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[400例椎管狭窄症——一项临床研究]

[400 intraspinal space-narrowing processes--a clinical study].

作者信息

Niebeling H G, Hohrein D

出版信息

Zentralbl Neurochir. 1978;39(3):241-52.

PMID:749432
Abstract

Among 400 observations by the authors, 2 per cent were admitted without and another 22 per cent with slight neurological disturbances. An incomplete transverse lesion of the cord with paraplegia was found in 61.7 per cent, a complete paralysis in 14.3 per cent of the cases. Meningiomas and neurinomas were found in 60 per cent of the patients. The average age of the tumour patients was 43,8 years. Meningiomas and metastases show a tendency to occur in older age groups. The "Glioma Age" was around 25 years. The majority of the tumours were located at the level of the thoracic cord. When breaking down according to the kinds of tumours, a different picture is obtained: neurinomas are chiefly located in the region of the cervical medulla and the thoracolumbar region; gliomas are mainly found in the cervical part of the medulla up to the central thoracic cord. A dissociation of the cerebrospinal fluid was found in 90 per cent of the examinations; in 50 per cent of the patients it was above 200 mg%. Within a period of four weeks after the operation, the following results were obtained: 5 per cent free from complaints, improvement in 39 per cent, aggravation in 10 per cent and 46 per cent still uninfluenced. Meningiomas and neurinomas showed the highest degree of improvement. 24 per cent of the patients suffered from transitory rectovesical disturbances, 15 per cent from urinary tract infections, 12 per cent from decubitus, 9 per cent from wound healing disturbances and another 9 per cent from pneumonia. Meningitis was found in 2 per cent. Within four weeks post operationem, the death rate was 10.5 per cent, but this was in the phase before the introduction of microsurgery. On the accuracy of the diagnoses: in 18 per cent the neurological findings were in agreement with the diagnosis and in 49 per cent they showed differences of 1 to 3 segments; in 11 per cent no definite diagnosis could be made. In 46 per cent the native X-ray picture showed pathological changes. Myelography with positive contrast media showed positive findings in 97 per cent and 98 per cent of positive findings were obtained with myeloscintigraphy.

摘要

在作者观察的400例病例中,2%的患者入院时无神经功能障碍,另有22%的患者有轻微神经功能障碍。61.7%的病例发现脊髓不完全横贯性损伤伴截瘫,14.3%的病例为完全性瘫痪。60%的患者发现有脑膜瘤和神经鞘瘤。肿瘤患者的平均年龄为43.8岁。脑膜瘤和转移瘤倾向于发生在年龄较大的人群中。“胶质瘤发病年龄”约为25岁。大多数肿瘤位于胸段脊髓水平。根据肿瘤类型分类时,情况有所不同:神经鞘瘤主要位于颈髓和胸腰段区域;胶质瘤主要见于颈髓至胸段脊髓中部。90%的检查发现脑脊液分离;50%的患者脑脊液分离值高于200mg%。术后四周内,结果如下:5%无不适,39%有所改善,10%病情加重,46%仍无变化。脑膜瘤和神经鞘瘤的改善程度最高。24%的患者有短暂的直肠膀胱功能障碍,15%有尿路感染,12%有褥疮,9%有伤口愈合障碍,另有9%有肺炎。2%发现有脑膜炎。术后四周内,死亡率为10.5%,但这是在显微手术引入之前的阶段。关于诊断的准确性:18%的神经学检查结果与诊断一致,49%的结果显示相差1至3个节段;11%无法做出明确诊断。46%的平片显示有病理改变。阳性造影剂脊髓造影的阳性发现率为97%,脊髓闪烁造影的阳性发现率为98%。

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