. Physical examination: body temperature 37.2℃, pulse 96 beats/min, breathing 24 beats/min, blood pressure 142/87 mmHg (1 mmHg =0.133 kPa), painful face, swelling of left cheek, scattered multiple bite marks on face, back and calf, local redness and swelling, burning sensation, mild tenderness, no petechiae and ecchymosis. Neurological system: Superficial coma, pupil diameter 3 mm, sensitive to light reflex, slightly low muscle tone in extremities, tendon reflex (+ +), bilateral pathological signs (-), remaining body examination does not cooperate. No previous history of smoking or poisoning. Laboratory test: white blood cells 20.58×10⁹/L, neutrophils 0.937, eosinophils 0, monocytes 0.016; Aspartate aminotransferase 52.0 U/L, creatine kinase 252.0 U/L, myoglobin 88.3 μ g/L, high-sensitivity C-reactive protein 1.4 mg/L, randomized blood glucose 10.85 mmol/L; D-dimer 0.28 mg/L and fibrinogen 2.47 g/L. Remaining kidney function, blood lipids, electrolytes, glycosylated hemoglobin, homocysteine, rheumatoid factor, hepatitis B, syphilis and HIV antibodies were normal. Emergency cranial CT: speckled low density shadows in right basal ganglia and left hemioval central area. Cerebral hemorrhage was excluded and "cerebral infarction" was proposed. After treatment with dexamethasone, edaravone, aescin, aspirin, Xingnaojing and fluid rehydration, the patient's consciousness gradually improved, and he was completely awake on the third day, leaving only motor aphasia and right limb paresis. MRI of the brain showed that the left frontotemporal lobe and basal ganglia showed patchy abnormal signal shadows with poor boundary, the maximum cross section was 7.71 cm ×4.27 cm, T₁The image shows a slightly low signal, and there are scattered flakes with a slightly high signal, T₂Image showed a slightly higher signal, water suppression showed a high signal, DWI showed a high signal, and ADC showed a low signal; The left parieto-occipital lobe showed small patches with poor borders and the same signal shadows, with the largest cross section of 2.65 cm ×2.62 cm, and scattered multiple patches of abnormal signal shadows around it; MRA: Absence of left middle cerebral artery and its branches, stenosis of left posterior cerebral artery main trunk and right posterior cerebral artery branches (Figure 1)。 Heart color ultrasound was normal. Carotid color Doppler ultrasound showed only bilateral carotid arteriosclerosis without plaque formation. One week later, the patient's facial swelling basically disappeared, and the sting area was crusted, but he still had motor aphasia, and the grip strength of his right hand was slightly poor, so he could walk and move independently. Reexamination of blood leukocytes 11.93×10⁹/L, neutrophils 0.72, aspartate aminotransferase and blood glucose were normal. Self-discharged. Follow-up 4 months later, there was improvement in speech expression and completely normal limb function, but TCD showed smooth blood flow in the left middle cerebral artery.

Dendritic cell (DC) and tumor cell (TC) fusion vaccine^[1]And peptide chain vaccines^[2]Both can effectively stimulate the immune response of specific cytotoxic T lymphocytes (CTL), and make the tumor of tumor-bearing mice shrink or even disappear. However, the clinical efficacy has not yet reached the expected value and is being explored.

triangular fibrocartilage complex (TFCC) is the main stable structure of the ulnar side of the wrist joint and the distal radioulnar joint. It has important biomechanical functions. It can decompose and absorb the stress on the ulnar side of the ulna and the wrist bone, so that the wrist joint can move smoothly and the forearm can rotate^[1,2]。 Injury of TFCC is a common cause of ulnar wrist pain^[3]Because of the complex anatomy, some early injuries are often overlooked and misdiagnosed, thus delaying diagnosis and treatment, resulting in affecting the functional recovery and quality of life of patients. Correct understanding and diagnosis of TFCC injury is of great significance to the hand surgeon to formulate appropriate treatment plan and the patient's functional recovery. In this paper, the normal anatomy, injury classification and various related imaging research progress of TFCC are reviewed.